Keum Ha Choi

Association between Elevated Pleural Interleukin-33 Levels and Tuberculous Pleurisy

Background Interferon-γ (IFN-γ) plays a crucial role in Mycobacterium tuberculosis induced pleural responses. Interleukin (IL)-33 up-regulates the production of IFN-γ. We aimed to identify whether an association between pleural IL-33 levels and tuberculous pleurisy exists and determine its diagnostic value. Methods Pleural IL-33, ST2 (a receptor of IL-33), adenosine deaminase (ADA), and IFN-γ, as well as serum IL-33 and ST2 were measured in 220 patients with pleural effusions (PEs). Patients with malignant (MPEs), parapneumonic (PPEs), tuberculous (TPEs), and cardiogenic (CPEs) pleural effusions were included. Results Pleural and serum IL-33 levels were highest or tended to be higher in patients with TPEs than in those with other types of PEs. The median pleural fluid-to-serum IL-33 ratio was higher in TPE cases (≥ 0.91) than in other PE cases (≤ 0.56). Pleural IL-33 levels correlated with those of pleural ADA and IFN-γ. However, the diagnostic accuracies of pleural IL-33 (0.74) and pleural fluid-to-serum IL-33 ratio (0.75) were lower than that of ADA (0.95) or IFN-γ (0.97). Pleural ST2 levels in patients with MPEs were higher than in patients with TPEs. Serum ST2 levels did not differ among the groups. Conclusions We identified an association between elevated pleural IL-33 levels and tuberculous pleurisy. However, we recommend conventional pleural markers (ADA or IFN-γ) as diagnostic markers of TPE.

Reactive lymphoid hyperplasia of the liver

Reactive lymphoid hyperplasia (RLH) is a rare benign condition that forms a mass-like lesion characterized by proliferation of non-neoplastic lymphocytes forming follicles and germinal centers. RLH is thought to represent a reactive immunological response, and some cases may arise in association with malignancy and hepatitis.1 Radiologically, RLH of the liver may mimic a primary or metastatic hepatic malignancy. Therefore, it is very difficult to diagnose correctly without pathological examination. In this issue, we present a case of hepatic RLH and discuss the histopathologic findings with a review of the literatures.

Preoperative embolization of a cerebellar haemangioblastoma using Onyx: case report and literature review

Haemangioblastoma is a slow-growing, highly vascular tumour and typically occurs in the cerebellum but can also occur in the brainstem and spinal cord. Because of their hypervascularity and location, cerebellar haemangioblastomas can be difficult to remove. The purpose of preoperative embolization of haemangioblastomas is to decrease the intraoperative blood loss and to facilitate excision. However, the safety and efficacy of this procedure remain controversial. Here, we report the case of a man with cerebellar haemangioblastoma who underwent preoperative embolization with Onyx. The tumour was completely removed with minimal tumour bleeding. There was no complication related to embolization.

Laparoscopic resection of ancient schwannoma embedded in the psoas muscle.

Schwannoma is a tumor originating from the Schwann cell of the peripheral nerve sheath. The diagnosis of schwannoma is based on histologic analysis of surgically excised sample. Retroperitoneal ancient schwannoma, a variant of schwannoma, is rarely observed in clinical practice. We report the case of a 46-year-old man with a retroperitoneal tumor embedded in the psoas muscle, which was treated by laparoscopic resection. The operative result was good, and pathologic analysis revealed a 5.5×4.5 cm ancient schwannoma.

Elevated Prx1 Provides Resistance to Docetaxel, But Is Not Associated with Predictive Significance in Lung Cancer

