Two Cases of Allergy to Insulin in Gestational Diabetes

Allergic reaction to insulin is uncommon since the introduction of human recombinant insulin preparations and is more rare in pregnant than non-pregnant females due to altered immune reaction during pregnancy. Herein, we report two cases of allergic reaction to insulin in gestational diabetes that were successfully managed. One case was a 33-year-old female using isophane-neutral protamine Hagedorn human insulin and insulin lispro. She experienced dyspnea, cough, urticaria and itching sensation at the sites of insulin injection immediately after insulin administration. We discontinued insulin therapy and started oral hypoglycemic agents with metformin and glibenclamide. The other case was a 32-year-old female using insulin lispro and insulin detemer. She experienced pruritus and burning sensation and multiple nodules at the sites of insulin injection. We changed the insulin from insulin lispro to insulin aspart. Assessments including immunoglobulin E (IgE), IgG, eosinophil, insulin antibody level and skin biopsy were performed. In the two cases, the symptoms were resolved after changing the insulin to oral agents or other insulin preparations. We report two cases of allergic reaction to human insulin in gestational diabetes due to its rarity.

Alteration of Bile Acid Transporter Expression in Patients with Early Cholestasis Following Living Donor Liver Transplantation

BACKGROUND: Intrahepatic cholestasis can occur early after living donor liver transplantation (LDLT). We investigated the changes in the expressions of the bile acid transporters and the liver histology in the patients who suffered with early cholestasis (EC) following LDLT. METHODS: The histological differences between 15 graft livers with EC after LDLT and 5 graft livers with biliary stricture following LDLT were evaluated. The hepatic mRNA levels of the bile canaliculi transporters (BSEP, MRP2, MRP3, MDR1, MDR3, NTCP) in 40 (20 graft livers, 20 matched donor livers) liver biopsy tissues were analyzed by performing real-time reverse-transcription polymerase chain reaction (RT-PCR). RESULTS: Microscopic examination revealed hepatocellular and/or bile canalicular cholestasis around acinar zone 3 in the livers of the patients with EC. In the livers with biliary stricture, the cholestasis was dominantly observed in the hepatocytic cytoplasm and in the bile ductules around the portal area rather than around acinar zone 3. The BSEP and MRP2 mRNA levels in the EC livers were significantly reduced by 44% and 23%, respectively (p=0.000), compared to the matched donor livers. The levels of MDR3 and NTCP mRNA in the EC livers increased by 738% (p=0.000) and 281% (p<0.01), respectively. The change of the expressions of the bile acid transporters in the patients with biliary stricture was less significant than that in the EC group. CONCLUSIONS: These results suggest that the altered expressions of the bile acid transporters may play a role in the pathogenesis of EC following LDLT.

Ameloblastoma Associated with Dentinogenic Ghost Cell Tumor: A Case Report

Dentinogenic ghost cell tumor (DGCT) is an uncommon odontogenic tumor. It is characterized by islands of odontogenic epithelial cells that contain numerous ghost cells and dysplastic dentin. Occasionally, DGCT combines with other odontogenic tumors, such as ameloblastoma. We report here on a 21-year-old female who complained of a tender solid mass in the left maxilla for the 7 month previous to her admission. MRI revealed a relatively well demarcated mass in the left maxilla with heterogenous signal intensity, measuring 3.2 x 2.8 cm, and this mass had invaded the left palate. Microscopically, the tumor was composed of nests of odontogenic epithelium that contained ghost cells and calcification with dysplastic dentin, which is all consistent with DGCT. Localized area showed odontogenic epithelial follicles that had peripheral palisading and satellite reticulum without ghost cells and dentin, and this is consistent with ame- loblastoma. The immunohistochemistry revealed cytokeratins, EMA, S100 and Bcl-2 positivity in areas of the DGCT and ameloblastoma. In the ameloblastoma, Bcl-2 positivity was noted in the palisading basal cells. We concluded that the tumor was an ameloblastoma associated with DGCT.

