Painful immunoglobulin G4-related thyroiditis treated by total thyroidectomy

No abstract available.

Small Cell Lung Cancer with Mutation of Epidermal Growth Factor Receptor in Patients with Lung Adenocarcinoma Resistant to Gefitinib / 대한내과학회지

Most epidermal growth factor receptor (EGFR) gene mutations are detected in lung adenocarcinomas. In contrast, these mutations have rarely been reported in small cell lung cancer (SCLC). We herein report two cases of EGFR-mutant SCLC transformed from and combined with lung adenocarcinoma. In one case, SCLC appeared to be transformed from EGFR mutant 19-del adenocarcinoma when the patient became resistant to gefitinib. The other patient had combined EGFR-mutant 19-del SCLC and adenocarcinoma at the initial diagnosis, which was resistant to gefitinib at multiple sites. Further comparative molecular analyses of these histologically distinct tumors would provide useful information regarding the role of EGFR mutation in the pathogenesis of SCLC. In conclusion, despite the presence of the same EGFR mutation, gefitinib was not effective in treatment of SCLC. Therefore, confirmation of SCLC cell morphology may become an important means of predicting resistance to EGFR tyrosine kinase inhibitors in addition to common secondary genetic alterations.

Stomach and Colon Metastasis from Breast Cancer / 이화의대지

Gastric metastasis from breast cancer is rare and only six cases have been reported in Korea. Colon metastasis is more rare than gastric metastasis. We report a 63-year-old woman with gastric and colon metastases of invasive lobular carcinoma of breast. She was diagnosed as right breast cancer, received right modified radical mastectomy 10 years ago and has been treated with chemotherapy and hormone therapy. Investigating for melena and a small caliber of stool, we found gastric and colon metastases. The diagnosis of metastatic breast cancer was made through gross pathologic and immunohistochemistry staining. We report a case with gastric and colon metastases from breast cancer and a review of the associated six case reports in Korea.

Promoter Methylation of CDKN2A, RARbeta, and RASSF1A in Non-Small Cell Lung Carcinoma: Quantitative Evaluation Using Pyrosequencing / 결핵및호흡기질환

BACKGROUND: While qualitative analysis of methylation has been reviewed, the quantitative analysis of methylation has rarely been studied. We evaluated the methylation status of CDKN2A, RARbeta, and RASSF1A promoter regions in non-small cell lung carcinomas (NSCLCs) by using pyrosequencing. Then, we evaluated the association between methylation at the promoter regions of these tumor suppressor genes and the clinicopathological parameters of the NSCLCs. METHODS: We collected tumor tissues from a total of 53 patients with NSCLCs and analyzed the methylation level of the CDKN2A, RARbeta, and RASSF1A promoter regions by using pyrosequencing. In addition, we investigated the correlation between the hypermethylation of CDKN2A and the loss of p16INK4A immunoexpression. RESULTS: Hypermethylation of CDKN2A, RARbeta, and RASSF1A promoter regions were 16 (30.2%), 22 (41.5%), and 21 tumors (39.6%), respectively. The incidence of hypermethylation at the CDKN2A promoter in the tumors was higher in undifferentiated large cell carcinomas than in other subtypes (p=0.002). Hyperrmethylation of CDKN2A was significantly associated with p16INK4A immunoexpression loss (p=0.045). With regard to the clinicopathological characteristics of NSCLC, certain histopathological subtypes were found to be strongly associated with the loss of p16INK4A immunoexpression (p=0.016). Squamous cell carcinoma and undifferentiated large cell carcinoma showed p16INK4A immunoexpression loss more frequently. The Kaplan-Meier survival curves analysis showed that methylation level and patient survival were barely related to one another. CONCLUSION: We quantitatively analyzed the promoter methylation status by using pyrosequencing. We showed a significant correlation between CDKN2A hypermethylation and p16INK4A immunoexpression loss.

Model Development of Papillary Thyroid Carcinoma by BRAFV600E Transgenic Mice / 대한갑상선학회지

