Chronic sclerosing sialadenitis, Mikulicz disease or Kuttner tumor has been recently recognized as a spectrum of IgG4-related sclerosing disease. IgG4-related disease is characterized by a high serum IgG4 level and tissue infiltration of IgG4-positive plasmacytes. We report three cases of chronic sclerosing sialadenitis with variably associated systemic involvement. All patients presented with a submandibular mass or swelling, and all the resected submandibular glands showed diffuse lymphocytic infiltration, lymphoid follicles, and septal fibrosis. Two of the specimens revealed numerous IgG-positive plasma cells, most of which were IgG4-positive on immunohistochemical staining. One of them was associated with dacryoadenitis and hypophysitis. The other patient had ureterorenal lesions. Immunohistochemical study was unavailable in remaining one case, but the histologic features along with elevated IgG level and associated pancreatitis supported the diagnosis. All patients received steroid therapy postoperatively and are doing well. Salivary gland involvement in IgG4-related fibrosclerosis should be recognized in systemic medical pathology.
Dacryocystitis ; Fibrosis ; Humans ; Immunoglobulin G ; Mikulicz' Disease ; Pancreatitis ; Plasma Cells ; Salivary Glands ; Sialadenitis ; Submandibular Gland

"We retrospectively reviewed the results of 1,850 fine needle aspiration cytology (FNAC) of thyroid nodules performed from 1990 to 1991 in the Department of Pathology, Seoul National University Hospital. Among 1,528 cases and 322 cases aspirated by clinicians and a pathologist, 465 cases (30.4%) and 13 cases (4.0%) of the aspirates were inadequate, respectively. In 227 cases, correlation of the FNAC diagnosis and histologic diagnosis was done. Excluding the inadequate cases, the sensitivity for the detection of neoplasm (malignancy together with follicular adenoma) was 86.4% and the specificity was 70.7%. The overall diagnostic accuracy was 79.0%. There were 16 false-positive cases (7.0%), and 19 false-negative cases (8.4%). The predictive value of each cytologic diagnosis was 92% in papillary carcinoma, and 100% in Hashimoto's thyroiditis. The expectancy of malignancy was 52.8% in ""suspicious malignancy"" and 26.7% in ""atypical lesion""."
Biopsy, Fine-Needle ; Carcinoma, Papillary ; Diagnosis ; Pathology ; Retrospective Studies ; Sensitivity and Specificity ; Seoul ; Thyroid Gland ; Thyroid Nodule ; Thyroiditis

PURPOSE: To evaluate the short-term therapeutic effectiveness of ovarian vein embolization using coils for pelvic congestion syndrome (PCS), a common cause of chronic pelvic pain, and to determine patient satisfaction. MATERIALS AND METHODS: Forty-four multiparous women aged 26-73 (mean, 39.9) years in whom chronic pelvic pain due to unknown causes had lasted for more than six months, and whose gynecologic findings and laboratory data suggested PCS, underwent transabdominal or transvaginal ultrasonography and selective ovarian venography. PSC was finally diagnosed in 21 of th 44, who underwent 22 ovarian vein embolizations (in one case, bilaterally). The simple pain rating system was used at admission, with a 'minimal' or 'moderate' grade representing discomfort in daily life, and 'severe' indicating the need for medication. Indications for coil embolization included dilatation of the ovarian vein to a diameter of more than 6 mm, reflux involving an incompetent valve, congestion of the pelvic venous plexus (involving the stasis of contrast media), and/or opacification of the ipsilateral internal iliac vein (or contralateral filling). Embolizations were undertaken using coils of optimal size and number, and the mean follow-up period was 217 (31-267) days. By means of a telephone questionnaire, the outcome was classified as a cure, pain reduction, or 'no change, or aggravation', and on the basis of whether or not they would opt for the same treatment, or recommend embolization to others, patient satisfaction was graded as 'substantial', 'moderate', or 'absent. RESULTS: Venous occlusion was confimed at postembolization venography in all 22 cases. Clinical treatment led to symptomatic relief in 76.2% of patients a cure in 33.3% (7/21), pain reduction in 42.9% (9/21) and no imchange, or aggravation, in 23.8% (5/21). Eighteen patients (85.8%) were very (9/21, 42.9%) or moderately (9/21, 42.9%) satisfied with coil embolization. In two, the coil migrated, and was successfully retrieved using a snare loop. CONCLUSION: In this study, ovarian vein embolization using coils for PCS appeared to be both safe and effective in controlling pain. If other causes of pelvic pain are absent, it is thought to be a valuable alternative to surgical procedures.
Dilatation ; Embolization, Therapeutic ; Estrogens, Conjugated (USP)* ; Female ; Follow-Up Studies ; Humans ; Iliac Vein ; Patient Satisfaction ; Pelvic Pain ; Phlebography ; Surveys and Questionnaires ; SNARE Proteins ; Telephone ; Ultrasonography ; Veins*