Ependymoma Arising from the Pelvis: A Case Report

We report here on a case of an ependymoma arising from the pelvis in a 25-year-old woman. She had no evidence of abnormality in her brain and bilateral ovaries. The diagnosis was based on light microscopic, immunohistochemical, and ultrastructural features of a typical ependymoma, including the patterns of pseudorosette or true ependymal rosette, the strong immunopositivity for glial fibrillary acid protein and intermediate filaments, and cilia of tumor cells. The mass was over 20 cm in maximum diameter, and it was located between the uterus and rectum without any connection to bilateral ovaries. There were many metastatic nodules in the pelvis and omentum. In addition, the proliferation index in the most active area was 10% by immunohistochemistry using monoclonal antibody MIB-1. Although the prognosis of the pelvic ependymoma is known to be difficult to evaluate, this case may serve to illustrate the poor prognostic course, according to the size of the tumor, the evidence of metastasis, and the MIB-1 labelling index.

Invasive Ductal Carcinoma Arising in a Recurrent Malignant Phyllodes Tumor: A Case Report

We report here on a case of invasive ductal carcinoma arising in a recurrent malignant phyllodes tumor. The patient was a 33-year-old woman who presented with a left breast mass, and an excision was then performed. The mass, measuring 7.0 x 4.0 cm in size, was relatively well demarcated with a nodular contour and showed pale gray and solid cut surface with clefts on it. Histologically, the mass mainly consisted of stromal components that were characterized by high cellularity, marked nuclear atypism and brisk mitosis. The sparse glandular components were leaf-like in shape and lined by bland ductal epithelium without any nuclear atypism. Sixteen months later, the patient revisited our hospital with a recurrent mass, and underwent total mastectomy. The recurrent mass contained foci of definite invasive ductal carcinoma in the background of malignant phyllodes tumor, which was identical to the primary mass. This case demonstrates that it is possible that an invasive ductal carcinoma might arise within, at least with, a recurrent malignant phyllodes tumor.

Expression of FHIT and p21 in Gastric Adenocarcinoma

BACKGROUND: The fragile histidine triad (FHIT) gene, located on the human chromosome 3p14.2, is frequently inactivated by its deletion in a number of human tumors, including gastric carcinomas. Its protein product, FHIT is presumed to have a tumor suppressor function. p21, one of the tumor markers acts as a regulator of the cell cycle, and inhibits cell proliferation. METHODS: The association of the expressions of FHIT and p21 protein, with clinicopathological features, such as age, gender, tumor size, histological type, depth of invasion, lymph node metastasis, lymphatic and vascular invasion, grade and stage were investigated, and correlation of their expressions with p21 expression in 82 gastric adenocarcinomas attempted by immunohistochemical staining. RESULTS: Of the 82 tumors analyzed, 58 (70.7%) were markedly reduced, or completely negative, for FHIT protein expression. The loss of FHIT expression was correlated with the depth of invasion (p=0.000), lymph node metastasis (p=0.001), lymphatic invasion (p=0.000), histological grade (p=0.000) and tumor stage (p=0.000). The loss of p21 expression was correlated with lymph node metastasis (p=0.026) and lymphatic invasion (p= 0.017), but not with the histological grade and tumor stage. The comparison of the FHIT and p21 protein expressions showed significant correlation (p=0.035). CONCLUSIONS: The loss of FHIT and p21 expressions may be a useful indicator of the post diagnostic prognosis. Also, FHIT could be related to cell cycle arrest.