Background This study was conducted in order to elucidate the effects of docetaxel on the growth of peroxiredoxin 1 (Prx1) knockdown A549 xenograft tumors and further tested the role of Prx1 as a predictor for how a patient would respond to docetaxel treatment. Methods Effects of docetaxel on the growth of scrambled- and shPrx1-infected A549 xenograft tumors in nude mice were measured. Moreover, immunohistochemical expression of Prx1 was evaluated in paraffin-embedded tissues from 24 non-small cell lung cancer patients who had received docetaxel-cisplatin regimens as a first-line treatment. Results Docetaxel treatment in Prx1 knockdown xenograft tumor resulted in reduced tumors growth compared with other groups. Prx1 knockdown increased the production of cleaved caspases-8 and -9 in the control itself compared to scramble tumors. Moreover, docetaxel treatment in Prx1 knockdown tissue led to an increased protein band. Phosphorylated Akt was found in Prx1 scramble tissues. Phosphorylated FOXO1 was detected in the docetaxel treatment group. On the other hand, Prx1 knockdown completely suppressed the Akt-FOXO1 axis. The median progression-free survival (PFS) of patients with low Prx1 expression was 7 months (95% confidence interval [CI], 6.0-7.7), whereas the median progression-free survival of patients with high Prx1 expression was 4 months (95% CI, 4.0-5.0). However, high Prx1 expression was not associated with decreased PFS (p=0.114). Conclusion Our findings suggest that elevated Prx1 provides resistance to docetaxel treatment through suppression of FOXO1-induced apoptosis in A549 xenograft tumors, but may not be related with the predictive significance for response to docetaxel treatment.

Co-development of autoimmune hepatitis and Sjögren's syndrome triggered by the administration of herbal medicines.

Autoimmune hepatitis (AIH) has been reported in association with Sjögrens syndrome (SS). Drug-induced AIH has been rarely reported. A rare case of the co-development of AIH and SS in a 53-year-old woman after the consumption of herbal medicines is described. After admission, the patient complained of dryness in her mouth, and she was subsequently diagnosed with SS, which had not been detected previously. The patients bilirubin and aminotransferase levels initially decreased following conservative management; however, they later began to progressively increase. A diagnosis of AIH was made based on the scoring system proposed by the International Autoimmune Hepatitis Group. The patient was administered a combination of prednisolone and azathioprine, and the results of follow-up liver-function tests were found to be within the normal range. This is an unusual case of AIH and SS triggered simultaneously by the administration of herbal medicines.

Epithelioid hemangioendothelioma of the liver

Epithelioid hemangioendothelioma is an uncommon vascular tumor of intermediate malignant potential.1-3 Hepatic epithelioid hemangioendothelioma (HEHE), a rare sarcoma of the liver, usually appears as multiple nodules involving both hepatic lobes, and can be misdiagnosed as metastatic carcinoma on the basis of its radiologic manifestations. HEHE is composed of neoplastic endothelial cells that closely resemble epithelial cells, and shows a characteristic zoning phenomenon. At the periphery, the tumor cells infiltrate preexisting sinusoids and terminal hepatic venules. The center reveals a marked desmoplastic stromal reaction with dense sclerosis, and these findings may mimic those of cholangiocarcinoma. Therefore, confirming that the tumor is of vascular origin using immunohistochemical staining for endothelial cell markers is critical for accurately diagnosing HEHE. In this issue, we present a case of HEHE in a 44-year-old woman and discuss the histopathologic findings.

Pleomorphic malignant fibrous histiocytoma/undifferentiated pleomorphic sarcoma of the glans penis

Primary sarcoma of the penis has an extremely low incidence, and its diagnosis and treatment are unclear. A 55-year-old man presented with an oval-shaped mass of the glans penis, which was treated by a wide excision. The pathologic result revealed an undifferentiated high-grade sarcoma, which was diagnosed as a pleomorphic malignant fibrous histiocytoma/undifferentiated pleomorphic sarcoma based on the World Health Organization classification. There was no recurrence at the12-months postoperative follow-up.

¹⁸F-FDG PET/CT imaging for mixed germ cell tumor in the pineal region.

Primary germ cell tumor (GCT) in the pineal region is very rare among all primary intracranial neoplasms. Here, we present the 18F-FDG PET/CT findings of a pineal mixed GCT in a 14-year-old boy. PET/CT showed little uptake of 18F-FDG in the mass in the pineal region, whereas MR imaging showed contra

Hepatic Alanine Differentiates Nonalcoholic Steatohepatitis From Simple Steatosis in Humans and Mice: A Proton MR Spectroscopy Study With Long Echo Time

To evaluate the hepatic metabolic alterations in nonalcoholic fatty liver disease (NAFLD) by using 1H‐MRS (proton magnetic resonance spectroscopy) with long echo time and to test the reproducibility of human study in an animal model. Liver biopsy is the gold standard for diagnosing NAFLD but with practical constraints. 1H‐MRS allows in vivo assessment of hepatocellular metabolism and has shown potential for biochemical differentiation in diffuse liver disease.