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Subependymoma is a rare, slow-growing, benign noninvasive tumor of the central nervous system that may be located in the fourth ventricle, the septum pellucidum, the third and the lateral ventricles, the aqueduct, and the proximal spinal cord. Symptoms, if any, usually result either from direct compression of the brain stem or from acute hydrocephalus due to occlusion of the foramen of Monro or aqueduct of Sylvius. In this report, we describe a case of subependymoma of the lateral ventricle with headache in a young female patient. This is the first reported case subependymoma in Korea that was documented along with Magnetic resonance image.

Parosteal osteosarcoma is a low-grade osteosarcoma, which occurs on the surface of the bone. We had experienced a parosteal osteosarcoma involving the flat bone, the scapula of a 21-year-old man. This is an extremely rare location for a parosteal osteosarcoma. Plain radiograph showed broad-based, well-defined radiodense lesion at the scapula. Computed tomogram demonstrated an intact cortex and absence of a medullary involvement. Tumor showed a lobulated, high-density lesion, indicating bone formation. Histologically, parosteal osteosarcoma is a well-differentiated osteosarcoma. The tumor is composed of a hypocellular proliferation of spindle cells, with minimal cytologic atypia. The bone is in the form of a well-formed bony trabeculae. Occasional cartilage is present in the form of a cap.

Vascular endothelial growth factor-C (VEGF-C) and its receptor, vascular endothelial growth factor receptor-3 (VEGFR-3), have been implicated as important factors in the formation of lymphatic vessels, but its role in osteosarcomas has not yet been fully investigated. This study aims to define the expression of VEGF-C and VEGFR-3 in primary and metastatic osteosarcomas and their relationship to various clinicopathologic parameters. Thirty-three primary osteosarcomas and two pulmonary metastatic samples were immunostained for VEGF-C and VEGFR-3. In addition, VEGF-C and vascular endothelial growth factor-D (VEGF-D) mRNA expression levels in three different human osteosarcoma cell lines and control fibroblasts were evaluated by real-time quantitative polymerase chain reaction (PCR). Both VEGF-C and VEGFR-3 were expressed mainly in the cytoplasm of the tumor cells. Of the 35 patients with osteosarcoma, 16 patients (45.7%) showed strong positive reaction with VEGF-C. Four cases (11.4%) were negative, and 15 cases (42.9%) showed weak immunoreactivity. For VEGFR-3, 12 patients (34.3%) showed strong positive reaction. Fifteen cases (42.9%) were negative, and eight cases (22.8%) showed weak immunoreactivity. A significant, positive correlation (Rs=0.42, p=0.01) was found between the expression of VEGF-C and VEGFR-3 in osteosarcomas. The expression of VEGF-C was significantly associated with the osteoblastic subtype and high histologic grade in osteosarcomas. However, the expression of VEGF-C showed no significant correlation with the presence of metastasis. Expression of VEGFR-3 was not related to any clinicopathologic features analyzed. Two of the three osteosarcoma cell lines tested showed amplification of VEGF-C mRNA compared with control cells. No amplification of VEGF-D was noted in these cell lines. Our data suggest that VEGF-C and its receptor are expressed in osteosarcomas. Although the level of VEGF-C was high, it does not seem to have a direct influence on tumor metastasis in osteosarcomas.

Dystrophic calcification can be defined as a calcification that occurs in degenerated or necrotic tissue. It is associated with multiple clinical conditions, such as collagen vascular diseases. It involves the deposition of calcium in soft tissues despite no generalized disturbance in the calcium or phosphorus metabolism, and this is often seen at sites of previous inflammation or damage. Potassium-titanyl phosphate (KTP) laser vaporization of the prostate is safe and relatively bloodless procedure that results in a shorter catheterization, immediate symptomatic improvement, and less severe postoperative irritative symptoms. However, longer follow-up studies or reports about complications are lacking. Here in we report a case of dystrophic calcification and stone formation on the entire bladder neck after performing KTP laser vaporization of benign prostate hyperplasia. That was treated by lithotripsy and transurethral resection.

Background context Gout of the spine is very rare. Forty-one cases of gout affecting the spine have been reported. Purpose To present a patient with tophaceous gout of the lumbar spine mimicking pyogenic discitis. Study design Case report. Methods The medical record, including operative notes, progress notes, discharge summary, clinical notes, radiological study, and pathological studies was reviewed. Results The patient had acute low back pain and radiculopathy with high spiking fever. Therefore, pyogenic discitis was suspected. However, histological diagnosis revealed tophaceous gout. Conclusions Tophaceous gout of the spine is very rare. However, when a patient presents with acute back pain and fever, spinal gout should be considered, particularly in a patient with a previous history of hyperuricemia or gout.

