A case of malignant fibrous histiocytoma with invasion into great vessels and heart which was confused with benign myxoma / 대한내과학회지

Cardiac tumors are rare. Benign myxoma is the most common among them. Malignant fibrous histiocytoma is a tumor originating from primitive mesenchymal cell and found most commonly in four extremities. Since this disease was first described by Shah in 1978, there have been a lot of case reports of cardiac malignant fibrous histiocytoma. If originating in the heart, it is usually found in left atrium which is unusual for malignant cardiac tumor. Since the advent of the echocardiography as a diagnostic tool in the cardiac disease, a lot more cases of cardiac tumor have been reported. Here, we report a case of cardiac malignant fibrous histiocytoma in a 67 year old man presenting with dyspnea who, at first sight, seemed to have benign myxoma but turned out to have malignant fibrous histiocytoma. However, strictly speaking,the case we found is a cardiac invasion of the retroperitoneal malignant fibrous histiocytoma.

A case of herpes simplex virus esophagitis with candidal esophagitis in the immunocompetent patient / 대한내과학회지

Herpes simplex virus esophagitis and candidal esophagitis can be found in immunocompromised patients. But it rarely occurs in immunocompetent patients. Diagnosis is usually established with an upper gastrointestinal endoscopy. The lesions of herpes simplex virus esophagitis involves the squamous mucosa, where the earlist manifestation is a vesicle, rarely. We report a case of herpes simplex virus esophagitis who, being immunologically healthy, presented with substernal pain and dysphagia and showed vesicle formation on endoscopy. The patient also showed whitish patch and spot on esophageal mucosae. The patient showed loss of symptom and improvement of endoscopic finding after conservative management and antifungal therapy.

A case of ribostamycin-induced anaphylaxis / 대한내과학회지

Anaphylaxis is a life-threatening, systemic reaction manifested by urticaria, angioedema, bronchospasm, syncope and hypotension, which occurs after the exposure to specific antigen such as antibiotics, aspirin, nonsteroidal antiinflammatory drugs, foods, bee sting, or exercise. A 33-year-old woman suffering from anaphylactoid attack after intramuscular administration of ribostamycin at private clinic, was visited to our emergency room and admitted. She had allergic rhinitis and her 8-year-old daughter had atopic dermatitis. She had three previous intramuscular administrations of ribostamycin at every three weeks due to recurrent pelvic inflammatory disease. At third time of ribostamycin administration, she had experienced generalized pruritus, flushing and shortness of breath but these symptoms were resolved spontaneously without medication. Therefore, she didn't notice to attending physician. During the fourth administration of ribostamycin, she developed generalized urticaria and angioedema with dyspnea, dizziness, and severe hypotension. We experienced a case of ribostamycin-induced anaphylaxis, which is rarely mentioned in published articles. We performed a skin prick test and an intradermal test to ribostamycin, which were positive, and report a case of ribostamycin-induced anaphyalxis.

A Case of Primary Leiomyosarcoma with Prominent Osteoclast-like Giant Cell of Lung with Cardiac Invasion / 결핵및호흡기질환

The incidence of a pulmonary leiomyosarcoma as a primary lung tumor is quite rare. We report a case of primary leiomyosarcoma with a cardiac invasion in a 76 year old man. He was admitted due to left anterior chest wall pain for one month. Chest computed tomography showed a 9x8x10cm sized , large round mass in the left upper and lower lobes, and an amorphous low density lesion within the left atrium. Chest magnetic resonance imaging showed a large round mass in the left upper and lower lobes with growth into the left atrium. A diagnosis of leiomyosarcoma with prominent osteoclast-like giant cells was made based on the microscopic and immunohistochemical findings of a permanent specimen by explothoracotomy. The pathologic features of the tumor showed round mononuclear hyperchromatic cells and multinucleated giant cells that resembled osteoclasts. The immunohistochemical staining showed that the giant cells are positive for CD68 but negative for the muscle markers while the round cells were positive for the muscle marker. The patient refused further treatment and died after two months.