Necrosis pulmonar masiva por micosis / Massive pulmonary necrosis due to mycosis

Introducción: La aspergilosis es una infección micótica oportunista que se presenta fundamentalmente en pacientes inmunodeprimidos y su principal fuente de transmisión lo constituyen las esporas presentes en el aire de salones de operaciones y unidades de cuidados intensivos. Objetivo: Presentar un caso de una micosis pulmonar masiva por una variante angioinvasiva de Aspergillus. Caso clínico: Se presenta un paciente con aspergilosis pulmonar grave, diagnosticada después de la resección de un tumor mediastinal. Se describen las características de la primera intervención, la evolución postoperatoria que condujo a la segunda, se muestran las imágenes tomográficas, quirúrgicas, microbiológicas y anátomo-patológicas que permitieron definir el diagnóstico. Conclusiones: La posibilidad de una micosis pulmonar debe tenerse en cuenta, aun cuando sea una afección rara y de manejo difícil, en pacientes inmunodeprimidos, con condensación pulmonar rebelde al tratamiento(AU)

Introduction: Aspergillosis is an opportunistic fungal infection that occurs mainly in immunosuppressed patients and its main source of transmission is the spores present in the air of operating rooms and intensive care units. Objective: To present a case of a massive pulmonary mycosis due to an angioinvasive variant of Aspergillus. Clinical case: A patient with severe pulmonary aspergillosis, diagnosed after resection of a mediastinal tumor, is presented. The characteristics of the first intervention are described, the postoperative evolution that led to the second one, the tomographic, surgical, microbiological and anatomo-pathological images that allowed to define the diagnosis are shown. Conclusions: The possibility of a pulmonary mycosis should be taken into account, even when it is a rare and difficult-to-handle condition, in immunocompromised patients, with pulmonary condensation that is rebellious to treatment. Aspergillosis is an opportunistic fungal infection that occurs mainly in immunosuppressed patients and its main source of transmission is the spores present in the air of operating rooms and intensive care units(AU)

Retinoic acid liposome-hydrogel: preparation, penetration through mouse skin and induction of F9 mouse teratocarcinoma stem cells differentiation

Retinoic acid (RA), a metabolite of retinol, is one of the most biologically active forms of retinoid and plays vital roles in embryonic development and in the regulation of cell proliferation and differentiation. Knowing that liposomes simulate cell membranes and that hydrogel is an ideal delivery vehicle for topical medicine, liposome-hydrogel is a novel preparation that has synergistic advantages over each component separately. Our objective was to investigate the characteristics of RA liposome-hydrogel. For quality control of the RA-loaded liposomes, we measured their morphology, particle size, Zeta-potential, and entrapment efficiency. Then we determined the viscosity of RA liposome-hydrogel. Next, the diffusion through mouse skin was explored, followed by investigation of the mRNA expression levels of Ker18, REX1, and α-FP using Q-PCR. The results showed that RA liposome-hydrogel penetrates the mouse skin effectively. The permeation rates were: Qn (%) of RA liposome-hydrogel < Qn(%) of RA-loaded liposome < Qn (%) of RA. The mRNA expression levels were dose-dependent and the effective dose decreased between vehicles due to their different release rates. F9 mouse teratocarcinoma stem cells were an ideal model to explore the mechanism of RA liposome-hydrogel in stem cell differentiation.

