Hepatic and Small Bowel Mucormycosis after Chemotherapy in a Patient with Acute Myeloid Leukemia: A Case Report and Literature Review / 감염과화학요법

We present a case of a 64-year-old woman with acute myeloid leukemia who developed a hepatic abscess during the neutropenic period after induction chemotherapy. To treat the abscess, meropenem and ciprofloxacin were administered to target Klebsiella pneumoniae and percutaneous drainage performed. As a result, the patient's fever and c-reactive protein (CRP) subsequently improved. After six weeks of antibiotic therapy, an abdominal computed tomography scan revealed remains of the liver abscess as well as an ileus in the small bowel. Molds from the Mucor genus were cultured from repeated liver abscess drainage and an abscess wall biopsy confirmed hepatic mucormycosis. Along with administration of amphotericin-B deoxycholate for four weeks, we performed lobectomy for hepatic mucormycosis and small bowel resection for a suspected small bowel mucormycosis. After these operations, the patient received liposomal amphotericin B for three weeks and was then maintained with oral posaconazole for more than four weeks. Our case report suggests that hepatic mucormycosis should be considered when a hepatic abscess exhibits a retarded response to antibacterial agents, especially for patients with risk factors. In addition, because an isolated hepatic mucormycosis is infrequent, a thorough search for the extent of the disease is necessary before surgical resection.

Successful treatment of disseminated interdigitating dendritic cell sarcoma with adriamycin, bleomycin, vinblastine, and dacarbazine chemotherapy

Interdigitating dendritic cell sarcoma (IDCS) is a very rare and aggressive neoplasm that arises from antigen presenting cells. IDCS usually involves lymph nodes; however, extra-nodal involvement has also been reported. Because a consistent standard therapy for IDCS has not been established to date, we report a case of the successful treatment of disseminated IDCS using ABVD chemotherapy (doxorubicin, bleomycin, vinblastine, and dacarbazine). A 64-year-old man was diagnosed with IDCS on the basis of immunohistochemical findings of a biopsy specimen of the inferior nasal concha. Immunohistochemical staining showed a positive reaction for CD68, leukocyte common antigen, and S-100 protein, but a negative reaction for CD34, CD1a, and CD21. Imaging studies showed cervical and axillary lymphadenopathies, subcutaneous nodules, and a soft tissue lesion in the nasal cavity. Treatment with the ABVD regimen resulted in complete remission after 8 cycles of chemotherapy.

Expression of HAT1 and HDAC1, 2, 3 in Diffuse Large B-Cell Lymphomas, Peripheral T-Cell Lymphomas, and NK/T-Cell Lymphomas

BACKGROUND: It has generally been proven that histone acetylation and deacetylation are involved in the malignant transformation. To date, however, this has rarely been studied in cases of malignant lymphoma. METHODS: We studied nine cases of reactive lymphoid hyperplasia, 78 cases of diffuse large B-cell lymphoma (DLBCL), 13 cases of peripheral T-cell lymphoma, not otherwise specified (PTCL-NOS), and 13 cases of extranodal NK/T-cell lymphoma, nasal type (NKTCL). Thus, we attempted to elucidate the associations of the degree of the expression of histone acetyltransferase 1 (HAT1), histone deacetylase (HDAC) 1, HDAC2, and HDAC3 with the clinical behaviors of above malignant lymphomas using the immunohistochemistry and a western blot analysis. RESULTS: The degree of the expression of HAT1 was higher in cases of DLBCL, PTCL-NOS or NKTCL as compared with reactive lymphoid hyperplasia (p0.05). CONCLUSIONS: HAT1, HDAC1, and HDAC2 play a critical role in the development of malignant lymphomas. Both HAT1 and HDAC1 might be indicators for a poor prognosis in cases of DLBCL as cooperating factors.

