A term "mesoesophagus" has been often used by surgeons, but the morphology was not described well. To better understand the structures attaching the human abdominal and lower thoracic esophagus to the body wall, we examined serial or semiserial sections from 10 embryos and 9 fetuses. The esophagus was initially embedded in a large posterior mesenchymal tissue, which included the vertebral column and aorta. Below the tracheal bifurcation at the fifth week, the esophagus formed a mesentery-like structure, which we call the "mesoesophagus," that was sculpted by the enlarging lungs and pleural cavity. The pneumatoenteric recess of the pleuroperitoneal canal was observed in the lowest part of the mesoesophagus. At the seventh week, the mesoesophagus was divided into the upper long and lower short parts by the diaphragm. Near the esophageal hiatus, the pleural cavity provided 1 or 2 recesses in the upper side, while the fetal adrenal gland in the left side was attached to the lower side of the mesoesophagus. At the 10th and 18th week, the mesoesophagus remained along the lower thoracic esophagus, but the abdominal esophagus attached to the diaphragm instead of to the left adrenal. The mesoesophagus did not contain any blood vessels from the aorta and to the azygos vein. The posterior attachment of the abdominal esophagus seemed to develop to the major part of the phrenoesophageal membrane with modification from the increased mass of the left fetal adrenal. After postnatal degeneration of the fetal adrenal, the abdominal esophagus might again obtain a mesentery. Consequently, the mesoesophagus seemed to correspond to a small area containing the pulmonary ligament and aorta in adults.
Adrenal Glands ; Adult ; Aorta ; Azygos Vein ; Blood Vessels ; Diaphragm ; Embryonic Structures* ; Esophagus* ; Fetus* ; Humans ; Ligaments ; Lung ; Membranes ; Mesentery ; Pleural Cavity ; Spine

PURPOSE: A feasible palliative care model for advance cancer patients is needed in Korea with its rapidly aging population and corresponding increase in cancer prevalence. This study describes the process involved in the development of a community-based palliative care (CBPC) model implemented originally in a Busan pilot project. MATERIALS AND METHODS: The model development included steps I and II of the pilot project, identification of the service types, a survey exploring the community demand for palliative care, construction of an operational infrastructure, and the establishment of a service delivery system. Public health centers (including Busan regional cancer centers, palliative care centers, and social welfare centers) served as the regional hubs in the development of a palliative care model. RESULTS: The palliative care project included the provision of palliative care, establishment of a support system for the operations, improvement of personnel capacity, development of an educational and promotional program, and the establishment of an assessment system to improve quality. The operational infrastructure included a service management team, provision teams, and a support team. The Busan Metropolitan City CBPC model was based on the principles of palliative care as well as the characteristics of public health centers that implemented the community health projects. CONCLUSION: The potential use of the Busan CBPC model in Korea should be explored further through service evaluations.
Aging ; Busan* ; Chronic Disease ; Humans ; Korea* ; Palliative Care* ; Pilot Projects ; Prevalence ; Public Health* ; Social Welfare

Cutaneous metastases from follicular thyroid carcinoma are extremely rare. A 59-year-old woman presented with a 1 month history of a slowly enlarging scalp nodule. Ten years earlier, the patient had been received total thyroidectomy for anterior neck mass, and diagnosed as poorly differentiated follicular thyroid carcinoma. The patient had developed pulmonary metastases 4 years after the initial surgery and concurrent chemotherapy. A biopsy from the scalp nodule showed an intradermal tumor composed of mostly thyroid follicular structures with colloid material. The tumor cells were monomorphic with scant pale cytoplasm and uniform nuclei, and stained positive for thyroid transcription factor-1 and thyroglobulin. We report a cutaneous metastasis from the follicular thyroid carcinoma as a rare case.
Adenocarcinoma, Follicular ; Biopsy ; Colloids ; Cytoplasm ; Female ; Humans ; Middle Aged ; Neck ; Neoplasm Metastasis ; Scalp ; Thyroglobulin ; Thyroid Gland ; Thyroidectomy

Cellular angiolipomas are fatty tumors that occur as multiple painful subcutaneous nodules on the trunk and arms of young male adults. Although clinically benign, they may occasionally mimic Kaposi's sarcoma or angiosarcoma histiogically. Encapsulation, septation, small size, endothelial cells without atypia, intravascular microthrombi, and clinical presentation in healthy individuals help to exclude a malignant diagnosis. We report a case of cellular angiolipoma on the extremities and trunk of a 19-year-old man. Histopathological findings showed well-circumscribed tumor composed of vascular endothelial cells and spindle cells forming vascular spaces intermingled with scattered adipocytes. Immunohistochemical studies demonstrated reactivities for endothelial and muscle markers, highlighting the obscured angiomatous component in the cellular areas of the tumor.
Adipocytes ; Adult ; Angiolipoma ; Arm ; Endothelial Cells ; Extremities ; Hemangiosarcoma ; Humans ; Hydrazines ; Lipoma ; Male ; Muscles ; Sarcoma, Kaposi ; Young Adult

