Granulomatous Mastitis

PURPOSE: Granulomatous mastitis (GM), reported for the first time by Kessler and Wolloch in 1972, is a rare and benign inflammatory lesion of the breast. The etiology of GM is currently unknown, but some reports have suggested autoimmunity. The aim of this study was to evaluate the clinical characteristic, clinical presentations and radiological features of GM. METHODS: A chart review was performed for 23 patients, with GM confirmed by a pathological examination, between July 1999 and December 2005. A retrospective review of the clinical and radiological finding, as well as the cytological results of the patients was undertaken. RESULTS: The ages of these patients ranged between 29 and 74 years, with a mean of 39.7 years. The median follow-up was 8 months. Twenty patients (87%) presented with a mass as the chief complaint, with a median size of 2.56 cm (range 0.78~6.5 cm). Eight patients (34.8%) had radiological findings suspicious of malignancy. Tuberculosis was diagnosed using Tb-PCR in 1 patient. Twenty-two of the 23 patients underwent a wide excision, and the one remaining patient underwent incision and drainage. One of 23 patients had a recurrent disease. CONCLUSION: GM is a rare breast disease, which clinically mimics cancer. As radiological imaging, such as mammography or ultrasonography, are unreliable in distinguishing GM from breast cancer, further special examinations, for example FNAB and gun biopsy, are necessary. The single most important differential diagnosis of GM is tuberculosis, especially in developing countries. We suggest that the evaluation for tuberculosis is essential for the differential diagnosis of GM using clinical and pathological methods.

Study on consecutive light microscopic changes of tumor cells and apoptotic index observed in serial cervical biopsies during neoadjuvant chemotherapy with 5-fluorouracil and cisplatin in locally advanced cervical cancer / 부인종양

OBJECTIVE: To determine the effects of neoadjuvant chemotherapy (5-fluorouracil plus cisplatin) on tumor cell morphology and apoptosis by analyzing the consecutive changes of apoptotic index (AI) and histology observed in the serially obtained cervical cancer tissues during the chemotherapy. METHODS: Cervical cancer tissues were obtained by punch biopsy just before starting the each cycle of neoadjuvant chemotherapy from five patients with locally advanced disease (stage IIb-IIIb), but previously untreated squamous cell carcinoma of uterine cervix. All patients were treated with three cycles of 5-fluorouracil (1,000 mg/m2 at day #1-5) and cisplatin (60 mg/m2 at day #1) at 3 weeks interval. All H & E stained cervical cancer tissue slides were scored for apoptotic index and observed for microscopic changes of tumor cells by a pathologist. RESULTS: After the first cycle of chemotherapy, AI was significantly increased (from 2 times to 8 times). And widespread injury to cytoplasm was observed and followed by karyorrhexis and karyolysis of nucleus of tumor cells. The size of tumor nests was reduced and it was also noted that fibrosis and infiltration of inflammatory cells were increased. The parts of tumor nests were replaced by mature squamous cells and the changes in nuclear morphologic features pointing in a more differentiated direction. But after the second cycle of chemotherapy, only one patient showed an increase in AI by 1.2 times over that after the first cycle of chemotherapy. The rest showed slight decreases in AI compared to that after the first cycle of chemotherapy. In addition, fewer microscopic morphologic changes of tumor cells induced by chemotherapy were observed after the second cycle of chemotherapy compared to those after the first cycle of chemotherapy. CONCLUSION: We found that AI hardly increased or rather decreased, and that microscopic changes of tumor cells were fewer after the second cycle of neoadjuvant chemotherapy compared to the situation after the first cycle of chemotherapy. Thus, we could deduce that chemoresistance might rapidly develop in cervical cancer cells after the first cycle of neoadjuvant chemotherapy using 5-fluorouracil and cisplatin. So we need to consider this problem when we treat the locally advanced cervical cancer patients with neoadjuvant chemotherapy using 5-fluorouracil and cisplatin.

Expression of MT1, 2, 3-MMP in invasive cervical cancer / 대한산부인과학회지

OBJECTIVE: Threre are several proteolytic enzymes such as Matrix Metalloproteinases (MMP), which are involved in tumor invasion and metastasis. The aim of this study was to determine the exprssion of Membranous Type MMPs (MT-MMPs) and investigate the relationship between their expression and questioned whether their expression is related to stages and other prognostic factors of cervical cancer. METHODS: The cervical and cervical cancer tissues were taken from the patients; healthy women (n=14), and the patients with cervical cancer (n=35). The protein expression of MT1, 2, 3-MMP with MMP-2 was examined using immunohistochemical staining and western blotting. MMP-2 activity was measured by zymogram. RESULTS: The expression of MT1, 2, 3-MMP was higher in cervical cancer than that of normal cervix (p0.05). But there were significant correlations between MT1-MMP, MT3-MMP and lymph node involvemen t (p<0.05). There was significant correlation between MT-MMPs and MMP-2 (p<0.05), too. CONCLUSION: According to the results, MT-MMP expression could be associated with the pathogenesis of cervical cancer. In addition, the evaluation fo MT-MMPs expression might be helpful to predict lymph node metastasis in cervical cancer. Further prospective study with a large number of cases is needed in future.

