A Case of Dermatomyositis Showing Vesicular Lesion Associated with Ovarian Cancer / 대한류마티스학회지

Dermatomyositis is a rare inflammatory myopathy with characteristic skin manifestations and accompanied by muscular weakness. Vesicle formation in dermatomyositis is rare. We report a case of dermatomyositis associated with ovarian cancer in a 62-year-old woman who had vesicles and bullae on her arms. She had erythema and edema on the face, chest, abdomen, and shoulder for 2 months. Diagnosis of dermatomyositis was established by clinical manifestations, muscle enzyme elevation, and a characteristic electromyogram. She was successfully treated with cyclosporin and high doses of steroids.

Seborrheic Keratosis of the Conjunctiva: A Case Report

Seborrheic keratosis is a benign epithelial neoplasia that occurs mainly in the skin of the eyelids and face. We describe a case of seborrheic keratosis of the conjunctiva confirmed by histopathology. A 72-year-old man presented with a recurrent conjunctival mass involving the nasal side of his right eye. Clinically, a diagnosis of conjunctival papilloma was made, and a mass excision was performed. The histopathological analysis evidenced a conjunctival-covering epithelium with papillomatous changes and irregular acanthosis, at the expense of a proliferation of basaloid cells. In addition, the lesion exhibited multiple pseudohorn cysts containing keratin. With the above findings, a diagnosis of conjunctival seborrheic keratosis was established. The occurrence of seborrheic keratosis on the conjunctiva is rare. In this case, seborrheic keratosis was confirmed by pathologic report despite its similar appearance with papilloma. Seborrheic keratosis should be considered in the differential diagnosis of conjunctival lesions.

A Case of Henoch-Shonlein Purpura Caused by Rifampin / 결핵및호흡기질환

Rifampin is one of the first line drugs for treating tuberculosis, but it might be associated with serious adverse effects, including renal failure. We report here on a case of a 57-year-old patient who developed Henoch-Shonlein purpura during antituberculosis therapy that included rifampin. The patient converted to negative on the AFB smear for tuberculosis two weeks after the initial administration of antituberculosis medication. After treatment for 60 days, this patient was diagnosed with Henoch-Shonlein purpura by the purpura lesion on the lower legs, the leukocytoclastic vasculitis, the renal impairment and the pathological examination. After stopping rifampin, the skin lesions disappeared in about 10 days and his renal function gradually improved. This case study showed that Henoch-Schonlein purpura can be caused by rifampin during antituberculosis therapy and we recommend that the use of rifampin should be restrained when clinical symptoms of Henoch-Shonlein purpura are observed.

Comparison of In-house Polymerase Chain Reaction Assay with Conventional Techniques for the Detection of Mycobacterium tuberculosis / 대한진단검사의학회지

BACKGROUND: The polymerase chain reaction (PCR) assay, introduced as a fast and sensitive diagnostic method, has been known to be useful in detecting Mycobacterium tuberculosis. Therefore the purpose of this study was to evaluate the usefulness of an in-house PCR assay in the detection of Mycobacterium tuberculosis by comparing PCR results with those of conventional diagnostic techniques. METHODS: We assessed the diagnostic yield of the in-house PCR assay retrospectively based on the patient's medical records using data from previously evaluated specimens submitted for PCR amplification IS6110 sequences by GeneAmp PCR system 9600 (Perkin Elmer, CT, USA). All samples had been examined for detection of M. tuberculosis by acid-fast stain and culture assay and the results from the 3 methods were analyzed. RESULTS: The majority of cases (1,727 cases, 96.6%) showed concordant results between in-house PCR, AFB stain, and culture methods; only 60 cases (3.4%) displayed discordant results. The sensitivities, specificities and positive and negative predictive values of each method were as follows: 81.0%, 99.6%, 95.0% and 98.4%, respectively for the in-house PCR; 63.4%, 100%, 100% and 96.9%, respectively for AFB staining method; and 83.8%, 100%, 100% and 98.6%, respectively for culture assays. CONCLUSIONS: The PCR assay shows a high sensitivity and specificity and is a reliable test for an early diagnosis of tuberculosis.

A Case of Malignant Myoepithelioma in Parotid Gland / 대한이비인후과학회지

Myoepithelial cells are a significant component of most types of salivary gland neoplasms, but, pure myoepitheliomas are rare, comprising less than 1% of all salivary gland tumors. Malignant myoepithelioma, or myoepithelial carcinoma, is even more rare. It occurs most frequently in the parotid gland among salivary glands, and is similar to benign myoepitheliomas. The palate is the most common intraoral site of involvement. As far as the treatment of myoepithelial carcinoma is concerned, surgical excision is the mainstay of therapy. The role of radiation therapy and chemotherapy is not yet established. We present a case of malignant myoepithelioma of the left parotid gland in a 67-year-old female patient who was treated with surgical excision followed by adjuvant radiation therapy.

