Ascariasis is probably the most common helminthic infestation of man, but it seldom causes severe illness. Pathologic conditions of Ascaris may be caused by adult worms, eggs or larvae. We describe a case of Ascaris egg granulomas that were found incidentally on the surface of the liver in a 75-year-old woman who had undergone a segmentectomy for an intrahepatic stone. Grossly, there were several yellowish calcific nodules of 0.4 cm in diameter on the lateral surface of the left lobe of the liver. Microscopically, the lesions were located in the hepatic capsule and consisted of fibrocalific nodules with many eggs. The eggs were round to oval, thick-shelled and measured 50~75x30~50 um. Most of the morphologically preserved eggs were fertilized eggs, but they had smooth shells without external protein coats. This case is of interest for the unusual location of the lesion, the presence of eggs without mammillation, and the association with the intrahepatic stone.
Adult ; Male ; Female ; Humans

PURPOSE: To evaluate the causative factors of the false positive CT findings of parametrial invasions of cervial cancer. MATERIALS AND METHODS: we analysed 17 parametria of 14 patients with the diseases staged over lib on CT, but confirmed to be under stage Ila on pathology. The CT findings were retrospectively reviewed, and compared with pathologic findings. RESULTS: The causes of false postive diagnosis of parametrial invasions on CT were prominent cardinal ligaments (n=12), vaginal fornix(n=3), and prominent uterine vessels(n=2). CONCLUSION: Familiarity with these CT finding may be helpful in avoiding false positive diagnosis of parametrial invasion in patients with uterine cervical carcinoma.
Diagnosis ; Humans ; Ligaments ; Pathology ; Recognition (Psychology) ; Retrospective Studies

Although assisted reproductive technology is associated with higher rates of interstitial pregnancy and heterotopic pregnancy, heterotopic pregnancy after bilateral salpingectomy is still extremely rare. We report a case of heterotopic pregnancy after bilateral salpingectomy in an in vitro fertilization/embryo transfer patient, who underwent cornual resection by laparotomy due to ruptured cornual pregnancy. However, 3 days after surgery, the remaining intrauterine pregnancy miscarried, and a dilatation and curettage was performed.
Dilatation and Curettage ; Embryo Transfer ; Embryonic Structures ; Female ; Fertilization in Vitro ; Humans ; Laparotomy ; Pregnancy ; Pregnancy, Heterotopic ; Reproductive Techniques, Assisted ; Salpingectomy

Background: There is a debate regarding the safety of etomidate. We evaluated the effects of etomidate on mortality in a large cohort of critical care patients. Methods: This retrospective matched-cohort study was performed using the Medical Information Mart for Intensive Care version 3 (MIMIC-III) database. Among 12,526 adult patients who were prescribed etomidate or propofol on the first day of mechanical ventilation, 625 patients administered etomidate were statistically matched with 6,250 patients administered propofol. The primary outcome measures were all-cause in-hospital mortality, 48-hour survival, cardiovascular morbidity, and infectious morbidity. Logistic regression analysis with stepwise selection of variables was performed to examine the dose–mortality relationship of etomidate. Results: All-cause in-hospital mortality was 1.84 times higher in the etomidate cohort (OR, 1.84; 98.75% CI, 1.42, 2.37). Compared to the propofol cohort, the etomidate cohort showed 57% lower odds of 48-hour survival (0.43 [0.27, 0.73]), no difference in odds of cardiovascular morbidity (0.86 [0.66, 1.12]), and 1.77 times higher odds of infectious morbidity (1.77 [1.35, 2.31]). Additionally, the odds of mortality increased by 1.36 times per 0.1 mg/kg of etomidate (1.36 [95% CI: 1.23, 1.49]). Conclusions Etomidate is a poor choice as a hypnotic drug on the first day of mechanical ventilation, as it is associated with a dose-dependent increase in all-cause mortality, and does not improve survival for the first 48 h.

