Tumor angiogenesis(TA) refers to the growth of new vessels toward and within a tumor. TA is necessary both at the beginning and at the end of the metastatic cascade of events. Recently, experimental evidence suggests that the growth of a tumor beyond a certain size requires angiogenesis. To investigate how tumor angiogenesis correlates with metastases in breast carcinoma, the microvessels were counted (per 200 / field) in the most active areas of neovas-cularization by two investigators. The microvessels within breast carcinoma were highlighted by in imunohistochemical staining for factor VIII-related antigen. Microvessel count(MVC) in node-positive carcinoma(59.66=35) was significantly higher than in node-negative carcinoma(44.76=17)(p=0.009). MVC was also statistically correlated with tumor size and stage, but not with histologic grading, DNA ploidy, or hormonal receptors(estro-gen and progesterone). MVC in invasive breast carcinoma may be one of many prognostic predictors of node-positive breast carcinoma. Assessment of tumor angiogenesis may therefore be valuable in selecting patients with early breast carcinoma for aggressive therapy.
Neoplasm Metastasis

Cholesteatoma in the kidney and ureter are accumulations of waxy, gray flakes of keratin materials, secondary to squamous metaplasia of the transitional epithelium. Herein, we describe a case of cholesteatoma in the renal pelvis of a 69-year-old woman, and give a brief review of the literature. In the upper pole of the left kidney was a 6 cm cystic lesion filled with a thick, flaky, grayish, comified material. Microscopically, the cystic area showed calyceal and pelvic structures being replaced by keratinizing stratified squamous epithelium. The surrounding renal parenchyma was atrophic with features of chronic pyelonephritis.
Female ; Humans

BACKGROUND: Neer type II distal clavicle fractures have the drawback of coracoclavicular instability and insufficient distal bony fragment, thereby making it difficult to achieve adequate fixation. Although various surgical treatments have been described for Neer type II fracture, the optimal treatment remains controversial. This study reports the clinical results and usefulness of anatomical locking plate with additional K-wire fixation. METHODS: A totally of 21 patients with type II distal clavicle fracture were included in the study. The surgical procedure reduced the fracture temporarily; it included insertion of one or two K-wire from the lateral margin of the distal fragment to the proximal fragment through the fracture site, followed by application and fixation of the locking plate. The bony union and migration of K-wire was evaluated in the follow-up radiography. The coracoclavicular distance and acromioclavicular joint arthrosis were assessed at the final follow-up. The Constant Score (CS) and Korean Shoulder Score (KSS) were evaluated for clinical scoring. RESULTS: Bone union was achieved in all cases. At the final follow-up, coracoclavicular distance of the injured shoulder was increased, as compared to the intact shoulder (p=0.002), with no accompanying clinical symptoms. No K-wire migration was observed. At the final follow-up, K-wire irritation was observed in two cases and acromioclavicular arthrosis in one case, with no other adverse effects. Pain visual analogue scale, CS, and KSS were improved in all cases. CONCLUSIONS: The method of anatomical locking plate with additional K-wire fixation could be useful in achieving beneficial clinical results.
Acromioclavicular Joint ; Clavicle* ; Follow-Up Studies ; Humans ; Methods ; Radiography ; Shoulder

Mesoblastic nephroma is an important differential diagnosis of a renal mass occurring in the neonatal period or in early childhood. It is a rare monomorphous congenital renal neoplasm most commonly recognized during the first 3 months of life. With the widespread application of ultrasound imaging, many cases are recognized prior to birth. We report a case of mesoblastic nephroma detected by ultrasonograph at 36 weeks of intrauterine fetal life and removed after birth. It showed a well circumscribed, grayish white, solid mass measuring 4x3x2 cm. The tumor was predominantly a classic type with a focal cellular pattern. Immunohistochemical and electron microscopic studies were done.
Diagnosis, Differential ; Kidney ; Kidney Neoplasms ; Nephroma, Mesoblastic* ; Parturition ; Ultrasonography