A Proposal for Creating a Guideline for Cancer Registration of the Fibromatosis, PEComa Group, Malignant Lymphoma In Situ and Dendritic Cell Tumors (III)

BACKGROUND: Understanding the biologic behavior of a tumor is a prerequisite for tumor registration code assignment. The aim of this report was to propose appropriate behavior codes of the International Classification of Disease Oncology 3 (ICD-O3) to rare, yet pathologically interesting hematopoietic and soft tissue tumors. METHODS: The Study Group for Hematopathology, the Bone and Soft Tissue Pathology Study Group, and the Cancer Registration Committee prepared the questionnaire containing provisional behavior codes of selected diseases. RESULTS: In situ lesions of mantle cell and follicular lymphomas, dendritic cell tumors, and neoplasms with perivascular epithelioid cell differentiation (PEComa), not otherwise specified were classified as malignant (-/3). The fibromatosis group, with the exception of lipofibromatosis, was proposed as benign (-/0). Lipofibromatosis and several diseases that belong to the PEComa group were proposed as uncertain malignant potential (-/1). For the hematologic and soft tissue tumors, 274 and 288 members of the Korean Society of Pathologists, respectively, provided opinions through questionnaire, and most responders showed agreement with the provisional behavior code proposed. CONCLUSIONS: The determination of behavior codes for the rare diseases described in this study, especially those of the PEComa group or malignant lymphoma, could be viewed as impractical and premature, but this study provides the basis for future research on this topic.

Endometrial mullerian adenosarcoma after toremifene treatment in breast cancer patients: a case report / 부인종양

Toremifene is an anti-estrogen which has been shown to be effective in the treatment of breast cancer, and is thought to be a less uterotrophic agent than tamoxifen. The risk assessment concerning endometrial cancer has been inconclusive because of its rare use up to the mid-1990s. We report a case of an adenosarcoma, which is a very rare type of uterine malignancy, after toremifene treatment for 5 years in a breast cancer patient. After 1 year of toremifene use, the patient had a benign Mullerian adenofibroma. After an additional 4 years of toremifene treatment, the endometrial polypoid lesion was transformed into a Mullerian adenosarcoma. Although toremifene is a promising anti-estrogenic agent in the treatment of breast cancer patients, clinicians should not neglect the possibility of a uterine malignancy.

The expression of clusterin, bax, p53, Ki-67, and apoptotic index in epithelial ovarian tumors / 대한산부인과학회지

OBJECTIVE: The purpose of this study was (1) to evaluate the expressions of clusterin, bax, Ki-67, p53, and apoptotic index in epithelial ovarian tumors, borderline and malignant ovarian tumors, (2) to find out the correlation between their expressions and clinicopathological parameters, and (3) to evaluate the effect on the patient's survival according to their expressions. METHODS: The histological and clinical findings of 22 cases of ovarian cystadenomas, 44 cases of borderline tumors and 96 cases of carcinomas were evaluated. Expressions of clusterin, bax, Ki-67, p53, and apoptotic index were studied on paraffin-embedded tissue sections by immunohistochemical methods. RESULTS: The expressions of clusterin, p53, and Ki-67 were higher in ovarian carcinomas than borderline tumors. The overexpression of p53, and Ki-67 were frequent in high stage, poorly differentiated and bilateral ovarian carcinomas. The overexpressions of clusterin, bax, p53, and Ki-67 showed a statistically significant correlation with histologic type. Apoptotic index was higher in bax overexpression group, but there was no correlation with overexpression of clusterin or p53. Ki-67 was higher in p53 overexpression group, but there was no correlation with overexpression of clusterin or p53. There was no statistically significant correlation with each other between the overexpressions of clusterin, bax, p53, and Ki-67. The overexpressions of clusterin, Ki-67, p53 was associated with overall patient's survival in borderline significance. CONCLUSION: The overexpression of p53, and Ki-67 were frequent in poorly differentiated ovarian carcinomas. So the overexpression of p53, and Ki-67 can be used as prognostic factor. The overexpression of clusterin was more in epithelial ovarian carcinomas than in borderline tumors but showed no significant correlation with the overall patient's survival. Further studies are required to clarify the possibility of using clusterin for target therapy in epithelial ovarian carcinomas.

