Cutaneous Metastasis of Renal Cell Carcinoma Presenting as Multiple Nodules: A Case Report / 대한피부과학회지

Renal cell carcinomas (RCC) account for 2.4% of all adult malignancies. RCC is known for its aggressive nature, with approximately one-third of patients presenting with metastasis at the time of diagnosis. Cutaneous metastasis is a rare presentation of this cancer. A 78-year-old male presented with numerous erythematous nodules of various sizes on the left flank, which he had had for a month. He had undergone a left partial nephrectomy for papillary RCC 3 years previously and had been receiving chemotherapy since surgery. Histopathology revealed papillary architecture with prominent atypical nucleoli throughout the dermis. Immunohistochemical findings were positive for CD10, cytokeratin 7, PAX-8, vimentin, and alpha-methylacyl-CoA racemase. These results led to a diagnosis of cutaneous metastases of papillary renal cell carcinoma. Papillary RCC rarely presents with cutaneous metastases.Because these lesions are easily accessible, cutaneous lesions in patients with risk factors for RCC should be excised and pathologically evaluated.

Baseline Characteristics, Disease Severity, Laboratory Findings, and Treatment History of Patients with Severe Atopic Dermatitis:A Single-Center Cohort Study in Korea / 대한피부과학회지

Background@#Since the disease burden of atopic dermatitis (AD) understandably increases with its disease severity, studies, especially on the baseline characteristics of severe AD, have been conducted in some countries to deepen the understanding of the disease and, by extension, formulate a relevant national policy. However, research on the baseline characteristics of severe AD in Korea remains insufficient. @*Objective@#To report the baseline demographics and describe the clinical characteristics of adult Korean patients with severe AD, including medical and treatment history, clinical manifestations, disease severity, and laboratory findings, in order to understand the characteristics of severe AD. @*Methods@#A single-center, prospective, non-interventional, observational, longitudinal study of 108 patients with severe AD was conducted between January 2021 and December 2022. Clinical data and patient-reported measures of signs and symptoms of AD were recorded at baseline. @*Results@#The mean Eczema Area and Severity Index score of the patients was 28.5±6.8. The mean pruritus numerical rating scale, Patient-Oriented Eczema Measure, Dermatology Life Quality Index, and Atopic Dermatitis Control Tool scores were 8.1±1.7, 23.6±4.8, 21.9±6.6, and 19.5±3.9, respectively. Although a larger proportion of the headeck and trunk are affected than both limbs, the key signs of AD were less severe in the headeck region than in the other regions. Erythema and lichenification were more representative clinical signs of severe AD than induration and excoriation. The baseline data on previous treatments reflected the AD treatment guidelines in Korea. @*Conclusion@#This real-world data will provide dermatologists with a better understanding of severe AD, which will eventually lead to better clinical and health policy decisions for patients with severe AD.

A Study on Lip Movements Area and Vowel Space Area According to the Depressive Disorders

Background and Objectives@#This study aims to investigate the lip movements area (LMA) and vowel space area according to depression.Materials and Method The participants diagnosed with voice disorders or thyroid cancer before treatment and surgery. All participants completed the depression questionnaire and recorded five vowels (/a, i, u, e, o/) phonation while shooting. Among the total 64 participants, there were 19 participants in the depressive disorders group and 45 participants in non-depressive group. The analysis parameters were LMA, vowel space areas (Area3 & Area5), formant centralization ratio (FCR), fundamental frequency (F0) and voice intensity (intensity). Multivariate analysis of variance (MANOVA) was applied, and age was treated as a covariate to correct for lip movement that could deteriorate as age increased. @*Results@#As a result of MANOVA, there was no significant difference between groups (p=0.517). Looking at the LMA, both male and female in the depressive disorder group showed a lower mean value than the non-depressive disorders group. The Area3 and FCR of the depressive disorder group were higher than those in the non-depressive disorders group, whereas for the Area5, the mean value of female in the depressive disorder group was higher than that of the non-depressive disorder group and the male’s non-depressive disorder group had a slightly higher mean value. @*Conclusion@#The voice intensity according to the presence or absence of depressive disorder was similar, but the depressive disorder group tended to show narrower oral area with smaller lip opening.

