Cystic nephroma (CN) is a benign cystic neoplasm composed of mixed epithelial and stromal elements. Less than 200 cases have been reported. We had a patient, a 41-year-old woman, who had a huge typical CN. The patient was admitted for a right renal mass that was found incidentally. On laparaoscopic right nephrectomy, there was an encapsulated 7 cm multilocular cystic mass at the upper pole. Microscopically, the cystic wall was lined by a single layer of low cuboidal or hobnail epithelium without a solid area. The thin septa were composed of bland, ovarian type spindle cells. The main differential diagnoses were mixed epithelial and stromal tumor (MEST), low grade multilocular renal cell carcinoma, and tubulocystic carcinoma. The results of immunohistochemical staining were cytokeratin 7/19(+/+) and CD10(-) in lining epithelium, estrogen receptor/progesterone receptor(+/+) in stromal cells. After surgery, she was free of recurrence for 10 months. We report this rare case and compare it with other cystic renal tumors, especially MEST.
Adult ; Carcinoma, Renal Cell ; Diagnosis, Differential ; Epithelium ; Estrogens ; Female ; Humans ; Keratins ; Kidney ; Nephrectomy ; Receptors, Estrogen ; Recurrence ; Stromal Cells

Tumoral calcinosis is a rare complication in uremic patients. An in-depth review of published literature suggests that most patients with uremic tumoral calcinosis do not respond to medical treatment. Here, we report the case of a patient on peritoneal dialysis who presented with infected multifocal masses on both hip joints and was successfully treated by medical intervention. The patient was diagnosed with uremic tumoral calcinosis by physical examination and radiologic imaging, and treated with low-calcium dialysis and a non-calcium phosphate binder, sevelamer, without increasing the dose of dialysis. At the 36-month follow-up, the majority of masses had disappeared and the patient was asymptomatic.
Calcinosis* ; Dialysis ; Follow-Up Studies ; Hip Joint ; Humans ; Peritoneal Dialysis* ; Physical Examination ; Sevelamer

BACKGROUND/AIMS: Kidney transplantation (KT) is the best treatment for end-stage renal disease patients. Although previous studies have demonstrated that the clinical outcome following living related (LR) KT is better than that following unrelated (LUR) KT in ABO-compatible KT recipients, recent studies showed no differences in clinical outcomes between the two treatments. In this study, we compared the clinical outcomes of LR and LUR KT in ABO-incompatible KT recipients. METHODS: From January 2011 to August 2013, 19 cases of ABO-incompatible KT were analyzed retrospectively. Eight kidneys (7 cases of parent-offspring and 1 case of siblings, Group 1) were donated from living-related donors and 11 (all spousal donors, Group 2) from living-unrelated donors. We investigated patient survival, graft survival, acute rejection, graft function, and complications. RESULTS: On Kaplan-Meier analysis, patient and graft survival during follow-up were 87.5% and 87.5% in Group 1; both were 100% in Group 2. Acute rejection, graft function, and medical and surgical complications were not significantly different between the two groups. CONCLUSIONS: The short-term clinical outcomes between LR and LUR KT in ABO-incompatible KT recipients were equivalent. Most domestic cases of LUR KT are from spousal donors and the spousal donor will be a major donor in ABO-incompatible KT patients.
Follow-Up Studies ; Graft Rejection ; Graft Survival ; Humans ; Kaplan-Meier Estimate ; Kidney Failure, Chronic ; Kidney Transplantation* ; Kidney* ; Retrospective Studies ; Siblings ; Tissue Donors ; Transplantation*

Invasive opportunistic infection by Aspergillus fungus is life-threatening for kidney transplant recipients. The occurrence of aspergillosis by hematogenous dissemination can affect multiple organs. Despite having a lower incidence rate relative to bacterial or viral infections in kidney transplant recipients, fungal infections produce the highest number of mortalities. We report a simultaneous case of invasive aspergillosis in the lung and liver of a 52-year-old female patient who underwent living donor kidney transplant. She suffered massive blood loss and high-volume transfusions due to postoperative bleeding. One month after transplantation, she reported intermittent coughing without febrile sensation. Computed tomography revealed nodules on the right and left upper lobes of the lung and multiple cystic liver lesions. Based on pathologic findings and culture from aspirate, she was diagnosed with invasive aspergillosis involving the liver and lung. After a 4 month voriconazole treatment the nodules in the lung and liver disappeared.
Aspergillosis ; Aspergillus ; Cough ; Female ; Fungi ; Hemorrhage ; Humans ; Incidence ; Kidney ; Kidney Transplantation ; Liver ; Living Donors ; Lung ; Middle Aged ; Opportunistic Infections ; Pyrimidines ; Sensation ; Transplants ; Triazoles