O ácido retinóico (RA) é um metabolito de retinol. Ele também é uma das formas mais biologicamente ativas de retinóide. Desempenha papel vital no desenvolvimento embrionário e na regulação da proliferação e diferenciação celular. Sabendo-se que lipossomas simulam a membrana das células e que hidrogel é um sistema ideal para o medicamento tópico, o lipossoma-hidrogel é uma nova preparação, que apresenta vantagens sinérgicas em relação a cada um dos componentes separados. Nosso objetivo foi investigar as características de RA lipossoma-hidrogel. A fim de controlar a qualidade do lipossoma carregado com RA, medimos morfologia, tamanho das partículas, potencial zeta e eficiência de retenção. Em seguida, determinou-se a viscosidade de RA lipossoma-hidrogel. Em seguida, avaliou-se a sua difusão através da pele de camundongos, seguida da investigação dos níveis da expressão de mRNA de Ker18, REX e de α-FP, utilizando-se Q-PCR. Os resultados mostraram que RA lipossoma-hidrogel pode penetrar na pele do camundongo de forma eficaz. As taxas de permeação foram: Qn (%) de RA lipossoma-hidrogel<Qn(%) de lipossoma RA- carregado <Qn (%) de RA. Os níveis de expressão de mRNA foram dependentes de dose e a dose efetiva diminuiu entre os veículos devido às diferentes taxas de liberação, As células estaminais de teratocarcinoma F9 de camundongo mostraram-se como modelo ideal para explorar o mecanismo de diferenciaçãode células tronco pelo RA lipossoma-hidrogel.

The propensity for tumorigenesis in human induced pluripotent stem cells is related with genomic instability / 癌症

The discovery of induced pluripotent stem cells(iPSCs) is a promising advancement in the field of regenerative medicine. Previous studies have indicated that the teratoma-forming propensity of iPSCs is variable; however, the relationship between tumorigenic potential and genomic instability in human iPSCs (HiPSCs) remains to be fully elucidated. Here, we evaluated the malignant potential of HiPSCs by using both colony formation assays and tumorigenicity tests. We demonstrated that HiPSCs formed tumorigenic colonies when grown in cancer cell culture medium and produced malignancies in immunodeficient mice. Furthermore, we analyzed genomic instability in HiPSCs using whole-genome copy number variation analysis and determined that the extent of genomic instability was related with both the cells' propensity to form colonies and their potential for tumorigenesis. These findings indicate a risk for potential malignancy of HiPSCs derived from genomic instability and suggest that quality control tests, including comprehensive tumorigenicity assays and genomic integrity validation, should be rigorously executed before the clinical application of HiPSCs. In addition, HiPSCs should be generated through the use of combined factors or other approaches that decrease the likelihood of genomic instability.

Chromatin organization and transcriptional activation of Hox genes / 대한해부학회지

Spatially and temporally programmed expression of the Hox genes along the antero-posterior (A-P) axis is essential for correct pattern formation during embryonic development. An accumulating body of evidence indicates the pivotal role of spatial chromatin organization for the coordination of gene regulation. Recently, chromosome conformation capture (3C) technique has been developed and opened a new way to study chromosomal interactions in the nucleus. In this study, we describe 3C method we applied in F9 embryonic teratocarcinoma cells and demonstrate that the chromosomal interactions at Hox loci are successfully detected. Interestingly, at Hoxc loci, the abundance of intrachromosomal interactions with neighboring fragments was drastically decreased when the genes are expressed. These results indicate the possibility of the dynamic pattern of chromosomal interaction in association with the transcriptional regulation of Hox genes.

Teratocarcinosarcoma rinosinusal: reporte de un caso / Rhinosinusal teratocarcinosarcoma: a case report

Teratocarcinosarcoma rinosinusal es una neoplasia maligna infrecuente y rara, que combina elementos de teratoma y carcinosarcoma. Se compone de epitelio benigno o maligno (fibroblastos), mesénquima (cartílago, hueso o músculo liso) y elementos neurales. Hasta el año 2008 se han reportado un total de 63 casos de ubicación rinosinusal. Presentamos el caso de un teratocarcinosarcoma de fosa nasal, en un hombre de 67 años de edad, que consultó por obstrucción nasal rápidamente progresiva. La lesión se resecó completamente por abordaje endoscópico. El diagnóstico fue confirmado por histopatología e inmunohistoquímica. Se realizó tratamiento complementario con radioterapia, sin evidencia de recidiva al año después de la cirugía.

