PURPOSE: Sarcoidosis is a noncaseating granulomatous disorder that can affect any organ. In its early phase, sarcoidosis is clinically similar to tuberculosis. We report a case of sarcoidosis diagnosed through ocular and systemic evaluations in a patient who developed multiple conjunctival nodules during antituberculous treatment for nasal mucosal nodules. CASE SUMMARY: A 37-year-old woman who had been on antituberculosis medications for 9 months because of multiple nasal mucosal nodules was referred for conjunctival hyperemia and the multiple nodules. The ocular examination revealed multiple conjunctival nodules in the upper and lower fornices. Biopsy and systemic evaluations were performed. A conjunctival biopsy specimen showed noncaseating granulomatous inflammation compatible with sarcoidosis. Laboratory tests revealed hypercalciuria and increased levels of ACE. Chest computed tomography showed bilateral hilar and mediastinal lymphadenopathy. Subconjunctival steroid injection was done for the conjunctival nodules and systemic steroid treatment was started as well. Complete resolution of conjunctival lesions was obtained. CONCLUSIONS: In cases of chronic, multiple conjunctival and nasal mucosal nodules, sarcoidosis should be considered in the differential diagnosis.
Adult ; Biopsy ; Conjunctiva ; Diagnosis, Differential ; Female ; Humans ; Hypercalciuria ; Hyperemia ; Inflammation ; Lymphatic Diseases ; Nasal Mucosa ; Sarcoidosis ; Thorax ; Tuberculosis

PURPOSE: We investigated the prognostic impact of discordance between the receptor status of primary breast cancers and corresponding metastases. METHODS: A total 144 patients with breast cancer and distant metastasis were investigated. The estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) status of primary tumor and corresponding metastases were assessed. Tumor phenotype according to receptor status was classified as triple-negative phenotype (TNP) or non-TNP. Concordance and discordance was determined by whether there was a change in receptor status or phenotype between primary and metastatic lesions. RESULTS: The rates of discordance between primary breast cancer and metastatic lesions were 18.1%, 25.0%, and 10.3% for ER, PR, and HER2, respectively. The rates of concordant non-TNP, concordant TNP and discordant TNP were 65.9%, 20.9%, and 13.2%, respectively. Patients with concordant ER/PR-negative status had worse postrecurrence survival (PRS) than patients with concordant ER/PR-positive and discordant ER/PR status (p=0.001 and p=0.021, respectively). Patients who converted from HER2-positive to negative after distant metastasis had worst PRS (p=0.040). Multivariate analysis showed that concordant TNP was statistically significant factor for worse PRS (p<0.001). CONCLUSION: Discordance in receptor status and tumor phenotype between primary breast cancer and corresponding metastatic lesions was observed. Patients with concordant TNP had worse long-term outcomes than patients with concordant non-TNP and discordant TNP between primary and metastatic breast cancer. Identifying the receptor status of metastatic lesions may lead to improvements in patient management and survival.
Breast Neoplasms ; Breast* ; Estrogens ; Humans ; Multivariate Analysis ; Neoplasm Metastasis* ; Phenotype* ; Prognosis* ; Receptor, Epidermal Growth Factor ; Receptors, Progesterone

Most cases of gastric subepithelial lesions follow a good clinical course; however, some lesions progress to malignant tumors, and treatment of tumors with a high risk of malignancy is essential. Surgical excision has been the primary treatment for tumors originating from the propria muscle layer, but it has the disadvantages of being invasive and causing postoperative functional abnormalities. With the development of endoscopic techniques and instruments, the role of endoscopic resection, which is a less invasive method for the removal of gastric subepithelial lesions, has been attracting attention. We performed an endoscopic full-thickness resection for 8 patients with gastric subepithelial lesions originating from the muscularis propria. No fatal complications occurred. Our findings suggest the need to develop various devices for resection and closure and to accumulate further experience through additional studies to prevent complications and specimen loss.