Purpose: The metastatic tumor antigen (MTA) gene is a recently identified metastasis-associated gene which has implications in the signal transduction or regulation of gene expression. However, the expression of MTA in osteosarcoma and its potential relationship with metastasis have not been examined, forming the basis of this study. Materials and Methods: We compared the expression levels of the MTA1 protein between 32 cases of highgrade osteosarcomas and 21 cases of low-grade osteosarcomas by immunohistochemistry. In addition, the mRNA expression levels of MTA1, 2, 3 in these osteosarcoma cell lines and control fibroblasts were evaluated by real-time quantitative PCR. Results: MTA1 immunoreactivity was present in 81.25% of high-grade osteosarcoma specimens. Its expression was predominantly localized to the nucleus or cytoplasm of osteosarcoma cells. Thirteen (86.6%) of 15 patients who died of osteosarcomas displayed strong MTA1 expression. Both primary bone and pulmonary metastatic lesions exhibited MTA1 expression. All lowgrade osteosarcomas were negative for MTA1 except for focal weak reactivity in two cases. The tested high-grade osteosarcoma cell lines showed marked amplification of MTA1 and MTA2 mRNA compared to control cells. Conclusion: These results suggest that MTA might be involved in the progression of high-grade osteosarcoma, particularly in hematogenous metastasis of osteosarcoma.

The purpose of this study was to investigate the efficacy of oral alendronate for children with osteogenesis imperfecta. Nine boys and seven girls of average age 9.5 years were given oral alendronate for an average of 4 years. Fracture frequency decreased, and in more than half of the patients the ambulatory/mobility status improved. Bone mineral density improved significantly, and restoration of collapsed vertebral bodies was observed. Urinary excretion of calcium and a bone resorption marker decreased significantly. Iliac crest physis biopsy showed an expanded primary spongiosa area with numerous multinucleated cells. This study reveals that oral alendronate caused biochemical, radiologic, and histologic changes along with clinical improvement. Oral alendronate treatment, which is convenient for the school-age group, was found to be a tolerable and efficacious treatment for children with moderate or severe osteogenesis imperfecta.

Adamantinoma of the long bones is a rare primary bone tumor of uncertain embryogenesis. It tends to involve the tibia almost exclusively. We report on adamantinomas occurring in a 16-year-old male patient, with synchronous tibial and fibular lesions. Histologically, there were characteristic clusters of epithelial cells in a fibrous background, forming a keratin cyst. Immunohistochemically, these cells were strongly positive for cytokeratin. This keratin cyst formation is quite an unusual finding in classic adamantinoma.

Amplification and overexpression of the HER-2/neu (c-erbB-2) oncogene have been observed in many cancers and are associated with a poor prognosis particularly in breast cancer. The human epidermal growth factor (HER)-2 receptor has recently been implicated in Ewing's sarcoma tumor cell line growth and chemosensitivity. The present study evaluates the amplification of HER-2/neu gene in paraffin sections from 42 cases of Ewing's sarcoma by a real-time quantitative polymerase reaction method using LightCycler system (Roche diagnostics, GmbH Mannheim, Germany). The relative copy number of HER-2/neu versus beta-globin was calculated at the crossing point. The mean calculated copy number in these cases of Ewing's sarcoma and normal controls was 26.43 and 26.93, respectively. The p value was 0.215 (p0.05). Our results demonstrated an absence of HER-2/neu oncogene amplification in Ewing's sarcomas, and we suggest that HER-2/neu is not a biologically or therapeutically important pathway in Ewing's sarcoma.

Background The recent discovery of two p53-related genes, p63 and p73, has revealed an additional level of complexity to the study of p53 function. Both genes encode multiple proteins arising from alternative promoter usage and splicing, with transactivation, DNA-binding, and tetramerization domains. Recent data support a role for p63 in squamous and transitional cell carcinomas, as well as in certain lymphomas and thymomas. Methods To characterize the involvement of p63 and p73 in the development of osteosarcoma, we analyzed the expression and mutation of TAp63 and TAp73 in six osteosarcoma cell lines and twelve osteosarcoma specimens. Results Semiquantitative DNA/PCR analysis revealed that eight (67%) and six (50%) out of twelve osteosarcoma specimens showed significantly reduced levels of p63 and p73 transcription, respectively. Direct sequencing of the entire coding region detected no mutations in cell lines or osteosarcoma specimens. Conclusions Our data suggest that low expression of p63 and p73 is relatively common in osteosarcomas and might contribute to their molecular pathogenesis.

Low-grade osteosarcoma is a rare variant of osteosarcoma. Although malignant, it must be distinguished from conventional osteosarcomas because of its excellent prognosis. Numerous published papers have described the expression of HER2/neu oncogene in osteosarcoma as a poor prognostic factor; however their results are discordant. To address the expression of HER2/neu and to validate the assessment methods of amplification of the HER2/neu oncogene, the authors have employed quantitative real-time PCR and fluorencent in situ hybridization analysis (FISH) in 21 low-grade osteosarcomas. We calculated the quantification of HER2/neu oncogene amplification as the ratio of measured HER2/neu gene/beta-globin reference gene in real-time PCR. All 21 cases had amplified signals in the quantitative real-time PCR. However, in the FISH analysis, HER2/neu oncogene amplification was only identified in 26% (5/19). The exact reasons for the discordance between these two methods are unknown; however, variable histological features might play a potential role. In conclusion, as our study showed amplification of HER2/neu oncogene in low-grade osteosarcoma, we assume that expression of HER2/neu is not a poor prognostic factor in low-grade osteosarcoma.

