Effect of epidural polydeoxyribonucleotide in a rat model of lumbar foraminal stenosis

Background@#We aimed to investigate the effect of epidural polydeoxyribonucleotide (PDRN) on mechanical allodynia and motor dysfunction in a rat model of lumbar foraminal stenosis (LFS). @*Methods@#This study was conducted in two stages, using male Sprague-Dawley rats. The rats were randomly divided into eight groups. In the first stage, the groups were as follows: vehicle (V), sham (S), and epidural PDRN at 5 (P5), 8 (P8), and 10 (P10) mg/kg; and in the second stage, they were as follows: intraperitoneal PDRN 8 mg/kg, epidural 3,7-dimethyl-1-propargilxanthine (DMPX) (0.1 mg/kg), and DMPX (0.1 mg/kg). The LFS model was established, except for the S group. After an epidural injection of the test solutions, von Frey and treadmill tests were conducted for 3 weeks. Subsequently, histopathologic examinations were conducted in the V, S, P5, and P10 groups. @*Results@#A total of 65 rats were included. The P8 and P10 groups showed significant recovery from mechanical allodynia and motor dysfunction at all time points after drug administration compared to the V group. These effects were abolished by concomitant administration of DMPX. On histopathological examination, no epineurial inflammation or fibrosis was observed in the epidural PDRN groups. @*Conclusions@#Epidural injection of PDRN significantly improves mechanical allodynia and motor dysfunction in a rat model of LFS, which is mediated by the spinal adenosine A2A receptor. The present data support the need for further research to determine the role of epidural PDRN in spinal stenosis treatment.

Effect of epidural polydeoxyribonucleotide in a rat model of lumbar foraminal stenosis

Background@#We aimed to investigate the effect of epidural polydeoxyribonucleotide (PDRN) on mechanical allodynia and motor dysfunction in a rat model of lumbar foraminal stenosis (LFS). @*Methods@#This study was conducted in two stages, using male Sprague-Dawley rats. The rats were randomly divided into eight groups. In the first stage, the groups were as follows: vehicle (V), sham (S), and epidural PDRN at 5 (P5), 8 (P8), and 10 (P10) mg/kg; and in the second stage, they were as follows: intraperitoneal PDRN 8 mg/kg, epidural 3,7-dimethyl-1-propargilxanthine (DMPX) (0.1 mg/kg), and DMPX (0.1 mg/kg). The LFS model was established, except for the S group. After an epidural injection of the test solutions, von Frey and treadmill tests were conducted for 3 weeks. Subsequently, histopathologic examinations were conducted in the V, S, P5, and P10 groups. @*Results@#A total of 65 rats were included. The P8 and P10 groups showed significant recovery from mechanical allodynia and motor dysfunction at all time points after drug administration compared to the V group. These effects were abolished by concomitant administration of DMPX. On histopathological examination, no epineurial inflammation or fibrosis was observed in the epidural PDRN groups. @*Conclusions@#Epidural injection of PDRN significantly improves mechanical allodynia and motor dysfunction in a rat model of LFS, which is mediated by the spinal adenosine A2A receptor. The present data support the need for further research to determine the role of epidural PDRN in spinal stenosis treatment.

Subacute progressive disseminated histoplasmosis in immunocompetent patient

No abstract available.

Therapeutic Effect of Epidurally Administered Lipo-Prostaglandin E1 Agonist in a Rat Spinal Stenosis Model