PURPOSE: To clarify the clinical benefit derived from the combined modality therapy (CMT) consisting of chemotherapy (CT) and involved field radiotherapy (RT) for stage I and II angiocentric lymphomas of the head and neck. MATERIALS AND METHODS: Of 143 patients with angiocentric lymphoma of the head and neck treated at our hospital between 1976 and 1995, 104 patients (RT group) received involved field RT alone with a median dose of 50.4 Gy (range : 20-70 Gy), while 39 patients (CMT group) received a median 3 cycles (range : 1-6 cycles) of CT before involved field RT. The response rate, patterns of failure, complications, and survival data of the RT group were compared with those of the CMT group. RESULTS: Despite a higher response rate, local failure was the most common pattern of failure in patients of both groups. The patterns of failure, including the systemic relapse rate were not influenced by the addition of combination CT. Although both modalities were well tolerated by the majority of patients, aberrant immunologic disorders or medical illnesses, such as a hemophagocytic syndrome, sepsis, intractable hemorrhage, or the evolution of second primary malignancies were more frequently observed in patients of the CMT group. The prognosis of patients in the RT group was relatively poor, with a 5-year overall actuarial survival rate of 38% and disease-free survival rate of 32%, respectively. However, their clinical outcome was not altered by the addition of systemic CT. Achieving complete remission was the most important prognostic factor by univariate and multivariate analyses, but treatment modality was not found to be a prognostic variable influencing survival. Conclusions : Involved field RT alone for angiocentric lymphoma of the head and neck was insufficient to achieve an improved survival rate, but the addition of CT to involved field RT failed to demonstrate any therapeutic advantage over involved field RT alone.
Combined Modality Therapy ; Disease-Free Survival ; Drug Therapy* ; Head* ; Hemorrhage ; Humans ; Lymphohistiocytosis, Hemophagocytic ; Lymphoma* ; Multivariate Analysis ; Neck* ; Prognosis ; Radiotherapy* ; Recurrence ; Sepsis ; Survival Rate

PURPOSE: We evaluated the efficacy of breast magnetic resonance imaging (MRI) for detecting additional malignancies in breast cancer patients newly diagnosed by breast ultrasonography and mammography. METHODS: We retrospectively reviewed the records of 1,038 breast cancer patients who underwent preoperative mammography, bilateral breast ultrasonography, and subsequent breast MRI between August 2007 and December 2010 at single institution in Korea. MRI-detected additional lesions were defined as those lesions detected by breast MRI that were previously undetected by mammography and ultrasonography and which would otherwise have not been identified. RESULTS: Among the 1,038 cases, 228 additional lesions (22.0%) and 30 additional malignancies (2.9%) were detected by breast MRI. Of these 228 lesions, 109 were suspected to be malignant (Breast Imaging-Reporting and Data System category 4 or 5) on breast MRI and second-look ultrasonography and 30 were pathologically confirmed to be malignant (13.2%). Of these 30 lesions, 21 were ipsilateral to the main lesion and nine were contralateral. Fourteen lesions were in situ carcinomas and 16 were invasive carcinomas. The positive predictive value of breast MRI was 27.5% (30/109). No clinicopathological factors were significantly associated with additional malignant foci. CONCLUSION: Breast MRI was useful in detecting additional malignancy in a small number of patients who underwent ultrasonography and mammography.
Breast ; Breast Neoplasms* ; Humans ; Information Systems ; Korea ; Limit of Detection ; Magnetic Resonance Imaging* ; Mammography* ; Retrospective Studies ; Ultrasonography* ; Ultrasonography, Mammary

Glossopharyngeal neuralgia (GPN) is a pain syndrome characterized by unilateral sharp pain in the sensory distribution of the ninth cranial nerve. The first line of treatment for GPN is medical. However, it usually provides only partial relief. Pulsed radiofrequency has been proposed as safe, nondestructive treatment method. We present two cases of secondary GPN that was managed with pulsed radiofrequency by extraoral approach. The results were satisfactory.
Glossopharyngeal Nerve ; Glossopharyngeal Nerve Diseases* ; Neuralgia ; Pulsed Radiofrequency Treatment*

Signet ring cell carcinoma is a rare form of gallbladder cancer and has a worse prognosis. Since few cases have been reported, information regarding the behavior and prognosis of the gallbladder carcinoma is limited. About twenty four cases of gallbladder signet ring cell carcinoma have been reported so far. We present a rare case of primary signet ring cell carcinoma of the gallbladder. A 58-year-old male presented with epigastric pain. Abdominal computed tomography showed diffuse gallbladder wall thickening with enhancement, gallstones, and choledocholithiasis. After endoscopic treatment of choledocholithiasis, laparoscopic cholecystectomy was performed. Pathologic examination of the resected gallbladder revealed adenocarcinoma of signet ring cell type in the epithelium. Immunohistochemical stain for cytokeratin 7 was positive for tumor cells. The final pathologic diagnosis was primary signet ring cell carcinoma of the gallbladder. Lymph node metastasis was detected and he received chemotherapy and radiotherapy. After one year of follow-up, bone metastasis in the lumbar spine and malignant ascites were found. The patient is being provided with palliative care.
Adenocarcinoma ; Ascites ; Carcinoma, Signet Ring Cell* ; Cholangitis ; Cholecystectomy, Laparoscopic ; Cholecystitis* ; Cholecystitis, Acute ; Choledocholithiasis ; Diagnosis ; Drug Therapy ; Epithelium ; Follow-Up Studies ; Gallbladder Neoplasms ; Gallbladder* ; Gallstones ; Humans ; Keratin-7 ; Lymph Nodes ; Male ; Middle Aged ; Neoplasm Metastasis ; Palliative Care ; Prognosis ; Radiotherapy ; Spine

