Coccidioidomycosis is a common infectious disease in southwestern North America, which is caused by the soil fungus, Coccidioides immitis. Due to the mobility of the modern population, increasing numbers of cases are being diagnosed outside the endemic areas. Moreover, diagnosis in non-endenmic areas may be delayed or confused due to its rarity. Here we report a case of pulmonary coccidioidomycisis in an immigrant. The patient presented with unexplained pulmonary symptoms. A history of recent travel to or immigration from an endemic area may suggest coccidioidomycosis. In addition an early tissue biopsy is helpful in establishing this diagnosis.
Bacterial Infections and Mycoses ; Biopsy ; Coccidioides ; Coccidioidomycosis* ; Communicable Diseases ; Diagnosis ; Emigrants and Immigrants* ; Emigration and Immigration ; Fungi ; Humans ; Mycoses ; North America ; Soil

Heat shock protein(HSP), first found in the MCF-7 human breast tumor cell line is one of the estrogen-regulated proteins and its synthesis is stimulated by estradiol. In this study, immunohistochemical staining was done for estrogen receptor(ER) and HSP on formalin-fixed, paraffin-embedded tissue sections in twelve normal cyclic and twenty carcinomatous endometria. 1) During the proliferative and early secretary phases, the nuclei of surface and glandular epithelial cells and stromal cells had moderate to strong staining for ER, whereas during the mid and late secretary phases, the glandular epithelial and stromal cells had weak staining for ER. The surface epithelial cells had positive staining of variable intensity. 2) From the early proliferative to mid secretary phases, the glandular and surface epithelial cells showed a positive reaction of variable intensity for HSP. In the late secretary phase, the glandular and surface epithelial cells showed a weak positive or a negative reaction for HSP. During the menstrual cycle, the stromal cells remained negative for HSP. 3) In adenocarcinomas of the endometrium, 8 of 11 (72.7%) well differentiated carcinomas were positive for both ER and HSP, while only 3 of 9(33.3%) moderately and poorly differentiated carcinomas were positive for ER and HSP. In conclusion, ER and estrogen-regulated heat shock protein(HSP) were closely related in normal and carcinomatous endometria and the reactivity was decreased according to poor differentiation.
Humans ; Adenocarcinoma

BACKGROUND: Angiogenesis is crucial for many biological processes such as embryogenesis, cyclic changes in the endometrium and wound healing. It is also critical for the growth, invasion and metastasis of solid tumors. Vascular endothelial growth factor (VEGF) acts as a mitogen for endothelial cells and is expressed by the presence of various tumor cells. The objective of this study is to evaluate if angiogenesis is involved in the mouse skin carcinogenesis and if VEGF is related to angiogenesis. METHODS: We induced premalignant and malignant lesions on mouse (BALB/c) skin using the two stage chemical carcinogenesis moedl, DMBA (7,12-dimethylbenzanthracene) initiation and TPA (tetra decanoyl-phorbol-acetate) promotion. And we analysed the microvessel densities (MVD) and expression of VEGF in various stages of premalignant and malignant lesions by immunohistochemical studies. RESULTS: Squamous papillomas, keratoacanthoma, dermatofibroma, and squamous cell carcinomas were developed in 20 weeks. There were no differences in the incidence of benign and malignant tumors between 10-week and 20-week promotion groups. There were significant increases in MVD from normal and hyperplastic skin through premalignant lesion to invasive squamous cell carcinoma (p<0.0005). But the degree of VEGF expression neither correlated with neither MVD nor the tumor groups. CONCLUSIONS: Increased angiogenesis begins from the hyperplastic stage. VEGF produced by tumor cells may not play major roles in the angiogenesis in the two stage chemical carcinogenesis model of the mouse skin.
9,10-Dimethyl-1,2-benzanthracene ; Animals ; Biological Processes ; Carcinogenesis* ; Carcinoma, Squamous Cell ; Embryonic Development ; Endometrium ; Endothelial Cells ; Female ; Histiocytoma, Benign Fibrous ; Incidence ; Keratoacanthoma ; Mice* ; Microvessels ; Neoplasm Metastasis ; Papilloma ; Pregnancy ; Skin* ; Vascular Endothelial Growth Factor A* ; Wound Healing

Acral persistent papular mucinosis has been thought to be a distinct for of cutaneous mucinosis not associated with systemic diseases. It was recently classified as one of five subtypes of localized lichen mixedematosus. A 64-year-old man presented with a 15-year history of flesh-colored to translucent papules and a few round hypopigmented patches on his wrists, back of the hands, and distal forearms. Biopsy from the papular lesions revealed focal mucin accumulation in the upper reticular dermis. The clinical and histopathological features were consistent with acral persistent papular mucinosis.
Biopsy ; Dermis ; Forearm ; Hand ; Humans ; Lichens ; Middle Aged ; Mucinoses ; Mucins ; Scleromyxedema* ; Wrist