Background: There is a debate regarding the safety of etomidate. We evaluated the effects of etomidate on mortality in a large cohort of critical care patients. Methods: This retrospective matched-cohort study was performed using the Medical Information Mart for Intensive Care version 3 (MIMIC-III) database. Among 12,526 adult patients who were prescribed etomidate or propofol on the first day of mechanical ventilation, 625 patients administered etomidate were statistically matched with 6,250 patients administered propofol. The primary outcome measures were all-cause in-hospital mortality, 48-hour survival, cardiovascular morbidity, and infectious morbidity. Logistic regression analysis with stepwise selection of variables was performed to examine the dose–mortality relationship of etomidate. Results: All-cause in-hospital mortality was 1.84 times higher in the etomidate cohort (OR, 1.84; 98.75% CI, 1.42, 2.37). Compared to the propofol cohort, the etomidate cohort showed 57% lower odds of 48-hour survival (0.43 [0.27, 0.73]), no difference in odds of cardiovascular morbidity (0.86 [0.66, 1.12]), and 1.77 times higher odds of infectious morbidity (1.77 [1.35, 2.31]). Additionally, the odds of mortality increased by 1.36 times per 0.1 mg/kg of etomidate (1.36 [95% CI: 1.23, 1.49]). Conclusions Etomidate is a poor choice as a hypnotic drug on the first day of mechanical ventilation, as it is associated with a dose-dependent increase in all-cause mortality, and does not improve survival for the first 48 h.

Malignant peripheral nerve sheath tumor (MPNST) is a rare entity of all soft tissue sarcomas. It has four different types of glandular, melanocytic, rhabdomyoblastic, and epithelioid. Epithelioid MPNST is composed of predominantly epithelioid cells. In contrast, typical MPNST is consisted of spindle cells, which is arranged in a fascicular or whirling pattern. A 33-old man showed two skin-color to reddish brown protruding nodules on the left thigh. Microscopically, one nodule was made up of epithelioid cell, primarily. In addition, the other nodule was composed of epithelioid cells and spindle cells, which also showed Antoni A and B. Immunohistochemical study showed the cells being positive for S-100 protein (weak and focal) and neuron-specific enolase, and negative for HMB-45, smooth muscle actin. Herein, we report a case of two different forms of malignant nerve sheath tumor on the left thigh, which was not associated with neurofibromatosis-1.
Actins ; Epithelioid Cells ; Muscle, Smooth ; Nerve Sheath Neoplasms ; Neurilemmoma ; Neurofibromatoses ; Peripheral Nerves ; Phosphopyruvate Hydratase ; Prognosis ; S100 Proteins ; Sarcoma ; Thigh

Generalized granuloma annulare (GGA) is benign granulomatous dermatosis of unknown causes characterized by a widespread papular eruption on the trunk and limbs. This differs from the localized form as it is distinguished by later onset, a protracted response to therapy, and concomitant diabetes mellitus in 20% of patients. GGA is a chronic disease with a relapsing course and a poor long term response to treatment, GGA lasted for 5 or more years in 25% of patients. Thus, more safe and effective therapeutic modalities are needed. The effectiveness and safety of hydroxychloroquine (6.5 mg/kg/day) which has a long history of efficacy in systemic lupus erythematosus is identified. We report a case of 48-year-old man presented with GGA lesions successfully treated with a low dose hydroxychloroquine (3 mg/kg/day) without side effect and the clinical improvement observed after 2 weeks. Low doses of hydroxychloroquine might be beneficial in the treatment of GGA, compared with other drugs, with low potency of side effect.
Chronic Disease ; Diabetes Mellitus ; Extremities ; Granuloma Annulare* ; Granuloma* ; Humans ; Hydroxychloroquine* ; Lupus Erythematosus, Systemic ; Middle Aged ; Skin Diseases

Pernio, or chilblains, are a localized inflammatory lesion of the skin resulting from an abnormal response to cold. The condition is characterized by cutaneous lesions located on the distal parts, such as the fingers, toes, nose and ears. Pernio develops among susceptible individuals who are exposed to non-freezing condition and most commonly occurs among young women and children. However, reports on childhood pernio are rarely found. Several conditions have been described as predisposing factors to pernio, including excessive cold exposure, low-grade vasculitis, the presence of cryoproteins, anorexia nervosa, systemic lupus erythematous and antiphospholipid antibodies. It is important, therefore, when evaluating a patient with chronic pernio who is resistant to conservative management, to exclude an underlying condition and also to determine whether additional testing is necessary. Herein, we present an uncommon case of a 5-year-old female patient with chronic pernio that may be associated with the presence of cold agglutinin. She received topical steroids prior to evaluation but no improvement was seen. Howere, treatment with calcium channel blocker, nifedipine, was of benefit to our patient.
Anorexia Nervosa ; Antibodies, Antiphospholipid ; Calcium Channels ; Causality ; Chilblains ; Child ; Child, Preschool ; Cryoglobulins ; Ear ; Female ; Fingers ; Humans ; Nifedipine* ; Nose ; Skin ; Steroids ; Toes ; Vasculitis

