Spindle cell oncocytoma of the sella turcica with anaplastic features and rapid progression in short-term follow-up: a case report with proposal of distinctive radiologic features

We present a rare case of spindle cell oncocytoma (SCO) of the sella turcica with malignant histologic features and rapid progression. A 42-year-old woman experienced bilateral blurred vision and was preoperatively misdiagnosed as having a pituitary macroadenoma on magnetic resonance imaging. After surgery, SCO was diagnosed by the histopathologic features of interlacing fascicles of spindle tumor cells with finely granular, eosinophilic cytoplasm. Focal anaplastic changes and necrosis were present. Immunohistochemically, the tumor cells were positive for vimentin, epithelial membrane antigen, S-100, galectin-3, and thyroid transcription factor 1. Four months later, the tumor had progressed, and second surgery with adjuvant radiotherapy was performed; the patients remains under observation. In this report, we proposed distinctive radiologic features for differential diagnosis between SCO and other pituitary tumors.

Spindle cell oncocytoma of the sella turcica with anaplastic features and rapid progression in short-term follow-up: a case report with proposal of distinctive radiologic features

We present a rare case of spindle cell oncocytoma (SCO) of the sella turcica with malignant histologic features and rapid progression. A 42-year-old woman experienced bilateral blurred vision and was preoperatively misdiagnosed as having a pituitary macroadenoma on magnetic resonance imaging. After surgery, SCO was diagnosed by the histopathologic features of interlacing fascicles of spindle tumor cells with finely granular, eosinophilic cytoplasm. Focal anaplastic changes and necrosis were present. Immunohistochemically, the tumor cells were positive for vimentin, epithelial membrane antigen, S-100, galectin-3, and thyroid transcription factor 1. Four months later, the tumor had progressed, and second surgery with adjuvant radiotherapy was performed; the patients remains under observation. In this report, we proposed distinctive radiologic features for differential diagnosis between SCO and other pituitary tumors.

Gastromalacia (Postmortem Gastric Perforation): Two Cases Reports / 대한법의학회지

Gastromalacia refers to the postmortem acute autolytic erosion of the gastric wall. It should be distinguished from gastric perforations caused by antemortem injuries or other pathologic processes, such as ulcer perforations. It appears as a slimy brownish-black perforation of the gastric wall. The diagnosis is based on the presence of a typical macroscopic perforation in the fundic portion of the stomach, lack of vital reactions in the adjacent organs, and lack of clinical or autopsy evidence of trauma. Here, we report two cases of gastromalacia: one in a 53-year-old woman who died from severe head injury and another in a 2-year-old child who died from neglect by his father. Gastromalacia is a welldefined phenomenon, but due to its rarity in the practical work, it could be misdiagnosed as other causes of gastric perforation.

A Study on the Usefulness of Postmortem Diabetes Mellitus-Related Tests / 대한법의학회지

Diabetes mellitus (DM) is a group of metabolic disorders, that have become a major cause of death worldwide. This study aimed to determine the usefulness of diabetes-related laboratory tests for diagnosis of postmortem DM. From March to August 2018, among the autopsy cases investigated by the National Forensic Service, heart blood and vitreous humor samples from 253 cases that had not been decomposed were collected, and the data from 208 cases except 45 cases that were incapable of testing were analyzed for statistical significance and compared with the causes of death on autopsy reports. The levels of C-peptide, insulin, acetoacetate, β-hydroxybutyrate (β-HA), total ketone, and HbA1c were measured in the heart blood, and the levels of glucose, blood urea nitrogen, creatinine, and potassium were measured in the vitreous humor. The levels of glucose in the vitreous humor and HbA1c, β-HA, and total ketone in the heart blood were significantly correlated. C-peptide and insulin levels were lower than normal levels in most cases (C-peptide 92.3%, P=0.480, insulin 97.6%, P=0.589), and were not useful measures indicating diabetic complications. In the group with DM history, the average levels of HbA1c from the heart blood and glucose from the vitreous humor were higher than in those with no or unknown history of DM, indicating their usefulness as diagnostic tools. The results of this study suggest a postmortem DM diagnosis model.Therefore, postmortem DM-related tests can help diagnose the cause of death in forensic medicine.

