Since 1972, a unique lymphadenitis called "subacute necrotizing lymphadenitis" has been described in much Japanese literatures and in a few English articles. Although this condition is accepted as a new entity in Japan, it is not yet accepted other countries. Occasionally, we have encountered lymph node biopsies which showed histologic pictures of subacute necrotizing lymphadenitis with clinical impressions of malignant lymphoma. As an initial step to investigating the etiology of this disease, the common clinicopathologic features in 24 cases of subacute necrotizing lymphadenitis were studied. The lesion frequently developed in the cervical lymph node of young women, causing simple enlargement of the lymph node and was accompanied occasionally by fever or pain. The duration of symptoms was within one month and seasonal distribution was not remarkable. In laboratory tests, WBC count was below 4000/mm3 in 8 cases and Widal test was negative in all 4 cases examined. Microscopically, the characteristic finding was the wide area of patch or confluent necrosis associated with numerous karyorrhectic nuclear dust and surrounded by diffuse infiltration of immunoblastic or activated histiocytoid cells. No appreciable increase in plasma cells or neutrophilic infiltration was noted.
Adolescent ; Adult ; Child ; Child, Preschool ; Female ; Human ; Infant ; Lymphadenitis/pathology* ; Male ; Middle Age ; Necrosis

We describe two cases of metastatic Wilms' tumor in the lung with emphasis on the cytologic features of specimens obtained by needle aspiration. One of them was extrarenal Wilms' tumor. The findings were correlated with the histopathologic fea- tures of the primary lesion. Cellular components in the fine needle aspiration cytology (FNAC) slides included blastemal, epithelial, stromal and inflammatory cells with immature tubular differentiation and rosette formation. Recognition of these cellular components in FNAC smears help in establishing FNAC diagnosis of Wilms' tumor. The blastemal cells were represented by small to medium sized cells with scanty cytoplasm having ill-defined borders and round to slightly oval nuclei with evenly dispersed chromatin and small marginated nucleoli. They were seen in our two cases. The differential diagnosis includes neuroblastoma, malignant lymphoma, malignant rhabdoid tumor, clear cell sarcoma, Ewing's sarcoma and embryonal rhabdo-myosarcoma. In conclusion, making a definite cytologic diagnosis of metastatic Wilms' tumor may be possible by light and electron microscopy and immunohi-stochemical staining. The above findings may contribute to the diagnosis of FNAC of metastatic Wilms' tumor.
Biopsy, Fine-Needle* ; Chromatin ; Cytoplasm ; Diagnosis ; Diagnosis, Differential ; Lung* ; Lymphoma ; Microscopy, Electron ; Needles ; Neoplasm Metastasis ; Neuroblastoma ; Rhabdoid Tumor ; Rosette Formation ; Sarcoma, Clear Cell ; Sarcoma, Ewing ; Wilms Tumor*

We report a case of patient with documented SLE who displayed dysuria, gastrointestinal (GI) symptoms and renal insufficiency associated with the unusual occurrence of bilateral hydroureteronephrosis due to urterovesical junction stricture (obstructive uropathy). Pathologic investigations disclosed chronic interstitial cystitis (IC) with evidence of focal immune complex deposition in the blood vessel walls of the bladder. The GI symptoms and dysuria regressed with initial therapy for SLE with steroids. However, the persistent obstructive uropathy (OU) and renal insufficiency required bilateral nephrostomy followed by steroids plus intravenous pulse injection of cyclophosphamide. The obstructive uropathy was relieved even after removing the nephrostomy tube and renal function remained stable. Including this case, nineteen SLE patients associated with clinical and radiographic findings of OU were found in the world literature and reviewed to find any consistent pattern of clinical features. Most of the patients with OU in SLE were female (mean age, 31.7 yr) and orientals (63%), and had interstitial cystitis (89%) as a common underlying cause with concomitant involvement of the GI tract (89%) and WHO class IV or V advanced glomerulonephritis (67%). Despite the remarkable response (68%) to steroids in majority of OU patients associated with SLE, certain patients still required surgical correction (32%) and some even died (32%). OU, potentially reversible, was not an exception in patients with SLE, which might be overshadowed by other major organ involvement of SLE.
Adolescent ; Adult ; Female ; Human ; Lupus Erythematosus, Systemic/*complications/*pathology ; Urethral Obstruction/*complications/*pathology

