Two Cases of Invasive Carcinoma of the Breast Composed Mostly of Signet Ring Cells in the Fine Needle Aspiration Cytology / 대한세포병리학회지

Scattered single cells or variable sized clusters of signet ring cells in the aspirated smears of breast lesions are almost exclusively associated with carcinoma. The signet ring cells are defined as those containing a prominent intracytoplasmic vacuole or amorphous cytoplasm diffusely dispersed with mucin. The primary signet ring cell carcinoma of the breast behaves more aggressively than carcinoma without signet ring cells. Therefore, it is very important to make a correct diagnosis of signet ring cell carcinoma. Fine needle aspiration cytology is useful for diagnosis of breast lesions including signet ring cell carcinoma. We report two cases, which showed mostly signet ring cells in the aspirated smears of the breast. One case consisted of numerous individual signet ring cells and variable sized cell clusters in rather mucoid background. The tumor cells had abundant amorphous cytoplasm filled with dispersed mucin or occasionally mucin vacuoles(PAS +) and eccentric nuclei. The resected mass revealed mucinous carcinoma. The other showed the cytologic findings of low cellularity, and small loosely cohesive signet ring cell clusters with mild nuclear pleomorphism. It was confirmed as lobular signet ring cell carcinoma in the resected tumor.

Clinical Features of Subacute Necrotizing Lymphadenitis in Children

PURPOSE: There is a predilection for subacute necrotizing lymphadenitis(SNL) in young Asian women. Few pediatric cases have been reported. This study was performed to evaluate clinical features of children with SNL. METHODS: We retrospectively analyzed clinical features of 23 cases of SNL under 15 years of age identified in Nowon Eulji Hospital from February 1995 to January 2002. Two cases were diagnosed by excisional biopsy and 21 cases by fine needle aspiration. RESULTS: The ages ranged from 14 months to 14 years(mean 8.1+/-3.8 years). The male to female ratio was 1 : 1.6. Ten cases(10/23) were diagnosed in 2000. The onset was more frequent in spring. The common presenting symptoms were neck mass(22/23), pain(12/20) and fever(8/18). Fever subsided within two weeks in seven out of eight and lymphadenopathy resolved within five months in 14 out of 15. The mean WBC count was 7,664+/-3,454/mm3. Elevated levels of ESR(10/ 12) and lactate dehydrogenase(5/6) and positive reaction for CRP(3/4) were frequent. Radiologically measured greatest diameter of the enlarged lymph nodes was less than 2 cm in 14 out of 15. One case occurred in a child with alopecia areata and one case with type 1 diabetes. Clinical outcomes were good in 23 cases. CONCLUSION: SNL should be considered in children with cervical lymphadenopathy regardless of fever or pain. SNL seems not rare in pediatric groups in Korea.

Two Pediatric Cases of Type 1 Autoimmune Hepatitis with Normal Immunoglobulin G Levels Presenting as Fulminant Hepatitis

Autoimmune hepatitis is a chronic necroinflammatory liver disorder of unknown cause associated with circulating autoantibodies and hypergammaglobulinemia. We report two pediatric cases of type 1 autoimmune hepatitis with normal serum immunoglobulin G levels who presented with fulminant hepatitis. The cases were associated with hereditary spherocytosis or atrioventricular septal defect. The first case was a 13-year-old boy with hereditary spherocytosis and gallstones. Acute cholecystitis and cholangitis developed during his clinical course and cholecystectomy, splenectomy and liver wedge biopsy were performed. The second case was an 8-year-old girl with repaired atrioventricular septal defect. In both cases, antinuclear antibody tests were positive and immunoglobulin G levels were normal. Interface hepatitis with moderate lobular inflammation were noted on their liver histology. They responded to the treatment of prednisolone and ursodeoxycholic acid.

