Epithelioid hemangioendothelioma is a recently described vascular neoplasm characterized by epitheloiod endothelial linings and its borderline biologic behavior. We report a case of epithelioid hemangioendothelioma in a 6-year-old male. The tumor was presented as a non-tender dermal nodule on the left middle finger. The microscopic sections revealed irregular proliferation of vascular channels lined by epithelioid cells with histiocytoid features and frequent intracytoplasmic vacuoles, mimicking so called signet ring cells. Immunohistochemical stainings for factor VIII and vimentin were positive both in epithelioid and vacuolated endothelial cell. Electron microscopic finding reveals abundant intermediate filaments.

Esophageal granular cell tumor of is rare neoplesin, and 3 cases were reported in Korea so far. We report a case of esophageal granular cell tumor in a 28 year old man. The patient was a 28 year old man who visited this hospital because of upper abdominal pain, acid belching and weight loss. A small nodule, 5 mm in diameter, was found in mid esophagus on esophagoscopy. This nodule was proved to be a granular cell tumor.
Male ; Humans

Authors experienced a rare adenocarcinoma arising in presacral sacrococcygeal teratoma in a adult and herein reported. The patient was a 52 year old female admitted because of lower abdominal pain for 5 to 6 months. Past and familial history were unremarkable. On rectal examination a mass was palpated 3 cm above the anal verge. The large bowel was displaced by an extrinsic mass but there was no evidence of intrinsic tumor lesion on barium enema, CT was done and showed a large presacral tumor attached to the sacrum. Clinical impression was sacrococcygeal teratoma. Resected tumor mass was a relatively well circumscribed cystic mass, measuring 11 x 11 cm and the cystic content was previously evacuated. Inner surface showed ragged appearance, and focal nodular solid area was noted. On microscopic examination, the tumor revealed the derivatives of three germ layers and main components were tissues of respiratory tract. Sections from the solid area showed a well differentiated adenocarcinoma and with stromal, capsular and perineural invasion. Borderline malignant epithelial lesions are also noted suggesting the pathogenesis and progression of this tumor. There was no recurrence for one year after surgery in the follow up.
Adult ; Male ; Female ; Humans ; Adenocarcinoma

BACKGROUND: Osteoarthritis(OA) of the knee represents a common chronic disease, especially in the elderly, leading to functional impairment and disability. And OA patients have depressive symptoms frequently. Several factors contribute to the level of depressive symptoms. Authors tried to assess these factors and show effect of these factors to depressive symptoms. Through this study in the future physicians must consider psychiatric problems besides the pain itself in the treatment of OA patients. METHODS: Subjects included in this study were 64 knee joint OA patients. We obtained depressive symptoms from the CES-D(The Korean version of the Center for Epidemiological Studies-Depression Scale), level of pain, stiffness, functional disability from KWOMAC(WOMAC Korean Version 2, The Korean version of Western Ontario and Macmaster Osteoarthritis Index Score) and other factors able to contribute to depressive symptoms. RESULT: We divided the patients into two groups using CES-D cut-off score of 21. Each group consists of 46(CES-D<21) and 18(CES-D> or =21) patients. Frequency of sleep disturbance and pain consistency and level of pain, stiffness and functional disability were different significantly between two groups(p<0.0l). Through the correlation analysis level of pain, stiffness and functional disability were associated with CES-D score significantly(p<0.0l). And through the stepwise multiple regression analysis we demonstratred that the CES-D score influenced by level of functional disability, BMI, disease duration and, pain but only level of functional disability and BML were statistically significant(p<0.0l). Level of functional disability explained 46% of CES-D score(partial R2=0.46) so influenced on depressive symptoms most effectively. CONCLUSION: This study suggested that functional disability was most important factors to explain depressive symptoms of knee joint OA patients.
Aged ; Chronic Disease ; Depression ; Humans ; Knee Joint* ; Knee* ; Ontario ; Osteoarthritis*

Thymic cyst is relatively rare tumor which usually occurs in the neck or mediastinum. Cervical thymic cyst is usually situated laterally and deep to the anterior border of the sternocleidomastoid muscle, simulating a branchial cyst. Thymic cyst of the mediastinum is usually detected incidentally and differential diagnoses include cystic degeneration of thymoma, and cystic teratoma. Two case of a cervical and a mediastinal thymic cysts were reported. The one was a cervical thymic cyst developed slowly growing mass in a 53-year-old male a for 10 years. The cyst was unilocular and measures 5.4x2.9x2.8 cm with columnar or squamous cell linings. The other is a mediastinal thymic cyst developed in a 37-year-old female with chest discomfort for 7 months. The cyst was uniocular and measures 2.8x2.2x2.0 cm. The epithelial lining of the cyst was largely desquamated and covered by macrophages with cholesterol granuloma. Involutional thymic stissue in their walls were noted in both cysts. In both cases presence of thymic tissue in the wall of the cyst thought to be the most important diagnostic feature.
Female ; Male ; Humans ; Diagnosis, Differential ; Cysts

