Résumé
The calcaneal insufficiency avulsion fracture usually occurs in an area of fused apophysis in adults without significant history of trauma or overuse activities. It is an uncommon injury which has been described in patients with complicated diabetes, Charcot neuroarthropathy, amyloidosis with neuropathy, severe osteoporosis, and other conditions. Discussion of the issue of fracture location is still not sufficient. We report on a case of a 50-year-old male who experienced a non-traumatic diabetic calcaneal insufficiency fracture. Intraoperatively, a biopsy specimen was obtained from the exposed fracture site for histological study. We assume that the calcaneal fused apophyseal line is the weak point of failure due to various incomplete mixtures of trabecular bone, woven bone, and cartilaginous tissues, and may fail when repeated tensile stress is imposed.
Sujets)
Adulte , Humains , Mâle , Adulte d'âge moyen , Amyloïdose , Biopsie , Calcanéus , Diabète , Fractures de fatigue , OstéoporoseRésumé
BACKGROUND: Few studies on how to diagnose pulmonary neuroendocrine tumors through morphometric analysis have been reported. In this study, we measured and analyzed the characteristic parameters of pulmonary neuroendocrine tumors using an image analyzer to aid in diagnosis. METHODS: Sixteen cases of typical carcinoid tumor, 5 cases of atypical carcinoid tumor, 15 cases of small cell carcinoma, and 51 cases of large cell neuroendocrine carcinoma were analyzed. Using an image analyzer, we measured the nuclear area, perimeter, and the major and minor axes. RESULTS: The mean nuclear area was 0.318+/-0.101 microm2 in typical carcinoid tumors, 0.326+/-0.119 microm2 in atypical carcinoid tumors, 0.314+/-0.107 microm2 in small cell carcinomas, and 0.446+/-0.145 microm2 in large cell neuroendocrine carcinomas. The mean nuclear circumference was 2.268+/-0.600 microm in typical carcinoid tumors, 2.408+/-0.680 microm in atypical carcinoid tumors, 2.158+/-0.438 microm in small cell carcinomas, and 3.247+/-1.276 microm in large cell neuroendocrine carcinomas. All parameters were useful in distinguishing large cell neuroendocrine carcinoma from other tumors (p=0.001) and in particular, nuclear circumference was the most effective (p=0.001). CONCLUSIONS: Pulmonary neuroendocrine tumors showed nuclear morphology differences by subtype. Therefore, evaluation of quantitative nuclear parameters improves the accuracy and reliability of diagnosis.
Sujets)
Tumeur carcinoïde , Carcinome à grandes cellules , Carcinome neuroendocrine , Carcinome à petites cellules , Tumeurs neuroendocrinesRésumé
Radiation therapy is one of the most important therapeutic modalities for the treatment of lung cancer. Radiation pneumonitis is one of the important complications associated with radiotherapy for lung cancer. Radiation pneumonitis is generally limited to the irradiated lung and is manifested by the insidious onset of dry cough, dyspnea, and mild fever, resulting in damage and edematous changes of alveolar structures on histologic inspection. Clinically, diffuse bilateral radiation pneumonitis accompanied with acute symptoms after unilateral thoracic irradiation appears very rarely. Histopathologic examinations for the diagnosis of out-of-field radiation pneumonitis are rarely performed. We herein describe a case of extensive bilateral radiation pneumonitis which developed acutely after salvage radiotherapy for squamous cell carcinoma in the left upper lobe of the lung. The condition was confirmed by a diagnostic help of histopathologic findings.
Sujets)
Carcinome épidermoïde , Toux , Dyspnée , Fièvre , Poumon , Tumeurs du poumon , Poumon radiqueRésumé
Eosinophilic esophagitis is a chronic inflammatory disorder characterized by dense eosinophilic infiltration of the esophageal mucosa. As an emerging disease during the last decade, eosinophilic esophagitis has gained increased recognition in both the medical and research communities. The pathogenesis is incompletely understood and food allergies and aeroallergens have been implicated. The most common clinical symptoms in adults are dysphagia and food impaction. We diagnosed two cases as eosinophilic esophagitis and treated them with a proton pump inhibitor and a systemic steroid. We confirmed improvements in clinical presentation and histologic findings and report these cases.
