MRI Findings of Intercostal Schwannoma: A Case Report

Intercostal schwannomas are uncommon, encapsulated neoplasms that originate in nerve sheaths of intercostal nerves. They account for less than 10% of primary neural tumors of the chest wall. Herein, we report a pathologically confirmed case of intercostal schwannoma with typical magnetic resonance imaging findings.

Poorly Differentiated Clusters in Colorectal Adenocarcinomas Share Biological Similarities with Micropapillary Patterns as well as Tumor Buds

In colorectal carcinoma, poorly differentiated clusters (PDCs) are a poor prognostic indicator and show morphological continuity and behavioral similarities to micropapillary patterns (MPPs) as well as tumor buds (TBs). Epithelial-mesenchymal transition (EMT) and inhibition of cancer-stromal interactions may contribute to the development of PDCs. To clarify the biological nature of PDCs, we examined immunohistochemical stainings for β-catenin, Ki-67, E-cadherin, epithelial cell adhesion molecule (EpCAM), MUC1, and epithelial membrane antigen (EMA), which are associated with EMT and cancer-stromal interactions. The expression frequencies and patterns of PDCs, TBs, and differentiated neoplastic glands from the tumor center (TC) were compared. In the study group (117 cases), the nuclear β-catenin staining index was higher in PDCs (37.3%) and TBs (43.3%) than in neoplastic glands from TC (8.9%, P < 0.001). The mean Ki-67 labeling index in TC was 71.5%, whereas it was decreased in PDCs (31.2%) and TBs (10.2%, P < 0.001). E-cadherin and EpCAM displayed a tendency to be found along the cell membrane in TC samples (91.5% and 92.3%, respectively), whereas they showed loss of membranous staining in PDC (44.4% and 36.8%, respectively) and TB samples (60.7% and 68.4%, respectively). An inside-out pattern for MUC1 and EMA was frequently observed in PDC (48.7% and 45.3%, respectively) and TB samples (46.2% and 45.3%, respectively), but not in TC samples. Our data demonstrate that there is a pathogenetic overlap among PDCs, TBs, and MPPs and suggest that they might represent sequential growth patterns that branch from common biological processes such as dedifferentiation and alteration in cancer-stromal interactions.

The Use of the Bethesda System for Reporting Thyroid Cytopathology in Korea: A Nationwide Multicenter Survey by the Korean Society of Endocrine Pathologists

BACKGROUND: The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) has standardized the reporting of thyroid cytology specimens. The objective of the current study was to evaluate the nationwide usage of TBSRTC and assess the malignancy rates in each category of TBSRTC in Korea. METHODS: Questionnaire surveys were used for data collection on the fine needle aspiration (FNA) of thyroid nodules at 74 institutes in 2012. The incidences and follow-up malignancy rates of each category diagnosed from January to December, 2011, in each institute were also collected and analyzed. RESULTS: Sixty out of 74 institutes answering the surveys reported the results of thyroid FNA in accordance with TBSRTC. The average malignancy rates for resected cases in 15 institutes were as follows: nondiagnostic, 45.6%; benign, 16.5%; atypical of undetermined significance, 68.8%; suspicious for follicular neoplasm (SFN), 30.2%; suspicious for malignancy, 97.5%; malignancy, 99.7%. CONCLUSIONS: More than 80% of Korean institutes were using TBSRTC as of 2012. All malignancy rates other than the SFN and malignancy categories were higher than those reported by other countries. Therefore, the guidelines for treating patients with thyroid nodules in Korea should be revisited based on the malignancy rates reported in this study.

Clinicopathologic Impacts of Poorly Differentiated Cluster-Based Grading System in Colorectal Carcinoma

