The aim of our study was to describe the radiologic findings of extensive acute lung injury associated with limited thoracic irradiation. Limited thoracic irradiation occasionally results in acute lung injury. In this condition, chest radiograph shows diffuse ground-glass appearance in both lungs and thin-section CT scans show diffuse bilateral ground-glass attenuation with traction bronchiectasis, interlobular septal thickening and intralobular smooth linear opacities.
Acute Disease ; Adenocarcinoma/radiotherapy ; Adenocarcinoma/pathology ; Adenocarcinoma/drug therapy ; Adenocarcinoma/complications* ; Carcinoma, Squamous Cell/radiotherapy ; Carcinoma, Squamous Cell/pathology ; Carcinoma, Squamous Cell/drug therapy ; Carcinoma, Squamous Cell/complications* ; Journal Article ; Human ; Lung/radiation effects* ; Lung/pathology ; Lung Neoplasms/radiotherapy ; Lung Neoplasms/pathology ; Lung Neoplasms/drug therapy ; Lung Neoplasms/complications* ; Male ; Middle Age ; Radiation Injuries/radiography ; Radiation Injuries/pathology ; Radiation Injuries/etiology* ; Thorax/radiation effects

Dermatomyositis (DM) is an uncommon inflammatory myopathy with characteristic rash accompanying, or more often preceding, muscle weakness. There is a well-recognized association between DM and several cancers, such as ovarian cancer, breast cancer, melanoma, colon cancer, and non-Hodgkin lymphoma. We report the first case of cancer of unknown primary site associated with DM. A 62-yr-old woman presented to us with both shoulder painful swelling and facial edema. She was diagnosed previously as cancer of unknown primary site, histologically confirmed with squamous cell carcinoma in a pelvic mass. For the following days, she complained of erythematous face followed by progressive weakness of the proximal muscles of upper and lower limbs. The laboratory tests showed an increased muscle enzyme and acute phase reactants. The electromyogram showed the typical findings of DM. After the treatment with high dose steroid and methotrexate, the proximal motor weakness improved, and she received palliative radiation therapy.
Carcinoma, Squamous Cell/complications/diagnosis/pathology ; Dermatomyositis/*complications/diagnosis/pathology/therapy ; Female ; Humans ; Middle Aged ; Neoplasms, Unknown Primary/*complications/diagnosis/pathology

A 68-year-old male patient presented with a week of sudden diplopia. He had been diagnosed with nasopharyngeal cancer 8 months prior and had undergone chemotherapy with radiotherapy. Eight-prism diopter right esotropia in the primary position and a remarkable limitation in abduction in his right eye were observed. Other pupillary disorders and lid drooping were not found. After three weeks, the marginal reflex distance 1 was 3 mm in the right eye and 5 mm in the left eye. The pupil diameter was 2.5 mm in the right eye, and 3 mm in the left eye under room illumination. Under darkened conditions, the pupil diameter was 3.5 mm in the right eye, and 5 mm in the left eye. After topical application of 0.5% apraclonidine, improvement in the right ptosis and reversal pupillary dilatation were observed. On brain magnetic resonance imaging, enhanced lesions on the right cavernous sinus, both sphenoidal sinuses, and skull base suggested the invasion of nasopharyngeal cancer. Lesions on the cavernous sinus need to be considered in cases of abducens nerve palsy and ipsilateral Horner's syndrome.
Abducens Nerve Diseases/*etiology ; Aged ; Carcinoma, Squamous Cell/complications/pathology/therapy ; Cavernous Sinus/pathology ; Combined Modality Therapy ; Horner Syndrome/*etiology ; Humans ; Magnetic Resonance Imaging ; Male ; Nasopharyngeal Neoplasms/complications/pathology/therapy