Sujets)
Adulte , Humains , Troubles de la déglutition , Oesophagite à éosinophiles , Granulocytes éosinophiles , Hypersensibilité alimentaire , Muqueuse , Pompes à protons , ProtonsRésumé
A low grade fibromyxoid sarcoma is a rare soft tissue tumor that has a tendency to develop in the deep soft tissue of young adults and the potential for local recurrence or distant metastasis. There have been several case reports and sporadic reports in the literature. However, only 1 case has been reported in Korea but without a follow-up result. We describe a 54-year-old female patient with a low-grade fibromyxoid sarcoma of the thigh that had been growing slowly for 34 years. A marginal resection of this tumor was performed. Currently, the patient is doing well without evidence of local recurrence or distant metastasis at 5 years after surgery.
Sujets)
Femelle , Humains , Adulte d'âge moyen , Fibrosarcome/anatomopathologie , Tumeurs des tissus mous/anatomopathologie , Cuisse/anatomopathologieRésumé
A 29-year-old woman presented with secondary amenorrhea, primary infertility, and virilization, which had developed over the past 2 years was suspected to have a virilizing tumor at her left ovary. Her serum testosterone level was markedly elevated (380 ng/dL). Left salpingooophorectomy was performed, and histopathological examination revealed a thecoma of the left ovary. The postoperative serum testosterone level returned to 65 ng/dL. The patient did not have regression of virilism soon. However, the patient had a normal menstruation 29 days after surgery and gave birth to a baby 13 months after surgery.
Sujets)
Adulte , Femelle , Humains , Grossesse , Menstruation , Tumeurs de l'ovaire/sang , Ovariectomie , Issue de la grossesse , Testostérone/sang , Thécome/sang , Virilisme/sangRésumé
Hydatidiform mole with a coexisting fetus is rare, but this condition has recently shown an increased incidence because of assisted reproduction technology. In most of the reported cases, termination at diagnosis was preferred due to poor fetal survival and maternal risk factors such as vaginal bleeding, preeclampsia, hyperthyroidism, potential of malignant change. However, considering the value of pregnancy by assisted reproduction technology, whether to continue or to terminate this condition is a dilemma. Based on currently available information, it seems that it is reasonable to allow the pregnancy to continue in the absence of maternal complications. We report on a case of the complete hydatidiform mole with two coexisting fetuses with a brief reviews of the literature.
Sujets)
Femelle , Grossesse , Foetus , Môle hydatiforme , Hyperthyroïdie , Incidence , Pré-éclampsie , Grossesse gémellaire , Reproduction , Facteurs de risque , Hémorragie utérineRésumé
Placenta increta is a life threatening complication of pregnancy, causing severe post-curettage bleeding. It is usually presented in the postpartum period with hemorrhage during difficult placental removal. It is especially rare in the 1st and 2nd trimesters, which is not easy to find and diagnose. We have confirmed a case of placenta increta after emergency hysterectomy due to severe vaginal bleeding following the dilatation and curettage during the 1st trimester of her pregnancy. So we report it with a brief case history and review of the concerned literatures.
Sujets)
Femelle , Humains , Grossesse , Dilatation et curetage , Urgences , Hémorragie , Hystérectomie , Placenta accreta , Placenta , Période du postpartum , Premier trimestre de grossesse , Hémorragie utérineRésumé
Hyperplastic polyps are often multiple and by far the most frequent lesions among gastric polyps, contributing for about 90% of the polypoid lesions observed in the stomach. However, hyperplastic gastric polyposis is rare and was not exactly evaluated for natural course. These lesions are considered reactive and not genetically determined conditions. So it has been claimed that the hyperplastic polyps and hyperplastic polyposis are non-neoplastic lesions that result from regenerative hyperplastic reaction to inflammation and erosion. Recently we experienced a hyperplastic gastric polyposis with morphological changes during short follow-up period and reported herein.