A Case of Severe Hypertensive Pulmonary Edema Associated with Neuroblastoma during Chemotherapy

The authors report a 7-year-old boy with neuroblastoma complicated by severe hypertension and pulmonary edema. Abdominal computed tomographic scan revealed a huge mass surrounding the aorta. After administration of cancer treatment, there was a marked increase in serum catecholamines level and hypertension, which resulted in pulmonary edema and heart failure. Alpha adrenergic blocking agents (prazocin, terazocin) were administrated, successfully controlling the hypertension. The tumor differentiated to ganglioneuroblastoma after chemotherapy. The catecholamine production of the residual neuroblastoma must have increased because the treatment induced differentiation. It is important to watch for the development of hypertension during the treatment of neuroblastoma.

A Case of Carney Complex / 대한내분비학회지

Carney Complex is an autosomal dominant syndrome characterized by multiple neoplasias, including myxomas at various sites and endocrine tumors, spotty pigmentations and schwannomas. The criteria for diagnosis of the complex is the presence of two or more of the following conditions: 1) cardiac myxoma, 2) cutaneous myxoma, 3) mammary myxoma, 4) spotty mucocutaneous pigmentation, 5) primary pigmented nodular adrenal cortical disease (Cushing's syndrome), 6) testicular tumors (sexual precocity), 7) pituitary adenoma secreting growth hormone (acromegaly or gigantism). It is thought that the genetic defects which are responsible for Carney complex maps to the short arm of chromosome 2 (2p16). There are about 200 patients with Carney complex reported in the world. We encounted a patient who had a cardiac myxoma with a family history of cardiac myxoma, acromegaly, lentigosis, testicular mass with calcification and left adrenal nodule. This patient met the criteria for the diagnosis of the complex. Therefore, we think this patient represents clinical presentation of the Carney complex and we report this case with reviews of the literatures.

An Unusual Case of Sweet's Syndrome Associated with Myelodysplastic Syndrome / 대한혈액학회지

Sweet's syndrome, initially described in 1964 as acute febrile neutrophilic dermatosis by Sweet, is characterized by five cardinal feature: fever; neutrophilia; abrupt appearance of erythematous, painful, cutaneous plaque, primarily located on the upper extremities, head and neck; a dermal infiltrate of mature neutrophils; and a rapid response to steroid therapy. More than 500 cases of Sweet's syndrome have been documented since original description of Sweet, of which, approximately, 15~20 percent of published cases occurred in patient with hematologic malignancy. The authors describe an unusual case of Sweet's syndrome in a man, who affected with myelodysplastic syndrome (RAEB). A 56-year-old male patient admitted to Yonsei University, Medical Center because of sustained fever and cellulitis of right lower leg. With anemia and thrombocytopenia, the bone marrow study revealed myelodysplastic syndrome (RAEB). On 4th hospital day, with the development of pneumonia, he was treated with mechanical ventilation and broad spectrum of antibiotics. Although the treatment of pneumonia was successful, erythematous nodules, showing Koebner phenomenon and strong positive pathergy reaction, was appeared on the whole body (21st hospital day). Skin biopsy was taken. Under the diagnosis of Sweet's syndrome associated with myelodysplastic syndrome (RAEB), oral prednisolone 60mg/day was prescribed. The cuteneous lesions were regressed, but the brownish pigmentation was remained, till the patient discharged.

Correlation between proliferating index and prognostic factors in papillary cystic tumors of the pancreas

Fifteen cases of papillary cystic tumor of the pancreas (PCTP) were studied (14 female patients, one male patient; mean age: 23.5 years). Most tumors developed in the head of the pancreas as a well circumscribed large mass. The tumor had a mean diameter of 6.7 cm(range; 2 to 15 cm). Histopathologically abundant delicate papillary fragments, monomorphic tumor cells and degenerative changes of the solid area of the tumor were characteristic. All but two cases had completely circumscribed capsules. Two cases had duodenal invasion; one of all cases had cul de sac metastasis. Compared with 12 non-aggressive tumors, the aggressive cases had larger tumor size (more than 9 cm) with a thicker capsule (more than 2 mm). In studies to investigate the prognostic index using nucleolar organizing region (NOR), proliferating cell nuclear antigen (PCNA) and flow cytometry as well as nuclear grade and mitotic index, we could not find the useful parameter to detect the malignant potential of PCTP. In the flow cytometric analysis of cellular DNA contents, two invasive cases and the only one case of the male patient among the non-aggressive group were aneuploid. In conclusion, although it is hard to predict the prognosis by microscopic findings only, those with a thick capsule and aneuploidy tend to be related to malignant potential.