Rhinosinusal teratocarcinosarcoma is a rare malignant neoplasm, which combines teratoma and carcinoma elements. It is composed of benign or malignant epithelium (fibroblasts), mesenchymatic (cartilage, bone or smooth muscle) and neural elements. Until 2008, a total of 63 cases of rhinosinusal location have been reponed. We present the case of a nasal cavity teratocarcinosarcoma ín a 67 year old man that presented with rapidly progressing nasal obstruction. The lesion was completely resected by endoscopic approach. Diagnosis was confirmed by histological pathology and immunohistochemistry Additional treatment by radiotherapy was administered, with no evidence of recurrences a year after surgery.

Sinonasal teratocarcinosarcoma: a clinical, radiologic and pathologic study of 5 cases / 中华病理学杂志

<p><b>OBJECTIVE</b>To study the clinical, radiologic and pathologic features, as well as differential diagnosis of teratocarcinosarcoma in nasal cavity and paranasal sinuses.</p><p><b>METHODS</b>Light microscopic examination and immunohistochemical study was performed in 5 cases of sinonasal teratocarcinosarcoma. The clinical, radiologic and pathologic features were analyzed and the literature was reviewed.</p><p><b>RESULTS</b>All 5 patients were males and their age ranged from 34 to 43 years (mean age = 39 years). The clinical presentation was nasal obstruction, epistaxis and headache. Physical examination often revealed a polypoid mass with contact bleeding. Computed tomography showed a homogeneous nasal mass with obturation of sinuses. Cystic changes, calcification or ossification was not observed. Histologically, the tumor showed a heterogeneous admixture of components from the 3 germ cell layers, exhibiting various degrees of maturation. Squamous epithelium, smooth muscle cells, chondro-osseous tissue, intestinal or respiratory type epithelium, "fetal-type" clear cells and immature neuroepithelium were commonly seen. Immunohistochemical study demonstrated that the epithelial component expressed cytokeratin and epithelial membrane antigen, while the mesenchymal component variably expressed vimentin, smooth muscle actin and S-100 protein. On the other hand, the neuroepithelial component expressed neuron-specific enolase, synaptophysin and chromogranin, and the primitive component expressed CD99. The initial biopsy diagnosis included capillary hemangioma, olfactory neuroblastoma, craniopharyngioma and malignant mixed tumor. Follow-up information was available in all patients. Two of which had local recurrence and 1 had cervical lymph node metastasis.</p><p><b>CONCLUSIONS</b>Sinonasal teratocarcinosarcoma is a rare and highly malignant tumor occurring in sinonasal tract. It manifests mainly in adult males and is characterized by a complex admixture of teratomatous and carcinosarcomatous components. "Fetal-type" clear cells, squamous epithelium and immature neuroepithelium represent important histologic characteristics useful in diagnosis.</p>

Effects of Hyaluronan on Proliferation and Differentiation Cultured Chondrocyte / 대한정형외과연구학회지

OBJECTIVES: Recent basic science studies continue to further our understanding of the fundamental mechanisms that likely underlie the therapeutic benefits of hyaluronan derivatives. The purpose of this study is to elucidate the effects of hyaluronan on ATDC5 proliferation and differentiation. METHODS: ATDC5 cells derived from mouse teratocarcinoma have the capacity to differentiate along a number of connective tissue pathways and are an attractive source of chondrocyte precursor cells. In this study, hyaluronan influencing ATDC5 chondrogenesis were investigated using an bone block culture system. The cell proliferation was analyzed by MTT assay. To validate ATDC5 differentiation we studied ALP activity, collagen content and western blot of Hsp40. RESULTS: In cell proliferation, ATDC5 cells didn't show significant difference between controls and hyaluronan-treated cultures. But hyaluronan induced ALP activity and increased collagen accumulation. Hyaluronantreated ATDC5 cells expressed Hsp40 mRNA and protein within 24 hours. CONCLUSIONS: Hyaluronan-induced chondrogenic differentiation was not associated with ATDC5 cell proliferation. Hyaluronan-induced Hsp40 in cells can protect the cell function from damaged protein. These data provide new insights into regulatory mechanism defining pharmacological effects of hyaluronan.

