Malignant melanoma is a neoplasm of the skin and mucous membrane. Extragenital malignant melanoma that metastasizes to the ovary is seen rarely, and in only a few cases has the diagnosis been made before autopsy. The most common histologic feature that should raise the question of metastatic melanoma is the presence of numerous epitheloid cells with abundant eosinophilic cytoplasm. Despite advances in chemotherapy and immunotherapy the efficacy of treatment of advanced melanoma remains limited and the prognosis of metastatic disease remains guarded. We describe a case of malignant melanoma metastatic to the ovary and right axillae occurring one year and four months after diagnosis of cutaneous malignant melanoma on the patient's back.
Autopsy ; Axilla ; Cytoplasm ; Diagnosis ; Drug Therapy ; Eosinophils ; Female ; Immunotherapy ; Melanoma* ; Mucous Membrane ; Ovary* ; Prognosis ; Skin

The most frequent ectopic locations of endometriosis include, in descending order of frequency, the ovaries, uterine ligaments, the rectovaginal septum, and peritoneum covering the pelvic organs, that is, uterus, fallopian tubes, rectum, sigmoid colon, and bladder. Endometriosis at the site of episiotomy scar and abdominal scar following cesarean section are very rare conditions among the extrapelvic endometriosis. We have experienced two cases of endometriosis. One occurred from episiotomy scar and the other occurred from abdominal scar following cesarean section. The diagnosis of scar endometriosis is suggested if the symptoms are cyclic or in association with the patient's menstrual cycle. We can use ultrasonography, computerized tomography, magnetic resonance imaging to differentiate from other tumors. Surgical excision is the method of choice for diagnosis and treatment. We report the two cases with review of rare extrapelvic endometriosis.
Cesarean Section* ; Cicatrix* ; Colon, Sigmoid ; Diagnosis ; Endometriosis* ; Episiotomy* ; Fallopian Tubes ; Female ; Ligaments ; Magnetic Resonance Imaging ; Menstrual Cycle ; Ovary ; Peritoneum ; Pregnancy ; Rectum ; Ultrasonography ; Urinary Bladder ; Uterus

Sertoli-Leydig cell tumor (SLCT) which belong to the group of sex-cord stromal tumors is a rare ovarian tumor. It usually develops the symptom of masculinization by excessive testosterone from the Leydig cell. In most cases, SLCTs are unilaterally localized (97-98%) and prognosis prove generally favorable with 5-year survival rate (79-90%). Recurrence is rare after a complete resection as well. Rare SLCTs secrete the alpha-fetoprotein (AFP). There is a increasing tendency for the SLCTs that have heterologous elements and low differentiation to secrete the AFP, which is useful in diagnosis of recurrence. The association of a thyroid adenoma and a SLCT has been described rarely. The relation between these two tumors has been suggested on the basis of a relatively high incidence of thyroid adenomas in the presence of such an uncommon ovarian neoplasm. It seems likely that this tumor complex is genetically determined by the aspect of familial neoplastic syndromes. We experienced a case of Sertoli-Leydig cell tumor with AFP-producing Sertoli cells in a 33-years old woman who has past history of thyroid adenoma, amenorrhea and a huge abdominal mass. Therefore, we present it with a brief review of literature.
Adult ; alpha-Fetoproteins* ; Amenorrhea ; Diagnosis ; Female ; Humans ; Incidence ; Ovarian Neoplasms ; Prognosis ; Recurrence ; Sertoli Cells ; Sertoli-Leydig Cell Tumor* ; Survival Rate ; Testosterone ; Thyroid Gland* ; Thyroid Neoplasms*

A gastric carcinoid is a rare disease that accounts for only 0.3% of all primary gastric tumors. It can be multiple or occur with other types of tumor. However, there has been a recent increase in incidence. While carcinoids of the appendix and rectum are accompanied by adenoma or adenocarcinoma, a gastric carcinoid rarely occurs with an adenocarcinoma, particularly with a gastric adenoma. We encountered a case of a gastric adenoma and carcinoid mixed as a composite tumor, which became a lesion. The lesion resembled a type IIc early gastric cancer at the endoscopic examination and was removed by an endoscopic mucosal resection. We report a composite tumor of the gastric antrum composed of areas of adenoma and carcinoid, with an analysis of the histological components by immunohistochemical staining. Microscopically, the lesion was composed of a gastric adenoma and carcinoid as a composite tumor.
Adenocarcinoma ; Adenoma* ; Appendix ; Carcinoid Tumor* ; Incidence ; Pyloric Antrum ; Rare Diseases ; Rectum ; Stomach Neoplasms