Marjolin's ulcer is the malignant lesion which develops in a burn scar or chronic fistula. Due to the low prevalence of this lesion, there has been disagreement regarding its clinical features, methods of treatment, and prognosis. We evaluated 19 cases of patients who had been admitted to Severance Hospital from Jan. 1970 to Dec. 1985. The results were as follows: The previous lesion was a burn scar in 52% of the cases and a fistula of chronic osteomyelitis in 32%. The mean latent period was 31.5 years. The initial symptoms were increased pain (74%), discharge with foul odor (68%) and bleeding (58%). Upon histological examination, all of the cases were squamous cell carcinoma. The rate of metastasis at the time of diagnosis was 32%. Of the 16 patients treated by surgery, local recurrence was noted in 4 cases. Three of these cases were patients who had been treated by excision and split thickness skin graft. The time interval for local recurrence ranged from 6 months to 11 months (average 8.8 months). In conclusion, the squamous cell carcinoma of marjolin's ulcer seems to have a worse prognosis than other squamous cell carcinomas and it requires aggressive treatment. The burn scar or chronic fistula that occurs in elderly patients especially requires more adequate treatment and close observation.
Adult ; Aged ; Burns/complications ; Carcinoma, Squamous Cell/*epidemiology/etiology/pathology/therapy ; Case Report ; Cicatrix/complications ; Combined Modality Therapy ; Female ; Fistula/complications ; Human ; Korea/epidemiology ; Male ; Middle Age ; Neoplasm Metastasis ; Neoplasm Recurrence, Local/epidemiology ; Osteomyelitis/complications ; Prognosis ; Skin Neoplasms/*epidemiology/etiology/pathology/therapy

OBJECTIVETo study the clinicopathologic features, histologic diagnosis and differential diagnosis of primary mucosal tuberculosis (TB) in the head and neck region.

METHODSForty-seven cases of primary mucosal TB of the head and neck region were studied by hematoxylin-eosin and Ziehl-Neelsen stains. The clinical and pathologic features were analyzed with review of the literature.

RESULTSThe patients included 26 male and 21 female, with mean age 47.1 years (range 14-84 years). There were three sinonasal TB, 19 nasopharyngeal TB, two oropharyngeal TB, 18 laryngeal TB, four middle ear TB, one salivary gland TB and one laryngeal TB complicating laryngeal cancer. The initial symptoms were nasal obstruction, mucopurulent rhinorrhea, epistaxis, snoring, hoarseness, dysphagia, odynophagia, serous otitis, hearing loss, tinnitus, and otalgia. Physical examination result was variable, from an apparently normal mucosa, to an evident mass, or a mucosa with an adenotic or swollen appearance, ulcers, leukoplakic areas, and various combinations thereof. CT and MRI findings included diffuse thickening, a soft-tissue mass, calcification within the mass and bone destruction resembling malignancy. Histologic examination showed granulomas with a central necrotic focus surrounded by epithelioid histiocytes and multinucleated Langhan's giant cells. Acid-fast bacilli were difficult to demonstrate but found in 13/45 cases. Follow-up data were available in 42 patients.

CONCLUSIONSPrimary TB arising in the head and neck mucosa is rare. It may mimic or co-exist with other conditions. The characteristic histopathology is a granuloma with central caseous necrosis and Langhans'giant cells. Identification of acid-fast bacilli and bacteriologic culture confirm the diagnosis of mycobacterial disease.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Antitubercular Agents ; therapeutic use ; Carcinoma, Squamous Cell ; complications ; microbiology ; surgery ; Diagnosis, Differential ; Female ; Follow-Up Studies ; Humans ; Laryngeal Neoplasms ; complications ; microbiology ; surgery ; Male ; Middle Aged ; Otorhinolaryngologic Diseases ; diagnostic imaging ; drug therapy ; microbiology ; pathology ; Tomography, X-Ray Computed ; Tuberculin Test ; Tuberculosis ; diagnostic imaging ; drug therapy ; pathology ; Tuberculosis, Laryngeal ; complications ; surgery ; Tuberculosis, Oral ; drug therapy ; pathology ; Young Adult