Epithelioid smooth muscle tumor is relatively rare and potentially malignant, especially in retroperitoneum. Distinct criteria for malignancy still have not been clarified in this epithelioid variant arising in retroperitoneum. We report a deceptively benign-appearing epithelioid leiomyosarcoma in a 50-year-old female. She was admitted with abdominal discomfort and dysuria. Abdominal CT showed a well-demarcated, 10 10 cm sized, solid mass in retroperitoneum. Concomitant metastatic lesions were noted in right lung field. Surgical excision of retroperitoneal mass and right lung lobectomy were performed. The retroperitoneal mass showed yellowish-tan, well-delineated and lobulated appearance. Histologically, this tumor was composed of predominantly epithelioid, round to oval cells with distinct clear cytoplasm and slightly atypical nuclei. Mitosis was rare (0~1/50 HPF). Lung lesions were morphologically similar to that of retroperitoneum.
Cytoplasm ; Dysuria ; Female ; Humans ; Leiomyosarcoma* ; Lung ; Middle Aged ; Mitosis ; Smooth Muscle Tumor ; Tomography, X-Ray Computed

No abstract available.
Brain Neoplasms* ; Brain* ; Child* ; Humans

Although spontaneous bacterial peritonitis is a frequent complication in the childhood nephrotic syndrome, it is very rare in adults with nephrotic syndrome. It frequently develops when the patients are either in relapse or receiving steroid therapy at the time peritonitis is diagnosed. We report an unusual case of a spontaneous bacterial peritonitis as the presenting feature in a 15-year-old male patient with nephrotic syndrome. He presented with diffuse abdominal pain and distension for 15 days. Abdominal paracentesis revealed the diagnostic laboratory findings of peritonitis, and the bacterial culture of the ascites showed a mixed growth of Escherichia coli and Pseudomonas aeruzinosa. His serum albu- min level was 1.6gldL and the amount of 24 hours proteinuria was 21.0g/day. Although he was treated with adequate antibiotics for 3 weeks, the peritonitis was more aggravated. We decided to insert a catheter into the peritoneal cavity for continuous drainage of the intractable ascites. Two weeks after drainage, the peritonitis improved as the peritonitis subsided, the proteinuria disappeared completely without a steroid therapy. Six months after spontaneous remission, the proteinuria have recurred, and the kidney biopsy then showed focal segmental glomerulorsclerosis.
Abdominal Pain ; Adolescent ; Adult ; Anti-Bacterial Agents ; Ascites ; Biopsy ; Catheters ; Drainage ; Escherichia coli ; Humans ; Kidney ; Male ; Nephrotic Syndrome* ; Paracentesis ; Peritoneal Cavity ; Peritonitis* ; Proteinuria ; Pseudomonas ; Recurrence ; Remission, Spontaneous

Iodinated contrast-induced acute renal failure is estimated to occur in 0.15 to 2% of all patients undergoing contrast imaging studies. Incidence is higher in patients with renal insufficiency, diabetes mellitus, dehydration, multiple myeloma, congestive heart failure, advanced age. We here report successful vascular interventional procedure by using gadopentetate dimeglumine(Gd-DTPA) as a contrast agent in a patient with chronic renal insufficiency and right superficial femoral artery stenosis. The patient had a history of iodinated contrast-induced acute renal failure. Gd-DTPA(0.17mmoVkg) diluted 1: 1 with 0.9% norrnal saline was used as contrast agent for the interventional procedure. Percutaneous transluminal angioplasty was successfully performed and there was no evidence of contrast material- induced acute renal failure after the procedure. Gd- DTPA is an alternative contrast agent for patients with chronic renal insufficiency.
Acute Kidney Injury ; Angioplasty* ; Constriction, Pathologic ; Dehydration ; Diabetes Mellitus ; Femoral Artery ; Gadolinium DTPA* ; Heart Failure ; Humans ; Incidence ; Multiple Myeloma ; Pentetic Acid ; Renal Insufficiency ; Renal Insufficiency, Chronic*