Prevalence and Genotype Distribution of Cervical Human Papillomavirus DNA in Korean Women: A Multicenter Study

Background: DNA prevalence and type distribution of human papillomavirus (HPV) varies geographically. We investigated HPV prevalence and type distribution in Korean women using the MyHPV DNA chip testing. Methods: A total of 2,368 women from five regions of the country underwent Pap smear examination and MyHPV chip testing. Results: Overall HPV positivity was 15.8% and 78.4% in women with normal and abnormal cytology, respectively. High-risk HPV infection was strongly correlated with cytological atypia. In women with abnormal cytology, the five most common HPV types were 16, 58, 18, 52, and 56/53, and HPV16 was significantly the most common type in most geographical regions. After HPV16, HPV58, and 52 were the next most frequently detected types. Women with normal cytology, in contrast, showed heterogeneity in HPV type distribution. High-grade intraepithelial lesions infected with HPV16, 18, 31 or 45 are more likely to progress to carcinoma. Conclusions: The HPV chip test can provide useful data regarding HPV positivity and type. The most common HPV type in Korean women with abnormal cytology is HPV16, with HPV58 and 52 being frequently present. Our data may have important implications for vaccination programs and the development of cervical screening.

Expressions of cyclooxygenase-2 and P-glycoprotein in epithelial ovarian carcinomas / 대한산부인과학회지

OBJECTIVES: The purpose of this study was to evaluate expression of cyclooxygenase-2 (COX-2) and P-glycoprotein (P-gp) in ovarian epithelial carcinomas, to find out the correlations between their expression and clinicopathological parameters, and to evaluate the response to treatment and clinical outcome according to their expression. METHODS: Immunohistochemical studies of COX-2 and P-gp were carried out in 64 cases that were treated with ovarian epithelial carcinomas at Department of Obstetrics and Gynecology, Korea University Hospital, Korea University from 1996 to 2005. RESULTS: COX-2 over-expression was detected in 20 (31.2%) cases and was significantly higher in non-responder than responder to chemotherapy (56.2% versus 22.9%, respectively; P=0.012). The patients of COX-2 overexpression showed shorter overall survival (P<0.001). Over-expression of P-gp was detected in 15 (23.4%) cases was significantly higher in non-responder than responder to chemotherapy (56.2% versus 12.5%, respectively; P<0.001). The patients of P-gp overexpression showed shorter overall survival (P= 0.042). CONCLUSION: COX-2 and P-gp overexpression could provide additional information to identify ovarian carcinoma patients with poor chance of response to chemotherapy.

Clinical Significance of c-kit Protein Expression and c-kit Gene Mutation in Nasopharyngeal Cancer / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The proto-oncogene c-kit is a receptor tyrosine kinase recognized to initiate essential signal transduction pathways that transmit biological signals for cellular proliferation, differentiation and metastasis. Aberrant expression or mutation of c-kit has been shown to be involved in the pathogenesis of many cancers. In this study, with the aim of identifying additional groups of tumors that may use the stem cell factor/c-kit pathway, we investigated the expression of c-kit in nasopharyngeal carcinoma. SUBJECTS AND METHOD: In this retrospective study, immunohistochemical stains for c-kit were performed on formalin-fixed paraffin embedded sections from 20 patients with nasopharyngeal carcinoma who were treated from 1996 to 2004. Gene mutation was analyzed by PCR-SSCP and direct sequencing. RESULTS: c-kit over-expression was found in 65% (13/20) of patients. Eight of the 13 samples (61.5%) exhibited strongly positive immunoreactivity for c-kit protein (staining of >50% of the tumor cells). c-kit gene mutation was found in 4 of 20 cases by the PCR-SSCP method. CONCLUSION: c-kit protein over-expre-ssion is found in 65% of the nasopharyngeal carcinoma patients. c-kit expression is correlated with c-kit DNA mutations and nasopharyngeal carcinoma may be potential targets for treatment with imatinib mesylate.