BACKGROUND/AIMS: Before the introduction of the HBV vaccination programs, the positivity of HBsAg among the general population was reported to be around 8% in Korea. Although recent reports revealed somewhat decreased values, a wide range of variation exists according to the authors. Major movements to control HBV infection include the programs such as the introduction of HBV vaccination in 1983, mass inoculation of the elementary school children since 1988 and inclusion of type B hepatitis in 1995 in Class III legal epidemics. The purpose of the present study was to examine the changing trend of the positivities of HBsAg, HBeAg and anti-HCV in army draftees in Korea since we believed that they are an ideal study group with a set of fixed variables such as gender and age. METHODS: From January 1, 1993 to December 31, 1999, we evaluated a total of 498,206 male army draftees for serum ALT, HBsAg, HBeAg and anti-HCV antibody. HBsAg (Genedia, Yongin, Korea) and HBeAg (Amrad, Austrailia) were examined by EIA and Immunochromatography, respectively. Anti-HCV antibody was tested by 3rd generation EIA (Genedia, Yongin, Korea). Serum ALT was determined by autoanalyser, Polystat 2000 (Hitachi, Japan). RESULTS: The majority of the draftees were 20 years old (68.8%). The positivity of HBsAg gradually decreased from 5.8% in 1993 to 4.3% in 1999(mean 4.8%). The positivity of HBeAg among the asymptomatic HBsAg carriers ranged from 47.9% to 55.6%(mean 51.8%). The positivity of anti-HCV antibody was seen in the range from 0.09% to 0.29%(mean 0.18%), and 84.5% showed normal ALT. The positivity of HBsAg among the anti-HCV positive subjects was 6.6%. CONCLUSION: The HBsAg positivity has significantly(p=0.001) decreased for the past 7 years. However, the positivity of anti-HCV antibody showed no significant pattern of change during the same period.
Child ; Gyeonggi-do ; Hepatitis ; Hepatitis B e Antigens ; Hepatitis B Surface Antigens* ; Humans ; Immunochromatography ; Korea* ; Male ; Vaccination ; Young Adult

Pemphigus vulgaris is a rare chronic disorder that is characterized by the development of bullae on the skin and mucous membrane due to an acantholysis mediated by circulating autoantibodies. It begins as painful, non- healing ulcerations in the mouth. After a period of weeks to months, the condition progresses to the skin. Occasionally, skin lesions may develop as the initial manifestation of this disease. However, esophageal involvement of pemphigus vulgaris is rare. An 84-year-old man was referred due to chest pain, dysphagia, oral ulcerations and facial bullae. The histopathological findings showed a suprabasal blister and acantholysis in the epithelium of the facial skin. An endoscopic examination revealed exfoliated erosions, ulcerations and hemorrhagic bullae on the oral and esophageal mucosa. The patient was started on high dose of corticosteroids and azathioprine, but there was no clinical improvement. The use of cyclophosphamide led to the remission of the lesions.
Acantholysis ; Adrenal Cortex Hormones ; Aged, 80 and over ; Autoantibodies ; Azathioprine ; Blister ; Chest Pain ; Cyclophosphamide ; Deglutition Disorders ; Epithelium ; Esophagus ; Humans ; Mouth ; Mucous Membrane ; Oral Ulcer ; Pemphigus* ; Skin ; Ulcer

Gastric carcinoma showing the features of a submucosal tumor (SMT) is extremely rare. The incidence of this type of tumor has been reported to be 0.1~0.63%. We report two cases of advanced gastric carcinomas showing the features of SMT. A 58-year-old man visited our hospital with a melena. An endoscopic examination revealed a 3.0 cm sized protruding lesion on the posterior wall of the gastric antrum. Most of the tumor surface was covered with normal mucosa and ulceration was observed in the center. Although the histological diagnosis could not be obtained prior to surgery, a gastrectomy was performed due to the high risk of malignancy. The tumor was diagnosed histologically as a lymphoepithelioma-like carcinoma. The other patient was a 64-year-old man with the chief complaint of epigastric discomfort. An endoscopic examination revealed a SMT like lesion with a central ulceration and hard coated exudate in the high body of the stomach. The microscopic examination revealed a poorly differentiated vimentin-positive adenocarcinoma. Unfortunately, he died from the disease two months later.
Adenocarcinoma ; Diagnosis ; Exudates and Transudates ; Gastrectomy ; Humans ; Incidence ; Melena ; Middle Aged ; Mucous Membrane ; Pyloric Antrum ; Rhabdoid Tumor ; Stomach ; Ulcer

