Primary leiomyosarcoma of lung is extremely rare and often diagnosed as a mass on routine chest radiography. Although advances have been made in treatment protocols, leiomyosarcoma remains one of the more difficult soft tissue sarcomas to treat. Surgical resection is usually curative for small and well-differentiated sarcomas. For poorly differentiated and non-resectable tumors, chemotherapy and radiation therapy are used as neoadejuvant or palliative treatment options. Generally, leiomyosarcomas are known to be resistant to radiation therapy alone. The authors experienced a 68-year-old woman who was diagnosed leiomyosarcoma by routine chest radiography. Although disease progression was observed despite of chemotherapy, radiation therapy reduced the size of tumor. This paper describes the curative potential of radiation therapy for primary pulmonary leiomyosarcomas through a case report and literature review.
Aged ; Clinical Protocols ; Disease Progression ; Drug Therapy ; Female ; Humans ; Leiomyosarcoma* ; Lung ; Palliative Care ; Radiography ; Radiotherapy ; Sarcoma ; Thorax

Although renal angiomyolipoma (AML) is a benign tumor, treatment may be necessary occasionally because it can cause potentially life-threatening retroperitoneal hemorrhage. Transarterial embolization (TAE) is a safe and effective treatment option to prevent the hemorrhagic rupture of AMLs and relieve the symptoms caused by enlarged lesions or active bleeding. However, there is no clear consensus regarding the indications for prophylactic TAE in patients with sporadic renal AMLs. In urgent TAE for bleeding AMLs, there is a likelihood of incomplete embolization when the focus is on stabilizing the clinical symptoms. This pictorial essay discusses the patient selection and technical considerations to achieve optimal therapeutic effects as well as the follow-up findings after TAE.

Transcatheter arterial chemoembolization (TACE) is suitable treatment method of hepatocellular carcinoma (HCC) for patients with decreased underlying liver function or unresectable disease. But this procedure can induce some embolic events. We report a case of a gallbladder infarction caused by the embolic event in TACE procedure. A 61-year-old man had been going to undergo 6th TACE for marginal recurrence of HCC. After the procedure, gallbladder infarction occurred and was detected by abdominal computed tomography (CT) scan for response evaluation of the treatment at out-patient-clinic. Then, he was treated with oral antibiotics and conservative therapy at out-patient clinic. In 6th week after the event, abdominal CT scan showed improved state of gallbladder.
Anti-Bacterial Agents ; Carcinoma, Hepatocellular ; Embolism ; Gallbladder* ; Humans ; Infarction* ; Liver ; Middle Aged ; Outpatients ; Recurrence ; Tomography, X-Ray Computed

Coccidioidomycosis is a fungal infection caused by Coccidioides immitis. The endemic area is mostly south-western United States. As increasing in overseas travel to endemic areas, the incidence rate has been recently increased in non-endemic areas. The diagnosis may be delayed in non-endemic area. It is important to elicit traveling histories and to differentiate lung consolidation with eosinophilia, for timely diagnosis of coccidioidomycosis. Recently, we experienced a case with pulmonary coccidioidomycosis in a Korean American who visited Korea showed consolidation in right lower lobe on chest X-ray and prolonged eosinophilia. In the case, a confirmatory diagnostic method was percutaneous transthoracic needle biopsy of lung. We report acute pulomonary coccidioidomycosis case and review previous published reports with pulmonary manifestation in Korea.
Asian Americans ; Biopsy, Needle ; Coccidioides ; Coccidioidomycosis* ; Diagnosis ; Endemic Diseases ; Eosinophilia ; Humans ; Incidence ; Korea* ; Lung Diseases, Fungal ; Lung* ; Thorax ; United States

Intervention treatment such as balloon retrograde or anterograde transvenous obliteration has been used for management of refractory hepatic encephalopathy as well as gastric variceal bleeding. Recently, plug-assisted retrograde transvenous obliteration without a help of balloon was newly developed to treat these patients. Here, we report three cases suffering refractory hepatic encephalopathy who were treated with this new technique.
Balloon Occlusion ; Esophageal and Gastric Varices ; Hepatic Encephalopathy* ; Humans ; Portasystemic Shunt, Surgical ; Splenorenal Shunt, Surgical*

