A Case of Ovarian Malignant Melanoma showing Peritoneal Dissemination with Unknown Primary Origin / 대한산부인과학회지

Malignant melanoma is a neoplasm of the skin and mucous membrane which very rarely occurs in the ovary. Malignant melanomas occurring in the ovary must be differentiated from primary and metastatic malignant melanoma. Primary malignant melanoma of the ovary is extremely rare and is thought to originate from a cystic teratoma. Malignant melanoma of ovary without evidence of residual teratoma must be considered metastatic even in the absence of a previously cutaneous or mucocutaneous lesion. Opinions about its histogenesis, diagnostic criteria and elective treatment are controversial because of rare manifestations, and the prognosis remains poor in spite of the variety of therapeutic measures. After thoroughly surveying the specific literature, we report case of malignant melanoma with multiple metastases located in the stomach, the omentum and both ovaries with unknown site of primary origin.

Expression of Mucin Genes in the Human Testis and Its Relationship to Spermatogenesis

In this study we investigate the expression pattern of mucin genes in the human testis and evaluate the relationship between the expression of mucin genes and impaired spermatogenesis in the human testis. Thirty human testis tissues were collected from patients undergoing diagnostic testicular biopsy to investigate the cause of infertility. One part of the tissue underwent histological observation, and the other part of the tissue was subjected to semiquantitative RT-PCR of mucin genes, that is, mucin1, 2, 3, 4, and 9. The relative amount of mucin mRNAs was calculated by densitometry using glyceraldehydes-3-phosphate dehydrogenase (GAPDH) as an internal control. The samples were histologically diagnosed as either obstructive azoospermia with normal spermatogenesis (n = 13) or non-obstructive azoospermia with impaired spermatogenesis (n = 17). In the human testis with normal spermatogenesis, mRNA expression of mucin1, 9, 13 and GAPDH were found, but RT-PCR products of mucin 2, 3 and 4 were not detected. In the testis with impaired spermatogenesis, however, RT-PCR product of mucin1 was not found. There was no difference in the other mucin mRNA expression patterns between the testis with either normal or impaired spermatogenesis. To our knowledge, this study is the first that has detected the mRNA of mucin9 and 13 in human testis. This study also shows that mucin1 expression might be closely related to spermatogenesis. Our findings should be substantiated by more direct evidence, such as mucin protein expression and localization.

Telomerase activity and Expression of MIB-1, Fas and Fas Ligand in Placentas from Women with and without Intrauterine Growth Retardation

BACKGROUND: The placenta from a pregnancy that is complicated by intrauterine growth retardation (IUGR) tends to be smaller than that from a normal pregnancy. To investigate this difference, we analyzed the telomerase activity, the proliferative activity and the mRNA levels of apoptosis mediators in placentas. METHODS: In 20 placentas from normal third-trimester pregnancies and 22 placentas form pregnancies that were complicated by IUGR, the telomerase activity was detected by a telomeric repeat amplification protocol assay. The proliferative activity was assessed by immunohistochemical staining using the MIB-1 monoclonal antibody. The expression of the apoptosis mediator was evaluated by semi-quantitative reverse transcription-polymerase chain reactions for fas and fas ligand. RESULTS: Telomerase activity was detected in 2 (10%) of 20 normal placentas, whereas it was not observed in all tested 13 placentas that were associated with IUGR. The proliferative activity was significantly low in the placentas that were associated with IUGR (7.44+/-2.96%), compared with the normal placentas (11.0+/-3.48%, p=0.002). There was no statistically significant difference in the mRNA levels of fas or fas ligand between two groups. CONCLUSIONS: Low telomerase and proliferative activities in the placenta may play a role in the pathogenesis of IUGR.

