Traditionally, it has been emphasized that hemolytic disease was the primary cause of gallstones (cholelithiasis) in most young patients. In recent years, gallstones and common bile duct calculi have been increasingly diagnosed in infants and children, unrelated to hemolytic diseases. On the matter, the World Health Organization (WHO) classified intraepithelial neoplasia (dysplasia) of gall bladder as one of the precursor lesions of invasive cancer. The following article describes the case of a 2-year-old girl who had a laparoscopic cholecystectomy due to cholelithiasis and the pathologic diagnosis was chronic cholecystitis with diffuse, mild mucosal dysplasia.
Child ; Cholecystectomy, Laparoscopic ; Cholecystitis ; Cholelithiasis ; Gallbladder ; Gallstones ; Humans ; Infant ; Preschool Child ; Urinary Bladder ; World Health Organization

Most tumors affecting Vater's ampulla are adenocarcinomas. Other histological variants or mixed forms are less frequent, even rare. We treated a rare case of composite signet-ring cell carcinoma and well differentiated neuroendocrine carcinoma of the ampulla of Vater in a 72-year-old Korean man with abdominal discomfort and jaundice for two weeks. Computed tomography (CT) and endoscopic retrograde cholangiopancreatography (ERCP) revealed a 2 cm protruding mass with an abrupt narrowing of the distal common bile duct. Pancreaticoduodenectomy was performed. An ill-defined nodular 2 cm mass in the ampulla of Vater invaded the entire duodenal wall and pancreatic parenchyma with duct dilatation of the remaining common bile duct and pancreatic duct. Two out of twenty regional lymph nodes were positive for metastases. Histopathologically, the tumor was composed of mucinous adenocarcinoma with predominant signet-ring cell components (80%) and well-differentiated neuroendocrine carcinoma (20%). There were intermingled and transitional areas between both elements as well as amphicrine tumor cells with dual differentiation. By Immunohistochemistry, the adenocarcinoma with signet-ring cells was positive for CK7 and CEA and the neuroendocrine carcinoma was diffusely positive for CK7, synaptophysin and chromogranin but negative for insulin and CEA. Of the two metastatic peripancreatic lymph nodes, one was a neuroendocrine carcinoma and the other was an adenocarcinoma. The postoperative course was uneventful. The patient refused adjuvant chemotherapy and was discharged to home 13 days later. The patient died of multiple liver metastases and carcinomatosis 11 months after surgery.
Adenocarcinoma ; Adenocarcinoma, Mucinous ; Aged ; Ampulla of Vater* ; Carcinoma ; Carcinoma, Neuroendocrine* ; Cellular Structures ; Chemotherapy, Adjuvant ; Cholangiopancreatography, Endoscopic Retrograde ; Common Bile Duct ; Dilatation ; Humans ; Immunohistochemistry ; Insulin ; Jaundice ; Liver ; Lymph Nodes ; Neoplasm Metastasis ; Pancreatic Ducts ; Pancreaticoduodenectomy ; Synaptophysin

Cystic hypersecretory carcinoma of the breast is a rare variant of ductal carcinoma of breast, first described in 1984 by Rosen and Scott. Histologically, it is characterized by the formation of dilated ducts and cysts containing an eosinophilic secretory product resembling thyroid colloid. Cytologic findings show a few clusters of atypical ductal epithelial cells in amorphous proteinaceous material with cracking artifact. Differential diagnosis include mucinous carcinoma and benign mucocele-like tumor. We present two cases of fine needle aspiration cytology of cystic hypersecretory intraductal carcinoma of the breast with a review of the literature.
Adenocarcinoma, Mucinous ; Artifacts ; Biopsy, Fine-Needle* ; Breast* ; Carcinoma, Ductal ; Carcinoma, Intraductal, Noninfiltrating* ; Colloids ; Diagnosis, Differential ; Eosinophils ; Epithelial Cells ; Thyroid Gland

