Diffuse-Type Tenosynovial Giant Cell Tumor of the Tendon Sheath in Both Wrists

Diffuse-type tenosynovial giant cell tumor (D-TSGCT), previously known as pigmented villonodular synovitis, is a locally aggressive neoplasm that may arise from the synovium, bursa, or tendon sheath. D-TSGCT is usually monoarticular and can be classified into intra- and extra-articular forms, the latter of which is rarer. Here, we report a case of D-TSGCT in a 64-year-old female that involved the entire flexor and extensor tendon sheaths of both wrists. We describe the ultrasonography and MRI findings, as well as review the relevant literature.

Ultrasound and MRI Findings of Giant Cell Fibroblastoma in the Abdominal Wall: Radiologic-Pathologic Correlations

Giant cell fibroblastoma (GCF) is a rare soft-tissue sarcoma of fibroblastic origin. To the best of our knowledge, only one brief description of the MRI findings of GCF exists in the pathologic literature. Herein, we report a case of histologically proven GCF in a 3-year-old boy who underwent ultrasonography and MRI of a superficial mass in the abdominal wall.

Multicenter Phase II Study of Oxaliplatin, Irinotecan, and S-1 as First-line Treatment for Patients with Recurrent or Metastatic Biliary Tract Cancer / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Although gemcitabine plus cisplatin has been established as the standard first-line chemotherapy for patients with advanced biliary tract cancer (BTC), overall prognosis remains poor. We investigated the efficacy of a novel triplet combination of oxaliplatin, irinotecan, and S-1 (OIS) for advanced BTC. MATERIALS AND METHODS: Chemotherapy-naive patientswith histologically documented unresectable or metastatic BTC were eligible for this multicenter, single-arm phase II study. Patients received 65 mg/m2 oxaliplatin (day 1), 135 mg/m2 irinotecan (day 1), and 40 mg/m2 S-1 (twice a day, days 1-7) every 2 weeks. Primary endpoint was objective response rate. Targeted exome sequencing for biomarker analysis was performed using archival tissue. RESULTS: In total, 32 patients were enrolled between October 2015 and June 2016. Median age was 64 years (range, 40 to 76 years), with 24 (75%) male patients; 97% patients had metastatic or recurrent disease. Response rate was 50%, and median progression-free survival and overall survival (OS) were 6.8 months (95% confidence interval [CI], 4.8 to 8.8) and 12.5 months (95% CI, 7.0 to 18.0), respectively. The most common grade 3-4 adverse events were neutropenia (32%), diarrhea (6%), and peripheral neuropathy (6%). TP53 and KRAS mutations were the most frequent genomic alterations (42% and 32%, respectively), and KRAS mutations showed a marginal relationship with worse OS (p=0.07). CONCLUSION: OIS combination chemotherapy was feasible and associated with favorable efficacy outcomes as a first-line treatment in patients with advanced BTC. Randomized studies are needed to compare OIS with gemcitabine plus cisplatin.

A Case of Hemangioma in the External Auditory Canal with Pulsatile Tinnitus / 대한이비인후과학회지

Hemangiomas are relatively common in the head and neck region, but their occurrence in the temporal bone are extremely rare. The hemangioma of the external auditory canal (EAC) is a rare otologic entity as only 22 cases of hemangioma of the EAC have been reported worldwide. Here we report a patient presenting with pulsatile tinnitus, which turned out to be caused by capillary hemangioma arising from the posterior medial portion of external auditory canal touching the tympanic membrane. Surgical excision of the tumor was successful. The clinical manifestations and management of benign vascular lesions of the EAC are discussed with a review of literature.

A case of levocetirizine-induced liver injury

Levocetirizine is a second-generation nonsedative antihistaminic agent that has been demonstrated to be safe and effective for treating allergic disease. There was only one case report of levocetirizine-induced liver toxicity, but a liver biopsy was not performed. In this article, we present the first case of levocetirizine-induced liver injury with histologic findings. A 48-year-old man was hospitalized with jaundice and generalized pruritus that had developed after 2 months of therapy with levocetirizine for prurigo nodularis. Laboratory findings revealed acute hepatitis with cholestasis. A liver biopsy demonstrated portal inflammation and hepatitis with apoptotic hepatocytes. The patient fully recovered 3 weeks after withdrawing levocetirizine. Although levocetirizine is safe and effective, physicians should be aware of its potential hepatotoxicity.

