Trichoblastic fibroma is a benign trichogenic tumor that has both epithelial and mesenchymal components and exhibits partial follicular induction. We studied 4 cases of trichoblastic fibroma and reviewed their clinical and histologic features. Two tumors were present in the face. The remaining two were in the vulva and perianal area, respectively. The age of the patients ranged from 53 to 68 years, with an average age of 62. All were female. Histologically, the lesions showed a well circumscribed mass, located at dermo-subcutaneous junction in three patients and subcutaneous in one. They demonstrated mesenchymal induction evidenced by hair germ-like structure and perifollicular sheath. There was no connection between the tumor and epidermis. Differentiation toward hair structure led to the formation of the infundibulum through inner root sheath. Trichoblastic fibroma may be confused clinically and/or histologically with basal cell carcinoma. Identification of the mixed epithelial and mesenchymal components, and the absence of epidermal connection and cleft within the stroma are important in differentiating this benign neoplasm from basal cell carcinoma.
Carcinoma, Basal Cell ; Epidermis ; Female ; Fibroma* ; Hair ; Humans ; Vulva

Ocular metastasis of metastatic carcinoma is the most common intraocular malignancy. The most common pr1mary Site of the lntraocular metastatic tumor is the breast ln women and the lung 1n men respectlvely and the choroid Is by far the most common site for intraocular metastasis. RadlOtherapy has been reported hlghly effect1ve in pal1iative treatment for metastatic tumor. We experienced a case choroidal metastasis in a known metastatic breast carcinoma patient and gained clinical lmprovement by rad1otherapy in this case.
Breast Neoplasms* ; Breast* ; Choroid* ; Female ; Humans ; Lung ; Male ; Neoplasm Metastasis*

We report a 57-year-old man with bilateral cranial nerve IX and X palsies who presented with severe dysphagia. After a mild head injury, the patient complained of difficult swallowing. Physical examination revealed normal tongue motion and no uvular deviation. Cervical X-ray findings were negative, but a brain computed tomography revealed a skull fracture involving bilateral jugular foramen. Laryngoscopy indicated bilateral vocal cord palsy. In a videofluoroscopic swallowing study, food residue remained in the vallecula and pyriform sinus, and there was reduced motion of the pharynx and larynx. Electromyography confirmed bilateral superior and recurrent laryngeal neuropathy.
Brain ; Brain Injuries* ; Cranial Nerve Diseases ; Craniocerebral Trauma ; Deglutition ; Deglutition Disorders ; Electromyography ; Glossopharyngeal Nerve ; Humans ; Laryngoscopy ; Larynx ; Middle Aged ; Paralysis* ; Pharynx ; Physical Examination ; Pyriform Sinus ; Skull Fracture, Basilar ; Skull Fractures ; Tongue ; Vocal Cord Paralysis

Invasive pulmonary aspergillosis (IPA) has been known to occur in immunocompromised patients, but has been rarely reported in immunocompetent patients. In immunocompetent patients, pulmonary fungal infections are not initially considered. This results in diagnosis and treatment delays, as well as poor prognosis. We report a case and serial CT findings of IPA in an immunocompetent 29-year-old male after congenital heart disease surgery.

Amyloidosis is a rare disease defined by extracellular deposits of amorphous fibrillar proteins, derived from aggregations of misfolded proteins. Localization of amyloidosis in the gallbladder is uncommon; only eight cases have been reported. We describe a case of amyloidosis diagnosed by cholecystectomy, which possibly also affected the liver and kidney. The patient was misdiagnosed with polymyalgia rheumatica, but after a cholecystectomy to treat chronic cholecystitis, we ultimately diagnosed him with amyloidosis. We review amyloidosis with gallbladder involvement in the literature.
Amyloidosis* ; Cholecystectomy ; Cholecystitis* ; Gallbladder ; Humans ; Kidney ; Liver ; Polymyalgia Rheumatica* ; Rare Diseases

