Primary lymphoma of the urinary bladder is a rare non-epithelial bladder tumor accounting for less than 1% of all bladder tumors. Approximately 17 cases of MALT lymphomas of bladder have been reported in the literature. Most reported MALT lymphomas of bladder have a female sexual preponderance with a mean age of 58 years with common presenting symptoms of hematuria, dysuria and urinary frequency. The reported prognosis of MALT lymphoma of the urinary bladder is excellent. We report a case of MALT lymphoma of urinary bladder in a 57-year-old woman patient who presented with a two-year history of persistent dysuria and urinary frequency. An intravenous pyelogram and cystoscopy revealed a 1 cm focal elevated lesion at the base of urinary bladder. The tissue obtained by transurethral resection (TUR) showed plasma cell infiltration consistent with low grade marginal zone B cell lymphoma. The immunohistochemical studies showed an immunoglobulin restriction to lambda light chain while the nested polymerase chain reaction analysis of the tissue showed a monoclonal Ig heavy-chain gene rearrangement. The clinical staging protocol revealed that the tumor was primarily arising from the urinary bladder with no evidence of other site involvements. The patient received radiation therapy of 3060 cGy in 17 fractions.
Cystoscopy ; Dysuria ; Female ; Gene Rearrangement ; Hematuria ; Humans ; Immunoglobulins ; Lymphoma ; Lymphoma, B-Cell, Marginal Zone* ; Middle Aged ; Plasma Cells ; Polymerase Chain Reaction ; Prognosis ; Urinary Bladder Neoplasms ; Urinary Bladder*

Hematopoietic neoplasm coexpressing CD4 and CD56 includes a subset of acute myeloid leukemia with myelomonocytic differentiation, plasmacytoid monocyte tumor, and other immature hematopoietic neoplasms of undefined origin. Herein, we report a CD4+CD56+CD68+ hematopoietic tumor that was thought to be a tumor of plasmacytoid monocytes. This case is unique in the absence of accompanying myelomonocytic leukemia and the faint expression of cCD3 on the tumor cells. The patient was a 22-yr old man presented with multiple lymphadenopathy and an involvement of the bone marrow. Tumor cells were large and monomorphic with an angulated eosinophilic cytoplasm of moderate amount. Nuclei of most tumor cells were eccentric and round with one or two prominent nucleoli. Rough endoplasmic reticulum was prominent in electron microscopic examination. Tumor cells expressed CD4, CD7, CD10, CD45RB, CD56, CD68, and HLA-DR and were negative for CD1a, CD2, sCD3, CD5, CD13, CD14, CD20, CD33, CD34, CD43, CD45RA, TIA-1, S-100, and TdT. cCD3 was not detected in the immunostaining using paraffin tissue, but was faintly expressed in flow cytometry and immunostaining using a touch imprint slide. T-cell receptor gene rearrangement analysis and EBV in situ hybridization showed negative results. Cytochemically, myeloperoxidase, Sudan black B, and alpha naphthyl butyrate esterase were all negative.
Adult ; Antigens, CD/*biosynthesis ; Antigens, CD3/*biosynthesis ; Antigens, CD4/*biosynthesis ; Antigens, CD45/biosynthesis ; Antigens, CD56/*biosynthesis ; Antigens, Differentiation, Myelomonocytic/*biosynthesis ; Bone Marrow Cells/pathology ; Cell Nucleus/pathology ; Eosinophils/metabolism ; Flow Cytometry ; Gene Rearrangement ; Humans ; Immunohistochemistry ; In Situ Hybridization ; Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis/*metabolism ; Lymph Nodes/pathology ; Male ; Microscopy, Electron ; Monocytes/*metabolism ; Receptors, Antigen, T-Cell/metabolism

