Lymphocytic Interstitial Pneumonia in Primary Sjogren's Syndrome: A Case Report

Sjogren's syndrome (SS) is an autoimmune disorder in which lymphocytes infiltrate the exocrine glands, resulting in the development of sicca symptoms. Lymphocytes may also invade various other organs and cause diverse symptoms. Interstitial pneumonia has been observed frequently in SS patients. Typically, the pneumonia responds well to systemic steroids, and fatal cases are rare. We experienced a case of lymphocytic pneumonia accompanied by SS and treated with cyclophosphamide pulse therapy, and we present details of the case herein.

Cyclosporine in Relapsed Subcutaneous Panniculitis-like T-Cell Lymphoma after Autologous Hematopoietic Stem Cell Transplantation / Journal of the Korean Cancer Association, 대한암학회지

Subcutaneous panniculitis-like T-cell lymphoma (SPTCL) is a rare T-cell lymphoma characterized by involvement of the subcutaneous tissue of neoplastic T lymphocytes. SPTCL with hemophagocytic syndrome (HPS) is associated with an aggressive clinical course and treatment of SPTCL with HPS is not well established. Cyclophosphamide, doxorubicin, vincristine, prednisolone (CHOP) therapy is not successful in most patients suffering from SPTCL with HPS. The role of high dose chemotherapy followed by hematopoietic stem cell transplantation (HSCT) remains controversial. We report a case of relapsed SPTCL after CHOP chemotherapy and salvage chemotherapy followed by autologous HSCT, which had rapid improvement within weeks after cyclosporine and prednisolone. Immunosuppressive therapy may be an important and successful treatment option in SPTCL patients, even though they may have clinically aggressive disease.

Clinical Significance of PTEN and Ki-67 Expression in Prostate Cancer

PURPOSE: Phosphatase and tensin homolog (PTEN) is a novel tumor suppressor gene located at chromosome 10q23. Ki-67 antigen is a human nuclear protein that is expressed in all active parts of the cell cycle. We evaluated the significance of PTEN and Ki-67 expression in prostate cancer and investigated the relation of this expression with clinico-pathological factors in prostate cancer. MATERIALS AND METHODS: Initially, we did two kinds of immunohistochemical staining for PTEN and Ki-67. Immunohistochemical staining was performed on 75 formalin-fixed paraffin-embedded cancer specimens. Staining on paraffin blocks from prostate carcinomas was compared with that for adjacent normal prostate. Stainings were considered positive if nuclear staining was seen. Positive stainings were analyzed with the patient's clinico-pathological findings. Statistical analysis was performed by using chi-square test with p0.05). PTEN expression was negatively correlated with lymph node or distant metastases (p<0.05). Ki-67 was positively correlated with the serum PSA level, the Gleason score, and metastases (p<0.05). CONCLUSIONS: PTEN and Ki-67 staining correlated well with Gleason score and PSA level in prostate cancer. These could be a possible predictor of prostatic neoplasms.

Immunohistochemical Study about the Origin of Bile Ductules Proliferation in Obstructive Liver Disease

BACKGROUND: The relationship between bile duct proliferation and portal fibrosis in obstructive liver diseases remains unclear. The purpose of this study is to analyze the relationship between hepatic stellate cells (HSC), hepatocytes and bile ductule proliferation in obstructive liver disease using immunoreactivity for alpha-SMA (alpha-smooth muscle actin), CK7, and CK19. METHODS: We used 20 human tissue samples with hepatic fibrosis due to intrahepatic stones and liver cirrhosis. Immunohistochemical staining was performed using the streptavidin-biotin method. RESULTS: Proliferations of bile ductules at the periphery of the hepatic lobules, and diffuse HSC activation in the perisinusoidal spaces were observed in all cases. Immunoreactivity of the hepatocytes for CK7 and CK19 suggested a possible phenotypic transformation into bile duct epithelium during fibrogenesis. Immunohistochemical-analyses of alpha-SMA expression profiles showed that intralobular HSCs and some hepatocytes underwent early phenotypic changes, and that the accumulation of collagen coincides with that of alpha-SMA-labeled myofibroblasts around portal/septal ductular structures. CONCLUSIONS: Our results showed the possibility of a phenotypic transformation of hepatocytes into bile ductular epithelium. It is suggested that hepatocytes might play a role in bile ductule proliferation in obstructive liver disease.