Tuberculous Lymphadenitis in a Patient Treated with Dupilumab: A Case Report

Tuberculous lymphadenitis is among the most frequent presentations of extrapulmonary tuberculosis; the most common presentation is isolated chronic non-tender lymphadenopathy in young adults without systemic symptoms. Dupilumab is a fully human monoclonal antibody directed against interleukin-4 receptor-α that blocks the synergistic effects of interleukin-4 and interleukin-13 on allergic inflammation. Its well-known adverse events are allergic conjunctivitis, injection site reaction, and dupilumab facial redness. A 32-year-old female with severe atopic dermatitis was treated with dupilumab for 2 months at our clinic. She complained of multiple enlarged palpable lymph nodes on the right side of the neck and inguinal area for 2 months. Laboratory tests showed an increased total eosinophil count and immunoglobulin E level, as well as positive interferon-γ release assays. Radiological examination showed multiple low echoic and heterogeneous well-enhancing lymph nodes in level II, III, IV, and V of the neck. Histological examination revealed caseous necrosis and tuberculoid granuloma. The lymph node enlargements were completely relieved after antituberculosis treatment. The mechanism for the development of tuberculous lymphadenitis in a patient receiving dupilumab is not fully understood yet. In some previous studies, treatment with dupilumab suppressed the expression of genes related not only to T helper 2 and eosinophil response but also to proinflammatory responses. It could not inhibit the intracellular growth of Mycobacterium tuberculosis in macrophages, predisposing them to the development of tuberculous infection. To the best of our knowledge, this is the first report on the development of tuberculosis lymphadenitis in a patient treated with dupilumab.

Very Early Patch Stage of AIDS-related Kaposi Sarcoma:A Case Report

Kaposi sarcoma (KS) is a vascular and lymphatic neoplasm caused by human herpesvirus 8 (HHV-8). AIDS-related KS has variable clinical courses ranging from mild disease presenting as an incidental finding to severe disease presenting as an aggressively progressing neoplasm that can lead to poor prognosis or even death. Typical clinical manifestation of KS is known as multiple cutaneous lesions on the extremities, trunk, and face with mucosal involvement. A 46-year-old male with AIDS complained of an erythematous patch on the right forearm which appeared 5 months ago. For a year, he was treated with antiretroviral drugs for AIDS. Physical examination revealed a 2.5-cm solitary erythematous patch only on the right forearm. Laboratory data revealed human immunodeficiency virus (HIV)-1 RNA of less than 40 copies/ml and a CD4 cell count of 264 cells/mm 3 . Histological examination revealed numerous slit-like spaces and vascular proliferation with primitive blood vessels dissecting between the collagen bundles and the dermis. Immunohistochemical staining showed positive HHV-8 nuclear staining of spindle cells. The histological features and positive HHV-8 immunohistochemical stain were consistent with the diagnosis of early patch stage of AIDS-related KS. KS can readily be misdiagnosed in early patch stage even by experienced clinicians, which leads to requirement of pathologic determination. On close inspection, it can be distinguished from other mimickers by its distinctive histologic features and immunohistochemical staining for HHV-8. Therefore, in cases of HIV-positive patients with clinically or histologically vascular-appearing mucocutaneous lesions, KS should be considered as a possible differential diagnosis.

A Case of Elastosis Perforans Serpiginosa in a Patient with Down Syndrome / 대한피부과학회지

Elastosis perforans serpiginosa (EPS) is a rare condition that belongs to the group of acquired perforating dermatosis. It usually appears as keratotic papules in serpiginous configuration with central atrophy on the head, nape, and extremities. It is characterized by the transepidermal elimination of elastic fibers with clumping and vertical orientation of elastic fibers. In many cases, it is associated with genetic or connective tissue diseases. A 26-year-old female patient with Down syndrome presented with brownish keratotic papules on both arms. The lesion had been present for 2 years, but there were no symptoms. The biopsy specimen showed transepidermal elimination of the degenerated elastic fibers. Verhoeff elastic staining revealed an increased number of thick elastic fibers. Based on these findings, the patient was diagnosed with EPS. Treatment with CO 2 laser was performed with a successful outcome.