Gallbladder tuberculosis is an extremely rare disease that is rarely reported in the literature. Arriving at the correct diagnosis of gallbladder tuberculosis is difficult, and it is usually made by histopathologic examination after cholecystectomy. However, due to the low sensitivity of acid-fast stain and culture result, diagnosing gallbladder tuberculosis is still demanding even after tissue acquisition. To overcome this problem, tuberculosis-polymerase chain reaction (TB-PCR) is performed on the resected specimen, which has high sensitivity and specificity. A 70-year-old female who had previously undergone total gastrectomy for advanced gastric cancer was admitted with right upper quadrant pain. Abdominal ultrasonography and computed tomography revealed acute cholecystitis without gallstones or sludge. She underwent cholecystectomy and the histopathologic finding of the specimen showed chronic active cholecystitis without gallstones or sludge. Because she was suspected to have pulmonary tuberculosis, TB-PCR was also performed on the resected gallbladder. TB-PCR showed positive reaction for Mycobacterium tuberculosis and we could diagnose it as gallbladder tuberculosis. Herein, we present a case of gallbladder tuberculosis diagnosed by TB-PCR from resected gallbladder.
Aged ; Antitubercular Agents/therapeutic use ; Cholecystitis, Acute/*diagnosis/surgery/ultrasonography ; DNA, Bacterial/analysis ; Female ; Humans ; Mycobacterium tuberculosis/genetics/isolation & purification ; Polymerase Chain Reaction ; Tomography, X-Ray Computed ; Tuberculosis/*diagnosis/drug therapy/microbiology

Purpose: Cytochrome P450 oxidoreductase (POR) deficiency is a rare autosomal recessive disorder caused by mutations in the POR gene encoding an electron donor for all microsomal P450 enzymes. It is characterized by adrenal insufficiency, ambiguous genitalia, maternal virilization during pregnancy, and skeletal dysplasia. In this study, we investigated the clinical, hormonal, and molecular characteristics of patients with POR deficiency in Korea. Methods: This study included four patients with POR deficiency confirmed by biochemical and molecular analysis of POR. Clinical and biochemical findings were reviewed retrospectively. Mutation analysis of POR was performed by Sanger sequencing after polymerase chain reaction amplification of all coding exons and the exon-intron boundaries. Results: All patients presented with adrenal insufficiency and ambiguous genitalia regardless of their genetic sex. Two patients harbored homozygous p.R457H mutations in POR and presented with adrenal insufficiency and genital ambiguity without skeletal phenotypes. The other two patients with compound heterozygous mutations of c.[1329_1330insC];[1370G>A] (p.[I444Hfs*6];[R457H]) manifested skeletal abnormalities, such as craniosynostosis and radiohumeral synostosis, suggesting Antley-Bixler syndrome. They also had multiple congenital anomalies involving heart, kidney, and hearing ability. All patients were treated with physiologic doses of oral hydrocortisone. Conclusion We report the cases of 4 patients with POR deficiency identified by mutation analysis of POR. Although the study involved a small number of patients, the POR p.R457H mutation was the most common, suggesting founder effect in Korea. POR deficiency is rare and can be misdiagnosed as 21-hydroxylase or 17α-hydroxylase/17,20-lyase deficiency. Therefore, molecular analysis is critical for confirmatory diagnosis.

Rheumatoid arthritis (RA) is a chronic autoimmune disease that typically results in strong inflammation and bone destruction in the joints. It is generally known that the pathogenesis of RA is linked to cardiovascular and periodontal diseases. Though rheumatoid arthritis and periodontitis share many pathologic features such as a perpetual inflammation and bone destruction, the precise mechanism underlying a link between these two diseases has not been fully elucidated. Collagen-induced arthritis (CIA) mice were orally infected with Porphyromonas gingivalis (Pg) or Pg preincubated with an anti-FimA antibody (FimA Ab) specific for fimbriae that are flexible appendages on the cell surface. Pg-infected CIA mice showed oral microbiota disruption and increased alveolar bone loss and had synovitis and joint bone destruction. However, preincubation with FimA Ab led to a significant reduction in the severity of both oral disease and arthritis. Moreover, FimA Ab attenuated bacterial attachment and aggregation on human gingival and rheumatoid arthritis synovial fibroblasts. In addition, we discovered bacteria may utilize dendritic cells, macrophages and neutrophils to migrate into the joints of CIA mice. These results suggest that disrupting Pg fimbriae function by FimA Ab ameliorates RA.