Loss of Heterozygosity on Chromosomes 3p,8p,9p and 17p in the Progression of Squamous Cell Carcinoma of the Larynx

Previous molecular genetic studies of laryngeal squamous cell carcinoma (SCC)have shown certain chromosomal regions with recurring alterations. But studies of sequential molecular alterations and genetic progression model of laryngeal SCC have not been clearly defined. To identify the chromosomal alterations associated with the carcinogenesis of laryngeal SCC, we analyzed genomic DNA from microdissected squamous metaplasia, squamous dysplasia, invasive SCC, and metastatic carcinoma samples from 22 laryngeal SCC patients for loss of heterozygosity (LOH) at microsatellite loci. Ten microsatellite markers on chromosome 3p, 8p, 9p, and 17p were used. LOH at 9p21 was observed in the all stages including squamous metaplasia, squamous dysplasia, invasive SCC and metastatic carcinoma. LOH at 17p13.1, 3p25 and 3p14.2 was observed from the squamous dysplasia, invasive SCC and metastatic carcinoma. LOH at 8p21.3-p22 was observed mainly from the invasive SCC and metastatic carcinoma. The results suggest that 9p21 in the early event, 17p13.1, 3p25 and 3p14.2 in the intermediate event and 8p21.3- p22 in the late event may be involved in the laryngeal carcinogenesis.

Metastasizing Atypical Chondroid Lesion: A Case Report

We recently experienced an atypical chondroid lesion metastatic to the lung. Examined under the microscope, the excised nodules displayed abundant amounts of chondroid tissue and necrosis with dystrophic calcification. The calcification had a characteristic "chicken wire" pattern. The chondroblasts contained one or two round to oval, focally indented nuclei with inconspicuous nucleoli. Although some enlarged nuclei with mild to moderate pleomorphism were present, significant nuclear atypia was lacking. Mitotic figures were scarce (1/10 high power field). Scattered multinucleated osteoclast-type giant cells were observed among the chondroblasts. Thus, the possibility of chondroblastoma was considered first. Metastasis of histologically benign chondroblastoma is a rare event, but well documented. The pulmonary metastatic nodules were described as ceasing to grow in some cases; and a significant number of patients were free of tumors following removal of the metastatic nodules. These findings suggest that the metastasis may represent a simple transport phenomenon. However, there are, as yet, no histologic parameters that help determine whether these metastases are to cease their growth or will progress to kill the host.

Antimicrobial Susceptibility of Inducible AmpC beta-lactamase-producing Enterobacter cloacae, Citrobacter freundii, and Serratia marcescens: a Korean Survey / 대한진단검사의학회지

BACKGROUND: Antimicrobial resistance to third-generation cephalosporins in gram-negative bacteria, especially Enterobacter, Citrobacter, and Serratia spp., is increasing. The resistance mechanism of these organisms are hyperproduction of AmpC beta-lactamase and plasmid-mediated extended-spectrum beta-lactamase (ESBL). This study was to determine the occurrence of AmpC hyperproduction and ESBLs in E. cloacae, C. freundii, and S. marcescens over a 3-month period in 2002. METHODS: We tested total of 619 consecutive, nonduplicate isolates (229 E. cloacae, 183 C. freundii, 207 S. marcescens) from 12 university hospitals and a commercial laboratory in Korea. Antimicrobial susceptibilities were tested using the disk diffusion method. AmpC hyperproduction was defined as nonsusceptible to cefotaxime or ceftazidime for E. cloacae and C. freundii and as nonsusceptible to cefotaxime for S. marcescens. ESBL production was determined by the double disk synergy test. RESULTS: Among the E. cloacae, C. freundii and S. marcescens derepressed strains were 20.5%, 30.1%, and 31.4% and ESBL producers were 23.6%, 10.9%, and 15.5%, respectively. The AmpC derepressed strains and ESBL producers revealed lower susceptibility rates for ciprofloxacin, piperacillin, piperacillin-tazobactam and aminoglycosides. CONCLUSIONS: These data reveal that the occurrence of AmpC derepressants and ESBL producers among E. cloacae, C. freundii and S. marcescens is relatively high. Continued nationwide surveillance is necessary to provide information on the spread of these important mechanisms of resistance to beta-lactams.

Eccrine Syringofibroadenoma: A Case Report

Eccrine syringofibroadenoma is an uncommon benign eccrine tumor, which was first described by Mascaro in 1963. It usually develops on the extremeties of elderly persons. Recently we experienceda case of eccrine syringofibroadenoma that occured in a 38-year-old woman. She presentedus an asymptomatic solitary reddish nodular plaque with a verrucous surface, whichshe'd had on her right arm for three months. Histologically, slender anastomosing epithelial cellcords with focal luminal differentiation resembling duct structures were embedded in a fibrovascularstroma. The net-like pattern of epithelial cells resembled that seen in fibroepithelioma.

