Lymphoepithelioma-like Carcinoma of the Renal Pelvis / 대한비뇨기과학회지

Lymphoepithelioma was originally described as a neoplasm in the nasopharynx. Tumors with histologic features similar to those of nasopharyngeal lymphoepithelioma have been identified in anatomic sites other than the nasopharynx, such as the salivary gland, lung, thymus and stomach; these tumors have been termed lymphoepithelioma-like carcinoma(LELC). The etiology and pathogenesis of this neoplasm in the renal pelvis is not clear. We have experienced a case of lymphoepithelioma-like carcinoma of the renal pelvis and we report here on this along with a brief review of the relevant literature.

Lymphoepithelioma-like Carcinoma of the Renal Pelvis / 대한비뇨기과학회지

Lymphoepithelioma was originally described as a neoplasm in the nasopharynx. Tumors with histologic features similar to those of nasopharyngeal lymphoepithelioma have been identified in anatomic sites other than the nasopharynx, such as the salivary gland, lung, thymus and stomach; these tumors have been termed lymphoepithelioma-like carcinoma(LELC). The etiology and pathogenesis of this neoplasm in the renal pelvis is not clear. We have experienced a case of lymphoepithelioma-like carcinoma of the renal pelvis and we report here on this along with a brief review of the relevant literature.

A Case of Tuberous Sclerosis Complicated with Massive Bleeding of Renal Angiomyolipoma / 대한신장학회지

Tuberous sclerosis (TSC) is a systemic, autosomal dominant disorder resulting from mutations in one of two genes, TSC1 (encoding hamartin) or TSC2 (enconding tuberin). TSC causes seizure, mental retardation and hamartomatous tumors in multiple organs, including facial angiofibromas, cortical tubers, pulmonary lymphangiomatosis, renal angiomyolipomas and polycystic kidney disease. Renal angiomyofibromas may cause serious complications such as life threatening retroperitoneal hemorrhage or hematuria. The following is a report concerning a 41-year-old man with TSC who suffered spontaneous hemorrhage within the angiomyofibroma of the left kidney and underwent curative selective renal embolization. Then larger angiomyolipoma was suggested to be more likely to bleed, so secondary prophylactic selective renal embolization was done into five angiomyolipomas of the right kidney. After selective embolization, tumor size decreased and renal function was preserved. This patient did not show neurologic abnormality and family history of tuberous sclerosis. However, the brain magnetic resonance imaging revealed typical signs of tuberous sclerosis, and the computerized tomography of the abdomen showed bilateral renal angiomyolipomas and polycystic renal lesion. Herein we present a rare case of bilateral renal angiomyolipomas with spontaneous hemorrhage and preserved renal function after curative and prophylactic selective embolization.

Changes in Electrophysiologic and Histologic Findings after thanol and Phenol Injection into the Sciatic Nerve of Rat

OBJECTIVE: In the management of spasticity, intramuscular neurolysis with small amount of dilute aqueous phenol has proved to be a useful measure. But, considerable problem has taken place in utilization of phenol. This study was attempted to compare the effect of phenol and alcohol for the peripheral nerve blocking in the management of spasticity. METHOD: Intraneural injection of 5% phenol, 50% alcohol and 90% alcohol solution carried out in each group of 10 rats. A total of 30 rat were injected and examined electrophysiologically before and after blocking the nerve (24 hour, 1 weeks, 2 weeks, 4 weeks, 8 weeks). The randomized one rat of each group was sacrificed for the histological examination of the sciatic nerve at every examined day. RESULTS: There was no difference of the distal latencies and amplitudes of compound muscle action potentials among the groups before injection. The latencies were prolonged at 24 hours post-injection and shortened at 1 week post-injection in all the groups. The amplitudes were markedly decreased at 24 hours post-injection and increased at 1 week post- injection and reached the pre-injection value at 8 week post-injection in all the groups. Histologic studies showed necrosis at 1 week post-injection and regeneration at 2 week post- injection in 50% and 90% ethanol groups. Phenol injection group showed necrosis at 4 week post-injection and regeneration after 8 weeks. CONCLUSION: Our preliminary experience with alcohol for peripheral nerve blocking with encouraging result has been described.

