Metaplastic breast carcinoma is very rare, and metaplastic carcinoma with chondroid differentiation is even rarer. Here, we report a case of metaplastic carcinoma with extensive chondroid differentiation mimicking chondrosarcoma that was challenging to diagnose. The tumor was characterized by an abundant chondromyxoid matrix. The definitive area of classic invasive ductal carcinoma was minimal. The peripheral portion of the tumor showed increased cellularity with pleomorphism and definitive invasive growth. Tumor cells in the chondrosarcomatous areas were diffusely immunoreactive for S-100 protein, patchy positive for cytokeratin, but negative for epithelial membrane antigen (EMA). Tumor cells in carcinomatous areas were diffusely positive for cytokeratin, S-100 protein, and patchy positive for EMA. In both areas, tumor cells were negative for smooth muscle actin (SMA) and CD34, while oncoprotein p53 was overexpressed. When pathologists encounter breast tumors with chondroid differentiation, careful sampling and immunohistochemistry for cytokeratin and SMA are most helpful to differentiate metaplastic carcinoma from malignant phyllodes tumor and malignant adenomyoepithelioma.
S100 Proteins/chemistry ; Neoplasm Metastasis ; Muscle, Smooth/pathology ; Middle Aged ; Metaplasia ; Keratins/metabolism ; Immunohistochemistry ; Humans ; Female ; Cell Differentiation ; Carcinoma/*complications/metabolism/pathology ; CA-15-3 Antigen/metabolism ; Breast Neoplasms/complications/metabolism/*pathology ; Antigens, CD34/biosynthesis ; Actins/metabolism

The loss of posterior support may cause attrition of anterior teeth, and loss of occlusal vertical dimension (OVD). The collapse of the posterior support will eventually cause the pathologic change of the TMJ and masticatory muscles, unesthetic facial appearance and decreased masticatory function. Patients with destroyed dentition need extensive prosthetic treatments. Proper diagnosis and treatment planning are necessary for the stability of the neuromuscular system and the TMJ, and esthetic and functional definitive restorations. In this case, 63 year-old male presented with decreased masticatory force and esthetic problems due to pathologic destruction of teeth structure on entire dentition. Based on assessment of OVD including intraoral findings, radiographic examination and diagnostic cast, full-mouth rehabilitation with increase of OVD was planned using fixed partial denture and removable partial denture. Diagnostic wax-up was done after 4 mm increase of OVD determined by assessment of OVD. The OVD was maintained with the overlay type removable interim prostheses for 12 weeks to ascertain his comfort and adaptation to the new OVD. After the adaptation period, second interim prostheses with tooth preparation maintaining the established OVD was delivered. After 4 weeks, final prostheses were fabricated and delivered. After 7 month follow-up period, occlusal stability is maintained. Through this procedure, satisfactory outcomes were achieved both in functional and esthetic aspects.
Bite Force ; Dentition ; Denture, Partial, Fixed ; Denture, Partial, Removable ; Follow-Up Studies ; Humans ; Male ; Masticatory Muscles ; Prostheses and Implants ; Temporomandibular Joint ; Tooth ; Tooth Preparation ; Tooth Wear ; Vertical Dimension

The study was undertaken to evaluate the effect of major blood components on the CT number. The CT numbers according to the various levels of hematocrit, total protein and cholesterol were checked and analysed by the dilution of pack cell, plasma and 184 complete blood cell count samples under same scanning conditions. In case of normal protein and cholesterol level(33 samples), the CT number was increased about 5.5 hounsfield unit according to 10% increase of hematocrit level: and In case of normal hematocrit and cholesterol level(39 samles), the CT number was increased about 3.5 hounsfield unit according to 1gm% increase of protein level. CT number changes were not predictable according to the changes of cholesterol level(34 samples). From these results, we concluded that major blood components should be considered in the CT number analysis of tissue.
Blood Cell Count ; Cholesterol ; Hematocrit ; Plasma Cells

Background: Transfusions in pediatrics need to be performed carefully because of various variables, such as the blood volume and immature immune system. As a result, adverse transfusion reactions may appear differently from adults. This study examined the frequency and types of adverse transfusion reactions in pediatric patients. Methods: From January 2018 to December 2021, this study was conducted on 58 children who requested red blood cells, platelets, and plasma blood components from Chungbuk National University Hospital. The frequency and types of adverse transfusion reactions were analyzed retrospectively by reviewing blood transfusion-related medical records and compared with previous studies. Results: Approximately 0.9% of total blood components were transfused into pediatric patients; 1,179 units of blood components were transfused. The number of transfusions for red blood cells, platelets, and plasma was 383, 712, and 84 units, respectively. Among 58 patients, 23 adverse transfusion reactions were observed in 15 (25.9%) patients. Of these, 18 were febrile nonhemolytic transfusion reactions, and five were allergic transfusion reactions. Febrile nonhemolytic transfusion reactions occurred in 66.7% of cases with red blood cells, and allergic transfusion reactions occurred with platelets in 60% of cases. Conclusion This paper reported the incidence and types of adverse transfusion reactions in pediatric patients. This is expected to be more frequent in pediatric patients than adults, but most of them were relieved by supportive treatment because the symptoms were mild. As the awareness of hemovigilance is still low, it is essential to recognize and deal with adverse transfusion reactions through continuous education.

