We report complete remission of dural-based leptomeningeal metastasis (LM) in an 80-year-old female patient with non-small cell lung cancer (NSCLC) by osimertinib. She was diagnosed with NSCLC (adenocarcinoma, T4N3M1a) 8 years ago. Mutation analysis of biopsied tissue revealed exon 19 deletion positive, and gefitinib was prescribed. Follow-up chest CT showed a radiological response, and wholebody positron emission tomography 3 years later revealed the disappearance of the previous high-uptake lesions. The medication was continued for maintenance but stopped 4 years later due to intolerable dermatitis. Two years after discontinuing chemotherapy, the patient had a gait disturbance, and brain MRI revealed a right cerebellar mass (diameter [d]=3 cm) with peritumoral edema, compatible with solitary brain metastasis. Retromastoid suboccipital craniotomy and gross total removal of the dura-attached lesion were performed. As the systemic cancer status evaluation revealed no radiological cancer lesion, only tumor bed radiation therapy was given (4,000 cGy/10 fractions) without re-introducing gefitinib. She was followed with a brain MRI at 6-month intervals, and a brain MRI 2 years postoperatively revealed a dural-based extra-axial mass in the left prepontine cistern (d=2.2 cm). Serial cerebrospinal fluid (CSF) cytology was positive for cancer cells. Upon LM diagnosis, the third-generation receptor tyrosine kinase inhibitor osimertinib was given. Two-month follow-up CSF cytology and five consecutive tests over 14 months demonstrated negative conversion. Five-month follow-up brain MRI revealed near complete remission of dural-based LM, and the response was maintained until the 13-month follow-up brain MRI.

We report complete remission of dural-based leptomeningeal metastasis (LM) in an 80-year-old female patient with non-small cell lung cancer (NSCLC) by osimertinib. She was diagnosed with NSCLC (adenocarcinoma, T4N3M1a) 8 years ago. Mutation analysis of biopsied tissue revealed exon 19 deletion positive, and gefitinib was prescribed. Follow-up chest CT showed a radiological response, and wholebody positron emission tomography 3 years later revealed the disappearance of the previous high-uptake lesions. The medication was continued for maintenance but stopped 4 years later due to intolerable dermatitis. Two years after discontinuing chemotherapy, the patient had a gait disturbance, and brain MRI revealed a right cerebellar mass (diameter [d]=3 cm) with peritumoral edema, compatible with solitary brain metastasis. Retromastoid suboccipital craniotomy and gross total removal of the dura-attached lesion were performed. As the systemic cancer status evaluation revealed no radiological cancer lesion, only tumor bed radiation therapy was given (4,000 cGy/10 fractions) without re-introducing gefitinib. She was followed with a brain MRI at 6-month intervals, and a brain MRI 2 years postoperatively revealed a dural-based extra-axial mass in the left prepontine cistern (d=2.2 cm). Serial cerebrospinal fluid (CSF) cytology was positive for cancer cells. Upon LM diagnosis, the third-generation receptor tyrosine kinase inhibitor osimertinib was given. Two-month follow-up CSF cytology and five consecutive tests over 14 months demonstrated negative conversion. Five-month follow-up brain MRI revealed near complete remission of dural-based LM, and the response was maintained until the 13-month follow-up brain MRI.

We report complete remission of dural-based leptomeningeal metastasis (LM) in an 80-year-old female patient with non-small cell lung cancer (NSCLC) by osimertinib. She was diagnosed with NSCLC (adenocarcinoma, T4N3M1a) 8 years ago. Mutation analysis of biopsied tissue revealed exon 19 deletion positive, and gefitinib was prescribed. Follow-up chest CT showed a radiological response, and wholebody positron emission tomography 3 years later revealed the disappearance of the previous high-uptake lesions. The medication was continued for maintenance but stopped 4 years later due to intolerable dermatitis. Two years after discontinuing chemotherapy, the patient had a gait disturbance, and brain MRI revealed a right cerebellar mass (diameter [d]=3 cm) with peritumoral edema, compatible with solitary brain metastasis. Retromastoid suboccipital craniotomy and gross total removal of the dura-attached lesion were performed. As the systemic cancer status evaluation revealed no radiological cancer lesion, only tumor bed radiation therapy was given (4,000 cGy/10 fractions) without re-introducing gefitinib. She was followed with a brain MRI at 6-month intervals, and a brain MRI 2 years postoperatively revealed a dural-based extra-axial mass in the left prepontine cistern (d=2.2 cm). Serial cerebrospinal fluid (CSF) cytology was positive for cancer cells. Upon LM diagnosis, the third-generation receptor tyrosine kinase inhibitor osimertinib was given. Two-month follow-up CSF cytology and five consecutive tests over 14 months demonstrated negative conversion. Five-month follow-up brain MRI revealed near complete remission of dural-based LM, and the response was maintained until the 13-month follow-up brain MRI.

