Enterovesical Fistula From Meckel Diverticulum

Meckel diverticulum is a common congenital malformation of the gastrointestinal tract and can cause complications such as ulceration, hemorrhage, intussusception, and perforation. This report describes a very rare complication of an enterovesical fistula associated with chronic Meckel diverticulum. A 51-year-old male presented with over 10 years of persistent pyuria. Tests were performed to rule out malignancy, including serum prostate-specific antigen level, urine cytology, bacterial culture, cystoscopy, and bladder computed tomography. An enterovesical fistula was identified, and laparoscopic exploration was performed. The findings suggested enterovesical fistula formation caused by chronic inflammation at the tip of a Meckel diverticulum. Segmental resection of the small bowel including the diverticulum and primary repair of the urinary bladder along with partial cystectomy were performed. The postoperative clinical course was uneventful. An enterovesical fistula is a very rare complication resulting from chronic inflammation of a Meckel diverticulum.

Enterovesical Fistula From Meckel Diverticulum

Meckel diverticulum is a common congenital malformation of the gastrointestinal tract and can cause complications such as ulceration, hemorrhage, intussusception, and perforation. This report describes a very rare complication of an enterovesical fistula associated with chronic Meckel diverticulum. A 51-year-old male presented with over 10 years of persistent pyuria. Tests were performed to rule out malignancy, including serum prostate-specific antigen level, urine cytology, bacterial culture, cystoscopy, and bladder computed tomography. An enterovesical fistula was identified, and laparoscopic exploration was performed. The findings suggested enterovesical fistula formation caused by chronic inflammation at the tip of a Meckel diverticulum. Segmental resection of the small bowel including the diverticulum and primary repair of the urinary bladder along with partial cystectomy were performed. The postoperative clinical course was uneventful. An enterovesical fistula is a very rare complication resulting from chronic inflammation of a Meckel diverticulum.

A multicenter study of interobserver variability in pathologic diagnosis of papillary breast lesions on core needle biopsy with WHO classification

Background@#Papillary breast lesions (PBLs) comprise diverse entities from benign and atypical lesions to malignant tumors. Although PBLs are characterized by a papillary growth pattern, it is challenging to achieve high diagnostic accuracy and reproducibility. Thus, we investigated the diagnostic reproducibility of PBLs in core needle biopsy (CNB) specimens with World Health Organization (WHO) classification. @*Methods@#Diagnostic reproducibility was assessed using interobserver variability (kappa value, κ) and agreement rate in the pathologic diagnosis of 60 PBL cases on CNB among 20 breast pathologists affiliated with 20 medical institutions in Korea. This analysis was performed using hematoxylin and eosin (H&E) staining and immunohistochemical (IHC) staining for cytokeratin 5 (CK5) and p63. The pathologic diagnosis of PBLs was based on WHO classification, which was used to establish simple classifications (4-tier, 3-tier, and 2-tier). @*Results@#On WHO classification, H&E staining exhibited ‘fair agreement’ (κ = 0.21) with a 47.0% agreement rate. Simple classifications presented improvement in interobserver variability and agreement rate. IHC staining increased the kappa value and agreement rate in all the classifications. Despite IHC staining, the encapsulated/solid papillary carcinoma (EPC/SPC) subgroup (κ = 0.16) exhibited lower agreement compared to the non-EPC/SPC subgroup (κ = 0.35) with WHO classification, which was similar to the results of any other classification systems. @*Conclusions@#Although the use of IHC staining for CK5 and p63 increased the diagnostic agreement of PBLs in CNB specimens, WHO classification exhibited a higher discordance rate compared to any other classifications. Therefore, this result warrants further intensive consensus studies to improve the diagnostic reproducibility of PBLs with WHO classification.

