Endodermal sinus tumor of the mediastinum is a very rare malignant tumor, usually affecting young adolescents, and its histologic findings are characteristic as that of gonadal germ cell origin. We describe the cytologic finding of fine needle aspiration of mediastinal endodermal sinus tumor in a 19-year-old male patient, comparing with tissue section. The tumor cells in smears were usually in tight clusters with large overlapping cells, which were arranged in a papillary or microacinar pattern, suggesting carcinoma. The tumor cells were large, round or oval with a small amount of cytoplasm which was occasionally vacuolated and had indistinct border. The nuclei were large, pleomorphic, and vesicular with large promi- nent nucleoli. The tissue sections showed typical findings of endodermal sinus tumor. Careful correlation of cytological findings and the serum alpha-fetoprotein level would be helpful to confirm the diagnosis.
Adolescent ; alpha-Fetoproteins ; Biopsy, Fine-Needle ; Biopsy, Needle ; Carcinoma, Papillary ; Carcinoma, Squamous Cell ; Child* ; Clonorchiasis ; Cytoplasm ; Diagnosis ; Dietary Proteins* ; Endodermal Sinus Tumor ; Female ; Germ Cells ; Giant Cells ; Gonads ; Humans ; Kidney Failure, Chronic* ; Male ; Mediastinum ; Middle Aged ; Thyroid Gland ; Urinary Tract Infections* ; Urinary Tract* ; Vesico-Ureteral Reflux* ; Young Adult

A case of invasive cribriform carcinoma of the breast is presented with fine need- le aspiration cytologic features. The aspiration was performed from a papable 2.0cm mass in the upper outer quadrant of the right breast in a 53 year-old woman. The aspirate showed cellular smear composed of larger three dimensional tight clusters, smaller monolayered loose clusters, and many individual cells on the clean background. In the clusters, the tumor cells were bordering central lumina, quite similar to the cribriform in histology. The tumor cells in the clusters and individual tumor cells had uniform, small and round nuclei. The chromatin was finely granular, and nuclear membrane was smooth. No discernible nucleoli were present (nuclear grade 1-2). Unless the abundance of individual cells and the cribriform growth pattern are recognized in the smear, the cytologic diagnosis of invasive cribriform carcinoma is difficult.
Female ; Humans ; Biopsy

No abstract available.
Aneurysm* ; Angiography* ; Circle of Willis*

So-called sclerosing hemangioma of the lung is a rare benign neoplasm which usually presents with a coin lesion detected through routine chest X-ray. We report two cases showing characteristic cytologic appearances which have been rarely reported. Both cases were young females with coin lesions in the lung. Fine needle aspiration of each case revealed unique but some different cytologic features. Case 1 showed bland-looking polygonal epithelial cells resembling bronchioloalveolar cells having pre- dominantly papillary configurations with loosely arranged solid sheets or isolated cells. Cytoplasms were plump, cyanophilic, and finely granular, with eccentric nuclei, The nuclei were usually monotonous, round-to-ovoid, and vesicular with a small but conspicuous nucleolus. In comparison to case 1, case 2 revealed largely loose pavement-like solid sheets or clusters rather than papillary patterns in the hemorrhagic background. The size of tumor cells were a little smaller than that of case 1. Bronchioloalveolar carcinoma and papillary adenocarcinoma of metastatic origin were considered to be one of the important differential diagnoses with these cytologic features. Histologically, both cases exhibited findings compatible with so-called sclerosing hemangioma of the lung.
Adenocarcinoma, Bronchiolo-Alveolar ; Adenocarcinoma, Papillary ; Biopsy, Fine-Needle ; Cytoplasm ; Diagnosis, Differential ; Epithelial Cells ; Female ; Humans ; Kidney* ; Lung ; Numismatics ; Pulmonary Sclerosing Hemangioma ; Renal Insufficiency* ; Thorax

Although procedures to reproduce the lost thumb through osteoplastic reconstruction and adjacent finger transfer operations appeared reasonably successful in providing for better prehension, nonetheless the methods lacked predictabiiity and too often the results were unacceptable esthetically. In recent years the development of microsurgery and surgical experiences has made it possible to free one stage transplantation of toe to replace missing thumb. Based on our past experiences with limb replantation since 1975, we accomplished the first toe to thumb transplantation done in Korea on October 28, 1978. Therafter we succeeded in one stage toe-to-thumb transplanatation in five cases. The shortest follow up period was thirteen months, and the longest, twenty-three months. One cases was excluded in this report due to short follow up period. Excellent results were achieved in all cases. There were no limping or pain while walking after removal of great toes or second toe. Great toe transplantation is more favorable donor area than second toe in toe-to-thumb transplantation. Free toe-to-thumb transplantation on making a thumb in missing thumb is the most excellent method of thumb reconstruction, but skillful technique and specialized microsurgical training is mandatory.
Extremities ; Fingers ; Follow-Up Studies ; Humans ; Korea ; Methods ; Microsurgery ; Replantation ; Thumb ; Tissue Donors ; Toes ; Transplantation ; Walking

Malignant gastrointestinal stromal tumors (GISTs) are rare non-epithelial, mesenchymal neoplasms of the gastrointestinal tract that metastasize or recur in 30% of patients who undergo surgical resection with curative intent. A 59-year-old man visited our hospital for an examination of a palpable mass in the left abdomen. Fourteen months prior to his visit, the patient underwent gastric wedge resection to remove a GIST of the gastric cardia. At the time of surgery, no evidence of metastatic disease was observed and the pathological interpretation was a high-risk GIST. A follow-up computed tomography scan of the abdomen revealed a partially necrotic solid mass (9.8 x 7.6 cm) and enhancing mass in the spleen (2.3 cm). On exploration, multiple masses were found in the liver, greater omentum, and mesentery. Here, we report a case of recurring GIST of the stomach that metastasized to the spleen. To the best of our knowledge, few reports of metastasis to the spleen exist.
Abdomen ; Cardia ; Follow-Up Studies ; Gastrointestinal Stromal Tumors ; Gastrointestinal Tract ; Humans ; Liver ; Mesentery ; Middle Aged ; Neoplasm Metastasis ; Omentum ; Spleen ; Stomach

