Two new cases of leiomyosarcoma of the esophagus, one with an associated squamous cell carcinoma, are presented with review of literature. lmmunohistochemical study of MDM2 gene is performed upon these cases, and one case revealed overexpression of the MDM2 protein, whereas the other case showed negative result. And the pathological significance of MDM2 gene expression in esophageal leimyosarcoma is discussed, as, to our knowlege, no esophageal leiomyosarcoma with confirmed MDM2 gene amplification has been reported in the literature, to date. Gross character of these tumors was polypoid. Microscopically, the tumors consisted of interlacing fascicles of elongated spindle-shaped cells. Mitoses could be found without difficulty, with more than five per 10 high power fields. The tumor cells of the both cases showed imunohistochemical reactivity for vimentin and actin. Electron microscopically parallel arrays of myofilaments with interspersed dense bodies in spindle cell components were confirmed. The itera-literature regarding the association of leiomyosarcoma with epithelial malignancy in the gastrointestinal tract as well as esophagus is reviewed, and we found that this is a highly unusual occurrences(3 cases reported so far).

No abstract available.
Stomach Neoplasms*

Lymphomatoid papulosis is an enigmatic disease entity which is clinically benign and histologically malignant. Although sporadic cases have been reported, we could not find any comprehensive report on the combined clinical and histologic features of lymphomatoid papulosis in the literature. Perhaps the most controversial aspect of lymphomatoid papulosis is its pathogenesis and categorization as a benign versus a malignant entity. To date, there are no reports on p53 and bcl-2 protein expression in lymphomatoid papulosis. We analysed the clinico-pathological findings of 18 cases with lymphomatoid papulosis during the 10 year period from 1984 to 1995 and examined the prevalence of immunoreactivity for CD30(DAKO, Ber-H2), p53(DAKO, DO-7), and bcl-2(DAKO, 124) using an immunohistochemical(ABC) method. The results obtained are summarized as follows. 1) Age distribution ranged from 20 to 65, with a mean age of 45 years and a sex distribution which showed a male predominence(8:1). The lesions were located on the trunk and extremities(8cases), extremities (7cases), and trunk(3 cases). The morphology of the lesions were papules or plaques(12 cases), and nodules(6 cases). 2) Histopathologic types were classified into 3 types: type A(4 cases), type B(8 cases) and mixed type (6 cases). 3) Positive immunoreactivity for CD30 was seen in 17%(3 of 18cases): type A(2 of 3) and mixed type(1 of 3). 4) The positive immunoreactivity for p53 and bcl-2 was observed in 29%(5 of 18) and 11%(2 of 18), respectively. 5) Cases showing positive immunoreactivity for P53 were type A(1 of 5), type B(1 of 5), and mixed type(3 of 5). 6) Cases showing positive immunoreactivity for bcl-2 were mixed type(2 of 2). One case developed into Ki-1 lymphoma. These results support the idea that lymphomatoid papulosis and Ki-1 lymphoma represent a continuum. The role of p53 gene mutation and bcl-2 activation in the development of lymphomatoid papulosis is currently unknown. But, our results suggest that p53 gene mutation and bcl-2 activation are not a critical step in the development of lymphomatoid papulosis. Further studies are needed to elucidate the role of p53 gene mutation and bcl-2 activation in the development and progression of lymphomatoid papulosis.
Male ; Humans ; Genes, p53

No abstract available.
Stroke*

PURPOSE: In 2002, extended-matching type (R-type) items were introduced to the Korean Medical Licensing Examination. To evaluate the usability of R-type items, the results of the Korean Medical Licensing Examination in 2002 and 2003 were analyzed based on item types and knowledge levels. METHODS: Item parameters, such as difficulty and discrimination indexes, were calculated using the classical test theory. The item parameters were compared across three item types and three knowledge levels. RESULTS: The values of R-type item parameters were higher than those of A- or K-type items. There was no significant difference in item parameters according to knowledge level, including recall, interpretation, and problem solving. The reliability of R-type items exceeded 0.99. With the R-type, an increasing number in correct answers was associated with a decreasing difficulty index. CONCLUSION: The introduction of R-type items is favorable from the perspective of item parameters. However, an increase in the number of correct answers in pick 'n'-type questions results in the items being more difficult to solve.
Discrimination (Psychology) ; Education, Medical ; Licensure* ; Problem Solving

