We report a case of neurotized nevus with a sclerotic fibroma-like change in a 60-year-old female patient, who presented with a brown colored pedunculated nodule on the upper quadrant of the abdomen. The skin biopsy revealed a well-circumscribed, non-encapsulated nodule in the reticular dermis, which consisted of hypocellular hyalinized collagen bundles separated by clefts mixed with nevus cells. Nevus cells are small with a spindle appearance and contain Meissner corpuscle-like structures called nevic corpuscles. We suggest that a sclerotic fibroma-like change is an evolutionary end-point of a pre-existing lesion. This is supported further by the fact that neuroid change in the intradermal nevus represents the end stage of maturation of melanocytes of the nevi.
Abdomen ; Biopsy ; Collagen ; Dermis ; Female ; Humans ; Hyalin ; Melanocytes ; Middle Aged ; Nevus* ; Nevus, Intradermal ; Skin

Here, we present a case of anaplastic giant cell ependymoma (GCE) occurring in a 15-year-old woman. Squash smear slides for intraoperative frozen section diagnosis revealed oval to round cell clusters with a papillary structure in a fibrillary background. This was occasionally accompanied by the presence of bizarre pleomorphic giant cells with hyperchromatic nuclei and prominent intranuclear inclusions. These intranuclear inclusions were a key clue to diagnosis of ependymoma. Histologic analysis revealed features of a high-grade tumor with perivascular pseudorosettes and bizarre pleomorphic giant cells, which established the diagnosis of GCE. We performed a review of literatures about the cytologic features of GCE, including our case, thus proposing that intraoperative frozen diagnosis of GCE would be established by squash smear preparations featuring the mitosis and necrosis, as well as the high cellularity, and the presence of giant cells showing hyperchromatic nuclei with eosinophilic cytoplasm and intranuclear inclusions/pseudoinclusions.
Adolescent ; Cytoplasm ; Eosinophils ; Ependymoma ; Female ; Frozen Sections ; Giant Cells ; Humans ; Intranuclear Inclusion Bodies ; Mitosis ; Necrosis

BACKGROUND: Acne vulgaris is one of the most prevalent and emotionally debilitating dermatologic diseases. Emerging problems with conventional acne treatments, such as the resistance of Propionibacterium acnes to antibiotics and the safety of oral isotretinoin, create a demand for other treatment modalities for acne. An evolving understanding of the Propionibacterium acnes-produced porphyrins and the development of a number of light sources have led to the application of photodynamic therapy for the treatment of acne. OBJECTIVE: To study the effect of light therapy on the treatment of Acne Vulgaris using acne mode intense pulsed light (IPL), and photodynamic therapy with a combination of topical 5-Aminolevulinic acid (ALA, 20%) and acne mode IPL. A comparison of the two treatment modalities would then be made to examine the effect on inflammatory acne lesions and sebum excretion. METHODS: Thirteen patients with varying degrees of acne were included in the study after a 4 week washout period. ALA (20%) was applied to half of the face on each patient. After one hour, the whole face was exposed to intense pulsed light (DECA(R), Italia) using an acne mode (400~1,200 nm) starting at a fluence of 11 J/cm(2). The procedure was carried out three times with 2 week intervals, and the patients were evaluated on post-op 2nd, 4th, and 6th weeks. Histologic changes were observed before and after treatment. RESULTS: After the first and second treatment, there was a statistically significant reduction in inflammatory acne lesion counts and the amount of sebum production from baseline, in both the ALA-PDT group and the IPL group (p<0.05). However, no statistically significant reduction was shown after the third treatment in both groups. There was a slightly higher reduction in the count of inflammatory lesions and the amount of sebum production in the ALA-PDT site compared to the IPL site, but it was not statistically significant. On histologic examination, dermal inflammatory cell infiltrations around the perivascular and periappendageal area were significantly reduced and sebaceous glands became smaller after the 3rd treatment. The adverse effects were negligible. CONCLUSION: ALA-PDT using acne mode IPL, and light therapy using acne mode IPL alone were effective in the reduction of inflamed lesions and sebum secretion in patients with mild to moderate acne vulgaris. Furthermore, no significant adverse effects were observed with both treatments. However, no remarkable contrast of therapeutic effect was statistically observed between the two therapies either.
Acne Vulgaris* ; Anti-Bacterial Agents ; Humans ; Isotretinoin ; Photochemotherapy* ; Phototherapy* ; Porphyrins ; Propionibacterium ; Propionibacterium acnes ; Sebaceous Glands ; Sebum

Dowling-Degos disease is a rare autosomal dominant genodermatosis with a genetically determined disturbance of epidermal proliferation. The clinical symptoms of Dowling-Degos disease are characterized by the acquired reticulate pigmented anomaly of the flexures. We report a case of Dowling-Degos disease in a 27-year-old female, who presented with numerous small, hyperpigmented macules in reticular pattern, localized to the axillae, inframammary and inguinal areas, popliteal fossa, neck, and face.
Adult ; Axilla ; Female ; Humans ; Neck

