Metastatic breast cancer from a hepatocellular carcinoma: a case report

Breast metastases from extramammary malignancies are rare. Here, we report a case of breast metastasis from hepatocellular carcinoma (HCC) after breast mass excision in a 63-year-old woman. A new breast nodule was noticed after transarterial chemoembolization, transarterial radioembolization, and stereotactic body radiation therapy for HCC. Breast ultrasound and core needle biopsy were performed to differentiate between the breast tumors. The biopsy result was invasive breast carcinoma, and wide excision of the breast was performed. The final pathological diagnosis was HCC breast metastasis based on histological findings and immunohistochemical staining results. After 9 months of follow-up, HCC and breast metastasis recurred. Despite palliative treatment, the patient died due to complications and general health deterioration. Although breast metastasis due to HCC is very rare, HCC breast metastasis should be considered when a new breast mass is discovered in a patient with a history of HCC for effective treatment and management.

Eosinophilic Mastitis: A Case Report

Eosinophilic mastitis is a rare disease in which eosinophils infiltrate the ducts and lobules of the breast, causing mammary inflammation. Although eosinophilic mastitis is a benign condition, it presents similarly to and is often mistaken for breast cancer. Here we report the first case of eosinophilic mastitis in Korea. A 43-year-old woman presented with redness and swelling in her right breast. A breast ultrasound revealed ill-defined isoechoic and hyperechoic areas in the upper half and lower inner quadrant of the right breast combined with axillary level I lymphadenopathy. A histopathological examination by core needle biopsy demonstrated lymphoplasma cell infiltration with eosinophils. A peripheral blood examination revealed an eosinophil count of 5,000/mm³. The patient was treated with oral steroids, antibiotics, and leukotriene receptor antagonists. Four months later, the eosinophil count had returned to normal, and breast ultrasound exhibited marked improvement.

Coexistence of Hodgkin's Lymphoma and Tuberculosis in the Same Axillary Lymph Nodes / 결핵및호흡기질환

Herein we report the case of a 71-year-old woman who complained of fatigue and enlarged right axillary lymph nodes for 18 months. At her first visit, her chest X-ray showed diffuse nodular opacities in both lung fields. Initial excisional biopsy of the axillary lymph nodes showed granulomatous lesions and acid fast bacilli were seen on Ziehl-Neelsen staining. However, even after 15 months of anti-tuberculosis (TB) medication, her right axillary lymph nodes were enlarged. We re-performed an excisional biopsy of the nodes, which showed Hodgkin's lymphoma (HL). A retrograde review of the biopsy before anti-tuberculous medication, revealed HL coexisting with TB. HL and TB cause difficulties in differential diagnosis due to similarities in clinical course, imaging procedures and histopathological analysis of the involved tissue. Therefore, it is important to consider the possibility of concurrent HL and TB when patients who undergo treatment for TB or chemotherapy for lymphoma complain of persistent systemic symptoms or enlarged lymph nodes.

Prostatic Stromal Tumor of Uncertain Malignant Potential (STUMP) Presenting with Multiple Lung Metastasis / 결핵및호흡기질환

We report the case of a 68-year-old man with a stromal tumor of uncertain malignant potential (STUMP), which had metastasized to the lung. The patient complained of an enlarged mass in the anterior chest. Chest computed tomography (CT) showed a sternal abscess with multiple nodules in both lungs. A thoracoscopic lung biopsy of the nodules and incision/drainage of the sternal mass were performed simultaneously. CT of the pelvis revealed an enlarged prostate with irregular cystic lesions in the pelvis. Prostate biopsy was done and demonstrated hypercellular stroma with minimal cytological atypia, a distinct pattern of STUMP. The sternal abscess proved to be tuberculosis and the lung lesion was consistent with STUMP, which had spread from the prostate. However, to our knowledge, the tuberculous abscess might not be assoicated with STUMP in the lung. The patient refused surgical prostatectomy and was discharged with anti-tuberculosis medication. On one-year follow up, the patient had no evidence of disease progression.

