Primary Bilateral Adrenal Non-Hodgkin's Lymphoma Presented with Adrenal Insufficiency: A Case Report

Primary adrenal lymphoma is a very rare disease and it is known to have a poor prognosis. We report here on a case of primary adrenal insufficiency that was secondary to primary bilateral adrenal lymphoma. A 54-year old man was hospitalized because of easy fatigability, weight loss and consistent malaise for 6 months. The physical examination revealed hyperpigmentation on the anterior chest and hypotension. According these findings and symptoms, we did a rapid ACTH stimulation test with a clinical suspicion of adrenal insufficiency. He showed an inadequate adrenal response and so he was diagnosed with adrenal insufficiency. The abdominal CT images showed bilateral huge adrenal masses and increased uptake of the adrenal glands on PET. The pathologic diagnosis by ultrasound-guided gun biopsy of the right adrenal gland was diffuse large B cell lymphoma. The patient was administered combination chemotherapy with the R-CHOP regimen, and after 8-cycles of chemotherapy, he achieved complete remission of tumor according to the image studies and he recovered his adrenal function. Primary adrenal lymphoma, although a rare disease, should be considered in patients with bilateral enlargement of the adrenal glands and when the adrenal glands show increased uptake on a PET scan, and especially there is adrenal insufficiency.

Outcomes of Diffuse-Type Pigmented Villonodular Synovitis (PVNS) after Open Total Synovectomy / 대한골관절종양학회지

PURPOSE: Pigmented villonodular synovitis (PVNS) is a rare soft tissue tumor, which usually arises in larger joints, such as the knee. It has a high recurrence rate after surgical treatment. The purpose of this study is to evaluate and analyze the clinical results of diffuse-type pigmented villonodular synovitis cases that were treated with open total synovectomy. MATERIALS AND METHODS: Between 1994 and 2006, 21 patients who had diffuse-type pigmented villonodular synovitis were selectively reviewed. Among the 21 cases studied, 14 patients presented at the knee, 5 at the ankle, and 2 at the shoulder and elbow. The mean follow up period was 5.5 years (range, 36-157 months). The average age of the patients was 34 years consist of 7 men and 14 women. Clinical outcomes were analyzed retrospectively, including range of motion and complications. RESULTS: Open total synovectomy and adjuvant electrocautrization were done in all cases except one. During the regular follow-up period after the surgery, two patients showed symptoms of recurrence. After re-operation, only one case was pathologically confirmed as a recurrence. The patient who had partial synovectomy and the other patient who had second operation due to recur rence received additional radiation therapy. Clinical outcome scores were improved in every aspect (p<0.0001). 2 out of 14 Patients who had pigmented villonodular synovitis at the knee developed stiff knee after the surgery. CONCLUSION: After the open total synovectomy with electrocautrization, a low recurrence rate and satisfactory clinical outcome was achieved, observed in a minimum of 3 years of follow-up.

A Choroidal Schwannoma Confirmed by Surgical Excision

Schwannomas rarely present as intraocular tumors and are often misdiagnosed as malignant melanoma. We describe a choroidal schwannoma confirmed by sclerouvectomy. A 30-year-old woman presented with a large nonpigmented intraocular mass of the choroid in the right eye and underwent surgical excision by sclerouvectomy. Histologically, the tumor was composed of a mixture of cellular solid components (Antoni A) and loose myxoid components (Antoni B). The tumor was eventually diagnosed as a schwannoma. Currently available ancillary studies are still of little value in definitively differentiating schwannomas from other choroidal tumors. In the case of atypical findings for a malignant melanoma, a benign neoplasm should be included in the differential diagnosis. This patient avoided enucleation by first having the mass excised. We are unaware of previous reports in which a choroidal schwannoma was diagnosed by surgical excision.

Transsternal Maximal Thymectomy is Effective for Extirpation of Cervical Ectopic Thymic Tissue in the Treatment of Myasthenia Gravis

PURPOSE: Extensive extirpation of cervico-mediastinal adipose tissue increases the chance of removing ectopic thymic tissues, thus potentially improving the prognosis of myasthenia gravis after thymectomy. We sought to increase efficacy and safety of transsternal maximal thymectomy (TSMT). MATERIALS AND METHODS: Twenty four patients who underwent TSMT from July 2006 to June 2007 were retrospectively reviewed and compared with 73 patients who underwent transsternal extended thymectomy (TSET) from January 2004 to May 2006. Ectopic thymic tissue in additionally excised cervicomediastinal fat tissue was examined histologically. RESULTS: In TSMT group, operation time, amount of cumulative drainage and duration of drainage were significantly higher than TSET group. However, the difference in hemoglobin count, amount of transfusion, duration of intensive care, postoperative hospital stay, and complication rates were not statistically different. There was no operative mortality in either group. Ectopic thymic tissue was found in 50% of patients. All patients had ectopic thymic tissues in the cervical area. Two patients had additional ectopic tissue in the aortopulmonary window, and 1 patient had ectopic tissue at posterior of the left bracheocephalic vein and lateral of the right phrenic nerve. CONCLUSION: TSMT is more effective in the extirpation of ectopic thymic tissues than TSET without significant impairment of safety, especially in the cervical area.

Nine-Year Survival of Lymphoblastic Lymphoma Patients

This study aimed to analyze the overall survival period of adult lymphoblastic lymphoma patients treated with various therapeutic regimens, and to assess the determinants affecting survival outcome. Twenty-five adult patients with lymphoblastic lymphoma who had been treated at Severance Hospital, Yonsei University College of Medicine, Seoul, Korea from June 1996 to June 2005 were analyzed retrospectively. As an initial remission induction chemotherapy, the hyper-CVAD regimen was performed in eight patients, the Stanford/Northern California Oncology Group (NCOG) regimen in five, the CAVOP regimen in four, the m-BACOP regimen in three, and the CHOP regimen in one patient. Patients were divided into two groups according to their therapeutic modalities. Twenty patients received conventional chemotherapy alone and five received subsequent PBSCT after conventional chemotherapy. Four patients of the PBSCT group underwent autologous PBSCT and one underwent allogeneic PBSCT. The overall response rate was 80% (60% showing a complete response, 20% showing a partial response) and the relapse rate was 73.3%. The overall survival (OS) rate was 55.1% at 1 year, 31.5% at 5 years, and 23.6% at 9 years. The disease-free survival (DFS) rate was 46.7% at 1 year and 30.0% at 7 years. The 5-year OS rate in relation to the regimens was 60% with the Stanford/NCOG regimen, 50% with the CAVOP regimen, and 33.3% with the m-BACOP regimen. The patients treated with the hyper-CVAD regimen had an 18.2% 2-year OS rate, and other patients with CHOP or COPBLAM-V expired early in their course. The OS rate in patients treated with conventional chemotherapy alone was 19.8%, whereas patients treated with subsequent PBSCT after chemotherapy showed 50% overall survival (p=0.25). The age at presentation influenced the outcome of the patients (p=0.01). The Stanford/NCOG regimen is an effective initial choice of therapy for lymphoblastic lymphoma patients, and is superior to the hyper-CVAD regimen in complete response rate and overall survival rate (p=0.36). Addition of PBSCT after chemotherapy may be needed for achieving optimal outcomes.

A Case of Primary Peripheral T-cell Lymphoma of the Stomach with Cytotoxic Phenotype / 대한소화기내시경학회지

Primary gastric lymphoma is the most common form of extralymphatic non-Hodgkin's lymphoma (NHL). Most cases are of B-cell origin and few cases of lymphoma of T-cell origin have been reported. Peripheral T cell lymphoma is a lymphoma of extrathymic origin. Expression of T-cell intracellular antigen (TIA)-1 can be detected in all cytotoxic cells, and the expression of this cytotoxic protein is associated with extranodal presentation. We report a case of primary peripheral T cell lymphoma of the stomach with cytotoxic T-cell phenotype in a 70-year-old male presenting with upper gastrointestinal bleeding.

Apoptosis and Proliferation in Paired Primary Colorectal Adenocarcinomas and Their Liver Metastases

The proliferation potentials and the level of apoptosis were compared in paired primary colorectal adenocarcinomas and their liver metastases within each individual. From a total of 22 patients 44 specimens of paired primary and metastatic tumors were obtained for analysis. The levels of spontaneous apoptosis (a spontaneous apoptosis index, SAI: % apoptotic nuclei among a total of 1000 nuclei) and of proliferation (KI-67 index: % positively stained cells for KI-67 among a total of 1000 cells) were analyzed between primary and metastatic tumors. Survival rates and its relationship with the clinical parameters were also analyzed. The overall survival rate at 5 years was 16.9% with the median survival time of 45 months. T-stage (p=0.005) and time to liver metastasis (synchronous versus metachronous, p=0.03) showed statistical significance in relation to survival. The mean SAI of primary tumors was 1.35 +/- 0.25, which was not statistically different from the 1.58 +/- 0.18 of metastatic tumors (p=0.33). The mean KI-67 indices in primary and metastatic tumors were 23.9 +/- 3.4 and 16.4 +/- 2.5, respectively, and this difference was statistically significant (p=0.016). Subset analysis showed significant difference in the KI-67 index in the synchronous group but not in the metachronous group. No significant difference was shown in the relative ratios of apoptosis to proliferation between the primary tumor and the metastasis within each individual. The results in this study may partly explain the indolent behavior of liver metastasis from colorectal cancer and provides a rationale for the active treatment of metastatic tumors as well as of primary disease.

Total Spondylectomy for Giant Cell Tumor of Cervical Spine

Giant cell tumor which is arisen at vertebra is rare and this tumor of the cervical vertebra has been very rarely reported tumor which is less than 1% of all giant cell tumor. When the treatment option is considered, the curretage is often selected rather than total resection because the anatomic relationship of adjacent structures is complicated and there are major vessels and organs around the cervical vertebra. The prognosis of this tumor is decided by degree of resection so, total sponylectomy should be considered as primary surgical option. We report a case of cervical giant cell tumor in which the total spondylectomy was performed successfully and discuss the feasibility of this procedure at cervical region.

Expression of Vascular Endothelial Growth Factor in Cancer Tissues and Serum of Gastric Cancer Patients: Correlation with Clinicopathologic Findings and Prognosis

PURPOSE: Vascular endothelial growth factor (VEGF) is known to be produced by various malignant tumors and thought to be involved in microvascular permeability and angiogenesis. However, the clinicopathologic significance of the expression of VEGF in gastric cancer remains unclear. METHODS: To examine the relationship between VEGF expression in gastric cancer and clinicopathologic factors or patient survival, tumor VEGF expression was assessed by immunohistochemical study in 144 gastric cancer patients. In addition, serum VEGF (S-VEGF) level was measured by enzyme-linked immunosorbent assay in 116 patients and in 32 healthy controls. RESULTS: Positive staining for VEGF was observed in 68.8% (99 out of 144) of gastric cancers, and its expression was observed more frequently in patients with intestinal type and serosal invasion tumors. However, there was no significant correlation between the patients' survival and VEGF positivity. Significant differences in preoperative S-VEGF level were found between healthy controls and patients with gastric cancer (P=0.014), whereas there was no significant difference in the S-VEGF level between control and curative resection group. When S-VEGF levels were compared between groups categorized by different clinicopathologic vari-ables, a significant correlation was found between a high S-VEGF level and a tumor size greater than 5 cm, serosal invasion, lymph node and distant metastasis. Moreover, postoperative S-VEGF levels were significantly elevated as compared to preoperative levels (P=0.000). When the median S-VEGF level was used as a cutoff level, the survival rate of patients with elevated S-VEGF levels was significantly lower than that of patients with low levels (P=0.001). CONCLUSION: These results demonstrate that a high preoperative S-VEGF level is associated with tumor progression, metastasis and a poor outcome in patients with gastric cancer. Further studies are warranted to determine the clinical value of S-VEGF as an tumor marker and an indicator of tumor angiogenesis in gastric cancer.

p53, Bcl-2 and Ki-67 Expression according to Tumor Response after Concurrent Chemoradiation Treatment for Advanced Rectal Cancer

PURPOSE: Concurrent chemoradiation treatment (CCRT) for locally advanced rectal cancer is an important modality for curative resection, but its tumor response shows wide spectrum. The aim of study is to investigate any correlation between a related genetic mutations, proliferative index and tumor response after CCRT. METHODS: A twenty three patients with rectal cancer, which preoperatively staged as over T3N1 or T4 determined by transrectal ultrasonography and MRI. Enrolled patients were given 5 FU 450 mg/m2 and leucovorin 20 mg/m2 intravenously for 5 days during the first and fifth weeks of radiation therapy (45~54 Gy). 4 weeks after completion of scheduled treatment, surgical resection was performed. Tumor response was classified into CR (complete remission), PR (partial response: 50% of diminution of tumor volume and downstaging), NR (no response). Paraffin-embedded tissues obtained before chemoradiation treatment were studied with immunohistochemical staining of p53, Bcl-2 and Ki-67. The extent of tumor response was correlated with proliferative activity as measured by immunostaining of Ki-67 proliferative antigen and expression of p53 and bcl-2 oncoproteins (less than 10%: negative, 10~25%: , 25~50%: , more than 50%: , Ki-67: to count a labeled cells per 1,000 cells). RESULTS: All patients were resectable. CR was obtained in 4 (17.4%), PR in 10 (43.3%) and NR in 9 (39.2%). p53 mutation was noted in 16 (70%). p53 mutation was found in NR: 5 (31.3%), PR: 9 (56.2%), CR: 2 (12.5%), respectively. Bcl-2 expression was noted in 11 (48%). NR as in 4 (36.3%), PR: 3 (28.4%) and CR: 4 (36.3%), respectively. Ki-67 labeling index was NR: 615.4 446.2, PR: 663.2 296.4, CR: 765.5 188.3, respectively (CR PR Vs NR, p=0.029). CONCLUSIONS: Immunohistochemical Expression of p53 and bcl-2 does not correlate with tumor response after CCRT, but Ki-67 labeling may be useful parameters for good radiosensitive tumor selected for CCRT.

The prognostic significance of steroid hormone receptors, bcl-2 and p53 mutation in correlation with clinicopathological prognostic factors in endometrial cancer / 대한산부인과학회잡지

No abstract available.

Determination of Chromosomal Alterations in Nasal NK/T-cell Lymphomas by DOP-PCR and Comparative Genomic Hybridization / 대한암학회지

PURPOSE: Because of difficulty of obtaining metaphase cells from tumor specimens, there are only a few cytogenetic studies in nasal NK/T-cell lymphomas, and so far no consistent specific chromosomal abnormalities have been described. In this study, we have used degenerate oligonucleotide primed PCR (DOP-PCR) and comparative genomic hybridization (CGH) to deter mine chromosomal alterations from 6 nasal NK/T-cell lymphoma tissues dissected from formalin- fixed paraffin-embedded slide sections. MATERIALS AND METHODS: For the isolation of tumor DNA, four 7-micrometer-thick tissue sections from each sample were dewaxed and rehydrated, and areas of high tumor cell content (more than 60%) were dissected and pooled into a tube. Normal DNA was prepared from the peripheral blood of a healthy volunteer. Tumor DNA was labeled with biotin-16-dUTP by DOP-PCR and normal DNA was labeled with digoxigenin-dUTP using a nick translation kit. In CGH, equal amounts of differently labeled DNA from the tumors and normal reference DNA were hybridized simul taneously to normal metaphase chromosomes. They were visualized by different fluordegrees Chromes, and the signal intensities were quantitated separately as gray levels for each chromosome. The over- and underrepresented DNA segments were determined by computation of image ratios and average ratio profiles. RESULTS: Our results show that gains of DNA copy number were more prevalence than DNA losses. The most commonly observed gains were mapped to chromosomal regions of 1p32.2 ter,19 and 20 in 4 of 6 cases (67%). The other frequent gains were found on chromosomes 12q in 3 of 6 cases. The most frequent loss was detected on 6q in 4 of 6 cases(67%), and less fre quently observed on 13q21.1 q34 and 13q14 q34. CONCLUSION: These genomic changes found in specific chromosomal regions are likely to harbor genes of importance in nasal NK/T-cell lymphomagenesis, therefore such cytogenetic mapping of genomic imbalance may be of value for further molecular delineation of NK/T-cell lymphoma.

A Case of acute respiratory distress syndrome induced by all-trans-retinoic acid / 결핵

Acute respiratory distress syndrome (ARDS) has been reported to be associated with a variety of medical and surgical conditions, including All-trans-retinoic acid (ATTA). ATRA is very efficaceous drug to acute promyelocytic leukemia (APL). This drug can induce complete remission at APL without fatal risk of disseminated intravascular coagulation. But ATRA treatment, sometimes, produces the symptoms of fever, weight gain and acute respiratory distress, renal function impairment. The causes of these symptoms are not fully proved, but supposed as the result of leukostasis and capillary leak syndrome from excessive leukocyte differentiation and cytokines release. Recently, we experienced a 24-year-old woman who complained gum bleeding for 6 days. At bone marrow biopsy, she was diagnosed as APL. 2 days after ATRA treatment, she was suffered from the symptoms of dyspnea and general ache. At laboratory examination, total leukocyte count was 50,400/mm3 PaO2 was 42.5 mmHg and chest PA revealed the findings compatible with ARDS. Treatment with low dose ara-C, corticosteroid and general supportive cares were tried. Within 3 days after treatment, the patient recovered from ADRD by evidence of arterial blood gas study and chest radiographs. She has acquired complete remission of APL with maintenance of ATRA. And so, we present this case with a review of related literatures.

A Case of Well-Differentiated Thymic Carcinoma with Extensive Cystic Degeneration / 결핵

Thymoma is the most common tumor in the compartment of anterior mediastinum. The malignant thymoma is classified into invasive thymoma( category I ) and thymic carcinoma( category II ). Recently, well-differentiated thymic carcinoma is a proposed category 1.5 used to describe a subset of thymic epithelial tumors, allowing for the existence of intermediate form based on the clinical features and the histological characteristics. Thymic cyst is a congenital or a acquired disorder. Congenital thymic cyst may develop due to failure of the thymopharyngeal duct to obliterate and acquired thymic cyst develops from inflammation( multilocular thymic cyst ), or neoplasm( cystic thymoma ). Cystic degeneration in thymoma is a relatively frequent but focal event. In rare cases, the process proceeds to the extent that most or all of the lesion becomes cystic. Until now, well-differentiated thymic carcinoma with extensive cystic degeneration has not been reported in our country. We experienced a case of 14 year-old female patient showing extensive cystic degeneration in well-differentiated thymic carcinoma. and so we report it with review of the articles related.

Apoptotic Change in Placenta of Pregnancy-induced Hypertension / 대한산부인과학회잡지

The mechanism of apoptosis was first discovered at the end of the 19th century, but it was only recently that its importance was recognized. Not only in a pathologic environment but also in a normal environment, apoptosis has an important role in homeostasis. The number of cells is restricted by apoptosis which is controlled by several SlgBS lll VlVO. In pregnancy, the placenta regulates the maternal-fetal exchange of molecules and functions as a barrier for the protection of the fetus. As the pregnancy proceeds, changes occur in the number and components of placental cells. Observing the placental tissues, apoptosis was found in the syncytiotrophoblasts of early and late pregnancy. In particular, the fact that apoptosis observed in the placenta of late pregnancy supports the hypothesis that pmgrammed cell death is a normal sequence. Pregnancy-induced hypertension is usually accompanied by abnormal placenta and intrauterine growth restriction. In this study, using the TdT-FragEL DNA fragmentation detection kit, the changes in the nucleus by apoptosis in the placental tissues of 23 to 40 gestational weeks in preeclampsia and eclampsia were compared with normal placenta. Apoptosis was observed in the normal term placenta and in pregnancy-induced hypertension patients, regardless of whether vasculopathy was observed in Doppler ultrasound or confirmed by pathology, more apoptoses were observed aside from the number of gestational weeks.

Clinicopathologic Analysis on Mucinous Adenocarcinoma of Colon & Rectum

We have performed a retrospective analysis of 59 patients with mucinous colorectal carcinomas who were operated at the department of surgery, College of Medicine, Yonsei University Hospital between 1993 and 1996. Among the total 914 patients who had been treated by surgery due to colon & rectal cancers during the same period, 62 were diagnosed as mucinous adenocarcinomas(MC) of colon & rectum. Of these 62 patients, we have analyzed 59 patients of colorectal MCs'comparing with another 59 patients of non-mucinous adenocarcinomas(NMC) who were randomly selected during the same period. Mean age of MCs' was 54.6(25-84) and that of NMCs'was 58.2(30-76). The sex ratio was 1.1:1 and 1.6:1 respectively. The age distribution showed peak incidences at 50s' for MCs' and at 60s' for NMCs'. The tumor locations were more proximal in MCs'. Preoperative CEA levels were similar but postoperative serum CEA levels were more reduced in NMCs' than in MCs'. There were more frequent perineural and vascular invasions in MCs' The distribution according to Modified Dukes'stages showed more frequences of NMC's in stage A and there were more frequent synchronous metastases in MCs'. 110 patients out of 118 were followed up. The mean fellow-up periods were 17.9 months in MCs' and 17.6 months in NMCs'. During the period of follow-ups, 12 patients were detected for recurrence in MCs', and 8 patients in NMCs'. Although there was no statistical significance, mucinous carcinoma showed more high incidences of local & systemic recurrences. The three-year survival in groups of Dukes' stage C was poorer in mucinous group. Despite short follow-up period and limited number of patients, our results showed more aggressiveness of mucinous carcinoma.

The effect of GnRH analogue on epidermal growth factor receptor in uterine myoma / 대한산부인과학회잡지

No abstract available.

Effect of antiandrogens upon the morphological development of gubernaculum and the testicular descent in rats / 대한비뇨기과학회지

We evaluated the effect of antiandrogens on both fetal and adult rats, noting especially the morphological changes in the gubernaculum and testicular descent. Two antiandrogens, flutamide and 5a-reductase inhibitor 4-methyl-4-aza-5-pregnane-3-one-20[s] carboxylate (4-MAPC) produce gross and histological changes in the gubernaculum, as well as having an effect on testicular descent. While the gubernacula of controls were like full water-drop at day 20 of gestation. the gubernacula of fetuses treated with flutamide were thin and elliptical and the gubernacula of fetuses treated with 4-MAPC were thin and elliptical or like small water-drop. The position of the gubernaculum was near the bladder neck and lower border of pelvic cavity, regardless of the antiandrogen treatment. But, the degree of invagination of gubernaculum into abdominal wall tended to be less in fetuses treated with either antiandrogen. The muscular layer of gubernaculum treated with either anti-androgen tended to be thinner than controls. In adult rats treated from embryo to adult with flutamide, atrophy of the sex accessory glands and hypospadias were occurred and the scrotums were bifid or undeveloped on one side which the testis remained in the abdomen. We feel that flutamide and 4-MAPC cannot interfere with trans-abdominal testicular descent, but can induce the morphological changes in gubernaculum with failure of the trans-inguinal testicular descent. Also, it would be suggested that the gubernaculum has not Wolffian duct like testosterone dependency shown in differentiation of epididymis, vas deferens and seminal vesicle, because of the presence of the effect of both flutamide and 4-MAPC on gubernaculum.

Prognostic significance of DNA ploidy in breast cancer patients

No abstract available.

A case of subacute necrotizing lymphadenitis with pancytopenia / 대한혈액학회지

No abstract available.