BACKGROUND: Abnormal over-expression or gene amplification of epidermal growth factor receptor (EGFR) is important in the prognosis of non-small cell lung cancer (NSCLC). We investigated the frequency of EGFR protein expression and gene amplification, and the correlation between EGFR status and survival in NSCLC. METHODS: We examined 360 cases of microarrayed NSCLC tissues for the EGFR protein expression and EGFR gene amplification using immunohistochemistry and fluorescent in situ hybridization. RESULTS: EGFR protein expression and EGFR gene amplification occurred in 110 cases (30.6%) and 24 cases (6.7%), respectively. EGFR protein expression and gene amplification were more frequent in squamous cell carcinoma than in adenocarcinoma. Differences in EGFR protein expression did not dramatically affect survival curves (p=0.740), but differences in gene amplification did (p<0.05): EGFR gene amplification was associated with a lower 5-year survival rate. CONCLUSION: EGFR protein expression and gene amplification showed moderate correlation with each other. EGFR gene amplification predicted a poor prognosis, whereas EGFR protein expression did not.
Adenocarcinoma ; Carcinoma, Non-Small-Cell Lung* ; Carcinoma, Squamous Cell ; Epidermal Growth Factor* ; Gene Amplification ; Gene Expression* ; Genes, erbB-1 ; Immunohistochemistry ; In Situ Hybridization ; In Situ Hybridization, Fluorescence ; Prognosis ; Receptor, Epidermal Growth Factor* ; Survival Analysis* ; Survival Rate

BACKGROUND: The histogenesis and interrelationship of the various types of germ cell tumors (GCTs) have been proposed. Dysgerminoma/seminoma (D/S) is a primitive GCT that has not acquired the potential for further differentiation, whereas other types of GCTs are in a dynamic process of differentiation towards a somatic or extraembryonal direction. A primordial germ cell giving rise to a GCT undergoes a developmentally regulated erasure and resetting of imprinted genes, but changes in the imprinting pattern in GCTs as the tumor differentiates have not been well defined. We aimed to investigate the changes of the SNRPN methylation pattern between the germinomas and non-germinomatous GCTs, as compared with the somatic methylation pattern. METHODS: We used formalin-fixed paraffin-embedded tissue sections of 97 GCTs (18 Ds, 21 Ss, 17 yolk sac tumors (YSTs), 19 immature teratomas, and 22 mature teratomas). DNA methylation was evaluated after bisulfite modification, PCR amplification, and restriction enzyme digestion. RESULTS: The SNRPN methylation pattern was changed in 53/74 (71.6%) of GCTs as non-somatic patterns. There were significant differences in the methylation pattern between the germinomas and non-germinomatous GCTs, the GCTs being frequently hypo- methylated in Ds/Ss (73.3%), in contrast to the frequent hypermethylation seen in the YSTs and teratomas (47.7%, p<0.05). CONCLUSIONS: The methylation status of an imprinting gene may be involved in the mechanism causing cellular differentiation and tumorigenesis of GCTs.
Carcinogenesis ; Digestion ; DNA Methylation ; Endodermal Sinus Tumor ; Genomic Imprinting ; Germ Cells* ; Germinoma ; Humans* ; Methylation* ; Neoplasms, Germ Cell and Embryonal* ; Polymerase Chain Reaction ; Ribonucleoproteins, Small Nuclear* ; snRNP Core Proteins ; Teratoma

BACKGROUND: The correlation between microsatellite instability (MSI) and the prognosis of patients with endometrial carcinomas is controversial. The endometrial carcinomas in the young adult group usually have an excellent prognosis, and these tumors might have a different frequency of MSI compared with those in old women. Further, the pathogenetic mechanisms of the two groups might be different. We investigated the frequency of MSI in the endometrial cancers of patients who were under the age of 40 and we correlated the frequency with other prognostic factors. METHODS: MSI analyses were performed using 5 primers (BAT25, BAT26, D2S123, D5S346 and D17S250) and with using the genomic DNA obtained from the paraffin embedded tumor and the paired normal tissues. RESULTS: All 23 cases we examined exhibited endometrioid adenocarcinomas, and most of them were of the low international federation of gynecologists and obstetricians (FIGO) stage (stage I: 22, IIB: 1); 78% were microsatellite stable and 22% were MSI-low; an abnormal peak was present at only one marker, and any case of MSI-high was not identified. The FIGO stages of the 5 MSI-low cases were variable. CONCLUSIONS: The frequency of MSI in the endometrial cancers of young patients is not significantly different from the frequencies reported for all age groups in the previous studies, MSI-low does not seem to be related to the other poor prognostic parameters, although the number of cases we studied is insufficient to draw any firm conclusion.
Adult ; Male ; Female ; Humans ; Adenocarcinoma

