A Case of Disseminated Multidrug-Resistant Tuberculosis involving the Brain

We report a case of a 23-year-old female immigrant from China who was diagnosed with multidrug-resistant tuberculosis affecting her lung and brain, resistant to the standard first-line therapeutics and streptomycin. She was treated with prothionamide, moxifloxacin, cycloserine, and kanamycin. However, her headache and brain lesion worsened. After the brain biopsy, the patient was confirmed with intracranial tuberculoma. Linezolid was added to intensify the treatment regimen, and steroid was added for the possibility of paradoxical response. Kanamycin was discontinued 6 months after initiation of the treatment; she was treated for 18 months with susceptible drugs and completely recovered. To our knowledge, this case is the first multidrug-resistant tuberculosis that disseminated to the brain in Korea.

A Case of Ileal Lipoma Misdiagnosed as Colonic Lipoma / 이화의대지

No abstract available.

Retrorectal Teratoma with Ovarian Teratoma / 이화의대지

No abstract available.

An Adrenocorticotropic Hormone-secreting Malignant Pancreatic Neuroendocrine Tumor / 대한내과학회지

Pancreatic endocrine tumors are low-to-intermediate-grade neoplasms arising from the pancreatic islets that produce various hormones. These tumors account for a minority of pancreatic tumors and are generally considered functional if they are associated with a hormonal syndrome. Adrenocorticotropic hormone-secreting tumors (ACTHomas) are very rare and require special clinical consideration. Patients with ACTH-secreting tumors usually present with Cushing's syndrome, due to ectopic ACTH production. ACTHomas have a poor prognosis because of early metastasis and difficulty controlling corticosteroid production. We report a 62-year-old male with an ACTH-secreting metastatic pancreatic neuroendocrine tumor, who did not respond to somatostatin analogs and died.

Cerebral Adrenomyeloneuropathy with Trp77-Leu82del Mutation in ABCD1 Gene

Cerebral adrenomyeloneuropathy is a subtype of X-linked adrenoleukodystrophy with a mutation of ABCD1; however, there have been no reported cases of cerebral adrenomyeloneuropathy with myelopathy. Here we report a 20-year-old male cerebral adrenomyeloneuropathy patient with myelopathy harboring a deletion mutation of c.225-242 (Trp77-Leu82del) from exon 1 of ABCD1. His spinal cord MRI revealed high signal intensities in the cervical spinal cord. Electrophysiological and histopathologic studies revealed mixed axonal and demyelinating neuropathy.

Jejunal Mass Presented by Anemia / 이화의대지

No abstract available.

Correlation of Glucose Transporter-1 Expression With Uptake of 18F-Fluorodeoxyglucose Positron Emission Tomography in Thyroid Papillary Carcinoma / 대한이비인후과학회지

Backgroud and Objectives: 18F-FDG Positron emission tomography (18F-FDG PET) is a noninvasive diagnostic tool for many kinds of human cancer, where glucose transporter-1 (Glut-1) acts as a main transporter in the uptake of 18F-FDG in cancer cells. The object of this study is to assess the expression of Glut-1 in human papillary carcinoma and the relationship between the expression and the uptake of 18F-FDG PET. SUBJECTS AND METHOD: We evaluated 30 patients diagnosed as papillary carcinoma. Tumor sizes were measured and Glut-1 expression rate (ER), expression intensity (EI) and total expression score (ES) were analyzed. 18F-FDG PET was performed in 19 patients and standardized uptake value (SUV) was measured in each case. The correlations between ER and SUV, ES and SUV, tumor sizes and SUV, ER and tumor sizes were analyzed statistically. RESULTS: 96.7% (29/30) of tumors were Glut-1 positive, the mean ER was 67.42+/-22.89% and the mean ES 131.8+/-71. Tumor cells showed higher expression of Glut-1 than normal thyroid tissue. 18F-FDG uptake was positive in 81% (17/21) of solitary thyroid papillary carcinoma and negative in 19% (4/21). The average SUV of the PET positive group was 6.75+/-4.8, ER 71.25 +/-20.6% and ES 134.68+/-51.4. The average size of PET positive tumors was 3.37+/-2.94 cm2 and that of negative tumors was 0.43+/-0.45 cm2. Both ER and ES of Glut-1 were correlated with SUV significantly. The size and SUV were also correlated significantly. But the size and ER were not correlated significantly. CONCLUSION: Thyroid papillary carcinoma has high ER of Glut-1 and there is a positive correlation between Glut-1 expression and the uptake of 18F-FDG PET. The size of tumor can also affect the 18F-FDG uptake. But there is no correlation between the size and Glut-1 expression and further studies are needed to find the mechanisms and to decide the cut-off value.

