Purpose: Plasma circulating tumor DNA (ctDNA) could reflect the genetic alterations present in tumor tissues. However, there is little information about the clinical relevance of cell-free DNA genotyping in peripheral T-cell lymphoma (PTCL). Materials and Methods: After targeted sequencing plasma cell-free DNA of patients with various subtypes of PTCL (n=94), we analyzed the mutation profiles of plasma ctDNA samples and their predictive value of dynamic ctDNA monitoring for treatment outcomes. Results: Plasma ctDNA mutations were detected in 53 patients (56%, 53/94), and the detection rate of somatic mutations was highest in angioimmunoblastic T-cell lymphoma (24/31, 77%) and PTCL, not otherwise specified (18/29, 62.1%). Somatic mutations were detected in 51 of 66 genes that were sequenced, including the following top 10 ranked genes: RHOA, CREBBP, KMT2D, TP53, IDH2, ALK, MEF2B, SOCS1, CARD11, and KRAS. In the longitudinal assessment of ctDNA mutation, the difference in ctDNA mutation volume after treatment showed a significant correlation with disease relapse or progression. Thus, a ≥ 1.5-log decrease in genome equivalent (GE) between baseline and the end of treatment showed a significant association with better survival outcomes than a < 1.5-log decrease in GE. Conclusion Our results suggest the clinical relevance of plasma ctDNA analysis in patients with PTCL. However, our findings should be validated by a subsequent study with a larger study population and using a broader gene panel.

Purpose: Analysis of circulating tumor DNA (ctDNA) in blood could allow noninvasive genetic analysis of primary tumors. Although there have been unmet needs for noninvasive methods in patients with primary central nervous system lymphoma (PCNSL), it is still not determined whether plasma ctDNA analysis could be useful for patients with PCNSL. Materials and Methods: Targeted deep sequencing of 54 genes was performed in cell-free DNA isolated from plasma samples collected pretreatment, during treatment, and at the end of treatment in 42 consecutively diagnosed PCNSL patients between January 2017 and December 2018. Results: Targeted sequencing of plasma cell-free DNA detected somatic mutations representing ctDNA in 11 cases (11/41, 27%). The detection of ctDNA was not related to the concentration of cell-free DNA or tumor volume. The mutation profiles of these 11 cases varied between patients. The most frequently mutated gene was PIM1 (4/11, 36.4%), whereas KMT2D, PIK3CA, and MYD88 were each observed in three patients (3/11, 27%). The mutations of 13 genes were concordantly found in primary tumor tissue and plasma ctDNA, giving a detection sensitivity of 45%. During the serial tracking of seven patients with complete response, the disappearance of ctDNA mutations was found in four patients, whereas three patients had detected ctDNA mutation at the end of treatment. Conclusion The plasma ctDNA mutation analysis still has limited value for surveillance and predicting treatment outcomes of PCNSL because the detection efficiency was lower than other systemic lymphomas. Thus, analytical platforms should be improved to overcome anatomical hurdles associated with PCNSL.

PURPOSE: To report a case of rhino-orbito-cerebral aspergillosis successfully treated with a combination of amphotericin B, posaconazole and amphotericin B irrigation. CASE SUMMARY: A 59-year-old male with hypertension, diabetes mellitus and hyperlipidemia was admitted to our neurology department for left facial paresthesia, pain and consulted to ophthalmology for left eyeball pain. His visual acuity was no light perception in the left eye, and fundus examination showed papilledema and a cherry-red spot. Left exophthalmos and complete ptosis with ophthalmoplegia were also observed. Orbital computed tomography revealed left maxillary and ethmoid sinusitis, and nasal endoscopic examination revealed a black eschar adjacent to the middle turbinate. Subsequent biopsy suggested mucormycosis. The patient was immediately treated with a combination of amphotericin B and posaconazole. In addition, left endoscopic sinus surgery was performed and aspergillosis was histopathologically confirmed. The patient underwent amphotericin B irrigation for 5 days after canula insertion up to orbital apex. The patient survived for 18 months and is still alive. CONCLUSIONS: A combination of amphotericin B, posaconazole and amphotericin B irrigation using the canula through the orbital apex may be helpful in treating patients with rhino-orbito-cerebral aspergillosis who refuse orbital exenteration.
Amphotericin B* ; Aspergillosis* ; Biopsy ; Diabetes Mellitus ; Ethmoid Sinus ; Ethmoid Sinusitis ; Exophthalmos ; Humans ; Hyperlipidemias ; Hypertension ; Male ; Middle Aged ; Mucormycosis ; Neurology ; Ophthalmology ; Ophthalmoplegia ; Orbit ; Papilledema ; Paresthesia ; Turbinates ; Visual Acuity

