During evaluation of follow-up curettage of endometrial hyperplasia after progesterone treatment, we have noticed that the foci of squamous or morular metaplasia are persistent or even markedly increased after the hyperplastic glands have all disappeared. These observations have led us to study the histological changes of squamous or morular metaplasia in the hyperplastic endometrium after progesterone treatment and to examine the changes of estrogen receptors(ER) and progesterone receptors(PR) to find out, if there is any pathogenetic role of progesterone administration on the squamous or morular metaplasia. Squamous or morular metaplasia was associated in 21 cases (13.5 %) out of 156 endometrial hyperplasia during the study periods and all of them were associated with complex hyperplasia, but not associated with simple hyperplasia. At follow-up curettage after progesterone treatment, squamous metaplasia newly appeared in 3 cases(20 %), markedly increased in 4 cases(26.7%), persisted in 4 cases(26.7%) and decreased in 4 cases(26.7%), even after hyperplastic glands have all disappeared or were markedly decreased. On immunohistochemical staining, metaplastic foci showed ER- and PR- in 13 cases (87 %) in contrast to the surrounding endometrium and the remaining 2 cases showed minimal ER+ and PR+ confined to several nuclei. Intensity or staining pattern of ER and PR in metaplastic foci were not changed with progesterone treatment. In the background endometrium, intensity of glandular ER+ and PR + was higher than that of the stroma at the initial curettage, however, progesterone treatment predominantly down-regulated glandular ER+ more than stromal ER+. Increment or persistence of squamous metaplasia along the progesterone treatment seemingly would implicate hormonal influences as playing a significant role in the formation of squamous or morular metaplasia and the absence of cellular receptors for these hormones in the metaplastic foci may suggest qualitative changes in the receptors.

Lentigo maligna, a precancerous tumor arising from abnormal melanocytes, is a chronic, slowly progressive, pigmented lesion with a range of colors from pale tan to black and an irregular shape, The commonest location of lentigo maligna is the face during the sixth and seventh decades of life. Less frequently, the lesion occurs on an extrafacial area such as the hand or lower leg. In the late stage, lentigo maligna transforms into invasive malignant melanoma. A 50-year-old male patient had a well-defined, black pigmented patch on the right sole for 30 years. The histopathologic examination revealed numerous vacuolated melanocytes clusters at the dermo-epidermal junction with invasion of the epidermis. There was no evidence of dermal invasion by atypical melanocytes.
Epidermis ; Hand ; Humans ; Hutchinson's Melanotic Freckle* ; Leg ; Lentigo* ; Male ; Melanocytes ; Melanoma ; Middle Aged ; Triacetoneamine-N-Oxyl

No abstract available.
Adrenalectomy* ; Multiple Endocrine Neoplasia* ; Pheochromocytoma*

Colonization of mammary cancers by melanocytes with heavy pigmentation of cancer cells by melanin can occur very rarely. It is not certain which mechanism operates to achieve this transfer. However, the melanocytes might inject melanin through their dendritic processes or alternatively, the cancer cells phagocytose the terminal parts of the dendritic processes with subsequent dispersal of the contained melanin contained melanin granules. We report a case of infiltrating ductal carcinoma of breast with melanocyte colonization and pigmentation in a 59-year old female.
Female ; Humans

Gestational trophoblastic disease associated with the tubal pregnancy is uncommon, and the incidence has been described as 1/5000 tubal pregnancy. We have experienced a case of metastatic gestational trophoblastic disease(GTD) in the lung occuring with complete hydatidiform mole arising in tubal pregnancy. The patient was a 39-year-old, G4P2A2L2 woman with amenorrhea for 5 weeks. Ectopic pregnancy in the right fallopian tube was suspected on transvaginal ultrasonogram. A right adnexectomy was performed. The fallopian tube was markedly dilated and ruptured. The right ovary and a round hematoma had adhered to the external surface of the fallopian tube. On gross examination, no molar tissue was identified. On microscopic examination, the lumen of the dilated fallopian tube was filled with blood clots admixed with several chorionic villi showing hydropic swelling and marked proliferation of atypical trophoblasts. Proliferating syncytio-and cytotrophoblasts invaded the wall of the blood vessels of the fallopian tube and sheets of trophoblasts and some villi were identified in the lumen of blood vessels. Multiple pulmonary nodules thought to be metastatic nodules were identified in the chest X-ray and serum beta-HCG had increased 2 weeks later. This case indicates that a careful pathological examination in the ectopic pregnancy is mandatory, because tubal GTD is not clinically distinguishable from ordinary tubal pregnancy.
Pregnancy ; Female ; Humans ; Neoplasm Metastasis