A Case of Esophageal Aspergillosis Developed in Patient with Rheumatoid Arthritis

Invasive fungal infections contribute substantially to death and illness. Invasive aspergillosis usually occurs in immunocompromised patients and is associated with high morbidity and mortality. Primary infection usually involves the respiratory tract following environmental exposure to Aspergillus and may, in severely immunocompromised patients, disseminate to other organs. A 35-year-old woman with history of rheumatoid arthritis for more than 10 years, developed dysphagia for 2 months following the combination therapy with prednisolone and etanercept. The patient was hospitalized and diagnosed as esophageal aspergillosis by gastroduodenoscopic biopsy. Fourteen days after initiation of itraconazole, dysphagia recovered completely. It is very rare case to develop only esophageal aspergillosis without invasion of any other organs. We report here, the case of localized aspergillosis in patient who took immunosuppressants for rheumatoid arthritis.

A Case of Esophageal Aspergillosis Developed in Patient with Rheumatoid Arthritis

Invasive fungal infections contribute substantially to death and illness. Invasive aspergillosis usually occurs in immunocompromised patients and is associated with high morbidity and mortality. Primary infection usually involves the respiratory tract following environmental exposure to Aspergillus and may, in severely immunocompromised patients, disseminate to other organs. A 35-year-old woman with history of rheumatoid arthritis for more than 10 years, developed dysphagia for 2 months following the combination therapy with prednisolone and etanercept. The patient was hospitalized and diagnosed as esophageal aspergillosis by gastroduodenoscopic biopsy. Fourteen days after initiation of itraconazole, dysphagia recovered completely. It is very rare case to develop only esophageal aspergillosis without invasion of any other organs. We report here, the case of localized aspergillosis in patient who took immunosuppressants for rheumatoid arthritis.

A Case of Bleeding Meckel's Diverticulm Diagnosed by Wireless Capsule Endoscopy / 대한소화기내시경학회지

Meckel's diverticulum is a remnant of the vitelline duct located in the distal ileum, and it is the most common cause of small bowel bleeding in patients who are under the age of 25 years. The ectopic gastric mucosa in Meckel's diverticulum causes ulceration and acute gastrointestinal bleeding. Capsule endoscopy is now a valuable tool for diagnosing obscure gastrointestinal bleeding. However, the identification of a Meckel's diverticulum by wireless capsule endoscopy has rarely been reported on. An 18-year-old man was admitted for recurrent melena and anemia. He underwent a small bowel series that showed a jejunal diverticulum, and capsule endoscopy then revealed a jejunal diverticulum with multiple ulcerations. After 2 months, he had fresh hematochezia and so he underwent small bowel segemental resection that included the jejunal diverticulum. The operation revealed Meckels' diverticulum at 180 cm distant from the ileocecal valve at the mesenteric side. We report here on a case of bleeding Meckel's diverticulum that was diagnosed by wireless capsule endoscopy, and we include a review of the relevant literature.

A Case of Bleeding Meckel's Diverticulm Diagnosed by Wireless Capsule Endoscopy / 대한소화기내시경학회지

Meckel's diverticulum is a remnant of the vitelline duct located in the distal ileum, and it is the most common cause of small bowel bleeding in patients who are under the age of 25 years. The ectopic gastric mucosa in Meckel's diverticulum causes ulceration and acute gastrointestinal bleeding. Capsule endoscopy is now a valuable tool for diagnosing obscure gastrointestinal bleeding. However, the identification of a Meckel's diverticulum by wireless capsule endoscopy has rarely been reported on. An 18-year-old man was admitted for recurrent melena and anemia. He underwent a small bowel series that showed a jejunal diverticulum, and capsule endoscopy then revealed a jejunal diverticulum with multiple ulcerations. After 2 months, he had fresh hematochezia and so he underwent small bowel segemental resection that included the jejunal diverticulum. The operation revealed Meckels' diverticulum at 180 cm distant from the ileocecal valve at the mesenteric side. We report here on a case of bleeding Meckel's diverticulum that was diagnosed by wireless capsule endoscopy, and we include a review of the relevant literature.