PURPOSE: To evaluate the efficacy of chemical peeling using 83% alcohol in patients with conjunctival nevus. METHODS: Chemical peeling using 83% alcohol was performed in 13 patients (13 eyes) who were clinically diagnosed with benign conjunctival nevus. Effects of procedure and recurrence were analyzed by retrospectively reviewing medical records. After topical anesthesia, conjunctival nevus was eliminated by rubbing with an alcohol-soaked cotton ball. Conjunctival nevus close to corneal limbus was removed by 15th blades of scalpel. RESULTS: A total of 13 patients, 8 males, and 5 females had a, mean age of 27 years (12-54 years). Eights of the eyes were right eyes, and 5 were left eyes. No recurrence was detected in any patient during the follow-up period (mean 54 months), and there were no cases of conjunctival scar, granuloma, or permanent conjunctival injection. All patients were satisfied with the cosmetic outcome of chemical peeling. CONCLUSIONS: Chemical peeling using alcohol for conjunctival nevus is a non-invasive technique and has benefits such as no intraoperative hemorrhage, low recurrence rate, easy method, and good cosmetic results. Based on these, this procedure is a good method for eliminating conjunctival nevus.
Anesthesia ; Cicatrix ; Female ; Follow-Up Studies ; Granuloma ; Hemorrhage ; Humans ; Limbus Corneae ; Male ; Medical Records ; Nevus* ; Recurrence ; Retrospective Studies

BACKGROUND/AIMS: Nonalcoholic fatty liver disease (NAFLD) may be one of the important causes of cryptogenic hepatocellular carcinoma (HCC). The aim of this study was to evaluate whether patients with cryptogenic HCC share clinical features similar to that of NAFLD. METHODS: Cryptogenic HCC was defined as HCC that occurs in patients with the following conditions: HBsAg(-), anti-HCV(-), and alcohol ingestion of less than 20 g/day. All patients diagnosed with cryptogenic HCC from 2005 to 2012 (cryptogenic HCC group), and all patients diagnosed with HBV associated HCC between 2008 and 2012 (HBV-HCC group) were enrolled in the present study. Clinical features, BMI, lipid profiles, presence of diabetes mellitus, hypertension, and metabolic syndrome were compared between the two groups. RESULTS: Cryptogenic HCC group was composed of 35 patients (19 males and 16 females) with a mean age of 70+/-11 years. HBV-HCC group was composed of 406 patients (318 males and 88 females) with a mean age of 56+/-7 years. Patients in the cryptogenic HCC group were older (p=0.001) and female dominant (p=0.042) than those in the HBV-HCC group. There were no differences in the laboratory test results including lipid profiles and Child-Turcotte-Pugh class between the two groups. Patients in the cryptogenic HCC group had higher prevalence of diabetes (37% vs. 17%, p=0.015), hypertension (49% vs. 27%, p=0.051), metabolic syndrome (37% vs. 16%, p=0.001), and higher BMI (25.3 kg/m2 vs. 24.1 kg/m2, p=0.042) than those in the HBV-HCC group. The tumor stage was more advanced (stage III and IV) at diagnosis in the cryptogenic HCC group than in the HBV-HCC group (60% vs. 37%, p=0.007). CONCLUSIONS: Cryptogenic HCC has clinical features similar to that of NAFLD and is diagnosed at a more advanced tumor stage.
Age Factors ; Aged ; Body Mass Index ; Carcinoma, Hepatocellular/*diagnosis/etiology/pathology ; Diabetes Complications ; Diabetes Mellitus/pathology ; Female ; Hepatitis B/complications ; Humans ; Hypertension/complications ; Lipids/blood ; Liver Neoplasms/*diagnosis/etiology/pathology ; Male ; Metabolic Syndrome X/complications ; Middle Aged ; Neoplasm Staging ; Non-alcoholic Fatty Liver Disease/*diagnosis/pathology ; Risk Factors ; Severity of Illness Index ; Sex Factors

