Epilepsy surgery can be a safe, effective treatment for individuals with intractable partial epilepsy. There is increasing evidence that brain abnormalities in focal epilepsy are not restricted to a single area. The longstanding debate around the relationship between structural lesions and the epileptic zone remains unresolved. Patients with DNT (dysembryoplastic neuroepithelial tumor), which is an essentially benign tumor, can be cured by epilepsy surgery-oriented approach. Cortical dysplasia is frequently associated with DNT and seems to contribute to epileptogenic activity of DNT. Surgical treatment should be aimed at removal of the associated cortical dysplasia as well as DNT itself for ideal treatment of the disease. Simple lesionectomy of cavernous angioma would relieve seizures significantly, but not always. The concept of epilepsy surgery needs to be recruited in the treatment of cavernous angioma with seizures because diffusion of hemosiderin into the surrounding brain tissue and formation of cortical scars can make epileptogenic areas. Cortical dysplasia is a highly epileptogenic lesion constituting an important cause of medically intractable epilepsy and surgery is a treatment of choice in a selected group of patients. Identification and complete resection of the lesion and ictal onset zone are necessary to achieve a good surgical results. Intractable epilepsy accompanied by benign brain lesions can be treated surgically using the entire armamentarium of presurgical investigations. Deliberate resective procedures aimed at complete removal of dysplastic tissue and epiletogenically active areas on and around the lesion ensure excellent seizure control without permanent neurologic deficit.
Brain* ; Cicatrix ; Diffusion ; Epilepsies, Partial ; Epilepsy* ; Hemangioma, Cavernous ; Hemosiderin ; Humans ; Malformations of Cortical Development ; Neurologic Manifestations ; Seizures

No abstract available.

BACKGROUND: Intractable partial epilepsy is the most frequent manifestation in cortical dysplasia (CD). The surgical removal of the epileptogenic focus in CD is the main therapeutic option for achieving seizure control. However, it is dif-ficult to predict surgical outcome by current diagnostic methods. We investigated 35 subjects with intractable epilepsy due to CD, in order to know the relationship the extent of lesion in a magnetic resonance imaging (MRI), the epilepto-genic foci in invasive electroencephalography (IEEG), pathologic grading, and surgical outcome. METHODS: We reviewed clinical findings (the seizure history, MRI), IEEG findings (interictal and ictal EEG), pathologic findings and surgical outcomes retrospectively and compared them. All the patients ranged in age from 2 to 45 years (mean: 21.8+10.8years). The time of their seizure onset ranged from 6 months to 31 years (mean:9.4+6.6years). The postopera-tive follow-up period ranged from 7 to 45months (mean:26+14months). RESULTS: Regarding MRI findings, the lesions were focal (within one lobe) in 10, diffuse (more than one lobe) in 7, and no abnormalities in 18 subjects. The ictal onset zones of ictal IEEG had one focus in 18, two in 7, three in 7, and four in 3 subjects. The area of focus was focal in 15, regional in 14, lobar in 4, and in diffuse areas in 2 subjects. Pathologic grading revealed mild in 18, moderate in 5, and severe changes in 13 subjects. Their surgical outcomes were: Engel's class I in 20, class II in 7, class III in 6, and class IV in 2 subjects. The relationships among clinical features, IEEG, regarding pathology and surgical outcomes, revealed that severe pathologic grading had a significant correlation with earlier ictal onset zones (p=0.003), and diffuse MRI lesions. Diffuse ictal onset zones had poor surgical outcomes (p<0.010). CONCLUSIONS: Cortical dysplasia may have a diverse pattern of epileptogenic foci in MRI and IEEG. The earlier the seizure onset is, the severe pathologic grading becomes. When the lesions in MRI as well as the ictal onet zones in IEEG were diffuse, the surgical outcome was poor.
Electroencephalography* ; Epilepsies, Partial ; Epilepsy* ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging* ; Malformations of Cortical Development* ; Pathology ; Retrospective Studies ; Seizures

During tumor progression, a subset of cells acquires metastatic properties, presumably through a series of genetic alterations. As the result, cells detach from the primary tumor, penetrate the basement membrane and invade the adjacent structures including lymph and blood vessels. Loss of adhesive functions and gain of new adhesive functions are thought to play a crucial role in this metastatic cascade. Since tumor metastasis is the principle cause of death for cancer patients including colon cancer, there is a consensus that a search for tools that allow effective assessment of the metastatic potential of tumors is a prime goal for cancer research. An immunohistochemical study of cell adhesion molecules, CD44H and its variant CD44v6, was done to evaluate their relationship with known prognostic factors related to the progression and metastasis of colorectal carcinoma in 94 cases of colorectal carcinoma tissues. The results were as follows. The CD44H expression was detected in 90 (95.7%) and CD44v6 in 53 (56.4%) out of 94 cases of colorectal carcinoma, and the CD44H was overexpressed in tumor tissue more than in normal mucosa in 62% of the cases. The expression rates of both protein were not significantly correlated with age and sex of the patients, invasion depth, lymph node metastasis, tumor differentiation, and tumor site. The coexpression of CD44H and CD44v6 in tumor was significant (p<0.05). The above results suggest that overexpression of CD44H and loss of function to control the alternative splicing of CD44 mRNA resulting in CD44v6 expression and alteration of adhesive function are closely associated with tumorigenesis of the colorectum.
Adhesives ; Alternative Splicing ; Basement Membrane ; Blood Vessels ; Carcinogenesis ; Cause of Death ; Cell Adhesion Molecules* ; Cell Adhesion* ; Colonic Neoplasms ; Colorectal Neoplasms* ; Consensus ; Humans ; Lymph Nodes ; Mucous Membrane ; Neoplasm Metastasis ; Prognosis ; RNA, Messenger