Effects of Calcitriol on Delayed Neuronal Damage of Hippocampus in Transient Global Ischemia Model of Mature Gerbil

BACKGROUND: It is well documented that calcium ions perform a major role in neuronal degeneration in cerebrovascular disease and the other degenerative diseases, and that 1,25-dihydroxyvitamin D3 (D3) has the dose-dependent protective effects. This study was performed to examine the effects of different D3 dosages against delayed neuronal damage of the hippocampus. METHODS: Mature mongolian gerbils were injected with either 0.8 microgram/kg/day (group 2) for 5 days or 1.0 microgram/kg/day for 8 days (group 3) prior to the 10 min ligation of the bilateral common carotid arteries. Immunohistochemical expression for the glial cell line-derived neurotrophic factor (GDNF), the basic fibroblast growth factor (bFGF) and the platelet-derived neurotrophic factor (PDNF) was observed in the D3-injected (0.8 microgram/kg/day for 5 days) group. RESULTS: Group 2 showed a highly significant attenuation of delayed neuronal damage in the lateral CA1 region at 7 days after reperfusion. Group 3 showed unilateral or bilateral hemispheric infarcts 24 h after the onset of reperfusion. The D3-injected group showed a markedly increased bFGF expression level. CONCLUSION: The dose-dependent effect of D3 suggests the importance of determining the appropriate D3 dose for clinical applications. Although the mechanism(s) of neuroprotection by D3 remains unclear, D3 may facilitate a reduction in ischemia-induced oxidative stress via the activation of the neurotrophic factors, including bFGF and GDNF.

Evaluation of the Usefulness of Immediate-Cytospin Wright-Stained Urine Cytology in the Screening and Monitoring of Bladder Cancer / 대한진단검사의학회지

BACKGROUND: The goal of this study is to assess the usefulness of immediate-cytospin Wright stain cytology with bladder tumor markers such as BTA and NMP22 in the screening and monitoring of bladder cancer. METHODS: We evaluated immediate-cytospin (cytospin 3, Shandon, UK) Wright stain and Papanicolau stain urinary cytology with the BTA stat (Bion Diagnostic Sciences, Inc., Redmond, WA, USA) and the NMP22 (Matritech, Newton, MA, USA) in 143 urine specimens for screening and monitoring of bladder cancer from September 2001 to May 2002. The cut-off decision level of NMP22 was determined by the receiver-operating characteristics (ROC) curve and those above the cut-off were classified as positive. The Wright and PAP stained urinary cytology results were reviewed by two experts. Negative and atypia cytology results were classified as negative, and suspicions of malignancy and malignancy results were classified as positive. RESULTS: The ROC curve analysis for NMP22 demonstrated optimal sensitivity and specificity (81.8% and 83.8%, respectively) with the cut-off decision level 11.0 IU/mL. Sensitivity, specificity, false positive rate, and false negative rate for the BTA stat were 62.5%, 92.9%, 47.4%, and 4.8%, respectively, and 81.8%, 83.8%, 55.0%, and 3.4%, respectively for the NMP22. Whereas, those values for immediate-cytospin Wright stain cytology were 90.9%, 98.4%, 16.7%, and 0.8%, respectively, showing a 100% concordance rate with Papanicolau stained cytology. The area under the ROC curve of the BTA stat, the NMP, and the immediate-cytospin Wright stain cytology was 0.78, 0.81, and 0.95, respectively. CONCLUSIONS: Immediate-cytospin Wright stain cytology was useful for the decrease in false positivity and false negativity for tumor markers such as the BTA stat and the NMP22 in screening and monitoring for bladder cancer.

A Case of Kimura Disease on Parotid Gland

Kimura disease(KD) is a chronic inflammatory disorder of unknown etiology and results from an abnormal proliferation of lymphoid follicles and vascular endothelium and rarely has been reported in Korea. Clinical findings of Kimura disease include solitary or multiple, firm, subcutaneous nodules, which usually are located on the head or neck but parotid region is the most common site. The clinical course of the disease is chronic, with lesions frequently persisting or recurring despite treatment. The prognosis for KD is good, with no potential for malignant transformation. Our case is a 45-years-old man who had huge mass on left cheek which had slowly grown since about 10 years before. We planned to perform superficial parotidectomy but the mass was poorly demarcated due to extensive fibrosis and adhesion and had easy bleeding tendency. After frozen biopsy, we performed tumor debulking operation followed by cyclosporin therapy by the dose of 2.5 mg/Kg/day. The lesion was almostly cleared successfully after 3 months later. We report important aspects of clinical findings, histologic features, and therapeutic options of the rare case of KD with review of the previous articles.