Acute graft-versus-host disease (GVHD) is a life threatening complication of allogeneic bone marrow transplantation. It is important to recognize the dermatologic manifestations of acute GVHD, as skin is often the initial organ of involvement. The rash typically is a blanchable, erythematous macular eruption. We present a case of acute follicular graft-versus-host reaction (GVHR) characterized by erythematous to violaceous follicular papular eruption clinically and follicular epithelial dyskeratosis histopathologically. Although acute follicular GVHR is rare, it is important to recognize it as an early skin manifestation of acute cutaneous GVHR allowing prompt therapy.
Bone Marrow Transplantation ; Exanthema ; Graft vs Host Disease ; Skin ; Skin Manifestations ; Transplants

Transepidermal elimination is a well known phenomenon describing cases where foreign materials or altered dermal constituents are removed from dermis through epidermis. The phenomenon of transepidermal elimination may occur as a primary process or as a secondary process. A 36-year-old women presented with three black papules on the ventral side of her right second toe for 1 year. Because of poliomyelitis, the lesion had been irritated repeatedly. The histopathology of the lesion showed solitary papular angiokeratoma with transepidermal elimination. In this case, we postulated that transepidermal elimination of this case could have developed through repetitive physical trauma.
Adult ; Angiokeratoma ; Dermis ; Epidermis ; Female ; Humans ; Poliomyelitis ; Toes

Argyria is a rare skin discoloration caused by the deposition of silver granules in the skin. We report a case of argyria occurring in a 46-year-old woman due to ingestion of colloidal silver solution over 2 years. She had a diffuse, slate gray discoloration on her face and hands. The biopsy specimen from the face revealed melanin hyperpigmentation in the epidermal basal layer. Numerous, round, tiny brown-black granules were deposited in the basement membrane surrounding eccrine glands. Silver solution is being advertised as a cure for a variety of diseases and is commercially available as a 'food supplement'. This case report highlights the potential risk of adverse effects following the use of food supplements.
Argyria* ; Basement Membrane ; Biopsy ; Colloids ; Dietary Supplements ; Eating ; Eccrine Glands ; Female ; Hand ; Humans ; Hyperpigmentation ; Melanins ; Middle Aged ; Silver ; Skin

Alloplastic materials used for orbital fracture reconstruction can induce complications, such as infection, migration, extrusion, intraorbital hemorrhage, and residual diplopia. Silicone is one of the alloplastic materials that has been widely used for decades. The author reports a rare case of spontaneous extrusion of a silicone implant that was used for orbital fracture reconstruction 30 years earlier. A 50-year-old man was admitted to the emergency room for an exposed substance in the lower eyelid area of the left eye, which began as a palpable hard nodule a week earlier. The exposed material was considered to be implant used for previous surgery. Under general anesthesia, the implant and parts of the fibrous capsule tissue were removed. Several factors hinder the diagnosis of implant extrusions that occur a long period after the surgery. So, surgeons must be aware that complications with implants can still arise several decades following orbital fracture reconstruction, even without specific causes.
Anesthesia, General ; Diagnosis ; Diplopia ; Emergency Service, Hospital ; Eyelids ; Hemorrhage ; Humans ; Middle Aged ; Orbit* ; Orbital Fractures* ; Orbital Implants ; Postoperative Complications ; Silicon* ; Silicones* ; Surgeons

Alloplastic materials used for orbital fracture reconstruction can induce complications, such as infection, migration, extrusion, intraorbital hemorrhage, and residual diplopia. Silicone is one of the alloplastic materials that has been widely used for decades. The author reports a rare case of spontaneous extrusion of a silicone implant that was used for orbital fracture reconstruction 30 years earlier. A 50-year-old man was admitted to the emergency room for an exposed substance in the lower eyelid area of the left eye, which began as a palpable hard nodule a week earlier. The exposed material was considered to be implant used for previous surgery. Under general anesthesia, the implant and parts of the fibrous capsule tissue were removed. Several factors hinder the diagnosis of implant extrusions that occur a long period after the surgery. So, surgeons must be aware that complications with implants can still arise several decades following orbital fracture reconstruction, even without specific causes.
Anesthesia, General ; Diagnosis ; Diplopia ; Emergency Service, Hospital ; Eyelids ; Hemorrhage ; Humans ; Middle Aged ; Orbit* ; Orbital Fractures* ; Orbital Implants ; Postoperative Complications ; Silicon* ; Silicones* ; Surgeons

Peritoneal origin serous papillary carcinoma is an uncommon primary malignancy occurring in the abdominal or pelvic peritoneum lining. It is characterized by peritoneal carcinomatosis with massive ascites, uninvolved or minimally involved ovary, and is histologically indistinguishable from ovarian serous tumors. Better recognition of this phenomenon in recent years has contributed to an increasing diagnostic frequency. We describe a rare case of peritoneal origin serous papillary carcinoma with unusual clinical presentations involving a solitary primary tumor originating from the peritoneal lining of the sigmoid colonal mesentery, without pelvic lymph node involvement or distant metastasis. Because of the location and morphological similarity, it was misdiagnosed as an ovarian malignancy. We aim to assist in the diagnosis of this disease with the following case report, thereby improving the management of patients with this condition.
Ascites ; Carcinoma ; Carcinoma, Papillary* ; Colon, Sigmoid ; Diagnosis ; Female ; Humans ; Lymph Nodes ; Mesentery ; Neoplasm Metastasis ; Ovarian Neoplasms* ; Ovary ; Peritoneum