The spine fracture of osteoporotic patients is considered as meaningful since it occurs prior to other life-threatening fractures (for example; fracture of proximal of femur). The purpose of this study were to analyze the relationship between BMD and spine fracture in patients who complained of back pain without any obvious trauma history. We studied the cases of one hundred thirty patients above an age of sixty years, whose visited the Department of Orthopaedic Surgery at Kosin University Medical Center, from March 1995 to April 1996. Both simple X-ray and Dual Energy X-ray Absorptiometry (DEXA) were checked in old patients. The following results were obtained. 1. The BMD of spine fracture group with the osteoporosis (mean; -3.66 standard deviation (SD)) was significantly lower than the nonfracture group (mean; -2.38 standard deviation (SD)) (P = 0.0000). 2. According that the BMD Z-score is decreased, the proportion of spine fracture is increased significantly (above-1.0SD; 16.67%, -1.0SD~ -2.0SD; 16.67%, -2.0SD~ -3.0SD; 37.83%, - 3.0SD~ 4.0SD; 51.61%, below -4.0SD; 61.54% (P = 0.000)). 3. The probability of developing the spine fracture based on above -2.0 standard deviation (SD) was 2.8 times in -2.0SD~ -3.0SD (P = 0.044), 5.3 times in -3.0SD~ -4.0SD (P = 0.004), and 7.9 times below -4.0SD (P = 0.001). We recommended more intensive treatment to the osteoporotic patients below -2.0 SD in BMD Z- score.
Absorptiometry, Photon ; Academic Medical Centers ; Back Pain ; Humans ; Middle Aged* ; Osteoporosis ; Spine*

PSTT has been established as a separate entity distinct from choriocarcinoma since 1983, because of its different morphological features, biologic behavior and response to chemotherapy. Most cases of PSTT have indolent clinical courses, but there have been several reports showing malignant behavior resulted in death of the patient. We report a case of PSTT showing vaginal metastatis. In biopsy specimen, it was difficult to make differential diagnosis from squamous cell carcinoma of uterine cervix due to uniform and mononuclear cytologic characteristics. Immunohistochemical stains for hPL and hCG were not typical for either PSTT or choriocarcinoma. We suggest that poorly differentiated PSTT may synthesize the lesser amount of hPL than typical PSTT and it may behave more aggressively.
Diagnosis, Differential ; Biopsy

We report a case of spinal subdural abscess spreading from a epidural abscess. A 70-year-old man was hospitalized for a mild fever, chill and severe back pain. Neurological examination on admission revealed back pain with numbness, sensory deficiency on left lower extremity and without bowel or bladder dysfunction. Lumbar magnetic resonance imaging(MRI) showed pyogenic spondylitis on L1, 2, 3 with epidural abscess. A patient was treated by empiric antibiotic therapy for 6 weeks. Six weeks later, follow-up MRI showed that the pyogenic spondylitis with epidural abscess had decreased, but a cylinder like subdural abscess after arachnoiditis. After surgery, the majority of the initial symptoms were relieved except a mild both lower extremities numbness.
Abscess* ; Aged ; Arachnoid ; Arachnoiditis ; Back Pain ; Epidural Abscess* ; Fever ; Follow-Up Studies ; Humans ; Hypesthesia ; Lower Extremity ; Magnetic Resonance Imaging ; Neurologic Examination ; Spondylitis ; Urinary Bladder

Twelve cases of primary malignant lymphoma of the central nervous system experienced between 1980 and 1990 were investigated by histological and immunohistochemical findings correlated with clinical observation. Of the 12 patients, 6 were male and 6 were female. Their ages ranged from 31 to 58 years(mean, 45.8 years). All Tumors were supratentorial except 1 case which was found in the spinal cord. The fronto-parietal lobe was the most common site, which accounted for 66.7%. Histologically, all the tumors showed unfavorable histology. Diffuse large cell type was the most frequent(66.7%). Immunohistochemical studies using monoclonal antibodies revealed predominance of B-cell phenotype. Although most cases were treated with a combination of surgery and irradiation, the outcome was poor in all.
Female ; Male ; Humans

The purpose of this article is to present the clinical and laboratory procedures for single tooth restoration using "Combination Implant Crown". It is cemented on implant abutment and that abutment is screw-retained over implant body. This type of implant restorations has the advantages of cement-retained restoration while being antirotational and retrievable. And, more esthetic and functional result can be achieved by minimizing the size of access hole. The results were as follow : 1. Preparation of abutment below the cuffline should be avoided 2. Axial reduction of implant abutment should not be excessive because it may weaken the abutment 3. More esthetical and functional occlusal surface was achieved with a minimal access hole which is slightly larger than the diameter of hex driver to enable future total retrievability. 4. Combination Implant Crown has the advantages of both the cement-retained and screw-retained type implant restoration. 5. Cementation between implant crown and abutment reduces screw loosening through even force distribution.
Cementation ; Crowns* ; Tooth*