Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH) Associated with Mediastinal Schwannoma

Syndrome of inappropriate antidiuretic hormone secretion (SIADH) is the most common cause of euvolemic hypo-osmotic hyponatremia. There are several etiologies of SIADH including neuroendocrine tumor, pulmonary disease, infection, trauma, and medications. Here, we report a case of SIADH associated with a schwannoma involving the mediastinum in a 75-year-old woman who presented with nausea, vomiting, and general weakness. Laboratory testing showed hypo-osmolar hyponatremia, with a serum sodium level of 102mmol/L, serum osmolality of 221mOsm/kg, urine osmolality of 382mOsm/kg, urine sodium of 55 mmol/L, and plasma antidiuretic hormone (ADH) of 4.40 pg/mL. Chest computed tomography identified a 1.5-cm-sized solid enhancing nodule in the right lower paratracheal area. A biopsy specimen was obtained by video-assisted thoracoscopic surgery, which was diagnosed on pathology as a schwannoma. The hyponatremia was completely resolved after schwannoma resection and plasma ADH level decreased from 4.40 pg/mL to 0.86 pg/mL. This case highlights the importance of suspecting and identifying the underlying cause of SIADH when faced with refractory or recurrent hyponatremia, and that on possibility is mediastinal schwannoma

Clear Cell Sarcoma of the Wrist: MRI Findings with Diffusion-Weighted Image and Histopathologic Correlation

Clear cell sarcoma is rare and difficult to diagnose. Herein, we present a case of clear cell sarcoma in the dorsum of the wrist with MRI findings, including diffusion-weighted imaging, and histopathologic correlation, which was initially diagnosed as giant cell tumor of tendon sheath.

An Elderly Man with Fatal Respiratory Failure after Eating a Poisonous Mushroom Podostroma cornu-damae / 결핵및호흡기질환

A 73-year-old, previously healthy man presented with nausea, vomiting, diarrhea, dry mouth and febrile sensation 3 hours after eating boiled wild mushrooms. After admission, he showed progressive severe respiratory distress, pancytopenia, azotemia, hypotension, hypoxemia and consolidation of the entire left lung on chest radiography. With a preliminary diagnosis of necrotizing pneumonia, he underwent left pneumonectomy in order to remove all necrotic lung tissue. Lung histology showed extensive hemorrhagic necrosis, massive inflammatory cell infiltration, prominent proliferation of young fibroblasts and the formation of an early-stage hyaline membrane along the alveolar wall. Despite aggressive treatment, including mechanical ventilation, continuous renal replacement therapy and administration of granulocyte colony stimulating factor and broad spectrum antibiotics, he died on hospitalization day 13. Subsequently, the mushroom was identified as Podostroma cornu-damae. This is the first case of a histological evidence of lung involvement by Podostroma cornu-damae poisoning in Korea.

A Case of Tongue Actinomycosis

Actinomyces israelii is a normal flora of the oral cavity and gastrointestinal tract, and can cause chronic suppurative granuloma. We report here on a case of tongue actinomycosis. The patient was a 71-year old woman who had undergone surgery for rectal cancer 4 years previously. During the follow-up study using PET-CT, hypermetabolic activities were recognized at the lung hilum, mediastinum and tongue base. Bronchoscopic biopsy sample of the tongue base ulcer revealed histopathologically sulfur granule and aggregations of filamentous bacteria was diagnosed as actinomycosis of the tongue.

A Case of Combined POEMS Syndrome and Multiple Myeloma with Positive M protein Only on Immunofixation / 대한혈액학회지

POEMS syndrome is a plasma cell proliferative disorder is characterized by the presence of peripheral neuropathy (P), organomegaly (O), monoclonal gammopathy (M), endocrinopathy or edema (E) and skin change (S). It can be rarely related to multiple myeloma. A 48-year-old man was admitted to our hospital due to paresthesia of both inguinal areas and weakness of both lower extremities. He had a history of Castleman's disease, and showed features of polyneuropathy, multiple osteoblastic lesions, hepatosplenomegaly, pretibial pitting edema, and papilledema. The serum and urine electrophoresis were negative, but urine immunofixagion could detect monoclonal protein. Plasmacytoma was confirmed through the biopsy for the osteoblastic lesions. We present a case of combined POEMS syndrome and multiple myeloma with positive M protein only on immunofixation in order to share our experience with physicians and specialists.