Systemic sclerosis is an autoimmune disease characterized by progressive fibrosis of the skin and visceral organs. Myasthenia gravis is also an autoimmune disease characterized by weakness and fatigue of skeletal muscles. The symptoms of systemic sclerosis and myasthenia gravis overlap clinically, so the recognition of disease co-occurrence may be delayed. Co-occurrence of myasthenia gravis and systemic sclerosis is very uncommon and usually diagnosed after use of D-penicillamine for treating the systemic sclerosis. We report a case of a 49-year-old female patient who complained of general weakness and was diagnosed with myasthenia gravis. Four months earlier she was diagnosed with systemic sclerosis with Sjogren's syndrome and her medications did not include D-penicillamine.
Autoimmune Diseases ; Fatigue ; Female ; Fibrosis ; Humans ; Middle Aged ; Muscle, Skeletal ; Myasthenia Gravis ; Penicillamine ; Scleroderma, Systemic ; Sjogren's Syndrome ; Skin

OBJECTIVE: Obtaining real-time image is essential for neurosurgeons to minimize invasion of normal brain tissue and to prompt diagnosis of intracranial event. The aim of this study was to report our three-year experience with a mobile computed tomography (mCT) for intraoperative and bedside scanning. METHODS: A total of 357 mCT (297 patients) scans from January 2009 to December 2011 in single institution were reviewed. After excluding post-operative routine follow-up, 202 mCT were included for analysis. Their medical records such as diagnosis, clinical application, impact on decision making, times, image quality and radiologic findings were assessed. RESULTS: Two-hundred-two mCT scans were performed in the operation room (n=192, 95%) or intensive care unit (ICU) (n=10, 5%). Regarding intraoperative images, extent of resection of tumor (n=55, 27.2%), degree of hematoma removal (n=42, 20.8%), confirmation of catheter placement (n=91, 45.0%) and monitoring unexpected complications (n=4, 2.0%) were evaluated. A total of 14 additional procedures were introduced after confirmation of residual tumor (n=7, 50%), hematoma (n=2, 14.3%), malpositioned catheter (n=3, 21.4%) and newly developed intracranial events (n=2, 14.3%). Every image was obtained within 15 minutes and image quality was sufficient for interpretation. CONCLUSION: mCT is feasible for prompt intraoperative and ICU monitoring with enhanced diagnostic certainty, safety and efficiency.
Brain ; Catheters ; Decision Making ; Follow-Up Studies ; Hematoma ; Intensive Care Units ; Korea ; Medical Records ; Neoplasm, Residual

The evolution of infarction in the rat middle cerebral artery(MCA) occlusion model was examined by atomic absorption spectrometric measurements of Na, K and Ca concentrations in brain tissue sample. At 2, 4, 6, 8, and 24 hours after MCA occlusion and sham occlusion the brain tissue samples were obtained. Tissue water concentrations were estimated from dry-wet weight measurement. The effects of nimodipine(2 microgram/kg/min for 10 min) administered intra-venously at 4 hours(Group A), 6 hours(Group B), and 9 hours(Group C) after MCA occlusion were investigated on both the size of infarction and tissue water, Na, K, Ca concentrations at 24 hours. The result were as follows : 1) Normal concentrations of water, Na, K, and Ca averaged 0.793+/-0.009ml, 54.06+/-4.18 micromole, 81.04+/-3.44 micromole, and 3.578+/-0.712 micromole/gm wet weight. At the infarct site by 24 hours, the changes of tissue water and ionic concentrations were conspicuously evident so that water increased by more than 10%(p<0.005), Na increased by more than 120%(p<0.005), K decreased by more than 75%(p<0.005), and Ca increased by more than 200%(p<0.005). 2) The remarkable shifts of Na, K, and Ca concentrations occurred at 4-6 hours so that 60-85% of the ionic shifts developed by 6 hours. This characteristics of chronological ionic changes correlated well with the findings of 2% TTC staining during the evolution of infarction. Water concentrations increased rapidly at 2-4 hours so that nearly 80% of water shift developed by 4 hours. 3) In group A(administered at 4 hours), nimodipine treatment significantly reduced both the ionic shifts at the infarct site and the size of infarction compared with non-treated rats(p<0.05). 4) In group B(administered at 6 hours), nimodipine treatment did not significantly reduce the ionic shifts but did reduce the size of infarction compared with non-treated rats(p<0.05). In group C(administered at 8 hours), nimodipine treatment significantly reduce neither the ionic shifts nor the size of infarction. In summary it was concluded that the progressive changes in tissue water and ionic concentrations developed at the infarct sites and the critical period of the changes was between 4 and 6 hours, and nimodipine treatment was effective when administered within 4 hours. The results suggested that measurement of tissue ionic concentrations could be used as an alternative method for assessing tissue damage and a reliable method to quantify the tissue damage. This method may be useful for determining the time window for therapeutic protocol, as well as for evaluating therapeutic effects.
Absorption ; Animals ; Brain ; Critical Period (Psychology) ; Infarction ; Infarction, Middle Cerebral Artery* ; Ischemia* ; Middle Cerebral Artery* ; Nimodipine* ; Rats*

