Sung-Hye Park

Spinal epidural cavernous hemangioma: MR findings.

Purpose Cavernous hemangiomas with a spinal epidural location are very uncommon vascular tumors in contrast to those in the vertebral body. The purpose of this study was to describe the radiologic findings, focusing on the MR studies, of spinal epidural cavernous hemangiomas. Method Five pathologically proven cases of spinal epidural cavernous hemangioma were retrospectively reviewed. MR (n = 5) and CT (n = 1) were evaluated. Results The level was thoracic (n = 4) or lumbosacral (n = 1). The mass was located in the epidural space and showed paravertebral extension in all cases. It showed a lobulated contour in all cases and encircled the spinal cord partially with a larger posterior (n = 3) or anterior (n = 1) component in four cases. In all cases, the mass showed high signal intensity on T2-weighted images and homogeneous, strong enhancement. Adjacent bony erosion (n = 5) and intervertebral neural foraminal widening (n = 4) were common. Conclusion Spinal epidural cavernous hemangioma shows characteristic MR findings of a lobulated contoured epidural mass partially encircling the spinal cord with a larger posterior component in the spinal canal, high signal intensity on T2-wieghted images, and homogeneous, strong enhancement.

Down regulation of Bc12 expression in invasive ductal carcinomas is both estrogen- and progesterone-receptor dependent and associated with poor prognostic factors

In normal breast, Bcl2 is expressed in the non-pregnant and non-involuting mammary epithelium. The exact mechanism and the effect of the down regulation of the Bcl2 expression on breast cancer cells are not clearly defined. We compared down regulation as well as the persistent expression of Bcl2 with ER, PR, p53, and c-erb-B2 overexpression and clinicopathologic variables, and tumor stage in 11 cases of ductal carcinomas in situ (DCIS) and 44 cases of invasive ductal carcinomas (IDC) of Korean women by immunohistochemical studies. Bcl2 down regulation was found in 39% of IDC and in 18% of DCIS cases. In IDC, while persistent Bcl2 expression was displayed in 95% and 78.9% of ER and PR immunoreactive ones and 71.9 % of c-erb-B2 immnonegative ones. Seventeen cases of Bcl2 down regulated IDC had a significant correlation with ER negativity (94.1%), PR negativity, (76.5%), and high nuclear (61.1% is grade III) and histological grade (76% is grade III). However, in DCIS, no significant correlation between the Bcl2 expression and various parameters were obtained, probably due to small sample size. In conclusion, the Bcl2 expression was both ER and PR dependent and down regulation of Bcl2 in IDC was significantly correlated with poor prognostic factors.

Suprasellar Chordoid Glioma Combined with Rathke's Cleft Cyst

Chordoid glioma has been recently described as a slow‐growing neoplasm with chordoid appearance, occurring exclusively in the regions of the third ventricle and hypothalamus of middle‐aged women. We experienced a case of a  48‐year‐old  woman  with  a  suprasellar  tumor  composed of chordoid glioma and Rathkes cleft cyst, which was confirmed by histopathological, immunohistochemical and electron microscopic examinations. Histologically, chordoid glioma comprised the major part of the tumor, and the prominent Rathkes cleft cysts were distributed focally in the same tumor tissue without any transitions. Chordoid glioma was immunoreactive for glial fibrillary acidic protein, S‐100 protein and vimentin, and focally positive for epithelial membrane antigen and CD34, while cytokeratin highlighted epithelial cells lining Rathkes cleft cysts. Ultrastructural examination of the chordoid glioma revealed short cytoplasmic processes, intermediate filaments, intercellular junctions of zonular adherens type, basal lamina, secretory granules and pinocytic vesicles. The ultrastructural observations of the current case are similar to those of the subcommisural organ, although cell body zonation or microvilli were not evident. The coexistence of chordoid glioma and Rathkes cleft cyst has not been reported previously and may represent a collision tumor.

Tumors of the Central Nervous System in Korea A Multicenter Study of 3221 Cases.