A Case of Obstructive Jaundice Caused by Cavernous Transformation of the Portal Vein / 대한소화기내시경학회지

Cavernous transformation of the portal vein is a rare condition probably arising secondary to extrahepatic portal vein thrombosis or obstruction with recannalization and/or collateral veins formation to bypass the obstruction. It is believed that cavernous transformation of the portal vein is caused by a variety of diseases associated with periportal collateral development and hepatopedal flow. It is known that portal vein occlusion, which is the actual cause of cavernous transformation, has a wide variety of etiologies, such as congenital abnormalities, omphalitis, pancreatitis, various carcinoma, and liver cirrhosis. In most cases, the revealing symptom is upper gastrointestinal bleeding. Rarely, however, diagnosis is made from obstructive jaundice. Extensive collateral veins due to portal vein occlusion may compress and narrow the biliary tract. A 39-year-old man was admitted due to jaundice and abdominal discomfort for 1 month. He was confirmed to have obstructive jaundice due to collateral vessels of cavernous transformation of the portal vein. We report a case of obstructive jaundice caused by cavernous transformation of the portal vein.

A Case of Early Developed Left Ventricular Free Wall Rupture Followed by Acute Inferior Myocardial Infarction

Myocardial free wall rupture is the most serious complication of acute myocardial infarction. Although it is not uncommon, it is difficult to treat successfully. We report a case of acute inferior myocardial infarction complicated with left ventricular free wall rupture that occurred 8 hours after onset of chest pain. In this case, progression of mild pericardial effusion to cardiac tamponade was monitored by transhtoracic echocardiography. Pericardiocentesis and draninage failed to treat cardiac tamponade, and surgical repair was performed successfully. The patient discharged uneventfully on 28th day and followed regularly at the outpatient department.

A Case of Methimazole-Induced Cholestatic Jaundice with Steroid Therapy / 대한내분비학회지

Cholestatic jaundice caused by imidazole derivatives is a rare complication of antithyroid drug therapy. We present a case of cholestatic jaundice with systemic hypersensitivity reaction, which developed in a 27-year old male one day after exposure to methimazole. The patient showed clinical improvement and gradual resolution of jaundice after the discontinuation of methimazole and treatment with prednisolone. Histologic findings of liver revealed bile pigment, predominantly in centrilobular area, and infiltration of chronic inflammatory cells in a few portal area without evidence of degeneration or necrosis of hepatocytes. Methimazole could be presumed as etiologic agent from clear chronological relationship and the lack of other causative factors. We report this unusual case with review of literature.

A Case of Multiple Systemic Embolism Associatied with Left Atrial Free-Floating Ball Thrombus

Left atrial thrombus is frequently associated with rheumatic mitral valvular heart disease. Left atrial thrombus is usually attached to the atrial wall, but rarely it is freely floating in the cavity. In that case the patient may present with the symptoms of acute hemodynamic decompensation due to the so-called "hole-in-one" effect or multiple systemic embolism. We report a case of multiple systemic embolism associated with left atrial free-floating ball thrombus in mitral valvular heart disease.

Localized Pulmonary Cryptococcosis Diagnosed by Fine Needle Aspiration Cytology: Report of a Case / 대한세포병리학회지

Initial rapid diagnosis of primary pulmonary cryptococcosis(PPC) occurring in a immunocompetent host was made by transthoracic fine needle aspiration cytology of a solitary subpleural nodule. Numerous refractile spherical organisms surrounded by a clear halo were demonstrated with haematoxylin-eosin and Papanicolaou stains. The organisms, 5 15 micrometer in diameter, were easily demonstrated with Gomori methenamine-silver stain. Many of the organisms showed narrow-base budding. Carminophilic cell walls were well demonstrated with mucicarmine stain.

A Case of Neonatal Sepsis after Operation of Annular Pancreas in Newborn

Annular pancreas is a rare congenital anomaly with the descending duodenum encircled by a ring of pancreatic tissue, which may cause partial or complete obstruction of the duodenum. In newborn, the symptoms can be those of duodenal stasis resulting from partial intestinal obstruction secondary to some degree of duodenal stenosis. A male newborn weighing 2.0 Kg was born by C-section delivery at 37 weeks' gestation to a 27-year-old mother who had a hydramnios. He was in relatively good condition at birth except regurgitation of saliva and intermittent apnea. A plain film of the abdomen showed the double-bubble of gas filled stomach and proximal duodenum, and upper gastrointestinal series showed a dilated proximal duodenum, with a complete obstruction of the descending duodenum. Intraoperative finding revealed encirclement of the duodenal second portion by pancreatic tissue. Duodenojejunostomy was performed. After the operation, he had developed two serious complications, neonatal septicemia by Enterobacter cloacae on postoperative day 12 and systemic candidiasis on postoperative day 19, and been managed with ventilatory support, antibiotics, and antifungal agents with recovery.