BACKGROUND AND OBJECTIVES: The BRAFV600E mutation has been regarded as the leading cause of papillary thyroid cancer (PTC). However, the multi-step carcinogenic process induced by BRAFV600E has been remained to be elucidated in thyroid gland. In this study, to investigate staged development of papillary thyroid carcinoma, we observed the histo-pathological findings of thyroid gland from BRAFV600E transgenic mice with a period of 60 weeks. MATERIALS AND METHODS: We histologically inspected 3, 9, 20, 27, 39, 44, 48 and 60 week old BRAFV600E transgenic mice derived from FVB/N background mice with a bovine thyroglobulin promoter which are providing thyroid specific BRAFV600E expression. RESULTS: Thyroid glands from 3 and 9 week old BRAFV600E transgenic mice were enlarged and showed abnormal histologic feature such as distorted follicular architectures. The 20 and 27 week old BRAFV600E transgenic mice showed irregularly enlarged thyroid gland sprouting out above the carotid arteries. Thyroid gland derived from 39 week old mice showed reduced formation of intact follicular structure and increased solid area. Thyroid glands were entirely replaced by firm tumor mass composed of poorly differentiated cell at 44 weeks. Interestingly, we could observe tracheal invasion, surrounding muscle invasion in thyroid gland from 48 week old mice and detect lung metastasis in 60 week old mice. CONCLUSION: Thyroid specific expression of BRAFV600E induced staged development of thyroid cancer. This finding may support that BRAFV600E have a role in entire carcinogenic process such as tumor initiation, development and progression.

MRI of a Subcutaneous Myolipoma in the Ankle: a Case Report

Myolipoma is a rare benign tumor, composed of irregularly admixed adipose tissue and smooth muscle fibers. Few literature studies have described the radiologic appearance of myolipoma, especially in the soft tissue. No MRI findings in subcutaneous myolipoma of an extremity have been reported. Here, we report on the case of a 34-year-old woman with myolipoma in the subcutaneous tissue of the ankle and describe MRI features of the lesion.

HIF-1alpha Expression in BRAF(V600E)-Positive Papillary Thyroid Microcarcinoma / 대한갑상선학회지

BACKGROUND AND OBJECTIVES: Recent studies have reported that vascular endothelial growth factor (VEGF) and hypoxia-inducible factor (HIF)-1alpha are up-regulated in BRAF(V600E)-positive papillary thyroid carcinoma (PTC). We investigated whether papillary thyroid microcarcinomas (PTMCs) also exhibited increased expression of VEGF and HIF-1alpha. In addition, we analyzed the relationship between BRAF(V600E) mutation and clinicopathological parameters, as well as HIF-1alpha expression in PTMC. MATERIALS AND METHODS: We retrospectively selected 225 patients with PTMC. Immunohistochemical staining for HIF-1alpha and VEGF was performed using paraffinembedded PTMC tissue microarrays. BRAF(V600E) mutation status was analyzed by dideoxy sequencing. RESULTS: PTMCs larger than 0.5 cm tend to be related to aggressive clinicopathological features such as thyroid capsular invasion (p=0.023) and bilaterality (p=0.047). Immunoreactivity to HIF-1alpha (20.7%) and VEGF (30.2%) was more prominent in PTMCs as compared to normal follicular cells. However, HIF-1alpha and VEGF expression was not correlated with clinicopathological features. BRAF(V600E) mutation was found in 70.7% (159/225) of the PTMC cases. PTMCs harboring the BRAF(V600E) mutation exhibited larger tumor sizes as compared to PTMCs without the BRAF(V600E) mutation (p=0.038). However, BRAF(V600E) mutation status did not correlate with the expression of HIF-1alpha (p=0.623) or VEGF (p=0.990). CONCLUSION: HIF-1alpha and VEGF were more frequently detected in PTMCs as compared to normal thyroid tissues. However, BRAF(V600E) mutation status was not correlated with the expression of HIF-1alpha or VEGF in PTMCs.

Ancient Schwannoma of the Thigh mimicking a Plexiform Malignant Peripheral Nerve Sheath Tumor: A Case Report

Ancient schwannoma is a rare variant of schwannoma and a slow growing benign tumor associated with degeneration that may be diagnosed as a malignant tumor, because it presents with a large size and an inhomogeneous signal intensity. The main differential diagnosis of plexiform soft tissue tumor includes plexiform neurofibroma, malignant peripheral nerve sheath tumor (MPNST). In this case, we describe the MRI findings in a case of ancient schwannoma involving left thigh of a 63-year-old woman mimicking a plexiform MPNST. The tumor appeared as an inhomogeneous signal intensity and multinodular appearance, causing misdiagnosis as a plexiform MPNST.

Strongyloidiasis of Gastric and Colonic Mucosa in a Patient with Monoclonal Gammopathy of Undetermined Significance: A Case Report

Here we report a case of Strongyloides stercoralis infection of the gastric and pancolonic mucosa in a 79-year-old female with a monoclonal gammopathy of undetermined significance. Endoscopic biopsies were performed in gastric antrum, cecum, distal ascending colon, and hepatic flexure of the colon. On microscopic examination, there were many adult worms, larvae and eggs in the gastric and colonic mucosa. Worms, larvae, and eggs were located in the crypts and within the lumen of the crypts. The body wall of the adult worm was composed of cuticle and a weak muscle layer. A routine stool examination failed to detect larvae or ova. Based on the histopathologic examination, these parasites were confirmed as S. stercoralis.

