Late Presentation of Metastatic Renal Cell Carcinoma as a Bleeding Duodenal Mass / 대한내과학회지

Gastrointestinal metastasis of a renal cell carcinoma is very rare, and the clinical course of the disease ranges from months to several decades. We experienced a case of solitary duodenal metastasis about 22 years after a right nephrectomy for clear-cell type renal cell carcinoma in a 77-year-old man who complained of melena. This case is the longest reported time interval between surgical nephrectomy to presentation with a duodenal metastasis. Patients usually present with recurrence within a year after radical nephrectomy but can present after many years, warranting lifelong surveillance.

Esophageal Gland Duct Adenoma

Benign ductal or glandular neoplasms of the esophagus unrelated to Barrett esophagus are extremely rare. Only 9 cases have been reported in the English language literature. We now report a case of esophageal gland duct adenoma incidentally found in a 73-year-old man. A 0.8 cm-sized, polypoid submucosal lesion in the distal esophagus was removed. Histologically, the lesion was well circumscribed and consisted of several ducts or cysts with focal papillary configurations. Interstitial lymphocytic infiltration with germinal centers was also observed. The lining cells of ducts or cysts were composed of two layers: an inner intensely eosinophilic luminal duct cell layer and an outer myoepithelial cell layer that was accentuated by alpha-smooth muscle actin. There was no significant nuclear atypia or mitosis. Mucin production was occasionally observed in a few goblet cells. To the best of our knowledge, this is the first case of benign ductal or glandular neoplasm of the esophagus among Koreans.

Clinical, radiographic, and histological findings of florid cemento-osseous dysplasia: a case report

Cemento-osseous dysplasias are a group of disorders known to originate from periodontal ligament tissue and involve, essentially, the same pathological process. They are usually classified into three main groups: periapical, florid, and focal cemental dysplasias depending on their extent and radiographic appearances. Radiographically, florid cementoosseous dysplasia (FCOD) appears as dense, lobulated masses, often symmetrically located in various regions of the jaws. The best management for the asymptomatic FCOD patient consists of regular recall examinations with prophylaxis. The management of the symptomatic patient is more difficult. A case of FCOD occurring in a 52-year-old edentulous Korean female is reported which is rare with regard to race and sex.

Clinicopathologic Features of Granulomatous Mastitis

BACKGROUND: Granulomatous mastitis (GM) is a rare chronic inflammatory condition that clinically mimics a carcinoma. The diagnosis of idiopathic GM depends on the exclusion of other granulomatous inflammations. The purpose of this study is to correlate the clinicopathological features of GM with etiologies. METHODS: We reviewed the clinical records of 58 cases that were histologically diagnosed as GM. We performed special stains for microorganisms such as Ziehl-Neelsen, periodic acid Schiff and gram stains, and polymerase chain reaction (PCR) for Mycobacterium tuberculosis (TB PCR). RESULTS: The mean age of patients was 35.3 years. Most patients were parous except three. Seven patients (12.1%) were related with pregnancy or lactation. TB PCR was positive in nine patients (15.5%). Five patients (8.6%) had gram positive bacilli that were recognizable as coryneform bacteria. Culture study demonstrated Staphylococcus aureus in only one case. Infectious GM had a greater tendency to form abscesses. Fat necrosis was more likely to be present in idiopathic GM, but other histological features were similar to each other. Twenty-two cases (37.9%) showed recurrence. CONCLUSIONS: We suggest that TB PCR and gram stain are essential tests for the differential diagnosis of GM, because the histologic features considerably overlap irrespective of the various etiologies.

Segmental Ischemia of the Small Bowel Caused by Cytomegalovirus Infection in a Patient with Multiple Injuries after a Traffic Accident