BACKGROUNDS/AIMS: To investigate survival rates and prognostic factors of patients with gallbladder cancer who were treated with surgery and postoperative radiation therapy. METHODS: Seventeen gallbladder cancer patients who received surgery and postoperative radiotherapy from October 1989 to April 1998 were included in this retrospective study. Five patients had stage II, 8 patients had stage III, and 4 patients had stage IV disease according to the 1997 American Joint Committee on Cancer (AJCC) staging. All patients received > or =40 Gy of postoperative radiotherapy with a daily dose of 2.0 Gy/fraction and 15 patients received concurrent chemotherapy. An analysis was performed for the endpoints of overall and disease-free survival. RESULTS: Of the 17 patients, 13 had no residual disease (R0), 1 had microscopic residual disease (R1), and 3 had macroscopic residual disease (R2) after surgery. Among patients with no residual disease, 4 had locoregional recurrences during the follow-up period. One patient with microscopic residual disease had local recurrence. The 5-year overall survival rate was 38.2%. The median overall survival time was 21 months and the median disease-free survival time was 12 months. Old age (> or =60 years old), female gender, a high pathological stage (> or =IVA), and the presence of residual disease after surgery were significant prognostic factors for disease-free survival. CONCLUSIONS: Despite a high proportion of patients with advanced disease and macroscopic residual disease, the prognosis of gallbladder patients who had postoperative radiotherapy is encouraging. Additional investigation to improve the loco-regional control of gallbladder cancer patients with adverse prognostic factors is warranted.
Disease-Free Survival ; Female ; Follow-Up Studies ; Gallbladder ; Gallbladder Neoplasms ; Humans ; Joints ; Prognosis ; Recurrence ; Retrospective Studies ; Survival Rate

PURPOSE: This study was attempted to evaluate the effect of adjuvant radiotherapy and chemotherapy after curative resection of extrahepatic bile duct cancer. MATERIALS AND METHODS: The authors performed a retrospective analysis of 57 patients with extrahepatic bile duct cancer not involving the hepatic duct confluence and curatively resected at Seoul National University Hospital between 1990 and 1995. Resection margins of all cases were confirmed pathologically as free of cancer cells. Among 57 patients, 29 received adjuvant therapy. Total 4000 cGy of external beam radiation was delivered to each. 5-fluorouracil (5-FU) was administered as a radiosensitizer. After 4 weeks of radiation therapy, 5-FU maintenance chemotherapy was started and given every 4 weeks up to 12 cycles or until evidence of relapse. RESULTS: The overall median survival of 57 patients was 24 months. I- and 2-year overall survival rate was 73.7 and 52.6%. There was no difference in overall survival rate between adjuvant therapy group (n=29) and operation-only group (n 28). We tried to evaluate the effect on survival of adjuvant therapy according to lymph node status. Patients of Tl stage were excluded from analysis. Adjuvant therapy had no survival benefit in the lymph node positive group. But in the lymph node negative group, 1- and 2-year survival rate of patients who underwent adjuvant therapy were 89.5% and 68.4% whereas 1 and 2-year survival rate of patients in operation-only group were 57.9% and 36.8%, which was statistically significant (p=0.0278, 0.0472). And by multivariate analysis, the survival improvement of 1- and 2-year survival rate in adjuvant therapy group was due to adjuvant therapy itself. CONCLUSION: Our trial of external beam radiotherapy combined with 5-FU chemotherapy after curative resection of extrahepatic bile duct cancer did not show improved overall survival. However the 1- and 2-year survival rate of patients with negative lymph node and advanced T stage ( > T 1) were improved in adjuvant therapy group, so adjuvant therapy may give survival benefit to a certain patient group with negative lymph node.
Bile Ducts, Extrahepatic* ; Drug Therapy ; Fluorouracil ; Hepatic Duct, Common ; Humans ; Lymph Nodes ; Maintenance Chemotherapy ; Multivariate Analysis ; Radiotherapy ; Radiotherapy, Adjuvant ; Recurrence ; Retrospective Studies ; Seoul ; Survival Rate

Protein-losing enteropathy is characterized by excessive protein loss into the intestinal tract in association with various disorders. We report a case of reversible protein-losing enteropathy as a cause of severe hypoalbuminemia in a patient with multiple renal abscesses. A 61-year-old woman presented with high fever and left flank pain. Abdominal computed tomography showed multiple abscesses in the left kidney. E. coli was cultured from her blood. Although hypoalbuminemia was severe (1.9 g/dL), the liver function tests including prothrombin time were normal and urine protein was negative. The results of 99mTc-human serum albumin scintigraphy were compatible with protein-losing enteropathy. Alpha-1 -antitrypsin clearence was 89 ml/24 hours (normal range <13 ml/24 hours). After the renal abscess was improved with antibiotic therapy, serum albumin increased to normal range and protein-losing enteropathy disappeared.
Abscess* ; Escherichia coli ; Female ; Fever ; Flank Pain ; Humans ; Hypoalbuminemia* ; Kidney ; Liver Function Tests ; Middle Aged ; Protein-Losing Enteropathies ; Prothrombin Time ; Radionuclide Imaging ; Reference Values ; Serum Albumin ; Technetium Tc 99m Aggregated Albumin

