Erythema multiforme(EM) is an acute, self-limited eruption of the skin and mucous membrane, characterized by distinctive target lesions. Although a wide range of factors have been implicated as precipitating EM, the pathogenesis is unknown. Recently, several studies on EM have been reportecl, showing the presence of immune complexes in patient with EM, and these authors suggested that such complexes may be cf immunopathogenic significance. The atudy was undertaken to irivestigate the pathogenesis of EM. In ten patients with EM, we performed serological study and direct immunofluorescence study. The reaults obtained were as follows. 1) There was no signifir.ant abnormality in CBC, urinalysis, chest PA, stool, and serology including ASO, CH, Ig quantitation, VDRL, HBsAg, ANA, RF, and cryoglobul in. 2 In direct immunofluorescence study, 4 biopsies showed IgM deposits in the su!erficial blood vessels, 4 demonstrated C, 2 showed IgG deposition and 2 biopsies showed fibrin deposition. All biopsies were negative for lgA. Additionally 1 biopsy demonstrated IgM depnsition along the dermoepidermal junction, and 1 showed both IgG and fihrin deposition. This study supports the view that deposition of immune complexes may play a role in the pathogenesis of EM.
Biopsy

BACKGROUND: JL1 is a novel antigen that has been reported to be expressed exclusively in immature CD4 CD8 double positive T-cells in the thymic cortex. Thymomas are often infiltrated with lymphocytes that are mostly immature T-cells. METHODS: We evaluated 67 cases of surgically resected thymomas and reviewed their histological, surgical, and clinical findings. Representative sections were immunostained using anti-JL1 monoclonal antibody and the immunostaining score was evaluated in each case. RESULTS: JL1 was strongly positive in immature T cells infiltrated in various subtypes of thymomas. The mean value of the immunostaining score was 0 for type A, 0.24 for the A areas of type AB, 2.71 for the B areas of type AB, 3 for type B1, 1.87 for type B2, 0.67 for type B3, and 0.13 for type C. The immunostaining score correlated with the histological subtypes according to the WHO classification, and stages according to the modified Masaoka system. CONCLUSION: JL1 was specifically detected in immature thymocytes in thymomas. Therefore, JL1 immunostaining can be useful for subtyping thymomas. JL1 can also serve as an adjunctive marker to diagnose thymomas in small biopsy specimens.
Biopsy

No abstract available.
Biopsy

Gastric mucosa shows continuous changes in surface epithelium as well as inflammatory reaction by various substances from the outside and their metabolic products. Gastric mucosal lesions are proven to be associated with bacterial infection by the discovery of Heliobacter pylori(H. pylori) and many studies about histopathologic changes of gastric mucosa associated H. pylori infection has been advanced. It is known that H. pylori associated gastritis displays surface foveolar epithelial changes, such as cytoplasmic vacuolation, mucin loss, juxtaluminal cytoplasm erosion, epithelial denudation, and mucosal irregularity. There have been many studies that H. pylori infection is associated with intestinal metaplasia, gastric dysplasia, and carcinoma. Also chronic H. pylori infection with its induction of gastric lymphoid follicle has been implicated as a precursor of gastric lymphoma of the unique B-cell type that arises from mucosa-associated lymphoid tissue(MALT). However, these gastric mucosal changes are also observed in gastritis with other causes. In this study, we aimed to define specific histopathiologic findings associated with H. pylori infection. A total of 463 gastric biopsy specimens were reviewed. They were Helicobacter-associated gastritis and were divided as many (MH), a few (AH), and no (NH), according to the number of H. pylori. 210 (MH), 131 (AH), and 122 (NH) biopsy specimens were included. Lymphocytes, plasma cells in lamina propria, eosinophils and neutrophils in surface epithelium and crypt as well as lamina propria were graded from 0 to 3. Surface epithelial changes including cytoplasmic vacuolation, mucin loss, juxtaluminal erosion, epithelial denudation and mucosal irregrarity were observed in 200 of 210 cases(95%) in MH group, 34 of 131 cases(26%) in AH group, and 6 of 122 cases(5%) in NH group. This result indicates there is significant difference in surface epithelial changes according to the number of H. pylori(p<0.001). Severity of eosinophil, neutrophil, lymphocyte, and plasma cell infiltration is increased in proportion to the number of H. pylori. Especially, neutrophilic infiltration is not identified in 95 of 122 cases(78%) in NH group, whereas MH group shows severe infitration (grade 3) in 127 of 210 cases(61%), and no (grade 0) in 11 of 210 cases(5%). This data well explains that the severity of neutrophil infiltration is associated with, the degree of H. pylori infection in chronic active gastritis, with statistical significance. The prevalence of lymphoid follicle formation was 17 of 120 cases(14%) in NH group, 24 of 131 cases(18%) in AH group, and 52 of 210 cases(25%) in MH group. This shows that lymphoid follicle formation correlates with the number of H. pylori, but without statistical significance. The prevalence of intestinal metaplasia in NH, AH, and MH was 43 of 122 cases(35%), 46 of 131 cases(35%), and 69 of 210 cases(33%), showing no association between intestinal metaplasia and H. pylori. In summary, H. pylori associated gastritis dispays characteristic histopathological changes in gastric mucosa, in which surface epithelial changes and various inflammatory infiltrates are increased in proportion to the number of H. pylori. Especially vacuolization of surface foveolar epithelium, cryptitis, and crypt abscess are specific findings of H. pylori associated gastritis.
Biopsy

