Primary adenocarcinoma of the renal pelvis in a young male: a case report

The patient was a 16-year-old male who visited our hospital with the chief complaint of microhematuria. Computed tomography revealed left hydronephrosis, renal stones and left renal tumor. Needle biopsy was performed under ultrasonography. The histological diagnosis was adenocarcinoma and left radical nephrectomy was performed. The histological diagnosis was mucinous adenocarcinoma of the renal pelvis. Postoperative chemotherapy was not given. The patient has had neither recurrence nor metastasis for 1 year following surgery. This is the 92nd reported case in the literature.     

Epithelial-myoepithelial carcinoma of parotid gland: a case report with immunohistochemical and ultrastructural studies

A 66-year-old man presented with a painless mass of the parotid gland. Light and electron microscopic studies verified the basic nature of the tumor as epithelial-myoepithelial carcinoma, a low-grade malignant neoplasm of the salivary gland. Pathologically, there were two types of cells; the inner eosinophilic epithelial cells lining the ducts and the outer clear cells. The former cells displayed immunoreactivity for cytokeratin and ultrastructural features of apical microvilli and desmosome. The latter cells were positive for actin, S-100 protein, vimentin and the cytoplasm contained actin microfilaments. Such pathological findings were characteristic features of this rare tumor. To our knowledge, this is the first reported case of EMC in Thailand.     

Detection of Epstein-Barr virus in the L & H cells of nodular lymphocyte predominance Hodgkin''s disease: report of a case documented by immunohistochemical, in situ hybridization, and polymerase chain reaction methods

The pharmacological response with tilt-table testing predicts long-term efficacy in neurocardiogenic syncope. However, beta-blockers for neurocardiogenic syncope are often not tolerated or are ineffective. Since cholinergic tone is important in the efferent part of the neurocardiogenic reflex, we investigated the pharmacodynamics and efficacy of propantheline bromide in preventing neurocardiogenic syncope. We studied 16 patients (11 males) with a mean age of 48.8 (+/- 15.1) years with presyncope or syncope and who had positive baseline tilt-table studies at a mean of 15.8 (+/- 10.3) minutes into the upright 60 degrees tilt. They were given propantheline bromide orally, an anticholinergic agent, at a dose of 64.3 (+/- 21.8) mg/day for 7 days, and tilt-table testing was repeated 1 hour after readministration of propantheline bromide, 30 mg orally. After propantheline bromide treatment, 13 of 16 patients (81%) had no inducible presyncope or syncope on repeat tilt-table testing. In this group of responders, the mean minimum heart rate during upright tilt-table testing increased from 43.2 (+/- 77.3) beats/min to 77.3 (+/- 17.2) beats/min after propantheline bromide (p < 0.005). More significantly, the minimum mean arterial blood pressure increased from 42.2 (+/- 25) mmHg to 81.3 (+/- 16.7) mmHg (p < 0.0005) during upright tilt. At a follow-up of 15.2 (+/- 7.4) months, in the responder group (12 patients with long-term follow-up), the average dose of propantheline bromide was 32.5 (+/- 23.8) mg/day, which was significantly reduced from the initial dose (p < 0.05). A clinical recurrence of symptoms occurred in only 4 out of 12 patients on propantheline bromide (33%), none of which were directly attributable to drug failure. It was concluded from this study that propantheline bromide is highly effective in preventing neurocardiogenic syncope. In addition, propantheline bromide's effectiveness is more than would be expected by prevention of cardioinhibition in neurocardiogenic syncope and would support a role for direct cholinergic control of vascular tone.     

Blastomycotic osteomyelitis of the pelvis: a case report

Blastomycosis dermatitis is an unusual fungal infection that can become a diagnostic dilemma if a high index of suspicion is not maintained in patients who present with a chronic granulomatous infection of bone and soft tissue. We present a patient with a long history of pain, systemic manifestations of chronic infection, a draining sinus, and lytic changes on plain films to illustrate the difficulty in establishing the diagnosis. Appropriate staging studies and a bone biopsy led to the correct diagnosis in the patient.     