A Comparison of Results after Anterior Cruciate Ligament Reconstruction in over 40 and under 40 Years of Age: A Meta-Analysis

PURPOSE: Anterior cruciate ligament (ACL) injury is one of the most common injuries that occur in the knee, and ACL reconstruction (ACLR) is commonly performed for preventing aggravation of degenerative changes and restoring of knee stability in young, athletic patients. This metaanalysis has a purpose of evaluating the clinical and arthrometrical outcomes of ACLR in a group of middle age patients (40 years and older) and comparing with patients under 40 years of age. METHODS: MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, Web of Science, and SCOPUS electronic databases were searched for relevant articles comparing the outcomes of ACLR between younger and older than 40 years of age until December 2016. Data searching, extraction, analysis, and quality assessment were performed based on the Cochrane Collaboration guidelines. Clinical outcomes were evaluated and compared between groups. The results were presented as mean difference for continuous outcomes with 95% confidence intervals whereas risk ratio for binary outcomes. RESULTS: Seven studies were included in the meta-analysis. Based on International Knee Documentation Committee classification, side-to-side difference, Tegner activity score, Lysholm knee score, there were no significant clinical and mechanical differences between the groups. CONCLUSIONS: This meta-analysis confirmed that after ACLR, middle age (>40 years) and young age (<40 years) patients did not present with significant difference in clinical and arthrometric results.

Myoferlin Expression and Its Correlation with FIGO Histologic Grading in Early-Stage Endometrioid Carcinoma

BACKGROUND: For endometrioid carcinoma patients, International Federation of Gynecologists and Obstetricians (FIGO) histologic grading is very important for identifying the appropriate treatment method. However, the interobserver discrepancy with this three-tiered grading system is a serious potential problem. In this study, we used immunohistochemistry to analyze the relationship between FIGO histologic grading score and myoferlin expression. METHODS: We studied the endometrioid carcinoma tissues of 60 patients from Gyeongsang National University Hospital between January 2002 and December 2009. Immunohistochemical analysis of myoferlin was performed on tissue microarray blocks from surgical specimens. RESULTS: Myoferlin expression was observed in 58 of 60 patients. Moderate and strong myoferlin expression was observed in low-grade endometrioid carcinoma, while there was a tendency toward loss of myoferlin expression in high-grade endometrioid carcinoma (p < .001). CONCLUSIONS: Our study revealed that myoferlin loss is significantly correlated with high FIGO grade of endometrioid carcinoma.

Thymoma and Synchronous Primary Mediastinal Seminomas with Florid Follicular Lymphoid Hyperplasia in the Anterior Mediastinum: A Case Report and Review of the Literature

Thymoma is the most common neoplasm of the anterior mediastinum and has malignant potential. Germ cell tumors (GCTs) found in the anterior mediastinum are usually benign, and malignant GCTs, such as seminomas, are rare. Histologically, mediastinal seminoma is indistinguishable from testicular seminoma except for site-associated morphological features such as lymphoid follicular hyperplasia. Therefore, excluding metastasis is very important. Recently, we treated a young adult patient with multiple thymic masses that occurred simultaneously. The patient underwent a thymectomy for the removal of the mediastinal masses, one of which was diagnosed as type B2 invasive thymoma, and two of which were diagnosed as primary mediastinal seminomas with massive follicular hyperplasia. The patient received adjuvant chemotherapy after surgical resection. To our knowledge, this is the first description of a thymoma and a mediastinal seminoma occurring simultaneously in the thymus. We present this case along with a literature review.

A Case of Severe HIV-Associated Psoriasis Successfully Treated with Acitretin Therapy

Psoriasis is a chronic inflammatory skin disease that involves immune-mediated cutaneous inflammation and keratinocyte hyperproliferation. Psoriasis in patients with HIV responds poorly to treatment and has a high morbidity rate, thus posing a challenge to clinicians. Until now, there have been no documented cases of acitretin therapy for HIV-associated psoriasis in Korea. Here, we report a case of safe and successful therapy with acitretin in a 52-year-old man with HIV-associated psoriasis that responded poorly to previous treatments including steroids and ultraviolet B phototherapy. We also review the relevant literature.

Tumoral Pseudoangiomatous Stromal Hyperplasia of Male Breast: A Case Report

Tumoral form of pseudoangiomatous stromal hyperplasia (PASH) of male breast is a rare disease entity. We report on a case of PASH that presented as a palpable subareolar breast mass in a 46-year-old male who has been on hemodialysis due to chronic renal failure. To the best of our knowledge, no case of PASH in a male with chronic renal failure has yet been reported. We describe its mammographic and sonographic findings with correlative histopathologic features, confirmed by surgical excision.

