A Case of Primary Tracheal Schwannoma / 고신대학교의과대학학술지

Although benign nerve sheath tumors have been described, primary tracheal schwannomas are extremely rare. We report a case of primary tracheal schwannoma, a rare benign nerve sheath tumor in a 58-year-old man with atypical symptoms of chronic cough, sputum and dyspnea for 2 months. Chest computerized tomography showed a 1.7 cm polypoid lesion in posterior wall of mid trachea. The results of bronchoscopic biopsy and immuno-histo-chemical studies were consistent with schwannoma. A surgical treatment of tumor resection and tracheal reconstruction by end-to-end anastomosis was performed.

The Immunohistochemical Expression of STAT3, Bcl-xL, and MMP-2 Proteins in Colon Adenoma and Adenocarcinoma

BACKGROUND/AIMS: Signal transducers and activators of transcription (STATs) are a family of transcription factors that are activated in response to cytokines and growth factors. STAT3 activation has been implicated in modulating the activity of downstream mediators, such as Bcl-xL and matrix metalloproteinase-2 (MMP-2). The aim of this study was to investigate the immunohistochemical expression of STAT3, B-cell lymphoma-extra large (Bcl-xL), and MMP-2 proteins according to histopathological parameters in colon adenocarcinomas, including lymph node metastasis, tumor differentiation, the TNM stage and the tumor size. METHODS: Immunohistochemical staining with monoclonal STAT3, Bcl-xL, and MMP-2 antibodies was performed on paraffin-embedded specimens from 20 colon adenomas and 39 adenocarcinomas. RESULTS: The expression of STAT3, Bcl-xL, and MMP-2 was increased in the adenocarcinomas as compared with the adenomas (p<0.001). STAT3 expression was stronger in tumors with a distant metastasis than in tumors without a distant metastasis (p=0.012). A larger tumor size was related to an increase in STAT3 expression (p=0.035). CONCLUSIONS: STAT3, Bcl-xL, and MMP-2 may play important roles in the tumorigenesis of colorectal carcinoma. STAT3 may be indicative of a poor prognosis due to its correlation with distant metastases and a larger tumor size.

A Case Study of a Gastric Collision Tumor with an Adenocarcinoma and a Carcinoid Tumor / 대한소화기내시경학회지

Adenocarcinoma is the most common malignant gastric neoplasm, contrary to a gastric carcinoid which is relatively uncommon. The occurrence of an adenocarcinoma and a typical carcinoid tumor is rare and are morphologically classified into two subgroups. The first type is a composite- type tumor, which is characterized as a randomly assorted adenocarcinoma and a typical carcinoid tumor. The second type is a collision-type tumor, which is a double tumor with a "side by side" or "overlay" pattern. To the best of our knowledge, only 2 cases of the collision type tumors have been reported in the Korean literature. We have encountered a collision tumor which occurred in the antrum of the stomach and which invaded the regional lymph nodes by means of a highly malignant gastric carcinoid. The following report is a description of the collision tumor case as well as a literature review.

Expression of c-erbB-2 and c-met Proteins in Gastric Adenoma and Adenocarcinoma / 대한소화기학회지

BACKGROUND/AIMS: The aim of this study was to investigate the immunohistochemical overexpression of c-erbB-2 and c-met proteins according to the histopathological parameters such as grade of dysplasia, histological type, depth of invasion, lymph node metastasis, and TNM stage in gastric adenoma and gastric adenocarcinoma. METHODS: Immunohistochemical staining using monoclonal c-erbB-2 and c-met antibodies was performed on paraffin embedded specimens in 43 adenomas and 44 adenocarcinomas. RESULTS: The expression rate of c-erbB-2 was higher in adenomas (91%) than adenocarcinomas (30%). The expression rate of c-met was higher in adenocarcinomas (77%) than adenomas (49%). In adenoma, the expression rate of c-met was higher in high grade dysplasia (94%) than in low grade dysplasia (22%). In adenocarcinoma, c-met expression was significantly related with lymph node metastasis. CONCLUSIONS: c-erbB-2 would be involved in the development of relatively early stage gastric carcinogenesis. c-erbB-2 is related with histologic type and c-met with lymph node metastasis in gastric carcinomas. Although meaning for the experession of these proteins in gastric carcinomas would be different, these proteins may play as important oncogenes in gastric carcinogenesis.