Follicular Lymphoma with Monoclonal Plasma Cell Differentiation: A Case Report

We present a case of recurrent follicular lymphoma with an extensive plasma cell component involving infra-auricular lymph nodes in a 64 year-old woman. Immunohistochemical staining showed a strongly positive reaction of the follicles with CD20, bcl-2, bcl-6, CD10 and CD21 on the first biopsy specimen. The intrafollicular and interfollicular plasma cells showed monoclonality for IgG heavy chain and lambda light chain. The histological and immunohistochemical findings in the recurrent tumor were identical with those of the original. Discussion is focused on the importance of the differential diagnosis between reactive lymphoid hyperplasia and other lymphomas having plasmacytic differentiation.

Sarcomatoid Carcinoma of the Renal Pelvis / 대한비뇨기과학회지

A sarcomatoid carcinoma of the urinary system is a rare malignant tumor, composed of both epithelial and stromal cells, is regarded as a similar disease entity to a carcinosarcoma. In Korea, only 1 case of primary sarcomatoid carcinoma and 4 cases of carcinosarcoma involving the bladder have been reported, but to date, no case of primary sarcomatoid carcinoma involving the renal pelvis has been reported. Recently, we experienced a case of sarcomatoid carcinoma involving the right renal pelvis in a 67-year-old male patient with intermittent gross hematuria. A CT scan demonstrated a 5x4cm sized mass in the right renal pelvis. Under the diagnosis of a right renal pelvic tumor, a right nephroureterectomy, with bladder cuff excision, was performed. The tumor was composed mostly of pleomorphic spindle cells, and in the peripheral part of the tumor and renal pelvis, a high grade transitional cell carcinoma and adenocarcinoma was also found. The tumor was pathologically confirmed as a primary sarcomatoid carcinoma of the renal pelvis.

Mesenteric Castleman's Disease

We report here a rare case of mesenteric Castleman's disease presenting as a mesenteric mass. A 13-year-old female child was admitted to our hospital complaining of intermittent vague abdominal pain. She had hypochromic anemia, thrombocytosis and an elevated erythrocyte sedimentation rate (ESR). Ultrasonography and computed tomography indicated an intra- abdominal mass might represent a lymphoma or gastrointestinal stromal tumor or leiomyoma, but the definitive preoperative diagnosis couldn't be confirmed. The surgical resection of the mass revealed the mesenteric hyaline vascular- type Castleman's disease.

Immunohistochemical Expression of Galectin-3 in Thyroid Tumors / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Galectin-3 is a beta-galactoside binding protein that has been reported to be implicated in numerous biologic and pathologic functions including cell growth, cell adhesion, inflammation, neoplastic transformation, and apoptosis. Most previous studies in thyroid tissue have found galectin-3 expression to be a feature of malignant and not of benign or normal tissue. The aim of this study was to investigate the expression of galectin-3 in 57 thyroid lesions, to assess its potential as a marker in the diagnosis and classification of thyroid malignancy. SUBJECTS AND METHOD: The followings were studied: 19 cases of papillary carcinomas, 8 of follicular carcinomas, one anaplastic carcinoma, one medullary carcinoma, 16 follicular adenomas, and 12 nodular hyperplasia. Formalin-fixed paraffin-embedded thyroid tissues were stained immunohistochemically for galectin-3. RESULTS: Galectin-3 expression was found in all cases, however, it was strong in papillary carcinomas than in follicular carcinomas or adenomas. In nodular hyperplasia, galectin-3 expression was very weak and focal. A significant difference was not found in the expression of galectin-3 between follicular carcinomas and follicular adenomas. CONCLUSION: Galectin-3 is a reliable marker of papillary carcinoma but not useful in identifying follicular carcinoma.

