A case of recurrent Kikuchi-Fujimoto disease with SLE / 대한내과학회지

Kikuchi-Fujimoto disease (KFD) is a rare self-limiting necrotizing lymphadenitis found mainly in young women. Patients typically present with lymphadenopathy and often with a high temperature. The etiology of the disease remains unknown, but various viral infection and autoimmune processes have been postulated to be the cause. One theory proposes that KFD may be a self-limiting form of systemic lupus erythematosus (SLE). This theory is strongly supported by the fact that microscopic features of KFD can be very similar to those found in lupus lymphadenitis. The diagnosis of KFD can precede, postdate or coincide with the diagnosis of SLE. No treatment is usually needed and relapse, although possible, is uncommon. Our case describes a young woman, originally diagnosed as having SLE, who subsequently developed recurrent KFD with axillary lymphadenopathy and fever.

Heterotopic Mesenteric Ossification: A Case Report

Heterotopic mesenteric ossification is a very rare reactive lesion in the small bowel mesentery, and it is related with trauma or surgical operation. It is pathologically characterized by well formed bone trabeculae and prominent osteoblastic rimming and is clinically related to rapid and recurrent bowel obstruction symptoms. This unusual reactive process shares many clinical and pathologic features with myositis ossificans. We report here on a rare case of heterotopic mesenteric ossification in 28-year-old man who underwent a delayed small bowel resection 15 days after trauma.

Ophthalmoplegia in Sphenoid Sinus Aspergillosis

Ophthalmoplegia due to spheniod sinus aspergillosis is rare. We report two cases of sphenoid sinus aspergillosis with diplopia. A diabetic patient presented with complete oculomotor nerve palsy and showed more rapid progression, severe symptoms, and delayed and incomplete recovery from the neurologic deficits. The other patient presented with trochlear nerve palsy and showed slower progression milder symptoms, and more rapid recovery. We suggest that immediate imaging should be performed to diagnose the cause of diplopia in patients with atypical unilateral persistent facial pain with diplopia especially in patients with diabetes mellitus.

Multiple Atypical Adenomatous Hyperplasia Mimicking Lung to Lung Metastasis: A Case Report

Atypical adenomatous hyperplasia (AAH) is regarded as a precancerous lesion in the multistep process for carcinogenesis of pulmonary adenocarcinoma. AAH is found in up to 25% of the lung tissue adjacent to cancer, particularly adenocarcinoma and also in 2-4% of autopsy cases. Until now, its main clinical significance is that some tumor recurrences are the lesions that have progressed from undetected AAH or they are newly developed cancers arising from AAH during the follow-up after the resection of adenocarcinoma. We present here the case of a 58-year-old woman having a large main adenocarcinoma with multiple small AAHs that mimicked lung-to-lung metastasis. AAH should be considered in the differential diagnosis of multiple small nodules during the preoperative evaluation and also during the follow-up of lung cancer patients.

Effects of TNF-alpha on Angiogenesis in CT-26 Mouse Colon Carcinoma Homograft Model / 대한소화기학회지

BACKGROUND/AIMS: Tumor necrosis factor-alpha (TNF-alpha) exerts its anti-tumor effect through direct cytotoxicity on tumor cells and damage to the tumor vasculature. However, its role in tumor angiogenesis is controversial. We evaluated the angiogenic effect of TNF-alpha on BALB/c mouse colon carcinoma homograft model. METHODS: Ten BALB/c mice were inoculated intraperitoneally with CT-26 mouse colon carcinoma cells. After a week, recombinant mouse TNF-alpha (2microgram/mL) were given four times on every other day to five animals and the same volume of phosphate buffered saline was given at the same interval to five animals as control. Harvested tumor tissues were stained by immunohistochemistry with CD31 and VEGF antibodies. Number of microvessels and VEGF expression were counted by light microscope. RESULTS: The mean microvessel counts per 200x field of TNF-alpha treated animals were 70.2+/-7.8 and those of nontreated animals were 83.8+/-8.3 (p<0.05). The VEGF score of both groups were 3. CONCLUSIONS: TNF-alpha treated animals showed decreased microvessel counts in tumor tissue but VEGF expression in both groups showed no difference. Therefore, TNF-alpha showed antiangiogenic effects on colon carcinoma homograft model.