Differentiation-based histologic grading of colorectal carcinoma (CRC) is widely used, but its clinical impact is limited by insufficient prognostic value, interobserver disagreement, and the difficulty of its application to CRC with specific histologic types such as mucinous and medullary carcinoma. A recently proposed novel grading system based on quantifying poorly differentiated clusters (PDCs) claims to have the advantages of reproducibility and improved prognostic value, and might apply to heterogeneous CRC. We aimed to validate the clinicopathologic significance of the PDCs-based grading system and to determine the relationship between this grading system and microsatellite instability (MSI). Two hundred and one patients who had undergone radical surgery were reviewed. Based on the number of PDCs, 85, 58, and 58 tumors were classified as grade (G) 1 (42.3%), G2 (28.9%), and G3 (28.9%), respectively. PDCs-based grade was significantly associated with T, N, and M stages; lymphovascular invasion; conventional histologic grade; and frequent tumor budding (all P <0.001). In multivariate analysis, PDCs-based grade was found to be an independent prognostic factor for disease-free survival (P = 0.022; hazard ratio, 3.709 [G2], 7.461 [G3]). G3 CRC significantly correlated with high MSI (MSI-H) compared to G1 and G2 (P = 0.002; odds ratio, 5.750). In conclusion, this novel grading would provide valuable prognostic information to a greater number of patients and would require continued verification. PDCs-based grading is feasible for CRCs with heterogeneous morphology, and we propose that the association between G3 and MSI-H be further evaluated in different histological subtypes of CRC.

Follicular Proliferative Lesion Arising in Struma Ovarii

Malignant struma ovarii is extremely rare and difficult to diagnose histologically, particularly in cases of follicular carcinoma. This case study is intended to describe three cases of follicular proliferative lesion arising in struma ovarii that we experienced. The first case was clearly malignant given the clinical picture of multiple recurrences, but there was little histological evidence of malignancy. Our second case featured architectural and cellular atypia and necrosis and was diagnosed as malignant despite the absence of vascular and stromal invasion. Our third case exhibited solid microfollicular proliferation without any definite evidence of malignancy (even the molecular data was negative); however, we could not completely exclude malignant potential after conducting a literature review. In cases such as our third case, it has been previously suggested that a diagnostic term recognizing the low-grade malignant potential, such as "proliferative stromal ovarii" or "follicular proliferative lesion arising in the stromal ovarii" would be appropriate.

Kikuchi-Fujimoto Disease Coexistent with Papillary Thyroid Carcinoma in a Single Lymph Node

Cervical lymphadenopathy can be developed from various causes such as viral infection, bacterial infection, Kikuchi-Fujimoto disease, tuberculosis, malignancy, and reactive changes. In patients who have malignancy, metastatic lymphadenopathy is possible but it is rare that other concomitant diseases are in the same lymph node. We experienced a case of coexistence of Kikuchi necrotizing lymphadenitis and papillary thyroid carcinoma in a single cervical lymph node. A 38-year-old man who was previously diagnosed with papillary thyroid cancer with cervical lymph nodes metastasis presented with cervical lymphadenopathy. The lymph node biopsy showed tuberculous lymphadenitis. After finishing anti-tuberculosis medication, recurrent lymphadenopathy had developed and a surgical biopsy was performed. At that time, the diagnosis was Kikuchi necrotizing lymphadenitis combined with metastatic papillary carcinoma in a single lymph node.

Pathology Reporting of Thyroid Core Needle Biopsy: A Proposal of the Korean Endocrine Pathology Thyroid Core Needle Biopsy Study Group

In recent years throughout Korea, the use of ultrasound-guided core needle biopsy (CNB) has become common for the preoperative diagnosis of thyroid nodules. However, there is no consensus on the pathology reporting system for thyroid CNB. The Korean Endocrine Pathology Thyroid Core Needle Biopsy Study Group held a conference on thyroid CNB pathology and developed guidelines through contributions from the participants. This article discusses the outcome of the discussions that led to a consensus on the pathology reporting of thyroid CNB.

A Tenosynovial Giant Cell Tumor Arising from Posterior Cruciate Ligament of Knee Joint: A Case Report / 대한골관절종양학회지

Localized forms of giant cell tumor are known to arise commonly in the synovial membrane of the finger joints. Multinucleated giant cells are its characteristic pathology finding, giant cell tumor shows a low rate of recurrence after complete excision. When occurring at the knee joints, giant cell tumor manifests a wide form of symptoms, from no symptom at all, to intermittent locking. Complete excision is possible by arthroscopy, but if done incompletely, it is reported to recur in 45% of cases. We present here a case of giant cell tumor that has arisen from the anterior portion of the posterior cruciate ligament, excised by arthroscopy and followed by pathologic confirmation.