Herein, we describe cases of pulmonary acute graft-versus-host disease (aGVHD) in two patients occurring after allogeneic hematopoietic stem cell transplantation (HSCT) due to precursor B-cell acute lymphoblastic leukemia in a 6-year-old patient and in acute myeloid leukemia in a 14-year-old boy. In both cases, chest CT revealed confluent ground-glass attenuation along the bronchovascular bundles, as well as some bronchial dilatation. Microscopically, in both cases we noted a characteristic bronchiolocentric pattern and bronchiolar epithelial changes, which included denudation of the bronchiolar epithelium, regenerating atypical cells, and wall thickening with subepithelial or transmural fibroblast proliferation, along with some lymphocytic infiltration. One patient died on day 86 after allogeneic HSCT due to sudden acute respiratory distress syndrome, and the other patient currently remains alive without active aGVHD. The authors' experiences in these two cases demonstrate that intense awareness of the pathologic findings of GVHD is mandatory after allogeneic HSCT.
Adolescent ; Child ; Dilatation ; Epithelium ; Fibroblasts ; Graft vs Host Disease ; Hematopoietic Stem Cell Transplantation ; Hematopoietic Stem Cells ; Humans ; Leukemia ; Leukemia, Myeloid, Acute ; Lung ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Precursor Cells, B-Lymphoid ; Respiratory Distress Syndrome, Adult ; Thorax

Recently we experienced a soft tissue sarcoma originated in the spinal epidural space at upper sacral area and extending into intrapelvic area in a young male patient. It was diagnosed primary Ewing's sarcoma histologically. Ewing's sarcoma is usually found in long bones. But rarely discovered in an extraosseous area. So, spinal epidural Ewing's sarcoma is rare to be found. Only 6 cases were reported in the English literature until 1986. We present the case with review of literatures.
Epidural Space ; Humans ; Male ; Sarcoma ; Sarcoma, Ewing*

Cerebral venous angomas are a rare form of intracranial vascular malformation and first reported by Wolf in 1967. The characteristic angiographic appearance of venous malformation is a local network of small veins that converged centrally into a single large drainage vein. The CT findings are linear or curvilinear enhancement after administration of contrast media. The authors present a case of venous angiomatosis of the both hemisphere combined with dural arteriovenous malformations demonstrated by the carotid angiography and bran CT, with clinical presentation of status epilepcus and following left hemiplegia due to cerebral infarction.
Angiography ; Angiomatosis* ; Arteriovenous Malformations* ; Cerebral Infarction ; Contrast Media ; Drainage ; Hemiplegia ; Vascular Malformations ; Veins ; Wolves

Pneumocystis pneumonia (PCP) is caused by the yeast-like fungus Pneumocystis jirovecii, which is specific to humans. PCP could be a source of opportunistic infection in adults that are immunosuppressed and children with prematurity or malnutrition. The diagnosis should be confirmed by identification of the causative organism, by analysis of the sputum, a bronchoalveolar lavage or a tissue biopsy. In both histologic and cytologic specimens, the cysts are contained within frothy exudates, which form aggregated clumps. The cysts often collapse forming crescent-shaped bodies that resemble ping-pong balls. We recently diagnosed nine cases of PCP using an immunohistochemical stain for Pneumocystis. The patients consisted of five human immunodeficiency virus positive individuals, two renal transplant recipients, and two patients with a malignant disease. All nine patients were infected with P. jirovecii, which was positive for monoclonal antibody 3F6. In conclusion, the immunohistochemical stain used in this report is a new technique for the detection of P. jirovecii infection.
Adult ; Biopsy ; Bronchoalveolar Lavage ; Child ; Exudates and Transudates ; Fungi ; HIV ; Humans ; Immunohistochemistry ; Malnutrition ; Opportunistic Infections ; Pneumocystis ; Pneumocystis jirovecii ; Pneumonia, Pneumocystis ; Sputum

