Hypereosinophilia secondary to Sézary syndrome

The Sézary syndrome is a leukemic form of cutaneous T-cell lymphoma characterized by the presence of erythroderma covering at least 80% of the body-surface area, lymphadenopathy, and the presence of clonally related neoplastic T cells with cerebriform nuclei (Sézary cells) in the blood, skin, and lymph nodes. Hypereosinophilia can be caused by hematologic malignancy with clonal abnormality, which is often associated with Sézary syndrome. Sézary syndrome has rarely been reported in Korea. However, hypereosinophilia in the Sézary syndrome has not been reported in Korea. Here, we report a case of 75-year-old man with hypereosinophila, erythroderma, and cutaneous T-cell lymphoma which was finally diagnosed as Sézary syndrome.

Retroperitoneal Bronchogenic Cyst Located in the Presacral Space: A Case Report

Bronchogenic cysts are rare congenital anomalies that are most frequently found in the mediastinum along the tracheobronchial tree, especially in the posterior aspect of the superior mediastinum. Bronchogenic cysts have also been reported in intrapulmonary, intrapericardial, abdominal, and retroperitoneal locations. Herein, we report a case of a retroperitoneal bronchogenic cyst in the presacral space. The patient was diagnosed based on a post-operative histopathological examination.

Pancreatic Schwannoma with Cystic Degeneration:A Case Report and Literature Review

Schwannomas originate from Schwann cells, and they are the most common benign neoplasms of the peripheral nerves. They can occur in most parts of the body but have a predilection for the head, the neck, and the flexor aspects of the extremities. Pancreatic schwannomas are uncommon, and only a few cases have been reported in the English literature. Approximately two-thirds of pancreatic schwannomas undergo cystic degeneration, and they should be considered in the differential diagnosis of solid pancreatic tumors with cystic changes to facilitate accurate diagnosis and optimal treatment. We report a case of a pathologically proven schwannoma in the pancreatic tail with multiple cystic and hemorrhagic changes followed by a review of relevant literature.

Pathological Analysis of Post-Burn Hypertrophic Scars according to Various Scar Ages

PURPOSE: This study investigated the morphological characteristics of hypertrophic scars of various ages. METHODS: This was a retrospective study. Tissue samples from 170 normal skin (control) and 126 scar tissue after undergoing conservative treatment (CT) (n=62) or split thickness skin graft (STSG) (n=64) were obtained. Time from injury (CT) or surgery (STSG) was grouped into periods as follows: first 6 months (period 1), 7~12 months (period 2), 13~24 months (period 3), 25~120 months (period 4), >120 months (period 5). Epidermal thickness (ET), dermal thickness (DT), and dermal collagen fiber thickness and length (CFT, CFL) were measured using an image analyzer. RESULTS: Scar tissue ET was significantly thicker compared to normal skin (P<0.05) and was greatest at period 1. Scar tissue DT was significantly thicker compared to normal skin (P<0.05), which increased until period 3 but then decreased afterwards. Scar tissue CFT was significantly thinner compared to normal skin (P<0.05) except for period 5. Scar tissue CFL was significantly longer compared to normal skin (P<0.05). Significant differences were observed especially in younger scar ET, DT, CFT, and CFL. CONCLUSION: These findings may assist to increase the understanding of the pathohistological changes in burn scar tissues over time and provide guidance in receiving burn treatment.

Interleukin-31, Interleukin-31RA, and OSMR Expression Levels in Post-burn Hypertrophic Scars

BACKGROUND: Although several studies have shown the role of interleukin-31 (IL-31) and its receptors in inducing pruritus in certain skin disorders, knowledge of its role in post-burn hypertrophic scars is insufficient. Therefore, the histopathological expression levels of IL-31, IL-31 receptor alpha (IL-31RA), and oncostatin M receptor (OSMR) in post-burn hypertrophic scar tissues were investigated and compared with normal tissue expression levels. METHODS: Samples of hypertrophic scar tissue were obtained from 20 burn patients through punch biopsy. Normal samples were obtained from areas adjacent to the burn injury site of the same patients. Samples were placed in 10% neutral buffered formalin, embedded in paraplast, and processed into serial 5-μm sections. Immunohistochemistry results were semi-quantitatively evaluated for IL-31, IL-31RA, and OSMR. By hematoxylin and eosin staining, epidermal and dermal thickness were assessed with a microscope and digital camera. Intensities were rated on a scale of 1 to 4. RESULTS: Percentages for IL-31, IL-31RA, and OSMR in the epidermal basal layer cell cytoplasm were significantly greater in the burn scar tissue compared to normal skin, as well as the dermal and epidermal thickness (p < .05). There was a significant difference in IL-31 epidermal basal layer intensity in burn scar tissue compared to normal skin (p < .05). Besides the OSMR basal layer intensity, IL-31 and IL-31RA intensities between the burn scar and normal tissues were not significant. However, correlations were significant, indicating that the greater the infiltration percentage, the higher the intensity (p < .05). CONCLUSIONS: IL-31, IL-31RA, and OSMR expression levels are increased in hypertrophic scars compared with normal tissue.

