Wilms' tumor is composed of a mixture of epithelial, stromal and blastematous elements in varing proportions. Adult Wilms' tumor, unlike that of childhood is a rare disease. Spontaneous rupture of the kidney with subcapsular or perirenal hematoma also is rarely seen in malignant renal tumor. A case of adult Wilms' tumor in 65-year old female is here reported, associated with spontaneous renal rupture, which was treated with radical nephrectomy and chemotherapy (vincristine, actinomycin D and doxorubicin).
Adult* ; Aged ; Dactinomycin ; Drug Therapy ; Female ; Hematoma ; Humans ; Kidney ; Nephrectomy ; Rare Diseases ; Rupture* ; Rupture, Spontaneous ; Wilms Tumor*

PURPOSE: The formation of a liposarcoma is Known to be associated with a mutation of the p53 and MDM2 genes, and the histopathological subtypes of a liposarcoma are related to the prognosis of the patient. This study was performd to examine the relationship between the histopathological subtypes, the type of p53 mutation, and the proliferative rate. METHODS: Immunohistochemistry was used to measure the p53 protein and Ki-67 (Mib-1 labeling index) expression levels in 24 liposarcomas cases in which the liposarcoma developed primarily in the abdominal cavity. RESULTS: p53 expression was observed in 11.1% of the well- differentiated liposarcoma cases, 27.3% of the myxoid and round cell liposarcoma cases, and 50% of the pleomorphic liposarcoma cases. There were significant differences between the Ki-67 expression level according to the histopathological subtypes. There were significant differences between p53 positive or negative group and the Ki-67 expression level, and there was a quantitative correlation between them. CONCLUSION: The p53 protein was expressed in 25% of all liposarcomas, particularly in pleomorphic liposarcomas because it was expressed more frequently than in the other liposarcoma subtypes (in 2 cases out of 4 cases). The survival rate was much higher in the mucinous round cell liposarcomas which had high p53 and Ki-67 expression levels. The p53 expression level might be a prognostic predictor of a liposarcoma.
Abdominal Cavity ; Humans ; Immunohistochemistry ; Liposarcoma* ; Mucins ; Prognosis ; Survival Rate

No Abstract Available.
Female ; Hormone Replacement Therapy* ; Humans ; Life Style* ; Osteoporosis*

BACKGROUND: Serious organ shortage necessitates ABO incompatible (ABOi) kidney transplantation (KT). Recent reports utilizing rituximab instead of splenectomy and tacrolimus (FK)-based triple immunosuppressants showed excellent graft outcome. METHODS AND RESULTS: Thirteen cases of ABOi living donor KT have been performed since Feb. 2007 in our center. Donor and recipient blood group was B to O (n=5), A1 to O (2), AB to B (2), AB to A1 (1), A1 to B (2) and B to A1 (1). Rituximab was given at 4 weeks before transplantation. Plasmapheresis (PP) was initiated at 7~14 days before transplantation with concurrent immunosuppressants. The number of pretransplant PP was 5.7+/-1.4. Posttransplant PP was also performed in 6 patients with higher initial titer of ABO antibody (IgG > or =256; n=2), rapidly rising antibody titer during the critical period of 2 weeks posttransplantation (n=2), or increase in serum creatinine during the critical period while awaiting pathology report of graft biopsy (n=2). Mean number of posttransplant PP in these 6 patients was 2.2+/-1.3. Median IgG anti-ABO antibody titer before precondition, at transplantation, at 2 weeks and at 6 months was 64 (8~512), 2 (1~8), 2 (1~16) and 6 (1~16), respectively. IgM titer at corresponding time point was 16 (2~128). 1 (1~1), 1 (1~2) and 1.5 (1~4), respectively. Median follow up was 8 (5~27) months. No patient or graft was lost. No patient developed acute humoral rejection. Graft function remained stable with latest serum creatinine 1.2+/-0.3 mg/dl. CONCLUSIONS: ABOi living donor KT without splenectomy can be safely performed with the use of current preconditioning and immunosuppressive regimen, and is therefore a valuable option for expanding donor pool and should be actively performed in Korea.
Antibodies, Monoclonal, Murine-Derived ; Biopsy ; Creatinine ; Critical Period (Psychology) ; Follow-Up Studies ; Humans ; Immunoglobulin G ; Immunoglobulin M ; Immunosuppressive Agents ; Kidney ; Kidney Transplantation ; Living Donors ; Plasmapheresis ; Rituximab ; Rejection (Psychology) ; Splenectomy ; Tacrolimus ; Tissue Donors ; Transplants