A case of calcifying synovial sarcoma, occuring in the deep muscle fascia of the left thigh is reported. The presence of extensive calcification in synovial sarcoma is a favorable sign for prognosis. The patient was a 31-year-old female. The tumor mass had been present for 3 years, accompanying local tenderness. X-ray revealed a soft tissue tumor with central calcification, which was located between the adductor magnus and brevis of the left thigh. The tumor size was 7 x 5.5 cm. There was no connection with the knee joint or the femur. Grossly, the tumor was a relatively well circumscribed hard tumor with massive calcification. Microscopically, the tumor was composed of predominantly spindle cells with accompanying hyalinization, numerous spherical concretions and ossification. The epithelial component was not clearly noted. Mitotic figures were rarely noted in the densely cellular area. Immunohistochemical staining for EMA, S-100, vimentin, and carcinoembryonic antigen was negative while vimentin and cytokeratin were weakly and focally positive. EM study revealed multiple desmosome-like calcification intercellular junctions with a slit-like lumen and an incomplete basal lamina, which suggest that tumor show these cells were undergoing epithelia] differentiation. Above evidence suggest that this tumor is a synovial sarcoma associated with a large area of calcification, a so called calcifying synovial sarcoma. No recurrence was noted in one and half years of follow up.
Female ; Humans

BACKGROUND: PUVA has been used effectively in the treat,ment of vitiligo, but the mechanism by which PUVA stimulat.es melanocyte proliferation in vitiligo is not known. Several mechanisms have been suggested to be involved in the process of repigmentation of vitiligo. First, UV light, with or without psoralen, directly stimulates the proliferation of melanocytes. Secondly, PUVA may act. on epidermal keratinocytes or dermal components to stimulate t,hem to release certain melanocyte growth st,inulation factors that enhance the proliferation of melanocytes in depigmented lesions. Thirdly, PUVA irnmunologically leads to the impairment of epidermal Langerhans cell function and alteration of circulating T and B cell function, which results in the suppression of the stimuli is for rnelanocyte destruction during the therapy. OBJECTIVE: To test, th hypothesis that PUVA induced repigmentation in vitiligo results from the stimulation of growth factors that induce melanocyte proliferation, and that PUVA may suppress the immune reacticin to melanocytes, especially in autoantibody synt,hesis, we examined the effects of sera on the growth of epidermal melanocytes and control cells, and t,he incidence of antibodies to melanocyte and melanoma cells(SK-Mel 2~3) in the sera of patients with vitiligo. We also had normal control individuals and studied the changes of the antibody titer in the sera of patients with vitiligo. METHODS: The rate of H thymidine uptake was estimat,ed in cultured melanocytes and fibroblasts t,reated by patients sera before and after PUVA treatment. SDS-PAGE and immunoblotting analysis were used to idcntify anti pigment cell autoantibodies and were compared to the titers of autoantibodies after PUVA. RESULTS: 1. Melanocyte and fibrablast proliferation was increased by PUVA treated sera. Their proliferation was in proportion to the duration of the PUVA treatment. Melanocytes proliferated more than fibroblasts. 2. Significant differences between vitiligo patients and normal controls were found in the inci dence of anti-pigment cell antibodies. The antibodies were predominantly directed to melanocyte antigens of 110 kD, 65 kD, 45 kD and melanoma cell antigens of 110 kD, 103 kD, 88kD, 70 kD, 56 kD, 41 kD. 3. The titer of anti piment cell antibodies showed a tendency to decrease after PUVA treat- ment in most patients regardless of clinical improvement. Conclusion ; PUVA treated sera induced proliferation of melanocytes and fibroblasts and the production of aut,oantibodies was suppressed against pigment cell antigens through irnmunosuppression, which might help in the repigmentation of vitiligo.
Antibodies ; Autoantibodies* ; Electrophoresis, Polyacrylamide Gel ; Fibroblasts ; Ficusin ; Humans ; Immunoblotting ; Incidence ; Intercellular Signaling Peptides and Proteins ; Keratinocytes ; Melanocytes* ; Melanoma ; Thymidine ; Ultraviolet Rays ; Vitiligo*