BACKGROUND AND OBJECTIVES: Salivary duct carcinoma (SDC) is a rare but highly malignant tumor of the salivary glands. Authors aimed to assess the current treatment outcome and to estimate the prognostic factors in the patients with SDC. MATERIALS AND METHODS: We reviewed the medical records of 11 patients with SDC, who were treated between Jan. 1995 and Jun. 2002 at the Department of Otolaryngology, Samsung Medical Center. Follow-up duration ranged from 10 to 76 months with a mean of 29.6. RESULTS: The parotid glands were more frequently involved (9 patients) than the submandibular glands (2 patients). Most patients were diagnosed to have an advanced stage of the disease. Curative surgical resections and/or postoperative radiation were the mainstay of the treatment. The adjusted 3-year survival rate was 64.9% and the disease-free 3-year survival rate was 34.1%. Four patients died of the disease at a mean interval of 22 months after the initial diagnosis. Presentation with the facial nerve paralysis, positive surgical resection margins and pathological vascular invasion had a tendency to result in poor survivals. Treatment failures due to distant metastasis were common (54.5%). CONCLUSION: We reconfirmed the aggressive clinical natures of SDC: frequent distant metastasis and poor survival rates. These findings strongly suggest that additional treatment modalities such as an adjunctive systemic treatment need to be considered in the patients with SDC especially when they have high risk factors or an advanced disease, which need further investigation.
Risk Factors ; Neoplasm Metastasis

Heterotopic pancreas, a developmental anomaly uncommonly noted both during operations and autopsies, is usually described in each instance as an incidental finding, Precise diagnosis can be made more often now by endoscopy. Rarely heterotopic pancreas can cause intra-abdominal hemorrhage or obstruction. We experienced a very rare case in which aberrant pancreas located at the Ampulla of Vater was found to be the cause of partial obstruction of the comon bile duct. Diagnosis was done by duodenoscopy and biopsy. So, we report a case of heterotopic pancreas at the Ampulla of Vater diagnosed by endoscopy with a review of relevant literatures.
Ampulla of Vater* ; Autopsy ; Bile Ducts ; Biopsy ; Diagnosis ; Duodenoscopy ; Endoscopy* ; Hemorrhage ; Incidental Findings ; Jaundice, Obstructive ; Pancreas*

Epstein-Barr virus (EBV) is one of eight human herpesvirus. Primary infection with EBV in childhood is generally asymptomatic or mild, however, often causes overt diseases such as infectious mononucleosis (IM) and lymphoproliferative disorder (LPD), the latter occursing in immunologically compromised individuals. Historically, EBV has been considered to be etiologically linked to human malignancies such as EBV genome positive Burkitt's lymphoma and nasopharyngeal carcinoma. Recently, however, another category of EBV-related disease, "chronic active EBV infection", has been made to describe persons without a clearly defined underlying disease. We report 4 cases of patients, presented with episodic fever of unknown origin (FUO), who were diagnosed as severe chronic active EBV infection. A combined application of serology for EBV and in-situ hybridization established the diagnosis of the EBV infection.
Burkitt Lymphoma ; Diagnosis ; Epstein-Barr Virus Infections ; Fever of Unknown Origin* ; Fever* ; Genome ; Herpesvirus 4, Human* ; Humans ; Infectious Mononucleosis ; Lymphoproliferative Disorders

Epstein-Barr virus (EBV) is one of eight human herpesvirus. Primary infection with EBV in childhood is generally asymptomatic or mild, however, often causes overt diseases such as infectious mononucleosis (IM) and lymphoproliferative disorder (LPD), the latter occursing in immunologically compromised individuals. Historically, EBV has been considered to be etiologically linked to human malignancies such as EBV genome positive Burkitt's lymphoma and nasopharyngeal carcinoma. Recently, however, another category of EBV-related disease, "chronic active EBV infection", has been made to describe persons without a clearly defined underlying disease. We report 4 cases of patients, presented with episodic fever of unknown origin (FUO), who were diagnosed as severe chronic active EBV infection. A combined application of serology for EBV and in-situ hybridization established the diagnosis of the EBV infection.
Burkitt Lymphoma ; Diagnosis ; Epstein-Barr Virus Infections ; Fever of Unknown Origin* ; Fever* ; Genome ; Herpesvirus 4, Human* ; Humans ; Infectious Mononucleosis ; Lymphoproliferative Disorders

