Lipogranuloma is a chronic inflammatory response to lipid material within tissues and may develop secondary to fat necrosis, trauma, or exogenous lipid exposure. We report a case of postoperative mid-sternal lipogranuloma with milky discharge in a 35-year-old man that occurred 6 months after surgery for gynecomastia performed through a periareolar incision with adjunctive liposuction. The patient presented with two firm, non-tender nodules at the sternal midline, distant from the operative site, and laboratory findings were unremarkable. Surgical exploration revealed milky white discharge, and histopathologic examination demonstrated lipid-laden macrophages, multinucleated giant cells, and fibrosis, consistent with lipogranulomatous inflammation. No evidence of malignancy or infection was identified, and no recurrence was observed during 2 years of follow-up. The proposed mechanisms include displacement of residual ductal epithelium or lipid material during surgical manipulation, as well as postoperative fat necrosis leading to secondary lipogranulomatous inflammation. This case highlights that postoperative lipogranulomatous inflammation may present at sites distant from the primary operative field. Recognition of this entity is important in the evaluation of postoperative chest wall masses to avoid misdiagnosis and unnecessary intervention.

Epidermoid and dermoid cysts are common congenital lesions of the pediatric periorbital region arising from ectodermal inclusion during embryologic development. Although these lesions originate in the soft tissue, chronic pressure from long-standing masses may induce cortical depression or remodeling of adjacent craniofacial bones, particularly in young children with malleable skeletal structures. We report a case of a 26-month-old girl presenting with a small periorbital epidermoid cyst associated with pressure-induced depression of the zygomatic surface. Radiologic evaluation revealed a well-circumscribed cystic lesion abutting the frontal process of the zygoma with smooth cortical indentation and no features suggestive of aggressive osseous pathology. Complete excision was performed through a lateral brow approach with preservation of the periosteum. Histopathologic examination confirmed an epidermoid cyst. Postoperative follow-up demonstrated progressive spontaneous restoration of the zygomatic contour without the need for bone grafting or alloplastic materials, reflecting the osteogenic potential of the pediatric periosteum. This case emphasizes the importance of distinguishing secondary pressure-related bone remodeling from true intraosseous lesions in the pediatric craniofacial region and highlights the capacity for natural osseous recovery following removal of the compressive source. A brief review of relevant embryologic and radiologic considerations is also provided.

The mismatch repair (MMR) system plays a crucial role in correcting replication errors; when the MMR system is deficient (dMMR), replication errors (particularly within microsatellites) accumulate throughout the genome, leading to microsatellite instability (MSI). The key MMR genes include MLH1, MSH2, MSH6, and PMS2. Germline mutations in these genes are associated with Lynch syndrome, whereas in sporadic solid tumors, dMMR is often caused by hypermethylation of the MLH1 promoter. As the clinical use of dMMR/MSI expands, the importance of reliable testing for dMMR or MSI in companion diagnostics continues to increase. dMMR/MSI is diagnosed using immunohistochemistry (IHC) for MMR proteins, polymerase chain reaction with fragmentation analysis, or next-generation sequencing. Although IHC has technical limitations, it requires less tissue, has a short processing time, and is cost-effective. Experienced or specialized pathologists and educational efforts are helpful for reliable diagnosis, in addition to the technical aspects. Solid tumors with dMMR/MSI exhibit distinct clinicopathological features, including prognostic significance and a predictive role in adjuvant cytotoxic chemotherapy. Solid tumors with dMMR/MSI are also characterized by a higher tumor mutational burden and abundant immune cell infiltration, making them promising candidates for immune checkpoint inhibitor therapy. However, the oncogenic processes and immune microenvironment are not identical across the organs of origin, between patients, and even within the same patient, which should be considered in future studies. This review provides an overview of the practical aspects of dMMR/MSI testing, along with the molecular mechanisms and immune microenvironments associated with dMMR/MSI solid tumors.