No abstract available.
Biopsy*

BACKGROUND: Pseudoepitheliomatous hyperplasia (PEH) is a reactive proliferation of surface epithelium and can be confused with invasive squamous cell carcinoma (SCC) in head and neck biopsy specimens. To distinguish PEH from invasive SCC, immunohistochemical staining for claudin-1, E-cadherin and p53 was performed. METHODS: Eighteen cases of PEH and 29 invasive SCC from head and neck lesions were immunostained and examined. RESULTS: The invasive SCC showed increased staining of claudin-1 (p<0.001) and p53 (p<0.001) and decreased staining of E-cadherin (p=0.005) compared to the PEH specimens. The combined score calculated by adding the positive sum of claudin-1 and p53 and subtracting E-cadherin was useful for the differentiation of SCC from PEH (89.7% sensitivity and 88.9% specificity, p<0.001). CONCLUSION: The combined immunostaining for claudin-1, p53 and E-cadherin may help differentiate PEH from invasive SCC. The results of this study suggest that the increased expression of claudin-1 and p53 and the decreased expression of E-cadherin maybe markers for the aggressive growth of invasive SCC.
Biopsy

We analysed 8 cases of gastrointestinal cytomegalovirus(CMV) infection including one autopsy, three surgically resected and four endoscopic biopsy cases. Involved sites were colon in four,stomach in three and small intestine in one. Three of them were associated with immu-nosuppressed condition but others had no clinical evidence of immune deficiency. Multiple aphthous mucosal ulceration was a common presentation, but one revealed a mucosal ulcer with segmental narrowing and thickening of wall. Microscopically, six showed cytomegalic inclusions in endothelial cells and fibroblasts, one in mucosal epithelial cells and the remaining one in both endothelial cells and mucosal epithelial cells. Immunohistochemical staining using monoclonal antibody against CMV confirmed postive result in seven cases. Serum IgM anti-CMV antibody was elevated in one case. We conclude that gastrointestinal CMV infection is currently not a rare condition and frequently associated with non-immunosuppressed condition, and thus a thorough histologic examination is required especially in the gastrointestinal ulcerative lesion. Once cytomegalic inclusion is suspected, immunohistochemical identification of CMV seems essential for specific diagnosis.
Biopsy