Ceruminous Gland Adenocarcinoma of External Ear Canal: A Case Report

Ceruminomas are rare tumors arising from the ceruminous gland, which is a modified apocrine gland in the skin of the external ear canal. There is controversy about these rare tumors regarding their histological classification, their origin and the importance of wide excision, and there is also terminological confusion for making the diagnosis. Ceruminous adenocarcinoma is a malignant subtype of ceruminoma. We report here on a case of adenocarcinoma of the ceruminous gland in a 71-year-old male patient.

Histopathologic Changes of Tracheal Mucosa in Burned Patients with Inhalation Injury / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Inhalation injuries can produce a wide spectrum of negative clinical effects. Respiratory failure remains one of the leading causes of death in burned patients with inhalation injury. Despite advances in understanding of inhalation injury, few studies have focused on histopathologic findings of tracheal mucosa. The purpose of this study is to investigate histopathologic changes of tracheal mucosa in burned patients with inhalation injury. SUBJECTS AND METHOD: Tracheotomy was performed on 31 patients who was admitted to the Hospital center from May 2005 to March 2006. Thirty-one patients were divided into two groups : patients with inhalation injury (group I)(n=16), patients without inhalation injury (group II)(n=15). Tracheal mucosa were taken out during the tracheotomy. The tracheal mucosa were read blindly by one pathologist. RESULTS: Histopathologic examination showed the following finding in the tracheal mucosa of all patients in the group I : epithelial ulceration. Different findings were observed in the group I as time passed by after inhalation injury, such as interstitial edema, inflammatory cell infiltration, capillary dilatation, and increased fibrosis. No abnormal findings were observed in the tracheal mucosa in the group II. CONCLUSION: Inhalation injuries cause histopathologic damages to tracheal mucosa. The different histopathologic findings of tracheal mucosa that take place in time following inhalation injuries suggest to process an inflammatory reaction. The study in related to clinical features should be needed due to tracheal mucosa injury may produce respiratory complications.

Degenerative Change of Femoral Head Cartilage in the Elderly with Hip Fracture / 대한정형외과학회잡지

PURPOSE: To evaluate the incidence, grade and extent of the degenerative changes in the femoral head articular cartilage in the elderly with hip fracture through gross, histological and immunohistochemical studies. MATERIALS AND METHODS: The study examined 30 femoral heads obtained from patients over 65 years with no arthrosis by radiograph, who had undertaken bipolar hemiarthroplasty due to hip fracture. The mean age of patients was 79.7 years and the study examined three weight bearing zones (anterior, middle and posterior) and one non-weight bearing zone (inferior) of each femoral head. RESULTS: The gross findings showed significant correlation with the Mankin grade for each zone (p<0.05). Twenty four cases (80%) showed mild degeneration according to the Mankin grade and the others moderate. The mean Mankin score at each zone of all femoral heads was 5 points, which indicated mild degeneration. No significant difference was found between the weight bearing zone and the non-weight bearing zone (p=0.75). The distribution of type II collagen antibody stainabilities mainly showed normal or mild degeneration (93.3%). CONCLUSION: Degeneration of the articular cartilage of the femoral heads in the elderly with hip fracture and no arthrosis by radiograph was mostly mild, and showed generalized changes regardless of the zone.