Visceral Pleural Invasion as a Prognostic Factor for Recurrence in Resected IB Non-small Cell Lung Cancer / 대한흉부외과학회지

BACKGROUND: Several trials have reported on whether adjuvant chemotherapy for resected stage IB non-small cell lung cancer is needed. The aim of our study was to investigate prognostic factors for recurrence to help identify patients who should receive adjuvant chemotherapy. MATERIAL AND METHOD: We reviewed the cases of 48 stage IB non-small cell lung cancer patients between 1997 and 2006. Disease-free survival and overall survival rates were calculated by the Kaplan-Meier method. Univariate analysis was performed with the log rank test and multivariate analysis was done using Cox's proportional hazard model. RESULT: The median follow-up time was 48 months. The overall survival rate was 55.9%, and the disease-free survival rate was 48.6%. Of 8 variables, two factors, visceral pleural invasion and lymphovascular invasion, were prognostic factors of disease-free survival (univariate analysis). Visceral pleural invasion was a significant prognostic factor in multivariate analysis, and overall survival in compared one or more variable such as visceral pleural invasion or, and lymphovascular invasion with the other variables. CONCLUSION: Visceral pleural invasion was identified as a poor prognostic factor and it may help select which patients will benefit from adjuvant chemotherapy in addition to more comprehensive follow-up.

Solitary Fibrous Tumor of the Sublingual Gland / 대한이비인후과학회지

Solitary fibrous tumor, a mesenchymal neoplasm that arises most commonly from the pleura of the lung, has been described in a variety of extrapleural sites including the abdominal cavity, soft tissue, upper respiratory tract and rarely in head and neck region. We present a rare case of solitary fibrous tumor that occurred in the sublingual gland. A 52-year old woman presented with a painless mass in the left side of the floor of mouth. The tumor was well-demarcated and easily dissected, and it showed highly cellular areas of spindle cells with pattern-less architecture alternating with hypocellular areas. The tumor cells were positive for CD34 but negative for cytokeratins and S-100 protein. During the 12 months of follow-up, there was no recurrence of tumor growth.

Extragastic Pedunculated Giant Gastrointestinal Stromal Tumor of the Stomach

Gastrointestinal stromal tumors (GISTs) are a mesenchymal tumor of the digestive tract and they have various clinical characteristics. We report here on the largest extragastric pedunculated GIST of the stomach that has been seen in Korea. The patient was a 67-year-old man with a giant abdominal mass occupying the whole abdomen, and both leg showed swelling for the previous several months. On computed tomography (CT) and magnetic resonance imaging (MRI), this appeared as a septated cystic tumor with a solid component. Laparotomy revealed a giant extragastric tumor arising from the lesser curvature of the stomach that measured 47x34x23 cm and it weighed about 40 kg. Surgical treatment was performed to remove both the giant mass and the gastric wall where the tumor was attached to a 3-cm pedicle. On immunohistochemistry, the tumor was positive for myeloid stem cell antigen (CD34) and c-kit (CD117). The final diagnosis was a pedunculated extragastric type GIST arising from the stomach. The postoperative course was uneventful and the swelling in both legs resolved.

