The patient was a 41-year-old healthy man, who developed a tender, cord-like serpiginous mass just proximal to the coronal sulcus for two weeks. He was a sexually active, non-promiscuous, married man. We had taken a biopsy, and noticed the subsiding of the lesion without further treatment. Nonvenereal sclerosing lymphangitis of the penis is a rare self-limiting peculiar disorder involving the lymphatics of the penile sulcus. Clinically, it presents as a cord-like nodular penile lesion with characteristic cartilaginous firmness. Histologically, it is described as hypertrophy and sclerosis of the lymphatic vessel walls with mild inflammatory cellular infiltration, and occasional obstruction of the lymphatic vessel. But, because such features including sclerosis varies according to the time when the biopsy was taken, they are not attributable to all cases. Our case shows the same clinical and pathological features of ‘benign transient lymphangiectasis’. Except for the painful cases, no specific treatments are usually warranted.
Adult ; Biopsy ; Humans ; Hypertrophy ; Lymphangitis* ; Lymphatic Vessels ; Male ; Penis* ; Sclerosis ; von Willebrand Factor

Purpose: This study aimed to identify attitudes toward advance directives (ADs) among female cancer patients and factors related to ADs. Methods: The study was conducted at a university hospital in Seoul from September 19, 2020, to January 20, 2021. The participants were 153 patients diagnosed with gynecological cancer or breast cancer. Data were collected using questionnaires and included general characteristics, disease- and AD-related characteristics, knowledge and attitudes about ADs, and attitudes about dignified death.Data were analyzed using the t-test, analysis of variance, and multiple regression analysis. Results: Only 2% of the participants completed ADs. The mean score for attitudes toward ADs was 3.30, indicating a positive knowledge and attitude toward dignified death. Thefactors related to attitudes toward ADs were attitudes toward dignified death (β=0.25, P=0.001), experience discussing life-sustaining treatment (β=0.17, P=0.037), preferred time to have a consultation about ADs (β=0.19, P=0.046), intention to write ADs (β= 0.15, P=0.038), and Eastern Cooperative Oncology Group Performance Status (β=-0.37, P＜0.001). The explanatory power of these variables for attitudes toward ADs was 38.5%. Conclusion Overall, patients preferred to have a consultation about ADs when they were still active, mentally healthy, and able to make decisions. Education about ADs should be provided to patients on the first day of hospitalization for chemotherapy or while awaiting treatment in an outpatient setting so patients can write ADs and discuss them with family and friends.

Subcutaneous panniculitis-like T-cell lymphoma (SPTCL) is a distinct cutaneous lymphoma subtype that is characterized by pleomorphic T-cell infiltration of the subcutaneous tissue. SPTCL is usually associated with indolent clinical course. However, it can be complicated by hemophagocytic syndrome (HPS), which leads to worse prognosis. Childhood SPTCL is rare and there is no standardized treatment regimen of SPTCL with HPS. Here we report a pediatric case of SPTCL with HPS who responded favorably with multi-agent chemotherapy of the BFM (Berlin‐Frankfurt‐Münster)-NHL (non-Hodgkin lymphoma)-90 protocol.

PURPOSE: Epidermal growth factor receptor (EGFR) is considered a potential therapeutic target for anti-EGFR therapy in triple-negative breast cancer (TNBC). However, the frequency of EGFR gene mutation in TNBC is low and varies with ethnicity. This study aimed to investigate the incidence of EGFR gene mutation in TNBC. METHODS: EGFR protein expression was evaluated by immunohistochemistry in tissue microarrays of 493 TNBC cases using four different primary antibodies, which included mutation-specific antibodies. For cases with an immunoreactivity level ≥1+, we performed pyrosequencing analysis for EGFR gene mutation. A case was considered mutation-positive when its mutation frequency minus its limit of detection (LOD) was >10%. Cases with mutation frequency higher than LOD were assessed for EGFR gene mutation status using the Cobas assay and by peptide nucleic acid-mediated polymerase chain reaction (PNA-clamping). RESULTS: Among 493 TNBCs, 148 (30.0%) exhibited staining ≥1+ for EGFR, including 78 with 1+, 49 with 2+, and 21 with 3+. Positive EGFR expression (≥2+) was significantly associated with lymphovascular invasion (p=0.010), but not with overall survival (p=0.444) or disease-free survival (p=0.388). None of the 493 TNBCs harbored an EGFR gene mutation. Among 148 cases with an EGFR staining result ≥1+, five (3.4%) showed mutation frequencies (4.4%–10.9%) higher than LOD (2.6%–4.3%) in exons 19 (L747_P753>Q) or 21 (L858R and L861Q) as determined by pyrosequencing. However, Cobas and PNA-clamping failed to detect the presence of EGFR gene mutation in these five cases. CONCLUSION: No activating mutation of EGFR gene of clinical significance was observed in 148 TNBC cases using three commercially available methods. Thus, EGFR gene mutation appears to be an extremely rare event in patients with TNBC.
Antibodies ; Breast Neoplasms ; Disease-Free Survival ; Epidermal Growth Factor* ; Exons ; Genes, erbB-1 ; Humans ; Immunohistochemistry ; Incidence ; Limit of Detection ; Mutation Rate ; Polymerase Chain Reaction ; Receptor, Epidermal Growth Factor* ; Triple Negative Breast Neoplasms*