Cytomegalovirus infections (CMV) of the gastrointestinal tract (GI) are common, and most often seen in patients with acquired immunodeficiency syndrome (AIDS), inflammatory bowel disease, or those receiving immunosuppressive therapy. CMV enteritis is uncommon in an immunocompetent individual. A CMV infection of the small bowel accounts for 4.3% of all CMV infections of the GI tract. The GI manifestations of CMV include: diarrhea, bleeding, obstruction and perforation, all of which are usually secondary to discrete erosions or ulceration. High mortality rates have been reported for CMV enteritis. Here, a rare case of CMV enteritis, resulting in segmental ileal ischemia, is reported in a 47-year old man following a traffic accident. On the 17th hospital day, he developed melena, watery diarrhea, fever and abdominal pain. An abdominal computed tomography (CT) on the 23rd hospital day showed an enlarged appendix with mild periappendiceal infiltration and segmental wall thickening in the terminal ileum. An ileocecal resection was performed. Pathological evaluation of the operative specimen revealed CMV inclusion bodies, with ulcerations. The patient was treated with ganciclovir therapy for 3 weeks after which his symptoms improved. If a CMV infection is highly suspected in multiply injured trauma victims, the earlier recognition of potential small bowel involvement can hopefully decrease the incidence of bleeding, ischemic demage to the bowel and perforation, which are usually fatal events.

Mature Teratoma of the Gastrohepatic Ligament

Teratomas are tumors composed of derivatives of all three germinal cell layers. They have been described in a variety of organs in both children and adults, most commonly in the gonads. Extragonadal intraperitoneal teratomas are very rare. We here report a case of a large mature teratoma of the gastrohepatic ligament in a 20-year-old woman. To the best of our knowledge, a teratoma of the gastrohepatic ligament has never before been described, although there are a few reports of teratomas arising from the greater and lesser omentum.

A Case of Hyperthyroid Myopathy Due to Graves' Disease

A 49-year-old woman was admitted with a three-month history of myalgia and progressive proximal and distal muscle weaknesses. Physical examination showed diffuse enlargement of the thyroid gland and mild muscle atrophy. Serum creatine kinase was slightly increased and electromyography showed a myopathic pattern. Muscle biopsy showed nonspecific myopathic changes. Serum thyroid-stimulating hormone was very low, whereas thyroxine (T4) was greatly increased as well as anti-thyroglobulin, anti-microsome, and TSH-receptor antibody. The patient's symptoms were improved during the treatment with propilthiouracil.

A Case of Sj o gren Syndrome Presented with Fever of Unknown Origin / 대한류마티스학회지

Sjogren's syndrome is a chronic,slowly progressive,autoimmune disease in which the exocrine glands are damaged by lymphocytic infiltration,resulting in xerostomia and xerophthalmia.Fever in patients with Sjogren's syndrome is rarely manifested with the exception of cases with complicated illness such as lymphoma.We experienced a 70-year-old male patient with Sjogren's syndrome who was presented with fever of unknown origin.Despite of thorough investigation,other diseases to cause fever could not be found.Fever and other clinical features were improved with empirical steroid therapy.

A Case of Autoimmune Hepatitis Associated with Systemic Lupus Erythematosus / 대한류마티스학회지

Hepatic involvement of systemic lupus erythematosus (SLE) has been considered to occur rarely. Viral hepatitis or previous treatment with potentially hepatotoxic drugs has usually been implicated as the major causes of liver diseases in patients with SLE. After careful exclusion of these etiologies, the difference between the hepatic involvement of SLE and autoimmune hepatitis is not clear due to similarities in clinical and biochemical features. We describe a 37-year-old female with SLE who simultaneously satisfied the criteria of autoimmune hepatitis.

A Case of Autoimmune Hepatitis Associated with Systemic Lupus Erythematosus / 대한류마티스학회지

Hepatic involvement of systemic lupus erythematosus (SLE) has been considered to occur rarely. Viral hepatitis or previous treatment with potentially hepatotoxic drugs has usually been implicated as the major causes of liver diseases in patients with SLE. After careful exclusion of these etiologies, the difference between the hepatic involvement of SLE and autoimmune hepatitis is not clear due to similarities in clinical and biochemical features. We describe a 37-year-old female with SLE who simultaneously satisfied the criteria of autoimmune hepatitis.