Extraskeletal myxoid chondrosarcoma is a rare soft-tissue sarcoma that usually occurs in deep soft tissues, especially those of the proximal extremities and limb girdles, but is rare in children. We present an unusual case of a tumor arising in the perineum and involving the bulbous urethra in a 21-month-old boy. The patient was treated with surgical excision and urethroplasty followed by combination chemotherapy.

The expression of HER-2/neu has been proposed to be a prognostic indicator in osteosarcoma. To clarify the actual frequency of HER-2/neu expression in primary malignant cartilaginous tumors, we examined 89 cases comprising 17 conventional chondrosarcomas, 33 mesenchymal chondrosarcomas, and 39 clear cell chondrosarcomas. We used real-time PCR (LightCycler) assay to quantify the HER-2/neu gene status. The crossing point of HER-2 in normal control bone was 27.77. The crossing points of HER-2 in conventional, mesenchymal, and clear cell chondrosarcomas were 28.48+/-1.79, 27.74+/-3.02, 28.57+/-1.54, respectively. In conclusion, the amplification and overexpression of the HER-2/neu oncogene is absent or at least very rare in malignant cartilaginous tumors. The level of expression of HER-2/neu was similar in all cartilaginous tumor types.

The bone mass and microarchitecture are important determinants of bone strength, with microarchitectural deterioration being one of the specific changes associated with osteoporosis. The purpose of this study was to evaluate and compare the results of microcomputed tomography (micro-CT) and histomorphometry of biopsied specimens. A bone biopsy was performed on the iliac crest of 10 normal premenopausal Korean women. Measurements of the bone mineral density (BMD), micro-CT, and bone histomorphometry were performed. The bone volume, as determined by both micro-CT and histomorphometry, was significantly correlated (r=0.88, p < 0.01). The osteoid surface was correlated with both the bone volume (r=0.84, p < 0.01) and the structure model index (SMI) (r= -0.89, p < 0.01) measured by micro-CT. The SMI was correlated with both the bone volume (r=-0.85, p < 0.01) and the total hip BMD (r=-0.65, p < 0.05). In conclusion, some, but not all of the parameters of the micro-CT, were well correlated with the bone histomorphometric results. Micro-CT and histomorphometry appear to be complementary techniques in the study of bone microarchitecture.

Malignant fibrous histiocytoma (MFH) is a rare primary neoplasm that constitutes less than 1% of the malignant tumors of bone, and involvement of the skull is very rare. We present a case of malignant fibrous histiocytoma of the skull, presenting an intraosseous lesion in a 43-yr-old woman. She had a rapidly growing, tender mass in the right parietal region. A plain radiograph showed an osteolytic lesion of the right parietal bone. Magnetic resonance imaging revealed that the lesion showed heterogeneous low signal intensity on T1-weighted images and slightly high signal intensity on T2-weighted images. No evidence of an extraosseous extension to the adjacent dura and soft tissue was found, and a wide excision of the parietal bone was performed. Histologically, the tumor was a typical MFH displaying pleomorphic spindle cells in a storiform pattern. The results of immunohistochemical stainings revealed that the tumor cells were positive for vimentin, alpha-1-antitrypsin, and p53, and negative for smooth muscle actin, S100 protein, desmin, and MyoD1. Three months later, a mainly cystic, recurrent mass was developed at the previously operated site. Before the resection, we first performed the percutaneous aspiration cytology, revealing diagnostic multinucleated pleomorphic cells. Thereafter, she had to receive repetitive resections of recurrent or residual lesions, and she died of postoperative meningoencephalitis two years after the first operation.

Tuberculosis remains a major international health problem despite advances in radiological diagnosis and antituberculous therapy. Disseminated tuberculous infection affecting a single bone and manifested as multifocal lytic cortical lesions is rare and unusual. We report on a 50-year-old man with multifocal involvement of the femur by tuberculosis and demonstrate positive reaction using tuberculosis-polymerase chain reaction on formalin-fixed, paraffin-embedded histological specimens.

We investigated the expression and mutation of three isoforms of the Ras effector RASSF1 in 10 primary osteosarcomas and 6 osteosarcoma cell lines. RASSF1A was not expressed in 40% (4/10) of the primary osteosarcomas and 83.3% (5/6) of the osteosarcoma cell lines. RASSF1B and RASSF1C expression was absent in 30% (3/10) and 0% (0/10) of primary tumors, and 100% (6/6) and 0% (0/6) of osteosarcoma cell lines, respectively. Treatment of these cell lines with the DNA methylation inhibitor 5-aza-2'-deoxycytidine reactivated the transcription of RASSF1A, but not that of RASSF1B or RASSF1C. No somatic mutations were noted in RASSF1 in either the primary tumors or cell lines. Our data indicate that epigenetic inactivation of RASSF1A by hypermethylation of its promoter region is a frequent event, and may play an important role in the tumorigenesis of osteosarcomas.