False Susceptibility to Imipenem by Vitek GPS Card in Enterococcus faecium / 임상검사와정도관리

BACKGROUND: Enterococcus faecium (E. faecium) is potential pathogens of mixed infections for which a broad-spectrum antimicrobial agents such as imipenem has a therapeutic role. But controversy continues concerning testing imipenem versus enterococci. The purpose of this study were 1) to investigate the ability of penicillin and ampicillin minimum inhibitory concentration (MIC) to predict in vitro susceptibility of E. faecium versus imipenem. and 2) to compare MICs of ampicillin, penicillin and imipenem by the Vitek system with those by agar dilution method. METHODS: Fifty-two isolates of E. faecium between April 2002 and May 2002 were tested. Each isolate was tested versus penicillin, ampicillin and imipenem. MICs were determined by Vitek system and agar dilution method according to NCCLS guidelines. Imipenem MIC determinations were repeated by E-test. RESULTS: MIC of Vitek system tends to be lower than that of agar dilution method, but there was good concordance between MICs of penicillin and ampicillin by Vitek system and agar dilution method. But for imipenem, the MICs by the agar dilution method did not correspond with the Vitek results. Of the 52 E. faecium isolates tested, in vitro activity of penicillin and ampicillin accurately predicts that of imipenem. CONCLUSIONS: MICs of ampicillin and penicillin are reliable, but imipenem MIC is not reliable for E. faecium by Vitek system. In vitro activity of penicillin and ampicillin versus E. faecium accurately predicts that of imipenem.

Relationship Between Adeno-Associated Virus and High Risk Human Papilloma Viruses in Cervical Biopsies Using Microdissection Technique / 대한산부인과학회잡지

OBJECTIVE: Adeno associated virus (AAV) is a human DNA virus and is included in the Parvovirus family. AAV has been detected in cervical tissues as well as cervical cancer cell lines. Previous studies showed that AAV infection has some negative effects on HPV infection and that the cervical cancer cell growth is inhibited by AAV infection. The aim of this study is to determine the prevalence of AAV 2 infection and its possible roles for influencing HPV 16 and 18 infection in Korean women by analyzing adjacent normal, CIN, and invasive cervical cancer tissue samples. METHODS: CIN I (20), CIN II (24), CIN III (25), invasive cervical cancer (23) tissues were investigated by microdissection and PCR analyses using primers of HPV 16, 18 and AAV 2 as well as beta- globin as an internal control. RESULTS: AAV 2 was detected in 57 out of 92 cervical lesion biopsies. Among these, mild dysplasia, moderate dysplasia, severe dysplasia and invasive cancer showed 55% (11/20), 95.8% (23/24), 52% (13/25) and 52.2% (12/23), respectively. However, HPV 16 was detected in 14 out of 92 cervical lesion biopsies. Among these, mild dysplasia, moderate dysplasia, severe dysplasia and invasive cancer showed 0% (0/20), 8.3% (2/24), 24% (6/25) and 26.1% (6/23), respectively. HPV 18 was detected in 3 out of 92 cervical lesion biopsies. Among these, mild dysplasia, moderate dysplasia, severe dysplasia and invasive cancer showed 0% (0/20), 4.2% (1/24), 8% (2/25) and 0% (0/23), respectively. In contrast, In 92 perilesional normal biopsies, AAV 2, HPV 16 and HPV 18 were detected to be 57.6% (53/92), 3.3% (3/92) and 0% (0/92), respectively. CONCLUSION: AAV 2 was detected in CIN and invasive cervical cancer biopsies by microdissection and PCR analyses in Korean women. It is difficult to confirm any significant roles of AAV 2 infection for developing cervical cancer. However, we observe that there is some correlation between AAV 2 and HPV infection in the carcinogenesis of cervical cancer. Further research remains to be done to further elucidate AAV 2 infection and its role for HPV infection and cervical cancer.