Efficacy of weekly paclitaxel and concurrent radiation therapy for locally advanced non-small cell lung cancer / 대한내과학회지

BACKGROUND: Combined modality therapy is standard treatment of unresectable, locally advanced stage III non-small cell lung cancer (NSCLC). However, the optimal chemotherapy regimen and duration of chemotherapy remain a matter of debate. We evaluated the efficacy and feasibility of concurrent chemoradiation therapy (CCRT) in patients with locally advanced NSCLC. METHODS: PS 0-2 patients with histologically proven inoperable stage III NSCLC were eligible for this trial. The patients received paclitaxel (60mg/m2) on days 1, 8, 15, 22, 29, 36 with a concurrent radiotherapy (5days/week, 1.8Gy/day) starting day 1 with a total dose of 63 Gy. After CCRT, four cycles of consolidation chemotherapy with paclitaxel (140mg/m2) and carboplatin (AUC 5) was administered to patients with a partial, complete remission or stable disease. RESULTS: Twenty eight patients with locally advanced NSCLC enrolled in this study. The median age of the patients was 60 years. Of the 28 patients, 19 received scheduled CCRT. Overall response rate was 71.4% including 5 complete responses and 15 partial responses. Grade 3 or 4 pulmonary complication was observed in 7 patients and 3 patients died of pneumonitis. The median overall survival was 17.5 months (95% CI, 12.5-22.5). The median progression free survival was 8.0 months (95% CI, 4.1-11.9). CONCLUSIONS: CCRT including paclitaxel in patients with locally advanced NSCLC led to an encouraging response rate and survival, but resulted in high incidence of severe pulmonary complication.

A Prostate Carcinoma Metastasized to Bilateral Breasts / 대한비뇨기과학회지

Antiandrogens are generally used for the treatment of prostate cancer, with gynecomastia the most common adverse event seen during therapy. However, a breast mass in a man with a carcinoma of the prostate may represent a metastatic disease or, less often, a primary carcinoma of the breast. Clinically diagnosed metastatic prostate cancer to the breast is a rare event. Breast metastasis represents an end-stage manifestation of the cancer, with an extremely poor prognosis. Herein, the case of a 62-year-old man, who presented with bilateral breast masses 7 months after antiandrogen therapy for the treatment of prostate cancer, is reported. An excisional biopsy of the breast mass revealed a metastatic prostatic adenocarcinoma.

Well Differentiated Adenosquamous Carcinoma of Lung Mimicking Benign Lesions in Fine Needle Aspiration Cytology: Report of a Case / 대한세포병리학회지

Fine needle aspiration (FNA) cytological examination is an appropriate method for the evaluation of pulmonary nodules. In major types of lung cancer, its diagnostic accuracy is quite high. However, it is sometimes difficult, using this technique, to differentiate between some unusual phenotypes including adenosquamous carcinoma, bronchioloalveolar carcinoma (BAC), neuroendocrine tumor, mucoepidermoid carcinoma, and sclerosing hemangioma. Here, we present a case involving extremely well differentiated adenosquamous carcinoma, mimicking benign lesions, such as pulmonary scar and adenomatoid malformation with squamous metaplasia. The patient was a 68-year-old man presenting with a solitary pulmonary nodule (1.6x1.6 cm), which was incidentally found at the periphery of the right lower lobe. FNA revealed some clusters of glandular cells with minimal atypia, in addition to squamous cells at a nearly full maturational state. Histological examination verified the cytological diagnosis on a lobectomy specimen. The tumor exhibited a well differentiated adenocarcinoma component, mimicking the bronchioles in scarred lung tissue, and a well differentiated squamous cell carcinoma component, mimicking the squamous cell nests of adenoacanthoma, in the other organs. In the present case, the possibility of adenosquamous carcinoma should have been considered if squamous cells were seen in the FNA from the peripheral pulmonary nodule, even though they appeared to be benign.