Primary Sjogren's syndrome is a chronic autoimmune disorder characterized by xerostomia and keratoconjunctivitis sicca result from lymphocytic infiltrations of salivary and lacrimal glands.It may accompany by the wide spectrums of extraglandular symptoms,such as musculoskeletal,pulmonary,renal,intestinal,hematologic,and nervous system.However,overt cardiac manifestations are very rare and are documented only a few cases sporadically. We report a patient with primary Sjogren's syndrome who developed reversible congestive heart failure as part of a myocarditis.A 39-year-old woman with primary Sjogren's syndrome developed fatigue,dyspnea,and abdominal discomfort.An echocardiography revealed global hypokinetic left ventricle with markedly decreased ejection fraction (EF=39%),abnormal restrictive filling pattern,secondary tricuspid valve insufficiency and no pericardial effusion or thickening.A myocardial biopsy disclosed myocardial degeneration with lymphocyte infiltration.Following treatment with digitalis,diuretics,ACE inhibitor and corticosteroid,the symptoms of congestive heart failure improved.A repeat echocardiography showed an improved ventricular contractility and recovered both diastolic (normalized E/A ratio)and systolic (EF=50%)functions.
Adult ; Biopsy ; Echocardiography ; Female ; Heart Failure ; Heart Ventricles ; Humans ; Keratoconjunctivitis Sicca ; Lymphocytes ; Myocarditis* ; Pericardial Effusion ; Sjogren's Syndrome* ; Tricuspid Valve Insufficiency ; Xerostomia

Lymphocytic gastritis (LG) is a rare subtype of chronic gastritis. It is defined as dense proliferation of intraepithelial lymphocytes (IELs) more than 25 lymphocytes per 100 epithelial cells. The known major causes of LG are celiac disease and Helicobacter pylori infection. H. pylori associated LG (HpLG) has more enhanced cytotoxic and apoptotic tendencies than chronic H. pylori gastritis. A 12-year-old girl with postprandial epigastric pain was diagnosed HpLG on endoscopic biopsy. After the 1st eradication therapy, H. pylori bacilli were still found, and urea breathing test was positive. Although the endoscopic finding was partially improved, clinical symptoms and histologic finding were persisted. We could achieve the improvement of clinical symptoms and disappearance of IELs after the 2nd eradication. The discordant of histopathologic and endoscopic improvement occurred after the 1st eradication therapy of HpLG. Therefore the clinical and histopathologic evaluation should be considered as well as endoscopic findings.
Biopsy ; Celiac Disease ; Child* ; Epithelial Cells ; Female ; Gastritis* ; Helicobacter pylori* ; Humans ; Lymphocytes ; Respiration ; Urea

Endolymphatic sac tumor (ELST) is a very rare adenomatous tumor of the temporal bone histologically characterized by a typical papillary pattern. This tumor often shows a locally aggressive growth and recurrence despite its relatively benign histology. We report a case of endolymphatic sac tumor of the right jugular foramen in a 50 year-old male. Microscopically, the tumor was composed of uniform cuboidal to low columnar epithelial cells arranged in an arborizing papillary pattern. Under immunohistochemistry, the tumor cells were positive for cytokeratin, CD56, epithelial membrane antigen, neuron specific enolase, and vimentin. Discussion on the classification and histogenesis of adenomatous tumors of the middle ear and temporal bone has been active in western countries during the recent decades; however, these tumors have been very unusual in Korea. This is the second report of ELST in Korea, and consists of a discussion on related problems.
Classification ; Ear, Middle ; Endolymphatic Sac* ; Epithelial Cells ; Humans ; Immunohistochemistry ; Keratins ; Korea ; Male ; Middle Aged ; Mucin-1 ; Phosphopyruvate Hydratase ; Recurrence ; Temporal Bone ; Vimentin