Strongyloidiasis of Gastric and Colonic Mucosa in a Patient with Monoclonal Gammopathy of Undetermined Significance: A Case Report

Here we report a case of Strongyloides stercoralis infection of the gastric and pancolonic mucosa in a 79-year-old female with a monoclonal gammopathy of undetermined significance. Endoscopic biopsies were performed in gastric antrum, cecum, distal ascending colon, and hepatic flexure of the colon. On microscopic examination, there were many adult worms, larvae and eggs in the gastric and colonic mucosa. Worms, larvae, and eggs were located in the crypts and within the lumen of the crypts. The body wall of the adult worm was composed of cuticle and a weak muscle layer. A routine stool examination failed to detect larvae or ova. Based on the histopathologic examination, these parasites were confirmed as S. stercoralis.

Therapeutic potential of adipose tissue-derived stem cells for liver failure according to the transplantation routes / 대한외과학회지

PURPOSE: Even though adipose tissue-derived stem cells (ADSCs) have been spotlighted as a possible alternative for liver transplantation in an experimental setting, the mechanism by which ADSCs improve liver dysfunction remains poorly characterized. The objective of this study was to evaluate the therapeutic ability of undifferentiated ADSCs, and find a few clues on how ADSCs alleviate liver damage by comparing the transplantation routes. METHODS: In vitro generated human ADSCs were checked for surface markers and stage-specific genes for characterization. Afterwards, they were transplanted into C57BL/6 mice with CCl4-induced liver injury. The transplantations were made via tail vein, portal vein, and direct liver parenchymal injection. At 1 and 3 post-transplantation days, serum biochemical parameters and/or liver specimens were evaluated. RESULTS: We have shown here that ADSCs have the characteristics of mesenchymal stem cells, and belong to endodermal and/or early hepatic differentiation stage. After transplantation into the mice with acute liver failure, markers of liver injury, such as alanineaminotransferase, aspartateaminotransferase, as well as ammonia, decreased. Of these transplantation routes, transplantation via tail vein rendered the most prominent reduction in the biochemical parameters. CONCLUSION: Undifferentiated ADSCs have the ability to improve hepatic function in mice with acute liver injury. Moreover, our transplantation route study supports the theory that ADSCs in systemic circulation can exert endocrine or paracrine effects to ameliorate the injured liver.

Clinicopathologic Review of the Intraductal Papilloma of Breast / 한국유방암학회지

PURPOSE: Intraductal papilloma of the breast (IDP) is the most common causes of nipple discharge and it is often a solitary, centrally located tumor that most commonly occurs in the fifth and sixth decades of life. There have been many conflicting reports on the malignant potential of IDP. METHODS: From February 2003 to November 2008, we operated 161 patients who were diagnosed with IDP at Konyang University Hospital. A retrospective review of all the pathologic reports and the corresponding radiological reports was undertaken. RESULTS: The mean age of the patients was 43.23 years (SD, +/-10.1). Eighty-three (51.6%) had nipple discharge, 37 (44.6%) had bloody discharge and 46 (55.4%) had yellowish serous discharge. Twenty-four had a mass and 2 had both bloody discharge and a mass. Radiologic significant findings were shown on 20 mammography exams, 71 ductography exams and 157 breast ultrasound exams. Onehundred forty-four (89.4%) patients with IDP or papillomatosis had surrounding pathologic lesions in the operated specimen according to the final pathology, 107 (66.5%) had fibrocystic change, 26 (16.1%) had fibroadenoma, 30 (18.6%) had atypical ductal hyperplasia (ADH), 11 (6.8%) had carcinoma in situ and 4 (2.5%) had invasive ductal carcinoma. During the follow up, 7 patients (4.3%) developed recurrent IDP, 3 patients developed ADH and 5 patients developed carcinoma in situ (4 patients had ductal carcinoma in situ and 1 patient had lobular carcinoma in situ). CONCLUSION: Intraductal papilloma should be closely followed up due to its malignant potential and the surrounding breast tissue with IDP should be carefully evaluated due to the high rate of developing other precancerous lesions.