Expression Patterns of E-cadherin and beta-catenin According to Clinicopathological Characteristics of Hepatocellular Carcinoma / 대한간학회지

BACKGROUND/AIMS: E-cadherin is involved in intercellular binding and cellular polarity formation. beta-catenin plays a fundamental role in regulation of the E-cadherin cell adhesion complex. The abnormalities of the components of the complex may disrupt this adhesive function. We investigated the expression patterns of E-cadherin and beta-catenin to determine the clinical significance of these proteins in hepatocellular carcinoma. MATERIALS/METHODS: Thirty-six hepaticellular carcinoma tissues and adjacent non-tumor specimens were analyzed. Subcellular distribution of E-cadherin and beta-catenin was examined by immunohistochemistry staining. We evaluated the patterns of the expression, and investigated the relationship with the cause of HCC; level of AFP; TNM stage; tumor size; growth types; metastasis; differentiation grade of HCC; and presence of portal vein thrombosis. RESULTS: Immunohistochemistry showed that all non-tumor tissues had membranous type staining of E-cadherin. All non-tumor tissues showed cytoplasmic type staining of beta-catenin, but no beta-catenin accumulation in nuclei was found. 58% (21/36) of HCC showed positive expression of E-cadherin in cytoplasmic membrane. The cytoplasmic expression of beta-catenin in HCC was 83% (30/36); nuclear expression in 14% (5/36); and no staining in 3% (1/36). Nuclear beta-catenin expression was observed in none (0/4) of the well-differentiated HCC; 17%(3/9) of moderate-differentiated HCC; and 17%(2/6) of poorly-differentiated HCC. There were no relationships between E-cadherin and beta-catenin expression with other clinicopathologic factors. CONCLUSIONS: Loss of cytoplasmic staining of E-cadherin and nuclear accumulation of beta-catenin were observed in HCC. Nuclear accumulation of beta-catenin was not found in well differentiated HCC but was found in poorly differentiated HCC.

Two Cases of Primary Carcinoma of the Fallopian Tube / 대한산부인과학회잡지

Primary fallopian tube carcinoma is a rare tumor, accounting for approximately 1% of all female genital tract malignancies. Its histologic appearance and clinical behavior resemble that of primary ovarian carcinoma, with a reported 5-year survival rate of about 30% to 50%. Presenting symptoms are variable, so pre-operative diagnosis of fallopain tube carcinoma is seldom made. Evaluation and treatment are also essentially the same as that of ovary cancer. Two postmenopausal women presented with pelvic mass and vaginal bleeding. One case was initially diagnosed as endometrioma, the other as endometritis but postoperatively pathologic examination of resected specimen revealed primary adenocarcinoma of the fallopian tube in debulking operation. We have experienced two cases of primary carcinoma of fallopian tube and reported with brief review of literature.

Invasive Ductal Carcinoma of the Male Breast: A Case Report and Review of the Literature / Journal of the Korean Cancer Association, 대한암학회지

Breast carcinomas are an uncommon neoplastic condition in men, accounting for only 1% of all breast cancers, and less than 1% of all malignancies in men. A 70-year-old man who presented a right breast mass was found to have infiltrating ductal carcinoma. We herein report the case with a review of the literature.

Effects of Delayed Test, Hemolysis and Turbidity on Measurement of PT and aPTT / 대한임상병리학회지

