Adult intussusception is rare involving of only 1% of the causes of bowel obstruction. We report a case of a 39-year-old female with intussusceptions due to inverted Meckel's diverticulum. She visited our hospital for diffuse abdominal pain during 1 week and aggravated abdominal pain for 2 days. Vital signs were stable, and there was periumbilical tenderness. She had no history of abdominal operation. CT scan showed a 3.7x2.1 cm of fatty mass with focal intussusception in the distal ileum. When the emergency operation was performed, the patient was found to be suffering from ileocolic intussusception. A manual reduction of intussusception showed inverted Meckel's deverticulum at 65 cm proximal to the ileocecal valve, and the segmental resection of small bowel including a Meckel's diverticulum was performed. Pathologic examination revealed a Meckel's diverticulum containing a 0.6x0.6 cm sized aberrant pancreas.
Abdominal Pain ; Adult ; Emergencies ; Female ; Humans ; Ileocecal Valve ; Ileum ; Intussusception ; Meckel Diverticulum ; Pancreas ; Stress, Psychological ; Vital Signs

PURPOSE: For the atypical cases of fine needle aspiration (FNA) cytology of thyroid nodules, ultrasonographic findings are a primary guideline for the surgical treatment. However, they have the intrinsic risk of overtreatment, as well. In this study we examined whether the Bethesda system could provide a real effect on the diagnostic rate of atypical cytology, and thereby reduce the number of cases diagnosed as atypical from FNA cytology. METHODS: We reviewed 166 cases diagnosed as atypical by FNA cytology at this institute between the years 2005 to 2010. We classified these cases on the basis of ultrasonographic and cytological findings and compared them with the histological results. RESULTS: Ultrasonographically, findings suspicious for malignancy and indeterminate were associated with 83.7% and 47.2% of malignancy rates, respectively. Cytopathologically, the malignancy rates varied according to the main cytological features and the highest malignancy rate was 77.3%. Based on the Bethesda system, 39.2% of the cases diagnosed as atypical could be grouped into the category of suspicious for malignancy and yielded a malignancy rate of 76.9%. CONCLUSION: Although ultrasonography provides an excellent guideline for the surgical treatment of atypical cases, it also showed considerable risk of overtreatment. The Bethesda system did not offer definitive effects on the rate of atypical cytology, but this system seemed to provide stricter boundaries for the atypical cytology and to aid in reducing the rates thereof. This in turn may permit that more limited cases are allotted to ultrasonographic decision making.
Biopsy, Fine-Needle ; Carcinoma, Papillary ; Decision Making ; Thyroid Gland ; Thyroid Nodule

BACKGROUND: Abnormal umbilical artery Doppler velocimetry is one of the important findings of intrauterine growth restriction (IUGR) and IUGR is associated with high perinatal morbidity and mortality. In addition, this abnormal Doppler velocimetry is correlated with placental insufficiency. The aim of this study was to determine the pathologic differences in the placentas from IUGR pregnancies with and without the absent or reversed end diastolic velocity (AREDV). METHODS: Among the cases that had undergone prenatal follow-up in our institute, a retrospective slide review was conducted for 18 cases of IUGR with AREDV and 17 cases with IUGR that had normal end-diastolic flow of the umbilical artery. RESULTS: The birth weight and the other clinical parameters were not different among the two groups. Grossly, the placental weight percentiles were significantly smaller in AREDV group when they were adjusted according to gestational age. Histologically, chronic deciduitis, mural hypertrophy of the decidual arteries, an intimal fibrin cushion of the large fetal vessels, increased syncytial knots, villous agglutinations, avascular villi, villous stromal-vascular karyorrhexis, and acute atherosis were more frequently found in the AREDV group and their presence showed statistical significance. CONCLUSIONS: These findings suggest that pathologic abnormalities due to fetal and maternal vasculopathies in the placenta may be the cornerstone for inducing AREDV in the umbilical artery.
Arteries ; Birth Weight ; Fetal Growth Retardation ; Fibrin ; Follow-Up Studies ; Gestational Age ; Hypertrophy ; Placenta ; Placental Insufficiency ; Pregnancy ; Retrospective Studies ; Rheology ; Umbilical Arteries