A Case of Nerve Sheath Myxoma with Electron Microscopic Study

We report a case of an uncommon cutaneous neoplasm of nerve sheath myxoma in a 25-year-old woman who had a papule on the left cheek of her face. The histologic findings of the lesion showed that lobulated tumors were composed of spindle shaped and stellate tumor cells in an abundant matrix of mucosubstances. The electron microscopic findings showed numerous cytoplasmic myelin figures, and interdigitating long cytoplasmic processes. 5-100 protein was not discovered and alcian blue and PAS stain showed positive. After surgical excision of tumor, the patient did not have any evidence of disease for one year.

The analysis of risk factors influencing lymph node metastasis in invasive carcinoma of the cervix / 대한산부인과학회잡지

No abstract available.

A case of angioimmunoblastic lymphadenopathy with dysproteinemia followed by Graves' disease / 대한혈액학회지

No abstract available.

A case of toxic shock syndrome in patient with CAPD / 대한신장학회잡지

No abstract available.

A case of tracheoesophageal cyst in the posterior mediastinum

We experienced a case of a tracheoesophageal cyst in the posterior mediastinum of a three-year-old girl, who complained of cough and fever. We confirmed this case by computerized tomography and pathologic examination after surgical resection. A brief review of the literature is presented.

A case of tracheoesophageal cyst in the posterior mediastinum

We experienced a case of a tracheoesophageal cyst in the posterior mediastinum of a three-year-old girl, who complained of cough and fever. We confirmed this case by computerized tomography and pathologic examination after surgical resection. A brief review of the literature is presented.

Histopathologic Study of the Mediastinal Tumors and Tumor-like Condition

Mediastinum is bounded by sternum, vertebra, 1st rib, and diaphragm externally, and by pleural cavity internally and includes important structures such as great vessels, nerves, thymus and many lymph nodes. Primary and metastatic cancers, cysts and inflammatory lesions can develop in this region, and the tumor developing in the mediastinum has a tendency to developed in a specific area of mediastinum depending on the histologic type. Therefore the developing site of tumor and the clinical findings are very important in diagnosing the tumor of the mediastinum. We studied not only the characteristics of mediastinal tumor and tumorlike conditions but the histologic classification and frequency of mass to a specific area and then observed if there is any information that could help in diagnosis of the lesion of the mediastinum. Results obtained were as follows: 1) Of the 95 cases of mediastinal lesion which excludes inflammatory process, there were 70 cases (73.5%) of primary tumors, 13 cases (13.1%) of metastatic tumors and 12 cases (12.6%) of tumor-like conditions. 2) Of the 70 cases of primary tumor, 54 cases (76.8%) were benign, 13 cases (20%) were malignant and 3 cases were unclassified or unidentified tumor with the overall 3.8:1 prevalence rate of benign tumor compared to malignancy. 3) Histologic classification of the 70 cases of primary tumor showed 27 cases (28.4%) of germ cell tumor, 22 cases (23.2%) of neurogenic tumor, 7 cases (7.4%) of thymoma, 6 cases (6.3%) of lymphoma and 5 cases (5.3%) of soft tissue tumors with the highest frequency of germ cell tumor. Germ cell tumor and neurogenic tumor exceeded to 50% of total primary mediastinal tumor. 4) Male to female prevalence rate showed that benigh tumor had a high frequency in female with the the ratio of 1:1.4. But malignant tumor showed much higher frequency in male with the ratio of 4.2:1. 5) Anterior mediastinum had germ cell tumor, thymoma and lymphoma in order of frequency. Metastatic tumor was the most common in superior mediastinum. Superior mediastinum had germ cell tumor and neurogenic tumor with about the equal number, and soft tissue tumor was also developed. Middle mediastinal tumor was less common in number compared to other portions of mediastinum but the majority of tumors developed was developmental cysts and metastatic tumors. And the majority of neurogenic tumors occured at the posterior mediastinum. 6) Mass sized 5-10 cm in diameter were about 55.7% of all tumor, 2.5-5 cm and 10-15 cm were 20% respectively. But the mass sized smaller than 2.5 cm and larger than 15 cm were about 5% respectively. And the malignant tumors have more larger size than benign tumors. 7) Patient with benigh tumor had no symptoms at all or some complaints of chest tightness, dyspnea, chest pain, shoulder pain and dysphagia. In addition to above symptoms, patient with malignant tumor complained of systemic symptoms such as weight loss and fever.

