Malignant Peripheral Nerve Sheath Tumor of Abdomen

PURPOSE: Malignant peripheral nerve sheath tumor without neurofibromatosis type 1 is very rare neoplasm. Development in the superficial soft tissue is exremely rare. Authors experienced one rare case of primary malignant peripheral nerve sheath tumor developed on abdomen. The clinical and histologic findings were described. METHODS: An 83-year-old man visited hospital with an 11x6.5x4.5 cm sized ulcerated and hemorrhagic mass on abdomen. The tumor was localized in abdominal skin and started growing 3 years ago. RESULTS: Wide excision with safety margin of 2cm and limberg flap was done. The postoperative biopsy revealed a malignant peripheral nerve sheath tumor. There was no evidence of recurrence of tumor for 16 months. CONCLUSION: Malignant peripheral nerve sheath tumor is an aggressive malignant tumor. An abrupt enlargement of size, ulceration and bleeding are suggestive of malignant chnages of the tumor. We recommand early wide excision with enough safety margin as treatment of malignant peripheral nerve sheath tumor.

Metastasizing Dermatofibroma to Lungs : A Case Report

PURPOSE: Dermatofibroma is a lesion several millimeters to several centimeters in size, arising from dermis or subcutaneous tissue, mostly at extremities of a middle aged female. It is a benign fibrous tumor that to our knowledge metastasis have not been reported and may recur only locally. Here we report a rare case of 36-year-old female with dermatofibroma arising from back and metastasized to both lungs. METHODS: We performed an en-block elliptical mass excision for skin lesion and metastatectomy for multiple nodules of both lungs. RESULTS: Histologically, the tumors of both lungs and skin lesion showed dilated cystic airspaces which were lined by respiratory epithelium with underlying layers of tumor cells. The tumor cells were composed of plump to spindled fibrohistiocytic cells arranged in storiform growth pattern. There were no cellular pleomorphism, atypical mitosis, and necrosis. These are the specific features of a dermatofibroma and we could examined the histologic findings of skin and lungs identical. Thus, this indicates that dermatofibroma of back was metastasized to both lungs. CONCLUSION: We report this case to notice that dermatofibroma is a benign tumor but it rarely metastasizes.

The Effect of Placenta Extract on Proliferation and Differentiation of Human Chondrocytes

PURPOSE: The isolated human chondrocytes for cartilage reconstruction and transplantation presents a major problem as these cells would change biologically in vitro. For more effective applications of these cells in the clinical field, it is necessary to get a large amount of cells in a short period without affecting their function and phenotype. METHODS: This study reports the effects of placenta extract on chondrocytes in vitro. We initiated this study on the basis of the hypothesis that placenta extract can influence both the proliferation of chondrocytes and their biologic functions(for example, to express cell specific gene or to produce their own extracellular matrix). Chondrocytes in monolayer culture with or without placenta extract were collected and analyzed by MTT assay, ECM assay, and RT-PCR. RESULTS: Placenta extract stimulated the proliferation of chondrocytes in monolayer culture. The phenotype of chondrocytes was well maintained during the expansion in monolayers. Chondrocytes expanded in the presence of placenta extract produced ECM, glycosaminoglycan, abundantly. Compared to chondrocyte expanded in culture medium only, chondrocytes expanded with placenta extract demonstrated higher COL2A1 expression that was biochemically comparable to primary chondrocytes. This study provides an evidence that placenta extract is helpful to expand chondrocytes during tissue cultivation, to maintain their differentiated phenotype and to promote their function. CONCLUSION: These results suggest that placenta extract during cultivation play an important role in controlling cell behaviors. Furthermore, these results provide a biologic basis for cartilage tissue engineering.