Xanthogranulomatous Pancreatitis Mimicking Pancreatic Cancer / 대한췌담도학회지

Xanthogranulomatous inflammation (XGI) is characterized histologically by the deposition of foamy macrophages and infiltration of inflammatory cells. While XGI is extremely rare, it has been reported in the gallbladder, kidney, stomach, and lymph nodes. A 61-year-old woman presented with epigastric pain for 2 weeks. Abdominal computed tomography and magnetic resonance imaging showed a pancreatic head mass with distal common bile duct wall thickening. Endoscopic ultrasonography followed by fine needle aspiration was performed, and subsequent pathology report revealed a benign disease. Because uncontrolled abdominal pain persisted and possibility of malignancy could not be excluded, Whipple's operation was eventually performed, and pathology report showed xanthogranulomatous pancreatitis (XGP). Herein, we report a case of symptomatic XGP mimicking of pancreas cancer. Although XGP is extremely rare, it should be considered as a differential diagnosis of neoplastic lesions of the pancreas.

Morphologic Analysis of Cytomegalovirus Infected Cells in Bronchial Washing Cytology: Comparison of Liquid-Based Preparation and Conventional Smear

BACKGROUND: The cytopathic effects of cytomegalovirus (CMV) infection have been well described since the virus was first reported; however, the morphology of CMV infection has not been clearly studied. We examined the difference in detailed cytologic findings in bronchial washing cytology between liquid-based and conventionally prepared smears. METHODS: Bronchial washing cytology was processed using either the conventional preparation (CP) or liquid-based preparation (LBP). Sixty-nine cells with typical cytopathic effects of CMV infection were detected on CP slides and 18 cells on LBP slides. Using the image analyzer, area, circumference, major axis, and minor axis of the cytoplasm, nucleus, and intranuclear inclusion were measured in singly scattered CMV-infected cells, and histiocytes were used as a control. RESULTS: The mean cytoplasmic area of CMV-infected cells was 1.47 times larger than that of histiocytes in CP and 2.92 times larger in LBP (p<.05). The mean nuclear area of CMV-infected cells was 2.61 times larger than that of histiocytes in CP and 4.25 times larger in LBP (p<.05). The nucleus to cytoplasm ratio and intranuclear inclusion to cytoplasm ratio of the mean area, circumference, major axis, and minor axis in CP were larger than those in LBP (p<.05). CONCLUSIONS: The sizes of cytoplasm, nucleus, and intranuclear inclusion were larger in LBP than in CP, indicating that CMV-infected cells are easily detectable in LBP. However, the nucleus-to-cytoplasm ratio was larger in CP, suggesting that differentiation from malignancy or regenerative atypia requires caution in CP.

Carney Complex with Multiple Cardiac Myxomas, Pigmented Nodular Adrenocortical Hyperplasia, Epithelioid Blue Nevus, and Multiple Calcified Lesions of the Testis: A Case Report

No abstract available.

Papillary Cystadenoma of the Fallopian Tube Not Associated with von Hippel-Lindau Disease: A Case Report

No abstract available.

The government's research and development policies and institutions for health technology

Health Technology Research and Development (R&D) national grant system has been progressed by the unique governance of each countries. From this reason, it has historical context and path-dependency. South Korea, also have started their investment from Bio Technology Master Plan of Ministry of Science and Technology (1994) and Korea Health Technology R&D Project of Ministry of Health and Welfare (1995), currently investing around 1.1 trillion won (in the year 2012) into the Ministry of Education, Science and Technology (now, Ministry of Science, ICT and Future Planning), Ministry of Health and Welfare and Ministry of Knowledge Economy (now, Ministry of Trade, Industry and Energy). This paper focuses on the Health Technology R&D national grant system in the aspect of governance, mid-long term strategic plan, main program, planning-evaluation-management system. And last but not least, implications. First, there would be important to build the effective governance, performance based policy and administration mechanisms of national grant system for the Health Technology R&D. Second, main objective of Health Technology R&D, which is improving the quality of life for the public, could not meet their target practically. Third, R&D investment has been enlarged from treatment based to prevention and care focused and from technology-centered into demand-centered, which based on the unmet health needs. Last, most of Health Technology R&D project could not consider sustainable health system, which would be the most important value in healthcare.