A persistent left superior vena cava(SVC) is found in about 0.3% of healthy individuals and 4.3% of patients with congenital heart disease. This anomaly is most frequently found in conjunction with a right-sided SVC, but may also be solitary. Recently, we experienced a case of persistent left SVC in patient with chronic renal failure. He required subclavian catheterization for hemodialysis due to leakage of peritoneal dialysate into external genitalia and pleural cavity. Because he had had a history of right subclavian catheterization for hemodialysis 3 months ago, the hemodialysis catheter was inserted in the left subclavian vein without any complication. Chest X-ray after insertion of the catheter showed that the distal tip of the catheter seemed to be within the aorta. Venography showed that the catheter was located within the left SVC and MRI showed isolated two SVC. He is receiving hemodialysis through the left subclavian catheter which is positioned within the left SVC without any problem.
Aorta ; Catheterization ; Catheters* ; Genitalia ; Heart Defects, Congenital ; Humans ; Kidney Failure, Chronic* ; Magnetic Resonance Imaging ; Phlebography ; Pleural Cavity ; Renal Dialysis* ; Subclavian Vein ; Thorax ; Vena Cava, Superior*

OBJECTIVES: The authors present a retrospective analysis of 100 consecutive adult patients harboring craniopharyngiomas who underwent microsurgical resection between 1981 and 1999 to assess the long-term outcome of surgical treatment and to determine the most optimal management strategy. METHODS: The extent of surgical removal was divided into four categories; GTR(gross total removal), RSTR(radical subtotal removal), STR(subtotal removal),and PR(partial removal). The median follow-up period was 50 months(4-198). CT scan and/or MR imaging and hormonal status were evaluated to the last follow-up. RESULTS: Visual disturbance was the most common presentation, which was improved in 42 cases and aggravated in 19 cases following the operation. Hypopituitarism was detected in 56 patients preoperatively, 82 during the immediate postoperative period, and 76 at the last follow-up. Improvement of pituitary function was not observed in any of these patients. Twenty of 100 patients showed recurrence at the mean of 27 months(3 to 196). The median progression-free survival(PFS) time of all patients was 145 months and 5-year PFS rate was 74%. Five-year PFS rate of GTR or RSTR group(71%) was significantly higher than that of STR or PR group(30%)(p=0.01). Postoperative radiation therapy significantly prolonged the PFS from 94 months in non-radiation group to 182 months(p=0.002). However, there was no statistical difference in number of patients who required hormonal replacement therapy between radiation and non-radiation group. CONCLUSION: Visual disturbance can be improved by early diagnosis and surgical decompression. GTR or RSTR in selected patients is considered a proper surgical strategy. Post-operative radiation therapy for residual tumors must be considered, although the ideal timing of radiation therapy is to be determined.
Adult* ; Craniopharyngioma* ; Decompression, Surgical ; Early Diagnosis ; Follow-Up Studies ; Humans ; Hypopituitarism ; Magnetic Resonance Imaging ; Neoplasm, Residual ; Postoperative Period ; Recurrence ; Retrospective Studies ; Tomography, X-Ray Computed

BACKGROUND: Chronic placental inflammation, such as villitis of unknown etiology (VUE) and chronic chorioamnionitis (CCA), is considered a placental manifestation of maternal anti-fetal rejection. The aim of this study is to investigate its frequency in twin pregnancies compared to singleton pregnancies. METHODS: Three hundred twin placentas and 1,270 singleton placentas were consecutively collected at a tertiary medical center in Seoul, Republic of Korea from 2009 to 2012. Hematoxylin and eosin sections of tissue samples (full-thickness placental disc and chorioamniotic membranes) were reviewed. RESULTS: Non-basal VUE was more frequent in twin placentas than in singleton placentas (6.0% vs 3.2%, p < .05). In preterm birth, CCA was found less frequently in twin placentas than in singleton placentas (9.6% vs 14.8%, p < .05), reaching its peak at an earlier gestational age in twin placentas (29-32 weeks) than in singleton placentas (33-36 weeks). CCA was more frequent in twin pregnancies with babies of a different sex than with those with the same sex (13.8% vs 6.9%, p=.052). Separate dichorionic diamniotic twin placentas were affected by chronic deciduitis more frequently than singleton placentas (16.9% vs 9.7%, p<.05). CONCLUSIONS: The higher frequency of non-basal VUE in twin placentas and of CCA in twin placentas with different fetal sex supports the hypothesis that the underlying pathophysiological mechanism is maternal anti-fetal rejection related to increased fetal antigens in twin pregnancies. The peak of CCA at an earlier gestational age in twin placentas than in singleton placentas suggests that CCA is influenced by placental maturation.
Chorioamnionitis ; Eosine Yellowish-(YS) ; Female ; Gestational Age ; Hematoxylin ; Humans ; Inflammation* ; Placenta ; Pregnancy ; Pregnancy, Twin* ; Premature Birth ; Republic of Korea ; Seoul ; Twins*