A Case of Synchronous Presentation of Primary Non-Small Cell Lung Carcinoma and Pheochromocytoma / 결핵및호흡기질환

We report a rare synchronous presentation of primary lung cancer and adrenal pheochromocytoma. A 59-year-old woman was diagnosed with right upper lobe non-small cell lung carcinoma measuring 2.8 cm and a right adrenal gland mass measuring 3.5 cm, which displayed increased metabolic activity on 18F-fluorodeoxyglucose positron emission tomography-computed tomography. The adrenal lesion was revealed to be asymptomatic. The patient underwent right adrenalectomy and histological examination revealed a pheochromocytoma. Ten days later, right upper lobectomy was performed for lung cancer. This case indicates that incidental adrenal lesions found in cases of resectable primary lung cancer should be investigated.

Performance Evaluation of Gentian Cystatin C on the Hitachi 7600 Automatic Analyzer / 임상검사와정도관리

BACKGROUND: Cystatin C, a 13-kDa protein synthesized in all nucleated cells, has been proposed as a replacement for serum creatinine in assessments of renal function. The Gentian Cystatin C immunoassay (Gentian, Norway) was recently developed using particle enhanced turbidimetric immunoassay. In this study, we evaluated the analytical performance of the Gentian Cystatin C immunoassay on the Hitachi 7600 Automatic Analyzer (Hitachi Ltd., Japan). METHODS: We performed precision and linearity studies using Hitachi Clinical Analyzer 7600 with Gentian reagent and compared the results to those obtained with the N Latex Cystatin C (Siemens, Germany) using a particle enhanced nephelometric immunoassay method performed on the Behring Nephelometer II (Siemens, Germany). We also analyzed the traceability of Gentian reagent and Siemens reagent to Cystatin C standard reference material, ERM-DA471/IFCC. RESULTS: The coefficient of variations (CVs) for within-run imprecision at low and high levels were 1.58% and 1.06% and the CVs for total imprecision at low and high levels were 2.53% and 2.09%, respectively. In the linearity test, the coefficient of determination (R2) was 0.9997 (range, 0.23 to 7.50 mg/L), and comparison with the results obtained by Siemens reagent showed an excellent correlation coefficient of 0.9982. In the traceability test, Gentian reagent is more accurate than Siemens reagent and the total accuracy was 96.0%. CONCLUSIONS: Gentian reagent provides good analytic performance on the Hitachi 7600 Automatic Analyzer and can be used for the diagnosis, treatment, monitoring, and risk assessment of renal function.

A Case of Intraperitoneal Immunoglobulin G4-related Inflammatory Pseudotumor / 대한소화기학회지

The term inflammatory pseudotumor (IPT) has been used to describe inflammatory and fibrosing tumoral processes of an undetermined cause that may involve a variety of organ system. IgG4-related disease is a newly recognized fibroinflammatory condition characterized by IgG4-producing plasma cell expansion in affected organs and, often but not always, elevated serum IgG4 concentrations. IgG4-related IPTs, a subtype of IPT, are characterized by dense infiltration of IgG4-positive plasma cells and stromal fibrosis. The association between inflammatory pseudotumor and IgG4 was first reported with a regard to sclerosing pancreatitis. Despite there are many reports on intraperitoneal IPTs including both cellular and lymphoplasmacytic type, only a few cases have been confirmed to be IgG4-related. We experienced a case of intraperitoneal IgG4-related inflammatory pseudotumor in an 83-year-old woman presenting with epigastric pain and malaise. Surgical specimens revealed an IgG4-related inflammatory pseudotumor.

A Case of Intraperitoneal Immunoglobulin G4-related Inflammatory Pseudotumor / 대한소화기학회지

The term inflammatory pseudotumor (IPT) has been used to describe inflammatory and fibrosing tumoral processes of an undetermined cause that may involve a variety of organ system. IgG4-related disease is a newly recognized fibroinflammatory condition characterized by IgG4-producing plasma cell expansion in affected organs and, often but not always, elevated serum IgG4 concentrations. IgG4-related IPTs, a subtype of IPT, are characterized by dense infiltration of IgG4-positive plasma cells and stromal fibrosis. The association between inflammatory pseudotumor and IgG4 was first reported with a regard to sclerosing pancreatitis. Despite there are many reports on intraperitoneal IPTs including both cellular and lymphoplasmacytic type, only a few cases have been confirmed to be IgG4-related. We experienced a case of intraperitoneal IgG4-related inflammatory pseudotumor in an 83-year-old woman presenting with epigastric pain and malaise. Surgical specimens revealed an IgG4-related inflammatory pseudotumor.