Influence of Human PapillomaVirus Infection Detected by Cervical Swap on In-vitro Fertilization Outcomes / 계명의대학술지

Human papilloma virus (HPV) infection had been suspected of harmful effect on reproduction by increasing blastocyst apoptosis and reducing the endometrial implantation of trophoblastic cells. However, the available evidence is conflicting concerning the impact of HPV in female reproductive system on the outcome of in-vitro fertilization (IVF) The aim of study was to evaluate IVF outcomes regarding the cervical HPV infection. Retrospective case-control study conducted in women suffered IVF cycle. All women were evaluated the HPV infection using PCR by cervical swap before the initiation of IVF cycle. One hundred thirty six cycles were evaluated. The harvested oocytes number, top quality embryo number, fertilization rate, implantation rate, clinical pregnancy rate, live birth rate and miscarriage rate were analyzed depend on HPV infection. Mean age of enrolled women was 35.20±4.79 years-old, mean parity was 0.17±0.57, and mean number of miscarriage was 0.81±1.49. Basal FSH was 5.42±2.59 IU/L and AMH level was 5.07±11.01 ng/mL, which was not different between two groups. Mean harvested oocytes was 6.36±4.32 in HPV infected women compared with 8.63±5.95 in women without infection, statistically insignificant. Top quality embryos of each group were not different (2.67±0.82, 2.53±1.53 separately). In women with HPV infection, ongoing pregnancy rate (27.3%) and live birth rate (18.2%) were similar with women without infection (23.7%, 14.0%). And also, fertilization rate and implantation rate were similar. Miscarriage rate of each group was 33.3%, and 40.7%, which was statistically insignificant. The HPV infection in women did not make the adverse influence on IVF outcomes.

Extramedullary tanycytic ependymoma of the lumbar spinal cord / 영남의대학술지

Tanycytic ependymoma is a rare variant of ependymoma that commonly affects the cervical and thoracic spinal cord. It usually arises as intramedullary lesions, and extramedullary cases are extremely rare. We report a case of a 44-year-old woman who was diagnosed with tanycytic ependymoma in her lumbar spine at level 2-3. The tumor mass developed in an intradural extramedullary location. Histopathologically, tanycytic ependymoma can be misdiagnosed as schwannoma or pilocytic astrocytoma. Immunohistochemical findings such as strong positivity for glial fibrillary acidic protein, perinuclear dot-like positive patterns for epithelial membrane antigen, and focal positivity for S-100 are helpful in diagnosing tanycytic ependymoma. It is important to be aware of this rare tumor to ensure appropriate patient management and accurate prognosis.

Gastromalacia (Postmortem Gastric Perforation): Two Cases Reports / 대한법의학회지

Gastromalacia refers to the postmortem acute autolytic erosion of the gastric wall. It should be distinguished from gastric perforations caused by antemortem injuries or other pathologic processes, such as ulcer perforations. It appears as a slimy brownish-black perforation of the gastric wall. The diagnosis is based on the presence of a typical macroscopic perforation in the fundic portion of the stomach, lack of vital reactions in the adjacent organs, and lack of clinical or autopsy evidence of trauma. Here, we report two cases of gastromalacia: one in a 53-year-old woman who died from severe head injury and another in a 2-year-old child who died from neglect by his father. Gastromalacia is a welldefined phenomenon, but due to its rarity in the practical work, it could be misdiagnosed as other causes of gastric perforation.

Gastromalacia (Postmortem Gastric Perforation): Two Cases Reports / 대한법의학회지

Gastromalacia refers to the postmortem acute autolytic erosion of the gastric wall. It should be distinguished from gastric perforations caused by antemortem injuries or other pathologic processes, such as ulcer perforations. It appears as a slimy brownish-black perforation of the gastric wall. The diagnosis is based on the presence of a typical macroscopic perforation in the fundic portion of the stomach, lack of vital reactions in the adjacent organs, and lack of clinical or autopsy evidence of trauma. Here, we report two cases of gastromalacia: one in a 53-year-old woman who died from severe head injury and another in a 2-year-old child who died from neglect by his father. Gastromalacia is a welldefined phenomenon, but due to its rarity in the practical work, it could be misdiagnosed as other causes of gastric perforation.

Review of Suicidal Electrocution in South Korea from 2008 Year to 2018 Year / 대한법의학회지

The authors investigated the cases of electrocution suicides in South Korea from 2008 to 2018. Out of 151,419 suicides during this 11-year period, suicide by electrocution was extremely rare. Only nine victims were recorded in eight cases, with one case involving a married couple. The majority of the victims were men (89%), and only one case involved a woman (11%). The mean age of the victims was 55 years, and ranged from 38 to 74 years. In all cases, the suicides occurred in the home, and low-voltage electricity was used. Two of the nine victims (22%) had an occupation related with electrical knowledge. Mental illness, such as depression and schizophrenia, was found in two cases (22%). An autopsy was not performed in all cases.

