Nongastric marginal zone B-cell lymphoma (NG-MZL) is a relatively uncommon indolent lymphoma. From 1990 to 2005, a total of 247 patients with histologically confirmed NG-MZL were analyzed. Ann Arbor stage I/II disease was present in 78% (167 out of 215). One hundred eighty-six patients out of two hundred eight were categorized into the low/low-intermediate risk group (89%) according to International Prognostic Index (IPI). Eighty percent (172/215) were in low risk group according to Follicular Lymphoma International Prognostic Index (FLIPI). Complete and partial remissions (CR and PR) were achieved in 140 (92.7%) and 8 (5.3%) of the 151 stage I/II patients. Especially, radiation containing treatment achieved 96% CR rate (108 out of 113). In 38 patients with stage III/IV, CR and PR were achieved in 17 (44.7%) and 11 (26.3%), respectively. The estimated five-year overall survival (OS) and progression-free survival (PFS) were 93.8% and 70.1%, respectively. Although anthracycline-containing regimen could achieve higher CR rate, it did not improve PFS. Stage III/IV, low hemoglobin, poor performance status, high/high-intermediate IPI, poor risk FLIPI, and nodal MZL were poor prognostic factors for PFS. NG-MZL is an indolent disease. FLIPI has strong power to predict the prognosis of NG-MZL.
To the Editor: Osteolipoma (OL) is a rare histological variant of lipoma, and it has numerous synonyms including the following: ossifying lipoma, osseous lipoma, lipoma with osseous metaplasia, and osteolipomatous hamartoma.1 It was first described by Plant in 1958.2 It usually presents as painless well-circumscribed nodular masses.3 Histopathologically, OL presents as lipoma with osseous components. It is characterized by proliferating mature adipose tissue with bone trabeculae.4 We report the rare case of a patient with OL that presented as multiple papules on the cheeks and had unique histological features. A 61-year-old woman presented with a 1-year history of asymptomatic erythematous papules on both cheeks (Figs. 1A, B). The patient had no specific medical history and no history of previous treatment of the lesions. A 3-mm punch biopsy specimen revealed cancellous concentrically layered bone tissue enclosing mature adipose tissue with no cellular atypia. Scanty lymphocytic infiltration was also observed in the adipose tissue (Figs. 2A, B). The patient was diagnosed with OL, but she refused further radiographic examination to determine the position, distribution, and treatment of the lesions. She was finally referred to another hospital for reconfirmation of the diagnosis, and rebiopsy was consistent with the earlier diagnosis.FIGURE 1.: Clinical pictures of the case. A and B, Multiple erythematous papules on the cheek (The biopsy specimen was obtained from the red annular pen-marked lesion).FIGURE 2.: Histological pictures of the case. A, Concentric layer of bony trabeculae in subcutaneous layer [hematoxylin and eosin (H&E), magnification ×10]. B, Cancellous bony trabeculae enclosing mature adipocytes without cellular atypia (H&E, magnification ×100).OL is a rare variant of lipoma and constitutes only 1% of all lipomas.5 OL has been known to occur in a variety of regions such as the skull, neck, suprasellar region, vertebral spine, forearm, knee, and oral regions, but it is rarely known to occur in the facial area.6–8 There are hitherto only 2 reports of OL that occurred on the face; 1 on the eyelid and 1 on the glabella. In both cases, the OL were removed by excision,7,8 which is the treatment of choice.6 In most cases, the diameter of OL is 0.8–20 cm9; however, the diameter of the papules in our patient was less than 0.3 cm. Our patient refused treatment out of fear of having multiple scars on her face because the lesions had a wide distribution. This is in contrast to the solitary lesions described in most of the patients in previous reports. The characteristic histological features of OL include predominantly mature adipose components with irregularly distributed mature lamellar bone tissue. However, in our patient, bone formation was uniform with a concentric layer enclosing the adipose marrow, and earlier reports describe only few cases of OL with concentric bone tissue layers.4,8,9 The differential diagnoses of OL include atypical lipomatous tumors, lipofibromatous hamartoma of the nerve, and osteosarcoma.6,9 Mature adipose tissue without cellular atypia or neural fibrosis and mature lamellar bone without osteoid matrix are other features of OL. Exclusion of the differential diagnoses in the case of our patient was based on the findings of histological examination. The pathogenesis of OL is still unclear, but some hypotheses have been proposed. Some hypotheses suggest that OL originates from multipotent undifferentiated mesenchymal cells, while others suggest that OL results from mesenchymal cells that have been altered by systemic or local stimuli such as trauma, chronic irritation, and hormonal factors like osteoinducing factors.3,4,6,8 Although our case is limited by the lack of radiographic examination of the multiple lesions due to patient refusal, our case still shows that OL should be considered in the differential diagnosis of multiple erythematous papules on the face. To the best of our knowledge, there has been no report of multiple tiny osteolipomas found on the face. In this report, we present the first case of OL as multiple erythematous papules on the cheeks.