Evidence of Epstein-Barr virus in lymphoepithelioma-like carcinoma of the uterine cervix: a case report

The prevalence of Loa loa infections in non-endemic areas such as Korea is very low, even though it is quite common in the endemic regions of West and Central Africa. We describe a patient who presented with temporary localized edema (classical Calabar swellings) after travelling to Cameroon and in whom the diagnosis of loiasis was made by ELISA. This is the second reported case of loiasis in Korea. As international travel is becoming more frequent, Loa loa infection should be considered in the differential diagnosis for patients with eosinophilia and Calabar swellings in Korea.     

Lethal asphyxiating juvenile laryngeal papillomatosis. A case report with human papillomavirus in situ hybridization analysis

Chronic, progressive, and recurrent laryngeal papillomatosis is an uncommon problem that primarily occurs in children and has been shown (in the pediatric age group) to be caused by human papillomavirus (HPV) types 6 and/or 11. Juvenile laryngeal papillomatosis is hallmarked by recurrences, necessitating repeated surgical procedures to maintain airway patency, and is rarely encountered cause of sudden and unexpected death. This case describes a 22-month-old girl who had been treated for laryngeal and pharyngeal papillomata that were diagnosed 3 months prior to her death, and who died in her sleep the night before she was to be again laryngoscoped and reevaluated. The autopsy disclosed exuberant, complex exophytic papillomata that essentially obliterated the laryngeal lumen. In situ hybridization analysis was performed on paraffin-embedded tissue, which revealed HPV type 6/11 positivity. This is the first time that in situ hybridization studies have been performed on autopsy tissues from someone who died suddenly and unexpectedly from upper-airway obstructive papillomatosis. The pathology and clinical characteristics of juvenile laryngeal papillomatosis are also presented and discussed.     

Cyclin A overexpression in carcinoma of the renal pelvis and ureter including dysplasia: immunohistochemical findings in relation to prognosis

Several in vitro studies have shown that cyclin A gene alteration in the cell cycle plays an important role in carcinogenesis. We immunohistochemically examined the expression of cyclin A protein in 120 patients with transitional cell carcinoma (TCC) of the renal pelvis and ureter, including adjacent dysplastic lesions to determine their significance for the tumor behavior and patient prognosis. Cyclin A immunostaining of the nucleus was observed in 29 tumors (24.2%). Furthermore, 17 cyclin A-positive tumors (58.6%) had dysplastic lesions positive for cyclin A antibody. The prevalence of cases exhibiting cyclin A staining was higher in the high grade (P < 0.01) and invasive tumors (P < 0.05) than in the other types of tumors. In the selected 117 cases, patients whose TCCs expressed a high level of cyclin A protein had a significantly poorer prognosis than those without cyclin A expression (P < 0.01). These in vivo findings provide the first evidence for frequent and redundant cyclin A protein overexpression in TCC and suggest that cyclin A overexpression is related to the tumor behavior and patient prognosis. In addition, our observations indicate that overexpression of cyclin A may be one of the early events, at least in some cases, in the carcinogenesis of TCC.     

Angiosarcoma of the tongue: report of a case with immunohistochemical findings

Angiosarcomas are rare, accounting for only 1-2% of all soft tissue sarcomas. Primary abdominal angiosarcomas usually arise in the liver or spleen. We report the first color Doppler findings of a rare, low-grade splenic angiosarcoma in a 52-year-old woman.     

Perineurioma with ossification: a case report with immunohistochemical and ultrastructural studies

We evaluated the elbow flexion test in 216 elbows without compression of the ulnar nerve at the cubital tunnel and without other neuropathies. We used Rayan's four positions as our test. The percentage of positive tests was only 3.6% at one minute, whereas evaluating the responses at three minutes we saw positive results in 16.2%. Therefore we find that if the test is performed for one minute it may be useful to help in diagnosing ulnar nerve compression at the cubital tunnel.     

Primary renal angiosarcoma: a case report with immunohistochemical, ultrastructural, and cytogenetic features and review of the literature