Hyaline Vascular Castleman Disease Involving Renal Parenchyma and a Lymph Node: A Case Report

Castleman disease is a rare lymphoproliferative lesion that is predominantly found in the mediastinum. Retroperitoneal and pararenal localizations are very rare. We describe a 36-year-old man with a hyaline vascular type of Castleman disease involving renal parenchyma and a paraaortic lymph node. Most reported renal Castleman disease was plasma cell type with systemic symptoms. Herein, we report the first Korean case of the hyaline vascular type of Castleman disease involving the renal parenchyma and the paraaortic lymph node simultaneously.

CD56 and High Molecular Weight Cytokeratin as Diagnostic Markers of Papillary Thyroid Carcinoma

BACKGROUND: The incidence of papillary thyroid carcinoma (PTC) has been increasing recently and a precise diagnosis is essential for optimal treatment. Ancillary immunohistochemical stains are important for diagnosing some difficult cases. METHODS: The dignostic value of CD56, high molecular weight cytokeratin (HMCK), galectin-3 (GAL3), and cytokeratin 19 (CK19) were evaluated to distinguish PTC from other benign thyroid lesions (BTL). We studied 23 cases of papillary thyroid overt carcinomas, 57 papillary thyroid microcarcinomas, five follicular adenomas, five cases of Hashimoto's thyroiditis, and 12 nodular hyperplasias. RESULTS: The statistical analysis showed significantly different expressions of CD56, HMCK, GAL3, and CK19 in PTC vs other BTL. The diagnostic specificity of HMCK and CD56 (90.9% and 72.7%, respectively) was higher than that of GAL3 and CK19 (50.0% and 36.4%, respectively). However, the sensitivity of HMCK and CD56 detection (92.5% and 95.0%, respectively) was lower than that of GAL3 and CK19 (98.8% and 100.0%, respectively). The combined use of CD56, HMCK, GAL3, and CK19 showed 87.5% sensitivity, 100.0% specificity, and 100.0% positive predictive value in differentiating PTC from other BTL. CONCLUSIONS: Although the differential diagnosis of thyroid follicular lesions are based on histological and cytomorphological criteria, CD56 and HMCK might be useful markers for diagnosing PTC.

Hidroacanthoma Simplex after Burn Injury / 대한피부과학회지

Hidroacanthoma simplex is a rare, benign intraepidermal skin tumor originating from eccrine ducts. It usually develops on the lower extremity or trunk of the elderly, and appears as a well-demarcated brownish to erythematous flat or verrucous plaque. It is often clinically misdiagnosed as seborrheic keratosis or Bowen's disease and the pathogenesis of the disease is not understood. Histopathologically, it shows characteristic intraepidermal nests not extended to the dermis, the so called Borst-Jadasshon phenomenon. The nests are composed of uniform cuboidal tumor cells with a round, basophilic nucleus. Here we report a case of hidroacanthoma simplex following burn injury in an 82 year-old woman.

Time Dependent Bladder Apoptosis Induced by Acute Bladder Outlet Obstruction and Subsequent Emptying is Associated with Decreased MnSOD Expression and Bcl-2/Bax Ratio

Ischemia/reperfusion (I/R) injury-induced oxidative stress plays an important role in the functional impairment of the bladder following acute bladder outlet obstruction (BOO) via induction of apoptosis. The purpose of this study was to investigate the time course of the bladder apoptosis, and apoptosis related molecular changes in the early stage of acute BOO. Twelve-week-old male Sprague Dawley rats were divided into control, acute BOO only (I), and acute BOO plus subsequent emptying (I/R) for 30, 60, 120 min, 3 days and 2 weeks. We examined the extent of bladder apoptosis, expression of Mn-superoxide dismutase (Mn-SOD), Bcl-2, Bax, caspase 3 and poly (ADP-ribose) (PAR) in the bladder. Bladder apoptosis was significantly increased in the I/R group at 30, 60, and 120 min following bladder emptying. BOO plus subsequent emptying for 30, 60, 120 min showed significant decrease in MnSOD and Bcl-2 expression, and significant increase in caspase 3, Bax expression, and amounts of PAR. These results indicate that bladder apoptosis, induced by acute BOO and subsequent emptying, is associated with decreased MnSOD expression, increased PARP activity and imbalance in apoptosis pathways.