Effects of Dialyzer Reuse on Clearances of Blood Urea Nitrogen and beta2-Microglobulin in the Three Different Membranes / 대한신장학회잡지

BACKGROUND: We performed the study on the changes of beta2-microglobulin(beta2M) clearance and urea reduction ratio after reuse of dialyzers with three different membranes. METHODS: 9 patients who had received regular hemodialysis more than five years were enrolled. Three kinds of dialyzer membrane were used; i.e. : Two of them were high-flux and the other was low-flux. Dialyzer reprocessing was performed by an automated machine using glutaraldehyde and bleach. Each dialyzer was reused 10 times. Solute clearance was determined for each dialyzer after the 1st, 5th, 8th and 10th reuse. RESULTS: Urea clearance was well maintained after reuse with both high-flux and low-flux membrane but beta2M clearance was significantly greater with high-flux dialyzers than low-flux dialyzer. Effects of each dialyzer reuse on beta2M clearance showed no significant decrease until the 10th reuse and no significant difference in beta2M clearance between the two high-flux dialyzers(polyamide vs PEPA membrane, p= 0.197). CONCLUSION: Reuse of dialyzers was cost-effective. After reuse of dialyzer, clearance of solute was maintained in both small and large solutes until the 10 th reuse. Further study is needed regarding the maintenance of solute clearance with increased number of reuses.

Prognostic Significance of Tumor Angiogenesis in Breast Cancer / 한국유방암학회지

The well-known prognostic factors for breast cancer, such as axillary lymph node status, do not always account for the exact outcome. The development of other accurate prognostic factors would help in assessing high risk for recurrence and death. Recently, much experimental evidence has accumulated showing that tumor growth and metastasis are dependent on tumor angiogenesis. To investigate the status of angiogenesis in breast cancer, we counted the microvessel density (MVD) of brest cancer tissues, which were stained with anti-CD34 antibody, as a measure of tumor angiogenesis. We classified 43 breast-cancer patients into 22 with low MVD ( or =47/200xPF). We estimated the correlations between the MVD and other established prognostic factors. We also calculated survivals based on MVD. The MVD was in the range between 10 and 93 (mean+/-SD=46.9+/-21.7). The positive rate of lymph-node metastasis in high MVD patients was 32.6%, which was higher than the 23.3% for low-MVD patients. We found a significant correlation between MVD and histologic grade (p=0.037), but could not fine any significant correlation between MVD and menopausal status, tumor size, nuclear grade, estrogen receptor, or progesterone receptor. Retrospectively, the receptor status of estrogen and of progesterone had significant impacts on survival (ER: p=0.0001, PR: p=0.0001). The 4-year disease-free survival rate of high-MVD patients was 56.6+/-12.5%, and that of low-MVD patients was 69.0+/-10.8% (p=0.449). The 4-years overall survival rate of high-MVD patients was 71.1+/-11.1%, and that of low-MVD patients was 74.1+/-12.2 (p=0.449). In conclusion, the determination of MVD in breast cancer tissue may be useful as a prognostic factor, but it is necessary to investigate the MVD in a large number of patients before this conclusion can be stated with certainty.

A Case of Acute Renal Failure due to Rhabdomyolysis Associated with Dermatomyositis in Breast Cancer / 대한신장학회잡지

Dermatomyositis is a clinical syndrome of unknown etiology characterized by a nonpurulent inflammatory myopathy involving striated skeletal muscle associated with rheumatoid arthritis, or systemic lupus erythematosus, sometimes underlying malignancy. A few cases of acute renal failure due to rhabdomyolysis in dermatomyositis has been reported. But, no case combined with breast cancer have been reported. We experienced a case of acute renal failure due to rhabdomyolysis associated with dermatomyositis. The patient was admitted to the our hospital due to breast cancer. After breast cancer operation, she complained of progressive muscle weakness. The heliotrope rash involved the eyelid, bridge of nose and forehead. And eczematoid dermatitis involved the lower abdomen and both forearm and hands. The laboratory findings revealed LDH 2,944IU/L, CPK 2,244IU/L and SGOT 214IU/L. Serum myoglobin and aldolase were increased, and antinuclear antibody was 1:40(positive, homogenous pattern). Electromyogram revealed myopathic findings compatible with dermatomyositis. Then, the patient developed acute renal failure requring hemodialysis. After acute hemodialysis, acute renal failure resolved. But, the patient died on the 113th hospital day due to sepsis. Here, we report a case of acute renal failure due to nontraumatic rhabdomyolysis associated with dermatomyositis in breast cancer.

A Case of Intrahepatic Cholangiocarcinoma in Polycystic Liver Disease / 대한간학회지

Cholangiocarcinoma has been associated with various fibrocystic diseases of liver and biliary tract, but cholangiocarcinoma in polycystic liver disease (PLD) was extremely rare. It was reported that the prognosis of cholangiocarcinoma associated PLD was very poor and distant metastases were common. We report a rare case of intrahepatic cholangiocarcinoma associated with PLD in 58- year- old female who presented vague abdominal pain. She had also polycystic kidneys with normal renal function. MRI showed well demonstrated tumor with central scar and a adjacent large cyst in the left lobe of the liver. She underwent extended left lobectomy. On microscopic examination, the tumor was moderately differentiated cholangiocarcinoma having abundant fibrous stroma and necrosis and the adjacent cyst showed focal in situ carcinomatous changes in the lining epithelium.