A Case of Teratocarcinoma with Central Diabetes Insipidus / 소아과

Central diabetes insipidus is a rare disorder that can result as a consequence of diverse etiologies, including malformations, autoimmune, infiltrative(e.g. neoplastic or histiocytosis) or traumatic processes, as well as mutations in the gene encoding arginine vasopressin. Idiopathic central diabetes insipidus is a diagnosis of exclusion, one that has been made less frequently through the decades. Idiopathic central diabetes insipidus in children and adolescent requires a frequent follow-up regimen using serial brain MRI and CSF examinations especially if an isolated pituitary stalk thickening or loss of a hyperintense signal in the posterior lobe is observed. Also, so-called "idiopathic" central diabetes insipidus warrants close follow-up to determine the etiology, especially if anterior pituitary hormone deficiencies are detected. We report a case of idiopathic central diabetes insipidus with growth hormone deficiency and loss of a hyperintense signal in the posterior lobe of pituitary in the brain MRI. We followed up with serial contrast enhanced brain MRI and CSF evaluation for the early detection of an evolving occult hypothalamic-stalk lesion and finally detected a newly developed teratocarcinoma in the suprasellar region.

Expression of Sec61alpha in F9 and P19 teratocarcinoma cells after retinoic acid treatment

Nascent procollagen peptides and other secretory proteins are transported across the endoplasmic reticulum (RE) membrane through a protein-conducting channel called the translocon. Sec61alpha, a multispanning membrane translocon protein, has been implicated as essential for translocation of polypeptides chains into the cisterns of the ER. However, it is not known whether Sec61alpha is ubiquitously expressed in collagen producing teratocarcinoma cells. Furthermore, the production, expression, and utilization of Sec61alpha may depend on the cell differentiation stage. Stem cells from many cultured teratocarcinoma cell lines such as F9 and P19 cells are capable of differentiation in response to low retinoic acid concentrations. This differentiation of the tumorigenic stem cells results in tumorigenicity loss. For this study, mouse F9 and P19 teratocarcinoma cells were grown in culture medium treated with or without retinoic acid. Expression of Sec61alpha was determined by reverse trancriptase polimerase chain reaction (RT-PCR). In untreated conditions, F9 cells expressed undetected Sec61alpha amounts. It was also demonstrated that Sec61alpha expression is stimulated in F9 cells after retinoic acid treatment for 72 hours. No changes were found in Sec61alpha expression in P19 cells after retinoic acid treatment. These data indicate that the expression of Sec61alpha is enhanced with retinoic acid induced differentiation of F9 teratocarcinoma cells

Sec61alpha synthesis is enhanced during translocation of nascent chains of collagen type IV in F9 teratocarcinoma cells after retinoic acid treatment

Nascent procollagen peptides and other secretory proteins are transported across the endoplasmic reticulum (ER) membrane through a protein-conducting channel called translocon. Sec61alpha, a multispanning membrane translocon protein, has been implicated as being essential for translocation of polypeptide chains into the cisterns of the ER. Sec61alpha forms a protein complex with collagen and Hsp47, an ER-resident heat shock protein that binds specifically to collagen. However, it is not known whether Sec61alpha is ubiquitously produced in collagen-producing F9 teratocarcinoma cells or under heat shock treatment. Furthermore, the production and utilization of Sec61alpha may depend on the stage of cell differentiation. Cultured F9 teratocarcinoma cells are capable of differentiation in response to low concentrations of retinoic acid. This differentiation results in loss of tumorigenicity. Mouse F9 cells were grown in culture medium at 37ºC and 43ºC (heat shock treatment) treated or not with retinoic acid, and labeled in certain instances with 35S-methionine. Membrane-bound polysomes of procollagen IV were then isolated. Immunoprecipitation and Western blot analysis were performed using polyclonal antibodies against collagen IV, Hsp47 and Sec61alpha. Under retinoic acid-untreated conditions, F9 cells produced undetectable amounts of Sec61alpha. Sec61alpha, Hsp47 and type IV collagen levels were increased after retinoic acid treatment. Heat shock treatment did not alter Sec61alpha levels, suggesting that Sec61alpha production is probably not affected by heat shock. These data indicate that the enhanced production of Sec61alpha in retinoic acid-induced F9 teratocarcinoma cells parallels the increased synthesis of Hsp47 and collagen type IV