BACKGROUND: A lipo-prostaglandin E1 agonist is effective for the treatment of neurological symptoms of spinal stenosis when administered by an oral or intravenous route. we would like to reveal the therapeutic effect of an epidural injection of lipo-prostaglandin E1 on hyperalgesia in foraminal stenosis. METHODS: A total of 40 male Sprague-Dawley rats were included. A small stainless steel rod was inserted into the L5/L6 intervertebral foramen to produce intervertebral foraminal stenosis and chronic compression of the dorsal root ganglia (DRG). The rats were divided into three groups: epidural PGE1 (EP) (n = 15), saline (n = 15), and control (n = 10). In the EP group, 0.15 microg.kg-1 of a lipo-PGE1 agonist was injected daily via an epidural catheter for 10 days from postoperative day 3. In the saline group, saline was injected. Behavioral tests for mechanical hyperalgesia were performed for 3 weeks. Then, the target DRG was analyzed for the degree of chromatolysis, chronic inflammation, and fibrosis in light microscopic images. RESULTS: From the fifth day after lipo-PGE1 agonist injection, the EP group showed significant recovery from mechanical hyperalgesia, which was maintained for 3 weeks (P < 0.05). Microscopic analysis showed much less chromatolysis in the EP group than in the saline or control groups. CONCLUSIONS: An epidurally administered lipo-PGE1 agonist relieved neuropathic pain, such as mechanical hyperalgesia, in a rat foraminal stenosis model, with decreasing chromatolysis in target DRG. We suggest that epidurally administered lipo-PGE1 may be a useful therapeutic candidate for patients with spinal stenosis.

Comparative Analysis of the Clinicopathological Characteristics of Patients with Prostate Cancer with a Pathological Gleason Score 3+4 versus Gleason Score 4+3 / 대한비뇨기과학회지

PURPOSE: Gleason score(GS) 7 tumors contain patterns 3 and 4 in various proportions. The clinical and pathological characteristics of patients with GS 3+4 and GS 4+3 found during a radical prostatectomy(RP) were retrospectively evaluated. MATERIALS AND METHODS: 124 cases of GS 7 prostate cancer were identified between April 2004 and February 2006. None of these patients had received either preoperative hormonal therapy, including 5alpha-reductase inhibitors, or radiation therapy. After classifying patients with GS 7 tumors into those with GS 4+3 and GS 3+4 tumors, the two groups were compared according to various clinicopathological parameters. RESULTS: In total, 84(67.7%) and 40(32.3%) of patients had final GS of 3+4 and 4+3, respectively. A final GS of 4+3 was associated with a higher pre-biopsy level of prostate-specific antigen(p<0.001) and a higher biopsy Gleason sum(p<0.001). Also, a higher pathological T stage(p=0.005), tertiary Gleason pattern 5(p<0.001), seminal vesicle invasion(p=0.008), bladder neck invasion(p=0.002), angiolymphatic invasion(p=0.008), perineural invasion(p=0.045), positive surgical margins(p=0.038) and larger tumor volumes(p<0.001) were associated with GS of 4+3. CONCLUSIONS: Our results demonstrated that the statistically significant differences exist between GS 3+4 and 4+3 prostate cancers. Thus, GS 7 prostate cancers may be considered heterogeneous in their biological behaviors, and GS 7 prostate cancers with a GS of 4+3 may be considered more aggressive tumors compared to those with a GS of 3+4.

Neuroprotective Effect of Cyclosporin A on Spinal Cord Ischemic Injury in Rabbits / 대한흉부외과학회지