Objective: Machine learning is emerging as a new alternative in various scientific fields and is potentially a new method of interpretation. Using the Light Gradient Boosting Machine (LightGBM), we analyzed the factors that influence the rechoice of emergency medicine responders. The survey is a cross-sectional study which provides an accurate understanding of a responder's current status. However, the results may vary depending on the composition, format, and question, and the relationship between the answers may be unclear. Methods: This study evaluated the modified 2020 Korean Emergency Physician Survey raw data. We applied the preferred model for random relationship check, random forest, support vector machine, and LightGBM models. The stacking ensemble model was used for the final decision process. Results: ‘It is fun working in an emergency room’was the most selected response factor for re-choice, followed by ‘interesting major’. The physical burden of age and lack of identity had a negative impact, whereas burnout and emotional stress factors had a lesser effect. Anxiety caused by the coronavirus disease 2019 (COVID-19) is thought to have a significant impact on this decision making. Conclusion Establishing the identity of emergency medicine and being faithful to its fundamental mission is a way to increase the rate of re-choice. Decreasing the burden of workload modified according to age is recommended to establish career longevity. The method of machine learning presents us with a new possibility of checking the relevance of survey results quickly and easily.

Objective: It has been reported that emergency physicians experience high levels of depression and psychological burnout due to night shifts and tend to consider early retirement. This study intended to check working hours and intensity, individual health, satisfaction, and overall welfare, given the increase in the numbers of emergency physicians. Methods: The study used the results of the ‘2020 Korean Emergency Physician Survey (KEPS)’ conducted from January 15 to February 26, 2021, which targeted 2,138 emergency physicians registered with the Korean Society of Emergency Medicine. The survey was conducted online through the web and mobile application. Results: One thousand three hundred seven out of the 2,167 emergency physicians (60.3%) registered at the society responded. The average age of the respondents was 42.6 years, and there were 1,148 male emergency physicians and 158 female emergency physicians. The average professional experience was 8.2 years, with 325 professors, 122 commissioned doctors, 648 public servants of which 90 had military service, and 45 medical practitioners. Conclusion In conclusion, the number of working hours of emergency physicians showed a decreasing trend compared to 2010 and 2015. However, emergency physicians often expected early retirement. This suggests that, while the absolute working hours are decreasing, the actual working intensity has not decreased. For the proper development of the emergency medical system, it is necessary to establish a stable working environment for emergency physicians. A systematic study is needed on the working hours and work intensity of emergency physicians.

Objective: As the history of emergency medicine grows longer, emergency medicine specialists are observed to comprise various age groups. There have been no prior studies on the generation shift analysis of emergency medicine specialists. Our study is designed to identify the characteristics of each generation and predict the generation shift in emergency medicine physicians. Methods: The analysis was based on the results of the 2020 survey of emergency medicine specialists. The study was conducted on 1,307 respondents and finally, the responses of 967 people were analyzed after excluding 199 who were not in charge of emergency room treatments and 141 who gave incomplete responses. The respondents were divided into four groups based on the following generations: first generation (1996-1999), second generation (2000-2008), third generation (2009-2014), and fourth generation (2015-2020), classified by the year in which they acquired their emergency medicine board license. The intergenerational difference analysis was done using the Kruskall-Wallis test. Results: The first generation was characterized by a high proportion of university hospital professors, large non-clinical activity hours, a few night shifts, higher social contributions, low satisfaction with the training and education environment, and a high retirement age compared to the later generations. In the second generation, the characteristics of the first, third, and fourth generations were generally mixed. The third and fourth generations showed similar characteristics overall, though there were differences in some categories. Conclusion There were significant differences by generation in the working environments, motivation for application, and retirement age. This is the first study that quantifies generational differences. Considering these trends, a discussion about the work environment needs to be initiated.