A case report: A case of fibroepithelial polyp on vulvoperineal area / 대한산부인과학회지

A case of fibroepithelial polyp on vulvoperineal area is described. Her age is 20 year old and the tumor measured 9 cm in its largest diameter and was connected to the left labium majus. This case is very unusual in that almost all reported vulvar fibroepithelial polyps are small and sessile, and should distinguish from malignant cancer. We have experienced an unusually large vulvoperineal mass that was surgically excised and histologically diagnosed as benign fibroepithelial polyp and present this case with a brief review of literature.

A Case of Thyroid Abscess Associated with Lymphocytic Thyroidits / 대한내분비학회지

No Abstract available.

Renoprotective Effect of the Combined Use of Steroid and Angiotensin II Receptor Blocker in IgA Nephropathy / 대한신장학회잡지

BACKGROUND: Several studies have examined the role of angiotensin II receptor blocker (ARB) or steroid treatment in decreasing proteinuria and preserving renal function in IgA nephropathy (IgAN). METHODS: We designed a prospective, randomized trial to assess the effects of combination therapy of steroid (daily high-dose for 6 months) and ARB in IgAN patients with proteinuria >or=1.0 g/d and serum creatinine (SCr)or=1.4 mg/dL at the last visit had older age and higher proteinuria level at 6 mo than those with SCror=1g/d that the combination of ARB and prednisolone was more effective in preserving renal function as well as in decreasing proteinuria than the ARB alone therapy.

A Case of Solitary Adult Type Myofibroma / 대한피부과학회지

Solitary myofibroma is a recently described, uncommon neoplasm of superficial soft tissue and presenting as an asymptomatic nodule of the skin, which mainly occurs in adults. It was thought to be the adult counterpart of infantile myofibromatosis. Although it has histopathological similarity to infantile myofibromatosis, it shows a discrete clinicopathological entity compared with infantile form on the basis of its much later onset, superficial location, invariable solitary occurrence and uniformly benign behavior. A 41-year-old female presented a skin lesion on the posterior neck for 1 year, which was a solitary, painless nodule. The excised tumor was diagnosed as myofibroma by light microscopy and immunohistochemistry.

Unilocular Extrahepatic Biliary Cystadenoma Mimicking Choledochal Cyst: A Case Report

We report here on a case of extrahepatic biliary cystadenoma arising from the common hepatic duct. A 42-year-old woman was evaluated by us to find the cause of her jaundice. Ultrasonography and CT showed a cystic dilatation of the common hepatic duct and also marked dilatation of the intrahepatic duct. Direct cholangiography demonstrated a large filling defect between the left hepatic duct and the common hepatic duct; dilatation of the intrahepatic duct was also demonstrated. Following excision of the cystic mass, it was pathologically confirmed as a unilocular biliary mucinous cystadenoma arising from the common hepatic duct.

A Retrospective Analysis on Reasons for Allograft Nephrectomy after Kidney Transplantation / 대한이식학회지

PURPOSE: Allograft nephrectomy has been done in considerable proportion due to many reasons after kidney transplantation. This study was undertaken to determine the incidence, causes, and time of allograft nephrectomy after kidney transplantation. METHODS: A total 141 kidney transplantations were performed between 1993 and 2003 Kyung Hee University Hospital. We found 22 cases of allograft nephrectomy in the same period and a retrospective analysis was conducted on 22 allograft nephrectomy. The patients records were reviewed for age, causes, and time of allograft nephrectomy after kidney transplantation. RESULTS: The pathological causes of allograft nephrectomy were chronic rejection in 18 cases (81.8%), acute rejection in 3 cases (13.6%), accelerated rejection in 2 cases (9.1%) and allograft infection, renal vessel thrombosis, cyclosporin toxicity, GVHD in each one case (4.5%). Of 18 cases with chronic rejection, acute rejection episode was occurred in 12 cases (66.7%). The interval from kidney transplantation to allograft nephrectomy was more than 5 years in most patients (63.6%). CONCLUSION: In our studies, allograft nephrectomy was performed in 22 cases, chronic rejection was major cause of allograft nephrectomy, and acute rejection episide was occurred in most chronic rejection. We suggested that early detection and aggressive treatment of acute rejection might be considered to lower the incidence of allograft nephrectomy after kidney transplantation.