Sujets)
Études de suivi , Inflammation , Polypes , EstomacRésumé
Mn (manganese) is known to induce Parkinsonian neurological disorder. Several lines of evidence suggest that apoptosis is involved not only in physiological cell death during normal development but also in neurodegenerative disease. The mechanism of Mn induced cell death remains poorly understood. In the present study, we evaluated the morphologic changes and apoptotic profile in basal ganglia using rat model of Mn toxicity. The rats were divided into three groups: the first group was a control; the second group was subdivided by administration dosage of Mn into group A (5, 10 mg MnC12/ kg) and group B (20, 40 mg MnC12/kg). The rats of each subgroup received a injection of Mn via tail vein every week for 4 weeks. The second group received 4 repeated injection of 10 mg MnC12/kg in the same manner and the rats were sacrificed at day 1, 3 & 7 in group I and at day 10, 21, 42, and 90 in group II after the last injection. A significant loss of neuron and gliosis were observed in the basal ganglia in the experimental groups (p<0.05), which were more pronounced in group II than in the control or group I. No significant difference in number of nerve cells or degree of gliosis was identified in the substantia nigra. Apoptotic cells were also increased in basal ganglia of experimental groups and appeared among neurons (10%), glial cells (10%), and endothelial cells (60%). Apoptotic figures were consistently noted through the entire experimental period after Mn injection in basal ganglia. In conclusion, these results demonstrate that Mn-induced cytopathic insult affects various cell types in basal ganglia and shows variable sensitivity in the different regions of brain, especially in the apoptotic cell death of the neuron. The overaccumulation of Mn in the brain might be attributed from the breakdown of blood-brain barrier due to the injury through the apoptosis.
Sujets)
Animaux , Rats , Apoptose , Noyaux gris centraux , Barrière hémato-encéphalique , Encéphale , Mort cellulaire , Cellules endothéliales , Gliose , Manganèse , Modèles animaux , Maladies du système nerveux , Maladies neurodégénératives , Névroglie , Neurones , Substantia nigra , VeinesRésumé
A case of poorly differentiated "insular" carcinoma of the thyroid is presented and discussed with references to the literature. In fine needle aspiration cytology of our case, the aspirates were highly cellular with tumor cells appearing as dispersed isolated cells as well as in dense clusters and syncytial formations. Occasional microfollicles containing colloid were evident. Most of nuclei were fairly uniform with considerable variability and a few showed definite atypical features. Nuclear grooving was additional features. Necrotic debris was not seen. Our cytologic findings were correlated well with histology, confirming typical insular pattern of tumor cells with the presence of occasional pleomorphic cells and papillary carcinoma-like features. With much attention to cytological features of insular carcinoma, it would be possible to diagnose a preoperative suggestive diagnosis, even though not definitive.
Sujets)
Cytoponction , Colloïdes , Diagnostic , Glande thyroideRésumé
A carcinoid tumor of the thymus combined with thymoma in a 62-year-old man is described. The mediastinal tumor had been present for 13 years and was associated with pure red cell aplasia. Carcinoid tumor occupied the central two-thirds of the tumor, consisting of nests and trabeculae of monotonous round cells, which ultrastructurally showed many intracytoplasmic dense-core granules. Typical spindle cell type thymoma surrounded the carcinoid area. Clinico-pathologic findings of this unique case suggested that the carcinoid tumor developed within a preexisting thymoma, illustrating a possibility of neuroendocrine differentiation of thymic epithelial cells.
Sujets)
Humains , Mâle , Adulte d'âge moyen , Tumeur carcinoïde/anatomopathologie , Tumeurs primitives multiples/anatomopathologie , Thymome/anatomopathologie , Tumeurs du thymus/anatomopathologieRésumé
Inclusion body myositis (IBM) is a chronic inflammatory myopathy with characteristic rimmed vacuoles. Cytoplasmic and intranuclear filamentous inclusions in muscle speci men. The clinical features manifest male dominance with the onset between the second and eighth decade but usually after the age of 50 years. Slow progression of painless muscle weakness, normal or mildly elevated serum CK level, myopathic and neurogenic eIectromyographic patterns and refractory to steriod therapy. The presence of rimmed vacuoles and filamentous inclusions in myofiber gives an important clue in the diagnosis of IBM, however, it is very difficult to differentiated young age onset IBM with distally predominant muscle weakness from distal myopathy with rimmed vacuole formation. While we present a young female patient who had slow progression of painless distal muscle weakness in both upper and lower extremities for 1 year, previously published articles concerning of IBM and distal myopathy with rimmed vacuole formation are reviewed and our own differential points are discussed in the diagnosis of this case as IBM.