Adenomyoepithelioma is a rare benign tumor which occurs mainly in the skin, salivary gland and very rarely in the breast. Histologically this tumor demonstrates biphasic differentiation of luminal epithelial cells and myoepithelial cells. We report a case of adenomyoepithelioma occuring in the outer lower quadrant of the right breast of a 56-year-old female, confirmed histologically with an aid of immunohistochemistry. This is the first documented report in Korean literature.
Adenomyoepithelioma* ; Breast* ; Epithelial Cells ; Female ; Humans ; Immunohistochemistry ; Middle Aged ; Phenobarbital ; Salivary Glands ; Skin

PURPOSE: The ictal perfusion patterns of cerebellum and basal ganglia have not been systematically investigated in patients with temporal lobe epilepsy (TLE). Their ictal perfusion patterns were analyzed in relation with temporal lobe and frontal lobe hyperperfusion during TLE seizures using SPECT subtraction. MATERIALS AND METHODS: Thirty-three TLE patients had interictal and ictal SPECT, video-EEG monitoring, SPGR MRI, and SPECT subtraction with MRI co-registration. RESULTS: The vermian cerebellar hyperperfusion (CH) was observed in 26 patients (78.8%) and hemispheric CH in 25 (75.8%). Compared to the side of epileptogenic temporal lobe, there were seven ipsilateral hemispheric CH (28.0%), fifteen contralateral hemispheric CH (60.0%) and three bilateral hemispheric CH (12.0%). CH was more frequently observed in patients with additional frontal hyperperfusion (14/15, 93.3%) than in patients without frontal hyperperfusion (11/18, 61.1%). The basal ganglia hyperperfusion (BGH) was seen in 11 of the 15 patients with frontotemporal hyperperfusion (73.3%) and 11 of the 18 with temporal hyperperfusion only (61.1%). In 17 patients with unilateral BGH, contralateral CH to the BGH was observed in 14 (82.5%) and ipsilateral CH to BGH in 2 (11.8%) and bilateral CH in 1 (5.9%). CONCLUSION: The cerebellar hyperperfusion and basal ganglia hyperperfusion during seizures of TLE can be contralateral, ipsilateral or bilateral to the seizure focus. The presence of additional frontal or basal ganglia hyperperfusion was more frequently associated with contralateral hemispheric CH to their sides. However, temporal lobe hyperperfusion appears to be related with both ipsilateral and contralateral hemispheric CH.
Basal Ganglia* ; Cerebellum* ; Epilepsy, Temporal Lobe* ; Frontal Lobe ; Humans ; Magnetic Resonance Imaging ; Perfusion ; Seizures ; Temporal Lobe* ; Tomography, Emission-Computed, Single-Photon

Malignant rhabdoid tumor is a distinct renal tumor in pediatric age group and extremely rare in adults. It was originally described as a rhabdomyosarcomatoid variant of Wilms' tumor. But subsequent studies failed to confirm myogenous differentiation, so the rhabdoid tumor is now considered to be a distinct and unique disease type of highly malignant renal tumor, histogenetically unrelated to Wilms' tumor. However the histogenesis have not been clearly defined until now. We report a case of malignant rhabdoid tumor of the kidney in a 34-year-old man who represented with a left abdominal mass. Grossly, a large mass occupying most of the left kidney except for a part of upper pole was invading beyond renal capsule and the perirenal soft tissue. It measured 18x14 cm in dimension and was soft, lobulated and yellowish gray with large areas of hemorrhage and necroses. Microscopically, the tumor mass was composed of sheets of round or polygonal neoplastic cells growing in a solid pattern. These tumor cells were medium to large in size with ample cytoplasm containing recognizable eosinophilic inclusion and had an eccentrically located, large nucleus with one or a few prominent nucleoli. Mitotic figures were frequently observed. Ultrastructurally, the tumor cells contained whorled filamentous inclusions corresponding to vimentin, epithelial membrane antigen and cytokeratin in immunostaining.
Adult ; Male ; Female ; Humans

No abstract available.

BACKGROUND: The detection of the phase reversal of somatosensory evoked potentials (SEP) has been well known to be a safe and reproducible method for defining the sensorimotor cortex. Brain stimulation (BS) has also been used to identify functional loci. The two tests, however have not to be compared in the cortical localization of the sensorimotor cortex yet. METHODS: We recorded the cortical potentials to median nerve stimulation from subdural grids which were in the frontoparietal areas of 12 epilepsy patients. After looking for phase reversals, we compared positive motor and sensory responses by brain stimulation from each electrode. In addition, the maximal amplitude areas of precentral positivity (max-P20) and postcentral negativity (max-N20) were analyzed, which were then compared with BS results. RESULTS: All patients showed phase reversals (average:4.7+1.61) on cortical SEP to median nerve stimulation. The electrodes before the phase reversal line had positive motor responses in 75% among electrodes with positive motor responses. The electrodes after the phase reversal line had positive sensory responses in 88.9% among electrodes with positive sensory responses. The maximal amplitude areas were recorded within a 2cm distance to the central sulcus. Max-P20's were located on the areas where BS showed a finger in 5 patients, hand in 3, forearm in 2, and tongue motor response in 2. Max-N20's were recorded on the areas where BS revealed a hand in 4 patients, forearm in 1, and undetected sensory responses in 7. CONCLUSIONS: These results suggest that SEP is different from BS in the functional localization of the perirolandic area. Thus, combined functional evaluation of the periolandic area by SEP as well as by BS is helpful in assessing sensorimotor functions.
Brain* ; Electrodes ; Epilepsy* ; Evoked Potentials, Somatosensory* ; Fingers ; Forearm ; Hand ; Humans ; Median Nerve ; Tongue

No abstract available.