Successful treatment with fluconazole of protothecosis developing at the site of an intralesional corticosteroid injection

We report a case of cutaneous protothecosis treated successfully with oral fluconazole. Fluconazole appears to be an effective alternative to conventional drugs for the treatment of cutaneous protothecosis. Cutaneous protothecosis is an uncommon infection due to achlorophyllic, saprophytic, algae-like unicellular organisms of the genus Prototheca that occurs mainly in immunocompromised patients. To date there is no standard treatment regimen. Surgical excision, oral ketoconazole, intravenous amphotericin B alone or in combination with oral tetracycline have been reported to be effective in the management of protothecosis. We report a 55-year-old immunocompetent woman with cutaneous protothecosis which developed at the site of intralesional triamcinolone acetonide injection, who was successfully treated with oral fluconazole.

Light microscopic and electron microscopic features of cyclosporine nephrotoxicity in rats

In order to clarify morphologic changes associated with cyclosporine (CS) nephrotoxicity, CS in ethyl alcohol at 25 mg/kg/day i.p. was administered to male Sprague-Dawley rats for periods of 1 to 8 weeks. Mean systolic BP was slightly increased in the CS group at 4 weeks (p < 0.05), but there was no difference compared to a control group at 8 weeks. Blood urea nitrogen was significantly elevated at 4 weeks and continued to rise (p < 0.005), whereas serum creatinine was elevated at 8 weeks. Microscopic examination of the kidneys from CS-treated rats at one week revealed cytoplasmic vacuolization in all segments of the proximal tubules, tubular inclusion bodies, and peritubular capillary congestion. Ultrastructurally, some vacuoles were neutral fat droplets, while others appeared as single membrane-bound structures due to dilatation of the endoplasmic reticulum. The tubular inclusion bodies were enlarged autolysosomes filled with distorted mitochondrial fragments. At two weeks, tubular regeneration was prominent, in addition to the above mentioned toxic tubulopathy. At four weeks, focal areas of interstitial fibrosis and tubular atrophy associated with cystic dilatation were seen. At 8 weeks, interstitial and intratubular microcalcification were present, in addition to patchy foci of interstitial fibrosis, but vascular lesions were not demonstrated. Although renal tubular changes characterized by vacuolization, inclusion bodies, and microcalcification and interstitial fibrosis are not specific for CS toxicity, these changes are commonly found in both humans and rats at high doses of CS.

An imported case of hepatic unilocular hydatid disease

A 38-year old man visited a private clinic complaining of epigastric discomfort for 2 months. A huge hepatic cyst was found by sonography and computerized tomography. An exploratory laparotomy was performed under the impression of hydatid disease. The cyst was successfully removed. A lot of living protoscolices of Echinococcus granulosus were found from the cystic fluid under light microscopy. During the operation, however, the cyst was accidentally ruptured and the cystic fluid spilled out. The patient was medicated with albendazole, and had been well without any signs of anaphylaxis or recurrence for 1 year follow-up period. He had been in Saudi Arabia for 3 years. This is the 16th case of hydatid disease reported in Korea and a case without immediate complication in spite of rupture of the cyst.

A highly malignant ameloblastic fibrosarcoma. Report of a case

Ameloblastic fibrosarcoma is an exceedingly rare tumor: only 44 cases have been reported. We report a case of ameloblastic fibrosarcoma with high-grade malignancy and discuss the clinical and histologic features.