A Case of Teratocarcinosarcoma Involving the Maxillary and Ethmoid Sinuses / 대한이비인후과학회지

Sinonasal teratocarcinosarcoma is a very unusual malignant neoplasm. This neoplasm histologically consists of an epithelial elements and one or more mesenchymal components with immature and embryonal characteristics. These tumors, which is variously termed as malignant teratoma, blastoma, teratocarcinoma, or teratocarcinosarcoma, probably comprise a group of neoplasm by their similar characteristics of histology and biology. This is a case of teratocarcinosarcoma in a 67-year-old male, involving the right maxillary sinus and ethmoid sinus with invasion of hard palate. The tumor was totally resected via total maxillectomy, and the patient was given post-operative radiotherapy. A follow-up PNS CT after 7 months of the surgery showed no recurrence of the lesion or residual tumor. Extensive tumor necrosis, rapid growth and local destruction are the prominent features of this neoplasm. The clinical presentation, pathological features and clinical course of this unusuat malignancy are discussed with a reivew of the literature.

Teratocarcinoma presenting with duodenal metastases diagnosed on endoscopic fine needle aspiration.

Upper gastrointestinal bleed as the first symptom of metastatic testicular tumors is rare. We describe a 17-year-old man who presented with upper gastrointestinal bleed; endoscopic fine needle aspiration cytology from a duodenal mass suggested germ cell tumor, which was later confirmed on histology of the testis.

Clinical Experience of Nonseminomatous Germ Cell Testicular Tumor: Risk Factors and Survival Rate / 대한비뇨기과학회지

PURPOSE: We reviewed clinical features and survival rates of nonseminomatous germ cell testicular tumors(NSGCTs) and analyzed pathological risk factors of relapse in stage I group under surveillance program. MATERIALS AND METHODS: Forty one patients were treated for primary NSGCTs from February 1983 to April 1998. 20(48.8%) patients were stage I and 19 of them were followed up under surveillance program after orchiectomy and 1 underwent orchiectomy and adjuvant therapy(RPLND and PVB chemotherapy). 11(26.8%) were stage II and 10(24.4%) stage III and all stage II and III patients underwent orchiectomy and adjuvant therapy. Statistical analysis with Fisher`s exact test was performed to identify that pathological risk factors affected relapse rate. RESULTS: Mean age at diagnosis was 26 years(range 16-47) and mean follow-up period was 58 months(range 5-163). According to histopathological types, embryonal carcinoma, teratoma, teratocarcinoma and mixed type represented 19.5%, 26.8%, 7.3% and 46.3%, respectively. Among 41 patients, 33 showed significant elevation of tumor markers at diagnosis. The 5-year survival rates of stage I, II and III were 95%, 80% and 56%, respectively and overall 5-year survival rate was 82%. Among stage I patients under surveillance program, there was statistically significant increase of relapse rate in the patients with pathological risk factors(presence of embryonal elements, local stage T2 or higher, presence of lymphovascular invasion) as compared to those without. CONCLUSIONS: In stage I NSGCT patients, if there are pathological risk factors after orchiectomy, aggressive therapy such as early retroperitoneal lymph node dissection or chemotherapy is selectively needed.

Clinical Experience of Testicular Germ Cell Tumor in Infants and Children / 대한비뇨기과학회지