Background/Aims: Early detection and removal of colon polyps are critical for preventing colorectal cancer. Computer-aided detection (CADe) systems have been introduced to increase the polyp detection rate (PDR) during colonoscopy, potentially enhancing its effectiveness. This study aimed to evaluate the efficacy of a CADe system in colorectal neoplasm detection. Methods: This prospective, randomized controlled trial was conducted at two tertiary centers (May 2023 to April 2025). Patients were randomly assigned to CADe or conventional colonoscopy and underwent screening, surveillance, or diagnostic colonoscopy. The primary endpoint was the adenoma detection rate (ADR), while the secondary endpoints were the PDR, relative risk (RR) of polyp detection, adenomas per colonoscopy (APC), and factors influencing adenoma detection. Results: Of 1,004 enrolled patients, 998 were randomly allocated into CADe and conventional colonoscopy groups (497 CADe system and 501 conventional colonoscopy). The CADe group had greater polyp counts (2.2 per colonoscopy vs 1.4 per colonoscopy; p<0.001) and APC values (1.2 vs 0.8; p<0.001). The CADe group showed significantly higher PDRs (72.2% vs 54.5%;p<0.001; RR, 2.173; 95% confidence interval [CI], 1.669 to 2.828) and ADRs (52.3% vs 36.1%;p<0.001; RR, 1.940; 95% CI, 1.505 to 2.499). CADe also significantly increased the detection rate of hyperplastic polyps (p=0.007; RR, 1.474; 95% CI, 1.113 to 1.952) and increased the detection rates across all sizes and locations. In multivariable analysis, CADe use was the strongest independent predictor of adenoma detection (odds ratio, 1.914; 95% CI, 1.467 to 2.496), outweighing male sex, older age, diagnostic indication, and withdrawal time. Conclusions Real-time CADe-assisted colonoscopy significantly increased PDR and ADR and proved to be a strong independent predictor of adenoma detection (cris.nih.go.kr, KCT0009664).

In this case, a patient with skeletal Class III malocclusion, loss of occlusal vertical dimension(OVD) as a result of bilateral mandibular posterior edentulism and generalized attrition of the remaining teeth, and severe anterior crossbite was treated with full-mouth prosthodontic rehabilitation to restore masticatory function and esthetics. To determine the appropriate OVD, comprehensive analyses of the temporomandibular joint (TMJ), physiologic rest position, phonetics, facial measurements, and lateral cephalometric radiographs were performed, and condyle stability in centric relation was evaluated using a CAD-CAM provisional denture. Bilateral posterior occlusion was re-established with implant-supported prostheses to recover vertical support, and the remaining teeth with severe attrition and structural damage were conservatively treated, recontoured at the cervical line, and restored with zirconia full-coverage crowns to regain function and esthetics. As a result, the severe anterior crossbite with full mandibular overlap of the maxillary anterior teeth was corrected to an edge-to-edge relationship, and mutually protected occlusion was achieved in eccentric movements. This case report demonstrates that establishing the correct centric relation and recovering an appropriate OVD are critical in alleviating abnormal anterosuperior mandibular rotation and severe anterior crossbite in patients with skeletal Class III malocclusion, along with improvements in masticatory function, phonetics, and esthetics, thereby contributing significantly to the enhancement of quality of life.

Purpose: Due to chronic toxicity, tacrolimus-sparing is an important issue in kidney transplant recipients (KTRs). Several studies have shown that bisphosphonate use is associated with favorable graft outcomes in KTRs. We investigated whether the association between tacrolimus trough levels (TTLs) and graft outcomes differed according to bisphosphonate use in KTRs. Materials and Methods: We conducted a retrospective study encompassing 1441 KTRs who were administered tacrolimus-based immunosuppressants. The primary exposure was a time-dependent cross-product of TTLs (low TTLs vs. normal-high TTLs with a reference of 6 ng/mL) and bisphosphonate use. Two primary outcomes were evaluated: overall graft loss (death or conversion to kidney replacement) and an estimated glomerular filtration rate (eGFR) <30 mL/min/1.73 m 2 . Results: During the median follow-up of 6.1 (3.4–9.7) years, overall graft loss occurred in 157 (10.9%) patients. Cox regression revealed that normal-high TTLs without bisphosphonate use were associated with a reduced risk of overall graft loss [adjusted hazard ratio (aHR), 0.65; 95% confidence interval (CI), 0.45–0.95] compared to low TTLs without bisphosphonate use. The use of bisphosphonate in conjunction with normal-high TTLs correlated with an even lower risk of overall graft loss (aHR, 0.25; 95% CI, 0.08–0.80) compared with low TTLs without bisphosphonate use. In patients with low TTLs, bisphosphonate use was associated with a reduced risk of overall graft loss compared with non-use (aHR, 0.20; 95% CI, 0.09–0.43). Similar trends were observed in the eGFR outcome. Conclusion The use of bisphosphonate was associated with favorable graft outcomes, even with low TTLs. Incorporating bisphosphonate into a conventional immunosuppressant regimen may potentially reduce tacrolimus requirement.