Flow cytometric DNA analysis of gastric cancer--correlation with histology and clinical outcome

Nuclear DNA content was analysed by means of flow cytometric measurements in 103 patients with gastric carcinomas, using paraffin-embedded archival tissue. DNA aneuploidy was found in 40 cases (38.8%). The mean DNA index of aneuploid tumors was 1.45(range 1.13 to 2.37). No significant association between ploidy and either age, sex, tumor location, size, stage, growth pattern, or histologic type was found. However, the incidence of aneuploidy was higher in high grade carcinomas than in low grade carcinomas; the incidence of aneuploidy was 10%, 68.8%, and 45.8% for Grade II, III, and IV carcinomas, respectively, as compared with Grade I carcinomas which were all diploid. On statistical analysis, Abnormal cellular DNA content was significantly correlated with high histologic grade (P < 0.005). Patients with aneuploid cancer (39.2%) had a poorer prognosis than those with diploid cancer (70.0%) based on (P < 0.01). The 2-year survival rate for advanced gastric carcinoma. Therefore, DNA ploidy might be a useful prognostic factor in cases of advanced gastric cancer.

Effect of glucose on the expression of c-myc gene in cultured RINm5F cell

The study was designed to examine the effect of glucose on the expression of c-myc gene in cultured RINm5F cells. After monolayer culture was established in RPMI 1640 media supplemented with 10% fetal calf serum (FCS), the cells were cultured in various concentrations of glucose and 1 or 10% FCS for another 24 hours. A mRNA was extracted from the cultured cells by a single step method, and Northern analysis was done to detect RNA band. A 0.5 kilobase single band was detected as c-myc mRNA. The expression of c-myc gene mRNA was reduced with increased concentration of glucose with 1% FCS. However, supplementation of 10% FCS abolished the effect of glucose on expression of c-myc gene. These findings suggested that glucose in conjunction with other growth promoting factors played an important role in expression of oncogene and cell growth in RINm5F cells.

Granulosa cell tumor of the ovary. Histopathologic and flow cytometric analysis with clinical correlation

Ten granulosa cell tumors of the ovary were investigated using clinicopathologic and flow cytometric parameters. Three of the patients had recurrent or metastatic lesions 3 to 9 years after resection of the primary ovarian tumor. These three cases demonstrated diploidy in both the primary tumor and metastatic or recurrent lesions. Among the seven cases without recurrence, five had diploid DNA indexes. One case was characterized by a high degree of cytologic atypia and tetraploidy (DNA index, 1.98); this patient died of metastatic breast cancer 4 years after resection of the ovarian tumor. Another case demonstrated a high mitotic rate and exhibited aneuploidy (DNA index, 1.33); this woman was alive and well at 5 years of follow-up. In this study, no correlation was found between the recurrence rate and ploidy but, in view of the small numbers and limited follow-up, we cannot definitively analyze these prognostic factors. It does not appear feasible to predict the clinical course of granulosa cell tumors by DNA flow cytometry. However, it can be concluded that: (1) most granulosa cell tumors have diploid DNA content and (2) DNA ploidy correlates well with histologic factors, such as cellular anaplasia and high mitotic activity, which may have predictive prognostic value for granulosa cell tumors.

Tubal metaplasia of the uterine cervix

Eleven cases of tubal metaplasia of the uterine cervix are presented. These are characterized histologically by architecturally normal endocervical glands containing ciliated or clear cells, nonciliated cells, and intercalary or peg cells, resembling normal tubal mucosa. Transitions from normal to ciliated epithelium within a single gland are frequently seen. Eight of these cases involved endocervical glands near the squamocolumnar junction, and six showed tubal metaplasia along the overlying surface epithelium. Superficial and (in one case) deep endocervical glands were involved. No correlation was found between the presence of tubal metaplasia and the degree of inflammation of the cervix or the presence or extent of squamous metaplasia. Immunohistochemically, the epithelium of tubal metaplasia was negative for carcinoembryonic antigen in five cases studied. In situ squamous carcinoma and a variety of benign glandular lesions, such as microglandular hyperplasia, mesonephric remnants, and endometriosis, were concurrently identified. Two cases also accompanied tubal metaplasia in proliferative and hyperplastic endometria, and tubal metaplasia was seen in the lower uterine segment in five cases. We emphasize that, as with other types of metaplasia, the main significance of recognizing this lesion in the cervix is in not confusing it with early endocervical glandular neoplasia.