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Basaloid squamous carcinoma (BSC) is an uncommon aggressive variant of squamous cell carcinoma with a predilection for hypopharynx, tongue base, and larynx. We present 5 cases of BSC of unusual sites, each from maxillary sinus, external auditory canal, submandibular gland, tonsil, and nasopharynx. Only a few cases arising in these sites have been reported to date. Patients included 3 men and 2 women with the age range of 45-69 years (mean, 56.4 years). Microscopically, the tumors were characterized by solid lobules and nests of ovoid basaloid cells with abundant desmoplastic stroma. Comedonecrosis, peripheral palisading of tumor cells, trabecular pattern, and rosette-like arrangement were commonly observed. Tumor cells had scanty cytoplasm and their nuclei were ovoid, relatively uniform, and hyperchromatic. In two cases, concomitant squamous cell carcinoma in situ was identified. Immunohistochemical stains revealed that tumor cells were strongly positive for pancytokeratin and negative or weakly positive for p63. Being aware of BSC that can arise from unusual sites would help diagnose correctly and treat properly this rare and distinct clinicopathologic entity.
Background : Second opinion diagnosis of outside pathology slides is a common practice for efficient and proper patient management. We analyzed cytology slides from outside hospitals submitted for a second opinion diagnosis to determine whether the second opinion diagnosis had any influence on patient care. Methods : We reviewed 1,153 outside cytology slides referred to Asan Medical Center for second opinions from January, 2007, to December, 2007. All cases were categorized into three groups; no diagnostic discrepancy, minor diagnostic discrepancies (no impact on the management), and major diagnostic discrepancies (significant impact on the management and subsequent follow-up). Results : The thyroid was the most common organ system (933 cases, 80.9%), Forty cases (3.6%) belonged to the major diagnostic discrepancy group and 149 cases (12.8%) to the minor discrepancy group. For validation of second opinion diagnoses in major discrepancy cases, subsequent biopsy or surgical resection specimens and clinical information were reviewed, which were available in 29 cases. The second opinion diagnoses resulted in alteration of clinical management in 21 of 29 cases. Conclusion : For all referred patients, second opinion diagnosis is important and mandatory for appropriate patient care.
정영종 ( Young Jong Jung ),김범 ( Beom Kim ),조영미 ( Yong Mee Cho ),김희섭 ( Hee Sup Kim ),김지호 ( Ji Ho Kim ),김수연 ( Soo Yeun Kim ),김봉석 ( Bong Seog Kim ),최윤미 ( Youn Mi Choi ),문경협 ( Kyoung Hyoub Moon ) 대한신장학회 2008 Kidney Research and Clinical Practice Vol.27 No.6
Polycythemia vera is a hematopoietic stem cell disease, characterized by sustained and excessive proliferation of erythrocytic, granurocytic and megakaryocytic cells in the bone marrow resulting in pancytosis in peripheral blood. There have been a few reports of glomerulonephritis with polycythemia vera, most of which were IgA nephropathy. We report a case of a polycythemia vera associated with proteinuria. We confirmed the polycythemia vera according to World Health Organization criteria. Renal pathology showed IgA nephropathy and minimal change disease. Periodic phlebotomy was done and hydroxyurea was administered without specific managements for renal disease. After 3-month treatment, hemoglobin level decreased and proteinurea disappeared.
A 66-year-old male was admitted for increasing azotemia. He was diagnosed with chronic antibody-mediated rejection and had received a livingdonor renal transplant from his 32-year-old son prior to his admission. The peritubular capillaries of his kidney were diffusely positive on C4d immunostaining. It is known that there is an agreement between C4d staining and serological and histopathological data during rejection that is thought to have a humoral component. The role of alloantibodies in chronic renal allograft deterioration and the corresponding morphologic changes have been increasingly recognized during the recent years. However the treatment guidelines for chronic antibody-mediated rejection have not yet been established. Intravenous immunoglobulin (IVIG) has been shown to decrease the titers of anti-HLA antibodies in highly sensitized patients awaiting transplant. There are also numerous proposed mechanisms regarding how IVIG exerts its immunomodulatory action. As we have experienced chronic antibody-mediated rejection and how IVIG treatment improves renal function, we recognize that IVIG has the potential to be used for treating certain subgroups of chronic allograft nephropathy patients with positive C4d staining and anti-HLA antibodies.