PURPOSE: To report a rare case of juvenile xanthogranuloma in the lacrimal sac. CASE SUMMARY: An 8-year-old female presented to our hospital with epiphora and palpable mass on the left medial canthal area. As a symptom, a sticky and bloody discharge through the punctum had begun on occasion 3 months previously. When pressure was applied on the left medial canthal area, a mucoid discharge through the punctum occurred, and a solid mass was palpable. The mass localized in the lacrimal sac and upper nasolacrimal duct was observed on orbit CT. No invasion into the surrounding tissue was present. The authors of the present study decided to perform endonasal dacryocystorhinostomy, and subsequently a skin-colored mass was found in the lacrimal sac. The histopathological and immunohistochemical diagnosis was histiocytic proliferation, compatible with juvenile xanthogranuloma. Six months later, the patient complained of epiphora recurrence with palpable mass on medial canthal area. The tumor recurrence was confirmed with enhanced orbit CT finding 14 months after the first surgery. A second surgery using endonasal dacryocystorhinostomy was performed to remove the mass.
Child ; Dacryocystorhinostomy ; Female ; Humans ; Lacrimal Apparatus Diseases ; Nasolacrimal Duct ; Orbit ; Recurrence ; Xanthogranuloma, Juvenile

PURPOSE: To evaluate the effects of the modified medial spindle and the lateral tarsal strip procedure in involutional ectropion patients. METHODS: The lateral tarsal strip procedure with the modified medial spindle procedure that adjusts the size and the position of the spindle along the severity of lower eyelid eversion was performed on 17 eyes of 12 patients with involutional ectropion. The average follow-up period was 19.6 months. RESULTS: All 12 patients were male, and the mean age was 65.4 years (range 54 to 78 years). There was no recurrence in any of the 17 eyelids. However, a mild lower lid retraction and a mild punctal eversion not requiring reoperation occurred in the follow-up period. CONCLUSIONS: The lateral tarsal strip procedure combined with the modified medial spindle appears to be effective in the surgical treatment of involutional ectropion.
Ectropion ; Eye ; Eyelids ; Follow-Up Studies ; Humans ; Male ; Recurrence ; Reoperation

PURPOSE: To evaluate the efficacy and safety of the inferior conjunctival transposition flap for primary pterygium surgery. METHODS: This study reviewed 59 eyes in 59 patients with primary pterygium who were treated with pterygium excision and an inferior conjunctival transposition flap. The inferior conjunctival flap was obtained from lower bulbar conjunctiva and was secured with 8-0 vicryl. Patients were followed-up on the third day after surgery and then at 1, 2, 4 and 12 weeks postoperatively. RESULTS: The mean patient age was 55.6 (ranging from 34 to 74) years. The mean follow-up period was 24.9 (ranging from 12 to 46) months. During the follow-up period, the pterygium recurred in one (1.7%) of the 59 eyes. There were no severe complications except for mild congestion and hemorrhage of the conjunctival flap. CONCLUSIONS: Inferior conjunctival transposition flap technique may be considered as a safe and effective method that reduces complications and recurrences after primary pterygium excision.
Conjunctiva ; Estrogens, Conjugated (USP) ; Eye ; Follow-Up Studies ; Hemorrhage ; Humans ; Polyglactin 910 ; Pterygium ; Recurrence