BACKGROUND: Mucosa-associated lymphoid tissue (MALT) lymphoma of the stomach has recently been defined as a distinct clinicopathologic entity, often associated with Helicobacter pylori (H. pylori) infection. Characteristics and treatment outcomes of 57 patients with gastric MALT lymphoma were analyzed. METHODS: Retrospective analysis of 57 cases of gastric MALT lymphoma who underwent treatment with various modalities at Samsung Medical Center from Mar. 1995 to Jul. 2000 was performed. RESULTS: The median age of the patients was 47 years (ranged from 22 to 75 years) and the ratio of males to females was 1.1:1. The presenting symptoms were abdominal pain, indigestion and GI bleeding. By Modified Ann Arbor system, stage IE accounted for 70.2%, stage II1E 14.0%, stage II2E 14.0%, and stage IV 1.8%, respectively. H. pylori had been evaluated histologically in 49 cases of which 81.6% was positive. Low grade histology accounted for 71.9% and high grade histology 28.1%. Treatment modalities included H. pylori eradication, surgery, chemotherapy, radiotherapy and their combination therapy. In one case, the patient was observed without treatment. Complete remission rate was 98.2%. H. pylori eradication alone resulted in lymphoma regression successfully in 20 out of 23 patients. With median follow-up of 33 months (3-61 months), median survival was not reached. Overall 3 year survival rate was 94.7%. CONCLUSION: Regardless of treatment modality, high survival rate (3 year survival rate 94.7%) was obtained. H. pylori eradication was feasible and safe in the cases of low grade, stage I, and H. pylori-positive lymphoma, and allowed stomach preservation. Longer follow-up evaluation is required to determine the long-term efficacy and side effects of H. pylori eradication.
Abdominal Pain ; Drug Therapy ; Dyspepsia ; Female ; Follow-Up Studies ; Helicobacter pylori ; Hemorrhage ; Humans ; Lymphoid Tissue ; Lymphoma ; Lymphoma, B-Cell, Marginal Zone* ; Male ; Radiotherapy ; Retrospective Studies ; Stomach ; Survival Rate

PURPOSE: Granulomatous mastitis is a benign inflammatory disease of the breast and its etiology is not clearly defined. In 1972, Kessler and Wolloch described the microscopic features of granulomatous mastitis, but frequently it mimics a carcinoma in a clinical setting. This study was performed to determine the modalities that are important for the diagnosis and the treatment of granulomatous mastitis. METHODS: We studied 12 patients who were diagnosed as having granulomatous mastitis based on pathology. Age, parity, time from last delivery, number of operations, past history of breast feeding and oral contra ceptives, radiologic findings, and cytologic results were retrospectively evaluated. In two recent cases, a polymerase chain reaction (PCR) for mycobacterium tuberculosis was performed to exclude tuberculous mastitis. RESULTS: Among the 12 patients, 8 were in the thirties, 2 in the twenties, 1 in the forties and 1 in the fifties. Of the 12 patients, 9 patients had breast fed and 2 patients had used oral contraceptive pills previously. No patients were suffered from pulmonary tuberculosis. The mean number of deliveries was two. The time from last delivery were varied from 3 weeks to 24 years but most were within 6 years. The location of the lesions were the upper outer quadrant in 6, upper inner quadrant in 3, inner area in 1, lower outer quadrant in 1 and lower inner quadrant in 1 patient. The mean size of the lesions was 3.52 cm. Preoperative mammography was not helpful in finding granulomatous mastitis. Ultra sonographically multiple clustered, contiguous tubular hypochoic lesions suggested the possibility of the disease. Furthermore, fine needle aspiration cytology showed epithelial histiocytes or giant cells and could be used to diagnose granulomatous mastitis. Cultures of microorganisms were sterile, and AFB stainings were all negative. Tuberculous mastitis was excluded by PCR in 2 cases. Surgical resection of the affected tissue was performed in 8 patients and steroid therapy was performed in the remaining 4 who had been surgically treated in other clinics before. All excision cases, except one, were cured. Among the patientsfor whom steroid therapy was used, 1 patient was cured, 1 had a recurrence and the remaining 2 are now under treatment. CONCLUSION: Although rare, granulomatous mastitis could be diagnosed with the aid of ultrasonography and cytology. Surgical excision of the affected tissue and long-term steroid therapy could be used to treat the disease.
Biopsy, Fine-Needle ; Breast ; Breast Feeding ; Diagnosis* ; Female ; Giant Cells ; Granulomatous Mastitis* ; Histiocytes ; Humans ; Mammography ; Mastitis ; Mycobacterium tuberculosis ; Parity ; Pathology ; Polymerase Chain Reaction ; Recurrence ; Retrospective Studies ; Tuberculosis, Pulmonary ; Ultrasonography

