The Ratio of Atypical Ductal Hyperplasia Foci to Core Numbers in Needle Biopsy: A Practical Index Predicting Breast Cancer in Subsequent Excision

BACKGROUND: Although core needle biopsy (CNB) is considered to be the standard technique for histological diagnosis of breast lesions, it is less reliable for diagnosing atypical ductal hyperplasia (ADH). We therefore assessed the characteristics of CNB-diagnosed ADH that are more likely to be associated with more advanced lesions on subsequent surgical excision. METHODS: We retrospectively examined 239 consecutive CNBs, 127 of which were diagnosed as ADH following surgical excision, performed at Asan Medical Center between 1995 and 2010. Archival slides were analyzed for the number of cores per specimen, the number of ADH foci, and the ratio of ADH foci to number of cores (FC ratio). RESULTS: We found that ADH foci in 3 or more cores (p=0.003) and the presence of ADH in 3 or more foci (p=0.002) were correlated with malignancy following excision lesion. Moreover, an FC>1.1 was significantly associated with malignancy in the subsequent excision (p=0.000). CONCLUSIONS: Including the number of ADH foci, the number of cores involved according to ADH, FC ratio, and histologic type in a pathology report of CNB may help in making clinical decisions about surgical excision.

Oncocytoma and Oncocytic Carcinoma of the Salivary Glands, Single Institute Experience

BACKGROUND: Oncocytic neoplasms of the salivary glands are rare and the differential diagnosis between oncocytic carcinomas (OCs) and oncocytomas is difficult. We present 5 cases of oncocytoma and 3 cases of OC of the salivary glands with clinicopathological and immunohistochemical comparisons. METHODS: Eight cases of oncocytic neoplasms diagnosed at Asan Medical Center between 1998 and 2009 were reviewed for clinical data and histological features. Immunohistochemical staining for epidermal growth factor receptor (EGFR), human epidermal growth factor receptor 2 (Her-2), c-kit, p53, and Ki-67 was done. RESULTS: Cytological differences between oncocytomas and OCs were not obvious, but unequivocal infiltrative growths were identified in 3 cases, rendering the diagnosis of oncocytic carcinoma. When the remaining cases were classified as oncocytomas, there was no difference in age, size, and clinical symptoms between oncocytomas and OCs. Two of 3 OCs showed strong membranous expression of c-kit, but all oncocytomas were negative. The proportion of p53-positive cells was larger in OCs than oncocytomas. Her-2 or EGFR expression was absent, and Ki-67 labeling indices were less than 1% in all cases. CONCLUSIONS: An infiltrative growth pattern, strong membranous expression of c-kit, and an increased proportion of p53-positive cells are features that can differentiate OCs from oncocytomas of the salivary glands.

Endoscopic Polypectomy of Primary Rectal Mature Teratoma: A Case Report / 대한소화기내시경학회지

Teratoma is a type of benign germ cell tumor that often contains several different types of tissue such as hair, muscle and bone, and these tissues arise from the three germinal layers. It occurs most often in the tailbones of children, the ovaries of women and the testicles of men. Primary rectal teratoma is extremely rare. We report here on a case of a 49-year-old woman with a primary rectal teratoma, and this was incidentally found during routine health screening. The rectal teratoma was a 15 mm-sized pedunculated polyp with a short stalk at the rectum, about 15 cm from anal verge as seen on CT colonography. On sigmoidoscopy and EUS, a fat and calcium containing well-defined polypoid lesion was noted in the upper rectum, with a narrow stalk attached to the colonic wall. The tumor was successfully excised by endoscopic polypectomy in order to obtain the histologic diagnosis and administer the proper treatment.

A Case of Spondylometaphyseal Dysplasia ( Kozlowski type ) / 대한정형외과학회잡지

Spondylometaphyseal dysplasia (SMD) is an extremely rare, which affects the spine and metaphy-ses of the tubular bones on terms of enchondrogenesis. Children who had Kozlowski dwarfism, type of SMD are not recognized until they reach school age since they have normal clinical feature, weight and size in early childhood. Authors experienced a typical case of Kozlowski type of SMD in a 10 years old male who had i) generalized platyspondyly with anterior tapering of vertebrae ii) generalized metaphyseal dysplasia iii) minimal changes in the carpal and tarsal bones. This case is to be reported with review of references.

Ananalysis of the Clinical and MRI Findings of the Bucket: Handle Meniscal Tears of the Knee Joint / 대한정형외과학회잡지

Recently MRI has been shown to be a sensitive and specific study for the noninvasive detection of meniscal tears and several MRI findings of bucket-handle meniscal tears have been reported. Therefore, the MRI findings of the menisci proven to be the bucket-handle tear with arthroscopy were evaluated and the typical MRI findings seen to be the bucket-handle meniscal tear of the knee were analysed. 76 patients with proven bucket-handle meniscal tears arthroscopically were reviewed retrospectively, in which MRI was performed in 24 patients. The 3 typical findings of bucket-handle meniscal tears were assessed: double PCL (posterior cruciate ligament) sign, flipped meniscus sign, and fragment in the intercondylar notch. In 245 cases of meniscus tears, bucket-handle meniscal tears were 76 cases (31.0%) with 52 cases at medial meniscus and 24 cases at lateral meniscus. As to clinical and physical findings of the bucket-handle meniscal tears, McMurray test, locking, joint line tenderness and giving way sense were presented in orders. The sites of bucket-handle meniscal tear were medial meniscus in 17 cases and lateral in 7 cases. The double PCL sign was seen in 10 cases (58.8%) of in medial bucket-handle meniscal tears and in 3 cases (42.9%) of 7 lateral bucket-handle meniscal tears. The flipped meniscus sign were seen in 3 cases (17.6%) of medial bucket-handle meniscal tears and in 3 cases (42.9 %) of lateral bucket-handle meniscal tears. Fragments were identified in the intercondylar notch in 8 cases (47.1%) of medial bucket-handle meniscal tears and in 3 cases (42.9%) of lateral bucket-handle meniscal tears. There were 19 cases (79.2%) in which at least one or more typical findings were presented on MR images. The MRI is a sensitive study for detection of bucket-handle meniscal tears but precise interpretation of MRI is needed for diagnosis of bucket-handle tears. In this respect, the above three typical findings are helpful and reproducible for diagnosis of bucket-handle meniscal tears with MR images; double PCL sign, fragment in the intercondylar notch and flipped meniscus sign.