BACKGROUND: The Pap smear has brought about a dramatic improvement in the prevention of cervical cancer in women worldwide. In an effort to decrease the occasional false negatives in the Pap smear and further increase the screened population, ThinPrep Pap Test (TP), a fluid-based cytology collection method, has been developed. With preservation of claimed advantages of TP, we have developed a Pap test solution for manual preparatory process and compared our manually processed fluid-based Pap smear with TP to identify cytologic similarities and differences between the two methods. METHODS: Cervical swipes of 204 patients were prospectively collected in the 'Pap solution' and also in PreservCyt solution for TP. Diagnoses and smear characteristics were compared. RESULTS: The diagnoses of the paired smears agreed in 190 of the 204 cases (93.1%). The smear characteristics regarding overall cellularity and background cellularities were similar in the two methods and the stainability of the cells was virtually the same. CONCLUSIONS: The 'Pap solution' has similar performance characteristics as TP in many aspects. With its advantages of cost-effectiveness and easier preparatory process, the 'Pap solution' can match previously implemented thin layer preparation.
Female ; Humans ; Prospective Studies ; Uterine Cervical Neoplasms

PURPOSE: This study was planned to determine the efficacy and safety of mycophenolate mofetil (MMF) as a rescue treatment in patients with membranous nephropathy (MN) and focal segmental glomerulosclerosis (FSGS) who were not responsive to standard therapy with steroid and immunosuppressive regimen. METHODS: We planned a prospective, non-randomized study from Oct. 2002 to Aug. 2009, including biopsy-proven MN or FSGS patients in Keimyung university Dongsan hospital. MMF was initiated at 0.5-0.75 g twice daily, and advanced as appropriate or as tolerated to 0.75-1 g twice daily. RESULTS: 14 cases with MN and 5 cases with FSGS was enrolled. The mean age of patients was 51.7+/-12.3 years, and mean treatment duration was 14.4+/-6.5 months. Five patients (26.4%) went into complete remission and the seven (36.8%) into partial remission. The mean value of 24hr total urine protein over the follow-up 6 months' period declined significantly from 7.6+/-6.2 g in pre-treatment, to 4.1+/-3.2 g in 3 months, and 3.1+/-2.1 g in 6 months (p=0.011). The mean 24hr total urine protein decreased from 7.5+/-6.3 g in pre-MMF to 1.9+/-1.8 g in post-MMF (p=0.001). The mean serum albumin rose from 3.2+/-0.8 g/dL in pre-MMF to 3.9+/-0.5 g/dL in post-MMF (p=0.001). There were no significant changes in mean value for WBC, hemoglobin, serum creatinine, and total cholesterol. Side effects of MMF were infrequent and generally mild. CONCLUSION: MMF appears effective in 63% of patients with MN and FSGS who are resistant to other forms of treatment. Studies with more cases and multicenter controlled trials are required to establish the role and standards of MMF in these disorders.
Cholesterol ; Creatinine ; Follow-Up Studies ; Glomerulonephritis, Membranous ; Glomerulosclerosis, Focal Segmental ; Hemoglobins ; Humans ; Mycophenolic Acid ; Prospective Studies ; Serum Albumin

BACKGROUND: The incidence of acute rejection has decreased with the introduction of new immunosuppressive agents. However, several studies have shown that allograft survival has not clearly improved over the past few decades. METHODS: We reviewed patients who underwent kidney transplantation between 1982 and 2007. We compared the causes of graft loss for three decades: 1982~1990 (period I),1991~2000 (period II), and 2001~2007 (period III), with the clinical characteristics of patients with functioning grafts and patients who lost their allografts. RESULTS: There were 785 recipients with a mean age of 36.1 years, and 65.2% were male. Graft loss occurred in 329 patients (41.9%), and the most common cause of graft loss was chronic allograft nephropathy (CAN, 52.0%), followed by patient death (17.6%), post-transplant glomerulonephritis (12.8%), and non compliance (7.9%). During the three time periods, 129, 172, and 28 patients lost their grafts, respectively. Five-year graft survival was 61.5%, 78.4%, and 90.8%, respectively, and increased significantly (P<0.000). CAN, as a cause of graft loss, fell from 65.1% (period I) to 32.1% (period III, P<0.000), but patient death increased from 12.4% to 32.1% (P=0.034). A multivariate analysis revealed that significant risk factors for graft loss included an older donor, transplantation at period I, and dual immunosuppression. Use of tacrolimus and mycophenolate mofetil was associated with a significantly reduced risk of graft loss. CONCLUSIONS: Graft survival has increased over the last three decades whereas the proportion of CAN, the most common cause of graft loss, has decreased. Attention to the main causes of graft loss, CAN, and patient death will offer potential improvement in graft survival.
Compliance ; Glomerulonephritis ; Graft Rejection ; Graft Survival ; Humans ; Immunosuppression ; Immunosuppressive Agents ; Incidence ; Kidney ; Kidney Transplantation ; Male ; Multivariate Analysis ; Mycophenolic Acid ; Rejection (Psychology) ; Risk Factors ; Tacrolimus ; Time Factors ; Tissue Donors ; Transplantation, Homologous ; Transplants ; Treatment Outcome