BACKGROUND: Lymphangioma of the mediastinum is an uncommon benign tumor of lymphatic origin that is most often seen in children, is very rare in adults and is frequently discovered incidentally on chest x-ray exams. While radiology (CT and MRI) may suggest the diagnosis and allow an assessment of the operative difficulties, the histology of the surgical specimen is required for precise diagnosis. Complete resection is the only treatment; however, in some patients resection was incomplete because of the infiltrating character of these tumors, leading to recurrence. We report three cases of mediastinal lymphangioma with a review of the literature.
Adult* ; Child ; Diagnosis ; Humans ; Lymphangioma* ; Mediastinal Neoplasms ; Mediastinum ; Recurrence ; Thorax

Pheochromocytomas are neuroendocrine tumors of chromaffin cell that originate in the paraganglia of the adrenal medulla. Approximately 10% of pheochromocytomas are found in the extra-adrenal paraganglia and are called paragangliomas. However, cases of middle mediastinal paragangliomas are very rare. In this case, the patient presented with a voice change and a headache. A middle mediastinal soft tissue mass with marked enhancement was detected on computed tomography of the chest. The 24-hour urine catecholamine level was markedly elevated. The middle mediastinal mass was biopsied via mediastinoscopy and the resulting immunohistochemical staining was compatible with a diagnosis of middle mediastinal paraganglioma. The mass was resected surgically and the symptoms were relieved.
Adrenal Medulla ; Chromaffin Cells ; Headache ; Humans ; Mediastinoscopy ; Mediastinum ; Neuroendocrine Tumors ; Paraganglioma ; Pheochromocytoma ; Thorax ; Voice

Low-grade gastric MALT lymphoma arises from long-standing Helicobacter pylori(Hp) infection. High remission rates for these lymphoma have been observed after H. pylori eradication. There was debates on the optimal treatment of low-grade gastric MALT lymphoma. The purpose of this study is to investigate clinical and endoscopic characteristics of primary low-grade gastric MALT lymphoma and to assess short-term clinical outcome of various modalities of treatment. METHODS: 30 patients(14 male, 16 female, mean age 44.9 years, range 26-76, mean follow-up 22.9 months) with primary low-grade gastric MALT lymphoma, diagnosed at the Samsung Medical Center from March 1995 to September 1998, were evaluated in a retrospective study. We evaluated patient's presenting symptoms, endoscopic finding, Hp status, staging by Musshoff system, and recurrence rate according to treatment mordalities. RESULTS: The most common symptom is epigastric discomfort or pain(36.7%). Endoscopic appearances of gastric MALT lymphoma shows the wide variation from mucosal thickening to overt malignancy. The most common site of gastric MALT lymphoma is the gastric antrum and lower body(9 and 6 patients). Histologically, 70% were found to be Hp infected. Of 21 Hp(+) patients, 11 patients were clinical stage IE and received Hp eradication by PPI-based triple regimens. 81.8%(9/11) showed complete remission. Among 11 patients, 6 patients studied by PCR. After Hp eradication, 5 in 6 patients showed persistent IgH rearangement by PCR. The mean follow-up time is 22.8 months(range 3 to 36 months), One patient, who showed complete histologic regression during second endoscopy, relapsed MALT lymphoma after 6 months. The other one patient showed no change of lymphoma and underwent surgery. 12 patients underwent surgical treatment and showed no evidence of relapse. The mean follow-up time is 35.9 months. 2 patients received chemotherapy with CHOP regimen and showed complete remission. The mean follow-up time is 6.7 months. 2 patients received radiotherapy and showed no evidence of relapse. The mean follow-up time is 15 months. CONCLUSION: Our study shows that complete remission rate after Hp eradication is as high as some studies recently reported. This suggest that Hp eradication may be considered as first-line therapy of low-grade gastric MALT lymphoma of stage IE.
Drug Therapy ; Endoscopy ; Female ; Follow-Up Studies ; Helicobacter ; Humans ; Lymphoma ; Lymphoma, B-Cell, Marginal Zone* ; Male ; Polymerase Chain Reaction ; Pyloric Antrum ; Radiotherapy ; Recurrence ; Retrospective Studies