Actinomycosis is rarely accompanied by fungus balls. It is difficult to distinguish between actinomycosis and a fungus ball due to their similar clinical and computed tomography scan results. Thus, a meticulous histopathological examination is required for definite diagnosis. We report a case of actinomycosis accompanied by a fungus ball, found incidentally in a patient without rhinologic symptoms. The patient was successfully treated with endoscopic sinus surgery, followed by short-term antibiotic therapy. We suggest that shortterm antibiotic therapy may be more appropriate than long-term antibiotic therapy based on our case study as well as several other studies.

Dioscoreae Rhizome (DR) has been used in traditional medicine to treat numerous diseases and is reported to have anti-diabetes and anti-tumor activities. To identify a bioactive traditional medicine with anti-inflammatory activity of a water extract of DR (EDR), we determined the mRNA and protein levels of proinflammatory cytokines in macrophages through RT-PCR and western blot analysis and performed a FACS analysis for measuring surface molecules. EDR dose-dependently decreased the production of NO and pro-inflammatory cytokines such as IL-1beta, IL-6, TNF-alpha, and PGE2, as well as mRNA levels of iNOS, COX-2, and pro-inflammatory cytokines, as determined by western blot and RT-PCR analysis, respectively. The expression of co-stimulatory molecules such as B7-1 and B7-2 was also reduced by EDR. Furthermore, activation of the nuclear transcription factor, NF-kappaB, but not that of IL-4 and IL-10, in macrophages was inhibited by EDR. These results show that EDR decreased pro-inflammatory cytokines via inhibition of NF-kappaB-dependent inflammatory protein level, suggesting that EDR could be a useful immunomodulatory agent for treating immunological diseases.
Blotting, Western ; Cytokines ; Dinoprostone ; Dioscorea ; Immune System Diseases ; Inflammation ; Interleukin-10 ; Interleukin-4 ; Interleukin-6 ; Macrophages ; Medicine, Traditional ; NF-kappa B ; Rhizome ; RNA, Messenger ; Transcription Factors ; Tumor Necrosis Factor-alpha ; Water

BACKGROUND: Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors in the gastrointestinal tract. Expression of KIT protein (CD117) is an important diagnostic criterion of GIST. However, about 5% of GISTs are CD117 negative. Discovered on GIST 1 (DOG1) was introduced recently as a promising marker for GIST. We tested this new antibody in 105 GISTs tissue specimens, including 6 cases of metastatic GISTs, to determine the usefulness of DOG1 expression in the diagnosis of GISTs. METHODS: We performed immunohistochemical (IHC) staining for DOG1 and CD117 on tissue microarrays that included 70 gastric GISTs, 29 small intestinal GISTs, 6 metastatic GISTs, 14 gastric leiomyomas and 16 gastric schwannomas. RESULTS: DOG1 was positive in 98.1% (103/105) of GISTs and CD117 was positive in 97.1% (102/105) of GISTs. Only 1 case was negative for both markers. Two (66.7%) out of 3 GISTs tested CD117 negative were tested DOG1 positive. All leiomyomas and schwannomas were negative for both DOG1 and CD117. CONCLUSIONS: DOG1 was highly expressed in GIST including CD117 negative cases. Adding DOG1 testing to the IHC panel for diagnosing GIST will help to identify GIST patients who are CD117 negative but may otherwise benefit from targeted therapy.
Gastrointestinal Stromal Tumors ; Gastrointestinal Tract ; Humans ; Immunohistochemistry ; Leiomyoma ; Neurilemmoma