Effect of Combined Treatment of Steroid and Angiotensin II Receptor Blocker (ARB) in Proteinuric IgA Nephropathy / 대한신장학회잡지

BACKGROUND: It has been reported that prednisolone (PDL) therapy favorably influences proteinuria and renal function in the patients with IgAN in whom ARB as well as ACE inhibitor has an anti- proteinuric effect. Therefore, we did a controlled prospective trial to test the effect of treatment with PDL (daily high-dose for 6 months) and ARB in proteinuric adult patients with IgAN. METHODS: Forty-two patients with proteinuria > or =1.0 g/day and serum Cr < or =2.0 mg/dL were randomized to treatment with PDL and ARB and to that with ARB alone. RESULTS: The follow-up period lasted 15.4+/-3.5 months in combination group (n=18) and 19.8+/-7.4 months in ARB group (n=20). Proteinuria was significantly reduced in the both groups (ARB group: from 4.31+/-2.85 g to 1.38+/-1.09 g vs. combination group: from 4.67+/-5.33g to 0.78+/-0.99 g). The rate of complete remission was 10% in ARB group and 44% in combination group at the final follow-up (p<0.05). There were no differences of mean serum Cr between groups before and after treatment. The number of patient with aggravation in renal function was five (25%) in ARB group and one (5%) in combination group. CONCLUSION: This study shows that the urinary protein excretion was effectively reduced by both groups and the rate of complete remission was higher in combination group than in ARB group. Long- term follow-up may be helpful to define the effect on the renal function in IgAN patients.

A Case of Primary Malignant Fibrous Histiocytoma of the Diaphragm / 결핵

A malignant fibrous histiocytoma (MFH) is a major subset of soft tissue sarcomas, which occurs principally on the extremities or in the retroperitoneum, as well as on the head and neck of elderly patient. However, it is an extremely rare event when a MFH occurs primarily in the diaphragm of a young people. A 25-year-old woman visited our hospital complaining of right chest pain. The chest X-ray showed a diaphragmatic mass. An exploratory thoracotomic biopsy revealed a primary MFH of the diaphragm. The patient was treated with combined chemotherapy consisting of ifosfamide and doxorubicin. A partial response was seen after 6 cycles of chemotherapy. However, she died of brain metastasis 12 months after the diagnosis.

A Case of Synchronous Mucinous Tumor of the Ovary and Appendix / 대한산부인과학회잡지

The coexistence of mucinous ovarian and appendiceal tumors in associated with pseudomyxoma peritonei is well established. But, ovarian and appendiceal mucinous tumors occur without involvement of other organs is unusual. When the two lesions are morphologically similar, it is difficult to determine whether one reflects a metastasis or whether the tumors are independent. The typical synchronous presentation of the ovarian and appendiceal tumors, their histologic similarity, the frequency of bilaterality of the ovarian tumors, the predominance of right-sided ovarian involvement. Adenocarcinoma of the appendix constitutes 0.2 to 0.5 percent of all gastrointestinal tumors and accounts for 6 percent of primary malignant lesion of the appendix. The authors experienced a rare case of synchronous tumor of ovary and appendix in 59 years old female patient who has suffered for 3-4 months from abdominal pain. Pathologic examination of the resected specimen revealed a synchronous mucinous type tumor of vermiform appendix and ovary.