Searching for Hidden, Painful Osteochondral Lesions of the Ankle in Patients with Chronic Lower Limb Pain: Two Case Reports

It is easy to overlook osteochondral lesions (OCLs) of the ankle in patients with chronic lower limb pain, such as complex regional pain syndrome (CRPS) or thromboangiitis obliterans (TAO, Buerger's disease). A 57-year-old woman diagnosed with type 1 CRPS, and a 58-year-old man, diagnosed with TAO, complained of tactile and cold allodynia in their lower legs. After neurolytic lumbar sympathethic ganglion block and titration of medications for neuropathic pain, each subject could walk without the aid of crutches. However, they both complained of constant pain on the left ankle during walking. Focal tenderness was noted; subsequent imaging studies revealed OCLs of her talus and his distal tibia, respectively. Immediately after percutaneous osteoplasties, the patients could walk without ankle pain. It is important to consider the presence of a hidden OCL in chronic pain patients that develop weight-bearing pain and complain of localized tenderness on the ankle.

Percutaneous vertebroplasty at C7 for the treatment of painful metastases: A case report / 대한마취과학회지

The cervical spine is a less common site for metastatic disease than is the thoracolumbar spine. Percutaneous vertebroplasty (PVP) in the cervical spine can be performed using an anteromedial or lateral approach. A 51-year-old woman with breast cancer had been experiencing severe weight-bearing neck pain for 2 months, even after undergoing radiation therapy. Imaging studies revealed an osteolytic compression fracture in the C7 vertebra. For performing PVP at C7 using the anteromedial approach, a needle was inserted from the left side of the patient's neck. The needle was advanced to the anterior 1/3 anterior 1/3 or 1/2 of the vertebral body by hammering, and approximately 2 ml of cement was injected. Immediately after the operation, the patient could move her neck without pain. In conclusion, PVP using an anterolateral approach may be an option for treating metastatic osteolytic vertebral lesions in the cervical spine for alleviating intractable axial neck pain.

Learning Curve and Clinicopathologic Analysis in Transperitoneal Laparoscopic Adrenalectomy; Performed by a Single Young Surgeon with No Experience of Open Adrenalectomy / 대한내분비외과학회지

PURPOSE: Adrenalectomy is a very rare operation and its associated learning curve has not yet been studied. The objective of this study was to determine whether the operation time decreases with experience and to evaluate the safety and feasibility of laparoscopic adrenalectomy performed by a surgeon who is new to laparoscopic and open-surgical adrenalectomy. METHODS: This study is a retrospective analysis of laparoscopic adrenalectomies performed between April 2007 and September 2012. All surgeries were performed by a single young surgeon who had no experience in performance of open or laparoscopic adrenalectomy. All surgeries were performed using the transperitoneal approach. RESULTS: In total, 42 cases were included. The average tumor size was 4.7 cm. The mean operating time was 125 min. Mean duration of hospital stay was 8.7 days. None of the cases showed conversion to open surgery or perioperative mortality. The operator achieved mastery after performance of left laparoscopic adrenalectomy in 12 cases and right laparoscopic adrenalectomy in 11 cases. CONCLUSIONS: A new surgeon can perform laparoscopic transperitoneal adrenalectomy successfully, independently, and safely after having performed the surgery in 12 cases.

Prenatal diagnosis of large subamniotic cyst compressing the umbilical cord on umbilicoplacental junction : A case report / 대한산부인과학회지

Placenta surface cyst classified subamniotic hematoma, subchorionic hematoma and subchorionic cyst by histological finding. These cysts did not affect the obstetrical outcome according to the previous report. However, we experienced that the subamniotic cyst compressed the umbilical cord to result in fetal deceleration. We report this case with brief review of literature.

Isolated torsion of the hydrosalpinx after hysterectomy: A case report / 대한산부인과학회지

Isolated tubal torsion is a rare disease that causes acute lower abdominal pain. In most of cases, the ovary and the fallopian tube are together twisted due to an ovarian tumor, but the fallopian tube alone is rarely twisted. Tubal torsion mainly occurs in fertile women, and it rarely occurs prior to menarche and during menopause. We experienced a case where isolated tubal torsion occurred in a perimenopausal female with total abdominal hysterectomy, while the findings showed a normal ovary. We report this case with a brief review of related literature.

Third trimester listeriosis in twin pregnant woman with multiple organ dysfunction syndrome and combined endocarditis: A case report / 대한산부인과학회지

Human listeriosis is a relatively rare but serious disease with mortality rate 20~40%. Listeria monocytogenes affects patients with decreased cell mediated immunity such as the elderly, transplant recipients, cancer patients, renal failure, diabetes, HIV, pregnant women and unborn child, neonate. We experienced a case of listeriosis in twin pregnant woman at 35th weeks without preterm labor. The pregnant woman present sepsis with fever at first time. Sepsis progress to MODS (multiple organ dysfunction syndrome) and combined endocarditis. We reported it with brief of literatures.