Urachal cyst presenting with huge abscess formation in adults / 대한외과학회지

Urachal disease, a disorder where embryonic remnant of the cloaca and the allantois present after birth as a midline fibrous cord, is usually detected in infancy and childhood. But urachal disease in adults is rare. We report a case of a huge abscess derived from a urachal cyst in an adult. A 52-year-old man presented with peri-umbilical distension and abdominal pain for 2 weeks. Ultrasonography and abdominal computed tomography scan demonstrated a huge abscess derived from the abdominal wall. After prompt incision and drainage, the remaining abscess cavity was removed completely under general anesthesia. Pathologic report was consistent with urachal duct cyst, and the patient was discharged in a week without complication.

Portal and Mesenteric Venous Thrombosis Complicating Endoscopic Injection Sclerotherapy / 대한소화기내시경학회지

Endoscopic injection sclerotherapy is an effective and relatively safe modality for controlling bleeding esophageal varices. Injection of sclerosant causes acute mural thrombosis with a necroinflammatory response and subsequent sclerosis in the venous system of the distal esophagus. A few cases of mesenteric venous thrombosis with small bowel infarction after sclerotherapy have been reported, and most of which were fatal. The association between mesenteric venous thrombosis and sclerotherapy has been strongly suggested, but this still remains unproved. We report here on a case of mesenteric venous thrombosis with small bowel infarction that developed after endoscopic injection sclerotherapy.

Microsatellite Instability in Endometrial Adenocarcinomas of Young Women

BACKGROUND: The correlation between microsatellite instability (MSI) and the prognosis of patients with endometrial carcinomas is controversial. The endometrial carcinomas in the young adult group usually have an excellent prognosis, and these tumors might have a different frequency of MSI compared with those in old women. Further, the pathogenetic mechanisms of the two groups might be different. We investigated the frequency of MSI in the endometrial cancers of patients who were under the age of 40 and we correlated the frequency with other prognostic factors. METHODS: MSI analyses were performed using 5 primers (BAT25, BAT26, D2S123, D5S346 and D17S250) and with using the genomic DNA obtained from the paraffin embedded tumor and the paired normal tissues. RESULTS: All 23 cases we examined exhibited endometrioid adenocarcinomas, and most of them were of the low international federation of gynecologists and obstetricians (FIGO) stage (stage I: 22, IIB: 1); 78% were microsatellite stable and 22% were MSI-low; an abnormal peak was present at only one marker, and any case of MSI-high was not identified. The FIGO stages of the 5 MSI-low cases were variable. CONCLUSIONS: The frequency of MSI in the endometrial cancers of young patients is not significantly different from the frequencies reported for all age groups in the previous studies, MSI-low does not seem to be related to the other poor prognostic parameters, although the number of cases we studied is insufficient to draw any firm conclusion.

Fine Needle Aspiration Cytology of the Plasmablastic Lymphoma in Human Immunodeficiency Virus(HIV) Negative Patient: A Case Report / 대한세포병리학회지

Plasmablastic lymphoma(PBL) is a recently described aggressive B-cell neoplasm, which usually manifests as a localized disease of the oral mucosa in individuals infected with human immunodeficiency virus(HIV). Recently, we encountered a case of plasmablastic lymphoma manifesting in the left maxillary sinus and cervical lymph node of a previously healthy HIV-negative man, 48 years of age. we conducted a fine-needle aspiration smear of the cervical lymph node, and this was found to be highly cellular with numerous large cells exhibiting eccentrically positioned nuclei, prominent nucleoli, and moderate quantities of basophilic cytoplasm. A biopsy of the mass in the maxillary sinus evidenced diffuse growth of similar plasmablastic cells. These tumor cells were negative for the leukocyte common antigens, CD20, CD3, CD30, and EMA. However, the cells tested positive for CD79a and CD138/syndecan-1. The tumor cells also exhibited L-light-chain restriction. The Ki-67 proliferation index was measured at almost 100%. The patient was diagnosed with plasmablastic lymphoma. After three cycles of combination chemotherapy and radiotherapy, the patient went into complete remission, and currently remains in this state.

Mixed Ductal-Endocrine Carcinoma of the Pancreas: A Case Report

Mixed ductal-endocrine carcinoma of the pancreas is composed of ductal and endocrine carcinoma components and each component makes up a significant proportion in the primary tumor as well as in the tumor of metastatic sites. Mixed ductal-endocrine pancreatic carcinoma is exceptionally rare and, to our knowledge, only five cases have been reported in the literature. Recently we experienced a case of mixed ductal-endocrine pancreatic carcinoma with regional lymph node and hepatic metastases in a 63-year-old woman. Here, we report a case of mixed ductal-endocrine pancreatic carcinoma with a review of the literature.