Acinic cell carcinoma(ACC) is the third common malignancy in major salivary gland. Fine needle aspiration cytology is a useful tool for the diagnosis of salivary gland lesions. However, some low grade malignancies, such as ACC and mucoepidermoid carcinoma show relatively high false negative rate, mainly due to deceptively benign cytomorphologic appearance. We experienced a papillary-cystic variant of ACC, having different cytopathologic features compared with those of classic ACC. Our case showed monolayered sheets and papillary clusters without any acinic structures or naked nuclei of the tumor cells. Foamy proteinaceous material was seen in the background. The tumor cells had a large amount of granular cytoplasm and eccentric nuclei. Many vacuolated or clear cells were also noted.
Acinar Cells* ; Biopsy, Fine-Needle* ; Carcinoma, Acinar Cell* ; Carcinoma, Mucoepidermoid ; Cytoplasm ; Diagnosis ; Salivary Glands*

PURPOSE: 99mTc-sestamibi (MIBI) and 99mTc-tetrofosmin have been used as substrates for P-glycoprotein (Pgp) and multidrug resistance associated protein (MRP), which are closely associated with multidrug resistance of the tumors. To understand different handling of radiotracers in cancer cell lines expressing Pgp and MRP, we compared cellular uptakes of 99mTc-MIBI and 99mTc-tetrofosmin. The effects of cyclosporin A (CsA), well-known multidrug resistant reversing agent, on the uptake of both tracers were also compared. MATERIALS AND METHODS: HCT15/CL02 human colorectal cancer cells for Pgp expressing cells, and human non-small cell lung cancer A549 cells for MRP expressing cells, were used for in vitro and in vivo studies. RT-PCR, western blot analysis and immunohistochemistry were used for detection of Pgp and MRP. MDR-reversal effect with CsA was evaluated at different drug concentrations after incubation with MIBI or tetrofosmin. Radioactivities of supernatant and pellet were measured with gamma well counter. Tumoral uptake of the tracers were measured from tumor bearing nude mice treated with or without CsA. RESULTS: RT-PCR, western blot analysis of the cells and immunochemical staining revealed selective expression of Pgp and MRP for HCT15/CL02 and A549 cells, respectively. There were no significant difference in cellular uptakes of both tracers in HCT15/CL02 cells, but MIBI uptake was slightly higher than that of tetrofosmin in A549 cells. Co-incubation with CsA resulted in a increase in cellular uptakes of MIBI and tetrofosmin. Uptake of MIBI or tetrofosmin in HCT15/CL02 cells was increased by 10- and 2.4-fold, and by 7.5 and 6.3-fold in A549 cells, respectively. Percentage increase of MIBI was higher than that of tetrofosmin with CsA for both cells (p< 0.05). In vivo biodistribution study showed that MIBI (114% at 10 min, 257% at 60 min, 396% at 240 min) and tetrofosmin uptake (110% at 10 min, 205% at 60 min, 410% at 240 min) were progressively increased by the time, up to 240 min with CsA. But increases in tumoral uptake were not significantly different between MIBI and tetrofosmin for both tumors. CONCLUSION: MIBI seems to be a better tracer than tetrofosmin for evaluating MDR reversal effect of the modulators in vitro, but these differences were not evident in vivo tumoral uptake. Both MIBI and tetrofosmin seem to be suitable tracers for imaging Pgp- and MRP-mediated drug resistance in tumors.
Animals ; Blotting, Western ; Carcinoma, Non-Small-Cell Lung ; Cell Line ; Colorectal Neoplasms ; Cyclosporine ; Drug Resistance ; Drug Resistance, Multiple* ; Humans ; Immunohistochemistry ; Mice ; Mice, Nude ; Multidrug Resistance-Associated Proteins* ; P-Glycoprotein* ; Radioactivity ; Technetium Tc 99m Sestamibi