ISUP/WHO Classification of Papillary Urothelial Neoplasms of Urinary Bladder: Consensus Study Conducted by Korean Society of Urogenital Pathology

BACKGROUND: Pathologic grading, one of the most important prognostic factors of papillary urothelial neoplasia (PUN) of the urinary bladder, has been revised continuously. The current study focused on the analysis of interobserver agreement on PUN of the urinary bladder bet- ween 1973 WHO classification (WHO 1973) and 1998 WHO/ISUP classification. METHODS: Seventy five cases from 15 institutions were collected, and after review by Korean Society of Urogenital Pathology (KSUP), 30 cases were selected as follows; group I, WHO grade 1 and papillary urothelial neoplasm of low malignant potential by ISUP (7 cases), group II, WHO grade 2 and low-grade papillary urothelial carcinoma (16 cases), and group III, WHO grade 3 and high-grade papillary urothelial carcinoma (7 cases). Seventy five general surgical pathologists who participated in this study were asked to grade the tumors based on WHO/ISUP classification. Interobserver agreement between the participants' diagnosis and KSUP consensus diagnosis was analyzed by kappa value. RESULTS: Interobserver agreement assessed by kappa value for all diagnostic groups was very low; for group I, kappa value was -0.900893722; for group II, -0.944650025, and for group III, -0.876728996. The overall kappa value of pathology residents was better than that of practicing pathologists. CONCLUSIONS: The 1998 WHO/ ISUP classification could not be easily translated from the 1973 WHO classification and because of poor interobserver agreement, it appears that further work would be needed before it can be practically applied.

A Case of Leiomyoma of Testicular Tunica Albuginea / 대한비뇨기과학회지

Leiomyoma is an uncommon lesion which may originate anywhere including the genitourinary system where smooth muscle is present. Five cases of leiomyoma of the testicular tunica albuginea were reported in the world literature. A case of leiomyoma of testicular tunica albuginea in a 58 year old male is presented. We preserved the testis with tumor resection. This is the first report of leiomyoma of testicular tunica albuginea in Korea.

A Recurred Case of Subacute Necrotizing Lymphadenitis(Kikuchi's Disease) During Childhood

Subacute necrotizing lymphadenitis, or Kikuchi's disease, primarily affects the cervical lyrnph nodes of lung adults and has a self-limited clinical course. Differential diagnoses are malignant lymphoma and systemic lupus erythematosus. Recurrence rate is low as 3.3%, and there have been a few reports describing the recurrence of the disease. The symptoms in almost all recurrent cases were similar to those of the early stages of the disease. The etiology of the disease remains unknown, but various viral infections and autoimmune processes have been postulated to be the cause. A 6-year-old boy presented with a fever of approximately 40C degrees, painless lumps on both sides of the neck, and intermittent abdominal pain for 2 weeks. Subacute necrotizing lymphadenitis was diagnosed 3 years before admission, which was reported by us in 1996. Diagnosis of recurred subacute necrotizing lymphadenitis was confirmed by histological examination of the lymph node. We report a recurred case of subacute necrotizing lymphadenitis during childhood.

Matrix Metalloproteinase Expression and Ldegrees Calization in Human Prostate Adendegrees Carcinoma: An Immunohistdegrees Chemical Study of MMP-2, -9, -3, -7 / 대한암학회지

No abstract available.

Solitary Fibrous Tumor of the Scrotum: A case report

Solitary fibrous tumor (SFT) is a rare spindle cell neoplasm that usually arises in the pleura and has been recently reported from unusual locations. We present a case of SFT that occurred in the scrotum. The patient was a 38-year-old man who presented with a painless, left, scrotal mass of five years' duration. Scrotal sonography and pelvic CT scan showed a soft-tissue mass of 11 cm in diameter. The resected tumor measured 11 8 7 cm and was well demarcated from the surrounding soft tissue. The cut surface revealed homogenously grayish-white and gelatinous appearance. No hemorrhage or necrosis was found. Microscopically, the tumor showed hypercellular spindle cell areas intermixed with hypocellular areas lying in a myxoid or collagenous stroma. The spindle cells had no mitosis or low mitotic figures, and little or no nuclear atypia. They exhibited a variety of growth patterns, including "patternless" pattern, and a prominent vasculature with hemangiopericytic pattern. Vimentin, CD34, and bcl-2 protein immunoreactivity were observed. Characteristic histologic and immunohistochemical features of this lesion were consistent with SFT. To arrive at a correct diagnosis of this lesion, especially when it occurs in unusual sites, immunohistochemical study including CD34 & bcl-2 protein is required in addition to characteristic histologic features.