BACKGROUND: The detection and early elimination of the causes for acute respiratory distress syndrome (ARDS) at the initial stage can result in a more favorable prognosis. Miliary tuberculosis as a cause of the ARDS is quite rare. A diagnosis of miliary tuberculosis is difficult due to the diversity of radiological patterns and non-specific clinical findings, and low sensitivity of sputum examinations for acid-fast bacilli(AFBs). An analysis of the clinical data is the first step in diagnosing these unusual, rare cases. METHODS: In this study the clinical features, laboratory data, radiological findings and diagnostic methods were analyzed in 9 cases with an initial presentation of ARDS due to miliary tuberculosis. The ARDS was defined by the definition of the American-Europian Consensus Conference 1992. RESULTS: The mean age of the patients was 67+/-18 years (F:M=7:2). The chief complaints were dyspnea (5/9), coughing (3/9) and fever(5/9). On a physical examination, fine or coarse crackles were noted(6/9). The ARDS developed on average 6.7 days after the initial respiratory symptoms. The mean PaO2/FiO2 of the patients was 133.5+/-53.4, the number of cases with a WBC <5000/mm3 was 4 out of 9 cases. A platelet count <70,000/mm3 was observed in 2 out of 9 cases, and the serum albumin level was 2.6+/-0.6 g/dL. The initial simple chest PA showed ground glass appearances and consolidation in all cases, However, the miliary nodular densities were observed in only 4 out of the 9 cases. HRCT revealed alveolar densities and a consolidation in 5 out of 6 cases, and miliary nodules in 5 out of 6 cases, The diagnosis of tuberculosis was made by a liver biopsy (4/4, 100% sensitivity), a bone marrow biopsy (1/2, 50% sensitivity), and an open lung biopsy (1/1), the sputum AFB was positive in only 2 out of 9 cases. The patient was treated with INH, RFP, EMB, PZA, and steroids. The survival rate was 55.5%. CONCLUSION: Miliary tuberculosis should be considered as one of the causes for ARDS in areas where there is a high prevalence of tuberculosis. The chief complaints of the patients on admission are dyspnea, fever and coughing without any specific riskfactors. A liver biopsy is particularly useful in ARDS patients with mechanical ventilation to determine the causes of the ARDS if miliary tuberculosis is suspected as being the underlying disease.
Biopsy

PURPOSE: The purpose of this study was to evaluate the impact of the use of external radiation therapy (ERT) in terms of survival and compliance in patients with anaplastic thyroid carcinoma. MATERIALS AND METHODS: The medical records of 17 patients with anaplastic thyroid carcinoma treated with ERT between 1993 and 2002 were retrospectively reviewed. ERT was administered after surgery in 14 patients and after a biopsy in three patients. Among the 14 patients who had undergone surgery, nine underwent a curative resection and five underwent a palliative resection. Six patients had associated well-differentiated thyroid carcinomas and 14 patients were diagnosed with a tumor size exceeding 5 cm. The radiation dose ranged from 6~70 Gy (median dose, 37.5 Gy). Eleven patients completed the planned course of ERT, whereas six patients did not. The follow-up period ranged from 1~104 months (median, 5 months; mean, 20 months). RESULTS: Five patients started the ERT without the presence of a gross mass and all of the patients completed ERT without a re-growth of tumor. Twelve patients (four patients after a curative resection, five patients after a palliative resection and three patients after a biopsy) started ERT with a gross mass present and only six patients were able to complete the planned course of ERT. Among the six patients who completed ERT, two patients showed a marked regression of the tumor mass, whereas two patients showed slight regression and two patients showed no response. The median survival was five months (range, 1~104 months) and the mean survival was 21 months. The overall survival was 41% at 1-year, 24% at 2-years and 12% at 5-years. Significant prognostic factors included the number of primary tumors present, tumor size, whether surgery was performed and completion of ERT as planned. Long-term survivors showed a tendency of having smaller sized initial tumors and smaller sized pre-ERT tumors than the short-term survivors. CONCLUSION: This study suggests that patients with a small initial tumor (< or =5 cm), which was treated by surgery (curative resection or palliative resection) before ERT, and without rapid re-growth of the mass seen at the surgical site at the beginning of the ERT course, would be the best candidates for postoperative ERT. In contrast, patients with a large initial tumor (>5 cm) and did not undergo surgery before ERT or that rapid re-growth of the mass was observed at the surgical site are likely to have a short survival time, along with the interruption of ERT. In these cases, the role of ERT is very limited and the omission of ERT could be considered.
Biopsy

Diabetic nephropathy is a clinical syndrome characterized by persistent albuminuria, a relentless decline in GFR and raised arterial blood pressure, and usually diagnosed on clinical grounds without a renal biopsy. Their renal injuries are irreversible and they become eventually end-stage renal disease. Recently, it has been reported that proteinuria are also induced by other causes, and some of the renal diseases was treatable. The detection of non-diabetic renal disease in diabetic patients by renal biopsy has the prognostic and therapeutic importance. We report a case of type II diabetic mellitus with minimal change nephrotic syndrome, and no evidence of diabetic glomerulosclerosis.
Biopsy