Takotsubo cardiomyopathy is a clinical syndrome characterized by chest pain, transient left ventricular dysfunction, and specific electrocardiographic changes induced by physical or emotional stress. We describe a rare case of this syndrome associated with acute mitral valve bacterial endocarditis in a young female.
Chest Pain ; Electrocardiography ; Endocarditis* ; Endocarditis, Bacterial ; Female* ; Humans ; Mitral Valve ; Stress, Psychological ; Takotsubo Cardiomyopathy* ; Ventricular Dysfunction, Left

Hepatocellular carcinoma (HCC) rarely invades the gastrointestinal (GI) tract. It occurs in 0.7% to 2% of clinical HCC cases. Moreover, gastric invasion with GI hemorrhage via peritoneal seeding is very rare. We report the case of 67-year-old woman who had a history of HCC rupture and was admitted due to left upper quadrant abdominal pain. The patient was diagnosed with three omental metastatic masses and underwent hepatic segmentectomy and omental tumorectomy. Two months later, the patient had massive melena, and an esophagogastroduodenoscopy showed very large ulcerated friable mass on the gastric body. The histology was consistent with the diagnosis of metastatic HCC. The patient died from persistent GI hemorrhage 93 days after the admission. This case illustrates the very rare event of peritoneal seeding of a ruptured HCC causing direct invasion of the stomach, followed by GI hemorrhage.
Aged ; Carcinoma, Hepatocellular/*diagnosis/radiography/secondary ; Female ; Gastrointestinal Hemorrhage/*diagnosis/etiology/radiography ; Gastroscopy ; Humans ; Liver Neoplasms/*diagnosis/pathology/radiography ; *Neoplasm Seeding ; Peritoneal Neoplasms/*diagnosis/radiography/secondary ; Stomach Neoplasms/*diagnosis/radiography/secondary ; Tomography, X-Ray Computed

Gastroduodenal Crohn's Disease (CD), which is uncommon in adults, involves the gastric antrum and proximal duodenum in most cases, and results in epigastric pain, weight loss, and gastric outlet obstruction, raising initial suspicion that it may be peptic ulcer disease or a malignancy. On upper endoscopy, aphthous ulcers are typical in the early stages but linear or stellate ulcers with a cobblestone appearance and luminal narrowing can be found in advanced diseases. Multiple mucosal biopsies are helpful for diagnosis despite the fact that granulomas are seen in less than one third of all cases. Gastroduodenal CD requires oral sulfasalazine therapy or systemic corticosteroid therapy in advanced cases. A case of gastroduodenal CD in a 37-year-old man admitted with epigastric pain, anorexia, vomiting and weight loss is herein reported. Malignancy was suspected as a result of the patient's clinical manifestations and endoscopic findings. An endoscopic biopsy revealed an active inflammation in the mucosa and lamina propria. The patient's condition improved with oral sulfasalazine and prednisolone therapy.
Adult ; Anorexia ; Biopsy ; Crohn Disease* ; Diagnosis ; Duodenum ; Endoscopy ; Gastric Outlet Obstruction ; Granuloma ; Humans ; Inflammation ; Mucous Membrane ; Peptic Ulcer ; Phenobarbital ; Prednisolone ; Pyloric Antrum ; Stomatitis, Aphthous ; Sulfasalazine ; Ulcer ; Vomiting ; Weight Loss