Effectiveness of Ex vivo Ultrasound for Detecting Sentinel Node Metastasis in Breast Cancer / 한국유방암학회지

PURPOSE: The presence of lymph node metastasis is a key factor for deciding upon radical axillary dissection during a breast cancer operation. We performed prospective research to assess the accuracy and effectiveness of ex vivo ultrasound for detecting sentinel node metastasis during the operation. METHODS: 183 fresh sentinel lymph nodes from 30 breast cancer patients had sonographic examination performed on them by a specialized radiologist immediately after surgical resection. The sonographic criteria for malignant lymph nodes were uneven cortical thickness, a node more than 3 mm in diameter, the absence of the hilum and a round hypoechoic node. After sonographic evaluation, the specimen were delivered to the department of pathology for frozen biopsy and permanent staining. RESULTS: Among 133 lymph nodes that were examined on frozen sectioning, 12 (9.0%) were revealed as metastatic nodes and 121 (90.9%) were revealed as benign. On US examination, 150 (81.9%) among the detected 183 nodes were read as benign and 33 (18.1%) were read as metastatic. Among 150 benign nodes, four (2.6%) were proven as metastasis on permanent pathology, and 20 (60.6%) among the 33 sonographic cancerous nodes were reported as metastatic nodes. The sensitivity, specificity, positive predictive value, negative predictive value, false positive rate, false negative rate and accuracy of ex vivo ultrasound were 83.3%, 91.8%, 60.6%, 97.3%, 8.2%, 16.7% and 90.7% respectively. CONCLUSION: Ex vivo ultrasound evaluation for detecting sentinel lymph node metastasis during the operation may be helpful to decide the extent of lymph node dissection.

The Efficacy of Sentinel Node Biopsy Using Subareolar Injection of Radioactive Material in Breast Cancer / 한국유방암학회지

PURPOSE: This study was designed to evaluate the feasibility of sentinel node biopsy (SNB) using subareolar injection of radioactive material in breast cancer. METHODS: The prospective study was performed of 112 breast cancers (T1 or T2 stages) at Ewha Womans University Mok-Dong Hospital from February 2001 to June 2003. Patients underwent lymphoscintigraphy using 99mTc sulfur colloid. The feasibility of SNB was assessed through comparison with simultaneous axillary node dissection. RESULTS: All patients were women, and the median age was 46 years. Internal mammary sentinel lymph node was identified in 2 cases (1.8%). The first node was appeared on lymphoscintigraphy around at 10.7 minutes after subareolar injection. Sentinel nodes could be identified in 111 (99.1%) among 112 patients with a gamma probe. The mean number of harvested sentinel nodes were 3.3 and metastasis was noted 80 of 368 nodes (21.7%). False negative rate was 4.1%. CONCLUSION: SNB using subareolar injection of radioactive material could be a alternative method to replace axillary node dissection in T1 or T2 breast cancers, especially in case of clinical node negative patients.

Ischemia-reperfusion Injury after Canine Liver Allo-transplantation: The Effect of Gadolinium Chloride

PURPOSE: The effective suppression of Kupffer cell function is believed to contribute to the prevention of preservation/ reperfusion injury. In this study, the effect of Gadolinium, a synthetic Kupffer cell suppressor, on the reperfusion injury was examined using a canine partial liver transplant model. METHODS: About 70% of the liver was harvested and reimplanted in a mongrel recipient dog weighing 20~25 kg. Gadolinium Chloride (10 mg/kg) was infused via the cephalic vein 24 hour before harvesting the partial liver (Gadolinium group, n=5). Serum Aspartate Aminotransferase (AST) Alkaline phosphatase (ALP), Lactate dehydrogenase (LDH), and morphological grading of the graft were compared with the control group (n=5). Statistical analysis was done with an independent T-test. RESULTS: The total ischemic time was 4 hours and 27 minutes on average. One hour after reperfusion, there were no significant differences in the AST, ALP and LDH level, and the pathologic scores. At 48 hours after reperfusion, the AST (P=0.03) and LDH (P=0.05) levels were significantly lower in Gadolinium group. CONCLUSION: Kupffer cell blockage using the Gadolinium chloride might be an effective way of reducing ischemia reperfusion injury. However, this effect was not evident in the early stages of reperfusion.