BACKGROUND: Altered cell cycle regulation may underlie the development and/or progression of human malignancies. The purpose of this study is to determine if the oncogenesis of soft tissue sarcomas could be better explained by examining the components involved in G1 phase progression. METHODS: Sixty-seven soft tissue sarcomas were studied for the immunohistochemical expression of cdk4, cyclin D1, retinoblastoma (Rb) and p16 proteins. For Rb and p16, samples showing either negative or heterogeneous (<80% of tumor cells) staining were considered to be altered. RESULTS: The cdk4 protein was observed in 64 cases (95.5%). Cyclin D1 was expressed in 14 cases (20.9%). The Rb expression was altered in 48 (71.6%). Sixty-three (94%) sarcomas demonstrated altered p16 expressions. All of the samples displayed altered expressions of either Rb or p16. A high percentage of the tumors with altered Rb were observed in relapsed patients (p<0.05). CONCLUSIONS: Disturbance in the cell cycle regulatory system involving the Rb/p16/cdk4/cyclin D1 pathway appears to be relatively frequent in soft tissue sarcomas and may play an important role in the tumorigenesis of these tumors. It is noteworthy that the reduced Rb expression correlates with tumor relapse, suggesting its prognostic significance.
Carcinogenesis ; Cell Cycle ; Cyclin D1* ; Cyclin-Dependent Kinase 4 ; Cyclins* ; G1 Phase ; Humans* ; Recurrence ; Retinoblastoma ; Retinoblastoma Protein* ; Sarcoma*

BACKGROUND: ras gene mutations have been described in various human malignancies, suggesting that their activation may play a role in oncogenesis. However, there are few reports concerning ras gene alterations in malignant fibrous histiocytomas. We therefore designed a study to determine the prevalence and type of mutations in the first exons of H-ras and K-ras genes in these tumors. METHODS: Twenty-seven malignant fibrous histiocytomas were investigated by direct sequencing analysis with the automated DNA sequencing of polymerase chain reaction-amplified ras sequences. RESULTS: Twenty-four mutations were found in 18 (67%) of the tumors: GGC to GAC transition mutations at codon 13 of K-ras (coding for aspartic acid instead of glycine) in 18 of the samples and GGC to GTC transversions at codon 12 of H-ras (coding for valine instead of glycine) in six of the lesions. CONCLUSIONS: Our data suggest an involvement of the ras gene mutation in conjunction with other yet unknown events in the tumorigenesis and/or progression of malignant fibrous histiocytomas. The K-ras gene activation predominated in these tumors by a mutation at codon 13. It is noteworthy that H-ras mutations were detected only in association with the lesions containing K-ras mutated genes, the significance of which remains to be determined.
Aspartic Acid ; Carcinogenesis ; Codon ; Exons ; Genes, ras* ; Histiocytoma, Malignant Fibrous* ; Humans ; Prevalence ; Sequence Analysis, DNA ; Valine

The human heart is a complex organ in which many complicated congenital defects may happen and some of them require surgical intervention. Due to the vast complexity of varied anatomical presentations, establishing an accurate and consistent nomenclature system is utmost important to facilitate effective communication among pediatric cardiologists, cardiothoracic surgeons and radiologists. The Van Praagh segmental approach to the complex congenital heart disease (CHD) was developed in the 1960s and has been used widely as the language for describing complex anatomy of CHD over the decades. It utilizes a systematic and sequential method to describe the cardiac segments and connections which in turn allows accurate, comprehensive and unambiguous description of CHD. It can also be applied to multiple imaging modalities such as echocardiogram, cardiac CT and MRI. The Van Praagh notation demonstrates a group of three letters, with each letter representative for a key embryologic region of cardiac anatomy: the atria, ventricles and great vessels. By using a 3-steps approach, we can evaluate complex CHD precisely and have no difficulties in communicating with other medial colleague. This pictorial essay revisits the logical steps of segmental approach, followed by a pictorial illustration of its application.
Congenital Abnormalities ; Heart ; Heart Defects, Congenital* ; Humans ; Logic ; Magnetic Resonance Imaging