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.

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

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

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

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

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*

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

The lower eyelid descent and ectropion is resulted from either a decrease in intrinsic forces by senile change or an increase in extrinsic forces by the augmented distraction activity as a result of surgery, laser therapy, or trauma. Although facial nerve palsy in patients with leprosy causes paralysis of the orbicularis muscle, its antagonizing muscles, namely, the levator of the upper lid and the capsulopalpebral fascia of the lower lid, are functioning properly, resulting in lagophthalmos and retraction of the eyelids. There are various conventional surgical methods to correct the ectropion and retraction of the lower lid such as lateral canthoplasty, lateral canthopexy, lateral tarsal strip procedure as well as medial tarsorraphy. Spacer graft, recently introduced, is used to create separation between the tarsal plate and the capsulopalpebral fascia, and to insert maerials like palatal mucoperiosteum, conchal cartilage or Alloderm into the space between the two structures. In this study, we added to one more process to the routine procedure, canthal sling, in which two ends of lengthened Alloderm by 15mm were fixed to both canthal ligaments like a fascial sling. Spacer graft combined with concomitant cnathal sling was proven to be effective in elevating and reducing retraction of the lower lid, and to be superior to any other conventional methods.
Cartilage ; Ectropion ; Eyelids ; Facial Nerve ; Fascia ; Humans ; Laser Therapy ; Leprosy ; Ligaments ; Muscles ; Paralysis ; Transplants*

The lower eyelid is anatomically composed of three layers consisting of the anterior lamellar, the middle lamellar and the posterior lamellar. The anterior lamellar is composed of skin and the orbicularis muscle. The middle lamellar is composed of the orbital septum and orbital fat. The posterior lamellar is composed of the tarsus and the capsulopalpebral fascia and conjunctiva. The function of the lower eyelid is dependent upon a net result of balanced forces from the tarsal plate, canthal tendon and the orbicularis muscle sling acting on the lower eyelid. These forces provide the intrinsic support required to maintain contact between the lower eyelid and the globe. Forces acting against the intrinsic support of the lower eyelid (extrinsic forces) provide inferior and anterior net vector from the globe. The normal anatomic function and aesthetic appearance of the eyelid is achieved when the intrinsic forces are greater than or equal to extrinsic forces. The lower lid descent and ectropion characterized by unfavorable imbalance are a result of either a decrease in intrinsic forces by weaking the support as in senescence or an increase in extrinsic forces by strengthening the distraction forces as a result of surgery, laser treatment, or trauma. Either way, the extrinsic forces become greater than intrinsic forces. Facial nerve palsy of a leprosy patient causes paralysis of the orbicularis muscle but its antagonistic action muscles (the levator muscle of the upper lid and the capulapalpebral fascia of the lower lid) are functioning resulting in retraction and lapophthalmus of the upper and lower eyelid. Ectropion and retraction in the lower eyelid require various traditional surgical methods such as cantopexy, canthoplasty, lateral tarsal strip procedure as well as medial tarsorrhaphy. In addition to traditional methods, we used a spacer graft consisting of hard palate mucosa or Alloderm. Spacer grafts can be used in either a posterior or anterior method. In the posterior method, the spacer graft is used to create separation between the tarsal plate and the capsulopalpebral fascia / conjunctiva structure. A 5 to 25mm elliptical strip of hard palate mucosa is harvested from the patient and insterted between the two structures. The conjunctiva is dissected in this procedure. In the anterior method, we disinserted the lower edge of the tarsus and the capsulopalpebral fascia. A 5 to 25mm elliptical shaped strip of Alloderm was then inserted between the two structures. The conjunctiva remains intact in this procedure. In addition, a 5 to 35mm Alloderm strip was inserted to immitate the function of the fascia sling and increase the elevation of the lower lid as a spacer graft. The spacer graft with traditional surgical methods was more effective in elevating the lower lid and significantly reducing retraction than using traditional methods alone.
Aging ; Ankle ; Conjunctiva ; Ectropion ; Eyelids ; Facial Nerve ; Fascia ; Humans ; Laser Therapy ; Leprosy ; Mucous Membrane ; Muscles ; Orbit ; Palate, Hard ; Paralysis ; Skin ; Tendons ; Transplants

The imbalance between paralyzed orbicularis oculi and normally functioning its antagonists such as the levator of the upper lid and the capsulopalpebral fascia of the lower lid in patients with leprosy causes ectropion, eyelid retraction and lagophthalmos. There are a lot of surgical methods to manage the ectropion and retraction of the lower lid including lateral canthoplasty, lateral canthopexy, spacer graft, canthal sling, medial tarsorraphy as well as temporal fascia transfer. In this study, we applied the lateral tarsal strip combined with Kuhnt- Szymanowski procedure to thirty-two patients with paralytic ectropion and this method was proven to be very effective in correcting the abnormal conditions.
Ectropion ; Eyelids ; Fascia ; Humans ; Leprosy ; Transplants