Bilateral Stafne Bone Cavity in the Anterior Mandible with Heterotopic Salivary Gland Tissue: A Case Report

No abstract available.

Uncommon and Rare Human Papillomavirus Genotypes Relating to Cervical Carcinomas

BACKGROUND: Human papillomavirus (HPV) is an oncogenic virus in cervical cancer and most invasive carcinomas (ICs) are caused by HPV16 and 18. However, the roles and contributions of other uncommon and rare genotypes remain uncertain. METHODS: HPV genotypes were retrospectively assessed using an HPV DNA chip that can specify up to 32 HPV genotypes. We arbitrarily regarded genotypes accounting for less than 6% of the total as uncommon and rare genotypes. RESULTS: A total of 3,164 HPV-positive cases were enrolled. In groups 2A, 2B, 3, and unclassified HPV genotypes, 2.4% of cases with uncommon HPV genotypes (68, 26, 34, 53, 66, 69, 70, 73, 40, 42, 43, 44, 54, 55, 61, 62, 6, and 11) showed high grade squamous intraepithelial lesions and ICs. There were no HPV32- and 57-infected cases. CONCLUSIONS: We found that the uncommon and rare HPV genotypes may provide incremental etiologic contributions in cervical carcinogenesis, especially HPV68, 70, and 53. Further studies on these uncommon and rare HPV genotypes will be of importance in establishing the significance of genotypes in different regions, especially in planning a strategy for further vaccine development as well as follow-up on the effectiveness of the currently used vaccines.

Clinicopathological Analysis of Hepatocellular Adenoma According to New Bordeaux Classification: Report of Eight Korean Cases

BACKGROUND: Hepatocellular adenoma (HCA) is a rare benign tumor of the liver. A subtype classification of HCA (hepatocyte nuclear factor 1alpha [HNF1alpha]-mutated, beta-catenin-mutated HCA, inflammatory HCA, and unclassified HCA) has recently been established based on a single institutional review of a HCA series by the Bordeaux group. METHODS: We used histologic and immunohistochemical parameters to classify and evaluate eight cases from our institution. We evaluated the new classification method and analyzed correlations between our results and those of other reports. RESULTS: Seven of our eight cases showed histologic and immunohistochemical results consistent with previous reports. However, one case showed overlapping histologic features, as previously described by the Bordeaux group. Four cases showed glutamine synthetase immunohistochemical staining inconsistent with their classification, indicating that glutamine synthetase staining may not be diagnostic for beta-catenin-mutated HCA. HNF1alpha-mutated HCA may be indicated by the absence of liver fatty acid binding protein expression. Detection of amyloid A may indicate inflammatory HCA. HCA with no mutation in the HNF1alpha or beta-catenin genes and no inflammatory protein expression is categorized as unclassified HCA. CONCLUSIONS: Although the new classification is now generally accepted, validation through follow-up studies is necessary.

Myxoid Liposarcoma with Cartilaginous Differentiation: A Case Study with Cytogenetical Analysis

Myxoid liposarcoma is a subtype of liposarcoma. This specific subtype can be identified based on its characteristic histological and cytogenetical features. The tumor has a fusion transcript of the CHOP and TLS genes, which is caused by t(12;16)(q13;p11). Most of the fusion transcripts that have been identified fall into three categories, specifically type I (exons 7-2), type II (exons 5-2), and type III (exons 8-2). A total of seven myxoid liposarcomas associated with the rare phenomenon of cartilaginous differentiation have been documented in the literature. Currently, only one of these cases has been cytogenetically analyzed, and the analysis indicated that it was a type II TLS-CHOP fusion transcript in both the typical myxoid liposarcoma and cartilaginous areas. This study presents a second report of myxoid liposarcoma with cartilaginous differentiation, and includes a cytogenetical analysis of both the myxoid and cartilaginous areas.

