Inflammatory Myofibroblastic Tumor of the Prostate Mimicking Prostate Cancer: A Case Report

Inflammatory myofibroblastic tumor (IMT) is an uncommon soft tissue tumor mimicking malignancy, which can be found in any part of the body. However, IMT involving the prostate is extremely rare. Previous reports on prostatic IMTs mainly focused on the pathological and immunohistochemical findings of the tumor and they lacked radiological findings. This report presents a case of prostatic IMT in a 60-year-old man who presented with voiding difficulty and elevated prostate-specific antigen (PSA) level. On magnetic resonance imaging, a hypointense mass was observed on T2-weighted images with broad and extensive extracapsular extension, showing diffusion restriction, early well enhancement and delayed mild washout, which could mimic prostate cancer. On needle biopsy of the prostate mass, cancer cells were not detected; and a benign tumor was suspected with a normalized PSA level. Finally, prostatectomy was performed to rule out prostate cancer; and prostatic IMT was confirmed on histopathologic examination.

A Case of Intracranial Solitary Fibrous Tumor/Hemangiopericytoma Repeatedly Misdiagnosed as Hypertensive Intracerebral Hemorrhage

Because solitary fibrous tumor (SFT) and hemangiopericytoma (HPC) contain identical genetic abnormalities, the World Health Organization coined the term SFT/HPC to describe these lesions. Here, we present a rare case of SFT/HPC in a 40-year-old man with massive repeated intracranial hemorrhage (ICH) in right medial temporal lobe. ICHs from a SFT/HPC were repeatedly misdiagnosed as hypertensive ICH by several departments and hospitals over approximately eight months, and the patient underwent inappropriate treatments. The amount of repeated ICH accompanying the tumor has increased significantly compared to the first ICH, which may suggest rapid tumor growth. To avoid misdiagnosis and inappropriate treatment, surgeons should carefully examine all past and current patient-related radiological images and medical records before considering surgery.

Atypical Thyroiditis Following Influenza B Infection

Viral infections are known to be a predisposing factor for subacute (De Quervain's) thyroiditis. In this report, we document a novel case of thyroiditis, with an atypical presentation, following an influenza B infection. A 13-year-old previously healthy female visited the outpatient clinic complaining of right neck pain. She had been diagnosed with an influenza B infection at a local clinic 3 weeks earlier. All laboratory tests were normal. A thyroid ultrasound showed an ill-defined hypoechoic mass (1.0×0.5×1.5 cm) in the right lower thyroid, and scintigraphy of the thyroid with Technetium-99m (99m-Tc) demonstrated the normal uptake of the radiotracer. Fine-needle aspiration from the nodule showed the presence of a few neutrophils. To the best of our knowledge, this is the first case of atypical thyroiditis associated with an influenza B infection described in the literature. Influenza B infection should be considered as a possible cause of atypical thyroiditis.

Are Irregular Hypoechoic Breast Masses on Ultrasound Always Malignancies?: A Pictorial Essay

Irregular hypoechoic masses in the breast do not always indicate malignancies. Many benign breast diseases present with irregular hypoechoic masses that can mimic carcinoma on ultrasonography. Some of these diseases such as inflammation and trauma-related breast lesions could be suspected from a patient's symptoms and personal history. Careful ultrasonographic examination and biopsy could help to differentiate these from malignancies.

Imaging Findings Of Desmoplastic Fibroma Rarely Involving The Clavicle: Case Report

Desmoplastic fibroma of bone is a rare locally aggressive, but non-metastatic tumor. In this case report, we present a desmoplastic fibroma in an unusual location, the clavicle. Desmoplastic fibroma involving the clavicle is extremely rare, with only 2 reported cases before 1985. We report the imaging findings of a desmoplastic fibroma of the clavicle with a review of the relevant literature.

Invasive Aspergillosis Arising from Ureteral Aspergilloma

Ureteral obstruction may develop in immunocompromised patients with an Aspergillus fungal infection. Infections can progress to invasive aspergillosis, which is highly lethal. We report a case of a 56-year-old man with alcoholic cirrhosis of the liver and diabetes. He had ureteral aspergilloma, discovered as a saprophytic whitish mass. It was treated by ureteroscopic removal, however, he refused antifungal treatment. His condition progressed to invasive aspergillosis, and died from sepsis and hepatorenal syndrome.

Acinic Cell Carcinoma of the Palatine Tonsil: A Brief Case Report

Acinic cell carcinoma (ACC) is a rare, low-grade malignancy of the salivary glands. Most cases occur in the major salivary glands, especially the parotid gland, with only a few cases involving the minor salivary gland previously described. A 67-year-old male patient was admitted complaining of an obstructive feeling in the throat. On examination, a lobulated mass in the tonsillar surface was noticed. Tonsillectomy was performed under general anesthesia. Histopathological examination of the mass revealed sheets of large, polygonal acinar cells with granular, slightly basophilic cytoplasm, which led to the diagnosis of ACC. Here, we present a case of low-grade ACC of the palatine tonsil, which we believe to be the first reported case of ACC in this location.