BACKGROUND: The purpose of this study is to ascertain the neuroprotective effect of cyclosporin A on the 25-min surgical ischemia model in the spinal cords of rabbits with neuropathological correlation and histoimmunochemical analyses. MATERIAL AND METHOD: Thirty-two New Zealand white rabbits were randomly divided into four groups: Rabbits were randomly divided into four groups: the control I2 group (n=8), the control I7 group (n=8), the cyclosporin Cs2 group (n=8), and the cyclosporin Cs7 group (n=8). The I2 group underwent a 25-min aortic cross- clamp without intervention and were sacrificed on the 2nd day postoperatively, while the I7 group underwent a 25- min of aortic cross-clamp without intervention and were sacrificed on the 7th day postoperatively. The Cs2 group received cyclosporin A (25 mg/kg) intravenously 15 min after the 25-min cross-clamp and were sacrificed on the 2nd day postoperatively, while the Cs7 group received cyclosporin A (25 mg/kg) intravenously 15 min after the 25- min cross-clamp and were sacrificed on the 7th day postoperatively. The rabbits underwent 25-min surgical aortic cross-clamp. Neurologic functions were evaluated on the 2nd day and 7th postoperative day using Tarlov scoring system. After scoring neurologic function, all rabbits were sacrificed for histopathologic observation. RESULT: All rabbits survived the experimental procedure. The values of Tarlov score did not show any differences between the control and cyclosporin groups on the 2nd day. The scores of group Cs7 (2.75+/-0.89) were significantly higher than those of group I7 (1.25+/-1.39) on the 7th day (p<0.05). On the histologic exanminations, specimens of the spinal cord showed necrosis and apoptosis. The pathologic scores of group Cs7 (1.0+/-0.53) was less than those of group I7 (2.13+/-1.36, p<0.05). TUNEL staing showed apoptosis of the specimen in group I2 and Cs2 but there was no stastically significant difference between groups on the score. There were more overexpression of HSP70 and nNOS in cyclosporine group than in control group. CONCLUSION: We think that cyclosporin A may decrease neuronal cell death with induced upregulation of HSP70 against 25-min ischemia of the spinal cord in the rabbit.

Effect of Surgery in Pediatric Neuroblastoma with Spinal Involvement

OBJECTIVE: Neuroblastoma is a very common pediatric malignant tumor and sometimes involves the spinal cord to result in neurological deficits. The authors perform a retrospective analysis of the 12 cases of pediatric neuroblastoma with spinal involvement to assess the characteristics and surgical outcome. METHODS: We retrospectively reviewed the 12 cases of pediatric neuroblastoma with spinal involvement which underwent surgery from 1988 to 2002 in our hospital. All the cases were confirmed by pathologic diagnosis and reviewed about initial presentation, the location of tumor, treatment, outcome and complication. RESULTS: The ratio of male to female was 1: 2 and mean age was 3.5 years(0.3-13.6). The chief complaint was motor weakness in 7 cases, mass in 2, urinary incontinence in one and 2 cases were asymptomatic. The tumor involved thoracic level in 5 cases, thoracolumbar level in 3, cervicothoracic level in 2, cervical and lumbar levels in one case each. All the cases underwent surgery, four had chemotherapy and four had both chemotherapy and radiotherapy. After 33.9 months of mean follow up, in all of the 4 cases whose intraspinal tumor was gross-totally resected, neurological status improved. Of the 4 cases with subtotal resection, all except one showed progression or no neurologic improvement. Postoperative spinal deformity has developed in 5 cases. Three cases expired because of chemotherapy complication and tumor progression. CONCLUSION: Active surgery about the spinal involvement of pediatric neuroblastoma shows neurological improvement regardless of the survival. It seems to be helpful to the quality of life in pediatric patients.

Molecular Subtypes of Primary Glioblastoma Identified by Gene Expression Profiling

BACKGROUND: The over-expression of the epidermal growth factor receptor (EGFR) occurs in nearly 50% of primary glioblastoma multiforme (GBM). Disruption of multiple signaling pathways is a critical factor in regulating the biological and clinical behavior of GBMs. In the future, therapy that specifically targets these disrupted pathways may represent the best potential treatment for patients with GBM. Large scale gene expression profiling provides a powerful approach to identify these disrupted genetic pathways and to uncover previously unknown molecular subtypes. METHODS: We used 13 cases of primary GBM biopsy samples obtained from untreated patients and Affymetrix high-density oligonucleotide arrays to identify novel subsets of primary GBMs. RESULTS: We showed that the expression of 90 genes differentiate EGFR+ from EGFR non-expressing (EGFR-) de novo GBMs, including expression of a number of potentially targetable molecules that act as growth/survival factors for GBMs. We also demonstrated the presence of two additional molecular subtypes of primary GBMs, including one characterized by the coordinate upregulation of contiguous genes on chromosome 12q13-15, which has a distinct global gene expression profile and expresses both astrocytic and oligodendroglial genes. CONCLUSION: We have shown that there are EGFR+ primary GBMs, GBMs with coordinate upregulation of genes on chromosome 12q13-15, and primary GBMs lacking either alteration. Moreover, they have distinct transcriptional profiles. Our findings strongly suggest that the three GBMs are biologically different tumor types, despite their identical microscopic appearance, and provide an important first step in developing a molecular taxonomy of GBMs.

