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Glandular papilloma of the lung with malignant transformation.

Yeungnam University Journal of Medicine.2017;34(2):298-302. doi:10.12701/yujm.2017.34.2.298

Glandular papilloma of the lung is one of three histologic types of solitary endobronchial papillomas. It is known as an uncommon benign neoplasm. No malignant glandular papillomas have been reported. Herein, the first case of granular papilloma with malignant transformation is reported. A 74-year-old man with huge right lung mass extended upper and lower lobe was admitted to the hospital complaining of progressive cough and dyspnea. An open lung biopsy was performed. Microscopically, the tumor showed papillary growth pattern with thick fibrovascular cores. The stroma of the fibrovascular cores shown the infiltration of lymphoplasmacytic cells and proliferation of capillaries. The epithelial cells surrounding the papillary fronds were cilliated columnar cells with focal cellar atypia, and frequent mitoses. Suspicious pleural invasion foci were identified. The Ki-67 labeling index was about 24.3% and p53 labeling index was about 31.7%. Glandular papilloma is known as a benign neoplasm, which is lack of atypia and mitosis. In present case, there were several indications of malignant transformation, such as cellular atypia, frequent mitosis, architectural distortion, and pleural invasion. Pathologists must be aware that glandular papilloma can have a changes of malignant transformation. Further studies about disease behavior and molecular characteristics are needed.
Aged ; Biopsy ; Capillaries ; Cough ; Dyspnea ; Epithelial Cells ; Humans ; Lung* ; Mitosis ; Papilloma*

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Cytokeratin 20 negative Merkel cell carcinoma consistent with negative Merkel cell polyomavirus.

Osung KWON ; Hyun CHUNG ; Joonsoo PARK

Yeungnam University Journal of Medicine.2017;34(2):293-297. doi:10.12701/yujm.2017.34.2.293

Merkel cell carcinoma (MCC) is a rare neuroendocrine tumor that is highly aggressive in nature and indolent in progression. The common risk factors for MCC are senility, prolonged exposure to sunlight, and immune deficient states. Moreover, Merkel cell polyomavirus has recently been characterized to be significantly associated with pathogenesis of MCC, including the expression of Cytokeratin 20 (CK20). Diagnosis is often difficult since histopathological results require a number of differential diagnoses through immunohistochemical (IHC) stains with other cutaneous malignancies. A 67-year-old man presented with a solitary domeshaped erythematous round mass on the left upper arm for 2 months. Biopsy and IHC studies revealed findings consistent with Merkel Cell Carcinoma of neuroendocrine origin. Common IHC stains usually confirm positive findings for CK20, which is also recognized as the key component in making the diagnosis. We present a CK20 negative MCC in light of expanding the knowledge of unusually stained IHC results in MCC.
Aged ; Arm ; Biopsy ; Carcinoma, Merkel Cell* ; Coloring Agents ; Diagnosis ; Diagnosis, Differential ; Humans ; Keratin-20* ; Keratins* ; Merkel cell polyomavirus* ; Neuroendocrine Tumors ; Risk Factors ; Sunlight

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Suddenly fixed upward ocular deviation under general anesthesia.

Won Jae KIM ; Sang Jin PARK ; Myung Mi KIM

Yeungnam University Journal of Medicine.2017;34(2):290-292. doi:10.12701/yujm.2017.34.2.290

Various changes in ocular position are possible during general anesthesia as opposed to the awakening state. However, unexpected ocular deviation under general anesthesia is a disconcerting event as it can lead to difficult complications intraoperatively. To date, sudden fixed upward ocular deviation has been rarely reported previously. This phenomenon was observed in an 8-year-old boy during strabismus surgery. Suddenly fixed upward ocular deviation occurred when the speculum was inserted into the right eye. When the eyeball was pulled down, using forceps, there was some resistance, such as contracture of superior rectus. The eyeball sprang back into the upward position when the forceps was released. These changes could hamper the good exposition of the surgical field, leading to significant intraoperative difficulties and complications. Surgeons should be aware of this possibility, despite general anesthesia; if it occurs, proceed with the surgery as planned preoperatively, and both ophthalmic and anesthetic interventions should be used to solve this problem.
Anesthesia, General* ; Child ; Contracture ; Humans ; Male ; Strabismus ; Surgeons ; Surgical Instruments

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Pheochromocytoma-induced cardiogenic shock successfully treated by extracorporeal circulation.