A spontaneous subcapsular hematoma in an allograft kidney is a rare condition with only a few cases reported in the literature. Common causes of subcapsular hematoma of an allograft include trauma, post-biopsy status, occult malignancy, vascular diseases, and infection. Chronic allograft dysfunction related to spontaneous subcapsular hematoma is extremely rare. We report a case of spontaneous subcapsular hematoma in a patient who underwent a renal transplant 14 years ago in which we could not find an associated condition.
Hematoma ; Humans ; Kidney ; Transplantation, Homologous ; Transplants ; Vascular Diseases

This study was performed to investigate the status of food restriction and the list of restricted foods in children with moderate to severe atopic dermatitis (AD), and to find out the effect of food restriction on the changes in nutrient intake and the severity of the disease. Sixty two patient children aged 12 months to 13 years presenting AD with a SCORing of Atopic Dermatitis (SCORAD) index between 20 and 50 were enrolled. The presence of food limitation, and list of restricted foods were surveyed through the caretakers and the patients were divided into 3 groups by the number of restricted food: non-restricted group, one to three restricted group, and more than three restricted group. Dietary intake was assessed for 3 months using a food frequency questionnaire (FFQ). Half of the subjects restricted foods. The restriction was higher in the order of soda, food additives, walnut, peanut, and other nuts as a single food item; and shellfish and crustacean group, processed foods, nuts, milk & dairy products, and meats as a food group. More than three restricted group ingested more fruits and less fish and meats, resulting in high consumption of vitamin C (p = 0.027). No significant difference in the ratio of nutrient intake by the number of restricted foods was observed in other nutrients. Significant improvement of AD symptom was observed in non-restricted group (p = 0.036) and one to three restricted group (p = 0.003). It is necessary to provide proper nutrition information and systematic and continuous nutrition management for balanced nutrient intake and disease improvement in children with AD.
Ascorbic Acid ; Child* ; Dairy Products ; Dermatitis, Atopic* ; Food Additives ; Fruit ; Humans ; Juglans ; Meat ; Milk ; Nuts ; Shellfish ; Surveys and Questionnaires

Recently, the rearrangement of RET proto-oncogene has been reported to be the most common genetic change in papillary thyroid carcinoma (PTC). However, its prevalence has been reported variably and its relation to clinical outcome has been controversial. The characteristic nuclear features of PTC usually render the diagnosis, but problem arises with equivocal cytologic features that are present focally. Although there remains some controversy, CK19 has been reported to be a useful ancillary tool for diagnosis of PTC. To evaluate the expression rate of RET/PTC rearrangement and CK19 in PTCs in a Korean population, we studied 115 papillary thyroid carcinomas in 3 mm-core tissue microarray based immunohistochemical analysis. The prevalence of Ret protein expression was 62.6% and the CK19 immunoreactivity was 80.9%. There was no statistically significant asso-ciation between the Ret positivity and CK19 immunoreactivity, although the percent agreement of the two was relatively high. The clinicopathological variables did not correlate with the expression of Ret. In conclusion, the prevalence of Ret protein expression and its clinicopathological implications in a Korean population are not much different from those reported in previous studies. However, its detection via immunohistochemistry can be a useful diagnostic tool for diagnosing papillary thyroid carcinoma in conjunction with CK19.
Adenocarcinoma, Papillary/*metabolism ; Adult ; Carcinoma/pathology ; Cell Line, Tumor ; Cytoplasm/metabolism ; Female ; Gene Expression Regulation, Neoplastic ; Humans ; Immunohistochemistry ; Keratin/*biosynthesis ; Korea ; Lymphatic Metastasis ; Male ; Middle Aged ; Oligonucleotide Array Sequence Analysis ; Oncogene Proteins/*biosynthesis ; Receptor Protein-Tyrosine Kinases/*biosynthesis ; Thyroid Neoplasms/*metabolism/pathology