A comparision study between autogenous nerve graft and Silicone tubing method in segmental defect of sciatic nerve in rats / 대한정형외과학회잡지

Recently autogenous nerve graft was usually used for segmental defect of peripheal nerve injury. In case of inappropriate size or amount of donor nerve graft, there were many studies included nerve regeneration with special nerve conduit material. To compare the result of autogenous nerve graft with that of silicone tubing method in segmental defect of sciatic nerve, the experiments were carried out on adult rats with autogenous nerve graft on the left side and silicone tubing on the right side. The results were as follows; 1. Myelinated nerve fibers were larger in silicone tubing method than autogenous nerve graft at postop. 4 weeks. 2. There was no difference in nerve regeneration in both groups at postop. 12 weeks. 3. Some atrophic changes were showed in denervated muscles in both groups at postop. 4 weeks. Skeletal muscle changes between the two groups were meagre. 4. Perineural adhension was rare in silicone tubing group in contrast to autogenous nerve graft group. 5. Nerve Conduction Velocity was similar between autogenous nerve graft and silicone tubing method after 4 weeks postoperatively. In conclusion, this study suggests that silicone tubing can be useful method to repair the large nerve gaps and has a potential clinical utilization in large segmental nerve defect.

Autogeous Bone-Articular Cartilage stored within Abdominal Wall / 대한정형외과학회잡지

Articular cartilage can be damaged by trauma or by progressive degradation caused by disease. Unfortunately, it has a extremely limited capacity for repair and regeneration. The use of joint prosthesis has revolutionized but remains limited in its use. To know the possibility of clinical application of clinical application of autogenous bone-articular graft in open complicated intraarticular fractures we studied the change of bone-articular cartilage defect in medial femoral condyle of rabbits and viability of autogenous bone-articular graft stored within abdominal wall of rabbits. The results were obtained as follows: 1. There was over 90% viability of subchondral bone after 10 days storage in the adbominal wall but the articular cartilage showed degenerative change about 40% after 5 days passed. 2. The bone-articular defect was replaced by undifferentiated mesenchymal tissue and fibrous tissue, postoperative 6 weeks later. 3. In implanted bone-articular cartilage graft at 3 days, the chondrocyte of basal cell layer in articular cartilage was relatively well preserved but in 7 days, transplanted articular cartilage graft showed almost necrotic chage. Most of subchondral bones were well healed with host bone without regard to duration of implantation.

Total Knee Replacement Arthroplasty in Rheumatoid Arthritis and Osteoarthritis / 대한정형외과학회잡지

Total knee arthroplaty has been used to treat the elderly patient who has severe arthritis but the early designs were associated with many problems, which frequently led to early failure. In 1974, the total knee arthroplasty was introduced and the reported results of this operation have improved consistantly with time. Recently the good results has been shown to treat rheumatoid patients and osteoarthritis patients less than 45 years old patients. At the department of orthopaedic surgery of Kosin Medical College, between 1984 and 1988, total knee arthroplasty was performed in 17 patients (22 kness) who had rhematioid arthritis (7 patients) and osteoarthritis (11 patients), and had followed for an average of 1 year and 8 months. The results were as follows 1. The knee that had rheumatoid arthritis had better knee scores than that of osteoarthritis. 2. The knee that remained the post cruciate lig. had better range of motion than that sacrificed. 3. The knees that had not used cement had better knee scores than that had used the cement. 4. The knees that had patella resulrfacing had better scores for pain than that had not.

The Prevalence of Scoliosis in Junior and Senior High School Students, Pusan, Korea / 대한정형외과학회잡지

Authors examined 40,000 minifilms(boys and girls each 10,000 in junior and senior high schools) which were taken for survey of pulmonary tuberculosis for junior and senior high school students and checked the prevalence of scoliosis. It was considered lateral curvature of spine more than 10 degrees as nonpostural scoliosis, which were analyzed prevalence rate, degree of curvature, distribution of size of curvature, pattern of curve and direction of curvature. Following results were obtained. 1. The overall prevalence rate was 1.56; male 1.38. and female 1.70%(Junior high school 1.06%, Senior high school 2.05%). 2. Scoliosis secondary due to bony abnormality was found in 5 cases. 3. The most common pattern of curvature was the thoracic curve. 4. In sihgle curve, right to left ratio was 1.7, especially senior high school girls had more right curve and junior high school boys had more left curve. 5. The prevalence of senior high school students was greater than that of junior high school students and the degree of curvature was also severe in senior high school students than in junior high school students.