Basal cell carcinoma (BCC) is noted for its many histologic variants because of its pluripotential origin from epithelial germ cells. Clear cell BCC has been recognized as a distinct variant and has a clear cell component made up of cells which are either vacuolated or display a finely granular eosinophilic cytoplasm. We report a case of clear cell BCC in a 62-year-old man who had a well-demarcated, skin-colored nodule on the left nasal ala. It was treated by surgical excision with a Burow's graft and no recurrence has been observed.
Carcinoma, Basal Cell* ; Cellular Structures ; Cytoplasm ; Eosinophils ; Germ Cells ; Humans ; Middle Aged ; Recurrence ; Transplants

Polyoma virus (PV) nephropathy is a known cause of graft loss after renal transplantation. In a renal transplant patient suspected of graft rejection, it is important to discriminate between PV induced interstitial nephritis and acute cellular rejection, because of similar pathologic findings. After the loss of the first allograft secondary to PV nephropathy, transplant graft nephroureterectomy before retransplantaton may have an influence in the recurrence of PV nephropathy. However, this question has not been completely resolved. Case: A 23-year-old male underwent first renal transplantation from his HLA haploidentical 25 year-old-sister. His renal function had been good with cyclosporine, steroid and azathioprine until 9 months after transplantation, when his serum creatinine level rose to 2.2 mg/dL. A renal biopsy revealed features of tubulitis and we confirmed PV nephropathy through a positive PV monoclonal antibody reaction to inclusion body. After gradual loss of graft function, he underwent hemodialysis. After 48 months of hemodialysis, the patient underwent cadaveric renal retransplantation without transplant graft nephroureterectomy. Thrombocytopenia and suspected delayed graft function occurred after 2 days of transplantation. A graft biopsy revealed thrombotic microangiopathy. Improved graft function was attained after a temporary stop of tacrolimus and ATGAM(R) bridging therapy. The patient is maintaining satisfactory graft function 33 months after retransplantation without clinical and serological evidence of recurrent PV infection.
Allografts ; Azathioprine ; Biopsy ; Cadaver ; Creatinine ; Cyclosporine ; Delayed Graft Function ; Graft Rejection ; Humans ; Inclusion Bodies ; Kidney Transplantation ; Male ; Nephritis, Interstitial ; Polyomavirus* ; Recurrence ; Renal Dialysis ; Tacrolimus ; Thrombocytopenia ; Thrombotic Microangiopathies ; Transplants* ; Young Adult

Colonoscopy is the current standard method for evaluation of the colon. The diagnostic accuracy and therapeutic safety of colonoscopy depend on the quality of colonic cleansing and preparation. Generally, all these preparations have been demonstrated to be safe for use in healthy individuals without significant comorbid conditions. Based on safety and efficacy concerns, polyethylene glycol (PEG) is most commonly utilized as a bowel preparation solution for colonoscopy. Adverse events in patients receiving PEG are mostly clinically non-significant. However, fatal adverse events rarely have been shown to occur in the few individuals who experience vomiting or aspiration. Anaphylactic shock associated with ingestion of PEG electrolyte solution is an extremely rare fatal complication, and reported mainly in Western countries. Here, we report the first case of anaphylactic shock following the ingestion of PEG solution in Korea.
Anaphylaxis* ; Colon ; Colonoscopy ; Eating* ; Humans ; Korea ; Polyethylene Glycols* ; Shock ; Vomiting

BACKGROUND/AIMS: There is substantial evidence supporting a role of inflammation in the pathogenesis of colorectal cancer; however, little is known about the association between serum C-reactive protein (CRP) and the risk of colorectal adenoma. This study was conducted to investigate the association between serum CRP and colorectal adenoma risk. METHODS: A retrospective cross-sectional study was performed on first-time screening colonoscopies in asymptomatic subjects who also had their serum CRP level measured during a routine health check-up between September 2006 and September 2009 in Korea. Serum CRP level was compared between high-risk and low-risk adenoma groups and independent predictors of high-risk adenoma were analyzed using multivariate regression analysis. RESULTS: Among the 3,309 eligible patients, the high-risk adenoma group had higher serum CRP levels than the low-risk adenoma group (P=0.000). In addition, patients with a high-risk adenoma were more frequently included in the high CRP group than in the low CRP group (8.6% vs. 4.0%, P<0.001). The prevalence of high-risk adenoma was 3.5 times higher in the highest quartile of CRP level (P=0.000) compared with that in the lowest quartile. In logistic regression analysis, a higher quartile CRP level was found to be an independent risk factor for high-risk adenoma (odds ratio, 1.8; 95% confidence interval, 1.3–2.5; P=0.000). CONCLUSIONS: High CRP level is associated with high-risk adenoma in both men and women. Our data may support the association between chronic inflammation and colorectal neoplasia, which warrants further investigation.
Adenoma* ; C-Reactive Protein* ; Colon ; Colonoscopy ; Colorectal Neoplasms ; Cross-Sectional Studies ; Female ; Humans ; Inflammation ; Korea ; Logistic Models ; Male ; Mass Screening ; Prevalence ; Retrospective Studies ; Risk Factors