Prognostic Significance of Tumor Angiogenesis in Breast Cancer

The well-known prognostic factors for breast cancer, such as axillary lymph node status, do not always account for the exact outcome. The development of other accurate prognostic factors would help in assessing high risk for recurrence and death. Recently, much experimental evidence has accumulated showing that tumor growth and metastasis are dependent on tumor angiogenesis. To investigate the status of angiogenesis in breast cancer, we counted the microvessel density(MVD) of breast cancer tissues, which were stained with anti-CD34 antibody, as a measure of tumor angiogenesis. We classified 43 breast-cancer patients into 22 with low MVD ( or =47/200 PF). We estimated the correlations between the MVD and other established prognostic factors. We also calculated survivals based on MVD. The MVD was in the range between 10 and 93(mean SD=46.9 21.7). The positive rate of lymph-node metastasis in high-MVD patients was 32.6%, which was higher than the 23.3% for low- MVD patients. We found a significant correlation between MVD and histologic grade (p=0.037), but could not find any significant correlation between MVD and menopausal status, tumor size, nuclear grade, estrogen receptor, or progesterone receptor. Retrospectively, the receptor status of estrogen and of progesterone had significant impacts on survival (ER : p=0.0001, PR : p=0.0001). The 4-year disease-free survival rate of high-MVD patients was 56.6 12.5%, and that of low-MVD patients was 69.0 10.8% (p=0.449). The 4-year overall survival rate of high-MVD patients was 71.1 11.1%, and that of low-MVD patients was 74.1 12.2 (p=0.449). In conclusion, the determination of MVD in breast cancer tissue may be useful as a prognostic factor, but it is necessary to investigate the MVD in a large number of patients before this conclusion can be stated with certainty.

A Case of Meigs` Syndrome with Elevated Serum CA 125 Level / 대한부인종양콜포스코피학회잡지

Meigs' sydrome is a relatively uncommon and the unusual condition of ascites and fluid in the chest associated with benign and solid tumors of the ovary with the gross appearance of a fibroma. The mechanism of this syndrome is not completely understood, but various lymphatics through the diaphragm seem the likely route for ascitic fluid into the chest. We present a case of Meigs' syndrome associated with fibrothecoma and elevate CA 125 with the brief review of literature.

The Effect of Pleurodesis with Doxycycline in the Rabbit / 결핵

BACKGROUND: The intrapleural instillation of tetracycline for pleural sclerosis had been most commonly used in patients with symptomatic malignant pleural effusion or recurrent pneumothorax for a long time. Unfortunately, at a time of expanding use of this agent, the production of injectable tetracycline hydrochloride used for pleurodesis was discontinued by its sole manufacturer in mid-1991 because the manufacturer was unable to meet US Food and Drug Administration purity standards. So we performed a preliminary study of doxycycline, as a alternative pleural sclerosant on rabbit pleura and compared its efficacy with that of tetracycline. METHOD: Eighteen New Zealand white rabbits weighing 2 to 3kg(mean 2.6kg) were divided into three groups. In each groups, one tetracycline(20 mg/ml/kg) and two doxycycline solutions(7 mg/ml/kg and 20 mg/ml/kg) instillated into the right pleural space through an 18-gauge angiocath with care to prevent pneumothorax. All rabbits were sacrificed after 28 days. RESULTS: 1) In the group of tetracycline 20 mg/ml/kg(six rabbits), five rabbits showed partial pleural symphysis with several fibrous bands, and one rabbit died on 22th day. 2) In the group of doxycycline 7 mg/ml/kg(six rabbits), three rabbits showed partial pleural symphysis and the other three rabbits showed complete pleural symphysis without necrosis of underlying parenchymal lung tissue. 3) In the group of doxycycline 20 mg/ml/kg(six rabbits), two rabbits showed complete pleural symphysis without lung necrosis, another two rabbits showed complete pleural symphysis with lung necrosis, and the other two rabbits died on 4th and 13th day, respectively. CONCLUSION: We concluded that doxycycline is a highly effective sclerosing agent having stronger pleurodesis effect with that of tetracycline by dose base and its optimal dosage was considered as 7 mg/ml/kg with minimal complications.

A Case of Hereditary Trichilemmal Cyst with Proliferating Trichilemmal Tumor / 대한피부과학회지

We report a case of hereditary trichilemmal cyst with proliferating trichilemmal tumor in a 64-year-oid man, who has generalized 157, variable sized firm cutaneous nodules for 40 years. The cystic nodules are chiefly located on the scalp and trunk which showed characteristic histopathologieal findings of trichilemmal cyst and proliferating trichilemmal tumors. His son also has multiple trichilemmal cysts and his mother seems to have had clinically similar lesions. The patient and his son were treated with surgical excision and therapeutic trial of oral isotretinoin for 2 months. Isotretionoin was ineffective in the patient, but the lesions of his son were decreased in size.