Insulin-Derived Cutaneous Amyloidosis: A Possible Complication of Repeated Insulin Injections

Primary localized cutaneous amyloidosis (PLCA) is characterized by extracellular deposition of pathological fibril aggregation of proteins in the skin without systemic involvement.Macular amyloidosis, lichen (papular) amyloidosis, and nodular amyloidosis are three different subtypes of PLCA. Although the pathological mechanism of PLCA has not yet been clarified, it is assumed that a nucleus formation of amyloid fibril is formed due to repeated external stimulation, such as subcutaneous injection, which often poses diagnostic challenges. Herein, we present a 54-year-old Korean male patient with cutaneous localized amyloidosis which occurred after repeated local insulin injections, and discuss the relationship between insulin therapy in patients with diabetes mellitus and dermal amyloid deposition.

Relationships between Lymph Node Metastasis and Expression of CD31, D2-40, and Vascular Endothelial Growth Factors A and C in Papillary Thyroid Cancer

OBJECTIVES: To investigate the relationships between lymph node metastasis (LNM) and expression of CD31, D2-40 and vascular endothelial growth factors (VEGF)-A and -C in patients with papillary thyroid cancer (PTC). METHODS: Paraffin-embedded thyroid tissues of 72 patients were evaluated, which included 25 patients with thyroid nodular hyperplasia (TNH), 24 PTC patients without LNM, and 23 PTC patients with LNM. Three pathologists, who were blinded to the patient's clinical information, assessed the immunohistochemical staining results. The amount of expression was scored as high (>25% of cells stained) or low (0-25%). RESULTS: A higher level of VEGF-A expression was observed in the PTC groups regardless of LNM when compared to the group with TNH (91.3%, 79.2%, 4.0%, respectively). VEGF-C expression in the PTC with LNM group was significantly higher than the other two groups (P<0.05). No difference in microvessel density (MVD) scores was observed using CD31 among the three groups. The lymphatic vessel density (LVD) score using D2-40 was significantly higher in patients having PTC with LNM than the other groups (P<0.05). CONCLUSION: VEGF-C and D2-40 were more highly expressed in patients having PTC with LNM than in patients having PTC without LNM or in those having TNH. Analysis of VEGF-C level and LVD using D2-40 may be helpful in the diagnosis of PTC and the evaluation of LNM potential in patients with PTC.

A Case of Intra-Abdominal Kikuchi's Disease with Increased FDG Uptake on PET-CT that Mimicked Intra-Abdominal Lymphoma

Kikuchi's disease is a benign disease characterized mainly by fever and cervical lymphadenitis. We report a case of Kikuchi's disease that manifested as intra-abdominal lymphadenitis. A 39 year old woman presented with fever that had persisted for one week. Her history and physical examination were unremarkable. The laboratory findings revealed mild leukopenia and increased C-reactive protein. Abdominal CT revealed multiple lymph node enlargements in the mesenteric root and around the ileocecal valve. Positron emission tomography-computed tomography (PET-CT) revealed increased 18-fluoro-deoxyglucose(FDG) uptake in the lymph nodes observed by abdominal CT. A laparoscopic excisional biopsy of the lymph node was performed for a confirmatory diagnosis and the pathology findings were compatible with Kikuchi's disease. Although intra-abdominal Kikuchi's disease is a rare disease, it should be considered in a differential diagnosis of intra-abdominal lymphadenopathy with increased FDG uptake on PET-CT.

Expression of Bcl-2, Bax and p27 in Patients with Papillary Thyroid Cancer with or without Lymph Node Metastasis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The aim of this study was to investigate the relationship between the expression of Bcl-2, Bax, p27 and lymph node metastasis (LNM) in papillary thyroid cancer (PTC). SUBJECTS AND METHOD: The thyroid tissue samples were obtained randomly from the department of pathology at Kangbuk Samsung Hospital. The specimens were from 72 patients, comprising 25 patients with thyroid nodular hyperplasia (TNH), 23 PTC without LNM, and 24 PTC with LNM between January 2006 and May 2008. Immunohistochemical staining for Bcl-2, Bax, and p27 was performed, and quantified blindly by three pathologists who had no clinical information of the patients. Immunohistochemical expression was scored as high (>25% of cells stained) or low (0-25%). RESULTS: Expression of Bcl-2 was scored as high for 1 (4%) TNH, 3 (13%) PTC without LNM and 4 (17%) PTC with LNM cases. Expression of Bax was scored as high for 0 (0%) TNH, 9 (39%) PTC without LNH and 16 (67%) PTC with LNM cases. Expression of p27 was scored as high for 13 (52%) TNH, 12 (52%) PTC without LNM and 13 (54%) PTC with LNM cases. Expression of Bax in the PTC with LNM group was scored higher than TNH (p<.01) and PTC without LNM (p<.05). There was no statistically difference in the immunoreactivity for Bcl-2 and p27 among the three groups. However, some positive expressions of p27 were noted at the cytoplasm of the PTC. CONCLUSION: Our results suggest that immunohistochemical analysis of Bax may be helpful in the diagnosis of PTC and in the evaluation of lymph node metastatic potential in PTC.