Min Young LEE ; Sang Bae LEE ; Hyun Seo CHA ; Ji Hong YOU ; Eui Young CHOI ; Jong Suk PARK

Yeungnam University Journal of Medicine.2017;34(2):285-289. doi:10.12701/yujm.2017.34.2.285

Pheochromocytoma can present with various symptoms including cardiogenic shock and cardiac arrest. Particularly, in cases of cardiogenic shock of unknown origin, pheochromocytoma should be considered. A 20-year-old woman without any medical history visited our emergency department due to nausea, vomiting, headache, and chest pain. Echocardiography revealed severe left ventricular dysfunction. Mechanical ventilation and veno-arterial extracorporeal membrane oxygenation (ECMO) were implemented owing to her unstable vital signs. For unstable vital sign and cardiogenic shock in a young woman without any previous medical history, pheochromocytoma was considered and diagnosed based on elevated levels of catecholamine derivatives in a 24-hour urine sample. Cardiac function recovered and ECMO was discontinued on the 5th day of hospitalization. She later underwent an elective adrenalectomy and no recurrence was found during the follow-up period. We reported a case of pheochromocytoma which was presented with cardiogenic shock in a young woman with no concomitant disease, and successfully treated with ECMO followed by an elective adrenalectomy.
Adrenalectomy ; Chest Pain ; Echocardiography ; Emergency Service, Hospital ; Extracorporeal Circulation* ; Extracorporeal Membrane Oxygenation ; Female ; Follow-Up Studies ; Headache ; Heart Arrest ; Hospitalization ; Humans ; Nausea ; Pheochromocytoma ; Recurrence ; Respiration, Artificial ; Shock, Cardiogenic* ; Ventricular Dysfunction, Left ; Vital Signs ; Vomiting ; Young Adult

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Pulmonary artery sarcoma manifesting as a main pulmonary artery stenosis diagnosed by 18F-FDG PET/CT.

Hoonhee LEE ; Han Bit PARK ; Yun Kyung CHO ; Jung Min AHN ; Sang Min LEE ; Jae Seung LEE ; Dae Hee KIM

Yeungnam University Journal of Medicine.2017;34(2):279-284. doi:10.12701/yujm.2017.34.2.279

Pulmonary artery sarcoma (PAS) is a rare and fatal disease that often mimics chronic thromboembolic pulmonary hypertension (CTEPH); therefore, diagnosis of PAS is often delayed. Herein, a healthy 74-year-old man was presented with a 4-month history of dyspnea. Chest computed tomography showed wall thickening and stenosis in the main pulmonary artery as well as in both proximal pulmonary arteries. In order to differentiate between unusual CTEPH, vasculitis, and PAS, we performed right heart catheterization and pulmonary angiography. The mean pulmonary arterial pressure was 21 mmHg, and there was severe pulmonary artery stenosis. Thrombi on the pulmonary arterial wall lesions were observed in intravascular ultrasound and optical coherence tomography. Furthermore, the patient had a history of deep vein thrombosis. Therefore, we diagnosed unusual CTEPH. After 6 months of rivaroxaban anticoagulation therapy, a chest X-ray revealed a left lower lobe lung mass, and a positron emission tomography later showed hypermetabolic lesions in the main pulmonary artery wall, in both pulmonary arteries walls, in the lung parenchyma, and in the bones. A biopsy of the right proximal humerus lesion revealed undifferentiated intimal sarcoma. Pulmonary sarcoma is rare, but should be considered when differentially diagnosing main pulmonary artery wall thickening and stenosis. A positron emission tomography may aid in this diagnosis.
Aged ; Angiography ; Arterial Pressure ; Biopsy ; Cardiac Catheterization ; Cardiac Catheters ; Constriction, Pathologic* ; Diagnosis ; Dyspnea ; Fluorodeoxyglucose F18* ; Humans ; Humerus ; Hypertension, Pulmonary ; Lung ; Positron-Emission Tomography ; Positron-Emission Tomography and Computed Tomography* ; Pulmonary Artery* ; Rivaroxaban ; Sarcoma* ; Thorax ; Tomography, Optical Coherence ; Ultrasonography ; Vasculitis ; Venous Thrombosis

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Partial spontaneous remission of small cell lung carcinoma with neurologic symptom.