The Study on the Expression of ICAM-1 in Transitional Cell Carcinoma of Bladder / 대한비뇨기과학회지

PURPOSE: ICAM-1(Intercellular Adhesion Molecule-1) is a cell adhesion molecule which facilitates the binding of LAK(Lymphokine Activated Killer )cell and cytotoxic T cell to tumor cell. This study investigates the role of ICAM-1 in transitional cell carcinoma(TCC) of bladder. MATERIALS AND METHODS: Immunohistochemical stain for ICAM-1 was done in 42 paraffin embedded tissue of primary TCC of bladder. And we compared the expression of ICAM-1 and the degree of immune cell infiltration, tumor grade, stage and survival rate of the patients. RESULTS: Immunohistochemical examination demonstrated expression of ICAM-1 on 17 of 42 bladder TCC but not on five normal transitional cells. The more frequently immune cells infiltrated, the more frequently ICAM-1 was expressed(p=0.018). And ICAM-1 was frequently expressed in higher histopathological grade and higher stage tumors(p=0.035, p=0.002). Survival rate was lower in ICAM-1 expressed tumors than in ICAM-1 non-expressed tumors even though it is insignificant statistically(p=0.11). CONCLUSIONS: These results suggest that ICAM-1 plays an important role on immune therapy for bladder TCC, and ICAM-1 expression in bladder TCC could be another prognostic factor and used as a response predictor for immune therapy such as intravesical BCG instillation.

Mesothelioma of Scrotum: A Case Report

Localized fibrous tumor of the scrotum is a very rare disease, and few radiologic features have been reported. We report the sonographic and CT findings of a case of localized fibrous tumor, which developed in the scrotum of a thirty-years-old man.

Tumor Angiogenesis Correlates with Prognosis in Patients with Stage 3 Gastric Cancer / 대한암학회지

PURPOSE: Several studies suggest that tumor angiogenesis is a significant prognostic factor in carcinoma of the breast, lung, prostate, oral cavity, and colon. We assessed whether intensity of tumor angiogenesis, as measured by microvessel counts in histologic sections, correlates with prognosis in patients with stage III gastric cancer. MATERIALS AND METHODS: Paraffin-embedded sections from 49 patients (23 stage IIla, 26 stage IIIb) with primary gastric cancer that had been completely removed were analyzed for angiogenesis. Vessels were stained with anti-factor VIII polyclonal antibody, and areas with the most discrete microvessels were counted in a 200X field. RESULTS: Patients with stage IIIa gastric cancer had fewer microvessels than those with stage IIIb gastric cancer (32.8+-14.5 vs. 40.3+-16.1, P=0.106). The mean microvessel count from patients who were alive were significantly lower than that from patients who had died at the time of follow-up (24.8+-10.0 vs. 42.9+- 14.5, P=O.OOO). The 5-year survival rate of patients with count less than 33 microvessels was higher than that of patients with count more than 33 microvessels (59.9% vs. 11.6%, P= 0.000). On multivariate analysis by Cox proportional hazards model, the microvessel count was a significant prognostic factor of stage III gastric cancer. CONCLUSION: Tumor angiogenesis assessed by microvessel count may be a significant prognostic factor of stage III gastric cancer and may prove valuable in selecting patients with stage III gastric cancer for aggressive adjuvant therapy and closer postoperative follow-up.