Hypoechoic Rim of Chronically Inflamed Prostate, as Seen at TRUS: Histopathologic Findings

OBJECTIVE: The purpose of this study is to correlate the findings of peripheral hypoechoic rim, seen at transrectal ultrasonography (TRUS) in chronic prostatitis patients, with the histopthologic findings. MATERIALS AND METHODS: Seven patients with pathologically proven chronic prostatitis were involved in this study. The conspicuity of the peripheral hypoechoic prostatic rim, seen at TRUS, was prominent and subtle, and to determine its histopathologic nature, the microscopic findings were reviewed. RESULTS: In five of seven cases (71%), TRUS demonstrated a prominent peripheral hypoechoic rim. Microscopic examination revealed that inflammatory cell infiltration of prostatic glandular tissue was severe in three cases (42.9%), moderate in two (28.6%), and minimal in two (28.6%). In all seven cases, the common histopathologic findings of peripheral hypoechoic rim on TRUS were loose stromal tissues, few prostatic glands, and sparse infiltration by inflammatory cells. CONCLUSION: The peripheral hypoechoic rim accompanying prostatic inflammation and revealed by TRUS reflects a sparsity of prostate glandular tissue and is thought to be an area in which inflammatory cell infiltration is minimal.

Two Cases of Intraventricular Arachnoid Cysts: Case Report

Intraventricular arachnoid cyst has been rarely reported. Here we present two cases of symptomatic intraventricular arachnoid cysts in the fourth ventricle and right lateral ventricle. The first patient was a 38-year-old female who complained of headache and left facial hypesthesia. Computed tomography and MR scan revealed large cystic lesion in the fourth ventricle. After cyst wall removal, facial hypesthesia disappeared immediately and headache improved slowly. The second patient was a 9-year-old girl who complained of headache, vomiting and paresthesia in her right low extremity. Cystic lesion in the right lateral ventricle was detected in the CT and MR scan. The symptoms improved after cyst wall removal. Surgical findings of these two cases showed that the cyst walls were attached firmly to the choroid plexus. Symptomatic intraventricular arachnoid cyst must be treated appropriately and we recommend complete cyst wall removal.

Epidural Baclofen in the Rabbit: Antinociceptive Effect and Neurotoxicity / 대한마취과학회지

BACKGROUND: Intrathecal baclofen has an analgesic effect. However, the analgesic effect and neurotoxicity of epidural baclofen has not been reported. METHODS: Twenty rabbits, weighing 2.5-3.0 kg, were randomly assigned to three groups; five rabbits receiving 0.9% saline (S), five rabbits receiving 0.1 mg morphine (M), ten rabbits receiving 0.5% baclofen (B). An epidural catheter was inserted at the L(6-7) interspace, and 0.6 ml of saline, morphine or baclofen was injected. Motor and sensory deficits were measured. After two weeks, a spinal cord segment 3 cm on each side of the catheter tip was removed for histological examination. RESULTS: In the M and B groups, no rabbits showed any response of the hindlimbs to the pinch toe test. On light microscopy findings, no inflammation of the meninges or degenerative myelopathy was observed in the S or M groups. In the B group, one rabbit showed local myelopathy of the white matter, and degenerative myelopathy of white and grey matter in the area adjacent to the epidural catheter. However, these changes are focal and minimal, and thought to be ischemic changes due to vascular damage caused by catheterization. Electron microscopy findings showed no morphologic difference between the S and B groups. CONCLUSIONS: Epidural 0.5% baclofen produced antinociceptive effect with slight motor weakness. No definite neurotoxicity was observed after a single epidural injection of 0.5% baclofen in the rabbit.

