The pathogenetic mechanism of focal segmental glomerulosclerosis (FSGS) is not known. Some authors suggest glomerular hypertrophy may precede the development of FSGS in patients with minimal lesion. It was recently reported that the size of nonsclerotic glomeruli in adults with FSGS is significantly larger than that of cases with minimal lesion. It is not clear whether glomerular hypertrophy observed in adults with FSGS is also seen in children with FSGS. Thus, we have analyzed 37 renal biopsies from children with FSGS by morphometry and the data were compared with 37 renal biopsies from age- and sex-matched patients with minimal lesion. The number of glomeruli submitted for morphometric analysis was 22.6+/-14.2 in cases with FSGS and 30.9+/-11.4 in cases with minimal lesion. Mean glomerular volume (MGV) in FSGS group was significantly larger than that of minimal lesion [(13.1+/-3.9) x10(5) microm3 vs. (10.1+/-1.9) x10(5) microm3, p<0.001]. The relative interstitial volume of renal cortex in patients with FSGS was significantly larger than that of minimal lesion [(0.106+/-0.051) microm3/microm3 vs. (0.029+/-0.012) microm3/microm3, p<0.0001]. In FSGS, the percentage of glomeruli with FSGS was significantly correlated with relative interstitial volume of renal cortex (r=0.79, p<0.0001). As is the case for adult FSGS, MGV of children with FSGS is significantly larger than that of minimal lesion. Thus, the presence of glomerular hypertrophy observed in biopsies with minimal lesion nephropathy seems to be an indication that the coexistent FSGS lesions are undetected due to sampling problems.
Child ; Adult ; Male ; Female ; Humans ; Biopsy

Thyrotoxicosis (thyroid crisis) is a known cause of sudden death; however, only a few cases of death resulting from thyrotoxicosis have been reported. Histopathologic examination and postmortem thyroid function tests may be helpful in postmortem diagnosis, but their usefulness seems to be limited. We report three autopsy cases associated with thyrotoxicosis.
Autopsy ; Death, Sudden ; Thyroid Crisis ; Thyroid Function Tests ; Thyrotoxicosis

OBJECTIVES: The diagnosis of ASCUS(atypical squamous cells of undetermined significance) and LSIL(low-grade squamous intraepithelial lesion) was introduced in 1988 by the Bethesda system for reporting cervical/vaginal cytologies. A significant proportion of women referred for colposcopy with low grade cervical cytologic abnormalities(ASCUS and LSIL) will have high grade cervical intraepithelial neoplasia(CIN II or CIN III) and therefore require adequate management. The purposes of this study were to evaluate the usefulness of high risk type HPV(human papillomavirus) DNA detection using PCR(polyerase chain reaction) in patients with low grade cervical cytologic abnormalities in the prediction of high grade CIN and invasive cancer and to determine the clinical triage in the management of low grade cervical cytologic abnormalities. METHODS: We reviewed 18,942 cases of Papanicolau smears that were performed at our hospital from Jan. 1995 to Mar. 1999. Colposcopically directed biopsy or LLETZ(large loop excision of transformation zone) or hysterectomy were performed on 318 patients with abnormal PAP smears of low degree. HPV PCR testing of high risk types(16 and 18) was also performed on 115 patients. RESULTS: Histologic outcome of ASCUS included 43 cases(38.4%) of high grade CIN and invasive cancer, and that of LSIL included 65 cases(47.5%) of high grade CIN and invasive cancer. In cases of high risk HPV type, 19 patients(73.1%) were at age over 30 years. A highly significant correlation was found between a positive test for high risk types of HPV and finding of high grade CIN and invasive cancer. Among 51 women with ASCUS, a positive test for high risk type had a sensitivity and specificity of 40.0% and 86.1%, and positive predictive value(PPV) and negative predictive value(NPV) of 54.5% and 77.5%, respectively. In 64 women with LSIL, a positive high risk type test was associated with sensitivity and specificity of 30.0% and 94.1%, and PPV and NPV of 81.8% and 60.4%, respectively. CONCLUSION: Our results suggest that high risk type HPV may be positively predictive of and may act as a surrogate marker for high grade CIN and invasive cancer in women with low grade cervical cytologic abnormalities. The management of women with a low grade cervical cytologic abnormalities should be active such as colposcopically directed biopsies.
Biomarkers ; Biopsy ; Colposcopy ; Diagnosis ; DNA* ; Female ; Humans* ; Hysterectomy ; Polymerase Chain Reaction ; Sensitivity and Specificity ; Triage