We report a case of symptomatic intraurethral prostatic cyst in a 42-yr-old man without clinical evidence of benign prostatic hyperplasia. The intraurethral cyst makes it unique from the all previously reported cases of prostatic cysts located medially within the prostate. Transurethral resection of the cyst with limited resection of the prostatic tissue at the base of the cyst was performed with successful resolution of voiding symptoms.

Objective. To evaluate the serial sonographic findings of experimental muscle injury and to correlate those findings with the pathologic findings at each period. Methods. A muscle injury was artificially inflicted in 18 legs of 9 rabbits. Sonographic follow-up images were obtained 1, 3, and 7 days and 2, 3, 4, 6, and 8 weeks after infliction of muscle injury. Pathologic specimens were obtained for comparison with sonographic findings on each date. Results. There was high echogenicity in the central portion after 3 days. It changed to low echogenicity after 7 days. There were linear echogenic lines in the central portion after 4 weeks, and these lines increased in number after 6 weeks. The peripheral portion exhibited high echogenicity up to 7 days. This high echogenicity was normalized after 2 weeks. Pathologic specimens showed hematomas, fibrin, and necrotic muscle fibers in the central portion up to 3 days after injury. Fibrin occupied most of the central portion after 2 weeks. Regenerating muscle fibers appeared within the fibrin clot after 4 weeks, and they became more prominent after 6 weeks. Necrotic muscle fibers, hemorrhage, and inflammatory cells of the peripheral portion disappeared after 2 weeks. Conclusions. Serial sonography of muscle injury was well correlated with the pathologic specimen up to 7 days after injury. After 4 weeks, regenerating muscle fibers showed a good correlation with the finding on sonography. Therefore, sonography can be helpful in diagnosis of muscle injury as well as in evaluation of the regenerating muscle fibers.

Chondroblastoma and chondromyxoid fibroma (CMF) has been investigated in numerous histological studies, but its biological nature and histogenetic origin are still a matter of debate. We evaluated the expression of type II collagen, S100A2, S100B, and osteocalcin to study the matrix biochemistry and phenotype of the neoplastic cells in these tumors. Immunohistochemically, the expression of type II collagen was diffuse in 15 cases (75%) among total 20 chondroblastomas and 12 (85.7%) among total 14 CMFs. The expression of S100B was also diffuse in all cases (100%) of chondroblastomas and 12 cases (85.7%) of CMFs. We were able to obtain the expression of S100A2, focally. The expression of osteocalcin was focally noted in 18 cases (90%) of chondroblastomas and 8 cases (57.1%) of CMFs. In conclusion, our data support that chondroblastoma and CMF are a distinct tumor entity with the basic expression of chondroid markers. But these tumors also show histologic diversity with focal co-expression of osteoid markers.

It has previously been shown that glucose uptake and use is more prevalent in carcinomas than in normal cells and tissues. We hypothesized that human erythrocyte glucose transporter-1 expression is increased in gallbladder carcinoma and might be correlated with prognostic significance.A total of 71 cases of gallbladder carcinomas, 2 cases of gallbladder dysplasia and 20 cases of gallbladder adenomas were examined immunohistochemically to evaluate the expression of glucose transporter-1 protein in the light of their relationship with various prognostic factors.Glucose transporter-1 was stained in the cell membrane of the cancer cells. Adjacent normal mucosa was negative for glucose transporter-1 staining. Thirty-seven gallbladder carcinomas (52.1%) showed positive staining for glucose transporter-1, however only one of the adenomas (5.0%) and none of the dysplasias were positive (P0.05). There was significant correlation between glucose transporter-1 expression and histologic tumor type, and tumor stage. In the multivariate analysis, tumor stage was statistically significant (P = 0.05), but glucose transporter-1 expression was not significant (P = 0.07). The mean survival periods of the glucose transporter-1 positive and negative groups were 24 months and 58 months, respectively (P = 0.003).Our results suggest that glucose transporter-1 protein expression is strongly associated with neoplastic progression in gallbladder carcinomas, and that glucose transporter-1 expression identifies with a worse prognosis in the patients with gallbladder carcinomas.

Low-grade osteosarcomas of the paranasal sinus are extremely rare. Most reported cases of maxillary sinus osteosarcoma are high-grade. We present a 51-year-old man with a low-grade osteosarcoma which was histologically difficult to diagnose in isolation since it had bland features. The presence of an aggressive destructive lesion on imaging influenced the final pathological diagnosis as often appears to be the case with this rare tumor. We briefly discuss paranasal sinus osteosarcomas.