BACKGROUND: Sentinel node biopsy has emerged recently as an alternative to routine axillary node dissection in predicting axillary nodal metastasis, and various studies have shown its effectiveness in patients with breast cancer. However, there have been some controversies in clinical application because of its high false negative rate. METHODS: One hundred forty patients with breast cancer underwent operative management in consideration of the results of sentinel node biopsies at the department of surgery, Samsung Medical Center, between Sep. 1995 and Jul. 1998. Sixty-three patients with tumor sizes of T1 or less were retrospectively evaluated. Intraoperative lymphatic mappings using vital blue dye and using a combination of vital dye and a 99mTc-antimony sulphide colloid were performed for 53 patients and 10 patients, respectively. RESULTS: Patient's ages were in the third decade for 2 patients (3.2%), in the fourth decade for 18 (28.6%), in the fifth decade for 18 (28.6%), in the sixth decade for 13 (20.6%) and in the seventh decade for 12 (19.0%). An infiltrating ductal carcinoma was observed in 51 patients (81.0%), an intraductal carcinoma in 8 (12.6%), a medullary carcinoma in 2 (3.2%), an infiltrating lobular carcinoma in 1 (1.6%) and a mucinous carcinoma in 1 (1.6%). Sentinel node was detected in 42 of the 53 patients (79.2%) evaluated with vital blue dye only and in 10 of the 10 patients (100%) evaluated with a combination of vital dye and a 99mTc-antimony sulphide colloid. Among the group of T1 or less, the sensitivity rates of vital dye and the combination were 81.8% and 100% and their accuracies of them were 95.2% and 100%, respectively. The false negative rates for all cases were 12.2% and 8.3%, respectively, but they were decreased to 6.1% and even 0% for the group of T1 or less. CONCLUSIONS: The detection rate and the accuracy of sentinel node biopsy were enhanced in patients with T1 or less breast cancer. If a combination of vital dye and a radioisotope is used, sentinel node biopsy may be applied clinically in limited patients such as those with T1 or less breast cancer.
Adenocarcinoma, Mucinous ; Biopsy* ; Breast Neoplasms ; Breast* ; Carcinoma, Ductal ; Carcinoma, Intraductal, Noninfiltrating ; Carcinoma, Lobular ; Carcinoma, Medullary ; Colloids ; Humans ; Neoplasm Metastasis ; Retrospective Studies

To evaluate the significance of placental histology, a collaborative histological and cytogenetic study was performed on the products of 88 spontaneous abortions, and subsequently bcl-2 immunostaining was performed on 62 cases. The morphometric parameters included were DCIRCLE, FORMSHAPE, CPRATIO, and the expression of bcl-2 immunostainig was graded in four categories (I to IV). The results were as follows: 1) 40% (n=35) were chromosomally abnormal: trisomies predominated (57%, n=20) and was followed by triploidy (14%, n=5), double trisomy (6%, n=2), monosomy X (6%, n=2), inversion (9) (6%, n=2). 2) mean of DCIRCLE in chromosomally abnormal pregnancy was 40 micrometer larger than that in chromosomally normal pregnancy (p=0.012, one side t-test), while no difference was found in FORMSHAPE and CPRATIO between chromosomally abnormal and normal pregnancy. 3) bcl-2 expression was found in syncytiotrophoblast and cytotrophoblast. bcl-2 expression was weaker in chromosomally abnormal pregnancy with intensity I and II of 59% than chromosomally normal pregnancy with intensity I and II of 24%. 4) In comparison bcl-2 expression with DCIRCLE, in chromosomally normal abortion one (10%) in I & II and one (3%) in III & IV showed large DCIRCLE (above 360 micrometer), while 11 (85%) in I & II and 3 (33%) in III & IV in chromosomally abnormal pregnancy. It would mean that bcl-2 protein is necessary in preservation of pregnancy and placental morphology. Abnormal villous diameter and weak bcl-2 expression may be suggestive of chromosomal anomaly. Besides other histologic parameters, application of bcl-2 immunostaining and morphometric analysis probably give more sensitive and specific results in identifying chromosomally abnormal abortion.
Abortion, Spontaneous ; Cytogenetics ; Female ; Humans ; Placenta* ; Pregnancy* ; Triploidy ; Trisomy ; Trophoblasts ; Turner Syndrome