KAI-1 Protein Expression in Breast Cancer: Correlation with Axillary Lymph Node Metastasis and other Prognostic Factors

BACKGROUND: KAI-1 is a metastasis suppressor gene. We have evaluated the correlationbetween KAI-1 protein expression in ductal carcinomas of the breast and axillary lymph nodemetastasis. METHODS: The expression of KAI-1 protein was confirmed by immunohistochemistryto examine breast tissues of ductal carcinomas from 50 patients with nodal metastasisand from 53 patients without metastasis. Western blot analysis was performed on fresh frozenbreast tissues from 17 cases with nodal metastasis and from 19 cases without metastasis. RESULTS: Immunohistochemical KAI-1 protein expression was decreased or negative in 39out of 50 cases with metastasis (78%), compared with 8 out of 53 cases with no metastasis(15.1%). The difference was statistically significant (p<0.05). Immunohistochemical KAI-1protein expression was significantly decreased in cases with higher modified Black's nucleargrade (p=0.027) and larger tumor size (p=0.039). Western blot analysis showed positivebands at 29.5 kDa in 8 out of 19 cases without metastasis (42.1%), and none of the 17 caseswith metastasis showed positive bands (p=0.0024). CONCLUSION: These results suggest thepossibility that KAl-1 might play a major role of a metastasis suppressor gene in addition tothe part it plays in the growth and progression of human breast ductal carcinoma. In addition, the decreased expression of KAI-1 protein in breast ductal carcinomas could be used as afactor suggesting poor prognosis.

Suprasellar Endodermal Sinus Tumor Presenting with Tonic-Clonic Seizure: An Autopsy Case Report

We report the clinical course and autopsy findings of a 19-year-old girl with endodermal sinus tumor involving the thalamus, hypothalamus, and basal ganglia. The patient initially had tonic-clonic seizures with abnormal signal involving the right hippocampus, amygdala, basal ganglia, putamen, and dentate gyrus. The signal intensity of the posterior pituitary on T1-weighted images was decreased at the time of admission, which was not associated with clinical symptoms of diabetes insipidus (DI). A huge tumor mass as well as central DI developed within 10 months. The postmortem examination showed gliosis with calcification involving the right basal ganglia, internal capsule, and white matter, in addition to a tumor mass involving the thalamus, hypothalamus, and basal ganglia. Dissemination of tumor cells in the leptomeninges and the gliotic area and hydrocephalus were also noted.

A Case of Churg-Strauss Syndrome Affecting Lung and Neuromuscular System / 결핵

Churg-Strauss syndrome(CSS) is a systemic vascular disorder that has an unknown cause with multiorgan involvement and diverse presentations. The three main histologically distinct phases were necrotizing vasculitis, tissue eosinophilia and extravascular granulomas. A diagnosis of CSS can be made on four or more of the following six criteria : 1) asthma, 2) peripheral eosinophilia >10% on the differential leukocyte count, 3) mononeuropathy (including multiple) or polyneuropathy, 4) paranasal sinus abnormalities, 5) nonfixed pulmonary infiltrates, and 6) biopsy evidence of extravascular eosinophils in the skin, the nerves, or the lungs. CSS has a good prognosis with systemic steroid therapy. The 5 year survival is approximately 70 %. We experienced a 66-year-old man who presented with cough, sputum, edema and numbness in both legs. He presented with all of the 6 CSS criteria. A nerve and muscle biopsy confirmed the diagnosis. Here, we report this case with a review of the relevant literatures.

A Case of Churg-Strauss Syndrome Affecting Lung and Neuromuscular System / 결핵

Churg-Strauss syndrome(CSS) is a systemic vascular disorder that has an unknown cause with multiorgan involvement and diverse presentations. The three main histologically distinct phases were necrotizing vasculitis, tissue eosinophilia and extravascular granulomas. A diagnosis of CSS can be made on four or more of the following six criteria : 1) asthma, 2) peripheral eosinophilia >10% on the differential leukocyte count, 3) mononeuropathy (including multiple) or polyneuropathy, 4) paranasal sinus abnormalities, 5) nonfixed pulmonary infiltrates, and 6) biopsy evidence of extravascular eosinophils in the skin, the nerves, or the lungs. CSS has a good prognosis with systemic steroid therapy. The 5 year survival is approximately 70 %. We experienced a 66-year-old man who presented with cough, sputum, edema and numbness in both legs. He presented with all of the 6 CSS criteria. A nerve and muscle biopsy confirmed the diagnosis. Here, we report this case with a review of the relevant literatures.