PURPOSE: The relative rarity of prepubertal testis tumors has resulted in poor understanding about incidence, histologic distribution and prognosis of germ cell tumors in children. We attempted to elucidate overall clinical features of testicular germ cell tumors in infants and children, to analyze risk factors for relapse in stage A yolk sac tumor(YST) and to find out possibility of testis-sparing surgery in prepubertal testicular teratoma. MATERIALS AND METHODS: Retrospectively, we reviewed 74 cases of primary testicular germ cell tumors of infants and children(under 15 years old) experienced in Seoul National University Hospital from January 1970 to November 1995. RESULTS: There were 38 YSTs(stage A, 34 cases, stage B; 3, stage C; 1), 32 teratomas(all stage A) and 4 teratocarcinomas(stage A, 3, stage C; 1). Median age of presentation was 2.0(range 0.4-15.0) years. Preoperative serum alpha-fetoprotein (alpha-FP) elevation was observed in 37 patients(100%) with YST, 2(7%) with teratoma, 3(100%) with teratocarcinoma and elevated serum beta human chorionic gonadotropin(beta-HCG) was observed in one patient(33%) with teratocarcinoma. Orchiectomy including 4 partial orchiectomy(all with teratoma) was done in all patients, chemotherapy in all patients with teratocarcinoma and stage B, C YST. Two-year survival rate was 92%(22 out of 24 patients who had been followed up) and 100%(19/19) with teratoma. Out of 4 patients with teratocarcinoma, 2 patients with stage A disease showed no evidence of disease, one patient progressed to death and follow-up was lost in the other one patient with stage C. In 9 patients with YST who had ultimately presented recurrence, initial symptoms and signs for recurrence were as follows; marker elevation(4), abdominal mass(3), inguinal mass(1) and scrotal mass(1). Their mean duration of relapse after surgery was 7.0 months. On pathologic review, 7 patients among total 34 patients with YST had at least one risk factors such as epididymal involvement(2), microangioinvasion(3) and focal embryonal component(2). Out of them(7), 5 patients proved to have relapse. There was statistically significant relationship between having risk factors and relapse(Fisher's exact test, p=0.0086). Complete remission rate after chemotherapy In all relapsed patients was 83%(5/6). Until now, there is no evidence of recurrence in 4 patients with teratoma who underwent partial orchiectomy CONCLUSIONS: YST is characterized as early presentation, high relapse rate and short relapse interval and had high response rate to chemotherapy and high survival rate. Therefore, careful surveillance is needed at least for 2 year in stage A patients with high risk group on pathology(microangioinvasion etc). Testis-sparing surgery may be considered as one of treatment options in prepubertal teratoma.

Testicular tumours; clinical and histological patterns in Bahawalpur

[1] To study the clinical presentation of testicular tumours. [2] To study the histological pattern of testicular tumours in Bahawalpur. DESIGN: A prospective study. SETTING: Bahawal Victoria Hospital Bahawalpur. PATIENTS: Fifteen consecutive patients of testicular tumours. METHODS: Presenting symptoms and findings of clinical examination were recorded. Abdominal ultrasonography and chest x-rays were performed in all the patients. Skeletal radiographs were taken in one patient presenting with back pain and paraplegia. Staging was done. Inguinal orchiectomy was performed and histology was done in all cases. 40% patients presented with primary testicular neoplasms. While 60% presented with clinical picture due to secondary deposits. Histologic pattern was 33.33% Seminoma, 6.67% Lymphoma, 6.67%. Teratoma, 13.34% Embryonal carcinoma, 6.67% Yolk sac tumour and 33.33% Teratocarcinoma. Patients with testicular tumours mostly presented with the clinical picture of their secondary deposits and were in advanced stage. Seminoma and teratocarcinoma were the commonest histological types

HRCT Findings of Bleomycin-Related Lung Toxicity: A Report of 2 Case

Many drugs can result in a variety of pathologic reactions in the lung, especially the cytotoxic drugs. Amongcytotoxic drugs bleomycin is a prototype. Bleomycin-related pulmonary toxicity is usually known as dose-dependent and can be enhanced with concurrent oxygen therapy, irradiation, or other chemotherapeutic agents. The incidence of bleomycin-induced pulmonary toxicity has been reported as varying from 2 to 46%, and 1% of fatal lung disease. We describe the radiographic and HRCT findings of bleomycin-related pulmonary toxicity developed in two patients: one in ovarian teratocarcinoma, the other malignant lymphoma patient. Chest radiographs and HRCT of these patients showed ground-glass opacities, consolidation, linear and reticular opacities, and interlobular septal thickening. These abnormalities were bilateral, and symmetrical and were found predominantly in the area of mid-and lower-lung zone.