No abstract available.
Bronchiectasis*

BACKGROUND: Chicken pox and herpes zoster are caused by the varicella-zoster virus(VZV). To investigate the epiderniologial relationship between clinical isolates of VZV, it is essential to distinguish different isolate. OBJECTIVE: This study was conducted to classify the VZV strains according to R5 tandem direct reiterations(TDR) copy numbers and Pst I endonuclease cleavage site mutation, and to analyze the distribution pattern of VZV strains isolated in Korea. METHODS: Strains of VZV were isolated from 61 patients with herpes zoster who had not been immunized with a live vaccine of VZV. Copy numbers of R5 TDR which was located in variable region IV were measured by PCR. The presence of a Pst I cleavage site in a middle portion of the long unique region of VZV genome was analyzed by PCR thereafter restriction enzyme digestion(PCR-RFLP). RESULTS: VZV strains isolated in Korea contained one to three copy numbers of R5 TDR. Of 61 isolates, 43(70%) comtained 2 copies of R5 TDR, while 11(18%) isolates contained only one copy and 7(12%) isolat s contained 3 copies. About 16% of the strains examined did not have a PstI cleavage site, although the majority of strains retained this site. VZV strains could be classified into 6 strains on the basis of the copy number of R5 TDR and PstI cleavage site, in which the strain with 2 copies of R5 TDR and PstI cleavage site positive was the most frequent type (36 out of 61 isolates) in Korea. Four batches of live attenuated vaccine(Biken) that is now used in Korea showed 2 copy numbers of R5 TDR and PstI site negative. CONCLUSION: The copy number of R5 TDR and the presence of PstI cleavage site seems to be a reliable marker for dicrimination of VZV strains in Korea. This discrimination can be used to study the molecular epiclemiology of VZV and as a criterion for identification of vaccine-related isolates.
Chickenpox* ; Discrimination (Psychology) ; Genome ; Herpes Zoster* ; Humans ; Korea* ; Polymerase Chain Reaction ; Repetitive Sequences, Nucleic Acid*

A case of myxoma of the breast was reported. A 25-year-old woman showed a lump in the left breast which was suddenly enlarged after the delivery of a baby. A tumor measuring 73.53cm was located in the upper outer quadrant of the breast. Fine needle aspiration cytology revealed scattered benign spindle shaped mesenchymal cells with abundant myxoid material. On excision, the tumor was partly solid, partly cystic and multilocular. Each nodule consisted of an abundant mucoid material with a few spindle or stellate mesenchymal cells. Pleomorphism and mitosis were absent. The mesenchymal cells showed immunoreactivities for S-100 protein, smooth muscle actin, and CD34. The myxoid stroma was positively stained with alcian blue and mucicarmine. These findings suggest that constituent cells derive from totipotential primitive mesenchymal cells.
Actins ; Adult ; Alcian Blue ; Biopsy, Fine-Needle ; Breast* ; Female ; Humans ; Mitosis ; Muscle, Smooth ; Myxoma* ; S100 Proteins

A case of myofibroblastoma of the breast in a 55-year-old man is described. Myofibroblastoma is a relatively recently recognized benign stromal tumor, and predominantly occurs in middle aged men. The pateint presented with a nontender firm mass in his right breast. Fine needle aspiration biopsy revealed bland looking stromal cell clusters without epithelial cells. Simple excision was done and the patient discharged uneventfully. The mass was well demarcated, lobulated and sligtly myxoid. Microscopically bipolar elongated spindle cell fascicles with interspersing broad collagen bands are so characteristic. Ultrastructurally the tumor cell show features of fibroblast as well as smooth muscle cell.
Male ; Humans ; Biopsy

No abstract available.

Granulomatous(lobular) mastitis is a distinct disease entity of unknown etiology which is characterized by noncaseating granulomatous lobulocentric inflammation. We describe a rare case of granulomatous(lobular) mastitis of a 36 year-old pregnant woman a review of the literature. The mass which was discovered in the third month of her pregnancy, began as a localized, nontender mass on the left breast and persisted during her entire pregnancy. It decreased slightly in size when she began taking post-partum bromocriptine. Clinically and mammographically, the mass was highly suspected as a carcinoma with axillary lymph node metastasis. Fine needle aspiration smears revealed numerous aggregates of granulomas composed of epithelioid histiocytes admixed with multinucleated giant cells of Langhans' and foreign body type, and collections of polymorphonuclear leukocytes. Ziehl-Neelsen, silver methenamine and PAS stain were negative for acid-fast bacilli, fungus, and bacilli on the smear respectively. Histologically, granulomatous inflammation was centered on the breast lobules. Caseation necrosis was absent, instead, numerous microabscesses were formed in the center of the granulomas. Cultures of the fresh tissue for the AFB, aerobic and anaerobic bacteria, and fungus were all negative. Excision of the mass was performed without further treatment and there was no recurrence of the mass 6 months postoperatively. An autoimmune mechanism, infection, and some association with oral contraceptives have been suggested as etiologic factors in the literature.
Pregnancy ; Female ; Humans

Cystic nephroma (CN) is a benign cystic neoplasm composed of mixed epithelial and stromal elements. Less than 200 cases have been reported. We had a patient, a 41-year-old woman, who had a huge typical CN. The patient was admitted for a right renal mass that was found incidentally. On laparaoscopic right nephrectomy, there was an encapsulated 7 cm multilocular cystic mass at the upper pole. Microscopically, the cystic wall was lined by a single layer of low cuboidal or hobnail epithelium without a solid area. The thin septa were composed of bland, ovarian type spindle cells. The main differential diagnoses were mixed epithelial and stromal tumor (MEST), low grade multilocular renal cell carcinoma, and tubulocystic carcinoma. The results of immunohistochemical staining were cytokeratin 7/19(+/+) and CD10(-) in lining epithelium, estrogen receptor/progesterone receptor(+/+) in stromal cells. After surgery, she was free of recurrence for 10 months. We report this rare case and compare it with other cystic renal tumors, especially MEST.
Adult ; Carcinoma, Renal Cell ; Diagnosis, Differential ; Epithelium ; Estrogens ; Female ; Humans ; Keratins ; Kidney ; Nephrectomy ; Receptors, Estrogen ; Recurrence ; Stromal Cells