A Case Of Granular Cell Tumor In The Stomach / 대한내과학회지

Granular cell tumor (GCT) may occur in any site of the body. Involvement of the gastrointestinal tract is uncommon. The esophagus is the gastrointestinal site most frequently affected, and occurrence of granular cell tumor in the stomach is extremely rare. We recently experienced a case of granular cell tumor in the stomach, presenting as a submucosal tumor, confirmed by endoscopic mucosal resection. So we report this case with review of the related literature.

Two Cases Of Primary Hepatocellular Carcinoma With Skull Metastasis / 대한내과학회지

Primary hepatocellular carcinoma (HCC) is one of the most common tumors in the world. HCC often metastases to the lung and the regional lymph nodes, but rarely to the bones. The most frequent sites of skeletal metastasis are the rib, spine, femur, pelvis and humerus, but the metastasis to the skull is very rare in HCC. Especially, the metastasis to the skull alone, or skull mass presented as first sign in HCC is extremely rare. We report a 74-year-old female who had HCC with the solitary skull metastasis and a 42-year-old male with HCC presented skull metastasis as the initial clinical manifestation.

Multilocular Cystic Renal Cell Carcinoma Accompanied by Autosomal Dominant Polycytstic Kidney Disease / 대한신장학회잡지

No abstract available.

A Case of the Ruptured Splenic Artery Aneurysm Treated with Transcatheter Embolization / 대한소화기학회지

Splenic artery aneurysms are the most common visceral artery aneurysms, which are usually found incidentally. The most common complication of splenic artery aneurysms is spontaneous rupture into the peritoneal cavity, which leads to acute peritonitis and shock. Less commonly, it may rupture directly into the stomach, small bowel or pancreatic duct and may present with acute gastrointestinal hemorrhage. We report a rare case of the ruptured splenic artery aneurysm, presenting as acute massive hematochezia which was treated with transcatheter embolization.

Etiology and Clinical Outcomes of Renovascular Hypertension / 대한신장학회잡지

BACKGROUND: Renovascular hypertension has variable etiologic diseases and therapeutic outcomes. We performed a retrospective analysis of the causes and treatment results of renovascular hypertension to elucidate long-term prognosis with respect to blood pressure and renal function. METHODS: We reviewed patients who were admitted to Seoul National University Hospital for evaluation of renovascular hypertension in period from January, 1983 to December, 2002. Diagnosis of renovascular hypertension was made by combination of positive functional studies such as captopril renal scintigraphy and/or captopril test and angiographic demonstration of significant stenoses in one or both of renal arteries. Patients who were followed up for more than six months were included and classified according to the etiologic disease and treatment modalities. Responses of blood pressure and renal function in each patient were periodically evaluated. RESULTS: Of 74 patients included, 37 were male and 37 were female. The median age of the patients was 40. Atherosclerotic renal artery stenosis was the most common diagnosis (31, 41.9%), followed by Takayasu's arteritis (21, 28.4%) and fibromuscular dysplasia (14, 18.9%). Control of blood pressure and preservation of renal function were significant in medical, radiological, and surgical therapy group. There was no significant difference in response of blood pressure and renal function to treatment among treatment groups. Poor response of blood pressure and deterioration of renal function were observed more frequently in patients with atherosclerotic renal artery stenosis than in those with Takayasu's arteritis or fibromuscular dysplasia. CONCLUSION: Atherosclerosis was the most common etiologic diagnosis of renovascular hypertension. Medical treatment showed satisfactory treatment results as compared to radiologic and surgical revascularization. Patients with atherosclerotic renal artery stenosis showed poorer control of blood pressure and preservation of renal function.