Expression of leptin receptors and the antiapoptotic effect of leptin on epithelial ovarian cancer cell lines / 대한산부인과학회지

OBJECTIVE: The potential role of leptin as an endocrine regulator is unknown in ovarian cancer. In the present study, we investigated the expression of letpin receptors in IOSE (Immortalized ovarian surface epithelium) and ovarian cancer cell lines, and potential role of leptin on the cell growth and taxol induced apoptosis. METHODS: To check the presence of leptin receptors in 4 human epithelial ovarian cancer cell lines (SK-OV-3, R182, A2780 and CP70), RT-PCR was done. In the RT-PCR, 2 primers were used; primers for short form of leptin receptor and for long form of leptin receptor. Cancer cell lines were treated with leptin and the cell viability was measured using the cellTiter 96 Aqueous One Solution Cell Proliferation Assay Kit. The antiapoptotic effect of leptin against taxol induced apoptosis on ovarian cancer cell lines was evaluated by checking caspase 3/7 activity. RESULTS: Leptin receptors on ovarian cancer cell lines were expressed differentially according to the type of isoform. There was long form leptin receptor on CP70, but no short form receptor. All other cell line showed both short and long form receptors. Leptin increased cell viability in all cell lines in a dose-dependent manner and reduced the number of apoptotic cells in A2780. CONCLUSIONS: There were leptin receptors in IOSE and some ovarian cancer cell lines. Chronic increase in leptin concentration may enhance the growth of ovarian cancers. In part, the increased cell growth after leptin treatment seemed to be due to the antiapoptotic effect of leptin.

Leptin-signal transduction pathways and relationship with cancer development / 부인종양

Leptin is a versatile 16 kDa peptide hormone, with tertiary structure resembling that of members of the long-chain helical cytokine family. It is mainly produced by adipocytes in proportion to fat size stores, and was originally thought to act only as a satiety factor. However, the ubiquitous distribution of leptin receptors in almost all tissues underlies the pleiotropism of leptin. This review will focus on the link between leptin, a cytokine that is elevated in obese individuals, and cancer development through clarifying the intracellular signaling pathways of leptin. First, I discuss the biological functions of leptin and its signaling pathways. Then, I summarize the effects of leptin on different cancer types in experimental cellular and animal models. Next, I analyze the relationship between obesity and the presence of cancer or cancer risk in patients. Finally, leptin as a target for cancer treatment in the future and prevention will be discussed.

Small Bowel Herniation Through a 5 mm Trocar Site: A Case Report / 대한산부인과학회지

Incisional hernias occur in or =10 mm. Bowel herniation through 5 mm trocar site is more uncommon than that of 10 mm trocar site. So we present a case of small bowel herniation through a 5mm trocar site with a brief review of literature.

Parovarian cyst torsion at pregnancy 29+4 wks / 대한산부인과학회지

Adnexal torsion in the third trimester is very rare. Because of changes in uterine size and anatomical position of abdominal organs, the diagnosis of adnexal torsion during pregnancy is difficult to establish on the basis of symptoms, physical findings, or radiologic technique. Delayed diagnosis and management can lead to serious complications, so a rapid, reliable, and accurate imaging is needed to evaluate pregnant women with acute abdomen. Ultrasonography has been the initial imaging modality of choice in evaluation of obstetric patient, but it is technically difficult in the third trimester. MR imaging can provide a broad evaluation of the pelvic organs and enables diagnosis of many causes of acute abdomen, especially in the third trimester. We have experienced a case of Parovarian cyst torsion at pregnancy 29+4 wks and reviewed it briefly.

Placenta Increta Presenting as Postabortal Uterine Mass in the First Trimester: A Case Report / 대한산부인과학회지

Placenta increta is rare, but life-threatening complication of pregnancy characterized by invasion of placenta villi into the underlying myometrium. Placenta increta is usually diagnosed in the third trimester and is associated with significant blood loss and uterine perforation or rupture as well as an increased risk of infection. It also has been described as a complication of selective pregnancy termination and spontaneous pregnancy loss in the second trimester and rarely in the first trimester. We report a case of placenta increta which was presented as uterine mass after dilatation and curettage (D and C) due to missed abortion in the first trimester.