Cerebral Amyloid Angiopathy: A report of two cases

Cerebral amyloid angiopathy (C.A.A) is characterized by the extracellular amyloid protein deposition in the vessel walls of the brain and meninges. It has been estimated to account for 5 to 10% of all primary, nontraumatic brain hemorrhage. We report two cases of C.A.A causing nontraumatic intracerebral hemorrhage in the frontal lobe. The first case was a 60-year-old female who was admitted for the left hemiplegia and dysarthralgia. Brain CT revealed right frontal lobe hemorrhage. The second case was a 72-year-old male who was admitted for amnesia and gait disturbance. Clinical impression was Alzheimer's disease. Brain MRI revealed multifocal small hemorrhage in the right frontal lobe. Microscopically, both cases showed dilated small arteries of superficial cortex and meninges with hyalinization. Some vessels showed microaneurysm and fibriniod necrosis. Congo-red stain also exhibited birefringence under polarized light. There was no evidence of Alzheimer's disease.

Correlation of changes in natural killer cell activity and glutathione S-transferase placental form positive hepatocytes in diethylnitrosamine-induced rat hepatocarcinogenesis

To evaluate the induction of preneoplastic hepatic foci in relation to natural killer cell (NK) activity, we sequentially analyzed glutathione S-transferase placental form positive (GST-P+) hepatocytes and NK activity during diethylnitrosamine (DEN) and phenobarbital (PB)-induced hepatocarcinogenesis in Sprague-Dawley rats. Previous studies have shown that NK activity can modulate the carcinogenic process induced by chemical carcinogens. Newborn females were initially given a single intraperitoneal injection of 15 mg DEN/kg and three weeks later, they were treated with 500 ppm phenobarbital (PB). From week 3, PB was administered in drinking water for 9 weeks. Interim and terminal sacrifices were performed at weeks 12, 15 and 30. GST-P+ hepatocytes increased with age in DEN-treated rats, especially in the population of more than two GST-P+ hepatocytes. The NK activity of DEN-treated rats did not significantly differ from that of control rats until week 12, but it progressively decreased from week 15 to 30. These results indicate that changes of NK activity inversely correlated with the induction of preneoplastic hepatic foci. This strong correlation of decreased NK activity with enhanced induction of GST-P+ foci suggests that NK activity is important in the early progression of hepatocarcinogenesis in rats.

Changes of Incompletely Embolized Aneurysm with Tungsten Coils: An Experimental Study in Dogs

PURPOSE: To evaluate changes of residual aneurysms according to the size of aneurysmal neck andthrombogenicity of a tungsten coil after incomplete embolization of experimental lateral aneurysms. MATERIALS AND METHODS: Eleven experimental lateral aneurysms with different aneurysmal neck size were created in the commoncarotid arteries of mongrel dogs. They were then divided into narrow-neck(n=3), wide-neck(n=6) and spontaneouslythrombosed control(n=2) groups. After confirmation of aneurysmal patency, incomplete embolizations of varyingdegrees (about 30% to near total occlusion) were performed using 5mm-diameter tungsten coils. Angiography wasperformed immediately before and after, and one and six weeks after embolizations. The size of residual aneurysmwas measured on each angiogram. After the last angiography, embolized aneurysms were excised and examined underlight and electron microscopes. RESULTS: On angiograms obtained 6 weeks after embolization, all residual narrowneck aneurysms were completely occluded, whereas in those with a wide-neck, therre was either no change (n=4) or aslight increase in size(n=2). On light microscopy, all narrow-neck aneurysms showed total organized fibrosis whileall control aneurysms and half those with a wide neck showed unorganized thrombi. The embolized group showed ahigher degree of organization in the aneurysmal cavity than did the control group. Neointima formation was seen inall embolized aneurysms, but no aneurysm showed foreign body reaction. On electron microscopy, uniform thicknessof plasma coatings was noted on the surface of the tungsten coils. CONCLUSION: A wide-neck residual aneurysm maypersist or increase in size, while one with a narrow-neck can be thrombosed after incomplete embolization withtungsten coils in a lateral aneurym. Careful consideration might be necessary in the embolization of wide-neckaneurysms. With plasma coatings on its surface and organized fibrosis, tungsten coil can be an useful forembolization of an aneurysm.