Review of Suicidal Electrocution in South Korea from 2008 Year to 2018 Year / 대한법의학회지

The authors investigated the cases of electrocution suicides in South Korea from 2008 to 2018. Out of 151,419 suicides during this 11-year period, suicide by electrocution was extremely rare. Only nine victims were recorded in eight cases, with one case involving a married couple. The majority of the victims were men (89%), and only one case involved a woman (11%). The mean age of the victims was 55 years, and ranged from 38 to 74 years. In all cases, the suicides occurred in the home, and low-voltage electricity was used. Two of the nine victims (22%) had an occupation related with electrical knowledge. Mental illness, such as depression and schizophrenia, was found in two cases (22%). An autopsy was not performed in all cases.

Pregnancy-Related Acute Myocardial Infarction: A Case Report / 대한법의학회지

Pregnancy-related acute myocardial infarction (AMI) is very rare and can be lethal if the diagnosis and management are delayed. The physiological changes during pregnancy, including in hemodynamics and hormonal status, can increase the risk of AMI even in young women. While atherosclerosis is the leading cause of AMI in the general population, coronary artery dissection is most common in pregnancy-related AMI. Pregnancy-related AMI, which is caused by coronary atherosclerosis, has been rarely reported in Korea. We report an autopsy case of postpartum sudden cardiac death in a 32-year-old woman.

Live twin tubal ectopic pregnancy after ovulation induction / 대한산부인과학회지

Twin tubal ectopic pregnancy is rare. Especially the live twin tubal ectopic pregnancy is extremely rare, just 10 cases have been reported until now. There were 9 cases of live twin tubal pregnancy after spontaneous conception and one case after IVF cycle. This is the first report of live twin tubal ectopic pregnancy after ovulation induction with clomiphene citrate. A 31-year-old woman, nulligravida complained of primary infertility and irregular menstruation. After ovulation induction with clomiphen citrate, beta-hCG was 1566 mIU/mL on missed period of 5 weeks 4 days. On 6(+1) weeks, beta-hCG was elevated to 3446 mIU/mL and transvaginal ultrasound revealed two separated gestational sacs, each containing yolk sac in the left tube. The variable dose of methotrexate therapy was tried using 1 mg/kg of methotrexate and 0.1 mg/kg of leukovorin. These were injected alternatively for 8 days. On 7(+3) weeks, beta-hCG was elevated to 8,029 mIU/mL and transvaginal ultrasound revealed two fetal poles with heart beat in each gestational sacs. Laparoscopic salpingectomy was performed. The diagnosis was confirmed by the operative finding and also in the pathologic report. It is needed that careful ultrasonographic examination especially in the case of ovulation induction or IVF-ET. Methotrexate treatment in twin tubal pregnancy was usually failed. There was only one successful report by the direct injection of methotrexate to the fallopian tube combined with single intramuscular injection. Further research for dosage or route of administration will be needed.

Expression and Mutational Analysis of c-kit in Ovarian Surface Epithelial Tumors

Coexpression of Kit ligand and c-kit has been reported in some gynecologic tumors. To determine whether imatinib mesylate is useful in ovarian epithelial tumors, we performed immunohistochemical and mutational analysis. The cases consisted of 33 cases, which included 13 serous cystadenocarcinomas, 1 borderline serous tumor, 8 mucinous cystadenocarcinomas, 6 borderline mucinous tumors and 5 clear cell carcinomas. Five cases of serous cystadenoma and 5 cases of mucinous cystadenoma were also included. In the immunohistochemical study, 3 cases (3/6, 50%) of borderline mucinous cystic tumor and two cases (2/8, 25%) of mucinous cystadenocarcinoma show positive staining for KIT protein. Only one case (1/13, 7.7%) of serous cystadenocarcinoma had positive staining. On mutational analysis, no mutation was identified at exon 11. However, two cases of borderline mucinous tumors and one case of mucinous cystadenocarcinoma had mutations at exon 17. In these cases, the immunohistochemistry also shows focal positive staining at epithelial component. Although, KIT protein expression showed higher incidence in mucinous tumors than serous tumors, they lack KIT-activating mutations in exon 11. Thus, ovarian surface epithelial tumors are unlikely to respond to imatinib mesylate.

A case of Pseudo-Meigs' syndrome with Brenner tumor / 부인종양

Meigs' syndrome is defined by the presence of ascites and hydrothorax in association with an ovarian fibroma, which spontaneously resolve soon after the removal of the tumor. Pseudo-Meigs' syndrome is rare syndrome associated with struma ovarii, yolk sac tumor, ovarian carcinoma, leiomyoma, Brenner tumor and tuberculosis which is combined with the same clinical feature. The cause and pathophysiology of Pseudo-Meigs' syndrome are uncertain. The diagnosis is done by characteristic clinical finding. We present a case of Pseudo-Meigs' syndrome with Brenner tumor with brief review of the literatures.