The Neuropathology Study Group of the Korean Society of Pathologists conducted a nationwide collection of central nervous system (CNS) tumors to evaluate the relative frequency in Korea of CNS tumors belonging to the revised World Health Organization (WHO) classification categories. A total of 3221 histologically proven cases of CNS tumors were collected from 13 institutes between 1997 and 1998. All the cases were classified according to the revised WHO histological types and analyzed for the relative frequency, the distribution of age and sex, and location of tumors. The most frequent type of CNS tumors in Korea was meningiomas, followed by pituitary adenoma, glioblastoma, astrocytoma, and schwannoma. Among the pediatric CNS tumors, pilocytic astrocytoma, medulloblastoma, craniopharyngioma, germ cell tumors, and ependymomas were common types of tumors. Compared with a previous nationwide study, the rates for neuronal/glial tumors, glioblastoma, malignant lymphoma, and cystic lesion were increased, and the rate of embryonal tumors was decreased. The overall male to female ratio was 0.9 : 1, which may be attributed to the greater number of female-predominate meningiomas and pituitary adenoma. Compared with Western countries, Koreans had higher rates of pituitary adenoma and meningiomas and lower rate of gliomas. The relative frequency of CNS tumors among Koreans is very similar to that reported in Taiwan. The occurrence rates for various subtypes of CNS tumors in Korea are distinct from those in the United States and Europe and similar in many ways to those in Asian and Mexican population.

Choroid plexus papilloma in the posterior cranial fossa: MR, CT, and angiographic findings

In this study, we reviewed the magnetic resonance (MR, n=5), computed tomography (CT, n=3), and angiography (n=3) of six patients with pathologically confirmed choroid plexus papilloma (CPP) in the posterior cranial fossa. CPPs in the posterior cranial fossa have several features, including a propensity to arise at the foramen of Luschka with extraventricular extension, occasional peritumoral signal voids/cysts or calcification, weaker enhancement on MR or CT, and less strong tumor staining by the anterior or posterior inferior cerebellar artery or angiography.

Apoptosis in Thymic Epithelial Tumors

We studied Fas/FasL, Bcl-2, and M30 CytoDeath in five cases of normal thymus and 41 cases of thymic epithelial tumors (TETs). In normal thymus, Fas was expressed in all epithelial cells, but not in thymic lymphocytes; FasL was weakly expressed only in medullary epithelium and Hassals corpuscles. In TETs, Fas was expressed in all epithelial cells and lymphocytes, while FasL was differently expressed in epithelial cells of different subtypes of TETs, i.e., type A (2/2), AB (12/12), B1 (0/9), B1/B2 (0/3), B2 (0/1), B2/B3 (1/3), B3 (6/10) and C (1/1), but not in lymphocytes. Bcl2 protein was strongly expressed in medullary-derived lymphocytes of normal thymus and TETs, and weakly expressed only in medullary (spindle) epithelium of TETs. On M30 CytoDeath immunostaining, apoptotic indices were very low in all TETs (0-1.2). In conclusion, since FasL was expressed on the epithelial cells of lymphocyte-depleted (LD) areas of type B2/B3 and/or LD subtypes (type A, AB, B3, C), FasL expression could be relevant for the intracytoplasmic processes of T-cell selection and the regulation of the lymphoid cells inside the tumor, at least partly. However, tumorigenesis of TETs is not necessarily induced by abrogation of apoptosis.

Ultrastructural study of Rasmussen encephalitis.

Rasmussen encephalitis (RE) is a well-known cause of seizures in children, manifesting histopathology of chronic inflammation of the brain. Its etiology remains unknown. Many reports have suggested the possibility of etiological heterogeneity of this disorder, including the possibility that it is caused by viral infection of the central nervous system, autoimmune phenomena, or a combination of both. The authors report ultrastructural study of 12 cases of RE. They identified most of the features of RE that have been described at the light microscopic level, but did not find any evidence of viral particles, immune complex deposits, or disruption of the blood-brain barrier except in 3 cases: intranuclear (intraneuronal) measle virus-like particles were seen in 1 patient, an electron-dense deposit in the basement membrane of the capillary of another, and a tubuloreticular body in the endothelium of a brain parenchymal capillary in a third (the first 2 rather exceptional findings were previously reported). At present, these appear to be rare findings and not reliable features of RE ultrastructure. The authors also investigated evidence of programmed cell death (apoptosis) of neurons, but only nonspecific degenerative changes of the neurons were found. At present, despite interesting light microscopic and ultrastructural features of RE, its pathogenesis remains cryptogenic.