저자들은 최소변화콩팥병증에 동반된 얇은기저막병 증례를 경험하였으며, 통상적인 고용량 스테로이드 치료에 좋은 반응을 보였다. 향후 우리나라 성인에 있어서 얇은기저막병이 동반된 최소변화콩팥병증의 임상상에 대한 자료 수집과 분석이 필요할 것으로 생각된다. Thin basement membrane disease is defined as diffuse thinning of the glomerular basement membrane, and is clinically characterized by persistent hematuria, minimal proteinuria, normal renal function, and a benign course. It can occur together with other glomerular diseases. We experienced a case of thin basement membrane disease concurrent with minimal-change disease. Treatment with corticosteroid resulted in improved proteinuria and peripheral edema during the follow-up period. (Korean J Med 2011;80:469-472)
저자들은 methicillin-resistant Staphylococcus aureus으로 인한 척수골수염 및 다발성 관절염으로 입원한 환자에서 발생한 단백뇨, 혈뇨, 크레아티닌 증가 및 C3 보체 감소의 원인을 확인하기 위한 신장 조직검사를 시행하여 황색포도구균 관련 사구체신염을 진단하고, 배농술과 함께 항생제 치료로 호전된 황색포도구균 관련 사구체신염 1예를 경험하여 국내 문헌고찰과 함께 보고하는 바이다. A 64-year-old woman was admitted with vertebral osteomyelitis and polyarthritis (both knees and the right shoulder). She had had no health problems before these conditions developed. Joint culture grew methicillin-resistant Staphylococcus aureus. During hospitalization, hematuria, proteinuria, azotemia, and decreased C3 were reported. The renal biopsy showed mesangial proliferative glomerulonephritis with C3 and IgA co-dominant deposits on immunofluorescence staining. Following incision and drainage of the right shoulder and right knee, and intravenous vancomycin for 15 weeks, the C-reactive protein, proteinuria, hematuria, and C3 level all normalized. Here, we report a case of Staphylococcus-associated glomerulonephritis with a brief review of the literature. (Korean J Med 2016;90:148-153)
본 증례는 유육종증이 피부와 신장을 동시에 침범하여, 특히 신장에서는 육아종성 간질성 신염에 의한 신부전까지 일으켰으나 고용량의 스테로이드에 좋은 치료 반응을 보인 예로써 신기능 저하와 고칼슘혈증이 동반된 환자에서 신장 유육종증은 주요 감별진단에 포함되어야 하겠다. Sarcoidosis is a granulomatous inflammatory disorder of unknown etiology. It can involve any organ and present in various clinical forms, but renal involvement is very unusual. We report on a 68-year-old man with renal sarcoidosis. He presented with unexplained renal impairment, hypercalcemia, and multiple light brown papules on the buttock and lower extremities. Non-caseating granulomas and interstitial nephritis were revealed in skin and kidney biopsies. The serum creatinine, hypercalcemia, and skin lesions rapidly improved on high-dose steroid therapy. One year later, the serum calcium level was normal, and serum creatinine was 1.3 mg/dL. (Korean J Med 77:S1226-S1230, 2009)
서지영 ( Ji Young Seo ),김광실 ( Gwang Sil Kim ),김대명 ( Dae Myung Kim ),김선영 ( Sun Young Kim ),유경돈 ( Kyung Don Yoo ),홍진희 ( Jin Hee Hong ),주혜원 ( Hye Won Joo ),조영미 ( Yong Mee Cho ),김상현 ( Sang Hyun Kim ),박원도 ( W 대한신장학회 2009 Kidney Research and Clinical Practice Vol.28 No.5
Kidney involvement in systemic lupus erythematosus (SLE) is common. The incidence of venous thrombosis in SLE ranges from 5-15%, and venous thrombosis in lupus nephritis associated with nephritic syndrome or antiphospholipid antibody syndrome is reported in 30-35%. Lupus nephritis with nephrotic syndrome is not infrequently encountered at the point of diagnosis of SLE, but venous thrombosis as the first manifestation of SLE is rare. Herein we present our clinical experience with a case of multiple venous thrombosis with nephrotic-range proteinuria as the first manifestation of lupus nephritis.