It has been postulated that programmed cell death via apoptosis may be critical for remodelling of glomeruli after inflammatory injury. To understand the regulatory mechanism of apoptosis in experimental crescentic glomerulonephritis (CGN), we examined the MIB-1 score (proliferation index, PI) and apoptotic index during the progression of experimental CGN to end-stage renal failure. CGN was induced in New Zealand White rabbits by administration of guinea pig anti-GBM IgG after sensitization with guinea pig IgG and their kidneys were analyzed for the development of crescents through sequential renal biopsies. Serum creatinine levels progressively increased in a time course until day 45. The PI in glomeruli, tubular epithelial cells, and interstitium progressively increased during the progression of experimental CGN. The mean numbers of MIB-1 positive intraglomerular nuclei (PI) were significantly correlated with degrees of crescent formation and the numbers of apoptotic cells in the glomeruli, tubules, and interstitium. Significant apoptosis was present from day 1 (15.8 10.16 cells/glomerular cross section) and increased in number with the proliferative lesions as glomerular inflammation continued. Moreover, apoptosis increased during the resolution of the glomerular inflammation, and many apoptotic cells were present in the sclerotic lesions in day 17 (18.6 12.99 cells/glomerular cross section). As glomerular inflammation subsided, cellular crescents progressed to fibrous crescents with a reduction of cellularity by day 45. On day 45, the glomerular PI and the numbers of apoptotic cells were markedly decreased. The correlations found in CGN between the creatinine level and the percentage of crescents, between the percentage of crescent and PI, and between the PI and number of apoptotic cells support the hypothesis that there is a change in the glomerular and tubulo-interstitial apoptosis under pathologic conditions. These findings indicate that apoptosis plays an essential role in the resolution of intra- and extraglomerular inflammation and in the elimination of glomerular cells within the sclerotic regions for progressive CGN. The regulation of the apoptotic phenomenon and increased PI during CGN may be important in the progression of glomerular inflammation and the development of pathologic glomerular sclerosis.
Animals ; Anti-Glomerular Basement Membrane Disease ; Apoptosis* ; Biopsy ; Cell Death ; Creatinine ; Epithelial Cells ; Glomerulonephritis* ; Guinea Pigs ; Immunoglobulin G ; In Situ Nick-End Labeling ; Inflammation ; Kidney ; Kidney Failure, Chronic ; Rabbits ; Sclerosis

Radiological investigation in patients with clonorchiasis is very important as this is the only method of evaluating the severity of clonorchiasis. In order to correlate the radiologic and pathologic findings of clonorchiasis, fourteen rabbits infested with Clonorchis sinensis and five control rabbits were examined radiologically by ultrasonography, computed tomography and cholangiography and the results were correlated with pathologic findings. Dilatation of the intrahepatic small bile ducts of the liver was due to obstruction by flukes: oval or elliptical small filling defects or irregular margin of the bile ducts on cholangiogram or intraluminal echoes on sonogram represented flukes per se; periductal thickening on sonogram and periductal enhancement of bile ducts on CT were due to inflammatory cell infiltration, adenomatous hyperplasia and periductal fibrosis: band like enhancement at the periphery of the liver on CT represented proliferated bile ducts, destruction of liver cells and resultant fibrosis. The study confirmed the pathological bases for the radiological findings of clonorchiasis in liver and bile ducts and will, perhaps, serve as a basis for the future radiologic-pathological correlation of clonorchiasis and in further clinical and experimental researches in the biliary tract diseases.
Bile Ducts ; Biliary Tract Diseases ; Cholangiography ; Clonorchiasis* ; Clonorchis sinensis ; Dilatation ; Fibrosis ; Humans ; Hyperplasia ; Liver ; Methods ; Rabbits* ; Trematoda ; Ultrasonography

Proliferative activity of a malignant tumor is known to reflect its biological aggressiveness. Proliferating cell nuclear antigen (PCNA) is a marker of cellular proliferation, and silver-stained nucleolar organizer regions (AgNORs) have been shown to correlate with ploidy and proliferative activity of cells. In transitional cell carcinoma of the renal pelvis, the prognostic value of these markers has not been well defined. We studied PCNA expression and the AgNORs count in 22 transitional cell carcinoma of the renal pelvis to assess their prognostic significance compared with their cumulative survival rate, the stage of disease and histopathologic features of the tumors. An immunohistochemical method and a standard colloidal silver staining were used. The mean percentage of PCNA positivity (PCNA index) and the mean number of AgNORs per nucleus (AgNORs score) were determined. In a multivariable analysis, PCNA indexes were significantly associated with tumor stage (p=0.024), whereas AgNORs scores were not significantly associated with the stage or histopatholgic features of the tumors. Histologic grade was correlated to disease stage at a significant level (p=0.000). But there was a trend of low tumor PCNA-indices or AgNORs counts with survival advantage for patients, but this did not reach statistical significance. The results suggest that the fraction of PCNA positive nuclei would be useful for investigating the malignant potential of renal pelvic cancers, although their clinical use as markers of biologic behavior may be limited.
Carcinoma, Transitional Cell* ; Cell Proliferation ; Colloids ; Humans ; Kidney ; Kidney Pelvis* ; Nucleolus Organizer Region ; Pelvic Neoplasms ; Ploidies ; Proliferating Cell Nuclear Antigen* ; Silver Staining ; Survival Rate