Dermoid cysts are rare congenital tumors that occur primarily at the midline at a characteristic intradural location. However, dermoid cysts located at extradural and lateral regions have been rarely reported until now. In the present study, the authors demonstrate the unusual instance of an intracranial extradural dermoid cyst at the lateral sphenoid ridge. A 53-year-old woman admitted because of progressive headache and dizziness. The patient had no neurologic deficits, and magnetic resonance imaging with no contrast enhancement revealed a mass at the right sphenoid ridge. The mass was accompanied with sphenoid bone erosion visible on computed tomography. The patient underwent right pterional craniotomy, and the tumor including the capsule was totally resected. Presence of a dermoid cyst was confirmed with histopathological examination. The patient had no complications during the postoperative period. This study suggests that dermoid cyst should be considered for differential diagnosis of extradural and lateral intracranial masses.
Craniotomy ; Dermoid Cyst* ; Diagnosis, Differential ; Dizziness ; Female ; Headache ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Neurologic Manifestations ; Postoperative Period ; Sphenoid Bone

Intracisternal accessory nerve schwannomas are very rare; only 18 cases have been reported in the literature. In the majority of cases, the tumor origin was the spinal root of the accessory nerve and the tumors usually presented with symptoms and signs of intracranial hypertension, cerebellar ataxia, and myelopathy. Here, we report a unique case of an intracisternal schwannoma arising from the cranial root of the accessory nerve in a 58-year-old woman. The patient presented with the atypical symptom of hoarseness associated with recurrent laryngeal neuropathy which is noted by needle electromyography, and mild hypesthesia on the left side of her body. The tumor was completely removed with sacrifice of the originating nerve rootlet, but no additional neurological deficits. In this report, we describe the anatomical basis for the patient's unusual clinical symptoms and discuss the feasibility and safety of sacrificing the cranial rootlet of the accessory nerve in an effort to achieve total tumor resection. To our knowledge, this is the first case of schwannoma originating from the cranial root of the accessory nerve that has been associated with the symptoms of recurrent laryngeal neuropathy.
Accessory Nerve* ; Cerebellar Ataxia ; Electromyography ; Female ; Hoarseness ; Humans ; Hypesthesia ; Intracranial Hypertension ; Middle Aged ; Needles ; Neurilemmoma* ; Spinal Cord Diseases ; Spinal Nerve Roots

The aneurysm arising from fenestrated proximal anterior cerebral artery (ACA) is considered to be unique. The authors report a case of a 59-year-old woman who presented with a subarachnoid hemorrhage (SAH) secondary to a ruptured aneurysm originating from the fenestrated A1 segment of right ACA. The patient had another unruptured aneurysm which was located at the right middle cerebral artery bifurcation. She was successfully treated with surgical clipping for both aneurysms. From the previously existing literatures, we found 18 more cases (1983-2011) of aneurysms associated with fenestrated A1 segment. All cases represented saccular type of aneurysms, and 79% of the patients had SAH. There were three subtypes of the fenestrated A1 aneurysms depending on the anatomical location, relative to the fenestrated segment. The most common type was the aneurysms located on the proximal end of fenestrated artery (82%). Azygos ACA and hypoplastic A1 were frequently accompanied by the aneurysm (33% and 31%, respectively), and multiple aneurysms were shown in three cases (16%). Considering that fenestrated A1 segment is likely to develop an aneurysm, which has high risk of rupture, early management may benefit patients with aneurysms accompanied by fenestrated proximal ACA.
Aneurysm ; Aneurysm, Ruptured ; Anterior Cerebral Artery ; Arteries ; Female ; Humans ; Intracranial Aneurysm ; Middle Cerebral Artery ; Rupture ; Subarachnoid Hemorrhage ; Surgical Instruments

OBJECTIVE: The prefabrication of customized cranioplastic implants has been introduced to overcome the difficulties of intra-operative implant molding. The authors present a new technique, which consists of the prefabrication of implant molds using three-dimensional (3D) printers and polymethyl-methacrylate (PMMA) casting. METHODS: A total of 16 patients with large skull defects (>100 cm2) underwent cranioplasty between November 2009 and April 2011. For unilateral cranial defects, 3D images of the skull were obtained from preoperative axial 1-mm spiral computed tomography (CT) scans. The image of the implant was generated by a digital subtraction mirror-imaging process using the normal side of the cranium as a model. For bilateral cranial defects, precraniectomy routine spiral CT scan data were merged with postcraniectomy 3D CT images following a smoothing process. Prefabrication of the mold was performed by the 3D printer. Intraoperatively, the PMMA implant was created with the prefabricated mold, and fit into the cranial defect. RESULTS: The median operation time was 184.36+/-26.07 minutes. Postoperative CT scans showed excellent restoration of the symmetrical contours and curvature of the cranium in all cases. The median follow-up period was 23 months (range, 14-28 months). Postoperative infection was developed in one case (6.2%) who had an open wound defect previously. CONCLUSION: Customized cranioplasty PMMA implants using 3D printer may be a useful technique for the reconstruction of various cranial defects.
Computer-Aided Design ; Decompressive Craniectomy ; Follow-Up Studies ; Fungi ; Humans ; Methylmethacrylate ; Polymethyl Methacrylate ; Reconstructive Surgical Procedures ; Skull ; Tomography, Spiral Computed