PURPOSE: MUC1 is a large transmembrane glycoprotein, which is overexpressed in the majority of carcinomas. The high expression of MUC1 is associated with aggressive tumors, with the MUC1 antigen used as a marker to monitor disease progression in breast cancer patients. Although the MUC1 tumor marker is both sensitive and specific for predicting a relapse in breast cancer, it is not commonly used during the follow-up of breast cancer patients. The aim of this study was to evaluate whether the differential patterns of MUC1 expression in different histological types of breast carcinoma could be used to distinguish tumors from benign lesions, and determine its prognostic relevance with other biological parameters. METHODS: 22 normal breast, 7 intraductal hyper-plasia (IDH) and 307 malignant lesions were selected and immunostained with MUC1. The patterns of reaction were classified as intraluminal border (ILB), cytoplasmic, intercellular membrane (ICM), intranuclear or mixed staining. RESULTS: All the normal breast samples showed weak cytoplasmic staining in the ducts and lobules. All the IDH samples showed moderate cytoplasmic and ILB staining. Of the 307 malignant lesions, only 2 (0.8%) showed negative staining; MUC1 positivity was observed in 4 (1.3%), with only ILB staining; 8 (2.6%) with weak cytoplasmic staining, 16 (5.2%) with weak cytoplasmic and intranuclear staining, 168 (54.7%) with moderate cytoplasmic and ILB staining, and 109 (35.5%) with strong cytoplasmic and ICM staining. MUC1 positivity with a moderate to strong staining intensity was observed in 90.6% of the infiltrating ductal carcinomas (221/244), 96.5% of the intraductal carcinomas (28/29), 87.5% of the infiltrating lobular carcinomas (7/8), 66.6% of the mucinous and secretory carcinomas (10/15), 100.0% of the apocrine carcinomas (5/5) and 100.0% of the medullary carcinomas (6/6). The expression of MUC1 was statistically significant between the histological tumor types (p = 0.034), tumor size (p = 0.046), and HER-2/neu (p = 0.004). CONCLUSION: These data suggest the expression of MUC1 was different in normal breast, IDH and malignant breast tumors, and was significantly correlated with the histological tumor types, tumor size and HER-2/neu oncogene.
Breast Neoplasms ; Breast* ; Carcinoma, Ductal ; Carcinoma, Intraductal, Noninfiltrating ; Carcinoma, Lobular ; Carcinoma, Medullary ; Cytoplasm ; Disease Progression ; Follow-Up Studies ; Glycoproteins ; Humans ; Immunohistochemistry ; Membranes ; Mucins ; Negative Staining ; Oncogenes ; Prognosis ; Recurrence

BACKGROUND: The incidence of Crohn's disease in the upper digestive tract, and especially in the stomach, is recently increasing. Focal inflammatory reaction without Helicobacter pylori (H. pylori) infection is thought to be the characteristic pathologic findings suggesting Crohn's disease in the stomach. Yet gastric involvement of Crohn's disease has not been studied in Korea. We studied the endoscopic and pathologic findings of patients with Crohn's disease in the stomach by taking biopsies. METHODS: Thirty patients with Crohn's disease who underwent gastroduodenoscopy followed by biopsies were included in the study. The pathology of the gastric biopsy specimens and the presence of H. pylori were evaluated. RESULTS: Among 30 cases, 22 cases (73.3%) were H. pylori negative and 8 cases (26.7%) were H. pylori positive. For the H. pylori negative cases, all but one cases showed pit abscess and focal lymphocytic collections in the antrum. Granulomas were found in 6 cases (20%) and they were exclusively located in the antrum. CONCLUSIONS: In the stomach, pit abscess and focal lymphocytic collections that are not associated with H. pylori infection are the characteristic pathologic findings found in Crohn's disease.
Abscess ; Biopsy ; Crohn Disease* ; Gastrointestinal Tract ; Granuloma ; Helicobacter pylori ; Humans ; Incidence ; Korea ; Pathology ; Stomach*

BACKGROUND: This study evaluated the accuracy of fine needle aspiration cytology (FNAC) in cases of follicular neoplasm (FN) on the basis of histologic diagnosis, and reviewed the cytologic findings of FN according to the FNAC. METHODS: Among the 66 cases diagnosed with thyroid FN by FNAC during the 7-year period from 2003 to 2009, 36 cases that had undergone thyroid surgery were available for review. Cytologic diagnosis was compared with the histologic diagnosis of each case. RESULTS: Among the 36 cases with a cytologic diagnosis of thyroid FN, histologic diagnosis was as follows: 20 follicular adenomas (55.6%), 3 Hurthle cell adenomas (8.3%), 2 follicular carcinomas (5.6%), 8 nodular goiters (22.2%), 2 papillary carcinomas (5.6%), and 1 Hashimoto's thyroiditis (2.8%), resulting in a diagnostic accuracy of FNAC for thyroid FN of 69.5%. CONCLUSIONS: This study shows that FNAC for thyroid FN is a useful primary screening method because when FN is diagnosed by FNAC, the rate of FN histologic diagnosis is relatively high, however, adequate sampling and experience is a prerequisite for this procedure.
Adenoma ; Biopsy, Fine-Needle ; Carcinoma, Papillary ; Goiter, Nodular ; Mass Screening ; Thyroid Gland ; Thyroiditis

BACKGROUND: The cytological examination of cerebrospinal fluid (CSF) using conventional cytology with a cytocentrifuge (cytospin) is an important method for evaluating the involvement of leukemia in the CNS. Liquid-based cytology (LBC) is now a widely used cytological method not only for gynecological and non-gynecological specimens, but its application to CSF for the identification of leukemic cell has not yet been reported. In this study, we tried to compare conventional cytology with using a cytospin with LBC and Papanicolaou (Pap) staining. We also examined the modified LBC with Wright staining to assess whether this modified method can be useful for diagnosing Leukemia. METHODS: We studied 30 cases of CSF that were obtained from 16 patients, including 17 cases of acute myeloid leukemia, 12 cases of acute lymphoblastic leukemia and 1 case of diffuse large B cell lymphoma. We applied conventional cytology with a cytocentrifuge (cytospin), LBC with Pap staining and modified LBC with Wright staining. RESULTS: The morphological features of the LBC with Pap staining showed difficulty for interpretation when compared with conventional cytology with a cytospin, and mainly because of cellular shrinkage. The modified LBC with Wright staining showed good morphological features. CONCLUSIONS: We suggest that modified LBC with Wright staining may be useful for examining CSF.
Humans ; Leukemia ; Leukemia, Myeloid, Acute ; Lymphoma, B-Cell ; Precursor Cell Lymphoblastic Leukemia-Lymphoma

