To clarify the characteristics of HBV-associated renal lesions, renal biopsies obtained from 22 HBsAg seropositive patients(M:F=32:1) were studied. Other than two(age 4 and 12), all were adults(17-77 y.o.). Twelve of the patients had nephrotic syndrome(NS), 5 NS and hematuria(H), 10 proteinuria and H, one gross H, one microscopic H, and 4 normal urinalysis at the time of biopsy. Light microscopy showed minimal change lesion(MCL) in 9 cases, mesangial proliferative glomerulonephritis(MSPGN) in 6, MPGN type I in 7, MPGN type III in 6, and mebranous nephropathy(MGN) in 5 cases. There were variable immunofluorescent(IF) findings of 25 cases studied; IF staining were predominant with IgG in 10 cases, with IgA in 5 and with IgM in 2 cases. Complements tended to be more strong for C1 &/or C4 than C3. In electron microscopic(EM) studies of MCL group, rare mesangial deposits were noted(3/5). In MSPGN, aside from mesangial deposits, there were occasional subendothelia(2/4) or subepithelial(1/4) deposits. In MPGN type I, in addition to the usual EM features of MPGN, some subepithelial deposits were also observed in 5 cases. In MGN, 3 out of 4 showed subendothelial deposits. Among 7 cases stained for HBsAg all were negative with IF and 2 were positive with PAP method. It is concluded that clinico-pathological findings of HBV-associated nephropathy are variable and partly show lupus-like features, different from primary glomerulopathy.
Adult ; Male ; Female ; Humans ; Biopsy

The prognostic significance of morphologic parameters was evaluated in 36 cases of renal cell carcinoma diagnosed during five years(1986~1990). We reviewed and classified on the basis of pathologic stage, tumor size, histologic pattern, cell type and nuclear grade. Mean age was 51 years old. Average tumor size was 7.3 cm in diameter. Six of 35 patients died of disease. Overall mean survival was 43.3+/-7.3 months. An increasing nuclear grade was generally correlated with a decrease in cummlative survival rate. Similarly, a higher stage at the time of diagnosis could predicated a low survival rate only for high nuclear grade carcinoma. There was an apparent positive correlation between grade and age, grade and size, grade and cell type, cell type and histologic pattern as well as stage and age. This positive correlations are in part a function of nuclear grade; only 20% of grade 3 & 4 tumor consisted of clear cells whereass 71% of grade 1 & 2 consisted of clear cell type. All 6 cases of granular cell types and 50% of mixed cell type were grade 3 & 4. The tumor size of the primary was well correlated with the nuclear grade. Nuclear grade was the most significant factor among the morphologic parameters studied.

BACKGROUND: Redundant and wrinkled face is a common finding in patients with long-standing leprosy, which is responsible for the appearance of premature aging. Chemical peeling plays a role in dermal regeneration in the treatment of wrinkles. However, the effect of chemical peeling has rarely been studied in patients with leprosy. OBJECTIVE: To investigate the effect of chemical peeling on dermal connective tissue components and clinical improvement of facial wrinkles in patients with leprosy. METHODS: Five patients with clinically and bacteriologically inactive lepromatous leprosy were treated with 70% glycolic acid plus 35% trichloroacetic acid (GA-TCA). Histologic and clinical changes were evaluated at 0 and 90 days postpeel. RESULTS: Histologically, collagen fibers and ground substance increased significantly but elastic fibers did not change at 90 days postepeel. Clinically, fine wrinkles improved considerably, whereas most deep wrinkles remained unchanged at day 90. CONCLUSION: This study demonstrates that chemical peeling with GA-TCA, or medium-depth peeling, causes an increase in collagen and ground substance but not in elastic fibers. These changes result in limited clinical improvement in the facial wrinkles of leprosy patients. Therefore, medium-depth chemical peeling may be insufficient to improve the premature aging appearance in patients with leprosy.
Aging, Premature ; Collagen ; Connective Tissue* ; Elastic Tissue ; Humans ; Leprosy* ; Leprosy, Lepromatous ; Regeneration ; Trichloroacetic Acid