The Clinical Usefulness of Focally Enhanced Gastritis in Korean Patients with Crohn's Disease / 대한소화기학회지

BACKGROUND/AIMS: Focally enhanced gastritis (FEG) has been suggested as a specific diagnostic marker for patients with Crohn's disease (CD). However, the usefulness of FEG for distinguishing CD from ulcerative colitis (UC) is uncertain and the incidence or prevalence of FEG for inflammatory bowel disease (IBD) patients in Korea has not been defined yet. In this study, we investigated the frequency of FEG and other gastric histological abnormalities in Korean patients with CD and UC. METHODS: We evaluated 37 patients with known CD, 43 patients with UC and 41 non-IBD control group; all underwent upper gastrointestinal endoscopy followed by biopsy from the antrum and the body. The pathology of the gastric biopsy specimens and the presence of Helicobacter pylori (H. pylori) were evaluated. FEG was characterized by a focal perifoveolar or periglandular inflammatory cell infiltrates. RESULTS: H. pylori positive gastritis was found in 10 of 37 (27.0%) of CD patients, in 16 of 43 (37.2%) of UC patients, and in 22 of 41 (53.7%) of non-IBD control group (p=0.054). In H. pylori-negative patients, FEG was found in 8 of 27 patients (29.6%) of CD patients, 6 of 27 (22.2%) patients with UC, and 2 of 9 (10.5%) of non-IBD control group (p=0.324). CONCLUSIONS: In H. pylori-negative patients, there was no statistically significant difference in the occurrence of FEG among CD, UC and control groups in Korea.

A Clinical Experience of Microcystic Adnexal Carcinoma in Lower lip and Back

Microcystic adnexal carcinoma(MAC), or sclerosing sweat duct carcinoma, may best be considered as a sclerosing variant of ductal eccrine carcinoma. This tumor is a deeply invasive and aggressive neoplasm, which most commonly occurs on the skin of the upper lip, but it also occurs on the chin, nasolabial fold, or cheek. Local recurrence is common, however,metastases have not been reported. We have experienced 2 cases of microcystic adnexal carcinoma or sclerosing sweat ductal carcinoma, in lower lip including mandible bone, and in back. In the case of lower lip, the wide excision and partial mandiblectomy including 6 teeth and supraomohyoid neck dissection was performed, and the defect was covered with radial forearm free flap. For the prevention of lower lip drooping, we used the palmaris longus tendon which is harvested at the same time of flap elevation for the suspension of free radial forearm tissue. As the recipient vessel, the facial artery and facial vein was used. Immediately after the operation, the flap survival result was excellent, and the excised mandible bone and 6 teeth were replaced with denture. Fourteen months after the operation, the local recurrence is not notified. There was no difficulty of mastication nor speech, no lower lip drooping nor flap drooping. In case of back lesion, wide excision and split thickness skin graft was performed. We excised the lesion above level of the fascia. The split thickness skin was harvested from the left thigh, skin graft was performed on the fascia and completed in 10 days without loss.There is no local recurrence or specific complication except mild hypertrophic scar in the 10th month after the operation. We report these 2 cases with the review of literature that provide the guidance in treatment of microcystic adnexal carcinoma.

Mutation and expression of the p27KIP1 and p57KIP2 genes in human gastric cancer

Cyclin-dependent kinase inhibitors (CDKI) are negative regulators of cell cycle progression by binding the cyclin-CDK complex and inhibiting the CDK activity. Genetic alteration in the CDKI genes has been implicated for carcinogenesis. To test the genetic alteration in the p27 and p57 genes, KIP family CDKI genes, 30 gastric tumor-normal pairs and 8 gastric cancer cell lines were analyzed for mutations by polymerase chain reaction-single strand conformational polymorphism (PCR-SSCP). No mutation was detected in these genes although length polymorphisms in the proline-alanine repeat of the p57 gene were detected. When the p27 and p57 mRNAs were analyzed in gastric cancer cell lines by RT-PCR, the p27 mRNA was expressed considerably high in tumor cells but expression of the p57 mRNA was much low in gastric cancer cell lines compared to that of normal cells. The result suggests that inactivation of gene expression rather than mutations in the p57 gene accounts possibly for the involvement of this gene in tumorigenesis of gastric cancer. However, expression of the p27 gene seems to be essential for cell survival.