Clinicopathologic Review of the Intraductal Papilloma of Breast / 한국유방암학회지

PURPOSE: Intraductal papilloma of the breast (IDP) is the most common causes of nipple discharge and it is often a solitary, centrally located tumor that most commonly occurs in the fifth and sixth decades of life. There have been many conflicting reports on the malignant potential of IDP. METHODS: From February 2003 to November 2008, we operated 161 patients who were diagnosed with IDP at Konyang University Hospital. A retrospective review of all the pathologic reports and the corresponding radiological reports was undertaken. RESULTS: The mean age of the patients was 43.23 years (SD, +/-10.1). Eighty-three (51.6%) had nipple discharge, 37 (44.6%) had bloody discharge and 46 (55.4%) had yellowish serous discharge. Twenty-four had a mass and 2 had both bloody discharge and a mass. Radiologic significant findings were shown on 20 mammography exams, 71 ductography exams and 157 breast ultrasound exams. Onehundred forty-four (89.4%) patients with IDP or papillomatosis had surrounding pathologic lesions in the operated specimen according to the final pathology, 107 (66.5%) had fibrocystic change, 26 (16.1%) had fibroadenoma, 30 (18.6%) had atypical ductal hyperplasia (ADH), 11 (6.8%) had carcinoma in situ and 4 (2.5%) had invasive ductal carcinoma. During the follow up, 7 patients (4.3%) developed recurrent IDP, 3 patients developed ADH and 5 patients developed carcinoma in situ (4 patients had ductal carcinoma in situ and 1 patient had lobular carcinoma in situ). CONCLUSION: Intraductal papilloma should be closely followed up due to its malignant potential and the surrounding breast tissue with IDP should be carefully evaluated due to the high rate of developing other precancerous lesions.

Postoperative Findings of the Cytological Diagnosis of Follicular Neoplasm or Hurthle Cell Neoplasm and Risk of Malignancy

No abstract available.

Completely Isolated Enteric Duplication Cyst Presenting as an Inguinal Hernia

Enteric duplication cysts are uncommon congenital anomalies whose embryogenesis remains unknown. We report here on an isolated enteric duplication cyst, that presents as an inguinal hernia. A 21-year-old woman was admitted with a month-long history of a palpable mass in the left groin. Radiologically, a computed tomography scan revealed a 3.5 x 2.5 cm sized cystic mass in subcutaneous layers of the left suprapubic area. Microscopically, the cystic wall resembled gut wall. The wall was composed of two distinct muscle layers with the presence of Auerbach's plexus. On examining the entire sections of the cyst wall very carefully, no epithelial lining was found on the inner surface. The submucosa was slightly fibrotic. The diagnosis was a completely isolated enteric duplication cyst.

Evaluation of the HPV ISH Assay in Cervical Cancer

BACKGROUND: Human papillomavirus (HPV) infection can be detected by in situ hybridization (ISH), in which a punctate signal pattern indicates integrated HPV DNA and a diffuse pattern denotes the presence of episomal viral DNA. This study was conducted to evaluate the usefulness of an HPV ISH assay for invasive cervical cancer. METHODS: The HPV ISH assay for high-risk HPV and immunohistochemical staining for p16(INK4a), p53, bcl-2, and Ki-67 were performed in a tissue microarray of 279 cervical cancers. RESULTS: High-risk HPV ISH was positive in 194 (69.5%) of the samples. Punctate, diffuse, and mixed signal patterns were observed in 157 (56.3%), one (0.4%), and 36 cases (12.9%), respectively. Positive results in high-risk HPV ISH were associated with p16 and bcl-2 expression (p = 0.01 and p < 0.01, respectively). According to a Cox regression analysis, HPV infection and its surrogate immunohistochemical markers such as p16, bcl-2, and Ki-67 were not independent prognostic factors, but stage and grade were independent prognostic factors. CONCLUSIONS: Our results confirm that an HPV ISH assay is reasonably sensitive for HPV infection and that it might be useful to identify integrated HPV DNA in formalin-fixed and paraffin-embedded specimens. Further study encompassing HPV type, E2/E6 ratio, and therapeutic modality is necessary to understand the clinical meaning of HPV status in cervical cancer.

Evaluation of the HPV ISH Assay in Cervical Cancer

BACKGROUND: Human papillomavirus (HPV) infection can be detected by in situ hybridization (ISH), in which a punctate signal pattern indicates integrated HPV DNA and a diffuse pattern denotes the presence of episomal viral DNA. This study was conducted to evaluate the usefulness of an HPV ISH assay for invasive cervical cancer. METHODS: The HPV ISH assay for high-risk HPV and immunohistochemical staining for p16(INK4a), p53, bcl-2, and Ki-67 were performed in a tissue microarray of 279 cervical cancers. RESULTS: High-risk HPV ISH was positive in 194 (69.5%) of the samples. Punctate, diffuse, and mixed signal patterns were observed in 157 (56.3%), one (0.4%), and 36 cases (12.9%), respectively. Positive results in high-risk HPV ISH were associated with p16 and bcl-2 expression (p = 0.01 and p < 0.01, respectively). According to a Cox regression analysis, HPV infection and its surrogate immunohistochemical markers such as p16, bcl-2, and Ki-67 were not independent prognostic factors, but stage and grade were independent prognostic factors. CONCLUSIONS: Our results confirm that an HPV ISH assay is reasonably sensitive for HPV infection and that it might be useful to identify integrated HPV DNA in formalin-fixed and paraffin-embedded specimens. Further study encompassing HPV type, E2/E6 ratio, and therapeutic modality is necessary to understand the clinical meaning of HPV status in cervical cancer.