PURPOSE: To investigate the effect of combined inhibition of protein kinase B (AKT) and SRC on the growth and metastatic potential of human pancreatic cancer cells. MATERIALS AND METHODS: AKT and SRC were inhibited using 10-DEBC and PP2, respectively. The expression of their messenger RNAs were down-regulated by specific small interfering RNA (siRNA). Changes in pancreatic cancer cell growth and metastatic potential were determined using a cell viability assay and a xenotransplant model of pancreatic cancer, as well as cell migration and invasion assays. Signal proteins were analyzed by Western blot. RESULTS: The inhibitors 10-DEBC and PP2 suppressed cell proliferation in a dose-dependent fashion in pancreatic cancer cell lines MIA PaCa-2 and PANC-1. The simultaneous inhibition of AKT and SRC at low concentrations resulted in a significant suppression of cell proliferation. Knockdown of AKT2 and SRC using siRNAs also significantly decreased cell proliferation. In a pancreatic cancer model, combined treatment with 10-DEBC and PP2 also significantly suppressed the growth of pancreatic cancer. Application of 10-DEBC with PP2 significantly reduced the metastatic potential of pancreatic cancer cells by inhibiting migration and invasion. The combined inhibition suppressed the phosphorylation of mTOR and ERK in pancreatic cancer cells. CONCLUSION: Combined targeting of AKT and SRC resulted in a synergistic efficacy against human pancreatic cancer growth and metastasis.
Blotting, Western ; Cell Line ; Cell Movement ; Cell Proliferation ; Cell Survival ; Humans* ; Neoplasm Metastasis ; Pancreatic Neoplasms* ; Phosphorylation ; Proto-Oncogene Proteins c-akt ; RNA, Messenger ; RNA, Small Interfering

In view of this pandemic, as of February 2020, South Korea has the second highest number of confirmed cases in the world. Herein, we report four confirmed coronavirus disease 2019 (COVID-19) cases in the early stage of the pandemic in South Korea and describe the identification, diagnosis, clinical course, and management, including one patient’s initial mild symptoms at presentation and their progression to pneumonia on day 21 of illness. Within 48 hours of hospitalization, all four patients underwent evaluation for initial laboratory parameters, COVID-19 polymerase chain reaction (PCR), and chest computed tomography (CT) findings. All four mild COVID-19 patients were discharged, and they were re-examined 14 days after discharge. Despite all four of them being asymptomatic, one patient was re-admitted after confirmation of COVID-19 through PCR viral nucleic acid detection. She could be discharged after 7 days with two subsequent negative COVID-19 PCR at 24-hour intervals. Patients with mild COVID-19 generally have normal follow-up chest CT scans after discharge, even if the early chest CT definitely indicates pneumonia. Re-hospitalized patients with COVID-19 PCR positive results after discharge were not related to her initial chest CT, lab, symptoms compared other three patients.

Background: and Purpose Spinocerebellar ataxias (SCAs) are the most common form of hereditary ataxias. Extracerebellar signs have been well described and are helpful in differentiating the SCA subtypes. However, there are few reports on the early-stage extracerebellar signs in various SCA subtypes. This study explored the clinical and magnetic resonance imaging (MRI) characteristics of early-stage SCAs in the Korean population. Methods: We retrospectively reviewed the medical records of genetically confirmed SCA patients with a disease duration of <5 years. Data on baseline characteristics, extracerebellar signs, and initial MRI findings were organized based on SCA subtypes. Results: This study included 117 SCA patients with a median age at onset of 40.6 years. The family history was positive in 71.8% of the patients, and the median disease duration and the score on the Scale for the Assessment and Rating of Ataxia at the initial visit were 2.6 years and 5.0, respectively. SCA3 was the most prevalent subtype, and oculomotor abnormalities were the most frequent extracerebellar signs in early-stage SCAs. Saccadic slowing was characteristic of SCA2 and SCA7, and gaze-evoked nystagmus was prominent in SCA6. Parkinsonism was relatively frequent in SCA8 and SCA3. Decreased visual acuity was specific for SCA7. Dementia was not an early manifestation of SCAs. Brain MRI revealed a pattern of pontocerebellar atrophy in SCA2 and SCA7, while SCA6 demonstrated only cerebellar cortical atrophy. Conclusions SCA patients exhibited diverse extracerebellar signs even in the early stage.Specific extracerebellar signs were characteristic of specific subtypes, which could facilitate differential diagnoses of early-stage SCAs.