Neurenteric Cyst of the Posterior Cranial Fossa: Case Report

Neurenteric cyst(enterogenous cyst) is a rare congenital lesion, usually affecting the lower cervical or upper thoracic areas, and its occurrence in cranial vault is even rarer. We present a patient with intracranial neurenteric cyst anterior to the pons and medulla oblongata. A 40-year old man presented with two-month history of occipital headache and facial spasm. The cyst was decompressed via far lateral suboccipital approach, and the patient recovered without permanent neurological deficits. Features on imaging studies and histological findings are discussed with the review of the literatures.

The Current Practice of the Autopsy Services and the Autopsy Records at the Seoul National University Hospital

This study outlines the current status of the autopsy practice and the medical records for autopsies at the Department of Pathology, Seoul National University Hospital. Total number of autopsy cases from 1954 to 1995 was 3,131. Adults aged over 17 were 371 cases and children were 2,515 cases. The demographic data in 245 cases was not available. The number of adult autopsies and its proportion among total number of autopsies during 10-year periods decreased from 144 cases (40%) during the 10-year-period from 1956 to 52 cases (3%) during the 10-year-period from 1986. The number of children cases during the same period groups increased slightly from 210 cases (58%) to 393 cases (25%). But the number of fetal cases increased rapidly from 7 cases (2%) to 1,146 cases (72%). Among fetal autopsies the proportion of fetuses died earlier than 24 weeks of gestation increased and this figure exceeds that of fetuses that died later than 24 weeks of gestation from 1992. Forty percent of the cases were submitted from the clinical departments of the Seoul National University Hospital but the remainders were referred from 73 hospitals. Final autopsy diagnoses were analysed according to the Korean Standard Classification of Disease (KCD)-3 coding system and by searching key words for all cases. Common diagnoses as coded among cases from 1990 were P9, P0, P2, Q2 and Q0. Common diseases by key words for adult cases were liver disease, tuberculosis and pneumonia. Common diseases for children cases were pneumonia, hyaline membrane disease, meningitis and tuberculosis. Through this study we could show the importance of autopsy services for fetuses. We could also establish a regular registration system for autopsies at general hospitals.

Diffusion- and T2-Weighted MR Imaging of Lipiodol Induced Cerebral Infarcts in Cat: Early Findings in the Findings in the First 3 Hours

PURPOSE: This study was designed to evaluate early parenchymal changes of acute cerebral ischemia / infarct by using T2-weighted, diffusion-weighted, and calculated apparent diffusion coefficient (ADC) MR imaging. MATERIALS AND METHODS: The brain MR images were successfully obtained 30, 60, 90, 120, 150 and 180 minutes after intraarterial administration of Lipiodol (0.4 - 0.6 ml) into the common carotid artery in 10 of 11 cats (91%). T2-and diffusion-weighted images and ADC were analyzed and compared with histopathologic findings. RESULTS: High signal intensity on T2-weighted and diffusion-weighted images was found in one cerebral hemisphere 30 minutes after Lipiodol injection, which tended to increase with time until 3 hours. Subcortical white matter showed higher signal intensity than cortical gray matter since 30 minutes after embolization. ADC images showed decreased signal intensity in the embolized hemisphere, which tended to decrease until 3 hours. Microscopic findings of the area corresponding to the abnormal signal intensity on MR images revealed varying degrees of edema in the gray and white matters involved. CONCLUSION: It is suggested that Lipiodol can be used as a good embolic agent causing early ischemic changes in experimental models. In addition to T2-weighted images, diffusion-weighted and ADC images can provide the further informations in the evaluation of the early parenchymal changes of cerebral infarct.