Double Intrahepatic and Extrahepatic Cholangiocarcinomas Arising from Biliary Papillomatosis: A Case Report

Biliary papillomatosis is a rare disease entity characterized by multiple papillary adenomas along the bile duct mucosa. It is widely accepted that the adenoma-carcinoma sequence represents the process by which most, if not all, cholangiocarcinomas of an intraductal-growing type arise. Interestingly, friable papillary projections easily detached from the primary site can be implanted into the other sites in the bile duct in suitable animal models, resulting in multiple tumors. A 76-year-old male was referred to our hospital due to intermittent abdominal discomfort. Imaging workups revealed two lesions: wall thickening in the proximal portion of the left interhepatic duct and abrupt narrowing of the distal common bile duct. A hepatopancreaticoduodenectomy was carried out and pathological analysis demonstrated a well-differentiated adenocarcinoma of the left hepatic duct and carcinoma in situ of the distal common bile duct on a background of biliary papillomatosis. Six days after the operation, the patient received a re-exploration due to ruptured mesenteric vessels. Unfortunately, 3 months after the initial operation, the patient died of aspiration pneumonia. Biliary papillomatosis can present with a broad spectrum of disease characteristics ranging from adenoma to, usually, low-grade adenocarcinoma. If there is a complete excision, and a favorable postoperative course is secured, excellent survival can be expected after surgery.

Bilateral Amyloidosis of the Oral Commisure Surrounding the Facial Artery / 대한이비인후과학회지

Amyloidosis is a disease characterized by deposition of extracellular fibrillar proteins in various tissues mainly derived from the mesoderm. We experienced a case of a 59-year old man with a localized bilateral mass at the angle of the mouth, which was surgically removed. It surrounded the facial arteries bilaterally with the same pattern, and was diagnosed as amyloidosis pathologically. Followed by further workup, he was finally diagnosed with the multiple myeloma. Cases such as this where an amyloidosis mass surrounded the main branches of the facial arteries has not yet been reported in the literature. We present a case of localized amyloidosis at the oral commisure surrounding the facial arteries with the review of its clinical patterns, diagnostic tools, pathologic findings and treatment.

Expression of CXCR4 and SDF-1alpha in Primary Breast Cancers and Metastatic Lymph Nodes / 한국유방암학회지

PURPOSE: A CXCR4/stroma derived factor-1alpha (SDF-1alpha, CXCL12) interaction is involved in many metastatic cancer mechanisms, including breast cancer. The primary objectives of this study were to investigate the correlation between CXCR4 and axillary lymph node metastasis and to clarify the interaction between CXCR4 in primary tumor cells and SDF-1alpha in metastatic lymph nodes. An analysis of the correlation between CXCR4, SDF-1alpha and clinicopathologic features was also performed. METHODS: Representative areas from 44 invasive ductal carcinomas were selected for construction of tissue microarrays using a 5 mm punch. Breast cancers (n=44), metastatic axillary lymph nodes (n=18) and non-metastatic axillary lymph nodes (n=26) were immunohistochemically stained for CXCR4, SDF-1alpha, estrogen receptor (ER), progesterone receptor (PR) and HER2. The parameters of age, tumor size, nuclear grade, histologic grade, lymph node status and pathologic node (pN) stage pN0 to pN3 were evaluated. RESULTS: CXCR4 expression was negatively correlated with increased age (p=0.005) and positively correlated with a large tumor size (p=0.043) and PR expression (p=0.027). CXCR4 expression was not correlated with metastatic lymph nodes (p=0.079) and SDF-1alpha expression in metastatic lymph nodes (p=0.062). However, CXCR4 nuclear positivity is correlated with lymph node metastasis (p=0.044). SDF-1alpha was not correlated with any clinicopathologic feature in a statistically significant manner. CONCLUSION: An evaluation of young age, large tumor size and PR expression helps predict lymph node metastasis and poor prognosis. Expression of CXCR4 nuclear positivity is correlated with a poor prognosis.