Adult Onset of Langerhans Cell Histiocytosis in the Rib: Report of 2 cases / 대한흉부외과학회지

Langerhans cell histiocytosis (LCH), previously called histiocytosis X, refers to a spectrum of disease characterized by idiopathic proliferation of histiocytes producing focal or systemic manifestations. Causes and pathogenesis remain unclear. The basic histopatholgic findings are identical in the three well-established clinical syndromes (eosinophilic granuloma, Hand-Shuller-Christian disease, Letterer-Siwe disease). The disease has a predilection for children, although it may occur in adults. We experienced two cases of adult onset Langerhans cell histiocytosis in the ribs. One case was associated with diabetes insipidus and the other case had a solitary lesion.

Expression of Matrix Metalloproteinase (MMP)-2, MMP-9, Tissue Inhibitor of Metalloproteinase (TIMP)-1 and TIMP-2 in Adenocarcinomas of The Gallbladder

BACKGROUND: Matrix metalloproteinase (MMP)-2 and MMP-9 degrade type IV collagen and are antagonized by the tissue inhibitors of metalloproteinase (TIMP)-2 and TIMP-1, respectively. METHODS: We studied by immunohistochemistry the expressions of MMP-2, MMP-9, TIMP-1 and TIMP-2 in 72 cases of adenocarcinoma of the gallbladder. RESULTS: The MMP-2, MMP-9 and TIMP-1 expressions were significantly higher in well/moderately differentiated adenocarcinomas than in poorly differentiated adenocarcinomas, in adenocarcinomas that had invaded the lamina propria/proper muscle than in those that had invaded the perimuscular connective tissue or beyond the serosa, and in adenocarcinomas with fungating growth than in those with infiltrative growth. The TIMP-2 expression showed a similar pattern without statistical significance. Regarding the status of lymph node metastasis, the MMP-2 expression was significantly higher in cases without lymph node metastasis. The MMP-2 and MMP-9 expressions were significantly related to those of TIMP-2 and TIMP-1, respectively, with regard to depth of invasion, differentiation, and growth patterns of the adenocarcinomas. CONCLUSIONS: MMP-2, MMP-9, TIMP-1 and TIMP-2 are suggested to play important roles in the progression to early invasion of adenocarcinomas, in which the function of MMP-2 is inhibited by TIMP-2.

Metaplastic Carcinoma of the Breast with Chondroid Calcification: A Case Report

Metaplastic carcinoma is a rare form of breast carcinoma in which a variety of metaplastic changes occur. These commonly involve squamous or spindle cells, but pure chondroid metaplasia is relatively uncommon. We report a case of metaplastic carcinoma of the breast which mainly involved chondroid metaplasia and in which chondroid calcifications were seen on mammograms.

Myxoglobulosis of the Appendix: A Case Report

Myxoglobulosis of the appendix is a rare and peculiar form of appendiceal mucocele. It is characterized by pearl or fish egg-like mucin globules in the lumen. We report a case of myxoglobulosis of the appendix in a 31-year-old man. Myxoglobules are composed of eosinophilic necrotic cell debris and mucin in the central nidus and lamellar structures alternating with necrotic cell debris and mucin in the peripheral zone. A stirring effect produced by vigorous appendiceal peristalsis may contribute to its lamellar growth.

Diffuse cerebrospinal gliomatosis with extensive leptomeningeal spread

A case of diffuse cerebrospinal gliomatosis with extensive leptomeningeal spread is presented. The patient, an 18-year-old girl, was admitted due to progressive weakness and paresthesia of both legs, following rapid neuropsychiatric deterioration. An initial magnetic resonance imaging (MRI) study of the T-spine showed diffuse high signal intensities from T9 to T12 spinal cords on a T2 sagittal image and diffuse cord bulging at T1WI. This suggested an inflammatory lesion such as tuberculosis or fungal meningoencephalitis. A limited autopsy was performed. A microscopic examination revealed multifocal GFAP-positive astrocytic proliferations that were low grade astrocytoma in the cerebral leptomeninges, parietal, occipital and temporal lobes and anaplastic astrocytoma in the spinal cord and spinal leptomeninges. The high proliferative indices of the spinal lesion and aneuploidy correspond to a diagnosis of malignant astrocytoma and a rapid fatal clinical course.

