During evaluation of follow-up curettage of endometrial hyperplasia after progesterone treatment, we have noticed that the foci of squamous or morular metaplasia are persistent or even markedly increased after the hyperplastic glands have all disappeared. These observations have led us to study the histological changes of squamous or morular metaplasia in the hyperplastic endometrium after progesterone treatment and to examine the changes of estrogen receptors(ER) and progesterone receptors(PR) to find out, if there is any pathogenetic role of progesterone administration on the squamous or morular metaplasia. Squamous or morular metaplasia was associated in 21 cases (13.5 %) out of 156 endometrial hyperplasia during the study periods and all of them were associated with complex hyperplasia, but not associated with simple hyperplasia. At follow-up curettage after progesterone treatment, squamous metaplasia newly appeared in 3 cases(20 %), markedly increased in 4 cases(26.7%), persisted in 4 cases(26.7%) and decreased in 4 cases(26.7%), even after hyperplastic glands have all disappeared or were markedly decreased. On immunohistochemical staining, metaplastic foci showed ER- and PR- in 13 cases (87 %) in contrast to the surrounding endometrium and the remaining 2 cases showed minimal ER+ and PR+ confined to several nuclei. Intensity or staining pattern of ER and PR in metaplastic foci were not changed with progesterone treatment. In the background endometrium, intensity of glandular ER+ and PR + was higher than that of the stroma at the initial curettage, however, progesterone treatment predominantly down-regulated glandular ER+ more than stromal ER+. Increment or persistence of squamous metaplasia along the progesterone treatment seemingly would implicate hormonal influences as playing a significant role in the formation of squamous or morular metaplasia and the absence of cellular receptors for these hormones in the metaplastic foci may suggest qualitative changes in the receptors.

BACKGROUND: Pilomatricoma is a rare benign follicular tumor in Asians OBJECTIVE: purpose of this study was to assess the clinical and histopathological features of the tumor. METHODS: The hospital charts and slides of 13 patients with pilomatricoma over a 12-year period at Ewha Womans University Tongdaemun Hospital were retrospectively reviewed. RESULTS: The age of patients ranged from 5 to 76 years with a mean of 21.5 years. The maleto-female ratio was 1:3.3. Seventy-seven percent of the tumors were located on the upper and lower extremities, followed by the face and neck. Most tumors appeared as a pea-sized hard movable skin-colored nodule. At histopathologic level, the most common morphological stage was the early regressive stage (stage 3), followed by late regressive (stage 4), fully developed (stage 2), and early (stage 1) stages. Foreign body giant cells, calci6cation, ossification were seen in 69.2%, 84.6%, and 7.7%, respectively; giant cells and inflammatory infiltrate were mostly seen in stage 3 tumors, calcification in stage 3 and 4 tumors, and ossification, only in the sole stage 4 tumor. Anetodermic changes of overlying dermis were seen in 2 cases (15.4%). CONCLUSION: The various histopathologic features of pilomatricoma can be explained by its chronological, morphological stages.Most pilomatricomas present for longer than 6 months are already in stage 3, and one can expect the histopathological features accordingly.
Asian Continental Ancestry Group ; Dermis ; Female ; Giant Cells ; Giant Cells, Foreign-Body ; Humans ; Lower Extremity ; Neck ; Pilomatrixoma* ; Retrospective Studies