Expression of Histone Deacetylases HDAC1, HDAC2, HDAC3, and HDAC6 in Invasive Ductal Carcinomas of the Breast / 한국유방암학회지

PURPOSE: DNA deacetylation by histone deacetylase (HDAC) is an important mechanism involved in the oncogenic tumorigenesis of breast cancer. Previous studies have reported an association of the estrogen receptor (ER) with HDACs and demonstrated the efficacy of HDAC inhibitors for the treatment of breast cancers via in vitro experiments. In this study, we examined the association of HDAC expression with clinicopathological parameters and disease-specific survival. METHODS: Immunohistochemical (IHC) analysis of HDAC1, HDAC2, HDAC3, and HDAC6 was performed using tissue microarrays in 300 invasive ductal carcinomas. IHC scoring was determined by multiplication of the intensity (0 to 3) and the proportion (0 to 4) of staining, and we classified tumors into low- and high-HDAC expression groups. RESULTS: High expression of HDAC1 was correlated with the molecular subtype (p=0.001) and human epidermal growth factor 2 (HER2) amplification (p=0.012). High expression of HDAC6 was correlated with a younger age (p<0.001), ER expression (p=0.025), progesterone receptor expression (p=0.034), molecular subtype (p=0.023), and HER2 amplification (p=0.011). High HDAC1 expression was correlated with luminal A tumors (p=0.001), while high HDAC6 expression was more common in luminal B tumors (p=0.023). Although the expression of HDACs did not exhibit prognostic significance in the entire cohort, high expression of HDAC1 and HDAC6 was associated with improved overall survival (OS) in patients with ER-positive tumors (p=0.017 and p=0.029, respectively), and high expression of HDAC2 was correlated with improved OS in ER-negative tumors (p=0.048) on univariate analysis. Furthermore, high HDAC6 expression was associated with improved disease-free survival (p=0.048) on multivariate analysis. CONCLUSION: HDAC1 expression is significantly correlated with the molecular subtypes of tumors, with the highest expression being observed in luminal A tumors. HDAC6 is a significantly correlated with ER expression and the molecular subtype, thereby supporting the estrogen regulatory property of HDAC6. HDAC1 and HDAC6 expression are good prognostic factors for ER-positive tumors.

Simultaneous Occurrence of Ductal Carcinoma In Situ within Juvenile Fibroadenoma in Both Breasts: A Brief Case Report

No abstract available.

Primary Extracranial Meningioma Presenting as a Cheek Mass

Meningioma is well known as common disease of the central nervous system, whereas primary extracranial meningioma is rare, representing 1% to 2% of all meningiomas. We have experienced a case of primary extracranial meningioma presenting as a right cheek mass. The tumor was completely excised via a right lateral rhinotomy incision. Histopathologic examination confirmed the diagnosis of primary extracranial meningioma.

Heterotopic Intestinal Cyst of the Submandibular Gland: A Case Study

Heterotopic gastrointestinal cysts are rarely found in the oral cavity. Most of these cysts are lined with gastric mucosa and involve the tongue. There have been no reported heterotopic intestinal cysts of the submandibular gland that are completely lined with colonic mucosa. An 8-year-old girl presented with an enlarging swelling in the left submandibular area, and a 4-cm unilocular cyst was fully excised. The cyst was completely lined with colonic mucosa that was surrounded by smooth muscle layer, and the lining cells were positive for CDX-2, an intestinal marker, indicating a high degree of differentiation. The pathogenesis remains unclear, but it may be related to the misplacement of embryonic rests within the oral cavity during early fetal development. Although heterotopic intestinal cysts rarely occur in the submandibular gland, they should be considered in the differential diagnosis of facial swellings in the pediatric population.

Differential Expression of CXCR4 in Conventional High-grade and Low-grade Central Osteosarcoma and Its Prognostic Implications / 대한골관절종양학회지

PURPOSE: The chemokine receptor CXCR4 has been reported to be aberrantly expressed in human cancer and has been shown to participate in cancer metastasis. We compared the expression of CXCR4 in conventional high-grade and low-grade central osteosarcomas, and determined if an association between CXCR4 expression and prognosis could be made. MATERIALS AND METHODS: We performed the immunohistochemistry for CXCR4 in a total of 63 patients with osteosarcoma and determined the relationships according to the clinicopathologic variables and overall survival rates. RESULTS: CXCR4 was detected in 76.3% of conventional high-grade osteosarcoma patients and in 36% of low-grade central osteosarcomas. Diffuse expression was noted in 47.4% of the high-grade osteosarcomas and all low-grade cases were focal positive. CXCR4 expression was significantly correlated with histologic grade (p<0.0001). While overall survival rate was reduced significantly with increased CXCR4 expression (p=0.0058), higher histologic grade (p<0.0001), and younger age (p=0.0140), survival rate did not correlate with gender, tumor size, or AJCC stage. CONCLUSION: Our results suggest that CXCR4 expression is associated with higher-grade tumors and with poor prognosis for osteosarcoma patients.