BACKGROUND: Cutaneous angiosarcoma (AS) is a rare malignant tumor of endothelial origin with a very poor prognosis, frequent recurrences, and high metastatic potential. Clinical suspicion is often raised too late, but histological findings and immunohistochemical assays have proved to be very helpful in the diagnostic process. OBJECTIVE: The purpose of this study was to evaluate the clinical and histopathologic features of angiosarcoma. METHODS: We retrospectively analyzed 12 patients with angiosarcoma who had visited our department of dermatology in Gyeongsang National University Hospital between 1998 and 2013. The clinical features, evolution, treatment, and outcome were examined, and biopsy specimens were reviewed by a trained dermatologist, with subsequent immunohistochemical assessment. RESULTS: Cutaneous AS was clinically diagnosed in 3 of 12 patients. There were many clinical misdiagnoses including lupus erythematosus, metastatic cancer, and infectious granuloma. The male to female ratio was 1:0.71 and the mean age of the patients was 66.25 years. The most frequent site of angiosarcoma was the scalp, in 8 of 12 patients. Histopathologically, well-differentiated angiosarcoma was composed of vascular channels, lined by flattened atypical endothelial cells that could be distinguished from their benign counterparts. Variable differentiation may be observed even in the same tumor. Immunohistopathologic analysis showed that the tumor cells were positive for CD31, CD34, Ki 67, and Factor VIII-related antigen. CONCLUSION: This study provides useful data on the clinical and histopathologic characteristics of angiosarcoma in the Korean population.
Biopsy ; Dermatology ; Diagnostic Errors ; Endothelial Cells ; Female ; Granuloma ; Hemangiosarcoma* ; Humans ; Male ; Prognosis ; Recurrence ; Retrospective Studies ; Scalp ; von Willebrand Factor

BACKGROUND: Angiokeratomas are vascular malformations that usually appear as multiple or solitary cutaneous papules, nodules, or plaques. Several clinical variants of angiokeratoma exist. The differential diagnosis of angiokeratoma can be difficult and some cases that are clinically suggestive of angiokeratoma are found to be caused by other diseases following skin biopsy. OBJECTIVE: The purpose of this study was to examine the diagnostic yield following analysis of clinically diagnosed angiokeratomas, which presented as multiple or solitary cutaneous papules, nodules, or plaques. METHODS: We retrospectively reviewed 36 patients who had visited the department of dermatology between January 2004 and December 2013, and who, following biopsy, had a clinical diagnosis of angiokeratoma or a differential diagnosis of angiokeratoma. We compared the clinical and histopathologic diagnoses, and analyzed the rate of concurrence and clinical features, including age, sex, location, and duration. RESULTS: The angiokeratoma patients accounted for 61.1% of all new patients and their mean age was 32.2 years. The most common subtype was solitary angiokeratoma (11 cases, 50%). Histopathologic analysis showed that 38.9% of patients had a different type of disease and their mean age was 31.4 years. The most common causes of disease for this latter group were pyogenic granuloma (21.4%) and hemangioma (21.4%), followed by calcinosis cutis, dermatofibroma, neurofibroma, pilomatricoma, verruca vulgaris, and herpes viral infection. CONCLUSION: Lesions suggestive of angiokeratoma need further examination and a biopsy is useful to determine the correct differential diagnosis between angiokeratoma and other diseases, to avoid erroneous management.
Angiokeratoma* ; Biopsy ; Calcinosis ; Dermatology ; Diagnosis ; Diagnosis, Differential ; Granuloma, Pyogenic ; Hemangioma ; Histiocytoma, Benign Fibrous ; Humans ; Neurofibroma ; Pilomatrixoma ; Retrospective Studies ; Skin ; Vascular Malformations ; Warts