BACKGROUND/AIMS: Alcohol may be a cocarcinogen in patients with chronic viral hepatitis. We investigated the effect of alcohol on the development of hepatocellular carcinoma (HCC) in liver cirrhosis (LC) caused by hepatitis B virus (HBV). METHODS: All patients with LC or HCC associated with HBV or alcohol, admitted between March 2001 and June 2005, were included. Patients were divided into three groups according to the etiology of LC: Alcohol (AL), HBV, or HBV+alcohol (HBV+AL). Age and laboratory data at the enrollment of study were analyzed. The logistic regression coefficiency for the prevalence of HCC was calculated by using variables such as age, gender, serologic markers, and etiology of LC. RESULTS: In LC patients (n=342), the proportions of AL, HBV, and HBV+AL groups were 44%, 39%, and 17%, respectively. The proportions of HCC in AL, HBV and HBV+AL groups were 17%, 55%, and 76%, respectively. Age at the diagnosis of HCC was younger in HBV+AL than in AL group (p=0.036). In logistic regression analysis for the risk factor of HCC, odds ratio of age was 1.056 (p<0.001). Odds ratios of HBV and HBV+AL group comparing AL were 8.449 (p<0.001) and 17.609 (p<0.001), respectively. Therefore, old age and chronic alcohol intake in patients with HBsAg were the risk factors of HCC. CONCLUSIONS: Chronic alcohol intake may be an additive factor for the development of HCC in patient with LC caused by HBV. However, a prospective cohort study is needed to confirm these findings.
Adult ; Aged ; Carcinoma, Hepatocellular/*epidemiology/etiology ; Cross-Sectional Studies ; Female ; Hepatitis B, Chronic/*complications/epidemiology ; Hepatitis, Alcoholic/complications/epidemiology ; Humans ; Liver Cirrhosis/*complications/virology ; Liver Cirrhosis, Alcoholic/*complications/epidemiology/virology ; Liver Neoplasms/*epidemiology/etiology ; Male ; Middle Aged ; Odds Ratio ; Regression Analysis ; Retrospective Studies ; Risk Factors

It was previously reported that the Korean predictive model could be used to identify patients at high risk of postoperative nausea and vomiting (PONV). This study investigated whether PONV in the high-risk and very high-risk patients identified by the Korean predictive model could be prevented by multiple prophylactic antiemetics. A total of 2,456 patients were selected from our previous PONV study and assigned to the control group, and 374 new patients were recruited consecutively to the treatment group. Patients in each group were subdivided into two risk groups according to the Korean predictive model: high-risk group and very high-risk group. Patients in the treatment group received an antiemetic combination of dexamethasone 5 mg (minutes after induction) and ondansetron 4 mg (30 min before the end of surgery). The incidences of PONV were examined at two hours after the surgery in the postanesthetic care unit and, additionally, at 24 hr after the surgery in the ward, and were analyzed for any differences between the control and treatment groups. The overall incidence of PONV decreased significantly from 52.1% to 23.0% (p< or =0.001) after antiemetic prophylaxis. Specifically, the incidence decreased from 47.3% to 19.4% (p< or =0.001) in the high-risk group and from 61.3% to 28.3% (p< or =0.001) in the very high-risk group. Both groups showed a similar degree of relative risk reductions: 59.0% vs. 53.8% in the high-risk and very high-risk groups, respectively. The results of our study showed that the antiemetic prophylaxis with the combination of dexamethasone and ondansetron was effective in reducing the occurrence of PONV in both high-risk and very high-risk patients.
Adult ; Anesthetics/adverse effects ; Antiemetics/*pharmacology ; Dexamethasone/administration & dosage ; Female ; Humans ; Incidence ; Korea ; Middle Aged ; Ondansetron/administration & dosage ; Postoperative Complications/prevention & control ; Postoperative Nausea and Vomiting/*prevention & control ; Postoperative Period ; Risk ; Risk Factors ; Treatment Outcome