Naked Cuticle Drosophila 1 Expression in Histologic Subtypes of Small Adenocarcinoma of the Lung

BACKGROUND: Naked cuticle Drosophila 1 (NKD1) has been related to non-small cell lung cancer in that decreased NKD1 levels have been associated with both poor prognosis and increased invasive quality. METHODS: Forty cases of lung adenocarcinoma staged as Tis or T1a were selected. Cases were subclassified into adenocarcinoma in situ (AIS), minimally invasive adenocarcinoma (MIA), and small adenocarcinoma (SAD). Immunohistochemical studies for NKD1 were performed. RESULTS: Forty samples comprised five cases of AIS (12.5%), eight of MIA (20.0%), and 27 of SAD (67.5%). AIS and MIA showed no lymph node metastasis and 100% disease-free survival, whereas among 27 patients with SAD, 2 (7.4%) had lymph node metastasis, and 3 (11.1%) died from the disease. Among the 40 cases, NKD1-reduced expression was detected in 8 (20%) samples, whereas normal expression was found in 15 (37.5%) and overexpression in 17 (42.5%). Loss of NKD1 expression was significantly associated with lymph node metastasis (p=0.001). All cases with predominant papillary pattern showed overexpression of NKD1 (p=0.026). CONCLUSIONS: Among MIA and SAD, MIA had better outcomes than SAD. Down-regulated NKD1 expression was closely associated with nodal metastasis, and overexpression was associated with papillary predominant adenocarcinoma.

The Utility of p16INK4a and Ki-67 as a Conjunctive Tool in Uterine Cervical Lesions

BACKGROUND: Immunohistochemical staining for p16INK4a and Ki-67 has been used to improve the accuracy in making a diagnosis of the uterine cervix cancer on biopsy. This study was conducted to examine the usefulness of these markers in the pathological diagnosis based on cervical biopsy. METHODS: We selected a consecutive series of 111 colposcopically directed cervical punch biopsies. Using these biopsy samples, we performed an immunohistochemical staining for p16INK4a and Ki-67 to establish a diagnosis. The slides were circulated among four pathologists in a sequential order: the hematoxylin and eosin (H&E) slide, H&E slide and p16INK4a-stained slide, and H&E slide, p16INK4a- and Ki-67-stained slides. RESULTS: The overall rates of the concordance in the first, the second, and the third diagnoses were 77.5%, 82.0%, and 82.0%, respectively. The rate of the concordance in the diagnosis of cervical intraepithelial neoplasm (CIN) 2/3 was increased from 62.2% to 73.0%. But there was a variability in the rate of the revision of the diagnosis between the pathologists. With the application of criteria for interpreting the expressions of p16INK4a and Ki-67, benign and CIN 1 lesions showed a p16INK4a expression score of 0 or 1. But CIN 2 and CIN 3 lesions showed a p16INK4a expression score of 2 and 3, respectively. CONCLUSIONS: The immunostain for p16INK4a and Ki-67 might be useful in reducing an inter-observer variability. But criteria for interpreting both markers should be strictly applied.

The Utility of p16INK4a and Ki-67 as a Conjunctive Tool in Uterine Cervical Lesions

BACKGROUND: Immunohistochemical staining for p16INK4a and Ki-67 has been used to improve the accuracy in making a diagnosis of the uterine cervix cancer on biopsy. This study was conducted to examine the usefulness of these markers in the pathological diagnosis based on cervical biopsy. METHODS: We selected a consecutive series of 111 colposcopically directed cervical punch biopsies. Using these biopsy samples, we performed an immunohistochemical staining for p16INK4a and Ki-67 to establish a diagnosis. The slides were circulated among four pathologists in a sequential order: the hematoxylin and eosin (H&E) slide, H&E slide and p16INK4a-stained slide, and H&E slide, p16INK4a- and Ki-67-stained slides. RESULTS: The overall rates of the concordance in the first, the second, and the third diagnoses were 77.5%, 82.0%, and 82.0%, respectively. The rate of the concordance in the diagnosis of cervical intraepithelial neoplasm (CIN) 2/3 was increased from 62.2% to 73.0%. But there was a variability in the rate of the revision of the diagnosis between the pathologists. With the application of criteria for interpreting the expressions of p16INK4a and Ki-67, benign and CIN 1 lesions showed a p16INK4a expression score of 0 or 1. But CIN 2 and CIN 3 lesions showed a p16INK4a expression score of 2 and 3, respectively. CONCLUSIONS: The immunostain for p16INK4a and Ki-67 might be useful in reducing an inter-observer variability. But criteria for interpreting both markers should be strictly applied.