Esophagus, Stomach & Intestine; Fundic Gland Polyps: A Clinical and Pathologic Analysis with Special Reference to Familial Adenomatous Polyposis / 대한소화기내시경학회지

BACKGROUND/AIMS: The aims of this study are to clarify the morphology of fundic gland polyp (FGP) and to compare the features of FGP between familial adenomatous polyposis-associated group and sporadic development group. METHODS: A total of 15 endo- scopic biopsy specimens of FGP from 13 patients were divided into three groups; Group A(3 cases; familial adenomatous polyposis family, multiple FGPs), Group B(3 cases; sporadic development, multiple FGPs) and Group C(7 cases; sporadic development, single FGP), and their endoseopic /microscopic features including mucin histochemistry and immunohistoc- hemistty(for PCNA) were compared. RESULTS: FGPs were confined to the gastric body and fundus in all 3 groups, and measured 2-8 mm. Their numbers varied even in Group A and Group B, The difference was observed in their median age: 26 years in Group A and 55 years in Group B, respectively, but there were no differences in endoscopic, histologic, mucin histochemical and immunohistochemical(for PCNA) features. Micro-scopically, all FGPs were composed of fundic glands and scattered microcysts with a spectrum of disordered glandular architecture which ranged from convoluted gland to Y-shaped gland, to stellateshaped gland, and to irregular tortuous glancl with dilated lumen. CONCLUSIONS: We assume that diversity af morphologic features of FGP may develop from progression of hyperplastic/hamartomatous fundic glandular proliferation which may end up with microcyst formation as an evolutional change. Familial adenomatous polyosis-associated FGPs were not endoscopically and histologically distingishable from sporadic deveoped FGPs.

A Case of Lymphocytic Infundibuloneurohypohysitis / 대한내과학회지

Lymphocytic infundibuloneurohypphysitis(LINH) is a newly classified disorder and proposed as a common cause of idiopathic central diabetes insipidus. It is characterized by thickening of the infundibulum and/or pituitary stalk and absence of high signal in the neurohypophysis in sellar MRI and the microscopic findings of diffuse lymphocytic infiltration within the neurohypophysis. A 12year-old boy presented polyuria and headache. The result of water deprivation test was compatible with central diabetes insipidus. Brain MRI showed thickening of the pituitary stalk and loss of high signal in the neurohypophysis. Craniotomy and excisional bi6opsy was done under the impression of pituitary tumor. Microscopically, neurohypophysis showed dense lymphocytic infiltration and no malignant cells. Six months after the operation, the previously thickened pituitary stalk and neurohypophysis appeared normal in follow-up MRI.

Clinicopathological Analysis of Laryngeal Leukoplakia: Clinical Follow-up and Immunohistochemical Expression of p53 and PCNA

Laryngeal leukoplakia is seen in a number of pathologic settings such as keratosis without atypia(KWOA), keratosis with atypia(KWA), squamous cell carcinoma in situ(CIS) and invasive squamous cell carcinoma, and it continues to be a confusing and controversial topic for both otolaryngologist and pathologist. This is largely due to the use of ambiguous and inconsistent terminology, the lack of unanimous agreement on the definition of these terms, failure of the clinician to obtain a representative biopsy, and the subjectivity of the pathologist interpreting the biopsy. To evaluate the applicability of the expression pattern of p53 and PCNA in borderline cases of histopathologic classification, we performed a histopathologic analysis of leukoplakia to includ clinical follow-up, correlation of disease progression and degree of atypia, and expression of p53 and PCNA according to the degree of atypia. Histologically, laryngeal leukoplakia included seven cases of KWOA, fourteen cases of KWA (mild-2, moderate-8, severe-4), three cases of CIS, and one case of invasive squamous cell carcinoma. Keratosis with atypia, a moderate degree or more, showed a strong tendency to progress to invasive carcinoma(p<0.05). The degree of p53 and PCNA expression correlated with the degree of atypia(p<0.05). p53-positive cases at the initial biopsy clearly tended to recur and develop into invasive carcinoma(p<0.01).