Comparison of Quantitative Results among Two Automated Rapid Plasma Reagin (RPR) Assays and a Manual RPR Test / 대한진단검사의학회지

BACKGROUND: We compared two automated Rapid Plasma Reagin (RPR) assay kits with a manual RPR assay kit to evaluate the possibility of using the two automated RPR assays as an alternative to the manual RPR assay for a quantitative monitoring. METHODS: One hundred eighty-five samples were analyzed, including 16 sera from patients with primary, secondary, and latent syphilis. Measured RPR unit (R.U.) values of two automated RPR assay kits, Mediace RPR (Sekisui Chemical Co., Ltd, Japan) and HBi Auto RPR (HBI Co., Ltd, Korea), were compared with the RPR titers of Macro-Vue RPR card test (Becton Dickinson BD Microbiology systems, USA). As a confirmatory test, Anti-Treponema pallidum EUROLINE WB (IgG) and Anti-Treponema pallidum EUROLINE WB (IgM) (Euroimmun, Germany) were used. RESULTS: There was a prozone effect with Mediace RPR at RPR titer (card test) of 1:16, but not with HBi Auto RPR. The R.U. values of the two automated RPR assays did not show proportional increase to the RPR titer. Agreement between manual RPR and two automated RPR assay kits, Mediace RPR assay and HBi Auto RPR assay, were 83.8% and 83.2%, respectively. CONCLUSIONS: The two automated RPR assay kits could not be used as an alternative to manual RPR test for quantitative analysis of RPR titer. As Mediace RPR shows a prozone effect at relatively low RPR titer, caution is needed in the interpretation of the measured values.

Effects of Subclinical Prostatitis on Benign Prostatic Hyperplasia

PURPOSE: Subclinical prostatitis is a very frequent histologic finding in pathological examinations of prostate surgery specimens. We evaluated the correlation between the symptoms of benign prostatic hyperplasia (BPH) and the grades of inflammation in surgical specimens of patients who had undergone operation for BPH without any evidence of clinical prostatitis. MATERIALS AND METHODS: Seventy five patients with BPH, who had gone through transurethral resection of the prostate (TURP) at our department from March 2004 to May 2007, were retrospectively studied. Of the 75 patients, 57 patients were pathologically diagnosed as having a BPH with prostatitis and 18 patients had the only BPH (group G0). Chronic inflammation was graded as I (group G1: scattered inflammatory cell infiltrate within the stroma without lymphoid nodules), II (group G2: nonconfluent lymphoid nodules) or III (group G3: large inflammatory areas with confluence of infiltrate). The serum prostate-specific antigen (PSA) level, PSA density (PSAD), International Prostate Symptom Score (IPSS) and maximum urinary flow rate were compared among the grades of inflammation. RESULTS: In the patients had undergone TURP, prostatic inflammation was found in 76% (57/75). The storage symptoms of IPSS and PSAD were significantly correlated to the extent of inflammation in each groups (p<0.05). No significant correlations were observed between PSA, size of prostate, voiding symptoms, quality of life (QoL) of IPSS, and maximum urinary flow rate. CONCLUSIONS: The extent of chronic inflammation had considerably more relationship with storage symptoms than voiding symptoms and with the increased PSAD. These findings suggest that the subclinical prostatitis may be one of the factors of storage symptoms of BPH patients and postoperative maintained lower urinary tract symptoms.

Malignant Mesothelioma Presenting as Large Neck Mass / 결핵및호흡기질환

Malignant mesothelioma is the most common primary malignant tumor involving pleura, but its diagnosis is difficult to determine by pathology in addition to the fact that it is rare. We present an unusual case of malignant mesothelioma, which initially presented as large neck mass contrary to the more common presentation of a rind like growth along the pleura demonstrated on imaging and by pathologic findings.

Malignant Fibrous Histiocytoma in the Breast: A Case Report / 한국유방암학회지

Malignant fibrous histiocytoma is the most common form of soft tissue sarcoma during middle and late adulthood in the deep connective tissues of the extremities, abdominal cavity, and retroperitoneum. Primary breast sarcoma is a rare disease entity, comprising less than 1% of all breast malignancies. Malignant fibrous histiocytoma of the breast is very rare. We presented one case of a malignant fibrous histiocytoma of the right breast in a 49-year-old woman and report the case with a review of the literature.