BACKGROUND: Sentinel node biopsy has emerged recently as an alternative to routine axillary node dissection in predicting the axillary nodal metastasis and various studies habe shown its effectiveness in patients with breast cancer. However there have been some controversies in clinical application because of high false negative rate. MATERIALS AND METHODS: One hundred and forty patients with breast cancer underwent operative management in consideration of the results of patients with breast cancer underwent operative management in consideration of the results of sentinel node biopsy at department of surgery in Samsung Medical Cancer between Sep. 1995 and July 1998. Sixty-three patients with tumor size of T1 or less were retrospectively evaluated. Intra-operative lymphatic mapping using vital blue dye was performed in 53 patients and using combination of vital dye and 99mTc-antimony sulphide colloid in 10 patients. RESULTS: patients ages were in the third decade in 1 patients (3.2%), in the forth decade in 18 (28.6%), in the fifth decade 18 (28.6%), in the sixth decade in 13 (20.6%) and in the seventh decade in 12 (19.0%). The patients had infiltrating ductal carcinoma in 51 patients(81.0%), intraductal carcinoma in 8 (12.6%), medullary carcinoma in 2 (3.2%), infiltrating lobular carcinoma in 1 (1.6%) and mucinous carcinoma in 1 (1.6%). Sentinel node was detected in 42 of 53 patients (79.2%) evaluated with vital blue dye only and 10 of 10 (100%) evaluated with combination of vital dye and 99mTc-antimony sulphide colloid. Among the group of T1 of less, each sensitivity rates of vital dye and combination were 81.8% and 100% and accuracy of them were 95.2% and 100% respectively. Each false negative were 12.2% and 8.3% in total cases but they were decreased to 6.1% and even 0% in the group of T1 or less. CONCLUSION: The detection rate and accuracy of sentinel node biopsy were enhanced in patients with T1 or less breast cancer. If the combination of vital dye and radioisotope is used, sentinel node biopsy may be applied clinically in limited patients such as T1 or less breast cancer.
Adenocarcinoma, Mucinous ; Biopsy* ; Breast Neoplasms ; Breast* ; Carcinoma, Ductal ; Carcinoma, Intraductal, Noninfiltrating ; Carcinoma, Lobular ; Carcinoma, Medullary ; Colloids ; Humans ; Neoplasm Metastasis ; Retrospective Studies

