Analysis of the association between different treatments and high-risk histopathologic features of bilateral retinoblastomas / 中华眼底病杂志

Objective:To evaluate the pathological features of bilateral retinoblastoma (RB) and the relationship between different treatments and high-risk histopathologic features (HHF).Methods:Retrospective series of case studies. From 1999 to 2018, 73 patients with binocular RB diagnosed by pathological examination in Department of Ophthalmology, Peking University People's Hospital were included in the study. Among them, 50 patients were male (68.5%, 50/73), 23 patients were females (31.5%, 23/73); 11 patitents had a family history of RB. The mean age at the first diagnosis was 14.8±15.6 months. The average time between first diagnosis and first intervention was 3.97±4.74 months. According to the international classification standard of intraocular RB staging, among the 73 eyes, C, D and E stages were 2 (2.7%, 2/73), 15 (20.5%, 15/73), and 56 (76.7%, 56/73) eyes, respectively. Ocular images for each patient were obtained using a wide-angle contact fundus camera during examination under general anaesthesia. The treatment protocol (globe salvaging or enucleation) depended on the result of several clinical features. Globe salvaging treatment included chemotherapy combined with local therapy such as intra-arterial chemotherapy (IAC), intravitreal chemotherapeutics injection, cryotherapy, laser, transpupillary thermotherapy and radiotherapy. If globe salvaging failed, enucleation was offered and histopathologic analysis was conducted of the enucleated eye, the ophthalmic pathologist read and evaluated the presence of HHF. Independent samples t-test was performed to compare the continuous variables. The pathological features and the relationship between different treatments and HHF were analyzed. Group difference was calculated with chi-square. Results:Among the 73 eyes, the first treatment was enucleation in 21 eyes (28.8%, 21/73); 52 eyes (71.2%, 52/73) were treated with eye protection. After enucleation, 9 cases (12.3%, 9/73) had recurrence and metastasis, and 7 cases (9.6%, 7/73) died. The intervention time of patients with recurrence and metastasis and those without recurrence and metastasis were 7.4±7.3 and 3.5±4.1 months respectively; the first intervention time of patients with recurrence and metastasis was significantly later than that of patients without recurrence and metastasis, but the difference was not statistically significant ( t=-1.561, P=0.154). The pathological examination results showed that there were 26 eyes (35.6%, 26/73) with HHF, 4 (26.7%, 15/26) and 22 (39.3%, 22/56) eyes were in stage D and E, respectively. Those who received other treatments before enucleation had lower HHF percentages after enucleation than those who did not receive corresponding treatments, but the difference was not statistically significant ( χ2=1.852, 0.074, 0.000, 1.007, 0.007, 2.729; P>0.05). Among the 26 eyes, 5 (83.3%, 5/6) and 21 (31.3%, 21/67) eyes were treated with systemic chemotherapy combined with and without IAC, respectively, and there was a significant difference in the percentage of HHF ( χ2=4.422, P=0.035). Conclusions:IAC eye-preserving therapy before enucleation has a significant effect on HHF.

Amoebic Encephalitis Caused by Balamuthia mandrillaris

We present the case of a 71-year-old man who was diagnosed with amoebic encephalitis caused by Balamuthia mandrillaris. He had rheumatic arthritis for 30 years and had undergone continuous treatment with immunosuppressants. First, he complained of partial spasm from the left thigh to the left upper limb. Magnetic resonance imaging revealed multifocal enhancing nodules in the cortical and subcortical area of both cerebral hemispheres, which were suggestive of brain metastases. However, the patient developed fever with stuporous mentality and an open biopsy was performed immediately. Microscopically, numerous amoebic trophozoites, measuring 20 to 25 µm in size, with nuclei containing one to four nucleoli and some scattered cysts having a double-layered wall were noted in the background of hemorrhagic necrosis. Based on the microscopic findings, amoebic encephalitis caused by Balamuthia mandrillaris was diagnosed. The patient died on the 10th day after being admitted at the hospital. The diagnosis of amoebic encephalitis in the early stage is difficult for clinicians. Moreover, most cases undergo rapid deterioration, resulting in fatal consequences. In this report, we present the first case of B. mandrillaris amoebic encephalitis with fatal progression in a Korean patient.