Objectives: This study investigated the relationship between living arrangements and metabolic syndrome (MetS) risk in the adult population in the Republic of Korea. Methods: The samples were derived from the data collected during the second year of the seventh Korea National Health and Nutrition Examination Survey. The study targeted a total of 6,265 adults who were aged 20 years and above, and multiple logistic regression analysis was conducted. Living arrangements were classified into 4 categories: single-person households, 1-generation households, 2-generation households, and other family types. MetS was identified by the presence of at least 3 out of the 5 National Cholesterol Education Program Adult Treatment Panel III criteria. Results: For men, the odds ratio (ORs) for MetS in 1- and 2-generation households, comparedto single-person households, were 0.92 (95% confidence interval [CI], 0.55–1.54) and 0.97 (95% CI, 0.58–1.62), respectively. The OR for other types of households was 0.96 (95% CI, 0.79–1.17). For women, the OR for MetS in 1- and 2-generation households, compared to single-person households, were 1.52 (95% CI, 1.15–2.01) and 1.29 (95% CI, 1.01–1.67), respectively. Conclusion Our study suggests that a national strategy involving tailored interventions for women living in high-risk conditions is necessary to reduce the risk of MetS in Korean women.

Granulomatous reaction associated with clear cell renal cell carcinoma (CCRCC) is a rare finding, and only a few cases have been described in the literature. It is postulated to occur due to cancer-related antigenic factors such as cancer cells themselves or soluble tumor antigens shed into the blood. Herein, we describe a case of a 56-year-old male patient diagnosed with CCRCC with intratumoral granulomatous inflammation.
Antigens, Neoplasm ; Carcinoma, Renal Cell* ; Humans ; Inflammation ; Kidney Neoplasms ; Male ; Middle Aged

BACKGROUND: The epidermal growth factor receptor (EGFR) is known to be involved in many tumor promoting activities. EGFR inhibition has been tried as a therapeutic modality in many human malignancies. METHODS: The expression of EGFR protein and the gene copy number changes were studied in 135 clear cell carcinomas and 16 papillary renal cell carcinomas (RCCs), and these tumors were diagnosed between 1995 and 1997. RESULTS: An EGFR protein expression (2+ and 3+) was found in 54.1% of the clear cell RCCs and in 43.8% of the papillary RCCs. In the clear cell RCCs, its expression was associated with male gender, the tumor size (> or =4 cm) and high T stages (T2 and T3), with statistical significance. Trisomy and polysomy of the EGFR gene were found in 27 (25.7%) and 40 (38.1%) of 105 clear cell RCCs, respectively. Trisomy and polysomy were correlated with an EGFR protein expression and a high clinical T stage, with statistical significance. Among 15 papillary RCCs, 13 tumors showed trisomy (86.7%) and one showed polysomy (6.7%). Amplification was not found in both the clear cell and papillary type RCCs. CONCLUSIONS: A considerable numbers of RCCs showed an overexpression of EGFR protein and increased EGFR gene copy numbers, yet the clinical significance of conducting a FISH study in RCC patients seems to be limited.
Carcinoma, Renal Cell ; Coat Protein Complex I ; Gene Dosage ; Genes, erbB-1 ; Humans ; Male ; Ploidies ; Receptor, Epidermal Growth Factor ; Trisomy

BACKGROUND: Basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) are the common malignant neoplasms of the skin. The p63 is a p53 homologue which is considered to be a reliable keratinocyte stem cell marker. Bcl-2 plays a key role in cell longevity by preventing apoptosis, whereas the bcl-6 gene functions as a transcriptional repressor. The p16-CDK4/6 complex arrests the cell cycle at G0 /G1 phase. In the present study, the expression of p63, bcl-2, bcl-6, and p16 in BCC and SCC was evaluated. METHODS: Forty-seven BCCs and 43 SCCs were selected and microarrayed in paraffin blocks. Immunohistochemical analysis was performed with specific antibodies for bcl-2, bcl-6, p16 and p63. RESULTS: p63 was found to be expressed in all BCCs and SCCs. Bcl-2 was exclusively expressed in BCCs (100%), but there was negative expression in SCCs, whereas bcl-6 was positively expressed in 18.2% of SCCs, and was negative in BCCs. In SCCs, p16 was expressed at high frequency (47.7%) than in BCCs (14.9%). The expression of p16 was correlated with the histologic grades of SCCs. CONCLUSION: The different patterns of bcl-2, bcl-6, p63 and p16 protein expression between BCCs and SCCs may represent the different histogenesis and morphologic features of two lesions.
Antibodies ; Apoptosis ; Carcinoma, Basal Cell* ; Carcinoma, Squamous Cell* ; Cell Cycle ; Keratinocytes ; Longevity ; Paraffin ; Proto-Oncogene Proteins c-bcl-6 ; Skin* ; Stem Cells