Sebaceous carcinoma is uncommon and usually presents in the ocular adnexa as a cancer of the meibomian glands. They are frequently mistaken for chalazion. Considerable time often elapses before a diagnosis is made. We present a case of sebaceous carcinoma of the left eye lid in 59 year old female who had a history of 3 repeated surgical resections clinically diagnosed as chalazion during last 3 years.
Female ; Humans

A case of extrastkeletal Ewing's sarcoma on lower extremity in a 60-year-old male is reported. Extraskeletal Ewing's sarcoma is a rare malignant neoplasm that shows similar histologic and ultrastructural features to Ewing's sarcoma of bone. Histologically, the neoplasm was composed of small, round to oval cells with scant cytoplasm that were arranged in sheets with large area of necrosis. Electron microscopy of the neoplastic cells revaled scant cytopasm containing glycogen rosettes and a paucity of organelles. There is no ultrastructural evidence to indicate the origin of the cells.
Male ; Humans

Embryonal carcinoma of testis may be composed of primitive cells with epithelial appearance showing prominent variation in size and shape, clear cytoplasm, overlapping nuclei. and many mitoses. Multiple lymph node enlargement was noticed in a 45-year-old man with known huge testicular tumor, 20 x 15 cm, and clinically malignant lymphoma was suspected. Microscopic and cytologic finding of both biopsy and needle aspiration from neck lymph node disclosed highly undifferentiated large cells, mostly in solid sheets and often forming glandular spaces. Massive necrosis was observed. Cytologic diagnosis of embryonal carcinoma was made possible, relied on the result of immunohistochemistry that revealed negative LCA, and positive cytokeratin and CEA as well as the cytologic features. Serum levels of HCG and AFP of the patient, in addition, were markedly elevated.
Male ; Humans ; Biopsy ; Neoplasm Metastasis

To investigate the mechanism of crescent formation, sequential pathologic changes from the New Zealand White rabbits with anti-GBM antibody induced GN by administration of guinea pig anti-GBM IgG were studied by light (LM), immunofluorescent (IF) and electron (EM) microscopy. Although no glomerular changes were observed in LM, swelling of the endothelial cells and the epithelial cells were noted in EM by day 2. By day 7, early and cellular crescents were evident. Proteinaceous materials and fibrins were noted in the glomerular capillary lumina (GCL) and Bowman's space (BS) associated with segmental hypercellularity. The GBM damage became progressively severe, followed by focal detachment of the visceral epithelial cells from the GBM. At day 14, fibrin strands, mononuclear cells and collagen fibrils were present between the proliferating extracapillary cells. At day 31, fibrocellular crescents were predominated. Elongated spindle cells, morphologically resembling myofibroblasts, were noted near the Bowman's capsule (BC). A degree of tubular atrophy, interstitial fibrosis, and inflammatory infiltrates increased as it did with fibrous organization of crescent. Intense linear IF staining for IgG and C3 were seen throughout the experiments along the GBM. In conclusion, the progression of crescent from an early "proteinaceous" stage through cellular, fibrocellular and fibrous stages was well documented in this study. Inflammatory cells and coagulation mechanism may activate the initiation of the GBM damage at the early stage. Activated periglomerular mononuclear cells may also cause disruption of BC which facilitates entry of activated periglomerular cells and fibroblasts into BS leading to progressive fibrous crescent formation.
Animals ; Atrophy ; Bowman Capsule ; Capillaries ; Collagen ; Endothelial Cells ; Epithelial Cells ; Fibrin ; Fibroblasts ; Fibrosis ; Glomerulonephritis ; Guinea Pigs ; Immunoglobulin G ; Microscopy ; Myofibroblasts ; Rabbits*