Kyung Hyun YUN ; Sung Heon SONG ; Chung Hyoun KIM ; Chan Hee HWANG ; Jun Ho LEE ; Je Hyoung CHOI ; Sun Young KIM

Yeungnam University Journal of Medicine.2017;34(2):275-278. doi:10.12701/yujm.2017.34.2.275

Small cell lung carcinoma (SCLC) is a cancer that shows aggressive behavior, early spread to distant sites, and frequent association with distinct paraneoplastic syndromes. Spontaneous remission of cancer, particularly of SCLC, is a rare biological event. Cases involving spontaneous regression of SCLC were reported, and were associated with paraneoplastic syndromes of the nervous system. This article reports on a 78-year-old man with SCLC in remission, with neurological symptoms. The patient visited the hospital because of generalized weakness, and imaging studies revealed a mass in the lower lobe of the left lung, pathological evaluation showed SCLC. The patient refused oncologic treatment and was treated only with conservative care. In follow-up study the diameter of the mass had decreased from initial 32 mm, 9 months after admission to 20 mm, 17 months after admission to 13 mm. The patient kept complaining of generalized weakness, dizziness, and paresthesia of limbs. We assumed that, in this case, the spontaneous remission of lung cancer was related to the immunologic response directed against the tumor, which is believed to be an important factor in the pathogenesis of paraneoplastic neurologic syndromes.
Aged ; Dizziness ; Extremities ; Follow-Up Studies ; Humans ; Lung ; Lung Neoplasms ; Neoplasm Regression, Spontaneous ; Nervous System ; Neurologic Manifestations* ; Paraneoplastic Syndromes ; Paraneoplastic Syndromes, Nervous System ; Paresthesia ; Remission, Spontaneous* ; Small Cell Lung Carcinoma*

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Malignant Fibrous Histiocytoma of the Spermatic Cord: A Case Report.

Ji Yoon KIM ; Seong Ho LEE ; Hee Chang JUNG ; Dong Sug KIM ; Jae Ho CHO

Yeungnam University Journal of Medicine.2003;20(1):85-91. doi:10.12701/yujm.2003.20.1.85

Malignant fibrous histiocytoma (MFH) of the spermatic cord represents an uncommon location for the most common soft tissue tumor in adults. MFH of the spermatic cord is extremely rare. No case report has been described in the Korean literature. We report a case of malignant fibrous histiocytoma, myxoid type, arising from left spermatic cord. A 77-year-old male presented with a painless left upper scrotal mass for 5 months. Simple mass excision was performed for a diagnosis. Grossly, the mass closely contacted with the left spermatic cord. Since a myxoid type of malignant fibrous histiocytoma was diagnosed from histopathological findings, left radical orchiectomy with high ligation of the spermatic cord was performed additionally. There were no evidence of local recurrence or metastasis at 6 months after surgery.
Adult ; Aged ; Diagnosis ; Histiocytoma, Malignant Fibrous* ; Humans ; Ligation ; Male ; Neoplasm Metastasis ; Orchiectomy ; Recurrence ; Sarcoma ; Spermatic Cord*

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A Case of Pyoderma Gangrenosum in Rheumotoid Arthritis Patient.

Dong Hwan RYU ; Chang Mo KWON ; Jung Hun LEE ; Young Hun HONG ; Choong Ki LEE

Yeungnam University Journal of Medicine.2003;20(1):79-84. doi:10.12701/yujm.2003.20.1.79

Pyoderma gangrenosum is uncommon neutrophilic dermatosis characterized by richness of the mature neutrophilic polynuclear dermal infiltrate. Pyoderma gangrenosum is associated with variable diseases, most commonly inflammatory bowel disease, hematological diseases, malignancies, but it is reported rarely in rheumatoid arthritis. We report a case of pyoderma gangrenosum in rheumoid arthritis patient. A 50-year-old woman admitted to our hospital due to painful pretibial ulcerative skin lesions. She had been treated as rheumatoid arthritis for 8 years. At admission, body temperature was 36.5degrees C and other vital sign was unremarkable. Physical examination revealed right pretibial ulceration, multiple pustules on left pretibial area and both palms. Laboratory studies revealed WBC count 7,600/uL (neutrophils 60.3%, eosinophil 3.2%), hemoglobin 11.4 g/dL, platelet count 319,000/uL, ESR 65 mm/hour. Other lab findings were also unremarkable. Skin biopsy was done, which showed dense dermal infiltrate of neutrophils and wound culture were negative. By 8 weeks after systemic high dose corticosteroid (1 mg/kg/day), cyclosporine A (5 mg/kg/day), sulfasalazine 2 g therapy, symptoms and skin ulceration were being improved. Without skin relapse, she is followed up our hospital with low dose corticosteroid and sulfasalazine.
Arthritis* ; Arthritis, Rheumatoid ; Biopsy ; Body Temperature ; Cyclosporine ; Eosinophils ; Female ; Hematologic Diseases ; Humans ; Inflammatory Bowel Diseases ; Middle Aged ; Neutrophils ; Physical Examination ; Platelet Count ; Pyoderma Gangrenosum* ; Pyoderma* ; Recurrence ; Skin ; Skin Diseases ; Skin Ulcer ; Sulfasalazine ; Ulcer ; Vital Signs ; Wounds and Injuries