Expression of HAT1 and HDAC1, 2, 3 in Diffuse Large B-Cell Lymphomas, Peripheral T-Cell Lymphomas, and NK/T-Cell Lymphomas

BACKGROUND: It has generally been proven that histone acetylation and deacetylation are involved in the malignant transformation. To date, however, this has rarely been studied in cases of malignant lymphoma. METHODS: We studied nine cases of reactive lymphoid hyperplasia, 78 cases of diffuse large B-cell lymphoma (DLBCL), 13 cases of peripheral T-cell lymphoma, not otherwise specified (PTCL-NOS), and 13 cases of extranodal NK/T-cell lymphoma, nasal type (NKTCL). Thus, we attempted to elucidate the associations of the degree of the expression of histone acetyltransferase 1 (HAT1), histone deacetylase (HDAC) 1, HDAC2, and HDAC3 with the clinical behaviors of above malignant lymphomas using the immunohistochemistry and a western blot analysis. RESULTS: The degree of the expression of HAT1 was higher in cases of DLBCL, PTCL-NOS or NKTCL as compared with reactive lymphoid hyperplasia (p0.05). CONCLUSIONS: HAT1, HDAC1, and HDAC2 play a critical role in the development of malignant lymphomas. Both HAT1 and HDAC1 might be indicators for a poor prognosis in cases of DLBCL as cooperating factors.

A Case of Tuberculous Pericardial Abscess Mimicking Thymic Carcinoma / 결핵및호흡기질환

We report here an unusual case of pericardial tuberculoma that was misdiagnosed as thymic carcinoma on an imaging study. A 48-year-old woman was referred for evaluation of an anterior mediastinal mass. Computed tomography (CT) scans of the chest displayed cystic masses mimicking thymic carcinoma at the anterior mediastinum. Pericardiotomy and surgical drainage of the cystic masses were done, and pathologic examination of the excised pericardial specimen showed a chronic granulomatous inflammation with necrosis, compatible with tuberculosis. Acid-fast bacilli were also identified in the specimen. After treatment with anti-tuberculosis drugs and steroids, the patient showed clinical improvement. Although tuberculous pericarditis usually presents as pericardial effusion or constrictive pericarditis, it can also present as a pericardial mass mimicking thymic carcinoma on CT. Therefore, we suggest that tuberculous pericardial abscess should be included in the differential diagnosis of a mediastinal mass in Korea, with intermediate tuberculosis prevalence.

The Analysis of Indeterminate Category in Thyroid Fine Needle Aspiration

BACKGROUND: Descriptive diagnosis reports have been causing some problems in communication. Our institution decided to use the category diagnosis system since June, 2008. So we evaluated the effectiveness of this change. METHODS: The category system is composed of unsatisfactory, suboptimal for diagnosis but suggestive of, most probably benign, indeterminate, suspicious for malignancy and malignancy. We evaluated 1,525 cases from June, 2008 to September, 2009. We analyzed 159 cases of the indeterminate category. RESULTS: Among the 159 cases, 21 were re-aspirated and 63 underwent an operation. The diagnoses of the re-aspirated cases were 2 positive for malignancy, 5 indeterminate, 13 most probably benign, and 1 unsatisfactory. The surgical diagnoses were 39 malignancies, 2 follicular adenomas and 1 Hurthle cell adenoma, and 21 benign lesions. Re-aspiration for the indeterminate cases could help decide whether the lesions need to be operated or not at above 70%. The indeterminate category could predict the surgical diagnosis of the thyroid nodule with statistical significance when the subcategories were indicated (p < 0.001). CONCLUSIONS: The category diagnosis is replacing the descriptive diagnosis for the thyroid fine needle aspiration. The indeterminate category is useful and effective for making the decision to operate and especially when the indeterminate subcategories are used.