Expression of p27Kip1 Protein in Colorectal Adenocarcinoma

p27Kip1 has been recognized as a negative regulator of cell cycle. Reduced level of p27 expression is associated with development and aggressiveness of several human tumors. To investigate the role of p27Kip1 on progression of colorectal adenocarcinoma, we studied 40 cases of human colorectal adenocarcinomas for expression of p27Kip1 protein using an immunohistochemical method, and compared these results with known prognostic parameters of colorectal adenocarcinoma. Among 40 cases of colorectal adenocarcinomas, p27Kip1 expression was detected in the nuclei of tumor cells in 14 cases (35%). The expression rate of p27Kip1 protein was significantly lower in the cases with lymph node metastasis (25.8%) than in those without lymph node metastasis (66.6%) (p<0.05). But it did not correlate with other parameters such as tumor size, histologic grade, vascular invasion, and Ki-67 labeling index. The results suggest that reduced expression of p27Kip1 protein plays a role in biologically aggressive behavior of colorectal adenocarcinoma.

Expression of HLA-DR, ICAM-1, IL-2 and IL-4 in Renal Biopsy of Trasplanted Patient / 대한이식학회지

PURPOSE: We performed this study to evaluate the value as early markers predicting the acute rejection and differential diagnosis with other causes of renal dysfunction. METHODS: Immunohistochemical stains for HLA-DR, ICAM-1, IL-2 and IL-4 were performed on 44 cases of implantation biopsies which were divided into cases with acute rejection (R group, 14 cases) and cases without rejection episode (N group, 30 cases), and 45 gun biopsies for renal dysfunction which divided into cases diagnosed as rejection (A group, 28 cases) and cases diagnosed as other causes rather than rejection (B group, 17 cases). We analysed immunohistochemical results, various clinical datas such as age and sex of donor, living or cadaveric status of donor, the mean number of HLA-DR mismatch, age and sex of patient, serum creatinine level at post op 2 day for implantation biopsy and at the day on biopsy for renal dysfunction between above groups. RESULTS: 1) In 44 cases of implantation biopsies, positive immunohistochemical stains for HLA-DR were more frequent in R goup (71.43%) than in N group (26.66%). There was no significant difference of clinical datas and immunohistochemical stains for ICAM-1, IL-2 and IL-4. 2) In 45 cases of gun biopsies for renal dysfunction, immunohistochemical stains for HLA-DR were all positive in A group (100%) with higher rate of 3 stains (39.28%) than B group (positive; 70.58%, 3 ; 5.88%). Immunohistochmical stains for ICAM-1 were more frequently expressed in A group (100%) than B group (76.47%). Both stains revealed no significant difference according to the grades of rejection, disease other than rejection. There was no significant diffrence of immunohistochemical stains for IL-2 and IL-4, and clinical datas between two groups. CONCLUSION: We can conclude that the immunohistochemical stains for HLA-DR on implantation biopsies may predict the devepoment of the acute rejection and the immunohistochemical stains for HLA-DR and ICAM-1 on gun biopsies at the time of renal dysfunction may differentiate the reje.

A Case of Sepsis due to Vibrio damsela / 대한임상병리학회지

Vibrio damsela is a halophilic bacterium that has been reported to cause skin ulcers and death in damselfish (Chromis punctipinnis) as well as wound and soft-tissue infections in human. Most of the previously reported cases in humans haute involved wound infections associated with exposure to seawater or handling fish. We experienced a case of primary septicemia due to V. damsela after eating raw fists in a healthy 66-year-old woman who had neither wounds nor history of exposure to sea- water. She presented fever and diarrhea followed by rapidly pregressive bullae and painful edema on left band and forearm. The patient was Improved by intensive surgical debrldement of necrotic tissue and antibiotic therapy.