Sarcomatoid Metaplastic Carcinoma of the Breast: A Case Report

Metaplastic breast carcinoma is a very rare disease with many different histologic subtypes including squamous cell, spindle cell, and heterologous mesenchymal growth (sarcomatoid, osseous). We report a case of sarcomatoid metaplastic carcinoma of the breast which was manifested as a well-circumscribed, round, hypoechoic mass on ultrasound.

Primary Parotid Non-Hodgkin's Lymphoma: A Case Report

PURPOSE: Primary malignant lymphomas of the salivary glands are uncommon, representing only 1.7% to 3.1% of all salivary neoplasms and 0.6% to 5% of all tumors and tumor-like lesions of the parotid gland. Lymphomas of the parotid glands are usually manifestations of a systemic disease process but primary lymphomas of the parotid glands are rare. Most of these lesions are classified as extranodal non-Hodgkin's lymphoma. We report the clinicopathological features of primary malignant lymphoma of the parotid gland based on an analysis of our cases. METHODS: The subject was a 48-year-old male patient with a malignant lymphoma originating in the parotid gland, which had been slowly increasing in size over previous 6 months. The diagnosis was established by MRI and a superficial lobectomy. After diagnosis, the patient was referred to an oncologist for staging and medical treatment. RESULTS: The stage was IIIA. The patient was treated with chemotherapy following surgery with rituximab and CHOP (Cyclophosphamide, Adriamycin, Vincristine, Prednisolone). The tumor was controlled successfully by chemotherapy. The patient was followed up for 1 year with no relapse. CONCLUSION: A case of primary non-Hodgkin's lymphoma of the parotid gland was treated with a superficial parotidectomy and chemotherapy. The disease was well controlled after a 1 year follow-up.

A Case of Septic Pulmonary Embolism Associated with MRSA Infective Endocarditis / 결핵및호흡기질환

Septic pulmonary embolism is the process in which an infected thrombus becomes detached from its site of origin and lodges in a pulmonary artery, and is usually associated with infective endocarditis, especially right-sided, or infection-associated with indwelling catheters, peripheral septic thrombophlebitis, and periodontal diseases, etc. Here, we report a case of septic pulmonary embolism associated with tricuspid valve infective endocarditis. A 23-year-old female was admitted to our hospital, due to fever, sore throat, and myalgia. In her past medical history, she had undergone a surgical operation for closure of a ventricular septal defect, but was informed that the operation resulted in an incomplete closure. The initial chest radiograph demonstrated multiple rounded, parenchymal nodules in various sizes; several nodules had central lucency suggesting cavitations. Echocardiography demonstrated a large vegetation attached to the septal tricuspid valve leaflet, extending from right ventricular inflow tract to outflow tract. Computed tomography of thorax revealed bilateral peripheral nodules and wedge-shaped consolidation at various sizes, mostly accompanied by cavitations.

F-18 FDG PET-positive Fibrous Dysplasia in a Patient with Intestinal Non-Hodgkin's Lymphoma / Journal of the Korean Cancer Association, 대한암학회지

Fibrous dysplasia (FD) is a common benign bone disorder of an unclear etiology. It is known that FD can appear without an increased FDG uptake on F-18 fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT). However, there are also several reports that FD showed increased FDG uptake and this mimicked malignant bone involvement on FDG-PET. Herein we describe a case of biopsy-proven FDG-PET positive FD in a patient with intestinal non-Hodgkin's lymphoma (NHL). A 45-year-old woman was diagnosed with intestinal NHL, which was removed by right hemicolectomy. After the operation, the FDG-PET/CT scan showed hypermetabolic activity in the right transverse process of the T10 vertebra. The patient then received a total of 6 cycles of R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone) chemotherapy every 3 weeks. After completion of the planned chemotherapy, the 2nd FDG-PET/CT showed increased FDG uptake (SUVmax=6.0 g/mL) of the previous bone lesion. The MR images revealed a T1-hypointense lesion with sharp borders in the same region, and this showed homogenous contrast enhancement on the fat-suppressed T1-weighted images. After the radiologic studies were carefully reviewed, the bone lesion was assumed to be benign such as FD. We performed bone biopsy and the histological examination confirmed the diagnosis of FD. In conclusion, bone lesions with FDG uptake need to be carefully interpreted when evaluating patients with known malignancy.