PURPOSE: Sporadic colorectal cancer with micosatellite instability (MSI) is supposed to have a distinct molecular profile, distinct clinocopathologic feature, and a distinct prognosis. However, the test for MSI is still expensive, and a big machine is needed for routine screening. This study was performed to examine the clinicopathologic of characteristics of MSI sporadic colorectal cancer and the efficacy of immunohistochemical staining for hMLH1 and hMSH2. METHODS: Five hundred sixty nine colorectal adenocarinomas resected from September 2003 to August 2004 at Asan Medical Center were prospectively collected. FAP (familial adenomatous polyposis), HNPCC (hereditary non-polyposis colo-rectal cancer), and incomplete tests of immunohistochemical staining or MSI were excluded. The MSI status was determined by using PCR (polymerase chain reaction). A first round of immunohistochemical staining for hMLH1/hMSH2 was performed, and a second round was performed for cases showing a disparity between the two exams. The clinicopathologic variables regarding the MSI status were analyzed, and the sensitivity and the specificity of immunohistochemical staining were evaluated. RESULTS: Sporadic colorectal cancers with MSI-H were 8.4% (n=48) and were associated with age (< or = 60 years), colorectal cancer familial history, synchronous colorectal cancer, right side tumor location, and poorly differentiated or mucinous cell type. However, age, synchronous colorectal cancer, and right side tumor location were associated an the multivariate analysis. In the first round of immunohistochemical staining, no expression of hMLH1 and/or hMSH2 was obserred in 71 cases (12.5%), and the sensitivity and the specificity were 50.0% and 91.9%, respectively. After repetitive immunohistochemical staining for the 71 cases showing disagreement with the to MSI status, the sensitivity and the specificity of the second round of immunohistochemical staining were 53.3% and 97.6%, respectively. CONCLUSIONS: Sporadic colorectal cancer with MSI appears to have distinct characteristics. However, immunohistochemical staining for hMLH1 and hMSH2 is not accurate enough to be used instead of MSI.
Chungcheongnam-do ; Colorectal Neoplasms* ; Mass Screening ; Microsatellite Instability* ; Microsatellite Repeats* ; Mucins ; Multivariate Analysis ; Polymerase Chain Reaction ; Prognosis ; Prospective Studies ; Sensitivity and Specificity

Pulmonary arteriovenous malformations (PAVMs) are induced right to left shunt and if untreated properly, those may cause severe neurological problems. A 35-year-old man who had a headache checked into an emergency room to define a brain abscess in his brain with CAT scan as well as to examine suspicious two PAVMs in his chest X-ray. Not long after the surgical management of the brain abscess, he suffered recurrent convulsive movements. We would proceed to operate his PAVMs to prevent recurrent critical neurologic complications such as brain abscess or meningitis.
Animals ; Arteriovenous Malformations ; Brain ; Brain Abscess ; Cats ; Emergencies ; Headache ; Meningitis ; Periodontitis ; Seizures ; Telangiectasia, Hereditary Hemorrhagic ; Thorax

BACKGROUND: Angioimmunoblastic T-cell lymphoma (AITL) is a complex lymphoproliferative disorder and often mimics a viral infection with frequent skin involvement. Epstein-Barr virus (EBV) and human herpes virus (HHV)-6 are reported to be associated with AITL, but there are conflicting results. OBJECTIVE: We evaluated the association of EBV and HHV-6 with AITL. METHODS: We reviewed the clinical, histological and immunophenotypical features of 19 cases of AITL. Among them, 11 lymph node biopsies of AITL were examined for HHV-6, -7, and -8 by polymerase chain reaction (PCR) using virus-specific primers. In situ hybridization of EBV early region RNA (EBER) was performed and T cell receptor (TCR) gene rearrangement was also investigated in some cases. RESULTS: Among these 19 cases, maculopapular, plaque or nodular skin lesions accompanied AITL in 12 cases. Clonal TCR gene rearrangement was seen in 8/9 cases tested. EBER in situ hybridization was positive in 8 cases (57.1%). Among 7 cases with skin biopsies, five cases were consistent with cutaneous involvement of AITL, 1 case was a drug eruption, and the other case was Kaposi's sarcoma. Except a HHV-8 (+) case who also had Kaposi's sarcoma, all of these cases were negative for HHV-6, -7 and -8. CONCLUSION: Skin manifestation seems to be a cardinal component of AITL, be it in the context of presentation, progression or recurrent disease. Recognition of clinicopathological features of skin lesions in AITL as diagnostic clues should be stressed among dermatologists. The lack of HHV-6, -7 and -8 in lymph node biopsy of AITL argues against a pathogenic role for HHVs in AITL.
Biopsy ; Drug Eruptions ; Gene Rearrangement ; Genes, T-Cell Receptor ; Herpesvirus 4, Human ; Herpesvirus 6, Human ; Herpesvirus 8, Human ; Humans ; In Situ Hybridization ; Lymph Nodes ; Lymphoma, T-Cell ; Lymphoproliferative Disorders ; Polymerase Chain Reaction ; Receptors, Antigen, T-Cell ; RNA ; Sarcoma, Kaposi ; Skin ; Skin Manifestations ; Viruses