Adenocarcinoma of the Sigmoid Colon with Prominent Rhabdoid Features: A Case Report

Colorectal adenocarcinoma with rhabdoid features is extremely rare and only two cases have been previously reported. We report here on a case of colorectal adenocarcinoma with prominent rhabdoid features in a 69-year-old female. The specimen was an ulcerative mass from the sigmoid colon, and it measured 3.5x3 cm. Microscopic examination of the tumor showed mostly rhabdoid cells that had eccentrically located large nuclei and foci of glandular formation. A transitional area from the poorly differentiated adenocarcinoma to the rhabdoid tumor was also noted. Immunohistochemical studies showed strong reactivity of the glandular forming cells for pan-cytokeratin, and the cells were occasionally positive for vimentin. The cells with rhabdoid features were diffusely positive for vimentin and focally positive for pan-cytokeratin. These results suggested that the cells with rhabdoid features originated from dedifferentiated primary adenocarcinoma. Since colorectal adenocarcinoma with rhabdoid features is highly aggressive and unresponsive to conventional therapy, making the preoperative diagnosis is important to facilitate the treatment.

Two Cases of Strongyloidiasis Diagnosed by Colonoscopic Biopsy

Strongyloides stercoralis is an intestinal nematode that is able to infect the host tissue and persist for many years through autoinfection, and it causes life-threatening hyperinfection in immunocompromised hosts. We report here on two cases of strongyloidiasis that were diagnosed by colonoscopic biopsy. One case was a 73-year-old woman who was hospitalized with complaints of melena. She was being treated with corticosteroid due to her asthma and rheumatoid arthritis. The other case was a 63-year-old man who suffered with abdominal discomfort and severe loss of body weight (18 kg) for 2 months. In both cases, colonoscopic examination revealed polyps and petechiae at the entire colon. Microscopically, a small illdefined granuloma with a longitudinally sectioned parasite was seen on the colonoscopic biopsy. Endoscopic examination was done after suspecting parasitic infestation. The gastric and duodenal mucosa showed numerous cross sections of adult worms, eggs and larvae that were developing in crypts. Even if such a patient is in an asymptomatic state, this illness must be treated due to the potential for fatal autoinfection.

Primary Retroperitoneal Mucinous Cystadenocarcinoma: A Case Report and Review of the Literature

Primary retroperitoneal mucinous cystadenocarcinoma is a rare tumor. Only about 30 such cases have been reported in the worldwide literature, and a few Korean cases have been reported. The pathogenesis is not clear, and coelomic metaplasia of the retroperitoneal mesothelium has gained wide support. There is no consensus on the appropriate treatment, but surgical exploration is needed for the diagnosis and treatment, and adjuvant chemotherapy may be recommended following complete surgical excision. The long-term prognosis has not been established. We report here on a 32-year-old woman who was diagnosed as having a retroperitoneal mucinous cystadenocarcinoma with mural nodules of sarcomatoid change. Tumor excision and adjuvant chemotherapy were done and the patient is doing well without any evidence of recurrence at 42 months postoperatively.

Sudden Death from Cardiac Sarcoidosis: A Case Report

Sarcoidosis is a systemic granulomatous inflammation with an unknown cause. The commonly involved sites are the lymph nodes, lungs, skin, eyes, and heart. Although cardiac involvement in sarcoidosis is rarely detected clinically, it is reported in 20-50% of autopsied sarcoidosis patients. Cardiac involvement is one of the most severe conditions of sarcoidosis and may cause sudden death. We report a case of a sudden death due to a massive cardiac sarcoidosis in a 43-year-old man. The microscopic examination revealed an extensive noncaseating granulomatous inflammation in the mediastinal lymph nodes and the heart with no evidence of myocyte necrosis. A special stain and molecular study excluded the possibility of other causes such as fungi or mycobacterium. The authors concluded that the cause of death was attributed to arrhythmia due to a cardiac sarcoidosis with massive involvement of the conduction system.

A Case of Solitary Myofibroma In Adult / 대한피부과학회지

Solitary myofibroma is a recently described, benign neoplasm of superficial soft tissue, which represents the adult counterpart of infantile myofibromatosis. In Korean literature, only one case has been reported, and we report an additional case of solitary myofibroma in a 57-year-old man. He presented with 2-month history of asymptomatic slightly elevated pale-skin-colored nodule occurring on the right side of philtrum. A histopathologic examination revealed diffuse proliferation of fibroblasts and spindle cells with a whorled arrangement and grouped fascicles. The tumor cells were positively stained for vimentin and smooth muscle actin.