A Case of Oligomeganephronia of the Solitary Kidney, Presented with Isolated Proteinuria

Oligomeganephronia is rare congenital anomaly characterized by striking reduction of the number of nephrons, which are markedly hypertrophied in renal hypoplasia. Since the first description of oligomeganephronia in bilateral renal hypoplasia in 1962, dozens of cases were reported. Van Acker reported the first case of oligomeganephronia developed in the solitary kidney and 8 cases were searched in the literature. We report a case of oligomeganephronia in the solitary kidney in 13 years old boy, presented with isolated proteinuria as a first case in Korea.

Effects of Methylprednisolone on TGF-beta, Apoptosis and Renal Scarring in Experimental Acute Pyelonephritic Weaning Rats

PURPOSE: Acute pyelonephritis of growing kidneys may result in renal scarring. TGF-beta, inflammatory cytokine, has been suggested to play an important role in promoting renal scarring through apoptosis, suppression of cellular proliferation and fibrosis. We observed the effects of a potent anti-inflammatory agent, methylprednisolone on apoptosis and renal scarring in experimentally induced acute pyelonephritic weaning rats. MATERIALS AND METHODS: To induce ascending pyelonephritis a saline solution containing Escherichia coli type ATCC No. 25922, pili-form (107 bacteria/mL) was infused into the bladder through the 16-guage silicone cannula for 48 hours to 102 three-week-old Sprague-Dawley rats (50-60g). Experimental groups were divided into three groups according to the treatment protocols, group I (ceftriaxone only, n=31), group II (methylprednisolone+ceftriaxone n=28), control group (n=43) was not treated. Histopathologic scores of inflammatory changes, fibrosis and tubular atrophy, the apoptosis index and TGF-beta1 expression score were observed at post-infection 1 and 3 week. Datas were analysed using ANOVA test and P value below 0.05 was interpreted as significant. RESULTS: The mortality rate (21.4%) of group II was not different to the control group (41.9%) and group I (32.3%). The inflammatory score of group II (0.8+/-0.87) at week 1 was significantly lower than those of the control group (2.3+/-0.87) and Group I (1.7+/-0.79) (P<0.05). Apoptosis index of group II (2.9+/-2.15) at week 1 was significantly lower than (10.0+/-0.95) and group 1 (8.3+/-2.53) (P<0.05). TGF-beta1 expression score of group II (0.8+/-0.72) at week 1 was significantly lower than those of the control group (1.9+/-0.68) and group I (1.8+/-0.60) (P<0.05). The fibrosis score of group II (1.1+/-0.10) at week 3 was significantly lower than that of the group I (1.8+/-0.83) (P<0.05). CONCLUSION: Combined treatment with methylprednisolone and ceftriaxone reduced inflammation, fibrosis, apoptosis and TGF-beta expression in acute pyelonephritic weaning rats, compared to ceftriaxone alone. Anti-inflammatory agent supplemented to antibiotics could prevent renal scarring more effectively.

A Case of C1q Nephropathy in Steroid-Dependent Nephrotic Syndrome

C1q nephropathy is an immune complex glomerulonephritis defined by the presence of mesangial C1q deposits in immunofluorescence microscopy and electron dense deposits on electron microscopy. It was described as a distinct disease entity in 1985 by Jennette and Hipp. Thirty four cases were reported in the literature but there has been no pediatric case reported in Korea yet. It commonly presents with steroid-resistent nephrotic syndrome in older children and young adults, and occasionally nephritic-nephrotic syndrome or rapidly progressive glomerulonephritis. We report a case of C1q nephropathy in a 23-month-old girl with steroid-dependent nephrotic syndrome.

Cytokine Expression and Cellular Phenotype in Skin Lesions of Borderline Lepromatous Leprosy during Multiple Drug Therapy / 대한피부과학회지

BACKGROUND: Distinct patterns of T cell cytokine production have been shown to influence the outcome of infection. There will be plethora of dynamic changes of T cells and their cytokine production after starting drug therapy in leprosy skin lesions. OBJECTIVE: To determine dynamics of cytokine expression, T cell and macrophage populations in the lesions taken serially in early part of World Health Organization-Multiple Drug Therapy in BL patients. METHODS: Cytokine mRNA expression of TNF-alpha, IFN-gamma, IL-4 and IL-10 in BL skin lesion was detected by RT-PCR analysis. To determine cellular phenotypes of infiltrated cells, immunohistochemical staining method was performed using antibodies to CD4, CD8, CD56, CD57, CD 68, gammadelta-TCR , and S-100 protein. RESULTS: TNF-alpha mRNA, initially showed no consistent change, increased 6 months after MDT. IFN-gamma and IL-10 mRNA showed decreasing tendency initially, but failed to show any consistent increase or decrease after 6 months. IL-4 mRNA was not detected in our patients. In reactional states, mRNA expression of TNF-alpha, IFN-gamma, IL-10 was increased in 2 patients but decreased in 1 patient compared to baseline. Ratio of TNF-alpha positive cells decreased during MDT compared to baseline(p<0.05), but ratio of cells expressing IFN-gamma showed no significant change after MDT. Only CD68 positive cells decreased after MDT(p<0.05). CONCLUSION: Variable treatment induced changes in cellular patterns and cytokine expression within BL lesion observed in this study suggest that complex mechanism of immune systems - including cytokine regulation and defect in macrophages - may exist and be involved in the pathogenesis of leprosy.