Amorphigenin inhibits Osteoclast differentiation by suppressing c-Fos and nuclear factor of activated T cells / 대한해부학회지

Among the several rotenoids, amorphigenin is isolated from the leaves of Amopha Fruticosa and it is known that has anti-proliferative effects and anti-cnacer effects in many cell types. The main aim of this study was to investigate the effects of amorphigenin on osteoclast differentiation in vitro and on LPS treated inflammatory bone loss model in vivo. We show here that amorphigenin inhibited RANKL-induced osteoclast differentiation from bone marrow macrophages in a dose dependent manner without cellular toxicity. Anti-osteoclastogenic properties of amorphigenin were based on a down-regulation of c-fos and NFATc1. Amorphigenin markedly inhibited RANKL-induced p38 and NF-kappaB pathways, but other pathways were not affected. Micro-CT analysis of the femurs showed that amorphigenin protected the LPS-induced bone loss. We concluded that amorphigenin can prevent inflammation-induced bone loss. Thus we expect that amorphigenin could be a treatment option for bone erosion caused by inflammation.

A Case of Multiple Fungal Balls Involving the Isolated Three Sinuses

The fungal ball usually occurs in a single sinus, most frequently in the maxillary sinus, and multiple sinus localization has rarely been reported? Recently, the authors experienced a rare case of multiple fungal balls involving three sinuses that were not contiguous, the bilateral maxillary sinuses and right sphenoid sinus. The patient had a history of endodontic treatment. We report this rare case with a literature review.

Visualization of Tumor Angiogenesis Using MR Imaging Contrast Agent Gd-DTPA-anti-VEGF Receptor 2 Antibody Conjugate in a Mouse Tumor Model

OBJECTIVE: To visualize tumor angiogenesis using the MRI contrast agent, Gd-DTPA-anti-VEGF receptor 2 antibody conjugate, with a 4.7-Tesla MRI instrument in a mouse model. MATERIALS AND METHODS: We designed a tumor angiogenesis-targeting T1 contrast agent that was prepared by the bioconjugation of gadolinium diethylenetriaminepentaacetic acid (Gd-DTPA) and an anti-vascular endothelial growth factor receptor-2 (VEGFR2) antibody. The specific binding of the agent complex to cells that express VEGFR2 was examined in cultured murine endothelial cells (MS-1 cells) with a 4.7-Tesla magnetic resonance imaging scanner. Angiogenesis-specific T1 enhancement was imaged with the Gd-DTPA-anti-VEGFR2 antibody conjugate using a CT-26 adenocarcinoma tumor model in eight mice. As a control, the use of the Gd-DTPA-anti-rat immunoglobulin G (Gd-DTPA-anti-rat IgG) was imaged with a tumor model in eight mice. Statistical significance was assessed using the Mann-Whitney test. Tumor tissue was examined by immunohistochemical analysis. RESULTS: The Gd-DTPA-anti-VEGFR2 antibody conjugate showed predominant binding to cultured endothelial cells that expressed a high level of VEGFR2. Signal enhancement was approximately three-fold for in vivo T1-weighted MR imaging with the use of the Gd-DTPA-anti-VEGFR2 antibody conjugate as compared with the Gd-DTPA-rat IgG in the mouse tumor model (p < 0.05). VEGFR2 expression in CT-26 tumor vessels was demonstrated using immunohistochemical staining. CONCLUSION: MR imaging using the Gd-DTPA-anti-VEGFR2 antibody conjugate as a contrast agent is useful in visualizing noninvasively tumor angiogenesis in a murine tumor model.

Intraventricular Malignant Meningioma with CSF-Disseminated Spinal Metastasis : Case Report and Literature Review

The authors report a case of 42-year-old woman with an intraventricular tumor in the trigone of the left lateral ventricle. The first operation achieved a microscopically complete resection. The tumor was histologically atypical meningioma. After 26 months, there were recurrences of intraventricular meningioma. Complete resection of the tumor and adjuvant radiation therapy were performed, and the histological diagnosis was malignant meningioma. Sixteen months after the second operation, spinal metastasis in cervicolumbar lesion was diagnosed and a subtotal removal of cervical intradural extramedullary mass was performed. We describe an unusual case of intraventricular malignant meningioma with cerebrospinal fluid-disseminated spinal metastases with review of the clinical courses of previous reports.