BACKGROUND: The risk profiles and stroke presentations may differ between elderly stroke patients and their younger counterparts. The most appropriate stroke-management regime for a better outcome can only be achieved with knowledge of the characteristics of elderly stroke patients. This study compared the clinical and radiological characteristics of elderly (> or =80 years) ischemic stroke patients with those aged <80 years. METHODS: Consecutive acute ischemic stroke patients were enrolled. The following parameters were obtained for each patient: clinical variables [i.e., risk factors, initial National Institutes of Health Stroke Scale (NIHSS) score, mode of onset, in-hospital complications, and modified Rankin scale (mRS) score at 3 months], radiological variables, and clinicoradiological discrepancies. RESULTS: Of the 436 enrolled patients, 60 (13.8%) were elderly. The proportion of men was lower among the elderly than among those patients aged >80 years (40.0% vs. 63.3%; p=0.001), while their initial NIHSS score was higher (median, 4 vs. 3; p=0.033). Furthermore, an unclear stroke onset (46.4% vs. 32.8%; p=0.049) and clinicoradiological discrepancies (13.8% vs. 5.7%; p=0.044) were more common among the elderly. The proportions of subjects with stroke of undetermined cause (30.0% vs. 18.0%; p=0.019) and multiple circulation infarctions (23.3% vs. 12.6%, p=0.030) were higher among the elderly. A favorable outcome (mRS score of 0 or 1) was more common in the younger stroke patients (57.5% vs. 25.9%, p<0.0001). Multivariate analysis revealed that younger age, male gender, and initial stroke severity were significantly associated with a favorable outcome. CONCLUSIONS: These results indicate that stroke presentation in the elderly differs from that of their younger counterparts in terms of clinical and radiological variables.
Aged ; Humans ; Infarction ; Male ; Multivariate Analysis ; National Institutes of Health (U.S.) ; Risk Factors ; Stroke*

Both lymphocytic gastritis and gastric mucosa associated lymphoid tissue (MALT) lymphoma are associated with Helicobacter pylori (H. pylori) infection. However, this association has not been fully elucidated. We report two cases of lymphocytic gastritis in 57-year-old male and 47-year-old female patients which were diagnosed after the H. pylori eradication to treat gastric MALT lymphoma. MALT lymphoma was successfully treated in case 1, but residual MALT lymphoma remained in case 2. During the follow-up endoscopic examinations, several elevated erosions in case 1 and irregular mucosal atrophy in case 2 were newly detected. Biopsy specimens showed marked infiltration of lymphocytes in the surface epithelium (56.6+/-15.9 intraepithelial lymphocytes (IELs)/100 epithelial cells in case 1 and 40.5+/-9.3 IELs/100 epithelial cells in case 2), which were exclusively CD8-positive T lymphocytes. These findings suggest that H. pylori infection may cause a monoclonal proliferation of B lymphocytes, leading to MALT lymphoma as well as polyclonal proliferation of T lymphocytes which subsequently infiltrated into the surface epithelium as a host immune reaction, resulting in lymphocytic gastritis.
Gastric Mucosa/*pathology ; Gastritis/*complications/microbiology/pathology ; Helicobacter Infections/*complications ; *Helicobacter pylori ; Humans ; Lymphocytes/*pathology ; Lymphoma, B-Cell, Marginal Zone/*complications/microbiology ; Male ; Middle Aged ; Stomach Neoplasms/*complications

BACKGROUND: The diagnosis of endometrial stromal sarcoma (ESS) is often difficult in cases showing diverse histological differentiation or in undifferentiated endometrial sarcoma (UES). Recently, JAZF1/JJAZ1 gene fusion has been described as a defining feature of low-grade ESS (LGESS). However, its prevalence is variably reported, and the diagnostic utility has rarely been examined for cases showing various histological differentiation. METHODS: To test the diagnostic utility of JAZF1/JJAZ1 gene fusion in difficult cases, we compared the prevalence of the JAZF1/JJAZ1 fusion gene in LGESS with and without histological differentiation. RESULTS: The JAZF1/JJAZ1 fusion transcript was detected in 18 of 21 LGESS (85.7%), including 14 classical LGESS (93%), four LGESS with diverse histological differentiation (67%), and two with UES (28.6%). Positive cases included two LGESS with sex cord-like differentiation, one with osseous differentiation, and two UES. LGESS showing smooth muscle differentiation revealed the fusion transcript only in the classic area. Direct sequencing analysis of two LGESS revealed a previously reported breakpoint at t(7;17)(p15;q21). CONCLUSIONS: The JAZF1/JJAZ1 fusion gene was identified in a significant proportion of LGESS showing secondary histological differentiation except in cases with smooth muscle differentiation. Thus, this fusion gene may be useful to confirm the diagnosis in difficult cases of LGESS.
Gene Fusion ; Muscle, Smooth ; Prevalence ; Sarcoma ; Sarcoma, Endometrial Stromal