The Bcl10 gene was recently isolated from the breakpoint region of t(1;14)(p22;q32) in mucosa-associated lymphoid tissue (MALT) lymphomas. Somatic mutations of Bcl10 were found in not only t(1;14)-bearing MALT lymphomas, but also a wide range of other tumors. To clarify the actual frequency and spectrum of Bcl10 mutations in primary malignant chondrogenic tumors, we examined 89 cases of malignant chondrogenic tumors comprising 17 conventional chondrosarcomas, 33 mesenchymal chondrosarcomas, and 39 clear cell chondrosarcomas. Polymerase chain reaction single-stranded conformation polymorphism and sequencing analyses were done. No Bcl10 mutations were found in our series of malignant chondrogenic tumors. While screening for mutations, we also found three polymorphisms at codons 8 exon 1 of the Bcl10 gene. Our results strongly suggest that somatic mutations of Bcl10 are extremely rare in malignant cartilaginous tumors and do not commonly contribute to their molecular pathogenesis.

The Bcl10 gene was recently isolated from the breakpoint region of t(1;14)(p22;q32) in mucosa-associated lymphoid tissue (MALT) lymphomas. Somatic mutations of Bcl10 were found in not only t(1;14)-bearing MALT lymphomas, but also a wide range of other tumors. To clarify the actual frequency and spectrum of Bcl10 mutations in primary malignant Ewing's sarcomas, we examined 31 cases of Ewing's sarcomas. Polymerase chain reaction single-stranded conformation polymorphism (PCR-SSCP) and sequencing analyses were done. No Bcl10 mutations were found in our series of Ewing's sarcomas. While screening for mutations, we found three polymorphisms at codons 8 exon 1 of the Bcl10 gene. Our results strongly suggest that somatic mutations of Bcl10 are extremely rare in Ewing's sarcomas and do not commonly contribute to their molecular pathogenesis.

Mutational inactivation of the cyclin-dependent kinase inhibitors (CDKIs) (p16 CDKN2a ) tumor suppressor gene has been found in a variety of human tumor types. To investigate the involvement of CDKI abnormality in clear cell chondrosarcoma, alterations of CDKIs were examined in clear cell chondrosarcoma tissues using a quantitative DNA/PCR, PCR-SSCP. Two of 38 specimens (5.2%) we analyzed showed abnormally low levels of p16 CDKN2a amplification, suggesting that the allelic deletion of the gene might be low frequent event in progression of this tumor. For detection of subtle sequence alterations such as point mutations, we performed SSCP analysis of the entire coding region of the p16 CDKN2a gene. No altered SSCP patterns were found in 38 clear cell chondrosarcoma specimens. This study reflects the very low incidence of genetic alterations of the p16 CDKN2a gene in clear cell chondrosarcoma. Therefore, we conclude that the alteration of the p16 CDKN2a gene is not involved significantly in the development of clear cell chondrosarcoma.

Gallbladder carcinoma is the most common malignancy of the biliary tract in Korea and known to be more common in East Asia and Latin America than in Europe and North America. However, their exact histopathological characteristics and carcinogenesis are not well-elucidated. A total of 71 cases of gallbladder carcinomas, two cases of gallbladder dysplasia and 20 cases of gallbladder adenoma were immunohistochemically studied to evaluate the expression of c-erb-B2 and p53 proteins in the light of their relationship with various prognostic factors. Thirty-three gallbladder carcinomas (46.5%) showed positive staining for c-erb-B2, but none of the dysplasia and adenoma were positive (p

Clear cell chondrosarcoma is one of the extremely rare chondrosarcomas. The pathogenesis and the molecular genetic events, which contribute to the development of clear cell chondrosarcoma, are not well elucidated, due in part to the lack of sufficient tumor tissue available. To characterize the involvement of the p53 gene abnormality in this disease, we analyzed expression and sequence alteration of p53 by immunohistochemical analysis of the protein expression and quantitative DNA/PCR and PCR-SSCP assays of the gene in 28 paraffin-embedded tissue specimens. Immunohistochemical analysis demonstrated that 7 (25%) showed patchy positive nuclear staining for p53 and 5 (18%) showed diffuse positive nuclear staining patterns. Sixteen (57%) were negative for p53 immunostaining. Quantitative DNA/PCR analysis revealed that none of the cases we studied showed significantly reduced levels of p53 amplification (

Purpose: To correlate magnetic resonance (MR) signal characteristics of bone bruises with histological findings. Materials and methods: In 14 tibiae of young pigs, bone bruises were created in the proximal tibial metaphysis. The signal intensity seen on the MR images were correlated with histological findings. The following findings were evaluated: (a) changes of signal intensity on the tibiae; (b) changes of histology on the tibiae; and (c) changes of (a) and (b) on follow-up examinations. Results: We observed three types of injuries on T1-weighted images: focal or diffuse low signal, normal signal and linear low signal intensities. Severe hemorrhagic areas showed low signal intensities on all sequences of MR imaging. Fast spin–echo (FSE) T2-weighted images showed a more distinct low signal intensity than T1-weighted images. FSE short tau inversion recovery (STIR) and FSE fat saturated (FSE-FS) T2-weighted images showed similar signal intensities with FSE T2-weighted images. FS T1-weighted enhanced images showed low signal intensities with variable enhancements. Upon histological examination, hemorrhages and edemas were prominent at the subcortical areas of the contusion sites. The areas of dense, low signal intensities in all imaging sequences showed signs of severe hemorrhage. The areas of diffuse low signal and enhanced areas showed mixed areas of hemorrhages and edemas. Follow-up MR imaging showed evolution of the processes of hemorrhages and edemas with fatty marrow changes. Conclusions: MR imaging can depict changes in the bone marrow resulting from direct injury to the bone. MR imaging is a useful tool for evaluating the evolution of bone bruises.