A Case of Splenic Marginal Zone Lymphoma / 대한진단검사의학회지

Splenic marginal zone lymphoma (SMZL) is a rare B-cell neoplasm characterized by massive splenomegaly, moderate lymphocytosis, bone marrow intrasinusoidal involvement of lymphocytes and a relatively indolent course. We report a case of SMZL diagnosed by bone marrow studies using immunophenotyping and immunohistochemical stain, and confirmed by splenectomy. The patient was a 61-year old male, who showed mild lymphocytosis in peripheral blood and bone marrow aspirates. Immunophenotyping of bone marrow aspirates showed lymphocytes positive for CD19, CD20, CD22 (dim), CD23 (dim) and negativie for CD5 and CD10. The immunohistochemistry of bone marrow and spleen also showed lymphocytes positive for CD20 and negative at for cyclin D1. Now he is being treated for chronic obstructive pulmonary disease and will receive chemotherapy.

Significance of Akt Expression in Node-negative Breast Cancer

BACKGROUND: Patients with lymph node-negative breast cancer show a 10-year recurrence rate of approximately 20%. In node-negative breast cancer, the prognostic factors are age, menopause, tumor size, hormone receptors, p53, DNA ploidy, Ki-67 index (Ki-67) and c-erbB2. Of these, ErbB2 (the protein of the c-erbB2 gene) is a member of the receptor tyrosine kinase family. Overexpression of ErbB2 is known to regulate cell proliferation, differentiation, growth and apoptosis via the ErbB2/Phosphoinositol 3-Kinase (PI 3-K)/Akt signaling pathway. Therefore, it is important to identify high- risk patients that would benefit from adjuvant therapies related with ErB2. For this purpose, the prognostic relevance of the ErbB2/PI 3-K/Akt pathway was examined in node-negative breast cancer. METHODS: A retrospective analysis was performed on the hospital records of all 72 patients diagnosed with breast cancer, and who underwent surgical treatment between January 1996 and December 2003. Clinicopathological data were compared with the results of immunohistochemical staining using the phospho-specific antibody for the expression of Akt. RESULTS: The mean age of the patient's was 48.6 years. Phospho-Akt (pAkt) was expressed in 24 cases (33.3%), but there was no statistical relationship between pAkt expression and the known prognostic factors of breast cancer. There was no statistical significance in the survival rates between the pAkt positive and negative expression groups (P=0.123). In the ErbB2 positive patients, the expression of pAkt was associated with a shorter disease-free survival (P=0.045), and the disease-free survival was shorter in patients whose tumors expressed pAkt and had a high level of Ki-67 (P=0.040). CONCLUSION: The co-expression of ErbB2 and pAkt positivity implied a poor prognosis in node-negative breast cancer patients, and the co-expression of high Ki-67 and pAkt positivity also revealed a poor prognosis in these patients. These results show that the expression of pAkt could be considered a prognostic marker of node-negative breast cancer with ErbB2 positive expression and high levels of Ki-67.

The Quantitative Analysis of Mitochondrial DNA Copy Number in Premature Ovarian Failure Patients Using the Real-time Polymerase Chain Reaction / 대한산부인과학회잡지

OBJECTIVE: To design a screening method which identifies women with a potential of progression to the premature ovarian failure (POF) in near future, particularly among young women who have high FSH level but no symptoms and signs of POF. METHODS: Peripheral venous blood samples were collected from 30 patients with POF (age range, 19- 39 years) and from 30 controls with normal serum FSH level who had delivered two or more naturally conceived babies (age range, 32-39 years). mtDNA/28S rRNA ratio was determined by real-time quantitative PCR. Comparative threshold cycle (CT) method was adopted for the relative quantitation between two groups and the effectiveness of the method was evaluated. RESULTS: A significant decrease in mtDNA/28S rRNA ratio was found in the POF group (0.58 0.38) when compared with the control group (1.15 0.67) (P<0.01). In both control and POF groups, there was positive correlation between mtDNA and mtDNA/28S rRNA ratio (r=0.774, P<0.001; r=0.556, P=0.001, respectively) and negative correlation between 28S rRNA and mtDNA/28S rRNA ratio (r=-0.677, P<0.001; r=-0.627, P=0.001, respectively), which indicated the suitability of the method. CONCLUSION: This study showed a significant decrease in mtDNA copy number in the peripheral venous blood of POF patients. The comparative CT method was found to be an effective and efficient alternative for the screening purposes. With this basis, further studies on the early diagnostic and/or screening method for the POF might be enriched.