A Case of Advanced Gastric Cancer with Perianal Skin Metastasis / 대한소화기학회지

The most common metastatic sites of gastric cancer are liver, lung, bone and adrenal gland. However, skin metastases from gastric cancer are relatively rare. We herein report a case of advanced gastric cancer with perianal skin metastasis in a 70-year-old male. On admission, patient presented with epigastric pain. Endoscopy and abdominal CT scan demonstrated the stage IV gastric cancer. He had one painless nodule on perianal skin area, biopsy of that lesion showed a feature of poorly differentiated adenocarcinoma clinically from the stomach. We suspected that the perianal lesion was originated from gastric cancer.

A case of endometrioma at the uterine incision scar of previous cesarean section / 대한산부인과학회지

Endometriosis is defined as condition, which is ectopic location of endometrial tissue other than uterus and cause many clinical symptoms. Among extrapelvic endometriosis, scar endometriosis secondary to surgery or procedure is very rare condition. We have experienced one interesting case of endometrioma in uterine wall cesarean section scar. The diagnosis was confirmed by histopathologic examination of the scar tissue taken after total abdominal hysterectomy.

Intracystic Papillary Carcinoma in the Male Breast: A Case Report / 한국유방암학회지

Intracystic papillary carcinoma of the breast is a variant of ductal carcinoma in situ (DCIS) characterized by the presence of papillary carcinoma within a cystically dilated duct. DCIS of the male breast is an uncommon disease, accounting for approximately 7% of all male breast carcinomas. Most DCIS in men is of the papillary type. We experienced one case of intracystic papillary carcinoma in the right breast of a 49-yr-old male and report the case with a review of the literature.

A case of abdominal pregnancy implanted on uterosacral ligament / 대한산부인과학회지

Abdominal pregnancy, a rare type of ectopic pregnancy is difficult to be suspected at its first presentation. The diagnosis of this rare disease may often be delayed, since early symptoms are usually non-specific. In some cases, delayed diagnosis of abdominal preganacy can be associated with catastrophic hemorrhage secondary to placental separation. A 24-year old woman visited our emergency unit, presenting with a sudden-onset low abdominal pain. She had undergone uterine curettage 3 weeks before. Transvaginal sonogram of the cul-de-sac revealed complex fluid consistent with blood. On diagnostic laparoscopic operation, we found a ruptured cystic, conception-like structure near the right uterosacral ligament. Histology of the resected structure finally showed chorionic villi consistent with abdominal pregnancy. In this report, we present an unusual case of abdominal pregnancy. This case underscores the careful ultrasonic determination of gestational location at early pregnancy.

Comparison of Two Plastic Vacuum Tubes and Glass Tube for Use in Thyroid Hormone Tests / 임상검사와정도관리

BACKGROUND: Plastic tubes have recently been used for blood collection tubes in clinical laboratories. The silicone coated plastic tube is said to be very similar with the glass tube and to show no difference with the glass tube in routine blood test except for some tests such as hormone tests and drug monitoring. So, we investigated the influence of plastic tube on the thyroid hormone test using two types of plastic vacuum tubes. METHODS: A total of 105 cases for the total triiodothyronine (T3), total thyroxine (T4), and thyroid stimulating hormone (TSH) were studied. The glass tube was a plain glass tube, and the plastic tube was a serum separator tube with gel. The plastic vacuum tubes used in this study were the SST II plus tube (Becton Dickinson, Franklin Lakes, USA) and the Vacuette tube (Greiner Bio-One, Kremsmunster, Austria). An IMMULITE 2000 analyzer (Diagnostic Products Corporation, Los Angeles, USA) was used to measure the total T3, total T4 and TSH. RESULTS: Comparisons of the measured values within 1 hour of blood collection in the plastic tube with that in the glass tube are as follows. There was no difference between the Vacuette tube and the glass tube for the three tests, while there was statistically significant difference between the SST II plus tube and the glass tube for the total T3 and total T4. CONCLUSIONS: It might need more cautious interpretation of the results by a solid-phase, competitive chemiluminescent enzyme immunoassay, when the plastic vacuum tube is used as a blood collection tube instead of the glass tube.