Congenital Seminal Vesicle Cyst Associated with Ipsilateral Renal Agenesis

PURPOSE: A seminal vesicle cyst in combination with ipsilateral renal agenesis is rarely encountered. We present cases of this disease entity with symptoms, which were treated with a laparoscopic approach as a minimally invasive surgical treatment. MATERIALS AND METHODS: We experienced 4 patients with seminal vesicle cysts and ipsilateral renal agenesis. The mean age was 45.8 years. Chief complaints were perineal pain and hematospermia. Seminal vesicle cysts and remnant ureters were excised by laparoscopic surgery with transperitoneal approaches. RESULTS: The mean operative time was 133.8 minutes. The mean hospital stay was 6.8 days. There were no operative complications or transfusions. CONCLUSION: In our report, patients of congenital seminal vesicle cyst associated with renal agenesis are presented. Laparoscopy is considered a minimal invasive management of these combined anomalies, providing a good image and an easy approach.

A Neurofibroma Confused with Sarcomatous Transformation on F-18 FDG PET/CT in Neurofibromatosis-1 / 핵의학분자영상

We present a patient with high 18F-fluorodeoxyglucose (FDG) uptake detected in a neurofibroma that was confused with sarcomatous transformation on a positron emission tomography/computed tomography (PET/CT) scan. A 39-year-old male patient with a 20-year history of neurofibromatosis-1 (NF-1) performed FDG PET/CT scan for the evaluation of lesions with sarcomatous transformation. The FDG PET/CT images demonstrated varying degrees of increased FDG uptake in the multiple nodules throughout whole body. The left pelvic mass with the highest FDG uptake had a maximum standardized uptake values (maxSUV) 5.0 and surgical resection was performed. Histological analysis confirmed the presence of a benign neurofibroma infiltrated with inflammatory cells.

Usefulness of a Small-Field Digital Mammographic Imaging System Using Parabolic Polycapillary Optics as a Diagnostic Imaging Tool: a Preliminary Study

OBJECTIVE: To evaluate the efficacy for spatial resolution and radiation dose of a small-field digital mammographic imaging system using parabolic polycapillary optics. MATERIALS AND METHODS: We developed a small-field digital mammographic imaging system composed of a CCD (charge coupled device) detector and an X-ray source coupled with parabolic polycapillary optics. The spatial resolution and radiation dose according to various filters were evaluated for a small-field digital mammographic imaging system. The images of a test standard phantom and breast cancer tissue sample were obtained. RESULTS: The small-field digital mammographic imaging system had spatial resolutions of 12 lp/mm with molybdenum and rhodium filters with a 25-micrometer thickness. With a thicker molybdenum filter (100 micrometer thick), the system had a higher spatial resolution of 11 lp/mm and contrast of 0.48. The radiation dose for a rhodium filter with a 25-micrometer thickness was 0.13 mGy within a 10-mm-diameter local field. A larger field image greater than 10 mm in diameter could be obtained by scanning an object. On the small-field mammographic imaging system, microcalcifications of breast cancer tissue were clearly observed. CONCLUSION: A small-field digital mammographic imaging system with parabolic polycapillary optics may be a useful diagnostic tool for providing high-resolution imaging with a low radiation dose for examination of local volumes of breast tissue.

A case of pheochromocytoma presenting as inverted Takotsubo cardiomyopathy / 대한내과학회지

A 61-year-old woman was admitted to the emergency department with acute chest pain. Echocardiography showed transient cardiomyopathy with akinesia of the basal and midportions of the left ventricle and hyperkinesia of the apex. No evidence of ischemic cardiomyopathy on myocardial SPECT or ergonovine stress echocardiography was observed. The patient's condition at discharge had improved, but she later was diagnosed as having pheochromocytoma. The findings of transient cardiomyopathy revealed inverted Takotsubo cardiomyopathy related to pheochromocytoma. The recognition of such a rare cardiac manifestation should be considered in the diagnosis of pheochromocytoma.

The Effect of Continuous Epidural Electrical Stimulation on Synapse and Neuronal Cell in Rat with Focal Ischemia

OBJECTIVE: To evaluate the effects of continuous epidural electrical stimulation (ES) on the behavioral recovery, and the molecular proliferation of synapse and neural cell in rats with photothrombotic stroke. METHOD: The male Sprague-Dawley rats were pre-trained on a single pellet reaching task (SPRT), and then received the photothrombotic infarction on dominant sensorimotor cortex (SMC) and implantation of electrode over the peri-lesion SMC surface. All rats were randomly assigned to one of two groups: anodal ES on infarcted SMC (ES group) and no ES on infarcted SMC (control group). Rats received daily SPRT and neurological examinations for 14 days. After the rats had been sacrificed, brain sections were immunostained for quantification of infarct volumes and evaluation of the structural remodeling markers (MAP2, synaptophysin and GFAP). RESULTS: The functional improvement of SPRT was significantly increased in the ES group compared to control group. There were no significant group differences in the infarct volumes, neurological examinations, structural remodeling markers. But, in the ES group, MAP2 and synaptophysin in affected peri-infarct area tended to increase compared with unaffected hemisphere. In affected hemisphere of ES group, many structural remodeling markers tended to increase compared with unaffected hemisphere. Especially, the staining of synaptophysin and GFAP in peri-infarct area showed more increased uptake than unaffected hemisphere in ES group and control group, respectively (p<0.05). CONCLUSION: The ES improved greatly the behavioral motor function after SMC infarction and induced the significant synaptogenesis with the widespread neuronal proliferation in peri-infarct area. Postischemic astrogliosis was not remarkable in ES group.