Renal diseases other than diabetic nephropathy can occur in diabetic patients. Urinary abnormalities or clinical courses inconsistent with the natural progression of diabetic nephropathy are suggestive of non-diabetic renal diseases and should lead to more extensive investigations. Presence of non-diabetic renal diseases in diabetic patients can alter the treatment plan and the prognosis. We report a 9-year-old girl who had type 1 membranoproliferative glomerulonephritis as well as type 1 diabetes mellitus.
Child ; Diabetes Mellitus, Type 1* ; Diabetic Nephropathies ; Female ; Glomerulonephritis, Membranoproliferative* ; Humans ; Prognosis

PURPOSE: To investigate the regional changes in gray matter volume by using optimized voxel based morphometry in the whole brain of patients with Alzheimer's disease (AD) and to determine its correlation with cognitive function. MATERIALS AND METHODS: Nineteen patients with AD (mean mini mental state examination (MMSE) score = 20.4) and 19 age-matched control subjects (mean MMSE score = 29) participated in this prospective study. T1-weighted 3D-SPGR scans were obtained for each subject. These T1-weighted images were spatially normalized into study-specific T1 template and segmented into gray matter, white matter and CSF. After the images were modulated and smoothed, all of the gray matter images were compared with control images by using voxel-wise statistical parametric test (two-sample t-test). RESULTS: In patients with AD, total gray matter volume was significantly smaller than normal control (552+/-39 mL vs. 632+/-51 mL, p<0.001). Significant gray matter loss was seen in both the hippocampus and amygdala complexes, and the parahippocampi and frontoparietal cortices (p<0.01, family wise error corrected). Left cerebral atrophy was more prominent than the right. Loss of gray matter volume in both the superior frontal gyri and left inferior temporal gyrus had a strong correlation with lower MMSE score. CONCLUSION: Optimized VBM was able to visualize pathologic changes of AD in vivo. In AD there was widespread gray matter volume loss in the frontoparietal lobes as well as the medial temporal lobes and had a strong correlation between volume loss of specific cortical areas and MMSE score.
Alzheimer Disease* ; Amygdala ; Atrophy ; Brain ; Hippocampus ; Humans ; Prospective Studies ; Temporal Lobe

BACKGROUND: There is a worldwide tendency of an increasing prevalence of obesity. Therefore, this study aimed at determining whether such a trend exists among cerebral palsy (CP) patients. We also tried to compare this trend with the trend in the general population. We also discuss the importance of obesity trends in CP patients. METHODS: This retrospective study was performed on 766 ambulatory patients who were diagnosed with CP since 1996 in our institution. The associations among the prevalence of obesity and the body mass index, age, gender, the type of CP, the gross motor function classification system and the time of survey were investigated. RESULTS: The overall prevalence of obesity was 5.7%, and the overall prevalence of obesity together with being overweight was 14.6% for the ambulatory patients with CP. The prevalence of obesity and of obesity together with being overweight did not show a statistically significant temporal increase. On the other hand, age and gender were found to affect the body mass index of the ambulatory CP patients (p < 0.001 and 0.003, respectively). CONCLUSIONS: The extent of obesity and being overweight in the ambulatory patients with CP in this study was far less than that reported in the United States (US). In addition, it appears that the differences of the prevalence of obesity in children and adolescents between those with and without CP are disappearing in the US, whereas the differences of the prevalence of obesity in children and adolescents between those with and without CP seem to be becoming more obvious in Korea. Accordingly, care should be taken when adopting the data originating from the US because this data might be affected by the greater prevalence of obesity and the generally higher body mass indices of the US.
Adolescent ; Body Mass Index ; Cerebral Palsy/*complications ; Child ; Child, Preschool ; Female ; Humans ; Korea/epidemiology ; Male ; Obesity/complications/*epidemiology ; Prevalence ; Walking ; Young Adult