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A Case of Unilateral Absence of Left Pulmonary Artery Presenting Hemoptysis.

Hye Jin YOON ; Tae Mook NO ; Seon Woong KIM ; Dong Hi PARK ; In Seek KIM ; Yeon Jae KIM ; Byung Ki LEE ; Ji Young PARK ; Jin Hong CHUNG

Yeungnam University Journal of Medicine.2003;20(1):71-78. doi:10.12701/yujm.2003.20.1.71

Unilateral absence of a pulmonary artery (UAPA) is a rare congenital anomaly that is frequently associated with other cardiovascular anomalies first reported by Fraentzel in 1968. Most patients who have no associated cardiac anomalies have only minor or absent symptoms. We experienced a case of isolated UAPA in a young female presenting hemoptysis. The chest radiograph showed a small left lung volume and high resolutional CT of chest showed multiple subpleural nodules and centrilobular nodules in parenchyma. The video-assisted thoracoscopic biopsy revealed diffuse dilated vessels in visceral pleura. The pulmonary angiogram confirmed the absence of the left main pulmonary artery.
Biopsy ; Female ; Hemoptysis* ; Humans ; Lung ; Pleura ; Pulmonary Artery* ; Radiography, Thoracic ; Thorax

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The Relationship Between Adiposity and Risk factors for Cadiovascular Disease at Normal Body Weight Male.

Woo Sung KWON ; Jun Su KIM ; Jin Wook CHAE ; Keun Mi LEE ; Seung Pil JUNG ; Yong MOON

Yeungnam University Journal of Medicine.2003;20(1):62-70. doi:10.12701/yujm.2003.20.1.62

BACKGROUND: Most of all studies about the relation between the health risk and obesity are based on the European and American data. The purpose of this study is to examine the relation between adiposity and risk factors for cardio vacular disease (CVD) in normal weight individuals. MATERIALS AND METHODS: Normal weight subjects with a body mass index (BMI) between 18.5 and 23 kg/m2 (76 subjects) and overweight subjects with a BMI between 23 and 25 kg/m2 (53 subjects) were retained for this study. Normal weight subjects were divided into three group of each adiposity variable, then three group and the overweight group were evaluated for the presence of CVD risk factors and analyze the correlation coefficients between adiposity variables and risk factors controlled for age in normal weight, overweight groups. Using logistic regression analysis, the odds ratio (OR) for the prevalence of risk factors for each group of adiposity variables and the overweight group was estimated relative to the first group in normal weight subjects. RESULTS: Systolic BP, diastolic BP, LDL cholestrol, HDL cholesterol, triglycerides in normal weight subjects were significantly correlated with all adiposity variables (P<0.01). Third group (3.7 for %fat and 4.7 for fat mass)of adiposity variables in the normal weight group and the overweight group (6.6 for %fat and 11.5 for fat mass) tended to have higher ORs compared to first group for risk factor variables. CONCLUSION: Normal weight subjects with elevated adiposity had higher prevalence of risk factors than normal weights subjects with less adiposity. Measuring of adiposity added additional information of cardiovascular disease risk factors in normal weight subjects.
Adiposity* ; Body Mass Index ; Cardiovascular Diseases ; Cholesterol, HDL ; Humans ; Ideal Body Weight* ; Logistic Models ; Male* ; Obesity ; Odds Ratio ; Overweight ; Prevalence ; Risk Factors* ; Triglycerides ; Weights and Measures

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