This report represents a very rare case of a gastric adenocarcinoma that was coexistent with hepatoid adenocarcinoma and neuroendocrine carcinoma. A 77-year-old man was admitted to our hospital due to a huge ulcerofungating mass identified at the proximal body of the stomach. After a pathological diagnosis of the tumor as a poorly differentiated adenocarcinoma was made, the patient underwent a total gastrectomy with lymph node dissection. Microscopically, the tumor consisted of three morphologically distinct components-tubular adenocarcinoma, hepatoid adenocarcinoma and neuroendocrine carcinoma. The hepatoid adenocarcinoma component resembled a hepatocellular carcinoma and produced alpha-fetoprotein. The neuroendocrine carcinoma component was positive for chromogranin and synaptophysin immunostains. This is an example of the diverse morphological and immunophenotypical differentiation of gastric carcinomas.
Adenocarcinoma ; Aged ; alpha-Fetoproteins ; Carcinoma, Hepatocellular ; Carcinoma, Neuroendocrine ; Gastrectomy ; Humans ; Lymph Node Excision ; Stomach ; Stomach Neoplasms ; Synaptophysin

BACKGROUND: Recently, many studies have focused on human epidermal growth factor receptor 2 (HER2) status in gastric cancer due to HER2-targeted therapy using trastuzumab. We investigated HER2 overexpression and amplification and their concordance rate in Korean gastric adenocarcinomas. METHODS: Tissue microarrays were constructed with 232 gastric adenocarcinoma samples. We performed immunohistochemistry (IHC), silver-enhanced in situ hybridization (SISH) and fluorescence in situ hybridization (FISH) for HER2. RESULTS: IHC was negative in 94.8% (218/232), equivocal in 1.7% (4/232) and positive in 3.5% (8/232) of cases. HER2 protein expression was heterogeneous in 75% (9/12) of IHC 2+/3+ cancers. Gene amplification was observed in 6.5% (15/230) by SISH and the same 15 cases were also FISH-positive. We observed HER2 amplification in 1.4%, 27.3%, 25%, and 100% of IHC 0, 1+, 2+, and 3+ gastric adenocarcinomas, respectively. The concordance rate between IHC and SISH results was 95.7%. CONCLUSIONS: HER2 overexpression and amplification were less frequent in gastric adenocarcinomas than breast carcinomas. Compared to breast carcinoma, (1) there may be IHC-negative but gene amplification-positive cases for HER2 and (2) frequent intratumoral heterogeneity of IHC for HER2 in gastric adenocarcinomas.
Adenocarcinoma ; Antibodies, Monoclonal, Humanized ; Breast ; Fluorescence ; Gene Amplification ; Humans ; Immunohistochemistry ; In Situ Hybridization ; In Situ Hybridization, Fluorescence ; Population Characteristics ; Receptor, Epidermal Growth Factor ; Receptor, erbB-2 ; Silver ; Stomach Neoplasms ; Trastuzumab

Purpose: Most of the currently used concepts and measurements of social support have been relevant for general population. The main purpose of this study is to conduct the concept analysis of perceived social support(PSS) of family caregivers for people with dementia. Methods: This study adopted the Walker and Avant concept analysis methodology. Results: Findings from this concept analysis suggested four defining attributes of PSS of family caregivers for people with dementia: 1) PSS is help or assistance that family caregivers perceive as available when needed; 2) PSS is offered through socio-ecological structure; 3) PSS has a specific function to meet the needs of family caregivers; and 4) PSS includes quality aspects where family caregivers choose, use, or evaluate it. Borrowing from the socio-ecological model, this study proposed the structural aspects of PSS. This study also identified functional aspects of PSS, such as emotional support, informational support, appraisal support, and practical support. Finally, this study assessed quality aspects of PSS, such as satisfaction, timeliness, usefulness, accessibility, and coordination. Conclusion Focusing on family caregivers for people with dementia, we proposed a new model of PSS. The present study helped refine and clarify the concept of PSS of family caregivers for people with dementia. The results of this study may also contribute to promoting the development of more effective instruments for the concept.