Long-term Chelation Therapy in Patients with Chronic Lead Nephropathy by Excessive Body Lead Burden / 대한신장학회잡지

BACKGROUND: Although chelation therapy with calcium disodium ethylenediamine tetraacetic acid (CaNa2EDTA) reduces body burden of lead and improves clinical side effects from lead, it is unclear whether long-term repeated chelation is safe for chronic lead poisoning with nephropathy. We described the consequential changes of renal function and clinicopathological findings during one to two years of monthly administration of CaNa2EDTA in patients with chronic lead nephropathy and excessive body lead burden. METHODS: Three patients diagnosed as chronic lead nephropathy received 1 g/day of intravenous CaNa2EDTA for a 3-5 day/cycle. A total of 48-86 g CaNa2EDTA was administered. Midtibial bone lead, chelatable lead, and blood lead levels were assessed. Renal function was determined in each chelation, and renal biopsies before and after chelation were conducted and compared for microscopic and immunofluorescence changes. RESULTS: Cortical bone lead levels showed a high burden of lead (>200 microgram Pb/g bone mineral). During CaNa2EDTA treatment, blood lead level and renal function were in steady state. No evidence of progression of renal pathology was observed in both renal biopsies, showing similar interstitial fibrosis and glomerular sclerosis. CONCLUSION: Our results suggest that long-term repeated chelation therapy with CaNa2EDTA is safe and effective for patients who have suffered from severe chronic lead poisoning, even though renal pathologic change has started.

A Case of Gastric MALT Lymphoma Presenting as a Submucosal Tumor (SMT)-like Lesion, Diagnosed by Endoscopic Mucosal Resection / 대한소화기내시경학회지

Gastric MALT lymphoma usually presents with various endoscopic morphologic characteristics. The majority of gross findings reveal multiple and superficial erosions or ulcerations. However gastric MALT lymphoma, presenting as a submucosal tumor, is very rare. We recently experienced a case of low-grade gastric MALT lymphoma, presenting as a submucosal tumor-like lesion without definite mucosal lesion, confirmed by endoscopic mucosal resection. So we report this case with a review of the related literatures.

Clinical Outcomes of Gram-negative Bacterial Peritonitis / 대한신장학회잡지

BACKGROUND: Peritonitis which is still the most important cause of morbidity and technical failure in peritoneal dialysis even though it has decreased significantly, has been known to lead to different outcomes by the type of causative pathogens. METHODS: To analyze clinical outcomes with trends of peritonitis rates by the type of causative pathogens, we retrospectively reviewed peritoneal dialysis patients in Seoul National University Hospital from 1995 to 2001. RESULTS: Three hundred fifty-seven cases of peritonitis occurred in 163 patients among total 307 peritoneal dialysis patients and the rate of peritonitis was 0.44 episodes/patient-year. There are 130 (38.1 %) episodes of Gram-positive bacterial peritonitis, 59 (17.3%) episodes of Gram-negative bacterial peritonitis and 25 (7.3%) episodes of mixed bacterial peritonitis. E.coli, Acinetobacter, and Pseudomonas were main Gram-negative isolates, in the order named. The rate of total peritonitis and the rate of Gram- positive peritonitis decreased significantly during the study period. But, the rate of Gram-negative peritonitis remained constant, and therefore its relative proportion tended to increase. Among Gram-negative bacteria, the proportion of Pseudomonas species declined persistently. Gram-negative peritonitis was a significant risk factor of hospitalization, independent of soft tissue infection and serum albumin, like S.aureus peritonitis. In Gram-negative peritonitis or Pseudomonas peritonitis, more catheters were removed regardless of soft tissue infection or peritoneal dialysis duration. CONCLUSION: In conclusion, we confirmed Gram- negative peritonitis and Pseudomonas peritonitis have poor prognosis. Therefore, Cautious evaluation of abdominal lesions and aggressive treatment are necessary for patients with Gram-negative peritonitis whose relative proportion increased.