Primary angiosarcoma of the kidney is a rare tumor for which fewer than 10 case reports appear in the English literature. A case of primary renal angiosarcoma is reported, in which the tumor showed poorly differentiated spindled sarcoma admixed with typical angiomatous differentiation. Antibodies against CD31, CD34, Ulex europeus lectin type I, factor VIII-related antigen, cytokeratin (AE1/AE3), vimentin, S100 protein, epithelial membrane antigen, carcinoembryonic antigen, desmin, and smooth muscle actin were examined. CD31 showed strong diffuse membranous staining of cells in the well-differentiated areas and strong membranous staining in the spindled, poorly differentiated areas. CD34 showed strong cytoplasmic and membranous staining in both the poorly differentiated and well-differentiated areas. Staining for factor VIII-related antigen and Ulex europeus was less intense and was limited to the well-differentiated areas. Staining for cytokeratin (AE1-AE3), S100, carcinoembryonic antigen, epithelial membrane antigen, desmin, and smooth muscle actin were negative. Electron microscopy showed spindle cells containing abundant pinocytotic vesicles, vimentin-type intermediate filaments, and rare Weibel-Palade bodies. A complex karyotype was found. Our findings suggest that CD31 and CD34 are useful in defining endothelial differentiation in poorly differentiated angiosarcomas in which reactions for Ulex europeus lectin type I and factor VIII-related antigen may be equivocal.     

Demonstration of Epstein-Barr viral DNA in paraffin-embedded tissues of Burkitt's lymphoma from Argentina using the polymerase chain reaction and in situ hybridization

Burkitt's lymphoma (BL) is the most frequent non-Hodgkin's lymphoma in children in Argentina. Although epidemiologic studies have linked Epstein-Barr virus (EBV) to more than 90% of African BL cases but to only 10-20% of American and French cases, increased EBV-specific antibody titers were demonstrated in 73% of Argentinian patients with BL. To characterize the relationship between EBV and BL in Argentina, we analyzed paraffin-embedded tissues from 16 cases of BL for the presence of EBV DNA using the polymerase chain reaction (PCR) and in situ hybridization (ISH). PCR analysis showed that only 4 of 16 specimens contained the EBV BamW fragment, and these specimens were all from cases diagnosed in 1984. Results of ISH performed with a specific biotinylated DNA probe against the NotI/PstI fragment of EBV correlated with the PCR findings. EBV sequences were detected with ISH in 70-90% of the tumor cells from the 4 positive cases. These data may suggest an epidemic outbreak of EBV-related BL in 1984 superimposed on sporadic cases of BL, for which EBV may not have been an essential factor. This study also demonstrates the value of using molecular techniques on archival tissue to track epidemiologic trends.     

Detection of the Epstein-Barr virus genome in cervical neoplasia is closely related to the degree of infiltrating lymphoid cells: a polymerase chain reaction and in situ hybridization approach

To cast light on the significance of Epstein-Barr virus (EBV) infection in cervical tumorigenesis, 44 cervical intraepithelial neoplasia (CIN) types I/II, and 70 CIN III lesions, 60 invasive squamous cell carcinomas (ISCC), and 20 normal cervical samples were investigated by polymerase chain reaction (PCR) and RNA in situ hybridization (RISH) assays. The EBV genome was detected by PCR using primers targeting the IR region in three (6.8%) of the CIN I/II, 15 (21.4%) of the CIN III and 13 (21.7%) of the ISCC lesions, while using an EBER oligonucleotide probe RISH revealed positive signals in infiltrating lymphocytes located in the cervical stroma, but not in dysplastic or tumor cells. There was a significant correlation between the presence of EBV DNA and the degree of lymphoid cell infiltration (P = 0.0223). In contrast, none of the normal cervical samples that were without inflammation demonstrated any EBV infection. Thus, the results indicated that a positive result for EBV on PCR may be simply dependent on the amount of lymphocytes in cervical stroma, suggesting that this virus does not play a major role in the etiology of cervical neoplasia.     

Adenosquamous carcinoma of the tongue: report of a case with histochemical, immunohistochemical, and ultrastructural study and review of the literature

The histologic examination of dental implants retrieved from humans is important to establish the causal determinants of implant failure, and to compare and validate the results obtained from animal studies. This study presents a retrospective review of the histologic features of 230 implants retrieved in an 8-year period (1989-1996). All the implants were treated to obtain thin (20 to 30 microm) ground sections. The majority of implants were retrieved because of mobility (n=56), peri-implantitis (n=54), or fractures (n=90). Peri-implantitis occurred more frequently before (n=44) than after (n=10) abutment connection. A dense fibrous connective tissue with no inflammatory cells was present at the interface in the implants retrieved for mobility; bone was found only in the most apical part. In many of these implants epithelial cells were present. The main histologic features of peri-implantitis consisted of the presence of a bone sequestrum near the implant, many bacteria present on the implant surface, and an inflammatory infiltrate (macrophages, lymphocytes, and plasma-cells) nearby. Histology showed that in the implants removed for fracture, there was a very high percentage (80 to 100%) of peri-implant bone.     