A Case of Gastric and Colonic Hyperplastic Polyposis Associated with Colonic Adenomas / 대한소화기내시경학회지

Hyperplastic polyps occur either sporadically or as a symptom of polyposis syndrome. When individuals exceed 50 polyps, they are diagnosed with hyperplasic polyposis. Moreover, since such cases are even more sporadic than hyperplastic polyps, the course toward this occurrence has not been properly evaluated. A change to malignancy in hyperplastic polyps is rare; however, when multiple lesions are present, the tendency increases. Colorectal polyposis syndromes with gastric polyps include familial adenomatous polyposis, Gardners syndrome, Peutz-Jeghers syndrome, juvenile polyposis and others with a non-genetic origin. Three cases of multiple colorectal hyperplastic polyposis with gastric hyperplastic polyposis have been reported worldwide; however, a case associated with multiple colonic adenomas has not yet been reported. This study reviews the existing literature and reports our recent experience of a case, in which a 53 year-old man with colorectal and gastric hyperplastic polyposis with associated multiple colonic adenomas.

Evaluation of BD Lab Reagents for Chemistry Analyzers / 임상검사와정도관리

BACKGROUND: Many modern chemistry analyzers are open systems and they can use reagents other than those supplied by the manufacturer of the analyzer. There are many generic reagents for use in open systems. The objective of this study was to evaluate the analytical performance of the BD Lab reagents (BD Lab co., Korea) which were generic reagents. METHODS: Sixteen kinds of reagents of total protein, albumin, blood urea nitrogen (BUN), creatinine, glucose, uric acid, aspartate aminotransferase (AST), alanine aminotransferase (ALT), total bilirubin, alkaline phosphatase (ALP), lactate dehydrogenase (LD), gamma glutamyl transferase (GGT), calcium, inorganic phosphorus, total cholesterol, triglycerides were tested for precision, linearity and correlation according to the NCCLS guidelines (EP5-A, EP6-A, EP9-A2). Toshiba 200-FR Neo (Toshiba Medical Systems Co., Japan) was used in this evaluation. RESULTS: All reagents showed acceptable precision with total coefficients of variation less than 7%. Comparison of BD Lab reagents with the current reagents by regression analysis resulted in slopes ranging from 0.86 to 1.06 and correlation coefficients more than 0.975. Fifteen of sixteen reagents showed good linearity in broad range. CONCLUSIONS: BD Lab reagents showed good precision, linearity, and correlation. Therefore, we conclude that the BD Lab reagents can be an alternative of currently used reagents in chemistry analyzers.

Comparison of Common Clinical Chemistry Analyte Levels between Greiner Bio-One Vacuette Tube and Glass Tube / 임상검사와정도관리

BACKGROUND: Serum separator tubes were introduced 25 years ago and are widely used in the clinical laboratory for collection of blood. Recently, the plastic serum separator tube has become available for blood collection for lightening and flexibility and suitability for automation. However few studies have been reported on stability of the common analytes in this tube. METHODS: We evaluated the concentrations of seventeencommonly ordered analytes: aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), total protein, albumin, sodium, chloride, calcium, phosphorus, triglyceride, low density lipoprotein (LDL)-cholesterol, potassium, uric acid, blood urea nitrogen (BUN), total cholesterol, glucose, creatinine in sera separated in plain glass tubes (no gel) and in sera separated in the plastic Greiner Bio-One Vacuette tubes containing serum separator gel (Greiner Bio-One, Kremsm?nster, Austria) by Toshiba 200-FR Neo. RESULTS: Results were analyzed using two-tailed paired t-tests and Bland-Altman plots. Results from 9 common analytes (glucose, total cholesterol, BUN, potassium, LDL-cholesterol, inorganic phosphorus, calcium, sodium, chloride) were statistically different between glass tube and plastic Greiner Bio-One Vacuette tube, but the differences were not considered to be clinically significant. CONCLUSIONS: We conclude that the plastic Greiner Bio-One Vacuette tubes are suitable for collection of blood and storage of serum for common analytes.