BACKGROUND: PUVA has been used effectively in the treat,ment of vitiligo, but the mechanism by which PUVA stimulat.es melanocyte proliferation in vitiligo is not known. Several mechanisms have been suggested to be involved in the process of repigmentation of vitiligo. First, UV light, with or without psoralen, directly stimulates the proliferation of melanocytes. Secondly, PUVA may act. on epidermal keratinocytes or dermal components to stimulate t,hem to release certain melanocyte growth st,inulation factors that enhance the proliferation of melanocytes in depigmented lesions. Thirdly, PUVA irnmunologically leads to the impairment of epidermal Langerhans cell function and alteration of circulating T and B cell function, which results in the suppression of the stimuli is for rnelanocyte destruction during the therapy. OBJECTIVE: To test, th hypothesis that PUVA induced repigmentation in vitiligo results from the stimulation of growth factors that induce melanocyte proliferation, and that PUVA may suppress the immune reacticin to melanocytes, especially in autoantibody synt,hesis, we examined the effects of sera on the growth of epidermal melanocytes and control cells, and t,he incidence of antibodies to melanocyte and melanoma cells(SK-Mel 2~3) in the sera of patients with vitiligo. We also had normal control individuals and studied the changes of the antibody titer in the sera of patients with vitiligo. METHODS: The rate of H thymidine uptake was estimat,ed in cultured melanocytes and fibroblasts t,reated by patients sera before and after PUVA treatment. SDS-PAGE and immunoblotting analysis were used to idcntify anti pigment cell autoantibodies and were compared to the titers of autoantibodies after PUVA. RESULTS: 1. Melanocyte and fibrablast proliferation was increased by PUVA treated sera. Their proliferation was in proportion to the duration of the PUVA treatment. Melanocytes proliferated more than fibroblasts. 2. Significant differences between vitiligo patients and normal controls were found in the inci dence of anti-pigment cell antibodies. The antibodies were predominantly directed to melanocyte antigens of 110 kD, 65 kD, 45 kD and melanoma cell antigens of 110 kD, 103 kD, 88kD, 70 kD, 56 kD, 41 kD. 3. The titer of anti piment cell antibodies showed a tendency to decrease after PUVA treat- ment in most patients regardless of clinical improvement. Conclusion ; PUVA treated sera induced proliferation of melanocytes and fibroblasts and the production of aut,oantibodies was suppressed against pigment cell antigens through irnmunosuppression, which might help in the repigmentation of vitiligo.
Antibodies ; Autoantibodies* ; Electrophoresis, Polyacrylamide Gel ; Fibroblasts ; Ficusin ; Humans ; Immunoblotting ; Incidence ; Intercellular Signaling Peptides and Proteins ; Keratinocytes ; Melanocytes* ; Melanoma ; Thymidine ; Ultraviolet Rays ; Vitiligo*

Glutathione S-Transferase (GST) is a conjugation enzyme in the metabolism of exogenous and endogenous lipophilic compounds for their excretion and detoxification. Acidic isozyme of GST, GST-Pi, has been recognized as a preneoplastic marker in the experimental hyperplastic nodules of liver in rats, and GST-Pi is abundant in the squamous cells of the skin, also. This histochemical study was carried out to evaluate the distribution and the relationship between the differentiation status of squamous cells in dysplastic or neoplastic epithelium in various organs. The human placental form of glutathione S-transferase (GST-Pi) were stained immunohistochemically with specific anti GST-Pi rabbit antibody in 23 cases of human squamous cell carcinomas. The patients consisted of 14 cases from the uterine cervix, 3 cases from the esopahgus, 3 cases from the lung and 3 cases from the larynx. The results obtained were as follows; 1. Basal cells in normal mucosa were stained negative for GST-Pi while superficial keratinocytes were stained moderately positive. Basal dysplastic cells were stained negatively or weakly positive. Carcinoma cells especially large cells either keratinizing or nonkeratinizing were stained moderately to strongly. Carcinoma cells surrounding keratin pearl were strongly reacted with GST-Pi than other carcinoma cells. 2. Differentiated cells of squamous cell carcinoma showed moderate to strong positive reaction to GST-Pi staining irrespective of its site of origin. 3. Therefore, Immunohistochemical staining pattern of GST-Pi in various squamous carcinoma cells showed similar immunohistochemical reaction to the GST-pi, which is closely correlated to the degree of differentiation, keratinigation and also suggested that squamous carcinoma cells had abundant GST-Pi related detoxifying system.
Humans ; Rabbits ; Animals

BACKGROUND: Chronic actinic dermatitis comprises a spectrum of chronic photosensitivity disorders. Treatment includes avoidance of UV light, application of broad-spectrum topical sunscreens, PUVA therapy, corticosteroid, azathioprine and cyclosporine. OBJECTIVE: Our purpose was to determine the efficacy of cyclosporine in the treatment of chronic actinic dermatitis. METHODS: Six patients with chronic actinic dermatitis refractory to conventional treatment were treated with cyclosporine 100-200mg a day for four to eighteen weeks. RESULTS: In all six patients improvement of the skin lesions and itching were dramatic, but in three of them hyperterision developed during the cyclosporine treatment. After stopping the cyclosporine therapy, their blood pressures normalized within two to five weeks. Other side effects of cyclosporine were not found. Although the skin lesions of all of the six patients were aggravated more or less after stopping the cyclosporine therapy, we could maintain their improved states with topical corticosteroids and oral antihistamines. CONCLUSION: 1. Cyclosporine is a good alternative in treating chronic actinic dermatitis patients who are suffering from severe symptoms refractory to conventional therapy. 2. Hypertension is the frequent side effect of cyclosporine.
Adrenal Cortex Hormones ; Azathioprine ; Cyclosporine* ; Histamine Antagonists ; Humans ; Hypertension ; Photosensitivity Disorders* ; Pruritus ; PUVA Therapy ; Skin ; Sunscreening Agents ; Ultraviolet Rays