Expression of Carbonic Anhydrase IX Correlates with Histologic Grade and Metastasis in Osteosarcoma

BACKGROUND: Carbonic anhydrase IX (CA9) is reportedly overexpressed in several types of carcinomas, but little is known about the expression pattern of CA9 in osteosarcoma. We aimed to assess the prevalence of CA9 expression and its prognostic implications in osteosarcoma patients. METHODS: We compared immunohistochemical expression of CA9 between conventional, high-grade and low-grade, central osteosarcomas. Specimens were obtained before chemotherapy and stained with anti-human CA9 antibody. We also evaluated the histologic grade, presence of metastasis, and patient prognosis. RESULTS: Among 38 samples of conventional high-grade osteosarcoma, 22 (57.9%) tumors displayed CA9 overexpression. Twenty-five cases of low-grade central osteosarcomas were all negative (p < 0.0001). CA9 expression was significantly associated with the presence of metastasis (p = 0.0010). The overall survival rate was significantly reduced with increased CA9 expression (p = 0.0012), higher histologic grade (p < 0.0001), and younger age (p = 0.0140). However, the overall survival rate was not significantly correlated with gender, tumor size, or American Joint Committee on Cancer stage. CONCLUSIONS: CA9 expression is a frequent and tumor-specific event in osteosarcoma. CA9 expression is associated with higher grade tumors, metastasis and poor prognosis for the osteosarcoma patients.

Solitary Pulmonary Lymphangioma in an Adult: A Brief Case Report

Solitary pulmonary lymphangiomas are extremely rare. We report here on an unique case of solitary pulmonary lymphangioma in an adult. A well-circumscribed, 6 cm-sized, pleural based lesion with fluid attenuation was found in a 50-year-old Korean male. He had no previous history of disease or trauma. The wedge-resected lung revealed an ill-demarcated lesion with multiple microscopic cysts and the cystic walls had loose intervening stroma.

Placental Transmogrification of the Lung: A Brief Case Report

Placental transmogrification (PT) is an unusual condition in which the alveoli develop a peculiar villous configuration that resembles the placental villi. We report a rare case of pulmonary PT in a 46-year-old man who presented with multiple cystic lesions and nodules on radiography. The patient was treated with a surgical excision. The cut surface of the lung lesion had a villous spongiform manifestation with a partly yellow granular appearance. Microscopically, multiple papillary cores mimicking the villous structures of the placenta were observed within the bullous airspaces. These papillary cores contained many vascular structures, lymphoid aggregates, interstitial clear cells, mature fat and dystrophic calcification. This case was solitary and not associated with other pulmonary or systemic diseases. The etiology is unknown, and further studies will be needed to understand the pathogenesis of the lesion.

Giant Multilocular Cystadenoma of the Prostate: A Case Report

Large multilocular cysts and cystic neoplasms of the prostate are very rare. A healthy 52-year-old man presented with acute urinary retension. Physical examination revealed a large abdominal mass. Pelvic MRI showed a 15x10x9 cm, lobulated, and multiseptated cystic mass in the pelvic cavity. Exploration laparotomy revealed a large cytic mass that compressd and displaced the urinary bladder antero-laterally, and adhered to the prostate and the sigmoid colon. Macroscopically, the mass was grayish white colored, multilocular cysts containing reddish-brown serous fluid. Microscopically, the tumor was composed of glands and cysts lined by the prostatic-type epithelium in the fibrous stroma. The prostatic nature of the lesion was confirmed by the lining epithelium expressing prostate-specific antigen.

Small Cell Carcinoma of the Uterine Cervix

BACKGROUND: Small cell carcinoma of the uterine cervix is a rare and aggressive neoplasm, for which there have been few diagnostic markers. METHODS: Eleven cases of small cell carcinoma of the uterine cervix were retrieved from pathology files. Immunohistochemical stains were performed for two epithelial markers (cytokeratin [AE1/AE3] and epithelial membrane antigen [EMA]) and four neuroendocrine markers (neuron-specific enolase [NSE], CD56, chromogranin, and synaptophysin). RESULTS: Of the nine cases followed up, two with initial distant metastasis died within one year. All seven remaining cases were diagnosed at stage Ib, and showed no evidence of recurrence. Nine cases were positive for one or more epithelial markers. Two cases showed positivity for epithelial markers in less than 10% of their tumor cells. The immunoreactivity for neuroendocrine markers showed variable results; four cases were reactive for chromogranin, four were positive for synaptophysin, and seven were reactive for CD56. All cases were positive for NSE. CONCLUSIONS: A diagnostic panel of chromogranin, synaptophysin, and CD56 rather than a single marker would be useful for the diagnosis of small-cell carcinoma of the uterine cervix.