The p53 tumor suppressor gene is one of the most frequently altered genes in human malignancies. To explore the implication of p53 alteration in Ewing's sarcoma, we analyzed the deletion and sequence alterations of p53 and abnormal amplification of MDM2, which acts as a functional inhibitor of p53, in 35 tissue specimens. Quantitative genomic PCR analysis showed that 2 of 35 tumors have extremely low levels of the p53 gene, indicating a homozygous deletion of the gene. Mutational analysis of exons 4 to 9 of p53 by PCR-SSCP revealed that 3 of 35 tumors carry sequence alterations in exons 5 or 8, and DNA sequencing analysis identified missense point mutations at codon 132 (AAG-->ATG, lysine-->methionine) and codon 135 (TGC-->TCC, cystein-->serine) in exon 5, and codon 287 (GAG-->GTG, glutamic acid-->valine) in exon 8 from these tumors. No abnormal amplification of the MDM2 gene was recognized. Taken together, our data demonstrate that p53 is genetically altered in a small fraction of Ewing's sarcoma.

A 72-year-old man who had suffered several episodes of syncope was diagnosed as having hyperinsulinemic hypoglycemia. Although imaging studies and percutaneous transhepatic portal venous sampling did not reveal the existence of any tumors in the pancreas, distal pancreatectomy was performed because the possibility of a small pancreatic endocrine tumor could not be completely rejected. External examination of the surgically removed pancreas did not reveal any tumors. Microscopically, the pancreas exhibited diffuse islet cell hyperplasia without nesidioblastosis. The patient remains euglycemic and has tolerated 24-hour fasting without any medication for a period of 10 months after the operation.

Leiomyoma may originate at any anatomic location of smooth muscle in the genitourinary system. The kidney capsule is the most common site for the genitourinary leiomyomas. Leiomyoma origination from the scrotum is rare. The previous reported cases presented as small, firm, nontender, slowly enlarging freely movable masses within the scrotum. We report a case of leiomyoma of the tunica dartos, a benign lesion arising from the wall of the left scrotum. It presented as a pedunculated lesion with a surface ulceration, which need to be differentiated from squamous carcinoma of the scrotum. It was treated with a simple surgical excision.

Combined hepatocellular carcinoma (HCC) and cholangiocarcinoma (CC) is sometimes found in resected livers, however, cases with double cancer of HCC and CC are very rare. As well, the rarity of CC arising in von Meyenburg complexes (VMCs) is appreciated. We report the case of a 74-year-old man found to have intrahepatic double cancer composed of well-differentiated HCC and CC which exhibited a histologic progression from VMCs to adenomatous lesions and CC. To our knowledge, this is the first case report published in the literature of a double HCC and CC associated with multiple VMCs. The pathogenesis and previous associated reports of these lesions are discussed.

Purpose: The purpose of this study was to describe the MR findings of chondroblastoma with pathologic correlation. Method: In 22 patients with pathologically proven chondroblastoma, MR signal characteristics were correlated with pathological findings. Results: On T2-weighted images, 12 (55%) lesions were hyperintense with hypointense areas in 9 lesions, whereas 10 (45%) were hypointense. Therefore, 19 of 22 (86%) lesions with pathologic correlation had hypointense areas entirely (n = 10) or partly (n = 9) on T2-weighted images. On gadolinium-enhanced images, 13 (59%) lesions showed lobular enhancement and 9 (41%) showed marginal and septal enhancement. Low signal intensity on T2-weighted MR images was most strongly associated with an abundance of immature chondroid matrix, hypercellularity of the chondroblasts, calcifications, and hemosiderin on histology. Conclusion: Chondroblastoma was found to show hypointense portions on T2-weighted images. Signal intensity on T1- and T2-weighted MR images in chondroblastoma was dependent on the amounts of histopathological components.

Sinus histiocytosis with massive lymphadenopathy is a non-neoplastic self-limiting disease of the bone marrow stem cell origin. It is characterized by painless, bilateral cervical lymphadenopathy accompanied by fever, leukocytosis, elevated erythrocyte sedimentation rate and hypergammaglobulinemia. Extranodal involvement including bone is rare. The patient is a 45-year -old female with multiple punch out lesions on her skull. MRI findings included iso-signal intensity mass at the diploid space on T1 weighted image and on T2 weighted image, mild high signal intensity was obtained. Histologically, the lesion showed proliferation of histiocytes in the fibroblastic background with formation of reactive germinal centers and many plasma cells. The histiocytes show round nuclei and occasional nucleoli and abundant cytoplasms. In area, there is lymphocytophagocytosis. Immunohistochemically, the histiocytes were positive for S-100 protein and lysozyme.