PURPOSE: In order to apply the item response theory to test results, the assumptions made about unidimensionality and item goodness-of-fitness should be tested before analysis. To know if the Korean Medical Licensing Examination results fulfill these assumptions, appropriate tests were done on these two features. METHODS: Three results(from three subjects) of the Korean Medical Licensing Examination, done in January 2004, were converted into 1, 0 data. The Holland and Rosenbaum Method(HRMH) and DETECT were used to test unidimensionality. The Winsteps was used to test goodness-of-fitness according to the Rasch model. RESULTS: Unidimensionality was rejected by HRMH but accepted by DETECT. With the Rasch model, 2 out of 550 items were inadequate. Each 137, 73 and 455 examinees out of 3,881 were inadequate in three subjects of 126, 400 and 24 items. CONCLUSION: The above results suggest that DETECT is desirable for testing unidimensionality of high-stakes tests with more than 100 items. According to the Rasch model, the Korean Medical Licensing Examination fulfills the goodness-of-fitness to be analyzed according to the item response theory.
Licensure* ; Netherlands

We describe a patient with cutaneous angiocentric immunoproliferative lesion (AIL) associated with the Epstein-Barr virus (EBV). An organ system survey revealed no evidence of internal involvement. A skin biopsy specimen .showed infiltrating cells involving mainly deeper dermis and subcutaneous tissue. An examination of the reticular dermis revealed polymorphous angiocentric and angioinvasive infiltrate containing some atypical lymphocytes and histiocytes. EBV encoded RNA (EBER) was demonstrated in lesional skin by the in situ hybridization technique. On the basis of these findings, we conclude that our case may represent a form of AIL associated with EBV showing histologic features of classical lymphomatoid granulomatosis.
Biopsy ; Dermis ; Herpesvirus 4, Human ; Histiocytes ; Humans ; In Situ Hybridization ; Lymphocytes ; Lymphomatoid Granulomatosis* ; RNA ; Skin ; Subcutaneous Tissue

The passing rate of the Medical Licensing Examination has been variable, which probably originated from the difference in the difficulty of items and/or difference in the ability level of examinees. We tried to explain the origin of the difference using the test equating method based on the item response theory. The number of items and examinees were 500, 3,647 in 2003 and 550, 3,879 in 2004. Common item nonequivalent group design was used for 30 common items. Item and ability parameters were calculated by three parametric logistic models using ICL. Scale transformation and true score equating were executed using ST and PIE. The mean of difficulty index of the year 2003 was -0.957 (SD 2.628) and that of 2004 after equating was -1.456 (SD 3.399). The mean of discrimination index of year 2003 was 0.487 (SD 0.242) and that of 2004 was 0.363 (SD 0.193). The mean of ability parameter of year 2003 was 0.00617 (SD 0.96605) and that of year 2004 was 0.94636 (SD 1.32960). The difference of the equated true score at the same ability level was high at the range of score of 200-350. The reason for the difference in passing rates over two consecutive years was due to the fact that the Examination in 2004 was easier and the abilities of the examinees in 2004 were higher. In addition, the passing rates of examinees with score of 270-294 in 2003, and those with 322-343 in 2004, were affected by the examination year.
Discrimination (Psychology) ; Education, Medical ; Licensure* ; Logistic Models

Klippel-Feil syndrome is characterized by congenital fusion of cervical vertebra which shows classic triad of short neck, low posterior hairline and limited range of motion of the neck. We report a case of Klippel-Feil syndrome not only associated with renal hypoplasia and sensorineural hearing defect but also with repetitive severe hypoglycemia with lactic acidosis.
Acidosis, Lactic ; Hearing ; Hypoglycemia* ; Klippel-Feil Syndrome* ; Neck ; Range of Motion, Articular ; Spine

Clear cell chondrosarcoma, first described by Unni in 1976, is distinguished from classical chondrosarcoma by a typical histological picture, mostly an epiphyseal site of origin, and relatively a benign clinical course. We present a case of clear cell chondrosarcoma arising from hyoid bone in a 70-year-old male. Histologically, large areas of closely packed cells with characteristic clear cytoplasm were seen in addition to the usual elements of a conventional chondrosarcoma. Our search and review of the literature did not reveal any reported case of clear cell chondrosarcoma arising from hyoid bone.
Aged ; Chondrosarcoma* ; Cytoplasm ; Humans ; Hyoid Bone* ; Male