A Case of Testicular Tunica Albuginea Cyst with Psammoma Body / 대한남성과학회지

We report a case of testicular tunica albuginea cyst with psammoma body which was treated with excision and testicular preservation. The presumptive diagnosis of a simple intratesticular cyst was made by ultrasound. The intraoperative pathological diagnosis was benign serous cyst and then simple excision of the lesion with testicular masses, and it may permit identification of lesions that can be excised locally with testicular preservation. To our knowledge tunica albuginea cyst with psammoma body, a characteristic histological finding, has not been reported. Its histogenesis was also discussed.

Primary Biliary Cirrhosis-Autoimmune Hepatitis Overlap Syndrome

Cases sharing features of both primary biliary cirrhosis and autoimmune hepatitis have been reported as a mixed type, overlap syndrome, immunocholangitis and autoimmune cholangiopathy. A primary biliary cirrhosis- autoimmune hepatitis overlap syndrome is unusual and characterized by overlapping features; cholestasis, high titer of alkaline phosphatase, bile duct damage and granulomas in the liver biopsy, high antinuclear antibody, increased IgG and IgM and intra-acinar hepatitis with piecemeal necrosis. Autoimmune mechanisms are thought to play a major role in the pathogenesis of the overlapping syndrome and the bases of immunosuppressive therapy. A 58-year-old female patient shows overlapping clinical and laboratory findings, chronic active hepatitis in initial liver biopsy which transits to primary biliary cirrhosis with cholangitis and granulomas. This is a case of hepatobiliary lesion showing overlapping features of both primary biliary cirrhosis and autoimmune hepatitis over 3-year period.

A Case of Behcet's Disease Involving Stomach and Entire Small Intestine Tereminal Ileum Perforation / 대한소화기내시경학회지

Behcet's syndrome is a multisystemic, chronic inflammatory disease with triad of oral ulcer, genital ulcer and inflammatory ocular lesion. Intestinal Behcet's disease accounts for 1-2% of Behc'ets disease and most commonly affects the ileocecal region as ulcerations. A 70-year-old male patient was admitted to this hospital because of melena for 5 days. There was a history of recurrent aphthous stomatitis and genital ulcer. Colonoscopy showed multiple, irregularly, rnarginated, ellipsoid ulcers surrounded by hyperemic mucosa with vessel exposure on terminal ileum. Esophagogastroduodenoscopy showed multiple, round punched out ulcers on antrum and duodenal bulb. He was taken the near total small bowel resection, right hemicolectomy and ileotransverse colostomy because of hemorrhage and terminal ileal perforation. Three days after operation, melena reappeared and esopbagogastoduodenascopy revealed bleeding from duodenal ulcers and impending perforation of antral ulcer. He was reoperated with antrectomy, truncal vagotomy and gastroduodenostomy. Resected small bowel was 510 cm in length and there were multiple small round transverse ulcers surrounded by hyperemic edematous elevated rnucosa. Three 'punch-out ulcers' were also found on resected gastric antrum. So, we report a case of gastrointestinal Behcet's disease involving stomach, duodenum, jejunum and ileum with terminal ileum perforation.

Sebaceous glands in the esophagus

We report a case of sebaceous glands in the esophagus diagnosed by endoscopic biopsy. The patient was a 47-year-old Korean man presented with postprandial pain of several months duration. An endoscopic examination disclosed an early gastric carcinoma in the gastric antrum and a 0.4 x 0.4 cm sized irregular lobulated nodule in the middle esophagus. Microscopically, the lobule was proven to be sebaceous glands in the submucosa. Possible histogenesis of this lesion is discussed.

Adenomyoepithelioma of the breast: its diagnostic problems and histogenesis

We report three cases of adenomyoepithelioma of the breast that occurred in middle aged women. The tumor is characterized by a balanced proliferation of epithelial tubules and surrounding myoepithelial cells that are spindle shaped or have clear cytoplasms. The first case mimicked tubular adenoma in the initial biopsy. However, on excision it turned out to be an adenomyoepithelioma of the tubular. The other two cases were lobulated types and had fibroadenomatous areas. The morphologic appearance of this tumor varies, making it misleading to other benign or even malignant lesions. The tumor has a potential for local recurrence, therefore, wide excision is recommended for proper diagnosis and treatment.