Portal Vein, Splenic Vein, and Superior Mesenteric Vein Thrombosis and Small Bowel Necrosis in the Patient with Hypereosinophilia: A Case Report

Eosinophils are only a small minority of peripheral blood leucocytes and, in normal subjects, most are found in the tissues of the lung and gastrointestinal tract. Peripheral blood eosinophilia is occurred by various causes, allergic diseases, parasite infection, clonal disorder, and drug. Moderate to severe eosinophilia may be caused by the idiopathic hypereosinophilic syndrome (HES), but the commonest cause of eosinophilia worldwide is helminthic infection and, in industrialized nations, atopic disease. Whatever the cause for the eosinophilia, in certain circumstances the eosinophils produce damage to various organs by activation of eosinophils, thrombotic events, release of eosinophil granule contents, and deposition of eosinophil proteins. Clinical manifestations are characterized by thromboembolic events of the involved organ, such as the heart, lungs, or nervous system. To our knowledge, the association between hypereosinophilia and intraabdominal multivessel (portal, splenic and superior mesenteric vein) thrombosis has never previously been reported. Thus, we report a case with portal, splenic and superior mesenteric venous thrombosis simultaneously with disseminated intravascular coagulapathy in the patient with hypereosinophilia.

Fine Needle Aspiration Cytology of the Intraductal Papillary Mucinous Tumor of the Pancreas: A Case Report / 대한세포병리학회지

Intraductal papillary mucinous tumor of the pancreas is characterized by intraductal papillary proliferation of mucin-producing epithelial cells with or without excessive mucin secretion. According to the degree of epithelial dysplasia, intraductal papillary mucinous tumor is classified into adenoma, borderline tumor, and carcinoma. We recently experienced a case of fine needle aspiration cytology of the intraductal papillary mucinous adenoma in a 69-year-old male. The fine needle aspiration cytology yielded flat sheets of columnar, mucin containing epithelial cells in the background of dense mucin containing degenerated cellular material and histiocytes.

A case of Goodpasture syndrome with diffuse pulmonary hemorrhage / 대한내과학회지

Goodpasture syndrome is an autoimmune disease with a triad of acute renal failure due to rapidly progressive glomerulonephritis (RPGN), pulmonay hemorrhage and circulating anti-glomerular basement membrane antibody (anti-GBM Ab). It was commonly reported from Europe in male with a peak incidence in their 20's. If patients are affected with the disease, relief of symptoms can be expected by eliminating the anti-GBM Ab from the circulatory system through hemodialysis, plasmapheresis and immunoadsorption. However, if the diagnosis or treatment is delayed, the patients usually die from massive pulmonary hemorrhage. It has been revealed that the main target of anti-GBM Ab's is NC1 domain on the alpha3 chain of type IV collagen. Currently there are many studies underway using this information as a basis to identify the pathogenesis of Goodpasture syndrome and to develop new therapeutic approach. The patient was a 20-year-old male with a chief complaint of edema. Unlike patients in the two previous cases, reported in Korea who had massive hemorrhage, he showed diffuse pulmonary hemorrhage which improved in only one week by hemodialysis. Renal biopsy demonstrated crescents in over 90% of glomeruli and showed signs of acute renal failure due to RPGN, with 618 U/mL (normal range <19.9 U/mL) of anti-GBM Ab titer.

Pulmonary Lymphangioleiomyomatosis and Micronodular Pneumocyte Hyperplasia associated with Tuberous Sclerosis: A Case Report

Lymphangioleiomyomatosis (LAM) is characterized by a hamartomatous proliferation of smooth muscle cells in the lung, mediastium, and abdomen. In the lung, an abnormal proliferation of smooth muscle is seen along the airways, blood vessels, and lymphatics, resulting in honeycombing of the lung. It occurs in 0.1-1% of tuberous sclerosis (TSC) patients. Micronodular pneumocyte hyperplasia (MNPH) is a rare but distinctive pulmonary manifestation of TSC, and appears to be a hamartomatous proliferation of the type II pneumocytes. We report a case of pulmonary LAM and MNPH associated with TSC and bilateral renal angiomyolipoma in a 26-year-old woman. Immunohistochemically, the spindle cells of LAM were positive for HMB-45, but the type II pneumocytes of MNPH were negative.