Distribution of Antideoxyribonuclease B Levels and Results of Throat Cultures in School Children in Seoul / 대한임상병리학회지

BACKGROUND: Antistreptolysin O (ASO) has been widely used to diagnose Streptococcus Pyogenes infections and their sequelae, rheumatic fever and acute glomerulonephritis. Butt in some cases there is no elevation of ASO that it is necessary to add one or more tests detecting immune response to S. pyogenes.. The authors analyzed the distribution of antideoxyibonuclease (ADNase) B and antistreptolysin O (ASO) among the children of an elementary school in Seoul and calculated their upper limit of normal (ULN) value. METHODS: ADNase B concentrations were determined by nephelometry (Behring Nephelometer 100 Analyzer, Germany) on 236 sera of healthy elementary school children in Seoul. Throat cultures were taken at the same time to compare ADNase B lovels between S. pyogenes carriers and non-carriers. RESULTS: The distribution of ADNase B concentrations among school children ranged from 77 (detection limit) to 1616 IU/ml and the ULN was estimated to be 362 IU/mL. The carriers of S. pyogenes clad significantly higher ADNase B levels (mean 392 IU/ml) than carriers of non-group A beta-hemolytic streptococci (BHS, 236 IU/ml) oY non-carriers of BHS (234 IU/ml). The relationship between ADNase B (Y) and ASO (X) levels was Y=0.4X+173 (r2=0.209). CONCLUSIONS: The distribution of ADNase B levels showed no close correlation with that of ASO, and ADNase B test was considered to have additive value to ASO test for detecting S. pyogenes infection.

Quantitative Analysis of Antideoxyribonuclease B Concentrations in the Carriers of Beta-hemolytic Streptococci

Although throat culture is a gold standard to diagnose group A streptococcal (GAS) pharyngitis or its sequelae, antistreptolysin O (ASO) is useful to confirm the diagnosis. In case there is no elevation of ASO, it is necessary to add one or more serologic tests, such as antideoxyribonuclease (ADNase) B test. ADNase B levels were analyzed in the carriers of beta-hemolytic streptococci (BHS) in this study. ADNase B concentrations were determined quantitatively by nephelometry (Behring Nephelometer 100 Analyzer, Germany) on 157 sera of healthy elementary school children in Chungnam who were positive of BHS in the throat culture. ASO levels were measured previously by autoanalyzer (Hitachi 747, Japan). Mean ADNase B and ASO levels were compared according to serological group of BHS and number of colonies. The carriers of GAS had significantly higher ADNase B levels (mean 453 IU/ml) than those of non-A beta-hemolytic streptococci (NGAS, 278 IU/ml), while the difference of ASO levels between GAS (482 IU/ml) and NGAS (350 IU/ml) carriers was not so high. The carriers who had more than 10 CFU of BHS had significantly higher ADNase B or ASO levels than those who had less than 10 CFU. The correlation between ADNase B (Y) and ASO (X) was Y=0.4X+229 (r2=0.13). ADNase B test could discriminate GAS from NGAS more effectively than ASO test. The carriers who have more than 10 CFU might undergo asymptomatic infection, as their ADNase B or ASO levels were significantly high. Because distribution of ADNase B showed little correlation to that of ASO, ADNase B test could be used as a supplementary test to diagnose GAS infection.

Bacteriological Survey of beta-Hemolytic Streptococci from the Throats of Elementary School Children in Chinju: Compared with the Results of Children in Kangwon, Chungnam and Seoul

PURPOSE: Throat culture for streptococcal pharyngitis is a gold standard to diagnose, but it may be misleading to interpret due to the carriers. The isolation rates of beta-hemolytic streptococci (BHS) and Streptococcus pyogenes in the school children in Chinju were investigated and compared with those of Kangwon, Chungnam and Seoul previously reported. METHODS: Throat cultures were taken from the healthy 476 elementary school children who had no symptoms or signs of upper respiratory tract infection in April 1995, and the beta-hemolytic streptococci were identified with bacitracin disk (0.04 U) and latex agglutination. RESULTS: One-hundred fifty-four (32.4%) yielded BHS and 88 (18.5%) had S. pyogenes. The serogrouping revealed 30 (6.7%) group G, 24 (5.0%) group C, 4 (0.8%) group B, and 8 (1.7%) non-group A,B,C,G respectively. CONCLUSIONS: The isolation rate of BHS in Chinju was significantly higher (p<0.001) than the results of Kangwon, Chungnam and Seoul. The identification of BHS was also different from the other areas. In addition to these bacteriologic investigation, the study should be followed whether these carriers were simple contact ones or suffered from asymptomatic infections, and the epidemiologic study using serotyping, such as M or T typing, is necessary.