PURPOSE: To report a case of corneal and lenticular pigmentation after prolonged clozapine therapy. CASE SUMMARY: A 56-year-old male visited our hospital with a progressive decline in vision that affected both eyes. He had a history of schizophrenia. He was being treated with 200 mg clozapine and 1 mg lorazepam daily, and had been treated with clozapine for 5 years. At the first visit, his best-corrected-visual acuity was 20/32 in both eyes. Slit lamp examination of the corneas showed bright, fine, grayish-brown deposits on the endothelium, and on dilation, bilateral central stellate opacity of the anterior portion of the lens capsule was revealed. CONCLUSIONS: Clozapine may induce corneal and lenticular pigmentation and thus may lead to a decline in vision. Patients on long-term clozapine therapy should be considered for regular ophthalmic review.
Clozapine ; Cornea ; Endothelium ; Humans ; Lorazepam ; Male ; Middle Aged ; Pigmentation ; Schizophrenia ; Slit Lamp

We report a patient with an isolated cerebellar nodulus infarction who presented with periodic alternating nystagmus (PAN), perverted head-shaking nystagmus (pHSN), and loss of tilt suppression of the vestibulo-ocular reflex (VOR). Several days after the initial symptoms resolved, the patient also presented with purely vestibular syndrome with vertigo, spontaneous horizontal nystagmus without the usual signs of cerebellar dysfunction. The chain of those symptoms were ascribed to ischemia of the cerebellar nodulus.
Cerebellar Diseases ; Humans ; Infarction* ; Ischemia ; Nystagmus, Pathologic* ; Reflex, Vestibulo-Ocular ; Vertigo

Peribiliary cysts involve cystic dilatation and necroinflammatory change in the peribiliary glandular tissue of the larger biliary tree in association with portal hypertension or severe hepatobiliary disease. They are usually asymptomatic and found incidentally. However, rare cases causing symptoms or the mass effect of bile duct compression require differential diagnosis. They may be benign or malignant lesions resulting from narrowing of the bile duct and involving dilatation of the proximal intrahepatic bile duct. We recently encountered a case of peribiliary cysts associated with intrahepatic duct dilatation, and confirmed by surgery, and present the imaging and pathologic findings. Sonography and CT revealed the presence of multiple cystic lesions along the hepatic hilum, and the larger left portal tract and left intrahepatic ducts were dilated. Histopathologic examination indicated that the cysts were compressing the central bile duct.
Bile Ducts ; Bile Ducts, Intrahepatic* ; Biliary Tract ; Diagnosis, Differential ; Dilatation ; Hypertension, Portal

Cystic lymphangioma of the broad ligament is very rare benign cystic lesion. They rarely present in adult life. We present the case of a 37-year-old female with a history of chronic recurrent left lower abdominal dull pain over a period of several months. Clinical presentation of these tumors varies greatly from an asymptomatic mass to serious complications. The therapy of choice is a complete excision, unless vital structures were involved. Once excised, the prognosis is excellent. Our patient had complete excision of her lesion with a good outcome.
Adult ; Broad Ligament* ; Female ; Humans ; Lymphangioma, Cystic* ; Prognosis

No abstract available.
Humans ; Lung*

Adventitial cystic disease of the popliteal artery is a rare disorder that causes localized stenosis or occlusion by compression of the vessel lumen. The disease produces lower extremity claudication, typically in young and middle-aged men. We report a case of the adventitial cystic disease of the popliteal artery in a 55-year-old man with symptom of left calf claudication. Diagnosis was done by ultrasound, angiography, and magnetic resonance imaging. The patient was treated with resection of the diseased popliteal artery followed by interposition of saphenous vein graft. Postoperatively, the symptom and sign resolved completely.
Angiography ; Constriction, Pathologic ; Diagnosis ; Humans ; Lower Extremity ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Popliteal Artery* ; Saphenous Vein ; Transplants ; Ultrasonography

PURPOSE: To determine the usefulness of CT for diagnosing metastases to primary and secondary echelon lymph nodes (LNs) and to investigate various CT findings of metastatic LNs in thyroid carcinomas. MATERIALS AND METHODS: We retrospectively reviewed the CT and histologic findings in 59 patients with thyroid carcinomas who had undergone thyroidectomy and neck dissection. Primary echelon LNs (Level VI) were removed by central neck dissection in all patients, and in 21, a total of 136 levels of secondary echelon LNs (Level II-V) were excised away by lateral neck dissection. CT criteria of metastatic LNs included large size, significant homogeneous enhancement, calcification, and cystic change. We evaluated the ability of CT to detect primary and secondary echelon LN metastasis and tried to determine which CT features were useful for the diagnosis of LN metastasis. RESULTS: Histologically, LN metastasis was found in 31 (53%) of 59 patients, including 30 with metastasis to primary echelon LNs. Of the 136 levels of secondary echelon LNs resected in 21 patients, 44 were found at histology to harbor metastatic foci. The sensitivities, specificities, positive and negative predictive values, and accuracies of CT in the diagnosis of metastasis to primary and secondary echelon LNs, respectively, were 27% and 93%, 100% and 93%, 100% and 87%, 57% and 97%, and 63% and 93%. While all secondary echelon LNs with at least one of the following CT criteria-large size (n=19), cystic or necrotic change (n=14), or calcifications (n=8)-were histologically proven to be metastatic, six (24%) of 25 such LNs with a sole sign of significant enhancement at CT were found to be due to reactive lymphadenopathy. CONCLUSION: Although CT was unable to detect metastasis to primary echelon LNs, it was useful in the detection of secondary echelon LN involvement. Large size, cystic change, and calcification are considered highly reliable signs of metastatic LNs.
Diagnosis* ; Humans ; Lymph Nodes* ; Lymphatic Diseases ; Neck Dissection ; Neoplasm Metastasis* ; Retrospective Studies ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy