In a 8 year-old boy who had epidural hematoma in the occipital area, had an episode of dislodgement of the endotracheal tube due to improper position. After operation, there were drowsy consciousness, irregular respiration, apnea, absence of cough reflex and swallowing reflex. Then these was no improvement in spite of treatment, and because of this hypoxic encephalopathy was diagnosed. WE suspected there might be some pathologic lesion volving the respiratory center and lower cranial nerves. CT scanning was performed and the result was diagnosed with epidural hematoma and subdural hematoma in the posterior fossa. The patient was reoperated.
Apnea ; Child ; Consciousness ; Cough ; Cranial Nerves ; Deglutition ; Hematoma* ; Hematoma, Subdural ; Humans ; Hypoxia, Brain ; Male ; Reflex ; Respiration ; Respiratory Center ; Tomography, X-Ray Computed

Hyperinsullinism and the resultant hypoglycemia are hallmarks of functioning beta islet cell tumors of the pancreas. The management of one case of insulinoma during surgery for the removal of the tumor is described and the available literature on the subject reviewed. The outline of the anesthetic management for the insulinoma is as follows: 1) Anesthetists should understand the signs and the symptoms of hypoglycemia and hyperglycemia. 2) Preoprative management: a) infusion of glucose for avoiding hypoglycemia due to NPO after midnight. b) glucocorticosteroid administration with premedications. 3) Operative management: a) continuous determination of blood glucose level may be helpful. b) Maintenance of the glucose level about 50mg% above symptomatic CNS level have the advantage that exicision of the infulinoma can be immediately judged. c) The use of an agent that decreases CMRO2 and does not affect the insulin-glucose ratio is rational choice when concern about hypoglycemia exists. Thiopental-enflurane anesthesia with controlled ventilation maintaining normocarbia is recommended. d) beta-adrenergic blocker. These drugs must be avoided in the hypoglycemic state.
Adenoma, Islet Cell ; Anesthesia ; Blood Glucose ; Glucose ; Hyperglycemia ; Hypoglycemia ; Insulinoma ; Pancreas ; Premedication ; Ventilation

Primary cutaneous mucinous carcinoma (PCMC) is a rare malignant neoplasm that originates from the deepest part of the eccrine sweat glands. Characterized by slow growth, PCMC often appears on the head and neck of older patients. Although it rarely metastasizes, its high recurrence rate leads to significant morbidity. Clinically differentiating PCMC from benign tumors is challenging due to its slow growth and asymptomatic nature, and a biopsy is often required for a definitive diagnosis. A 77-year-old man presented with a non-tender lesion on his left lower eyelid that had been gradually progressing over a decade. The lesion was excised, and histological examination confirmed it as PCMC. A positron emission tomography-computed tomography scan conducted to differentiate between primary and metastatic cancer showed no abnormal findings. Computed tomography was then performed to assess the remaining primary site, followed by a wide excision. The frozen biopsy revealed no cancer in the margins from five directions; however, the permanent biopsy confirmed the presence of cancer in the base margin. After consultation with the hematology-oncology department, the patient underwent additional radiation therapy. One year post-surgery, there were no signs of recurrence.

Primary cutaneous mucinous carcinoma (PCMC) is a rare malignant neoplasm that originates from the deepest part of the eccrine sweat glands. Characterized by slow growth, PCMC often appears on the head and neck of older patients. Although it rarely metastasizes, its high recurrence rate leads to significant morbidity. Clinically differentiating PCMC from benign tumors is challenging due to its slow growth and asymptomatic nature, and a biopsy is often required for a definitive diagnosis. A 77-year-old man presented with a non-tender lesion on his left lower eyelid that had been gradually progressing over a decade. The lesion was excised, and histological examination confirmed it as PCMC. A positron emission tomography-computed tomography scan conducted to differentiate between primary and metastatic cancer showed no abnormal findings. Computed tomography was then performed to assess the remaining primary site, followed by a wide excision. The frozen biopsy revealed no cancer in the margins from five directions; however, the permanent biopsy confirmed the presence of cancer in the base margin. After consultation with the hematology-oncology department, the patient underwent additional radiation therapy. One year post-surgery, there were no signs of recurrence.

Primary cutaneous mucinous carcinoma (PCMC) is a rare malignant neoplasm that originates from the deepest part of the eccrine sweat glands. Characterized by slow growth, PCMC often appears on the head and neck of older patients. Although it rarely metastasizes, its high recurrence rate leads to significant morbidity. Clinically differentiating PCMC from benign tumors is challenging due to its slow growth and asymptomatic nature, and a biopsy is often required for a definitive diagnosis. A 77-year-old man presented with a non-tender lesion on his left lower eyelid that had been gradually progressing over a decade. The lesion was excised, and histological examination confirmed it as PCMC. A positron emission tomography-computed tomography scan conducted to differentiate between primary and metastatic cancer showed no abnormal findings. Computed tomography was then performed to assess the remaining primary site, followed by a wide excision. The frozen biopsy revealed no cancer in the margins from five directions; however, the permanent biopsy confirmed the presence of cancer in the base margin. After consultation with the hematology-oncology department, the patient underwent additional radiation therapy. One year post-surgery, there were no signs of recurrence.

Targeted therapies guided by molecular diagnostics have become a standard treatment of lung cancer. Epidermal growth factor receptor (EGFR) mutations and anaplastic lymphoma kinase (ALK) rearrangements are currently used as the best predictive biomarkers for EGFR tyrosine kinase inhibitors and ALK inhibitors, respectively. Besides EGFR and ALK, the list of druggable genetic alterations has been growing, including ROS1 rearrangements, RET rearrangements, and MET alterations. In this situation, pathologists should carefully manage clinical samples for molecular testing and should do their best to quickly and accurately identify patients who will benefit from precision therapeutics. Here, we grouped molecular biomarkers of lung cancers into three categories—mutations, gene rearrangements, and amplifications—and propose expanded guidelines on molecular testing of lung cancers.
Biomarkers ; Gene Rearrangement ; Humans ; Lung Neoplasms* ; Lung* ; Lymphoma ; Pathology, Molecular ; Phosphotransferases ; Precision Medicine ; Protein-Tyrosine Kinases ; Receptor, Epidermal Growth Factor

Rearrangement of anaplastic lymphoma kinase (ALK) gene is the best predictor of response to crizotinib, an ALK tyrosine kinase inhibitor. However, the prevalence of the ALK fusion is low, so accurate patient identification is crucial for successful treatment using ALK inhibitors. Furthermore, most patients with lung cancer present with advanced-stage disease at the time of diagnosis, so it is important for pathologists to detect ALK-rearranged patients while effectively maximizing small biopsy or cytology specimens. In this review, we propose a guideline recommendation for ALK testing approved by the Cardiopulmonary Pathology Study Group of the Korean Society of Pathologists.
Biopsy ; Diagnosis ; Gene Rearrangement* ; Humans ; Lung Neoplasms* ; Lung* ; Lymphoma ; Pathology* ; Phosphotransferases ; Prevalence ; Protein-Tyrosine Kinases

The spleen is one of the largest organ in the reticuloendothelial system and plays an important role in theac-tivation of immune response. It is the organ most commonly injured after blunt abdominal trauma, and malig-nantlesions such as lymphoma, or these due to metastasis, occur not infrequently. Even so, it is ignored even inabdominal ultrasonography. Some benign splenic lesions, however can cause severe symptoms and result in high mortality, and their accurate diagnosis is therefore essential. This study describes the imaging findings andhistopathologic features of various nontraumatic benign splenic lesions.
Diagnosis ; Lymphoma ; Mononuclear Phagocyte System ; Mortality ; Neoplasm Metastasis ; Spleen ; Ultrasonography

Mutations of the epidermal growth factor receptor (EGFR) are the strongest predictive factor for response to EGFR tyrosine kinase inhibitors (TKIs), such as gefitinib and erlotinib. EGFR TKIs are approved in Korea as a first-line treatment for lung cancer patients with mutated EGFR. Rapid and accurate EGFR mutation testing is essential for patient selection and establishing targeted therapies with EGFR TKIs. Thus, a standard set of guideline recommendations for EGFR mutation testing suitable for the Korean medical community is necessary. In this article, we propose a set of guideline recommendations for EGFR mutation testing that was discussed and approved by the Cardiopulmonary Pathology Study Group of the Korean Society of Pathologists.
Humans ; Korea ; Lung ; Lung Neoplasms ; Patient Selection ; Protein-Tyrosine Kinases ; Quinazolines ; Receptor, Epidermal Growth Factor ; Erlotinib Hydrochloride

BACKGROUND: Since cigarette smoking is an important risk factor for respiratory infections and alters the immune response, the severity of influenza illness and the immunogenicity of influenza vaccination may differ between cigarette smokers and non-smokers. This study investigated the effect of cigarette smoke exposure on the severity of influenza illness and vaccine-induced antibody production in mice. MATERIALS AND METHODS: Cigarette smoke exposed (CE) and non-cigarette smoke exposed (NCE) mice were infected with mouse-adapted influenza A/PR8/8/34 (H1N1). Influenza virus was quantified in bronchoalveolar lavage fluid by real-time polymerase chain reaction and the lung pathology was examined to investigate the influence of smoke exposure on the severity of illness. To assess immunogenicity, hemagglutination inhibition antibodies were measured in pre- and post-influenza vaccination blood samples from CE and NCE mice. RESULTS: Influenza viral proliferation was higher and inflammatory changes such as macrophage infiltration in the alveolar space and necrotizing bronchitis were more pronounced in CE mice, compared with controls. Vaccine-induced immunogenicity was achieved in both CE and NCE mice. CONCLUSIONS: Cigarette smoke exposure enhanced influenza viral replication and the inflammatory changes associated with influenza illness, but had no significant effect on vaccine-induced immunogenicity.
Animals ; Antibodies ; Antibody Formation ; Bronchitis ; Bronchoalveolar Lavage Fluid ; Hemagglutination ; Inflammation ; Influenza, Human ; Lung ; Macrophages ; Mice ; Orthomyxoviridae ; Real-Time Polymerase Chain Reaction ; Respiratory Tract Infections ; Risk Factors ; Smoke ; Smoking ; Tobacco Products ; Vaccination