We studied two intraabdominal desmoplastic small cell tumors. The patients were two men, 37 and 23 years old, with jaundice and palpable abdominal masses. On exploratory laparotomy, each patient revealed a huge mass in the greater omentum with disseminated peritoneal seeding, measuring 32 cm and 11 cm in its greatest dimension, respectively. The tumor involved the diaphragm, rectal shelf, and cul de sac in case 1, and it involved the porta hepatis, retroperitoneum, and serosal surface of the ascending and transverse colon in case 2. Omentectomy of the huge mass and satellite masses was performed in each patient. Both tumors showed nearly the same histopathologic features. The histologic pattern was suggestive of a metastatic small cell carcinoma, but there was no specific, single primary site. The tumors consisted of variably sized, discrete islands of epithelial-like small cells in dense desmoplastic stroma. The tumor cells revealed divergent epithelial, mesenchymal, and neural differentiation by histologic, immunohistochemical, and electron microscopic observations. Only one cycle of chemotherapy including cisplatin and VP-16 was given in case 1 because of a subsequent hepatic problem, who, thereafter, showed massive intraabdominal recurrent tumors 6 months after diagnosis. In case 2, the poor condition of the patient had made chemotherapy and radiotherapy impossible. Case 2 died of disseminated intravascular coagulation following progressive cachexia 7 months after diagnosis.
Neoplasm Metastasis

Fibrous pseudotumor of the testicular tunics is a rare benign fibrous proliferative disorder, but it is the second most common mass-forining lesion of the testicular tunics. While these lesions are not strict neoplasms, they do form nodules and are often mistaken for neoplasms. Herein, we report 2 cases of fibrous pseudotumor with characteristic histologic findings. Both cases had been incidentally found as slow growing scrotal masses and underwent excision. There were several nodules along the testicular tunics which had bulging whitish-gray cut surface with focal myxoid change and a whorling appearance. These two cases showed the histologic spectrum seen in fibrous pseudotumor from a haphazard arrangement of fibroblastic type cells with intervening collagen and focal lymphocytic infiltrates in case 1, to a densely collagenized lesion in case 2.

BACKGROUND: To evaluate the effect of preoperative fatty degeneration of deltoid and teres minor muscles on the clinical outcome in patient with reverse total shoulder arthroplasty (RTSA). METHODS: Nineteen patients with RTSA were enrolled. The mean follow-up period was 16.1 months. The fatty degeneration of three distinct parts in each deltoid and the teres minor muscle was measured using a preoperative magnetic resonance imaging. Postoperatively, the muscle strengths for forward elevation (FE), abduction (Abd), and external rotation (ER) were measured using a myometer at the last follow-up. The parameters for clinical outcome were Constant Score (CS) and Korean Shoulder Score (KSS). RESULTS: The number of cases was 10 in group 1 and 9 in group 2. The strength of FE and Abd were significantly higher in group 1 (p<0.001 and p<0.001, respectively), and the strength of ER was not different significantly between two groups (p=0.065). For the clinical outcome, both CS and KSS were higher in group 1 (p=0.002 and p=0.002, respectively). The number of patients in group A was 11, and group B was 8. Although there was not a significant difference in terms of FE and Abd between group A and B (p=0.091, p=0.238), ER was significantly higher in group A (p=0.012). We did not find a significant difference in the clinical scores (CS, p=0.177 and KSS, p=0.238). CONCLUSIONS: These findings suggest the importance of a preoperative evaluation of the fatty degeneration of deltoid and teres minor muscles for predicting postoperative strength and clinical outcome.
Arthroplasty* ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Muscle Strength ; Muscles* ; Shoulder*