An Endobronchial Fibroepithelial Polyp Treated by Bronchoscopic Excision / 결핵및호흡기질환

An 81-year-old man underwent bronchoscopy to investigate the cause of his dyspnea symptoms. A benign natured mass was observed in the bronchus and was excised. The pathology examination revealed a fibroepithelial polyp. He has been asymptomatic since the simple bronchoscopic excision. A fibroepithelial polyp is a benign tumor with a mesodermal origin. It is commonly found in the skin, urogenital area and chest, but is extremely rare in the respiratory system. We report a case of a fibroepithelial polyp in the bronchus, which was treated with a bronchoscopic excision, with a brief review of the relevant literature.

Renal Cell Carcinoma Detected by Solitary Vaginal Metastasis / 대한비뇨기과학회지

Variable clinical manifestations and the unpredictable biological behavior of renal cell carcinomas are well known. About a third of patients have metastasis by the time they are first seen by a physician, most commonly to the lung, frequently to the bone and/or liver and less commonly to a virtually unlimited range of tissues and organs. Vaginal cancer represents approximately 1-3% of all genital tract malignancies, and most cases present as metastasis from the cervix, endometrium or colon. Vaginal metastasis from a renal cell carcinoma can be confused with a primary vaginal clear cell carcinoma, and metastasis of a renal cell carcinoma to the vagina is extremely rare. Here, we report a case of a renal cell carcinoma, detected by a metastatic vaginal mass.

Relationship Between the Extent of Chromosomal Losses and the Pattern of CpG Methylation in Gastric Carcinomas

The extent of unilateral chromosomal losses and the presence of microsatellite instability (MSI) have been classified into high-risk (high- and baseline-level loss) and low-risk (low-level loss and MSI) stem-line genotypes in gastric carcinomas. A unilateral genome-dosage reduction might stimulate compensation mechanism, which maintains the genomic dosage via CpG hypomethylation. A total of 120 tumor sites from 40 gastric carcinomas were examined by chromosomal loss analysis using 40 microsatellite markers on 8 chromosomes and methylation analysis in the 13 CpG (island/non-island) regions near the 10 genes using the bisulfite-modified DNAs. The high-level-loss tumor (four or more losses) showed a tendency toward unmethylation in the Maspin, CAGE, MAGE-A2 and RABGEF1 genes, and the other microsatellite-genotype (three or fewer losses and MSI) toward methylation in the p16, hMLH1, RASSF1A, and Cyclin D2 genes (p<0.05). The non-island CpGs of the p16 and hMLH1 genes were hypomethylated in the high-level-loss and hypermethylated in the non-high-level-loss sites (p<0.05). Consequently, hypomethylation changes were related to a high-level loss, whereas the hypermethylation changes were accompanied by a baseline-level loss, a low-level loss, or a MSI. This indicates that hypomethylation compensates the chromosomal losses in the process of tumor progression.

Malignant Gastrointestinal Stromal Tumor of the Gallbladder

Gastrointestinal stromal tumors (GISTs) of the gallbladder are representative of an extremely rare group of tumors. We have encountered a patient with a malignant GIST of the gallbladder and presented it with a review of some articles. A 72-yr-old woman initially presented with right upper quadrant abdominal pain, fever and chills. Emergency cholecystectomy was performed under the impression of gallbladder empyema. Liver metastasis was found at 7 months postoperatively and the patient expired 9 months after the surgery. At the time of cholecystectomy, the gallbladder showed a necrotic serosal surface with an irregular thickened wall. A mass, 6 cm in length and 3 cm in width, encircled the whole wall of the neck and upper body of the gallbladder. Microscopic findings revealed frequent mitotic figures (more than 20/50 HPF) and tumor necrosis. Hyperchromatic, pleomorphic and spindle shaped neoplastic cells that were arranged in a pattern of short fascicles infiltrated the entire layer of the gallbladder. The tumor cells were immunoreactive for CD117 antigen (c-kit protein) and vimentin. They were negative for desmin, smooth muscle actin and S-100 protein. Mutations of the c-kit proto-oncogene were not found in this case. These findings were sufficient to provide enough clinical, histopathological and immunohistochemicalevidence in diagnosing our case as a malignant GIST.