Clinicopathologic Characteristics of Ulcerative Colitis Diagnosed by Endoscopic Biopsy Specimen: An analysis of discrepancy between clinical and pathologic diagnosis

Chronic ulcerative colitis is a systemic inflammatory disease with uncertain etiology primarily involving the colonic mucosa. The mucosal biopsy interpretation is important for an evaluation of the disease state and further medical or surgical treatment. However, few clinical and pathological studies of the endoscopic diagnosis of this disease are available in Korea. Therefore, we evaluated the clinical and pathological characteristics of it diagnosed by endoscopic biopsy and analysed the reasons for the discrepancy between clinical and pathologic diagnosis for a more accurate endoscopic mucosal biopsy diagnosis in the future. A total of 702 cases of colonic mucosal biopsy specimens during Feb. 1994 and Jan. 1995 at Severance hospital, Yonsei University College of Medicine were reevaluated for the study. A clinical diagnosis of ulcerative colitis, after endoscopic examination, was made in 61(8.7%) cases. A pathological diagnosis was made when there is an increased inflammatory cell infiltration in the mucosa with evidences of a chronic crypt injury in the biopsy specimens. Using this criteria, a diagnosis was made in 32(52.3%) cases. In 29 cases the diagnosis was made in the first biopsy specimen and in the remaining 3 cases the diagnosis was made in the second or third biopsy specimens. No pathologic diagnosis of ulcerative colitis was made in the cases that clinical diagnosis was not. In the 32 cases diagnosed as ulcerative colitis, 14 cases were involved the rectum and sigmoid colon, 9 cases were involved up to the descending colon, 1 case was involved up to the transverse colon and 8 cases showed pancolonic involvement. In 29 cases, which ulcerative colitis was suspected clinically but was not consistent with it pathologically, 8 cases were proved to be ischemic colitis, 5 cases were acute infectious colitis and one case was Crohn's disease by repeat examination and follow up. Ten cases were histologically within normal range and lesions subsided spontaneously with no recurrence. A conclusive diagnosis could not be made in 5 cases during this study period. From these results, we conclude that ulcerative colitis can be diagnosed accurately by endoscopic biopsy, and clinical follow up and repeat examination are valuable in the differential diagnosis of this disease.

Immunohistochemical Sdtudy of Cytokeratin and Epithelial Membrane Antigen Expression in Osteosarcoma

Immunohistochemical analysis of 24 paraffin-embedded osteosarcomas was studied to evaluate the expression of simple cytokeratin, basal cytokeratin and epithelial membrane antigen(EMA) according to the histologic subtypes and anatomical locations. Mean age of the patients was 18 years. Anatomical locations of the tumors were femur(8), tibia(10), humerus(4), lumbar spine(1), and zygomatic arch(1). Histologic subtypes included osteoblastic(14), fibroblastic(4), chondroblastic(4), epithelioid(1), and mixed osteoblastic and fibroblastic(1). All were positive in the immunohistochemical stain for vimentin. The expression of cytokeratin and/or EMA was found in 10 cases(41.7%) regardless of anatomical locations and histologic subtypes. Positive immunoreaction for EMA was demonstrated in osteoblastic(5), chondroblastic(2), epithelioid(1), and mixed osteoblastic and fibroblastic(1) types. Osteoblastic (2), chondroblastic(2), and epithelioid(1) types among them also showed immunoreactivity with anti-simple cytokeratin monoclonal antibody, NCL-5D3. The expression of basal cytokeratin (NCL-LL002) was found in two osteoblastic, one chondroblastic, one epithelioid, and one mixed osteoblastic and fibroblastic types. These findings indicate that cytokeratin and EMA immunoreactivity can not be regarded as an absolute specific marker of the epithelial origin of tumor and may also occur in osteosarcoma.