Gangliocytic paragangliomas are rare benign neuroendocrine tumors that arise mainly in the duodenum. A total of 3 cases of duodenal gangliocytic paraganglioma have been reported in Korea. The authors encountered another case of a gangliocytic paraganglioma in the duodenum. A 48-year old man presented with a mass in the duodenum that had been found incidentally in a medical checkup. The endoscopic examination revealed a 3.5x2.2 cm sized polypoid mass in the second portion of the duodenum. The patient underwent a polypectomy in the form of a wedge resection under general anesthesia. Microscopically, the tumor was composed of epithelial cells forming paraganglioma like patterns, spindle cells and ganglion cells. Gangliocytic paragangliomas are believed to be benign tumors but regional lymph node metastasis and recurrence can occur in rare cases. During the 27-month follow-up after treatment, there was no evidence of recurrence or lymph node metastasis. We report this case to help improve the understanding of this rare disease.
Anesthesia, General ; Duodenum* ; Epithelial Cells ; Follow-Up Studies ; Ganglion Cysts ; Humans ; Korea ; Lymph Nodes ; Middle Aged ; Neoplasm Metastasis ; Neuroendocrine Tumors ; Paraganglioma* ; Rare Diseases ; Recurrence

Various types of glomerulonephritis can occur at the same time with Hodgkin lymphoma, including minimal change disease and membranous glomerulonephritis. However, the concurrence of IgA nephropathy with Hodgkin lymphoma is rare. We report here on a case of IgA nephropathy in a patient with newly diagnosed Hodgkin lymphoma: A 60-year-old man presented with weight loss and anorexia. The patient showed lymphadenopathies in the neck on physical examination, and multiple lymphadenopathies in the mediastinum and abdomen on computerized tomography. Diagnosis of Hodgkin lymphoma was made after cervical lymph nodes were excised, but during the course of the chemotherapy, laboratory findings of hematuria and an elevated creatinine level were observed and IgA nephropathy was additionally diagnosed from a renal biopsy. There were fluctuations in the creatinine level and the amounts of hematuria and proteinuria, but by the time of the eighth cycle of chemotherapy, the patients condition had rapidly deteriorated, mainly due to the newly developed adult respiratory distress syndrome. The patient died soon thereafter.
Abdomen ; Anorexia ; Biopsy ; Creatinine ; Glomerulonephritis ; Glomerulonephritis, IGA ; Glomerulonephritis, Membranous ; Hematuria ; Hodgkin Disease ; Humans ; Immunoglobulin A ; Lymph Nodes ; Lymphatic Diseases ; Lymphoma ; Mediastinum ; Middle Aged ; Neck ; Nephrosis, Lipoid ; Physical Examination ; Proteinuria ; Respiratory Distress Syndrome, Adult ; Weight Loss

Although chronic myelogenous leukemia (CML) may be involved in any part of the body, infiltration of the body fluid has rarely reported in the literature. Here we report on a 35 year-old male patient who was diagnosed chronic myelogenous leukemia ten years previously and he received allogenic hematopoietic stem cell transplantation. He then presented with left knee pain eight years after the initial diagnosis. MRI revealed a soft tissue mass at the distal femur. Cytology of the joint fluid revealed myeloblasts, promyelocytes, eosinophilic myelocytes, band neutrophils, megakaryocytes and orthochromatic erythroblasts, which was all consistent with leukemic infiltration of the knee joint fluid. The immunohistochemistry was positive for CD34, CD117 and myeloperoxidase (MPO). Despite that the patient underwent radiation therapy, MRI revealed growth of the mass, and ten months later, the lymphoid blast phase of CML was confirmed after biopsy. The patient received an above knee amputation. Five months later, multiple masses were revealed on PET-CT at the left iliopsoas muscle, abdominal wall and bones. Bilateral pleural effusion occurred shortly after this. Cytologic evaluation of the pleural fluid also revealed blast-like cells, and histologic evaluation of the abdominal mass confirmed the lymphoid blast phase of CML with positivity for CD3, UCHL-1, CD34 and CD117, but negativity for MPO.
Abdominal Muscles ; Amputation ; Biopsy ; Blast Crisis ; Body Fluids ; Eosinophils ; Erythroblasts ; Femur ; Granulocyte Precursor Cells ; Hematopoietic Stem Cell Transplantation ; Humans ; Immunohistochemistry ; Joints ; Knee ; Knee Joint ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive ; Leukemic Infiltration ; Male ; Megakaryocytes ; Neutrophils ; Peroxidase ; Pleural Effusion