Struma ovarii, the most common monodennal teratoma of the ovary, causes diverse problems in differential diagnosis. The literature on the pathology of struma ovarii has focused principally on the problem of formulating criteria of malignancy. In contrast, unusual gross and microscopic features of struma ovarii and its resultant problems in differential diagnosis have received relatively little attention. We report an ovarian teratoma which was almost entirely cystic, causing the diagnosis of struma to be overlooked. The removed ovarian tumor showed all the features of adenomatous goiter of the thyroid gland. The lining epithelium of the cysts was frequently flattened, and the follicles in the cyst wall were few and atrophic. The patient was a 58-year-old woman who was found to have an ovarian tumor by routine monographic examination
Diagnosis ; Diagnosis, Differential ; Epithelium ; Female ; Goiter* ; Humans ; Middle Aged ; Ovary ; Pathology ; Struma Ovarii* ; Teratoma ; Thyroid Gland*

Sarcomatoid renal cell carcinoma is an uncommon tumor that has to be distinguished from renal carcinosarcoma. We have described three cases of sarcomatoid renal cell carcinoma showing different clinical and light microscopic features. An ultrastructural study of the tumor cells from the sarcomatoid area revealed frequent desmosomal junction, confirming the epithelial nature of the neoplasm. All three cases showed an aggressive clinical course and tended to invade adjacent organs or tissues. We believe that an histological and immunohistochemical examination in conjunction with an electron microscopic examination are necessary to diagnose sarcomatoid renal cell carcinoma.
Carcinoma, Renal Cell* ; Carcinosarcoma* ; Desmosomes ; Microscopy, Electron

No Abstract Available.
Humans

PURPOSE: We compared the clinical manifestations of patients with tsutsugamushi disease between children and adults. METHODS: From January 2003 to December 2012, 768 patients diagnosed with tsutsugamushi disease were retrospectively reviewed, and the clinical characteristics, laboratory findings, and complications were compared between children and adults. RESULTS: No patterns of annual increases in the number of patients were noted in both children and adults. The higher incidences occurred in October and November respectively. By gender, male outnumbered female in children, but the opposite trend was seen in adults. By residential area, the urban distribution of children was higher than that of adults. Rashes (P=0.001) and eschar (P=0.004) were more common in children, while myalgia was more common in adults. Children had a high prevalence of anemia (P=0.041), and low incidence rates of thrombocytopenia, abnormal liver and renal function. Children yielded better results in the duration of their hospital stay and the incidence of complications (P<0.001). A comparison of the therapeutic effects of doxycycline and macrolide antibiotics, which was performed only on the children, did not reveal any significant differences. CONCLUSION: Compared to adults, children had higher incidence rates of male patients and more often suffered from rashes and eschar. Children yielded better results in the laboratory findings and duration of the hospital stay and complications. Therefore, when children are suspected to have tsutsugamushi disease, especially during its peak occurrence period, detailed physical examination and serological test should be performed to ensure a prompt diagnosis, and the use of macrolide antibiotics, which have fewer side effects, is expected to yield the same therapeutic effects.
Adult* ; Anemia ; Anti-Bacterial Agents ; Child* ; Diagnosis ; Doxycycline ; Exanthema ; Female ; Humans ; Incidence ; Length of Stay ; Liver ; Male ; Myalgia ; Physical Examination ; Prevalence ; Retrospective Studies ; Scrub Typhus* ; Serologic Tests ; Thrombocytopenia

Ampulla of Vater (AoV) is a small dilated duct less than 1.5 cm long, formed by the union of pancreatic duct and common bile duct. AoV has also anatomic layer of mucosa, sphincter of Oddi, perisphincteric or duodenal submucosa, and duodenal proper muscle, which corresponds to mucosa, muscularis mucosa, submucosa, and proper muscle layer of other gastrointestinal tract organs, respectively. Because of its small compact size and variation of anatomic structure, it is sometimes difficult to identify layering architecture of AoV. This anatomic difficulty may cause some problem in T classification of ampullary carcinoma (AC). The most confusing point in T classification is the vague definition of T2, "Tumor invades duodenal wall". It seems that duodenal wall includes duodenal mucosa, submucosa, and proper muscle layer. However there is no precise description or definition about duodenal wall that might lead personal variation in T classification of AC staging. We found that clinical course of AC with perisphincteric and/or duodenal submucosal invasion is more close to AC with T2 than T1. Although it is described as T1b according to T classification scheme of ordinary gastrointestinal tract cancer, we thought AC with T1b may have more high-grade malignant potential than those of other gastrointestinal (GI) tract malignancy. AC showed various clinicopatholgic findings that represent heterogeneous tumor groups within category of AC. Recently site-specific classification of AC was introduced, and it showed relatively well-categorized clinical prognosis. It may be reasonable to understand site-specific tumorigenesis in AC. The standard gross protocol is needed to evaluate pathologic T classification of AC. In conclusion, ampullary neoplasm is composed of various subtypes, which require a separate approach according to anatomic epicenter of ampullary neoplasm. Although submucosal invasion in AC was classified into pT1b, its' biologic behavior is more close to pT2.
Ampulla of Vater ; Carcinogenesis ; Classification ; Common Bile Duct ; Duodenum ; Gastrointestinal Neoplasms ; Gastrointestinal Tract ; Humans ; Mucous Membrane ; Neoplasm Staging ; Pancreatic Ducts ; Prognosis ; Sphincter of Oddi