Application of Human Dermal Fibroblast and Keratinocyte on Allogenic Dermis(AlloDerm(R))

PURPOSE: Large skin defect by various causes, should be covered by autologous skin graft. But, the donor site of autologous skin graft is limited and leaves permanent donor scar and contracture. There have been our trial to engineer artificial skin using allogenic dermis (AlloDerm) with basement membrane. METHODS: Dermal and epidermal layer were separated by immersing in dipase solution for 30 minutes, and the separated layers were treated with 0.05% trypsin for 10 minutes. And then each layer was cultivated to fibroblasts and keratinocytes on a culture medium. Fibroblasts were first penetrated into basement membrane of allogenic dermis facing down, then allogenic dermis was flipped over to face up and keratinocytes were transplanted to allogenic dermis. RESULTS: Observing artificial skin fabricated in vitro, we found following: 1) The artificial skin opened in air for 5 days formed epidermal layer. In dermal layer, fibroblast was distributed evenly among all. 2) The artificial skin opened in air for 30 days formed thicker and thicker, and it formed basement membrane, spinous and granular layers. PAS stain to confirm existence of basement membrane showed positive reaction. 3) Cytokeratin 10 stain to confirm the formation of epidermal layer showed positive reaction. 4) The formation of thick keratin, lamellar body and desmosome similar to human skin were observed in result of an electron micrograph. CONCLUSION: As a result of research, the structure seen in normal skin such as rete ridge, is found in reproduced artificial skin. This type of artificial skin can be used as a useful model for investigating skin disease and for clinical application also.

Medial Pedicle Vertical Reduction Mammoplasty

Most recent breast reduction techniques tend to get natural cone shaped breast with minimal scar. On this purpose, we have performed 7 cases of vertical reduction mammoplasty with medial pedicle from August 2003 to August 2005. The mean age of patient was 29, and the average resection amount was 760 gram per breast. The most of the patient were satisfied with their postoperative size, shape and scar. As compared with classical superior pedicle vertical reduction mammoplasty, by using medial pedicle, this technique could use short and wide-ranging pedicle, avoid skin undermining, evade exposure of pectoralis major fascia and remove the fixation as well. And this technique did not operate liposuction. As descrived above, the advantages of vertical mammoplasty using a medial pedicle are as follows: 1. Limited postoperative scar of incision. 2. More effective preservation of sensation to the nipple-areolar complex and physiological function as breast feeding. 3. More aesthetic shape of breast. 4. The procedure is easy to perform. 5. Shortening the period of postoperative care.

Correction of Severe Post-traumatic Enophthalmos through Transconjunctival Approach

Surgical treatment of post-traumatic enophthalmos is one of the most challenging procedures following facial injury. The purpose of this study is to evaluate the advantage of transconjunctival approach and/or medial and lateral extension in reconstruction of orbit in patient with severe post-traumatic enophthalmos. This study includes 7 patients. All operative procedures were performed through preseptal transconjunctival approach and/or medial and lateral extension. After release of scar tissues around orbital contents, reconstruction of orbit was performed using titanium dynamic mesh and silastic sheet. In 5 patients, repositioning of the malunited zygoma was done as concomitant surgery. The aesthetic and functional results were satisfactory. The results were good in 5 patients(72%) and fair in 2 patients(28%). Postoperative improvement of enophthalmos and ocular dystopia were statistically significant by paired t-test(p-value<0.05). No patients complained of postoperative lower lid ectropion. Finally, this approach is much advantageous in patient with severe post-traumatic enophthalmos as wide exposure of lesion and no visible scar on lower lid.

Treatment of the Cubital Tunnel Syndrome by Modified Eaton's Method of Anterior Transposition of Ulnar Nerve with Fasciodermal Sling

We evaluated the postoperative results of cubital tunnel release with modified Eaton's method of anterior transposition of ulnar nerve using fasciodermal sling. This study included 12 patients. According to Dellon's classification, patients were categorized 3 groups as mild(n=2), moderate(n=6), and severe(n=4). Through the longitudinal incision on the medial aspect of the elbow, ulnar nerve was released both proximally and distally. And then, ulnar nerve was wrapped with fasciodermal sling about 3 4 cm in size, which was elevated from the fascia of the common origin of the flexor and pronator muscles. Postoperative results were assessed by modified Kleinman and Bishop's rating system. There were excellent in 4 patients(33%), good in 7 patients(58%) and fair in 1 patient(9%). No patient complained of tingling sensation of the ring and/or small finger. Although all patients showed some improvement of key- pinch, grip-power and static 2-point discrimination, those were not statistically significant. Finally, this procedure has advantages as simple operative technique, short postoperative immobilization, and brief rehabilitation period.