A Case of Isolated Adenomatous Polyp of Rectum in a Child: Tubulovillous adenoma / 대한소아소화기영양학회지

Isolated rectal adenomatous polyp without genetic background is rarely found in children. A 4-year and 5 month-old girl was admitted for intermittent bloody stools lasting 4 months. A 1.5x1.2 cm sized rectal polyp was found by air contrast barium enema. Endoscopic polypectomy was performed without complications. In histopathologic examination, it was found to be a tubulovillous adenoma. Typical radiologic, colonoscopic, and pathological pictures are presented.

A Case of Kallmann's Syndrome: MR Imaging and Histopathology

Kallmann's syndrome is a rare genetic disorder defined as a combination of anosmia or hyposmia and hypogonadism due to hypothalamic-pituitary deficiency. The incidence of Kallmann's syndrome is one in 100,000 men and one in 50,000 women. However, the syndrome is found in one in 25 people with hypogonadism. The clinical evaluation of these patients includes historical and physical examinations ; chemosensory testing, which includes olfactory threshold and identification tests ; laboratory testing for hormonal abnormalities ; MR imaging of the olfactory apparatus ; and histopathologic findings through an olfactory epithelial biopsy. We report the case of a 19-year-old male patient who had anosmia since birth and who was diagnosed with Kallmann's syndrome.

The Expression of TGF-beta1 and TGF-beta Receptor I in Human Lung Cancer

A majority of human lung cancer cell lines have developed resistance to growth inhibition via the activation of transforming growth facter-beta (TGF-beta). Previous studies have reported that growth inhibition of TGF-beta is linked to the expression of transforming growth factor-beta receptor type I (TGF-betaRI). Immunohistochemical studies of TGF-beta1 and TGF-betaRI have been carried out in 43 cases of lung neoplasm; including 25 cases of squamous cell carcinoma, 13 cases of adenocarcinoma, 2 cases of adenosquamous cell carcinoma, and 1 case each of undifferentiated carcinoma, small cell carcinoma and neuroendocrine carcinoma. Reverse transcriptase polymerase chain reaction (RT-PCR) for TGF-beta1 mRNA was also performed in 40 cases of tumors and 14 control cases of normal parenchyme. Immunohistochemically, TGF-beta1 and TGF-betaRI expression were noted in the cytoplasm of all type of tumor cells. The staining intensity and areas were examined and scored from 0 to 5. As a whole, TGF-beta1 staining scores in the neoplastic lesions were higher than that of the adjacent normal parenchyme, bronchial epithelium or alveolar epithelium. However, TGF-betaRI staining scores were generally lower than that of the adjacent normal components. The TGF-beta1 mRNA showed a higher percentage of expression in tumors than in normal control. Tumor size, lymph node metastasis, histological differentiation and histological type of tumors did not correlated with the staining score of TGF-beta1 and TGF-betaRI. These results indicate that although various types of human lung carcinoma cells produce TGF-beta1, they show a reduction in TGF-betaRI, resulting in an escape from growth inhibition by TGF-beta1.

Large Cell Neuroendocrine Carcinoma of the Lung 2 cases including one presented as an ovarian mass

Pulmonary tumors exhibiting neuroendocrine differentiation are classified as typical carcinoid, atypical carcinoid, and small cell lung carcinoma(SCLC). Travis et al. proposed a fourth category of large cell neuroendocrine carcinoma, which is characterized by light microscopic neuroendocrine appearance, cells of large size, polygonal shape, low nuclear cytoplasmic ratio, coarse nuclear chromatin, with prominent nucleoli high mitotic rate and frequent necrosis; and neuroendocrine features by immunohistochemistry or electron microscopy. High grade neuroendocrine carcinoma (LCAC-NE) revealed aggressive clinical course. We report two cases of neuroendocrine tumors of the lung characterized by a trabecular pattern of large pleomorphic cells with frequent mitoses and wide necrosis. The frequent metastatic sites of atypical carcinoid were liver, bone and brain. One of our case is presented, at first, as an ovarian mass, which shows multifocal rosettes and revealed metastasis from lung. Both cases expressed neuroendocrine differentiation by light microscopy and immunohistochemistry. However clinical neuroendocrine symptom were not present.