Clinico-radiologic, laboratory, and histopathologic profile of patients diagnosed with neonatal cholestasis at Philippine Children's Medical Center

@#<p style="text-align: justify;"><strong>BACKGROUND:</strong> Neonatal Cholestasiswarrants early, accurate and prompt intervention and comprises a wide spectrum of differential diagnosis which present with overlapping features, thus making a diagnosis difficult.</p><p style="text-align: justify;"><strong>OBJECTIVE:</strong> To evaluate the clinical and laboratory parameters that could aid to differentiate between intrahepatic and extrahepatic neonatal cholestasis.</p><p style="text-align: justify;"><strong>METHODS</strong>: Retrospective and Descriptive study of Neonatal Cholestasis patients who underwent Liver Biopsy and admitted at the Philippine Children's Medical Center from January 2007 to December 2011.</p><p style="text-align: justify;"><strong>RESULTS:</strong> Factors that favor an intrahepatic cause of Cholestasis are ultrasound finding of a normal gallbladder, marked degree of giant cell transformation and presence of extramedullary hematopoiesis. Factors that favor an Extrahepatic cause of Cholestasis are presence of Splenomegaly, markedly elevated GGT, and histopathology findings of Portal and Periportal Ductal proliferation, bile plugs, lesser degree of giant cell transformation, septal fibrosis and cirrhosis, portal and neoductular cholestasis, and Portal-Portal bridges.</p><p style="text-align: justify;"><strong>CONCLUSION:</strong> In this study, meticulous history and physical examination aid in the diagnosis of Neonatal Cholestasis. Splenomegaly and markedly elevated serum GGT are suggestive of Biliary Atresia, and a normal Gallbladder by Ultrasound favors Neonatal Hepatitis. Although there is significant overlap of histopathologic findings of patients with neonatal cholestasis, certain parameters favor an extrahepatic over an intrahepatic process.</p>

A Clinical and Histopathological Study of 324 Cases of Epidermal Cyst / 대한피부과학회지

BACKGROUND: Epidermal cysts are a common occurrence. But there have been few studies to determine the clinical and histopathological characteristics of epidermal cysts. OBJECTIVE: To evaluate the clinicopathological characteristics of 324 cases of epidermal cyst. METHODS: We evaluated the clinical and histopathologic features of 324 cases of epidermal cyst at the Department of Dermatology at Korea University Anam Hospital over 5 years, from January 2001 to December 2005. RESULTS: The ratio of male to female patients was 1.7 : 1. Age distribution ranged from 7 to 91 years old. The duration of lesions was variable with mean duration of 29.3 months. The most common site of occurrence was the face. Histopathologic changes of cystic walls were atropy, acanthosis, hypergranulosis, vacuolation and parakeratosis. We identified parakeratotic cells, red blood cells, calcifications and bacterial colonies in the cystic contents. We also found verrucous architectures in the cystic walls of 23 cases. Initially, some cases were clinically diagnosed as epidermal cysts, but histopathological findings then discovered only inflammation, granulation, pilomatrichoma or lipoma, rather than an epidermal cyst. We discovered that there was also a close relation between erythema and rupture of the cystic wall. CONCLUSION: Our clinical and histopathologic findings of the epidermal cysts were similar to previous reports. However, we did find verrucous architectures on not only the palmoplantar area, but also many other areas of the body. Quite a few cases which had initially been clinically diagnosed as epidermal cysts, turned out not to be upon histopathologic investigation.

Clinical and Histopathological Features in Inverted Follicular Keratosis / 대한피부과학회지

BACKGROUND: Inverted follicular keratosis has distinctive histopathological features and is infrequently encountered by dermatologists. To date, the pathogenesis of inverted follicular keratosis has not been elucidated. Many authors have suggested several theories for the nature of inverted follicular keratosis including verruca vulgaris with squamous eddies, irritated seborrheic keratosis and distinctive follicular tumors. There are no comprehensive studies about the clinical and histopathological features of inverted follicular keratosis in Korea. OBJECTIVE: The purpose of this study was to analyze the clinical features and histopathological findings of inverted follicular keratosis with literature review. METHODS: We studied 14 patients with inverted follicular keratosis for clinical features including the duration of the disease, the location and size of the lesions, the clinical impressions at the first visit and we made a record of the patients' age and sex, histopathological findings. RESULTS: Eight of the 14 patients were male and the ages ranged from 40 to 83 years(mean 59.3 years). The lesions were situated on the face(5/14), scalp(3/14), abdomen(2/14), hand(2/14), buttocks(1/14), shin(1/14). The average size of the lesions was 1.38cm. Seborrheic keratosis was the most common clinical diagnosis(6/14), followed by verruca vulgaris(4/14), cutaneous horn(1/14), melanoma(1/14), soft fibroma(1/14) and pigmented nevus(l/14). Solid and nodular types were the most common histopathological type(7/14), followed by keratoacanthoma-like type(5/14), filiform or wart like type(2/14). CONCLUSION: Inverted follicular keratosis have unusual clinical and histopathological features. We recommend that verrucous plaque lesions should be diagnosed correctly by histopathologic examination and it may be helpful to avoid inappropriate therapeutic approach.