The Patterns of Invasion and Lymph Node Metastasis of Stomach Cancer by Histopathological Types

Stomach cancer is the most common malignant neoplasm among Korean men and considered as one of the most important malignant disease in many countries. Thus, many studies have been established about factors affecting prognosis of stomach cancer. These include studies of histopathological pattern which were performed by Mulligan and Rember (1954), Lauren (1965), Ming (1977), and Teglbjerg and Vetner(1977). The present study is aimed to evaluate the useful factors to predict the prognosis of patient of stomach cancer in relation to the histopathological patterns. The material consisted of 284 cases which were diagnosed as gastric carcinoma at the Department of Pathology, Yonsei University, College of Medicine from January, 1981 through December, 1982. After the classification of gastric carcinoma by Ming (1977), Willis (1967), and Mulligan and Rember (1954), age and six of the patients, histopathologic patterns, depth of invasion, degree and major component of inflammatory reaction, lymphatic permeation and metastatic incidence to the regional lymph nodes were investigated, and the results obtained were as follows; 1) The overall male to female ratio was 1.4 : 1 and mean age was 51.6 years old. The mean age of patients with EGC was 46.8 years old, while that of patients with invasive cancer was 52.2 years old, indicating about 5 years difference. 2) The classification of 284 cases by Ming's method showed 36.3% of expanding type and 63.7% of infiltrative one. The incidence of metastasis to regional lymph nodes was 58.3% in expanding type and 72.4% in infiltrative one. 3) The classification of 284 cases by Willis' method showed 45.8% of adenocarcinoma and 23.2% and of signet ring cell carcinoma. Adenocarcinoma anaplastic carcinoma had high degree of desmoplasia. Among them, moderately well differentiated adenocarcinoma and anaplastic carcinoma showed markedly lower metastatic rate to regional lymph nodes than others. 4) The classification of 284 cases by Mulligan and Rember's method showed 15.1% of intestinal cell carcinoma, 21.5% of pyloro-cardiac gland cell carcinoma and 61.6% of mucous cell carcinoma. Highly differentiated intestinal cell and pylorocardiac gland cell carcinomas and desmoplastic mucous cell carcinoma had high degree of desmoplasia. Among them, highly differentiated intestinal cell carcinoma and desmoplastic mucous cell carcinoma showed markedly low metastatic rate to regional lymph nodes. 5) Adenocarcinoma with good differentiation showed higher mean age and male predominancy in comparison to carcinoma with poor differentiation. 6) The degree of inflammatory reaction did not show significant difference in relation to the patterns of gastric carcinoma and the rate of regional node metastasis. However, according to the cell types involved in inflammatory reaction, plasma cell-predominant inflammatory reaction showed low metastatic rate to regional lymph nodes. 7) The more the degree of desmoplasia was observed, the less the rate of metastasis to regional nodes was noted and the difference was statistically significant. 8) The rate of metastasis to regional nodes showed marked difference by the depth of cancer invasion; confined to mucosa, 0% : to submucosa, 15.4%; to muscular layer, 66.7%; and to serosa and perigastric area, 76.5%. In summary, the results of this study indicated several factors suggesting good prognosis, such as; (1) expanding growth pattern, (2) good differentiation, (3) high degree of desmoplasia as stromal reaction, (4) plasma cell-predominant infiltration, and (5) lesser deep invasion. These factors were better evaluated by Mulligan and Rember's classification.

2 Cases of von Gierke's Disease

No abstract available.

Frozen Section: Indications, limitations, and accuracy

The rapid frozen section method is a means of intraoperative pathological diagnosis, first introduced by Welch in 1891 and developed as a diagnostic tool by Cullen, Wilson, MacCarty et al. This method serves useful purposes, such as determining the malignancy or benignancy of a suspected lesion, determining the adequacy of a biopsy of a suspected lesion, confirming the presence or absence of metatasis, and identifying small structures. But it bears many disadvantages, the most of which is the danger of incorrect diagnosis. We studied the indications, the limitations and the accuracy of the frozen section method and the materials studied was total cases of frozen section during recent 5 years. The ovarall accuracy of the frozen section diagnosis of 1,603 cases was 96.2% with 0.3% of false positive, 3.5% of false negative and 2.8% of incorrect histological diagnoses or grading errors the tissues submitted for frozen section were lymph node, breast, gastrointestinal tract and soft tissue in decreasing order of frequency. The false positive cases were four in number, while the false negative cases were 53, one third of which were the misdiagnoses of the presence of ganglion cells in Hirschsprung's disease.

Tow Cases of Cerebral Cavernous Hemangiomas in Children

Recently we experienced two cases of cerebral cavernous hemangioma in children at Pediatric Department of Yonsei Medical School. We are reporting these two cases with literature review.