Expression of Vascular Endothelial Growth Factor and Interleukin-6 in Multiple Myeloma / 대한혈액학회지

BACKGROUND: Vascular endothelial growth factor (VEGF) is a multifunctional cytokine involved in angiogenesis as selective mitogen for endothelial cells as well as potent permeability factor. And interleukin-6 (IL-6) is also known to be a growth factor of myeloma cells. To determine the role of angiogenesis, VEGF and IL-6 in the patients with multiple myeloma, the relationship between the level of VEGF expression, microvessel count (MVC), IL-6 expression in the bone marrow specimen of multiple myeloma patients and stage, response, survival duration were evaluated in 18 patients with multiple myeloma who underwent bone marrow biopsy. METHODS: VEGF expression, MVC and IL-6 expression were assessed by immunohistochemical stain with polyclonal antibody to VEGF, factor VIII related antigen and IL-6 respectively. RESULTS: VEGF expression was higher in multiple myeloma than that of control (61.4+/-34.4% vs 19.0+/-25.9%, P<0.001), and MVC was also higher in multiple myeloma than that of control (11.7+/-6.1 vs 6.2+/-3.8, P=0.005). IL-6 was expressed in 66.7% of multiple myeloma but not in control (P<0.001). Between high VEGF expression group and low VEGF expression group, there were no significant differences in the stage, response or survival. There were no significant differences between hypervascular group and hypovascular group. Also IL-6 expression was not a prognostic indicator. After treatment, VEGF expression, MVC and IL- 6 expression were decreased in the responder, but these differences were not statistically significant (P=0.23, P=0.07, P=0.06), probably due to limited number of cases. CONCLUSION: VEGF, angiogenesis and IL-6 can play a role in the pathogenesis of multiple myeloma. But we cannot confirm the prognostic role of those parameters. Further study with more cases in longer duration as well as prospective study would be necessary for the establishment of relationship between VEGF expression, neovascularization, IL-6 expression and disease severity and prognosis of multiple myeloma.

Accompanied Histopathologic Findings and Association of Serum beta-HCG Levels with Myosalpingeal Invasion in Ectopic Tubal Pregnancy

Most ectopic pregnancies occur in the fallopian tubes. There have been numerous theories to explain the occurrence of ectopic pregnancy in fallopian tubes. The most commonly held view is that the passage of the fertilized ovum through the fallopian tube is delayed or hindered by chronic inflammation and its sequelae. We designed a study to evaluate the details of histopathologic changes and the location of implantation and how they relate to the clinical history. 182 fallopian tube specimens from patients who had undergone total or partial salpingectomy were examined. A high incidence of non-specific inflammation of plicae and wall of tube (31.9%) and salpingitis isthmica nodosa (12.6%) were observed. Other associated findings included acute salpingitis, complex plicae or complex hyperplasia of tubal epithelium, fibrous adhesion with ovary, endometriosis, and calcification. History of previous ectopic tubal pregnancy was found in 8 cases. The cases with serum beta-HCG value above 2,500 I.U./L (group I, n=97) were more frequently noted in those exhibiting myosalpingeal invasion of trophoblast (67 cases) than in those without invasion (30 cases). Of the 182 tubal pregnancies, 117 (64.3%) cases were found in the ampulla and 47 (25.8%) cases in isthmic location. In 117 ampullary pregnancies, the products of conception were found intraluminally in 71 cases (60.7%), and extraluminally in 34 (29.1%) cases, of which the products of conception were found entirely extraluminal. The products of conception, found both within and outside the tubal lumen, were found in 12 cases (10.2%). Of 47 tubes with isthmic pregnancies, 33 cases were intraluminal (70.2%), 12 cases were extraluminal (25.5%), and two cases were mixed (4.3%). In conclusion, significant histopathologic abnormalities accompany a majority of ectopic tubal pregnancy, and myosalpingeal invasion of trophoblast is correlated with high serum beta-HCG. Thus, it is necessary to confirm not only the ectopic placental tissue but also the accompanying details of the other histopathologic findings or the pathologic evaluation of ectopic tubal pregnancy.