No abstract available.
Female* ; Humans ; Urinary Incontinence*

BACKGROUND: Nevus sebaceus of Jadassohn is a complex anomaly involving the epidermis, dermis, apocrine glands and hair follicles, as well as the sebaceous glands, and a variety of benign and malignant tumors and neurologic abnormalities may be associated with it; however, only a few studies on it have been reported in the Korean literature. OBJECTIVE: The objectives of this study was to document clinical and histopathologic features of nevus sebaceus in Koreans and compare them to those in the previously reported studies. METHOD: Clinical records and histopathology of 53 cases of nevus sebaceus diagnosed at Ewha Womans University Tongdaemun Hospital during a period of 18 years were reviewed and analyzed. RESULTS: The average incidence rate of nevus sebaceus among new patients was 0.03%. The male-to-female ratio was 1.04 and the average age at visit, 16.5 years. The lesions had been present since birth or had developed before age 10 in 85% of the cases. A11 lesions were situated on the head, and the most common site was the scalp. Linear 1esions (20.8%) were mostly facial lesions. Histopathologically, the incidence of sebaceous and apocrine glandular hyperplasia was most notable in the 13-18 and over-18 age groups. The sebaceous glands showed small punched out defects or "holes" in 24.5%; ectopic apocrine glands were found in 24.5 %. Mature hair follicles were absent or greatly reduced in number in 75.5%. Acanthosis nigricanslike pattern of acanthosis and mild papillomatosis were the dominant changes in the epidermis. Hyperplasias and neoplasms were associated in 15.1%, which included 5 cases of primitive follicular induction and 1 trichoblastoma. CONCLUSION: In this series, no examples of malignant neoplasms were identified; however, an early total excision before age 13 is recommended since a variable "deficit malformation" of the follicles with hyperplasia of the epidermis and sebaceous glands becomes more prominent after that age.
Apocrine Glands ; Dermis ; Epidermis ; Female ; Hair Follicle ; Head ; Humans ; Hyperplasia ; Incidence ; Nevus* ; Nevus, Sebaceous of Jadassohn ; Papilloma ; Parturition ; Scalp ; Sebaceous Glands

BACKGROUND: A majority of patients undergoing chemical peeling complain of pain severe enough to disturb the process of the peeling. However, there has been few controlled studies on pain control during chemical peeling. OBJECTIVES: We evaluated the efficacy and safety of pretreatment with intramuscular ketorolac (Tarasyn, 30 mg) and oral diazepam(Valium, 5 mg) in comparison with control and diazepam groups, and compared the sensitivity of pain between two sexes. METHODS: The patients were randomly assigned to one of three groups; control, diazepam, and ketorolac plus diazepam groups. Pain intensity was assessed 5 times at every ten minutes from the beginning of the peeling using visual analog scale(VAS). RESULTS: At every 10 minutes of pain assessment, ketorolac plus diazepam group recorded the lowest VAS among the three groups. Except at the first 10 minutes, nificant. There was no significant difference in the pain intensity between the sexes at all five times. After application of Jessner`s solution, there was significant increase of VAS in all groups. CONCLUSION: The ketorolac pretreatment is a safe and effective modality of pain relief prior to chemical peeling without the adverse reactions.
Diazepam ; Humans ; Ketorolac* ; Pain Measurement ; Premedication*

A 22-year-old woman with no history of trauma or other diseases presented with a slowly enlarging firm nodule with a central pointed opening on the right chest. An excisional biopsy revealed a pilomatricoma associated with an epidermoid cyst. Histopathologically, an epidermoid cyst located in the deep dermis was lined mostly by keratin-forming stratified squamous epithelium but focally had columns of shadow cells that projected from the epithelial lining of the cyst into the lumen. The lumen also contained masses of shadow cells, unattached to the epithelial lining. In the stroma surrounding the cyst, numerous masses of shadow cells with giant cell reaction and focal calcification were seen, which were in turn surrounded by a connective tissue capsule. These features are similar to those seen in infundibular cysts associated with Gardner's syndrome. Since epidermoid cysts and pilomatricomas originate in common from the pilosebaceous unit and pilomatricomas begin as infundibular matrix cysts, we suggest that they can occur simultaneously, although rarely, in a healthy person.
Biopsy ; Connective Tissue ; Dermis ; Epidermal Cyst* ; Epithelium ; Female ; Gardner Syndrome ; Giant Cells ; Humans ; Pilomatrixoma* ; Thorax ; Young Adult

Gestational trophoblastic disease associated with the tubal pregnancy is uncommon, and the incidence has been described as 1/5000 tubal pregnancy. We have experienced a case of metastatic gestational trophoblastic disease(GTD) in the lung occuring with complete hydatidiform mole arising in tubal pregnancy. The patient was a 39-year-old, G4P2A2L2 woman with amenorrhea for 5 weeks. Ectopic pregnancy in the right fallopian tube was suspected on transvaginal ultrasonogram. A right adnexectomy was performed. The fallopian tube was markedly dilated and ruptured. The right ovary and a round hematoma had adhered to the external surface of the fallopian tube. On gross examination, no molar tissue was identified. On microscopic examination, the lumen of the dilated fallopian tube was filled with blood clots admixed with several chorionic villi showing hydropic swelling and marked proliferation of atypical trophoblasts. Proliferating syncytio-and cytotrophoblasts invaded the wall of the blood vessels of the fallopian tube and sheets of trophoblasts and some villi were identified in the lumen of blood vessels. Multiple pulmonary nodules thought to be metastatic nodules were identified in the chest X-ray and serum beta-HCG had increased 2 weeks later. This case indicates that a careful pathological examination in the ectopic pregnancy is mandatory, because tubal GTD is not clinically distinguishable from ordinary tubal pregnancy.
Pregnancy ; Female ; Humans ; Neoplasm Metastasis