Quick-FISH: a rapid fluorescence in situ hybridization technique for molecular cytogenetic analysis

OBJECTIVE: To evaluate the pregnancy results of an ovarian hyperstimulation protocol for IVF-ET that combines GnRH agonist down-regulation, cessation of GnRH agonist therapy with the onset of menstruation, and high-dose gonadotropin administration in low responders. DESIGN: Prospective analysis. SETTING: Academic IVF program. PATIENT(S): One hundred eighty-two low responders undergoing 224 IVF-ET cycles. INTERVENTION(S): Down-regulation was obtained with the administration of leuprolide acetate beginning in the midluteal phase and ending with the onset of menses. Daily administration of 6 ampules of FSH alone or in combination with hMG was initiated on cycle day 3. MAIN OUTCOME MEASURE(S): Stimulation characteristics and pregnancy rates (PRs) were compared between fresh cycles in which pure FSH alone was used and 35 cycles in which a combination of FSH and hMG was administered. RESULT(S): The clinical PR per transfer, the ongoing PR per transfer, and the implantation rate were 32%, 24%, and 9%, respectively. No differences were noted between cycles in which pure FSH alone was used in comparison with cycles in which a combination of FSH and hMG was administered. CONCLUSION(S): Short-term ovarian suppression begun in the luteal phase and discontinued with the onset of menses followed by high-dose stimulation with gonadotropins yields favorable pregnancy results in low responders.     

Neuroendocrine (Merkel cell) carcinoma of the oral mucosa: report of a case with immunohistochemical study and review of the literature

Merkel cell carcinoma (Mcc) is an uncommon and aggressive tumour with neuroendocrine features that occur predominantly in the head and neck region. The rarity of this tumour, especially when it arises in the oral mucosa, makes both early identification and standardisation of treatment difficult, particularly as regards complementary treatment. The availability of monoclonal antibodies with restricted specificity for some antigens thought to be related to neuroendocrine carcinomas, such as Merkel cell carcinoma, and ultrastructural studies offer some new leads to investigation. This has allowed, a greater number of these tumours to be discovered, thereby increasing the chances of effective management. A case of Mcc of the floor of the mouth is reported, together with the results of cytokeratin, neuron specific enolase and chromogranin immunohistochemistry.     

Inflammatory pseudotumor of the pelvis: case report with review of recent developments

A case of a successfully treated inflammatory pseudotumor (IPT) of the pelvis in a 9-year-old male is presented. Review of the literature indicates that IPTs have been reported from a variety of anatomic locations. They form a spectrum of lesions ranging from benign, infection-related lesions to low-grade malignancies, capable of local recurrences and rare distant metastases. The site of involvement seems to have prognostic implication. Pulmonary IPTs are found in older patients and are almost always benign, whereas extrapulmonary IPTs tend to occur in younger patients and are, in general, more aggressive, with a recurrence rate of up to 24 per cent and mortality of up to 7 per cent. The treatment of choice is complete resection of the lesion.     

A case of invasive renal pelvic cancer: usefulness of auxiliary diagnosis using fluorescence in situ hybridization

A 65-year-old man, on whom transurethral resection had been performed twice for bladder cancer in the past, was admitted to our hospital for further Class V urinary cytology examination. A low density area of 1.5 cm in diameter in the left renal pelvis without enhancement was the only abnormal sign on computed tomographic (CT) imaging. Malignant cells were not detected by random biopsy of the urinary bladder. The retrograde pyelogram showed no filling defect on the left renal pelvis or ureter. The cytological diagnosis of the right split renal urine was Class III, and that of the left split renal urine was Class V. Fluorescence in situ hybridization (FISH) analysis, using specific probes for chromosome 8q21.3 and the centromere chromosome 11, was performed on cells from the bilateral split renal urine. Cells collected from the right split renal urine showed a normal disomic pattern, while those from the left split renal urine included an aneusomic pattern with polysomy. Left total nephroureterectomy was carried out. Histopathology proved invasive renal pelvic cancer. Thus FISH analysis may be useful for the localization of renal pelvic or ureteral cancers, which are difficult to diagnose.