Three Cases of Prurigo Pigmentosa / 대한피부과학회지

Prurigo pigmentosa is a chronic inflammatory dermatosis characterized by reticulated erythematous papules, hyperpigmentation with severe pruritus and usually occurs in young femals around their twenties. Most cases have been reported from Japan, but only twelve cases have been reported in Korea. Histopathologic findings of erythematous papules shows spongiosis, exocytosis, liquefaction degeneration of the basal cell, perivascular lymphohistiocytic infiltration in the dermis and finally dermal fibrosis and deposit of dermal melanophages in hyperpigmented lesions. We report three cases of prurigo pigmentosa which showed various histopathologic features of early, fully-developed and late stage, respectively.

An Analysis of Histopathologic Evaluation of Lung Carcinomas in Last Ten Years

Lung cancer is one of the most common types of malignancy in western nations with serious health problem, and it has become the leading cause of cancer death of males, second only to stomach cancer, in Korea. A review of the histopathology of 1363 cases (1231 patients) of lung carcinoma, diagnosed at the Keimyung University Medical center from 1987 to 1996, was performed to reclassify the type of carcinomas and to investigate the change in the distribution of histologic types of lung carcinoma according to age, sex and year. Among the 1363 cases, 132 patients underwent a surgical operation after biopsy. The diagnosis of each case was proven by histopathologic analysis of surgical specimens (13.2%) and biopsy materials (86.8%). The histologic types in our study were basically based on modified WHO classification (1982) and on new WHO classification (1999). The classification of small cell carcinoma was based on International Association for the Small Cell Lung Cancer (IASLC, 1988). Of the 1231 patients with lung carcinoma, 1012 were male and 219 were female (male to female ratio was 3.6:1). According to the analysis of age distribution, the most prevalent age group was 60~69 years in both sex as (n=516, 42.0%). Changing trends in sex distribution of lung carcinoma patients showed that the proportion of men had decreased throughout the years, whereas the proportion of women had significantly increased. Histologically, squamous cell carcinoma was the most common (n=624, 50.7%), followed by small cell carcinoma (21.1%), adenocarcinoma (18.1%), large cell undifferentiated carcinoma (2.1%), adenosquamous carcinoma (0.4%), and large cell neuroendocrine carcinoma (0.4%), in order of frequency. In men, squamous cell carcinoma was the most frequent type (55.1%). In women, adenocarcinoma was the most frequent type (39.7%). In both sexes, adenocarcinoma was the most common type in patients under the age of 40 (n=12, 41.4%), while squamous cell carcinoma proved the most frequent type in patients over the age of 40 (n=617, 51.3%). Changing trends of histologic types of lung cancer showed that the incidences of squamous cell carcinoma had significantly decreased throughout the years, whereas those of adenocarcinoma and small cell carcinoma had increased. In conclusion, the results showing increases in the percentage of female patients and in the number of cases of adenocarcinoma were noteworthy, and well correlated with other related reports.

Histopathologic Study of Dermatophytosis / 대한피부과학회지

BACKGROUND: Dermatophytosis is sometimes difficult to diagnose deinitively if it has atypical clinical characteristics and mycological tests are negative. Histopathologic findings may be different depending upon the location and causative dermatophytes. OBJECTIVE: The purpose of the present study was to evaluate histopathologic characteristics nf dermatophytosis depending upon the areas of involvement. METHODS: We evaluated the clinical and histopathologic features of 32 cases of dermatophytosis which were diagnosed by skin biopsies at the Dermatology Department of branch hospitals of Catholic University Medical College from March 1985 to August, 1994. Histopathologic features were observed in three dilferent groups divided by location, area of terminal hair, areas of vellus hair and hairless areas. RESULTS: Epidermal changes including hyperkeratosis, parakeratos, acanthosis, spongiosis and neutrophilic exocytosis were frecuently observed in the three groups of Iermatophytosis. In 7 cases of tinea capitis and linea barbae, follicular and inflamma or changes of the deep dermis were important. Hyphae and spores were observed in 71%(5 cases) and 57%(4 cases) respectively, in the follicles. In 19 cases of tinea faciale, tiriea corporis and tinea cruris, change epidermis and superficial dermis as well as findings of follicular infundibulum were important. Herphae were observed in 84%(16 cases) and 53%(10 cases) in the stratum corneum and vellus hir follicle respectively, and in 3 cases the hyphae were observed only in the vellus hair follicle. Sandwich sign, known to be important clue of dermaliophytosis, was observed in only 5%(1 cacse, In 6 cases of tinea manus and linea pedis, hyphae and spores were rebserved in 100% (6 cases) and 33%(2 cases) respectively, in the stratum corneum. CONCLUSION: We consider tha histopathologic observations may of great help to diagnose some difficult cases of dermatophytosis and the presence of hyphae n .he vellus hair follicle may be a more frequent and important finding than the sandwich sign the dermatophytosis of the vellus hairy regions.