PURPOSE: Neoadjuvant chemoradiotherapy applied to the locally advanced rectal cancer reduces local recurrence and improves survival. We assessed tumor regression grade (TRG) and its influence on survival in rectal cancer patients treated with chemoradiotherapy followed by surgical resection. METHODS: We studied 108 patients that were seen at our hospital between August 2004 and December 2008. Patients received preoperative chemoradiotherapy consisting of 5-fluorouracil and leucovorin by continous infusion during the first and fifth week, delivered with concurrent pelvic radiation of 50.4 Gy, followed by radical surgery at 6-8 weeks. The TRG was determined by the amount of fibrosis in the tumor embedding area and was divided into 5 grades based on the relative amount of fibrosis. We analyzed all preoperative clinicopathologic factors, postoperative pathologic stages, TRG and prognosis, retrospectively. RESULTS: Downstaging of rectal cancer through neoadjuvant chemoradiotherapy occurred in 64 (59%) patients. The numbers of total regressions (TRG4), good regressions (TRG3), moderate regressions (TRG2), minor regressions (TRG1), and no regression (TRG0) were 19 (18%), 65 (60%), 17 (16%), 6 (5%), and 1 (1%) respectively. The TRG was inversely correlated with perineural invasion and lymphovascular invasion (P = 0.008, P = 0.032). The local recurrence rate declined as the tumor regression grade increased (P = 0.032). The 19 patients with TRG4 had a better three-year disease free survival than the 89 patients with TRG0-3 (P = 0.034). The 16 patients with pathologic complete remission (pCR) had a better three-year disease free survival than the 92 patients with non-pCR (P = 0.025). CONCLUSION: Higher TRG after preoperative chemoradiotherapy for rectal cancer closely correlates with better survival and low local recurrence. The TRG is considered to be a significant prognostic factor.
Chemoradiotherapy ; Disease-Free Survival ; Fibrosis ; Fluorouracil ; Humans ; Leucovorin ; Prognosis ; Rectal Neoplasms ; Recurrence ; Retrospective Studies

Multifunctional tissue transglutaminase (tTGase) is found in the cytoplasm and cell surface, as well as in the extracellular matrix. However, it is difficult to determine the exact function of tTGase in each cell compartment. This study focused on the potential role of cell surface tTGase in the process of "outside-in" signal transduction. Immunofluorescence study and western blotting was performed to localize the overexpression of tTGase. tTGaseoverexpressed H9c2/tTGase cells were treated with anti-tTGase antibody to evaluate the potential functions of tTGase on the outside-in signal process. The tTGase level markedly increased in each cell compartment and the culture media of H9c2/tTGase cells that show overexpression of tTGases. Anti-tTGase monoclonal antibody reduced tTGase levels in the whole lysate of H9c2/tTGase cells, and concomitantly increased the activity of the Akt. The results suggest that the cell surface expression of tTGase may be associated with an intracellular signaling pathway via the phosphoinositol-3 kinase/Akt. Phosphorylation of mitogen activated protein kinase family, ERK1/2, and Jun N-terminal Kinase (JNK), was also inhibited in the anti-tTGase antibody-treated H9c2/tTGase cells. These results suggest that cell surface tTGase may regulate intracellular signaling pathways in an autocrine or paracrine manner.
Blotting, Western ; Culture Media ; Cytoplasm ; Extracellular Matrix ; Fluorescent Antibody Technique ; GTP-Binding Proteins ; Humans ; Phosphorylation ; Phosphotransferases ; Protein Kinases ; Signal Transduction ; Transglutaminases

Though the renal abnormality is usually accompanied in the patient with antiphospholipid syndrome, it is not frequent that the symptoms of antiphospholipid syndrome are confined to kidney. We experienced a case of 40-year-old woman suffered from intermittently developed nephrotic range proteinuria combined with generalized edema during last 10 years. She had no past history of thrombosis, spontaneous abortion, or symptoms related to SLE. Laboratory findings revealed that she had nephrotic syndrome. Her antinuclear antibody was negative, but her serum antiphospholipid IgG antibody level was 32 GPL IU. In the renal biopsy specimen, half of the glomeruli showed global sclerosis and remaining glomeruli showed chronic thrombotic microangiopathy and membranoproliferative glomerulonephritis without immune deposit. Combined therapy with steroid and aspirin improve the amount of proteinuria, and she is free from edema without deterioration of renal function during follow up. Though this case lacked the typical symptoms of antiphospholipid syndrome, her glomerulonephritis presented with membranoproliferative pattern may be associated with it. We report this case with a review of literatures.
Abortion, Spontaneous ; Adult ; Antibodies, Antinuclear ; Antiphospholipid Syndrome* ; Aspirin ; Biopsy ; Edema ; Female ; Follow-Up Studies ; Glomerulonephritis ; Glomerulonephritis, Membranoproliferative* ; Humans ; Immunoglobulin G ; Kidney ; Nephrotic Syndrome ; Pregnancy ; Proteinuria ; Sclerosis ; Thrombosis ; Thrombotic Microangiopathies