Background: This study aimed to investigate the capability of an automated immunohistochemical (IHC) evaluation of hormonal receptor status in breast cancer patients compared to a well-validated quantitative reverse transcription–polymerase chain reaction (RT-qPCR) method. Methods: This study included 93 invasive breast carcinoma cases that had both standard IHC assay and Oncotype Dx assay results. The same paraffin blocks on which Oncotype Dx assay had been performed were selected. Estrogen receptor (ER) and progesterone receptor (PR) receptor status were evaluated through IHC stains using SP1 monoclonal antibody for ER, and 1E2 monoclonal antibody for PR. All ER and PR immunostained slides were scanned, and invasive tumor areas were marked. Using the QuantCenter image analyzer provided by 3DHISTECH, IHC staining of hormone receptors was measured and converted to histochemical scores (H scores). Pearson correlation coefficients were calculated between Oncotype Dx hormone receptor scores and H scores, and between Oncotype Dx scores and Allred scores. Results: H scores measured by an automated imaging system showed high concordance with RT-qPCR scores. ER concordance was 98.9% (92/93), and PR concordance was 91.4% (85/93). The correlation magnitude between automated H scores and RT-qPCR scores was high and comparable to those of Allred scores (for ER, 0.51 vs. 0.37 [p=.121], for PR, 0.70 vs. 0.72 [p=.39]). Conclusions Automated H scores showed a high concordance with quantitative mRNA expression levels measured by RT-qPCR.

The diagnostic accuracy of fine needle aspiration cytology (FNAC) had been reported about 88-99% in the preoperative diagnosis of breast cancer. High false negative results were reported in the diagnosis of breast cancers, which were small size desmoplastic type, infiltrating lobular cancer, tubular cancer and mucinous cancer. The purpose of this study is to define the possible histopathologic characteristics of breast cancer affecting the results of fine needle aspiration cytology. From Jan. 1997 to Dec. 1998, we performed 622 cases of FNAC at the department of surgery, Korea University Hospital. Among these aspirate, 246 cases were followed by subsequent pathological confirmation and were included in this study. The results of fine needle aspiration cytololgy were classified as benign, suspicious and malignant cells. Pathological reports for breast specimens were reviewed for the size, the location, grade or pathological subtypes and presence or fibrosis in the breast lesions. The pathological characteristics were compared statistically with the results of fine needle aspiration cytology. The likelihood ratios for malignant, suspicious, atypical, benign and unsatisfactory cytological diagnosis were 98.7, 5.5, 1.1 and 0.6, respectively. Absolute and complete sensitivities for the malignant lesions were 64.5% and 90.3%. The specificity was 71.9%. False negative and positive rates were 4.3% and 0.7%. The predictive value for malignant cytology in malignancy was 98.4%. The rate of unsatisfactory diagnosis was 9.3%. The range of tumor size is from 0.6 cm to 6.5 cm. The concordance rates of FNAC results wee 75% of less than 1 cm, 60.7% of 1-2 cm, 76.5% of 2-5 cm, and 50% of greater than 5cm of tumor, respectively (p=0.01). The location of tumor also affect the FNAC result and the highest concordant rate was found in the tumor of lower outer quadrant of breast (73.3%, p=0.001). The Bloom-Richardson grade histologic type of breast cancer also affect the FNAC result. Low grade tumor, medullary carcinoma, metaplastic, carcinoma, lobular carcinoma, adenoid cystic carcinoma and mucinous carcinoma usually showed discordant FNAC results. The presence or absence of fibrotic pathology did not affect the FNAC result (p=0.39) In conclusion, the sensitivity of FNAC was 90.3% in the diagnosis of breast cancer and the false negative rate was 4.3%. The great concordance of FNAC diagnosis was found in the patients with tumor of less than 5cm and located in the axilla and locoregional recurrent area. The FNAC results of breast cancer were frequently incorrect in the low grade tumor and cancer of rare pathological type such as lobular, medullary, mucinous and adenoid cystic carcinoma of breast.
Adenocarcinoma, Mucinous ; Axilla ; Biopsy, Fine-Needle* ; Brain Stem Neoplasms ; Breast Neoplasms* ; Breast* ; Carcinoma, Adenoid Cystic ; Carcinoma, Lobular ; Diagnosis* ; Fibrosis ; Humans ; Korea ; Mucins ; Pathology ; Sensitivity and Specificity