OBJECTIVE: With improved technology, the values of intraoperative computed tomography (iCT) have been reevaluated. We describe our early clinical experience with a mobile CT (mCT) system for iCT and discuss its clinical applications, advantages and limitations. METHODS: Compared with intraoperative magnetic resonance imaging, this mCT system has no need for major reconstruction of a preexisting operating room for shielding, or for specialized instruments or equipment. Patients are placed on a radiolucent head clamp that fits within the gantry. Because it consists simply of a scanner and a workstation, it can be moved between locations such as an operating room, an intensive care unit (ICU) or an emergency room without difficulty. Furthermore, it can achieve nearly all types of CT scanning procedures such as enhancement, temporal bone imaging, angiography and three-dimensional reconstruction. RESULTS: For intracranial surgery, mCT can be used for intraoperative real-time neuronavigation by interacting with preoperative images. It can also be used for intraoperative confirmation of the extent of resection of intracranial lesions and for immediate checks for preventing intraoperative unexpected accidents. Therefore, the goals of maximal resection or optimal treatment can be achieved without any guesswork. Furthermore, mCT can achieve improved patient care with safety and faster diagnosis for patients in an ICU who might be subjected to a ventilator and/or various monitoring devices. CONCLUSION: Our initial experience demonstrates that mCT with high-quality imaging offers very useful information in various clinical situations.
Angiography ; Emergencies ; Head ; Humans ; Intensive Care Units ; Korea ; Magnetic Resonance Imaging ; Neuronavigation ; Operating Rooms ; Patient Care ; Temporal Bone ; Ventilators, Mechanical

Neurinomas of the trigeminal nerve are relatively rare tumors that are arising from the gasserian ganglion or trigeminal nerve root and constitute 0.2% of all brain tumors. Although the most common clinical feature is the signs of trigeminal nerve involvement, the symptoms and signs are so variable that middle fossa syndrome, symptoms and signs of cerebellopontine angle tumor, cerebellar and brain stem compression may be developed sequentially through the extension of tumor. Radiological studies such as plain skull x-ray, angiogram and pneumoencephalogram are known to be helpful, but now the CT scan gives the early detection of the small tumors as well as the definite diagnostic clues and anatomical location. The profusely and beautifully illustrated one hundred thirty one cases that have been found from the literature are reviewed. Authors present four cases of neurinoma of the trigeminal nerve operated during recent one year with the analysis of clinical features, comparing with the cases reviewed from the literature.
Brain Neoplasms ; Brain Stem ; Neurilemmoma* ; Neuroma, Acoustic ; Skull ; Tomography, X-Ray Computed ; Trigeminal Ganglion ; Trigeminal Nerve*

The Present study investigated not only the feasibility of organotypic spheroid culture system taken from human malignant gliomas, but also the similarities and differences between surgical specimens and cultured spheroids using light microscopy, electron microscopy, and flow cytometric examination. Surgically resected tumor specimens from eighteen human malignant gliomas were minced and explanted into agarose-coated culture wells. After three to five days, these microtumor fragments emerged as spheroids and could be maintained as organotypic spheroids for more than eight weeks. Measurements of the spheroids showed that they decreased during the initial two to three weeks and afterwards remained unaltered over a specific period of time. This growth pattern of the spheroids was consistent with the condition of tumors in vivo suggesting the linkage of cell proliferation and loss. Light microscopic and electron microscopic studies of the spheroids demonstrated that morphological structures were similar to those of the original tumor tissue in vivo and histopathologic characteristics of the original tumor were maintained over a long culture period. The spheroids contained connective tissues, blood vessels, macrophages, and neutrophils maintaining a three-dimensional architectural resemblance to the original tumors. Of three pairs of the surgical and spheroid specimen examined by the flow cytometry, one showed a change of ploidy pattern and two contained increased fractions of proliferating cells. It is concluded that this microtumor spheroid system can maintain the characteristics of the original tumors, and may serve as an alternative to the in vivo xenograft model for the research of brain tumor biology, invasion and immunology while providing a valuable technique for the evaluation of new therapies, such as biological response modifiers.
Allergy and Immunology ; Biology ; Blood Vessels ; Brain Neoplasms ; Cell Proliferation ; Connective Tissue ; Flow Cytometry ; Glioma* ; Heterografts ; Humans* ; Immunologic Factors ; Macrophages ; Microscopy ; Microscopy, Electron ; Neutrophils ; Ploidies