A case of placental site trophoblastic tumor / 대한산부인과학회잡지

Placental site trophoblstic tumor(PSTT) is a rare variant of trophoblastic disease. This type of trophoblastic tumor apparently exhibits different biologic behaviors as compared with choriocarcinoma. Diagnosis is made by finding a predominance of intermediate trophoblasts and absence of fetal tissue in the dilatation and currettage specimens. The intermediate trophoblastic cells produce relatively little beta-hCG and hPL and unlike other trophoblastic tumors, they are frequently resistant to chemotherapy1. But patients with metastasis frequently exhibit a progression of disease and die despite of aggressive multiagent chemotherapy. We report a case of PSTT, in which a 36-year-old woman presented with vaginal bleeding after D&CB at 14 weeks of pregnancy. Despite of blood transfusion, the patient was under shock state, and hysterectomy was done. After hysterectomy, the pathological diagnosis was PSTT confirmed by immunohistochemical study, and the result was strong positive for hPL & cytokeratin but weak positve for beta-hCG2.

A Case of Lymphoepitheliomalike Carcinoma of the Uterine Cervix / 대한산부인과학회잡지

The lymphoepitheliomalike carcinoma of the cervix is histologically similar to lymphoepithelioma of the nasopharyngeal region or medullary carcinoma of the breast which has grossly circumscribed, histologically poorly differentiated nonkeratinized squamous cell carcinoma with prominent stromal inflammation. Although the entity has been rarely reported in the united states, it has been reported relatively common in Japan. The Japanese literature suggests that patient with this varient may have a more favorable prognosis when compared with the usual squamous cell carcinoma of the cervix A patient with a squamous cell carcinoma of the uterine cervix with marked lymphocyte and plasma cell infiltration is reported and the literature reviewed.

Intramuscular Bronchogenic Cyst of Gastric Body: A Case Report

Developmental foregut cysts, whether bronchogenic, esophageal, gastroenteric or pericardial, are frequently encountered in the mediastinum, and are also occasionally found in the upper abdomen, where they can mimic adrenal, pancreatic, renal or gastric masses. We present the computed tomographic (CT) and histologic findings of an intramuscular bronchogenic cyst of the gastric body, mimicking a retroperitoneal cystic mass. CT scanning demonstrated the presence of a relatively hyperattenuating cystic mass without enhancement. Histologic examination revealed a bronchogenic cyst secreting mucoid materials.

Clinical Course of Patients with IgA Nephropathy between Combined Treatment of Immunosuppressive Agents and ACE Inhibitor and ACE Inhibitor alone

BACKGROUND: It has not been clear whether immunosuppressive therapy favorably influences renal function and proteinuria in IgA nephropathy (IgAN). Angiotensin converting enzyme inhibitor (ACEi) has an anti-proteinuric effect in IgAN. A retrospective study was done to see whether the addition of immunosuppressive therapy to ACEi produces a more excellent anti-proteinuric effect and preserves better renal function than ACEi alone. METHODS: A total of 49 patients with proteinuria>1.0 g/day and serum creatinine concentrations<1.5 mg/dL were followed-up from at least 1 year to 9 years. Among them, 25 patients were treated with the combination of cyclophosphamide, prednisolone and ACEi while the other 24 were treated with ACEi alone. RESULTS: The combination therapy or ACEi alone both reduced proteinuria with significant value (the combination group: from 5.74+/-5.08 to 2.29+/-2.77 g/day, ACEi group: from 3.85+/-2.54 to 1.68+/-1.91 g/day), while no significant differences in reduction of proteinuria were noticed between the two groups. There was no significant elevation of serum creatinine in both groups during follow-up (the combination group: from 0.91+/-0.20 to 1.03+/-0.38 mg/dL, ACEi group: from 0.93+/-0.27 to 0.99+/-0.37 mg/dL). This study showed no significant differences in the change in slope of 1/serum creatinine levels during the follow-up period between the two groups. CONCLUSION: We conclude that immunosuppressive therapy may not be beneficial in patients with proteinuric IgAN. ACEi may be a valuable therapeutic agent avoiding serious side effects of immunosuppressive agents.