Well-differentiated osteosarcoma is extremely rare, there is no sex predominance and the mean age is in the third decade. The tumor has a strong predilection for the long bones of the extremities, especially the metaphysis but may also occur in the diaphysis. Radiologically, the lesion shows no distinctive features, often simulating fibrous dyplasia or desmoplastic fibroma. We report a case of well-differentiated osteosarcoma involving the rib of a 45-year-old female. This is a peculiar case of well differentiated osteosarcoma involving an unusual site and older patient. We also discuss histological differential diagnosis as well as clinical features of this rare disease.

CD44 is a member of cell surface glycoproteins which are involved in cell-matrix adhesion and tumor metastasis. Certain types of tumors express complex CD44 isoforms generated by alternative splicing of 2v-10v exons, and their expression appears to promote metastasis of tumor cells. Using a nested RT-PCR, we analyzed expression of CD44 variants in 26 stomach carcinoma, 21 matched normal tissues, and 2 carcinoma cell lines. We observed frequent and complex patterns of CD44 variant expression in tumor tissues. While exons 6v and 7v expression was detected in most normal and tumor tissues, exon 9v was most rarely detected. Exon 5v showed a significantly frequent expression in carcinoma, suggesting that its expression might contribute to the malignant progression. While exon 9v was frequently observed in diffuse-type tumors, the other 8 variant exons including 6v showed more frequent expression in intestinal-type tumors. Exons 9v and 10v were predominantly expressed in advanced tumor tissues and exon 8v was expressed more frequently in tumors of lymph node metastasis. We believe that series with a longer follow-up now need to be tested to clarify the association between CD44 splice variant expression and distant metastasis or long-term prognosis.

Rapidly destructive hip disease (RDHD) is an uncommon disorder of the hip that has been considered a disease of unknown cause and distinct from isch-emic necrosis of the femoral head. The objective of this study was to investigate ischemic necrosis of the femoral head as one potential cause of RDHD. In 600 patients who underwent MR imaging of the hip, 20 cases of ischemic necrosis involving the entire femoral head in 18 patients (3%) were retrospectively studied with routine radiography and MR imaging. All patients had surgically confirmed ischemic necrosis of the femoral head. All patients showed rapid destruction of the femoral head on routine radiography and MR imaging as compared with the gradual onset of clinical symptoms. Plain radiographs showed several bone fragments at the inferomedial aspect of the femoral head (75%), acetabular erosions (55%), eccentric depression at the lateral articular surface of the femoral head conforming to the adjacent acetabulum (35%), and mild osteoarthritis (15%). Bone sclerosis was often present at sites of impaction between the femoral head and the acetabulum. MR imaging showed marked distention of the joint capsule in all cases. In 14 of 20 cases, the contents of the joint space showed predominantly low or inter-mediate signal intensity on T1- and T2-weighted images. Ischcmic necrosis involving the entire femoral head may represent one of the causes of RDHD.

The findings with histologically proven calcific tenosynovitis of the tibialis anterior tendon associated with calcific myonecrosis are described. This case emphasizes the typical appearance of this unusual relationship such as peripheral plaque-like calcifications of the tendon sheath, fluid-calcium levels, presentation as painless mass, and calcification and liquefaction of muscle bundles.

Giant cell tumor (GCT) is a relatively rare neoplasm. In GCT, the bone affection of the axial skeleton is extremely rare. Most GCT arises in the meta-epiphyseal ends of the long bones. Its peak incidence is between 30 to 40 years of age. GCT is usually classified as benign, but shows locally aggressive behavior and may occasionally undergo a malignant transformation. The patients with GCT in the spine often complain of the lower back pains, as the tumors primarily involve the sacrum. We report a case of an adolescent female complaining of the upper back pain with a sudden weakness of the lower extremities, later diagnosed with the GCT of the T2 vertebra. The present patient showed American Spinal Injury Association Impairment Scale (AIS) D before the surgery, which changed to AIS E after the treatments including the surgery, radiation therapy and rehabilitation.

Actinomyces species are members of the endogenous flora of mucous membranes, and are frequently cultured from the gastrointestinal tract, bronchi, and female genital tract. Infections due to Actinomyces are usually associated with the breakdown of normal physical barriers, such as disruption of mucosal membranes in the mouth and gastrointestinal tract. The major sites of actinomycoses are cervicofacial, abdominopelvic, and thoracic sites, where it usually presents with the development of an abscess, a draining sinus tract, fistulae, and tissue fibrosis.1 Less common sites of actinomycotic infection include the central nervous system (CNS) and musculoskeletal soft tissue. In Korea, only two cases of CNS actinomycoses have been reported.2,3 Herein, we report a rare case of CNS actinomycosis that caused a cerebral abscess.