A Case of Collision Tumor: Bronchogenic Squamous Cell Carcinoma in Cervical Hodgkin Disease / 대한이비인후과학회지

In the head and neck fields, collision tumor is very rare, especially in the cervical lymph node. Clinical and pathological findings are reported concerning a 56-year-old woman with Hodgkin disease and metastatic bronchogenic squamous cell carcionma within the right supraclavicular lymph node. The primary site of squamous cell carcinoma was diagnosed by transbronchial lung biopsy. Each component retains its own biologic characteristics, so the most suitable treatment must be determined on a case-by-case.

Gastric Inflammatory Myofibroblastic Tumor: Case Report

We report a case of gastric inflammatory myofibroblastic tumor in a 25-month-old boy. The condition is very rare and is of unknown pathogenesis. Because it is large and invades adjacent organs, imaging procedure do not provide easy differentiation between an inflammatory myofibroblastic tumor and malignacy, and it should thus be included in the differential diagnosis of an infiltrative upper abdominal mass occurring in children.

Quantitative Nuclear Characteristics of Lung Cancer Cells Using Image Analysis

BACKGROUND: The usefulness of quantitative nuclear image analysis in the classification of lung carcinoma is widely investigated and published. In this study, we tried to measure the nuclear characteristics of primary lung carcinomas by image analysis and to find the possibility of differential diagnoses. METHODS: Seventeen cases of adenocarcinomas (not including bronchioloalveolar carcinoma), seven of bronchioloalveolar carcinomas, eight of large cell neuroendocrine carcinomas, five of small cell carcinamas, and 26 of squamous cell carcinomas were analysed. Three different images of each case were captured by digital camera, and we analyzed the nuclear area, perimeter, circularity, and density using the Optimas 6.5 Image Analyser software package. Statistical analyses were done using the statistical program STATISTICA kernel release 5.5. RESULTS: The mean nuclear area was 0.52+/-0.25micrometer2 in the adenocarcinomas, 0.50+/-1.82micrometer2 in the squamous cell carcinomas, 0.45+/-0.20micrometer2 in the large cell neuroendocrine carcinomas, 0.42+/-0.16micrometer2 in the bronchioloalveolar carcinomas, and 0.31+/-0.12micrometer2 in the small cell carcinamas. The nuclear area was significantly different between the small cell carcinomas and the non-small cell carcinomas (p<0.01) and between the adenocarcinomas and the bronchioloalveolar carcinomas (p=0.02). The mean nuclear perimeter was 3.36+/-0.92micrometer2 in the adenocarcinomas, 3.24+/-0.67micrometer2 in the squamous cell carcinomas, 3.16+/-0.82micrometer2 in the large cell neuroendocrine carcinomas, 3.05+/-0.80micrometer2 in the bronchioloalveolar carcinomas, and 2.54+/-0.62micrometer2 in the small cell carcinamas. The nuclear perimeter was significantly different between the small cell carcinomas and the non-small cell carcinomas (p<0.04). The nuclear circularity showed no statistical difference. Nuclear density was the highest in the squamous cell carcinomas, and the lowest in the small cell carcinomas. The large cell neuroendocrine carcinomas showed the lowest standard deviation in nuclear density. CONCLUSION: The analysis of nuclear characteristics using an image analyser can be used as an objective method in the classification of lung carcinoma.

Ovarian Mature Cystic Teratoma Containing Homunculus: A Case Report

We report a partial fetus-like structure (homunculus) in benign ovarian mature cystic teratoma removed from a 23-yr-old female. The cyst displayed various tissues derived from the three germ layers. The homunculus had a distinguished fetal cranial structure with one upper extremity. A partially developed osteocartilagenous skeleton was identified in the cranial structure of the homunculus. Intracranial structures such as cerebral cortex, retinal pigment, and leptomeninges were extruded from the partially disrupted calvarium.