PSTT has been established as a separate entity distinct from choriocarcinoma since 1983, because of its different morphological features, biologic behavior and response to chemotherapy. Most cases of PSTT have indolent clinical courses, but there have been several reports showing malignant behavior resulted in death of the patient. We report a case of PSTT showing vaginal metastatis. In biopsy specimen, it was difficult to make differential diagnosis from squamous cell carcinoma of uterine cervix due to uniform and mononuclear cytologic characteristics. Immunohistochemical stains for hPL and hCG were not typical for either PSTT or choriocarcinoma. We suggest that poorly differentiated PSTT may synthesize the lesser amount of hPL than typical PSTT and it may behave more aggressively.
Diagnosis, Differential ; Biopsy

Luteal phase defect (LPD) is an ovulatory disorder of considerable clinical importance that leads to delayed endometrial maturation and inadequate endometrium for blastocyst implantation. This disorder is implicated in infertility and recurrent spontaneous abortion. We analyzed the endometrial histological maturation, and the estrogen receptor(ER) and progesterone receptor(PR) status in patients with unexplained delayed ovulation, and in patients with ovulation induction by clomiphen citrate. The purpose of this study was to determine whether the length of the follicular phase influences the endometrial histological maturation and the hormonal receptor status, and to know the effect of clomiphen citrate on the endometrium. In the delayed ovulation group, the endometrium was characterized by an irregular outpouching and dilated lumina of the glands, a decreased secretory activity and predecidualization, and a decreased number of granulocytes in the stroma. In the clomiphen citrate-ovulation induction group, glandular proliferation was markedly diminished with poorly convoluted and narrow glands, secretory activity was decreased, stroma was undecidualized, and there was an absence of granulocytes. ER expression was increased in the glandular epithelium in the delayed ovulation group, and both ER and PR expressions were markedly decreased in the glandular epithelium and stromal cells in the ovulation induction group. Endometrial maturation and differentiation may be diminished by increased estrogenic and relatively deficient progesterone effects in patients with delayed ovulation. The hormonal receptor status might also be influenced by hormonal changes. Clomiphen citrate successfully induced ovulation in patients with delayed ovulation, however, endometrial proliferation and maturation were markedly suppressed. This might be related to the lower pregnancy rate and higher abortion rate in patients with clomiphen citrate induced ovulation.
Pregnancy ; Female ; Humans

Congenital self-healing reticulohistiocytosis (CSHRH) is a rare Langerhans cell disorder usually showing spontaneous resolution within 3-4 months. By electron microscopy, the identification of Birbeck granules and laminated dense bodies in the infiltrated cells is mandatory for the diagnosis of CSHRH. However, in some reported cases, Birbeck granules could not be demonstrated and only cytoplasmic dense bodies were seen. If the lesion is more advanced, Birbeck granules are transformed to lysosomes, i.e., 'unique phagosomes', in which they are degraded. A 2-month-old Korean girl presented with congenital, numerous red-brown pigmented papules on the left side of trunk and upper extremity without systemic symptoms. A biopsy specimen demonstrated papillary dermis containing epidermotropic infiltrates of histiocytes with abundant eosinophilic cytoplasm. Some had kidney-shaped nuclei and PAS-positive cytoplasmic inclusions. Immunohistochemically, infiltrating cells expressed S-100 protein and ultrastructurally, no Birbeck granules but many dense laminated bodies and unique phagosomes were found. It was ten months since the skin lesions developed that they have started resolving.
Biopsy ; Cytoplasm ; Dermis ; Diagnosis ; Eosinophils ; Female ; Histiocytes ; Humans ; Inclusion Bodies ; Infant ; Lysosomes ; Microscopy, Electron ; Phagosomes ; S100 Proteins ; Skin ; Upper Extremity