We have performed this study to define the usefulness of an anti-human progenitor cell antigen-1(anti-CD34) to distinguish some kinds of soft tissue tumors in formalin-fixed, paraffin-embedded tissues. Sixty three cases of vascular, fibrohistiocytic, neural and other tumors were immunostained for CD34 using the streptavidin-biotin immunoperoxidase method. All of the vascular tumors including hemangiomas, epithelioid hemangioendotheliomas, hemangiopericytomas, and lymphangiomas revealed strong CD34 positivity along the cytoplasmic membranes. Among the fibrohistiocytic lesions, all of five examples of dermatofibrosarcoma protuberans showed diffuse, strong, and linear staining along the cytoplasmic processes. In contrast, none of the benign fibrous histiocytomas and malignant fibrous histiocytomas expressed CD34. CD34-positive cells with delicate dendritic processes could be identified within the normal nerves, neuromas, neurofibromas, and Antoni B areas of neurilemomas. However, all of the malignant peripheral nerve sheath tumors were uniformly negative. In addition, an epithelioid sarcoma and four cases of leiomyosarcoma revealed focal, weak positivity with anti-CD34. In conclusion, this study demonstrated variable anti-CD34 staining pattern of certain fibrohistiocytic, muscle, and neural tumors and confirmed the potential usefulness of anti-CD34 in differentiating fibrous histiocytoma from dermatofibrosarcoma protuberans. It's also helpful to diagnose epithelioid hemangioendothelioma from other epithelioid-type tumors.

Osteocalcin is one of the most abundant noncollagenous proteins found in adult bone. It is a highly conserved gamma-carboxyglutamic acid-containing protein that is believed to be produced exclusively by osteoblasts. In this study, intracellular and extracellular localization of osteocalcin in osteosarcoma was examined with anti-osteocalcin antibody and in situ hybridization using a synthetic oligonucleotide. Immunohistochemically, osteoblastic osteosarcomas were all positive for osteocalcin. The chondroblastic osteosarcomas were positive on the neoplastic chondrocytes. The five fibroblastic osteosarcomas out of seven were positive for osteocalcin immunostaining over the neoplastic spindle cells. Five cases of osteoblastic osteosarcomas out of seven were positive for osteocalcin in situ hybridization. Two cases of chondroblastic osteosarcomas and three cases of fibroblastic osteosarcomas were positive for in situ demonstration of osteocalcin. The malignant tumor giant cells were positive for osteocalcin immunostaining 83%. They were also positive for in situ hybridization. The benign giant cells in five giant cell tumors and five aneurysmal bone cysts were negative for osteocalcin immunostaining. The benign giant cells in three chondroblastoma and three Paget's disease were positive for osteocalcin. In this study, the osteocalcin in situ hybridization and immunostaining has very important meaning for making differential diagnoses of, especially giant cell rich bone forming tumors.

A case of well-differentiated osteosarcoma of the sphenoid bone was reported. The pathological differentiation of this rare entity from fibrous dysplasia, the radiographic appearance, and the differential diagnosis were discussed.

A total of 471 cases of colonic adenocarcinomas and 28 cases of colonic adenomas were examined immunohistochemically to evaluate the expression of p53 protein in the light of their relationship with various prognostic factors. A monoclonal antibody, p53 DO-7, was used in the study. Two hundred and fourteen adenocarcinomas (45.5%) showed positive staining for p53, however only three of the adenomas (10.3%) were positive (P < 0.05). p53 was stained to neoplastic nuclei. Adjacent normal mucosal cells were negative. There were no significant correlations between p53 expression and prognostic parameters such as age, sex, gross configuration, modified Astler-Coller stages, microscopic tumor growth patterns, tumor depth, tumor size and lymph node involvements. However, left sided adenocarcinomas (49.3%) expressed p53 more often than right sided adenocarcinomas (35.6%) (P = 0.01). The positive rates were different according to the histologic differentiation; 45.2% in well differentiated, 51.3% in moderately well differentiated, 23.8% in poorly differentiated, and 26.5% in mucinous carcinomas (P = 0.011). The mean survival periods of the p53 positive and negative groups were 29 months and 32 months, respectively (P = 0.385). However, overall survival for patients with grade one and two positive p53 was better than those of grade three and four positive cases (P = 0.028). In conclusion, the result of this multivariate analysis suggests that immunohistochemically strong p53 protein expression (more than 30% of tumor cells) has value in estimating a prognosis for patients with colorectal adenocarcinomas.

Small cell osteosarcoma is rare, representing 1-4% of all osteosarcomas. We experienced a case of small cell osteosarcoma in an 8-year-old girl on her calcaneus. Histologically, the tumor consists of small round cells that resemble those of Ewing's sarcoma, and variable foci of lacy osteoid formation between tumor cells. The rare location, histologic characteristics and differential diagnostic points are discussed.