Simultaneous Lung and Liver Aspergillus in a Kidney Transplant Recipient / 대한이식학회지

Invasive opportunistic infection by Aspergillus fungus is life-threatening for kidney transplant recipients. The occurrence of aspergillosis by hematogenous dissemination can affect multiple organs. Despite having a lower incidence rate relative to bacterial or viral infections in kidney transplant recipients, fungal infections produce the highest number of mortalities. We report a simultaneous case of invasive aspergillosis in the lung and liver of a 52-year-old female patient who underwent living donor kidney transplant. She suffered massive blood loss and high-volume transfusions due to postoperative bleeding. One month after transplantation, she reported intermittent coughing without febrile sensation. Computed tomography revealed nodules on the right and left upper lobes of the lung and multiple cystic liver lesions. Based on pathologic findings and culture from aspirate, she was diagnosed with invasive aspergillosis involving the liver and lung. After a 4 month voriconazole treatment the nodules in the lung and liver disappeared.

Clinical outcomes of Asymptomatic Urinary Abnormalities in Adults / 대한신장학회지

PURPOSE: Urinalysis is one of the best methods for early detection of renal disease and recent wide- spread use of mass screening led to increasing prevalence of asymptomatic urinary abnormalities. Usually, primary chronic glomerulonephritis first presents with asymptomatic urinary abnormalities and chronic glomerulonephritis commonly causes end-stage renal disease. However, clinical outcome of asymptomatic urinary abnormalities in adults is not well known. METHODS: Between Jan 1995 to Aug 2009, 333 patients with asymptomatic urinary abnormalities who underwent percutaneous renal biopsy were enrolled. A retrospective study was performed to clarify the prognostic factors and the long-term renal outcome of this disease. RESULTS: According to clinical manifestation, there were 79 (23.7%) of isolated microscopic hematuria, 30 (9.0%) of isolated proteinuria and 224 (67.3%) of mixed hematuria and proteinuria. The patients were significantly younger in case with microscopic hematuria. Group with microscopic hematuria had significantly shorter follow up period (p=0.013). In pathologic diagnosis, IgA nephropathy was most common with 244 patients (73.3%). The proteinuria group and mixed group showed significantly higher rate of progression to chronic renal failure than the microscopic hematuria group (p=0.015). The group that 24-hour proteinuria was more than 0.5 g/day showed significantly higher progression rate to chronic renal failure (p<0.000). Using univariate regression analysis, 3 risk factors for progression to chronic renal failure were identified: age, serum creatinine, 24-hour total urine protein. In multivariate regression analysis, only 24-hour proteinuria was the independent prognostic factor for progression to chronic renal failure. CONCLUSION: IgA nephropathy is the most common cause of asymptomatic urinary abnormalities in adults. The group of proteinuria has higher progression rate to chronic renal failure than other groups. Over 0.5 gm of 24-hour proteinuria is a significant risk factor for progression to chronic renal failure in multivariate regression analysis.

D2-40, Podoplanin, and CD31 as a Prognostic Predictor in Invasive Ductal Carcinomas of the Breast / 한국유방암학회지

PURPOSE: Distant metastasis and recurrence are major prognostic factors associated with breast cancer. Both lymphovascular invasion (LVI) and blood vessel invasion (BVI) are important routes for metastasis to regional lymph nodes and for systemic metastasis. Despite the importance of vascular invasion as a prognostic factor, application of vascular invasion as a histopathological criterion is controversial. The aim of this study was to distinguish LVI from BVI in prognosis and recurrence of breast cancer using an endothelial subtype specific immunohistochemical stain (podoplanin, D2-40, and CD31). METHODS: Sections from 80 paraffin-embedded archival specimens of invasive breast cancer were stained for podoplanin, D2-40, or CD31 expression. Immunohistochemical staining results were correlated with clinicopathological features, such as tumor size, status of lymph node metastases, estrogen receptor status, progesterone receptor status, human epidermal growth factor receptor-2 expression, and recurrence. Patients with ductal carcinoma in situ and stage IV breast cancer were excluded. RESULTS: A significant correlation was found between D2-40 LVI positivity and lymph node metastasis (p=0.022). We found a significant correlation between D2-40 LVI positivity and recurrence of breast cancer (p=0.014). However, no significant correlation was found between BVI and recurrence. A poorer disease free survival was shown for D2-40 positive LVI (p=0.003). In a multivariate analysis, the presence of D2-40 LVI positivity revealed a significant association with decreased disease-free survival. CONCLUSION: D2-40 LVI positivity was a more prognostic predictor of breast cancer than BVI.