Phospholipase C (PLC) plays a role in ligand-mediated signal transduction for cellular activity such as proliferation and differentiation. A recent observation that PLC- gamma1 is highly expressed in some kinds of human cancer tissue supports the view that PLC-gamma1 may be involved in proliferation and carcinogenesis. PLC-gamma2 is known to be involved in B cell differentiation and maturation. However, there have been few studies about the expressions of PLC-gamma1 and gamma2 in human lymphoid malignancy. In the present study, we examined the contents of PLC-gamma1 and gamma2 in 10 cases of B cell, 10 cases of T cell non-Hodgkin's lymphoma and 5 cases of Hodgkin's lymphoma to find out whether these enzymes play any role in the carcinogenesis by immunohistochemistry and immunoprecipitation. Immunoprecipitation analysis revealed that in contrast to increased expression of PLC-gamma2 only in B cell lymphoma, a considerably higher level of PLC-gamma1 was detected in both B and T cell lymphoma. Immunohistochemical finding confirmed this observation. PLC-gamma1 and PLC-gamma2 were expressed in the cytoplasm of most tumor cells. PLC-gamma2 was also expressed in mature B cells, while PLC-gamma1 was not expressed in reactive non-tumor cells. These results suggest that PLC-gamma1 mediated signal transduction implicates a significant role in the carcinogenesis of all types of lymphoid tissue, and PLC-gamma2 may play a role in the carcinogenesis of B cell lymphoma as well as B cell differentiation.
B-Lymphocytes ; Carcinogenesis ; Cell Differentiation ; Cytoplasm ; Hodgkin Disease* ; Humans ; Immunohistochemistry ; Immunoprecipitation ; Lymphoid Tissue ; Lymphoma, B-Cell ; Lymphoma, Non-Hodgkin ; Lymphoma, T-Cell ; Phospholipases* ; Signal Transduction ; Type C Phospholipases

Vegetable granuloma or pulse granuloma results from the implantation of food particles of vegetable origin. Pulse granulomas have mainly been reported in association with lung aspirations, the oral cavity with a history of oral procedures and less frequently in gastrointestinal tracks. We report a 31-year-old woman who presented with right nasal obstruction and was found to have a firm mass in the right nasal cavity. Paranasal sinus computerized tomography scans identified a calcified ring lesion in her right nasal cavity. Endoscopic sinus surgery was performed, and pathology examination revealed a lesion consistent with a pulse granuloma that contains starch granules with cellulose envelopes appearing as hyaline rings surrounded by inflammation cells and concentrically arranged delicate connective tissue. Pulse granuloma is a well described entity with distinct histopathology. However, pulse granulomas are rare, and especially extraoral pulse granulomas are extremely rare. We found that pulse granuloma can be occurred in the nasal cavity through regurgitation.
Adult ; Aspirations (Psychology) ; Cellulose ; Connective Tissue ; Female ; Granuloma* ; Humans ; Hyalin ; Inflammation ; Lung ; Mouth ; Nasal Cavity* ; Nasal Obstruction ; Nose ; Pathology ; Starch ; Vegetables*

Solitary fibrous tumor (SFT) was originally described in the pleura. An increased number of extrapulmonary sites of SFTs has been described. We report a case of SFT of the meninges in the pituitary fossa. A 56-year-old man was admitted with a severe headache and visual disturbance. The tumor, with osteolytic bony change, was 3.5 cm in greatest dimension and extended from the sphenoid sinus to the third ventricle level. Histologically, the tumor showed the typical features of a solitary fibrous tumor with no evidence of being high grade. By immunohistochemical study, the tumor cells were positive for CD34, vimentin, and Bcl2, but were negative for epithelial membrane antigen and S-100 protein. When fibrous tumors or tumors with hemangiopericytic vascular pattern involve the meninges, the possibility of their being SFTs should be considered, and a proper immunostaining is recommended. To our knowledge, ours is the first description of a case of SFT occurring at the meninges in the pituitary fossa.
Headache ; Humans ; Meninges* ; Middle Aged ; Mucin-1 ; Pleura ; S100 Proteins ; Solitary Fibrous Tumors* ; Sphenoid Sinus ; Third Ventricle ; Vimentin

A Bednar tumor is a rare neoplasm of intermediate malignant potential that accounts for 1-5% of all cases of dermatofibrosarcoma protuberans (DFSP). This tumor is considered a pigmented variant of DFSP, because the clinical and histological findings resemble DFSP. The diagnosis is commonly made in early to middle adult life except in cases with melanin containing cells. In the case presented here, the patient was a 3-year-old male who presented with a painless slow-growing 2.0x1.5x1.0 cm mass on the dorsal aspect of his right hand. Histological examination of the biopsy specimen revealed typical features of a Bednar tumor, which was composed of CD34 positive monomorphous spindle shaped cells arranged in a storiform fashion with moderate mitotic activity (up to 5 per 10 HPF) and scattered pigmented cells with dendritic processes. We report a rare case of Bednar tumor affecting a pediatric patient and review the medical literatures.
Adult ; Biopsy ; Child, Preschool ; Dermatofibrosarcoma* ; Diagnosis ; Hand ; Humans ; Male ; Melanins ; Pediatrics ; Pigmentation