Clinicopathologic Study of 8 Cases of Primary Cutaneous CD30-positive Cutaneous Large Cell Lymphoma / 대한피부과학회지

BACKGROUND: Although several cases of primary cutaneous CD30-positive large cell lymphoma have been reported, immunohistochemical study on the tumor has not been reported in Korea. OBJECTIVE: Our purpose is to evaluate the clinicopathologic and immunohistochemical findings of primary cutaneous CD30-positive large cell lymphoma. METHODS: An immunohistochemical study was performed on paraffin sections of 8 primary cutaneous CD30-positive large cell lymphoma using CD3, CD45RO, CD45, CD20, CD30, and epithelial membrane antigen(EMA). RESULTS: Primary cutaneous CD30-positive large cell lymphoma occurred equally on males and females. The average age of the patients was 49. The lesion occurred most commonly as nodules on the extremities. Spontaneous regression occurred in 3 cases. The most common treatment was radiotherapy. Histopathologically, 2 of 8 cases showed epidermal hyperplasia with intraepidermal neutrophils. Epidermotropism was found focally in 1 case. Inflammatory cells were present at the periphery of the lesions in 2 cases, but they were admixed with the large atypical cells in 1 case. Tumor cells invaded the subcutaneous tissue in 4 of 6 cases. Immunohistochemically, the large anaplastic cells showed CD30 positivity. Tumor cells in all cases showed positivity for CD3, CD45RO, and CD45, but negative for CD20. Tumor cells stained with EMA in 1 of 6 cases. CONCLUSION: Primary cutaneous CD30-positive large cell lymphoma showed immunophenotype of T-cell lymphoma. It showed some clinicopathologic features of lymphomatoid papulosis, which suggests that both entities represent 2 ends(malignant and benign) of a spectrum of CD30-positive lymphoproliferative disorders. Therefore, for the diagnosis of primary cutaneous CD30-positive large cell lymphoma, all clinicopathologic and immunohistochemical findings should be considered together.

Clinical Analysis of Aneurysmal Subarachnoid Hemorrhage

The authors analyzed 377 consecutive cases of aneurysmal subarachnoid hemorrhage admitted to the Department of Neurosurgery at Yonsei University Hospital from 1980 through 1984. The results of analysis were summarized as follows. 1) Mean age of the patients was 48.8 years. Aneurysmal SAH occured more frequently in female(201) than male(176). 2) Incidence of clinical vasospasm was 33.2%(125/377) and of rebleeding was 11.7%(44/377). 3) Surgery was done for 191 patients which accounts for 50.7% of all patients. Functional recovery was noted in 179 of these 191 surgically treated patients(93.7%). Operative mortality was 3.7%. 4) Conservative treatment was done for remaining 186 patients. Among them, 124 patients died or disabled : 40 from initial insult, 59 from vasospasm, 25 from rebleeding. Aneurysm could not be found on angiography in 19 cases. Remaining 43 patients refused surgery. Despite of dramatic improvement of surgical treatment for ruptured intracranial aneurysms, overall mortality and morbidity for ruptured cerebral aneurysm still remain unchanged over the past two decades. As shown in this study, most of the management mortality and morbidity came from the patients who didn't or couldn't receive surgical treatment. The authors suggest several directions to improve overall management outcome in all aneurysmal patients.

Delayed CT Guided Stereotaxic Evacuation of Hypertensive Intracerebral Hematoma

The authors analyzed 11 patients of hypertensive intracerebral hematoma who had undergone the delayed CT guided stereotaxic evacuation. this delayed stereotaxic evacuation seemed to be highly effective in improving the motor weakness rather than mental state. Such effect was appeared immediately after the procedures in most of the patients, even in very small amount of hematoma. In addition, we could shorten the total hospital periods. The most effective time of this delayed stereotaxic evacuation was seemed to be in around 2 weeks after the hemorrhage.

A Case of Frontal Sinus Osteoma Causing Brain Abscess

The author reports a patient with a frontal sinus osteoma causing pansinusitis, epidural abscess and brain abscess. For while this tumor is benign its complications are serious. So the author recommends that these tumors should be removed while small, before producing serious symptoms.

Calcified Pituitary Adenomas

Two cases of calcified pituitary adenoma are reported, which comprise 2.44% among a surgical series of 82 pituitary adenomas. Both patients had very high serum prolactin level, which suggested the possibility of hormonal influence in formation of the calcification. The tumors were removed by a subfrontal approach to prevent and reduce possible damage to the surrounding structures.

"High Pressure" Cerebrospinal Fluid Rhinorrhea due to Parieto-Occipital Meningioma, a Case Report

A case of non-traumatic "high pressure" cerebrospinal fluid rhinorrhea is reported. There was a huge fibroblastic meningioma in the left parieto-occipital region along with hydrocephalus. Initially a ventriculoperitoneal shunt was done and then 12 days later the tumor mass was removed totally. After the operations the patient became free of leakage and a direct approach for the cerebrospinal fluid rhinorrhea was not needed.

Post-traumatic Sympathetic Dystrophy: A Case Report

A case of post-traumatic sympathetic dystrophy following crushing injury to the left fingers is described. A brachial angiogram showed obliteration of the radial artery at the level of the wrist joint. Following dorsal sympathectomy, the persistent pain was relieved and trophic changes disappeared.

Clinical Analysis of 158 Surgically Treated Intracranial Aneurysms

The author analyzed 158 cases of intracranial aneurysm surgically treated in the Department of Neurosurgery, Yonsei University Medical College, from Jan. 1965 to Sept. 1976. Of the 158 cases 124 underwent direct intracranial approach (clipping, ligature, coating, wrapping, proximal vessel occlusion, and trapping) for the treatment of the aneurysms, and 33 cases underwent proximal carotid ligation in the neck as the choice of treatment. The aneurysms arising in the posterior communicating artery (46) are most common, followed by anterior communicating artery (43), middle cerebral artery M2 portion (22), and carotid bifurcation (12) in order. We also found cavernous aneurysm (2), ophthalmic artery aneurysms (3), anterior choroidal artery aneurysm (2), anterior cerebral artery A1 portion aneurysm (6), distal anterior cerebral artery aneurysm (2), middle cerebral artery M1 portion aneurysm (8), m3 portion aneurysm (2), posterior cerebral artery aneurysm (1) and basilar artery aneurysm (1). Multiple aneurysms were found in 8 cases. There was no significant difference according to sex. There were 18 cases over 60 years of age, of whom 2 were 75 years old. On this basis, we cannot consider ligation was 18.2%. If patients who were operated on in emergency because of large intracranial hematoma of repeated, or chain rupture of aneurysm are excluded, the mortality rate for purely elective cases using the intracranial approach drops to 4.3%. After introduction of the surgical microscope and newly designed temporary clipping system, 37 patients were operated on with only one death (2.7%), a patient who had repeated ruptures of the posterior communicating artery aneurysm and was operative on only 7 days after the last bleeding. So recently we have not had to pay much attention to the mortality rate of the intracranial attack for the aneurysms. There are instances when imperfection which cannot be seen by the naked eye are noticed only after the aneurysmal neck is magnified from 6 to 40 times with use of microscope. In these cases, it is obvious that correction of clipping as well as coating, which prevents rupture of the aneurysmal sac and reinforces or prevents slipping of the clip are inevitable. Various factors, such as grade of the patient's condition vasospasm, cerebral edema, presence of intracranial hematoma, state of intracranial pressure, preoperative management, timing of surgery, points of operative technique according to the sites of aneurysms, postoperative complications and their management, all of which affect the clinical and postoperative course, are discussed.