The sixth edition of the Korean Medication Algorithm Project for Depressive Disorder (KMAP-DD) was published in 2025. This review compared KMAP-DD 2025 with four major international clinical practice guidelines: Canadian Network for Mood and Anxiety Treatments Clinical Guidelines for the Management of Major Depressive Disorders, National Institute for Health and Care Excellence Depression Guideline, Royal Australian and New Zealand College of Psychiatrists Clinical Practice Guidelines for Mood Disorders, and British Association for Psychopharmacology Guideline. While KMAP-DD is based on expert consensus, and others on evidence-based methods, overall treatment strategies for depressive episodes were fairly consistent. Especially, KMAP-DD 2025 offers more structured recommendations in areas lacking strong evidence, such as premenstrual dysphoric disorder, perinatal depression, and depression with medical comorbidities. KMAP-DD 2025 also reflected Korean clinical practice patterns emphasizing rapid symptom relief and early use of combination strategies. Despite limitations as a consensus-based guideline, KMAP-DD 2025 complements evidence-based approaches and provides practical, situation-specific guidance for real-world clinical decision-making in Korea.

Purpose: This study aimed to identify reproducible locations for evaluating masseter muscle function by measuring its thickness using ultrasonography (US). The study focused on comparing two measurement locations: the thickest part of the masseter muscle during ultrasonographic scanning (TMUS) and the most prominent part during clenching (PMC). Methods: Forty healthy adults (20 males and 20 females) participated in the study. US images were obtained from both sides of the masseter muscle under resting and clenching conditions. Measurements were taken at the TMUS and PMC locations, and the clenching-to-resting (C/R) ratio was calculated. Intra- and inter-rater reliability were assessed using intraclass correlation coefficients (ICCs), and the agreement between the two locations was further analyzed using Bland–Altman (BA) plots. Results: The measurements at both TMUS and PMC showed high intra- and inter-rater agreement, with no significant difference in measurements between the two locations.However, the PMC location demonstrated slightly higher ICC values (0.94) compared to TMUS (0.91). The C/R ratio for PMC showed higher consistency (0.89) compared to TMUS (0.65). BA plots indicated that the agreement between TMUS and PMC was slightly better during clenching than at rest, with smaller mean differences in clenching (–0.06 mm) than resting (–0.13 mm). Additionally, the number of measurements outside the upper and lower limits was lower during clenching (10) than at rest (13). Conclusions Both TMUS and PMC locations demonstrated reliable measurements, but the PMC location showed slightly better consistency across different muscle states. The findings suggest that PMC provides a more reproducible and standardized approach for masseter muscle assessment, making it a better choice for both clinical practice and research in evaluating masticatory function.

Purpose: Considering the high disease burden and unique features of Asian patients with breast cancer (BC), it is essential to have a comprehensive view of genetic characteristics in this population. An institutional targeted sequencing platform was developed through the Korea Research-Driven Hospitals project and was incorporated into clinical practice. This study explores the use of targeted next-generation sequencing (NGS) and its outcomes in patients with advanced/metastatic BC in the real world. Materials and Methods: We reviewed the results of NGS tests administered to BC patients using a customized sequencing platform—FiRST Cancer Panel (FCP)—over 7 years. We systematically described clinical translation of FCP for precise diagnostics, personalized therapeutic strategies, and unraveling disease pathogenesis. Results: NGS tests were conducted on 548 samples from 522 patients with BC. Ninety-seven point six percentage of tested samples harbored at least one pathogenic alteration. The common alterations included mutations in TP53 (56.2%), PIK3CA (31.2%), GATA3 (13.8%), BRCA2 (10.2%), and amplifications of CCND1 (10.8%), FGF19 (10.0%), and ERBB2 (9.5%). NGS analysis of ERBB2 amplification correlated well with human epidermal growth factor receptor 2 immunohistochemistry and in situ hybridization. RNA panel analyses found potentially actionable and prognostic fusion genes. FCP effectively screened for potentially germline pathogenic/likely pathogenic mutation. Ten point three percent of BC patients received matched therapy guided by NGS, resulting in a significant overall survival advantage (p=0.022), especially for metastatic BCs. Conclusion Clinical NGS provided multifaceted benefits, deepening our understanding of the disease, improving diagnostic precision, and paving the way for targeted therapies. The concrete advantages of FCP highlight the importance of multi-gene testing for BC, especially for metastatic conditions.

This case report presents an 81-year-old edentulous female patient with congenital cleft lip and palate, rehabilitated with a maxillary obturator and a mandibular complete denture. A defect in the hard palate causes nasal leakage and hypernasalization of speech. Velopharyngeal insufficiency due to a defect in the soft palate causes reflux during swallowing and decreased clarity of pronunciation.The anatomical structures, such as Passavant’s ridge, were considered to prevent respiratory problems when impression taking. We achieved satisfactory results including velopharyngeal closure for pronunciation, mastication, and swallowing, as well as improved aesthetics. Therefore, we report the process and considerations of the treatment.