Serial neurosonographic examinations are routinely performed at frequent intervals during nursery course of all preterm infants of very low-birth-weight who are admitted to the intensive care nursery of Presbyterian Medical Center from November 1, 1990 to July 30, 1992. After discharge, the following survivors who had received periodic, serial scanning by meas of cranial ultrasonography were longitudinally observed in an interdisciplinary neurodevelopmental follow-up program to a mean corrected age of 13 months. Neurodevelopmental outcome was assessed by means of Vojta's postural reaction and other neurological examinations. The results are as follows: 1) The incidence of PV-IVH in the study was 79%. 2) According to Papile's grading system of PV-IVH, gradel was 20%, gradell was 46%, gradelll was 19%, and grade IV was 13%. 3) The risk factors associated with PV-IVH were birth weight, gestational age, apgar score, ventilator care, RDS, and sepsis. 4) The mortality of PV-IVH was 20% for gradel, 19% for gradell, 44% for gradelll, and 67% for grade lV. 5) According to relationship between PV-IVH and neurodevelopmental outcome, in two of the four subjects with grade lll PV-IVH, moderate/severe CCD was developed. 6) According to relationship between PVE with cysts and nuerodevelopmental outcome, moderate/severe PVE with periventricular cysts larger than 3mm in diameter was associated with development of severe CCD.
Apgar Score ; Birth Weight ; Follow-Up Studies ; Gestational Age ; Hemorrhage* ; Humans ; Incidence ; Infant, Newborn ; Infant, Premature* ; Critical Care ; Mortality ; Neurologic Examination ; Nurseries ; Protestantism ; Risk Factors ; Sepsis ; Survivors ; Ultrasonography ; Ventilators, Mechanical

Hobnail hemangioma(HH) is a benign acquired vascular tumor of endothelial origin which should be differentiated from other malignant vascular neoplasm such as Kaposi's sarcoma or angiosarcoma. We report a case of hobnail hemangioma in a 21-year-old woman who had a dusky-red patch on her left shin. Histologically, ectatic vascular channels with a single layer of plumped endothelial cells were seen and the vascular channels seemed to dissect the collagen bundles. She underwent treatment with surgical excision with primary closure.
Collagen ; Endothelial Cells ; Female ; Hemangioma* ; Hemangiosarcoma ; Humans ; Sarcoma, Kaposi ; Vascular Neoplasms ; Young Adult

Atypical cutaneous fibrous histiocytoma (ACFH) is not well known and only a small number of cases have been reported. Characteristically, ACFH is found on the trunk and limbs of middle-aged women. Although considerable cellular atypia may be present, it occurs focally, the remainder of the tumor representing more classical cutaneous fibrous histiocytoma. A 37-year-old woman presented with a solitary brownish firm nodule on her right forearm. No other abnormalities were found in her personal or family history. Clinically, the tumor simulated a benign fibrous histiocytoma. Histologic examination revealed a poorly delineated intradermal tumor with the usual appearance of benign cutaneous fibrous histiocytoma, but a variable pro-portion of cells in the tumor were scattered atypical cells or bizarre multinucleated giant cells. We report upon a rare case of ACFH.
Adult ; Extremities ; Female ; Forearm ; Giant Cells ; Histiocytoma, Benign Fibrous* ; Humans

This is a report of five patients who experienced slow, severe, unilateral central vision loss without a history of any other systemic illness. All patients were female and the age of the patients ranged from 21 to 33 years, with a mean age of 27 years. The follow-up period was 1 to 3 years. Each patient had a small yellowish spot in the fovea, which was associated with subretinal or retinal hemorrhage. No inflammatory cells were found in the vitreous or anterior chamber. Most patients presented with a visual acuity of 0.3 to 0.6. In one patient, the presenting visual acuity was 1. 0. Each patient described a central scotoma which was confirmed by Amsler`s grid test. The presenting manifestations of the disorder did not progress or recur in any of these patients during the period of follow-up. Visual acuity recovered to the visual acuity of the initial visit in three of five patients. The fluorescein angiogram revealed the early hyperfluorescence in the spot of the fovea which remained the same through the late phase. Three of five patients demonstrated a neurosensory detachment of the macula usually with irregular margins. The spot of the fovea showed hypofluorescence on the indocyanine green angiography. No hyperfluorescence in the center of the macula was found on the ICG-A. To the best of our knowledge, this unique clinical entity does not seem to be consistent with any previously described maculopathies in its clinical, angiographic features, and its natural course.
Angiography ; Anterior Chamber ; Female ; Fluorescein ; Fluorescein Angiography ; Follow-Up Studies ; Humans ; Indocyanine Green ; Retinal Hemorrhage ; Scotoma ; Visual Acuity

Cerebral amyloid angiopathy (C.A.A) is characterized by the extracellular amyloid protein deposition in the vessel walls of the brain and meninges. It has been estimated to account for 5 to 10% of all primary, nontraumatic brain hemorrhage. We report two cases of C.A.A causing nontraumatic intracerebral hemorrhage in the frontal lobe. The first case was a 60-year-old female who was admitted for the left hemiplegia and dysarthralgia. Brain CT revealed right frontal lobe hemorrhage. The second case was a 72-year-old male who was admitted for amnesia and gait disturbance. Clinical impression was Alzheimer's disease. Brain MRI revealed multifocal small hemorrhage in the right frontal lobe. Microscopically, both cases showed dilated small arteries of superficial cortex and meninges with hyalinization. Some vessels showed microaneurysm and fibriniod necrosis. Congo-red stain also exhibited birefringence under polarized light. There was no evidence of Alzheimer's disease.
Aged ; Alzheimer Disease ; Amnesia ; Amyloid ; Arteries ; Birefringence ; Brain ; Cerebral Amyloid Angiopathy* ; Cerebral Hemorrhage ; Female ; Frontal Lobe ; Gait ; Hemiplegia ; Hemorrhage ; Humans ; Hyalin ; Intracranial Hemorrhages ; Magnetic Resonance Imaging ; Male ; Meninges ; Middle Aged ; Necrosis