Liver Pathology after Transplantation of Short-Term Preserved Canine Liver with Euro-Collins or UW Solution / 대한이식학회지

PURPOSE: In living donor partial liver transplantation, the organ cold preservation time is relatively short, thereby, Euro-Collins (EC) solution could be used with comparable result to University of Wisconsin (UW) solution. METHODS: About 70% partial liver was harvested and reimplanted after 3.5 hours of cold preservation with EC or UW solution in same mongrel dog weighing about 25 kg. In 5 cases EC solutions were used, and UW solutions were used in another 5 cases. Blood sample and liver biopsy specimens were taken just before donor hepatectomy, postreperfusion 1 hour, 7 days and 14 days after operation. Serum aspartate aminotransferase (AST), alkaline phosphatase (ALP), and lactate dehydrogenase (LDH) were monitored, and morphologic grading of liver injury was performed as Spiegel et al. reported in 1999. RESULTS: Total ischemic time was 4 hours and 27 minutes in average. At 1 hour after reperfusion, there were no significant differences in liver enzyme and morphological score between the UW solution group and the EC group. Survival rate was similar in two groups; 2 dongs were alive at postoperative 7th day, and 1 dog was alive at postoperative 14th day in each group. CONCLUSION: In living donor partial liver transplantation where both operations could be performed simultaneously with relatively short graft preservation time, EC solution could be used with comparable results to UW solution.

Analysis about Correlation between the Shape and Histopathological Locations of Mammographic Microcalcifications

PURPOSE: To analyze the location of microcalcifications present on pathologic specimens and the relationshipbetween the shape of clustered microcalcifications seen on mammogram and the location of these microcalcificationson pathologic specimen. MATERIALS AND METHODS: In 84 female patients aged 25-68, we analysed the location ofmicrocalcifications seen on pathologic speciments. In 65 cases, the shape of these microcalcifications correlatedwith their location. These shapes, as seen on mammograms, were classified as granular, linear, or branching ; thelocation of microcalcifications was difined as intraductal, stromal, lobular, or a mixture of the three. Todetermine the difference, if any, between pathologic diagnosis and pathological location and shape as seen onmammograms, statistical analysis using the Chi-square test was performed. RESULT: Among 84 cases, 51 were benignand 33 cases were malignant. In both types of disease, in 45% and 58% of cases, respectively, microcalcificationswere located intraductally. There was no statistically significant difference between pathologic diagnosis andpathologic locations (p = 0.191) ; analysis of the relationship between shape of microcalcification andpathological location similarly revealed no statistically significant difference ( p > 0.05 ) . In four of 33cases of malignant disease(12 %), there was microcalcification not only of the tumor itself but also of theadjacent non-tumorous region. CONCLUSION: Regardless of whether the disease was benign or melignant,microcalcifieations were most commonly intraductal. The relationship between shape and location ofmicrocalcifications seen on pathologic specimens demonstrated no statistical significance.

A Case of Drug-Induced Acute Interstitial Nephritis Accompanying Prominent Neutrophil Infiltration / 대한내과학회지

Drug-induced acute interstitial nephritis, induced by unknown immunologic mechanisms, is inflammatory lesions of the tubulointerstitial area due to several kinds of drugs as hapten and a rare, but increasingly recognized cause of acute renal failure. Drugs implicated include not only methicillin and other penicillins but also diuretics and nonsteroidal anti-imflammatory agents. Diagnosis of acute interstitial nephritis is important, because withdrawal of the offending agent will usually result in rapid improvement in renal function, and steroid therapy may reduce residual chronic renal damage. We are reporting a case of diuretic-induced acute interstitial nephritis in a 49 year-old female patient, who was given hydrochlorothiazide to treat hypertension. A percutaneous biopsy showed tubulointerstitial nephritis accopanying prominent neutrophil infiltration without glomerulitis. Withdrawal of the drug and use of corticosteroid led to remarkable improvement with renal function returning to normal.

Small Cell Carcinoma of the Ovary of Pulmonary Type: Immunohistochimical and Ultrastructural Study A Case Report / 대한부인종양콜포스코피학회잡지

No abstract available.

Two cases of a family of benign familial hematuria / 대한신장학회잡지

No abstract available.

A case of intussusception due to lekemic infiltration as a presenti- ng manifestation of relapse in adult acute lymphoblastic leukemia / 대한혈액학회지

No abstract available.