Fine Needle Aspiration Cytologic Diagnosis of Thymoma Presenting as a Thyroid Nodule: A Report of Two Cases / 대한세포병리학회지

Thymoma is the most common anterior mediastinal tumor in adults. Rarely, it is presented as the anterior neck mass, commonly located in the anterolateral aspect of the neck or adjacent to the thyroid. We experienced two cases of fine needle aspiration cytology of thymoma, mimicking thyroid mass. The first case was an ectopoic cervical thymoma in a 31-year-old female. The fine needle aspiration cytology was misinterpreted as reactive hyperplasia of lymph node. But the histologic diagnosis was thymoma, predominantly lymphocytic type. The second case was an invasive thymoma in a 66-year-old female, who complained a large anterior neck mass. The fine needle aspiration cytology revealed biphasic population of some clusters of epithelial cells and scattered lymphocytes. The cytologic diagnosis was thymoma and was confirmed as invasive thymoma after the biopsy. Therefore, when the cytologic feature of anterior neck mass shows the both lymphocyte and epithelial component, the differential diagnosis should include the possibility of thymoma.

Interventricular Septum Rupture due to Blunt Chest Trauma: A Case Report / 대한법의학회지

Blunt chest trauma may cause a variety of cardiac injuries, such as cardiac contusion, congestive heart failure due to myocardial injury or disruption of intracardiac structures, and more severely, instantaneous death. Traumatic rupture of the interventricular septum secondary to blunt chest trauma is extremely rare. Rupture of the interventricular septum may occur almost immediately after injury or many days later. The most common site of rupture is in the muscular portion of the septum near the apex. The exact mechanism of ventricular septal rupture in blunt trauma is unknown but it is thought to occur by external compression of the heart between the sternum and the vertebrae or as a result of extreme changes in intrathoracic pressure during sudden deceleration. We report an autopsy case of intraventricular septum rupture due to blunt chest trauma. A comatous 28-year-old male was admitted to emergency room after blunt chest trauma by unidentified object. He was treated with supportive care but expired two days later. The autopsy findings were as follows. The dead boy was slightly slender. External wound and patterned bruise were not present. In submentopubic incision, both pleural fluid (right 700ml, left 450ml) and ascites (400ml) were noted. The posterior wall of left ventricle showed hemorrhage measuring 1cm in diameter. On opening the heart, there was interventricular septum rupture measuring 3.5cm in length. Other cardiac structures were unremarkable. On light microscopic examination, endothelial cell was not seen in ruptured portion and both lung showed severe congestion and edema.

Interventricular Septum Rupture due to Blunt Chest Trauma: A Case Report / 대한법의학회지

Blunt chest trauma may cause a variety of cardiac injuries, such as cardiac contusion, congestive heart failure due to myocardial injury or disruption of intracardiac structures, and more severely, instantaneous death. Traumatic rupture of the interventricular septum secondary to blunt chest trauma is extremely rare. Rupture of the interventricular septum may occur almost immediately after injury or many days later. The most common site of rupture is in the muscular portion of the septum near the apex. The exact mechanism of ventricular septal rupture in blunt trauma is unknown but it is thought to occur by external compression of the heart between the sternum and the vertebrae or as a result of extreme changes in intrathoracic pressure during sudden deceleration. We report an autopsy case of intraventricular septum rupture due to blunt chest trauma. A comatous 28-year-old male was admitted to emergency room after blunt chest trauma by unidentified object. He was treated with supportive care but expired two days later. The autopsy findings were as follows. The dead boy was slightly slender. External wound and patterned bruise were not present. In submentopubic incision, both pleural fluid (right 700ml, left 450ml) and ascites (400ml) were noted. The posterior wall of left ventricle showed hemorrhage measuring 1cm in diameter. On opening the heart, there was interventricular septum rupture measuring 3.5cm in length. Other cardiac structures were unremarkable. On light microscopic examination, endothelial cell was not seen in ruptured portion and both lung showed severe congestion and edema.