A Clinical and Histological Study of Allergic Colitis in Infant

PURPOSE: This study was done to evaluate the clinical and pathologic aspects of allergic colitis. METHODS: This study evaluated 19 infants who presented with fresh blood mixed stools. Limited colonoscopy and biopsy were performed. Among the 19 infants, 13 infants were diagnosed as allergic colitis by histological findings. We analyzed the clinical and histological characteristics of 13 infants. RESULTS: Male and female were 8 and 5 respectively. The mean age of the infants was 3 months (4 days to 12 months). Major symptoms were rectal bleeding (13), mucoid stool (6), diarrhea (5), vomiting (2). Feedings before diagnosis were breast milk (3), formula milk (4), formula and breast milk (5), and weaning diet (1). In labortory data, anemia (2) and eosinophilia (12) were found in some infants. Endoscopic findings were focal erythema (7), nodularity (1), erythema and nodularity (4), hemorrhage (1). Histopathologic finding was eosinophilic infiltration in lamina propria with preserved mucosal architecture in all. In addition, cryptitis (13), lymphoid follicular hyperplasia (7), crypt abscess (1) were also observed. All the infants improved with cessation of rectal bleeding and diarrhea within three days after dietary change. CONCLUSION: Allergic colitis should be considered as one of the major cause of rectal bleeding in healthy appearing infants. Limited colonoscopy and biopsy should be considered in establishing a definitive diagnosis.

A Case of Bilateral Intrapulmonary Sequestration / 소아알레르기및호흡기학회지

A pulmonary sequestration is a mass of nonfunctioning, embryonic lung tissue that has no communication with the normal bronchial system and is usually supplied by an aberrant systemic artery. Bilateral intrapulmonary sequestration is very rare. This case was a 16 months old boy who showed persistent right lower lobe infiltration on chest X-ray. We found the consolidation lesions on left lower lobe and right lower basal segment which had the multiple cyst like lesions on the chest computed tomography. We confirmed the bilateral intrapulmonary sequestration by angiography which showed each sequestrated tissue being supplied by 2 aberrant arteries. The lobectomy of left lower lobe and the ligation of right aberrant artery were performed. Four months later, residual right lower lobe sequestrated tissue regressed markedly on the following chest computed tomography. Herein, we report a case of bilateral intrapulmonary sequestration which was successfully treated by the ligation of aberrant artery without subsequent complications.

Clinicopathological Analysis of Laryngeal Leukoplakia: Clinical Follow-up and Immunohistochemical Expression of p53 and PCNA

Laryngeal leukoplakia is seen in a number of pathologic settings such as keratosis without atypia(KWOA), keratosis with atypia(KWA), squamous cell carcinoma in situ(CIS) and invasive squamous cell carcinoma, and it continues to be a confusing and controversial topic for both otolaryngologist and pathologist. This is largely due to the use of ambiguous and inconsistent terminology, the lack of unanimous agreement on the definition of these terms, failure of the clinician to obtain a representative biopsy, and the subjectivity of the pathologist interpreting the biopsy. To evaluate the applicability of the expression pattern of p53 and PCNA in borderline cases of histopathologic classification, we performed a histopathologic analysis of leukoplakia to includ clinical follow-up, correlation of disease progression and degree of atypia, and expression of p53 and PCNA according to the degree of atypia. Histologically, laryngeal leukoplakia included seven cases of KWOA, fourteen cases of KWA (mild-2, moderate-8, severe-4), three cases of CIS, and one case of invasive squamous cell carcinoma. Keratosis with atypia, a moderate degree or more, showed a strong tendency to progress to invasive carcinoma(p<0.05). The degree of p53 and PCNA expression correlated with the degree of atypia(p<0.05). p53-positive cases at the initial biopsy clearly tended to recur and develop into invasive carcinoma(p<0.01).

Fine Needle Aspiration Cytology of Peripheral Neuroepithelioma of Soft Tissue: Report of A Case / 대한세포병리학회지

Peripheral neuroepithelioma (PNE) of soft tissue is a malignant neuroectodermal tumor arising from peripheral(nonautonomic) nerve. It may occur in both children and adults, and are highly aggressive neoplasms that rapidly give rise to metastatic disease and death. We exprienced a case of peripheral neuroepithelioma of soft tissue in the upper arm in a 18-year-old female. Cytologic features revealed small round cells with scanty cytoplasm occurring both singly and in clusters. The clusters frequently tended to form Homer-Wright rosettes. The cells had a round to oval nucleus with fine chromatin and inconspicuous nucleoli in a hemorrhagic background.