BACKGROUND: The prevalence of ret/PTC rearrangement in papillary thyroid carcinomas has been found to have wide variance in different populations. Recent studies, however, have been reporting no significant geographical difference between Asian and Western countries. In addition, there are some arguments about the correlation of ret/PTC expression with clinical aggressiveness. We have performed this study in order to examine the prevalence of ret/PTC-1, -2 and -3 rearrangements in korean papillary throid carcinomas and to ascertain its clinical relevance. METHODS: Fourteen thyroid tumors histologically confirmed to be papillary carcinomas were included in this study. To find rearrangements, we adopted RT-PCR and automated direct sequencing. Initial and follow-up clinical data were obtained form the patients medical records. The plasmid containing ret/PTC-2, and 3 was kindly provided by Dr. Ahn (Ulsan University, Seoul Choonang Hospital). RESULTS: We identified one tumors containing ret/PTC-1(1/14, 7.1%), and two containing ret/PTC-2 (2/14, 14.2%), and could not find ret/PTC-3 rearrangement in other patients (0/11). There was no significant correlation of ret/PTC with clinical aggressiveness. CONCLUSION: We found that the prevalence of ret/PTC rearrangement (3/14, 21.4%) in papillary thyroid carcinomas from Korea was similar to those recently reported in other nations. ret/PTC rearrangement may not affect biological behaviors of papillary thyroid carcinomas.
Asian Continental Ancestry Group ; Carcinoma, Papillary ; Follow-Up Studies ; Humans ; Korea* ; Medical Records ; Plasmids ; Prevalence ; Seoul ; Thyroid Gland* ; Thyroid Neoplasms*

BACKGROUND: A secretory carcinoma is one of the least common carcinomas of the breast. Most studies of this carcinoma have been single case reports or separate analyses of the problem in either children or adults. METHODS: We studied 4 female patients treated in Samsung Medical Center from Nov.1994 to Dec. 1998. All of them were diagnosed as having a secretory carcinoma by using pathologic examination. RESULTS: All patients were female and they were 21, 29, 49, and 69 years of age. The initial symptom in two cases was a palpable mass. One patient presented with nipple discharge, but a palpable mass was found during the physical examination. The other carcinoma was detected on screening mammography. Mammography and ultrasonography suggested malignancy in three cases. One case was preoperatively misinterpreted as an intraductal papilloma. Preoperative ultrasonography-guided core biopsy performed in one case was diagnosed as a secretory carcinoma. All the patients were in a relatively early stage, stages IIb, I, I, and I. Estrogen receptors were negative in three and positive in one, but progesteron receptors were negative in all four cases. Postoperative courses were good, and there have been no recurrence or side effects yet. CONCLUSIONS: A secretory carcinoma is a rare condition of the breast, but the prognosis seems to be favorable with a mortality rate lower than that of the usual breast cancer. Exact diagnosis with preoperative aspiration cytology and biopsy will make it possible to perform more conservative surgery.
Adult ; Biopsy ; Breast Neoplasms ; Breast* ; Child ; Diagnosis ; Female ; Humans ; Mammography ; Mass Screening ; Mortality ; Nipples ; Papilloma, Intraductal ; Physical Examination ; Prognosis ; Receptors, Estrogen ; Recurrence ; Ultrasonography

The incidence of a primary central nervous system (CNS) lymphoma in western countries is about 1% of all the intracranial tumors and has increased 2.2% over the last decade. A similar pattern of increased frequency is observed in Korea. Although most CNS lymphomas in western countries are high grade tumors carrying poor prognosis, the clinicopathologic features of the Korean CNS lymphoma have not been well studied. We report clinicopathological features of 18 cases of histologically proven primary brain lymphoma. The mean age of the patients was 50 years and there was no sex difference. The clinical and radiological characteristics included multiple site of occurrence, infrequent extracranial spread, and frequent seeding via cerebrospinal fluid. No patients were immune-compromised host. Of 18 cases, 15 cases were of B-lineage and 2 cases were of T-lineage. According to REAL classification, there were 12 cases of diffuse large B cell lymphoma, two cases of B cell lymphomas of small lymphoid cell, and two cases of peripheral T cell lymphoma, unspecified. The remaining subtypes were not subclassified because of inadequate material. Pleomorphic cytologic features and necrosis of varying extent were frequent in the cases of diffuse large B-cell lymphoma. These results suggest that overall clinicopathologic features of primary malignant lymphomas of the central nervous system in Korea are similar to those of western countries.
Brain ; Central Nervous System* ; Cerebrospinal Fluid ; Classification ; Humans ; Incidence ; Korea ; Lymphocytes ; Lymphoma* ; Lymphoma, B-Cell ; Lymphoma, T-Cell, Peripheral ; Necrosis ; Prognosis ; Sex Characteristics