Effect of Jak2 Inhibitor AG490 on Osteoclast Differentiation / 대한해부학회지

Osteoclasts are cells of hemopoietic origin that play an critical role in bone resorption and responsible for bone diseases, including osteoporosis, periodontal disease, and rheumatoid arthritis. In this study, we examined the effect of AG490, a Jak2-specific inhibitor on osteoclast differentiation. AG490 significantly inhibited receptor activator of NF-kappaB ligand (RANKL)-mediated osteoclast differentiation in a dose-dependent manner. RANKL stimulated the phosphorylation of p38, ERK, and JNK and promoted I-kappaB degradation. However, AG490 suppressed the phosphorylation of p38 induced by RANKL treatment. AG490 suppressed the mRNA expression of TRAP, c-Fos, NFATc1, and OSCAR in bone marrow-derived macrophages (BMMs) treated with RANKL. Also, AG490 significantly inhibited the protein expression of c-Fos and NFATc1 in response to RANKL. These results suggest that AG490 inhibited osteoclast differentiation by suppressing the expression of c-Fos and NFATc1.

Carcinosarcoma (True Malignant Mixed Tumor) of the Parotid Gland: A Report of a Case with Small Cell Carcinoma as the Carcinoma Component

True malignant mixed tumor (carcinosarcoma) of the salivary gland is an extremely rare tumor. By definition, it is a heterologous neoplasm that's composed of both malignant epithelial and mesenchymal components. We report here on a case of an 83 year old female patient with a parotid gland mass. Histologic examination showed a biphasic pattern of growth with both a poorly differentiated epithelial component and a sarcomatous spindle cell background. The immunohistochemical and ultrastructural findings support the diagnosis of a small cell neuroendocrine epithelial tumor and an undifferentiated malignant mesenchymal features. The histologic and ultrastructural features along with the immunohistochemical findings are presented. We also review the literature and we discuss the different opinions on the exact histogenesis of the true malignant mixed tumor of the salivary gland. To the best of our knowledge, this histological pattern has not been previously reported in the English medical literature.

Expression of Mutant p53 Protein, p21(waf1/cip1) and Cyclin D1 in Dysplasia and Adenocarcinoma of Stomach / 대한소화기내시경학회지

BACKGROUND/AIMS: Gastric carcinoma is a major cause of morbidity and mortality in Korea. It evolves through dysplasia to an invasive adenocarcinoma. The carcinogenesis of dysplasia and adenocarcinoma in the stomach was investigated by examining the levels of mutant p53 protein, p21(waf1/cip1), and cyclin D1 expression in gastric dysplasia and invasive adenocarcinoma. METHODS: Formalin- fixed paraffin-embedded tumors were examined immunohistochemically using the monoclonal antibodies to the 53 protein, p21(waf1/cip1) and cyclin D1. RESULTS: Mutant p53 protein, p21(waf1/cip1) and cyclin D1 expression were found in 66.6% (12/18), 72.2% (13/18) and 33.8% (6/18) of dysplasia, and 45.0% (9/20), 15.0% (3/20) and 30.0% (6/20) of invasive adenocarcinoma, respectively. CONCLUSIONS: These results suggest that p21(waf1/cip1), which is controlled by the p53 protein, plays a more important role in the carcinogenesis of the stomach than cyclin D1.

Adrenocortical Oncocytoma: A Case Report

Adrenocortical oncocytomas have rarely been reported on in the medical literature, and most of them have been nonfunctional and benign. We report here on a case of a 43-year-old man with a left abdominal mass. The patient showed no signs of hypertension or hormonal imbalance. The abdominal CT scans showed a huge mass that measured 11 cm in diameter, and it was located at the left adrenal area. Grossly, the tumor was well encapsulated and homogenous with central necrosis. Microscopically, the tumor was composed of oncocytes with abundant granular cytoplasm. Immunohistochemically, these cells were diffusely positive for cytokeratin and focally positive for synaptophysin and NSE. The ultrastructural studies showed numerous mitochondria in the cytoplasm. We will discuss the criteria that indicates malignancy as presented by Weiss et al. and we summarize the difference between conventional and oncocytic adrenocortical neoplasm. This case showed some features of malignancy based on the criteria presented by Weiss et al.