BACKGROUND: Sometimes we receive specimens collected several hours ahead, hemolyzed, or turbid. To decide to analyze the samples or not, the influence of storage time, hemolysis, and turbidi-ty on PT and PTT were studied. METHODS: Total of 198 cases for PT and 192 for aPTT were studied to clarify the effect of storage time on PT and aPTT. We performed the tests of PT and aPTT at 0, 2, 4, and 8 hours after collection of specimens. For the hemolysis effect study, we used 31 cases. Slightly, moderately, and severely hemolyzed plasma were obtained by adding hemolysate to plasma. For the turbidity effect study, we used 30 cases. Slightly, moderately, and severely turbid plasma were obtained by adding Intrali-pos (20% soybean oil) to plasma. RESULTS: Delayed test time affected the aPTT results after 8 hours. Hemolysis affected the PT and aPTT results. Turbidity did not affect the PT and aPTT results; however, the Coagrex-100s rejected to analyze the severely turbid samples. CONCLUSIONS: It is recommended that specimens be evaluated immediately or within 4 hours and that hemolysed or severely turbid specimens for PT and aPTT tests not be used.

Ras Gene Mutations and Expression of ERK1 and ERK2 Proteins in Stomach Cancer

BACKGROUND: We investigated stomach cancers for ras abnormalities and expression of ERK1 and ERK2 to determine their significance in the tumor development and/or progression and to evaluate their potential correlation with clinicopathologic parameters. METHODS: Seventy gastric adenocarcinomas were studied immunohistochemically in paraffin-embedded tissue sections for the expression of ERK1 and ERK2 proteins. All tumors were further analyzed with the use of a polymerase chain reaction technique and a direct sequence analysis procedure for the presence of the mutated ras gene. RESULTS: ERK1 and/or ERK2 was expressed in 65.7% (46/70) of the tumors; overexpression of ERK1 was observed in 38 (54.3%) tumors, whereas ERK2 was detected in 29 (41.4%). Nine (12.8%) samples demonstrated multations in the ras gene: 4 in H-ras and 5 in K-ras. Seven of the 9 (77.8%) mutated tumors were of the intestinal type. No association was established between the ras abnormalities and the overexpression of ERK1 and/or ERK2. However, the correlation between ERK2 and progression (early vs. advanced) was statistically significant (p<0.05). CONCLUSIONS: These data indicate that ras abnormalities are uncommon events in gastric adenocarcinomas. The majority of ras mutations, however, occurred in intestinal-type tumors, supporting the notion of different molecular mechanisms involved between the intestinal-and diffuse-type lesions. Enhanced ERK2 activity may provide assistance in the determination of tumor penetration in these tumors.

A Case of Septicemia by Transient Glycopeptide: Dependent Enterococcus faecium / 감염

The isolation of clinical strains of enterococci requiring vancomycin for growth has been reported, but transient strain has not been reported. Transient glycopeptide-dependent Enterococcus f aecium was isolated from the blood of a 59-year-old female with advanced rectal carcinoma during long term broad-spectrum antimicrobial therapy. This strain showed transient glycopeptide dependency, but glycopeptide-resistant revertants were found on subculture to blood agar without vancomycin. It was found to be the vanA genotype by the polymerase chain reaction analysis.

Oligodendroglioma Arising in a Sacrococcygeal Immature Teratoma

Tumors of neuroepithelial origin are extremely rare in teratoma and tend to be derived from glial or primitive neuroectodermal cells. We describe a case of 2- month-old baby girl with an oligodendroglioma arising in an immature teratoma of the sacrococcygeal region. Histologically, the tumor was identical in appearance to low grade oligodendroglioma within the adult brain. Because immature teratoma was grade II, the patient received adjuvant chemotherapy. The patient died of progression of the intra-abdominal tumor 6 months after surgical excision. The authors believe this to be the first presentation in the world literature.

Streptococcus pneumoniae Isolates with Decreased Susceptibility to Optochin / 대한임상미생물학회지

Streptococcus pneumoniae is the most common cause of community-acquired pneumonia in adults and an important agent in other infections, including meningitis, otitis media, and conjunctivitis, etc. The optochin susceptibility test is the most widely used method to discriminate S. pneumoniae from other streptococci. However, 0.8-1.5% of S. pneumoniae contain optochin resistant population. Recently, we experienced three cases of variants of S. pneumoniae with decreased susceptibility to optochin. Equivocal optochin disk test should be confirmed by bile solubility, agglutination test, or DNA probe test.