Facial nerve paralysis in leprosy adversely affects facial regions from the forehead to the lip. In particular, lagophthalmos in patients with leprosy causes exposure keratitis, corneal and conjunctival dryness which can progress blindness and disfigurement. The function of the eyelids is controlled by the oculomotor nerve and the facial nerve. In leprosy patients the oculomotor nerve continues to function causing the levator muscle to lift the eyelids. However, paralysis of the facial nerve prevents the orbicularis oculi muscle from closing the eyelids, resulting in lagophthalmos. Various methods were developed to correct lagophthalmos, one of which was temporal muscle transfer(TMT) reported in 1934 by Gillies. Since we noted relatively high occurrence of ptosis as a complication in patients treated previously with the TMT, we performed other surgical procedures for laglphthalmos over 15 years, not to make the ptosis. Although most of the patients quite improved post-operatively, partial lid-gap frequently persisted. It may be related to involutional changes and paralyzed orbicularis muscle. Recently, we conducted 4 different TMT methods for last 4 years to reduce ptosis. The methods used included Brown & McDowell, McCord & Codner, modified Gillies & Anderson, and modified Gillies. Seventy-five TMT operations in 60 patients(26 males and 34 females) were done between 2011 and 2014. The age range of the patients was 54~87 years(the mean was 70.1). Fifteen patients had bilateral TMT procedures. As a result, ptosis appeared in 14(18.7%) out of 75 TMT procedures for 4 years. Four technical points should be considered for the initial assessment to prevent or reduce the incidence of ptosis. The first is the increase of the length of temporalis muscle flap to approximately 8cm with a parallel course to the lateral canthus, which will reduce the oblique pull. Second, the width of the fascia sling in the upper eyelid is narrow(3~4mm) to reduce weight on the eyelid. Third, the fascia sling in the upper lid is not tied with that of the lower lid at the medial canthal tendon to reduce tension. Lastly, the fascia sling in the upper eyelid is shallow(subdermal level) in location and as near as possible to the lid margin.
Aged ; Blindness ; Eyelids ; Facial Nerve ; Fascia ; Forehead ; Humans ; Incidence ; Keratitis ; Leprosy* ; Lip ; Male ; Oculomotor Nerve ; Paralysis ; Temporal Muscle* ; Tendons

Lepra bacilli invade the nasal mucosa from early stage. The infiltrated mucous membrane breaks down and ulcerates easily. Irritating crusts and ulcers occur, creating in perforation of the septum. When most of the septum and inner mucosal lining of the nose is destroyed, the nose is deprived of its support and it collapses. The nasal bones are typically intact, and the collapsed nose adheres to the facial skeleton, giving the characteristic 'sunken and short nose' deformities. We have operated on 25 patients with deformities such as short nose, sunken nose, collumela deformity and ala collapse since 1992. In short nose we operated with a paramedian forehead flap and rib cartilage graft in a cantilever pattern. In ala collapse we used a conchal cartilage graft. Lastly, in collumela deformity we used the local flap and a composite graft.
Cartilage ; Congenital Abnormalities* ; Forehead ; Humans ; Leprosy* ; Mucous Membrane ; Nasal Bone ; Nasal Mucosa ; Nose ; Ribs ; Skeleton ; Transplants ; Ulcer

Since 1992, We have treated nearly nine hundreds cases with paralytic ectropion and lagophthalmos as a sequela of Hansen's disease. Treatment to correct paralytic ectropion was performed by already established conventional surgical methods or their minor modifications. Although most of patients quite improved postoperatively, lagophthalmos frequently remained partially. Involutional orbital changes superimposed on decreased tone of the paralyzed orbicularis muscle make the corrective effect short-lived, which in turn brings about recurrence of ectropion and lagophthalmos. Of the surgical techniques, dynamic Gillies' temporalis muscle transfer was used mostly in the early stage. After that, various static methods such as gold plate insertion, transsection of levator muscle and spacer graft in the upper eyelid, and medial tarsorrhaphy, medial canthoplasty, horizontal wedge resection, spacer graft, lateral tarsal strip and lateral canthoplasty in the lower eyelid were applied. Sometimes canthal sling with Alloderm or autologous fascia to pull upward the lower eyelid or Kuhnt-Szymanowsky flap to tighten eyelid skin was added to the surgical procedures. In future, the more sophisticated techniques must be exploited to fulfill complete eyelids closure and to lower the recurrence rate. Upgrade of canthal sling method or return to Gillies' method may be an alternative at present.
Collagen ; Ectropion ; Eyelids ; Fascia ; Humans ; Leprosy ; Muscles ; Orbit ; Recurrence ; Skin ; Transplants