A case of Pseudo-Meigs' syndrome with Brenner tumor / 부인종양

Meigs' syndrome is defined by the presence of ascites and hydrothorax in association with an ovarian fibroma, which spontaneously resolve soon after the removal of the tumor. Pseudo-Meigs' syndrome is rare syndrome associated with struma ovarii, yolk sac tumor, ovarian carcinoma, leiomyoma, Brenner tumor and tuberculosis which is combined with the same clinical feature. The cause and pathophysiology of Pseudo-Meigs' syndrome are uncertain. The diagnosis is done by characteristic clinical finding. We present a case of Pseudo-Meigs' syndrome with Brenner tumor with brief review of the literatures.

A Case of Inflammatory Fibroid Polyp in the Duodenum / 대한소화기내시경학회지

Inflammatory fibroid polyp is a relatively uncommon, localized benign lesion of the gastrointestinal wall. It is seen mostly as a single entity and the majority of inflammatory fibroid polyps have been reported with pathologic examination in the stomach but rarely in small intestines. A 70-year-old woman was presented with intermittent epigatric discomfort and gastroduodenoscopy showed a polypoid lesion with oval shaped, central depression, and normal mucosal covering. Endoscopic ultrasonography showed 8x6 mm sized hypoechoic tumor which was located mainly in the third layer of the duodenal wall with indistinct margin. The tumor was successfully removed by endoscopic resection after the injection of hypertonic saline solution with epinephrine and banding. The tumor consisted of loose fibrous stroma, small blood vessels and inflammatory cells. We present a case of inflammatory fibroid polyp of the duodenum with review of the literatures.

Vaginal Delivery in Hirschsprung's disease complicating pregnancy / 대한산부인과학회지

Bowel obstruction is a rare complication of pregnancy. The usual causes include previous abdominal surgery, volvulus, intussusception, colonic neoplasm, or the enlarging uterus. Bowel obstruction secondary to uncorrected Hirschsprung's disease as a complication of pregnancy is difficult to diagnosis, its occurrence can have grave implications for both mother and fetus, and anticipation of dystocia. Hirschsprung's disease is diagnosed and treated in the neonatal period. Persistence of Hirschsprung's disease into adulthood is very rare and confirmed by rectal biopsy providing the absence of the ganglion cell in Auerbach and Meissner's plexus. We experienced vaginal Delivery in Hirschsprung's disease complicating pregnancy and report our own case study with a brief literature review.

Scrotal Arteriovenous Malformation / 대한비뇨기과학회지

Arteriovenous malformation (AVM) of the scrotum is a rare vascular lesion, which is distinguished histologically by ambiguous vessels displaying both arterial and venous characteristics and abnormal muscularization of variable sized ectatic vessels. Complete excision is recommended as a definitive treatment. Here, a case of arteriovenous malformation involving the scrotal vessels is reported.

Fine Needle Aspiration Cytology of Eccrine Spiradenoma: Report of a Case / 대한세포병리학회지

Eccrine spiradenoma is a rare adnexal tumor of the skin and its cytomorphology has seldom been described in literature. To evaluate the cytologic features and diagnostic pitfalls of eccrine spiradenoma, we report a case of 33-year-old male whose clinical presentation was a painful subcutaneous mass at the right preauricular area. Fine needle aspirates revealed tight clusters of multilayered, uniform, cuboidal cells arranged around hyalinized perivascular spaces. Some epithelial cells showed tubules or rosette formations. The background showed scattered, naked nuclei. The histologic findings confirmed the eccrine spiradenoma. The recognition of peculiar cytologic features and clinical correlation could be helpful in the diagnosis of skin adnexal tumors.

Two Cases of Primary Ovarian Transitional Cell Carcinoma / 대한산부인과학회잡지

Primary ovarian transitional cell carcinoma (TCC) is extremely rare tumor and recently it has been recognized as one of histologic subtype of ovarian epithelial carcinomas. Primary ovarian TCC has been classified as a different subtype from malignant Brenner tumor for it's histologic and clinical characteristics. Several recent studies repoert immunohistochemical stains are helpful to differentiate this tumor from TCC of bladder. Primary ovarian TCC usually presents at an advanced stage and behaves aggressively however, these tumors appear to be more sensitive to chemotherapy than other ovarian carcinomas and may have a better prognosis. We experienced two cases where operation and chemotherapy have made for primary ovarian TCC patients and report our own case studies with a brief literature review.