A Case of Epstein-Barr-Virus-Associated Lymphocytic Interstitial Pneumonia / 소아알레르기및호흡기학회지

Lymphocytic interstitial pneumonia (LIP) is a benign lymphoproliferative disorder characterized histologically by diffuse infiltration with predominantly mature lymphocytes, plasma cells and reticuloendothelial cells in the alveolar septae and along the lymphatic vessels. LIP is an uncommon disease frequently associated with autoimmune diseases such as Sj?gren's syndrome, systemic lupus erythematosus, chronic active hepatitis, thyroiditis, myasthenia gravis, autoimmune hemolytic anemia and Human Immunodeficiency Virus (HIV) or Epstein- Barr virus (EBV) infection. LIP can progress to pulmonary or systemic lymphoma. LIP in children has variable disease courses such as spontaneous resolution, episodic worsening or progression to frank respiratory failure. Intravenous immunoglobulin and corticosteroids yield variable results, and some children may respond to them for several years. We report herein a case of EBV-associated, HIV-negative LIP diagnosed by thoracoscopic lung biopsy and a clonality study in a 5 year-old boy who was admitted with recurrent coughing and dyspnea. The patient was treated and fully recovered with methylprednisolone and high dose acyclovir. At the 3-year follow-up, he showed no clinical symptom despite increased EBV copy in bronchoalveolar lavage and progressive bronchiectasis in the right middle lobe.

Adenocarcinoma Arising from Heterotopic Gastric Mucosa in Cervical Esophagus: A Case Report

Heterotopic gastric mucosa (HGM) of the upper esophagus, referred as "cervical inlet patch (CIP)", is a benign lesion that is present in 3.8-10% of the adult population. Adenocarcinomas arising from HGM of the upper esophagus are exceedingly rare. The authors report one additional case of histologically confirmed adenocarcinoma arising from a CIP. The patient had concomitant primary adenocarcinoma of the colon. The right hemicolectomy specimen and total esophagectomy specimen after preoperative chemoradiotherapy showed histologically different adenocarcinomas. The residual esophageal tumor was characterized by large mucin pools, fibrous septa, and floating tumor cells. HGM of both the fundic and antral types was seen on the surface and sides of the tumor. The independent origins of the two cancers were confirmed by immunohistochemical studies for cytokeratins 7 and 20. Without further treatment, the patient remained free of disease after 29 months of follow-up.

Biochemical Rather than Virologic Response to Interferon Therapy may be More Closely Associated with Decrease of Hepatocellular Carcinoma Incidence in Patients with Chronic Hepatitis B

BACKGROUND/AIMS: The authors examined whether the response to interferon (IFN) therapy can affect the development of hepatocellular carcinoma (HCC) in chronic hepatitis B (CHB) patients. METHODS: Out of 353 biopsy-proven CHB patients, 229 (65%) were treated with IFN-alpha for 6 to 12 months. They were followed for a median period of 75 months (range, 6-120). In patients treated with IFN, biochemical and virologic responses were evaluated at the end of treatment (EOT). The cumulative incidence rates of HCC were calculated and analyzed in relation to baseline characteristics as well as biochemical and virologic responses to IFN therapy. RESULTS: The overall cumulative incidence of HCC was 0%, 0.8%, 3.7% and 5.5% at 3, 5, 7 and 8 years, respectively. Age, serum AFP levels and the stage of fibrosis were significantly associated with the occurrence of HCC. As a whole, IFN therapy did not affect the occurrence of HCC. Among the patients treated with IFN, biochemical responders had low HCC incidence rates compared with non-responders (p=0.018). However, the HCC incidence rates of virologic responders were not different from non-responders (p=0.203). CONCLUSIONS: Biochemical rather than virologic response to IFN therapy may be more closely associated with decrease of HCC incidence in CHB patients.

Granular Cell Tumors of the Larynx: Report of Three Cases

Granular cell tumors are rare and usually benign neoplasms that can occur in various parts of the body. We recently encountered three cases of granular cell tumor of the larynx; here, we present their clinicopathologic features, along with a review of reported Korean cases.

Clinicopathologic Analysis of Lymphocytic Gastritis

BACKGROUND: Lymphocytic gastritis (LG) is defined as an infiltration of more than 25 intraepithelial lymphocytes (IELs) per 100 surface epithelial cells, and the histological differential diagnosis of LG and residual mucosa associated lymphoid tissue (MALT) lymphoma can be difficult. Helicobacter pylori (H. pylori) is regarded as one of the possible causes of LG, but its clinicopathologic features of LG have not been clarified in Korea, which has a much higher prevalence of H. pylori infection than Western countries. We analyzed the clinicopathologic findings of LG in Korean patients and compared the cytologic findings of IELs of LG with those of MALT lymphoma. METHODS: Sixty six cases of LG and 59 cases of MALT lymphoma were selected and clinicopathologic features were analyzed. RESULTS: Eighteen cases (27.3%) of LG were found to be associated with H. pylori infection. The IELs in LG were found to diffusely and regularly infiltrate in the epithelium, but MALT lymphoma showed patchy IELs. IELs in LG and MALT lymphoma were CD 8+T lymphocytes and CD20+B lymphocytes, respectively. The mean nuclear size of IELs in LG was 4.37 micrometer, which was significantly smaller than those in MALT lymphoma (5.19 micrometer). CONCLUSION: LG, a rare variant of chronic gastritis is partly associated with H. pylori infection and more complex unknown causative factors. In addition to the immunophenotyping, the nuclear sizes of IELs can be helpful in the differential diagnosis of LG and residual MALT lymphoma.

Traumatic Neuroma in the Pancreas Head Following Excision of Pseudocyst: A Brief Case Report

We describe here a case of traumatic neuroma that developed in the pancreas head as a rare complication of pancreatic surgery for pseudocyst. A 50-year-old man presented with septic shock. The patient was a heavy drinker with history of operation for pancreatic pseudocyst 28 years ago. On the radiologic examinations, a poorly defined mass-like lesion was found in the uncinate process of pancreas, and it had features of chronic pancreatitis and a stricture of the distal common bile duct. Whipple's operation was performed due to the diagnosis of suspected pancreas head cancer. The pancreas revealed an ill-demarcated 4 cm sized firm mass with grayish white fibrotic cut surface in the head portion. On the microscopic examination, the mass was composed of haphazard proliferations of nerve fascicles in a fibrocollagenous matrix and this case was diagnosed as traumatic neuroma. Although traumatic neruoma is a rare cause of a pancreatic mass, it should be included as a differential diagnosis of pancreatic mass in patients with a history of pancreatic surgery.