Effects of the Specific COX-2 Inhibitor, Celecoxib, on Paclitaxel-Induced Apoptosis in SK-OV-3 Epithelial Ovarian Cancer Cell Line / 대한산부인과학회지

OBJECTIVE: In vitro studies have revealed that treatment of various human cancer cell lines with specific cyclooxygenase 2 (COX-2) inhibitors induces apoptotic cell death. The goal of this article is to investigate the benefits of combining COX-2 inhibitors with existing treatment modalities in the management of ovarian cancer. METHODS: In this study we sought to determine the effects of combining paclitaxel and the COX-2 inhibitor celecoxib on apoptosis of epithelial ovarian cancer (EOC) cells. SK-OV-3 cells were exposed to increasing concentrations of paclitaxel (10(-7) M, 10(-6) M and 10(-5) M) and celecoxib (10(-8) M, 10(-7) M, 10(-6) M, 10(-5) M and 10(-4) M) as well as a combination of both drugs. The activity of apoptosis was evaluated by the morphologic examination and the MTT assay. The pattern of apoptosis was also assessed by the caspase-3 activity and the fraction of cleaved PARP (poly ADP-ribose polymerase) protein. RESULTS: Single application of both drugs could significantly increase the rate of apoptosis after 24 hours of continuous exposure. But concomitant treatment of SK-OV-3 EOC cell line with paclitaxel and celecoxib resulted in marked impairment of paclitaxel-induced apoptosis. The pattern of apoptosis induced by paclitaxel on SK-OV-3 EOC cell line was caspase-3 independent. CONCLUSION: Combining COX-2 inhibitors and paclitaxel does not have an additive or synergistic tumoricidal effect. On the contrary, celecoxib treatment markedly inhibited the apoptotic effects of paclitaxel in SK-OV-3 EOC cell line.

In Vitro Responses of SK-OV-3 Ovarian Cancer Cell Lines to Tamoxifen and Celecoxib / 대한산부인과학회지

OBJECTIVE: There are some evidences that some epithelial ovarian cancer cells respond to hormonal therapy. And in vitro studies have revealed that treatment of various human cancer cell lines with selective cyclooxygenase 2 (COX-2) inhibitors induces apoptotic cell death. The goal of this article is to evaluate the effects of tamoxifen and celecoxib, a selective COX-2 inhibitor, on the ovarian cancer cells and the benefits of combining these agents in the management of ovarian cancer. METHODS: SK-OV-3 epithelial ovarian cancer cells were exposed to increasing concentration of tamoxifen (10(-8) M, 10(-7) M, 10(-6) M, 10(-5) M and 10(-4) M) and celecoxib (10(-8) M, 10(-7) M, 10(-6) M, 10(-5) M and 10(-4) M) as well as a combination of both drugs. The activity of apoptosis was evaluated by the morphologic examination and the MTT assay. The pattern of apoptosis was also assessed by the caspase-3 activity and the fraction of cleaved PARP (poly ADP-ribose polymerase) protein. RESULTS: Single application of both drugs could significantly increase the rate of apoptosis after 24 h of continuous exposure. Concomitant treatment of SK-OV-3 cells with tamoxifen and celecoxib induced significant increase in apoptosis, comparing with single drug exposure. The pattern of apoptosis induced by these agents on SK-OV-3 cells seemed to be caspase-3 dependent. CONCLUSION: Our data suggest that combining tamoxifen with selective COX-2 inhibitor seems to have at least an additive tumoricidal effect. A more definitive role for this combination therapy in clinical settings in ovarian cancer will need to be defined through the conduct of clinical trials.

Extremely elevated CA 125 due to an unruptured large endometrioma: A Case Report / 대한산부인과학회지

CA 125 is a high molecular weight glycoprotein expressed in the cell surface of some derivatives of embryonic coelomic epithelium. It presents in over 80% of non-mucinous epithelial ovarian carcinomas and it also occurs in the serum of healthy males and females at low concentrations (1,000 IU/mL) and after excision of the ovarian tumor, the CA 125 levels returned to normal. Our case further emphasizes the association of high levels of CA 125 with benign gynecologic conditions and we discussed the possible explanations for this abnormal elevation of CA 125 levels.