We aimed to examine the effect of gum chewing after laparoscopic colorectal cancer surgery.We reviewed the medical records of patients who underwent laparoscopic colorectal cancer surgery in Incheon St. Mary's Hospital, The Catholic University of Korea School of Medicine. We divided the patients into 2 groups: group A consisted of 67 patients who did not chew gum; group B consisted of 65 patients who chewed gum. We analyzed the short-term clinical outcomes between the two groups to evaluate the effect of gum chewing.The first passage of gas was slightly earlier in group B, but the difference was not significant. However, the length of hospital stay was 6.7 days in group B, which was significantly shorter than that in group A (7.3 days, P = 0.018).This study showed that length of postoperative hospital stay was shorter in the gum-chewing group. In future studies, we expect to elucidate the effect of gum chewing on the postoperative recovery more clearly.
immunoglobulin heavy chain gene rearrangement and B-cell lymphoma 2 staining would be helpful to make the diagnosis clear 4 .In summary, a diagnosis of CP should be considered when dermatologists encounter cases of asymptomatic neuronal pigment dermatosis.We speculate that further investigations on the association of the neural pathway with respect to the pathophysiology would be helpful to improve our understanding about CP.
Summary Introduction Latanoprost is a prostaglandin F2α analogue, which has been used as a first‐line drug for open‐angle glaucoma. Common side effects of latanoprost include hyperpigmentation. While it usually occurs on irides or periocular skin, diffuse facial hyperpigmentation is rarely reported. Case presentation A 71‐year‐old woman was presented with diffuse gray‐brown colored maculopatches on her face. The symptom appeared 1 week after she started to use latanoprost eye drops for glaucoma. Biopsy specimen revealed vacuolar degeneration of dermo‐epidermal junction and pigment incontinence in dermis. Objective The aim of this paper is to introduce a rare adverse effect of latanoprost and effective way of treatment. Methods We stopped her from using latanoprost. She was also treated with 532‐nm potassium titanyl phosphate laser and low‐fluence 1064‐nm Q‐switched Nd:YAG laser, while using topical agents. Result After 10 weeks, we observed hyperpigmentation of her face was effectively and safely treated. The patient was satisfied with the result. Conclusion Diffuse facial pigmentation could be one of the latanoprost‐induced adverse effects and the laser treatments with topical agents we used can make it improve faster.
Multinucleate cell angiohistiocytoma (MCAH) is a rare cutaneous disease entity characterized by multiple red‐to‐brown or violaceous papules usually located on the acral regions, such as the face and the distal arms and legs. It affects elderly women more than men and rarely occurs at a young age. The exact pathogenic mechanism of MCAH is not yet clearly understood. We report an exceptionally rare case of a 14‐year‐old boy who presented with multiple asymptomatic erythematous papules and a single flat brownish plaque on the left chest. The brownish plaque lesion histologically showed proliferation of dilated small vessels in the upper‐mid dermis and numerous oddly shaped multinucleate cells intermingled with lymphocytes and macrophages. The erythematous papules also showed dilated small vessels in the upper‐mid dermis and multiple interstitial histiocytic infiltrations, but no multinucleate cells were detected. In immunohistochemistry studies, CD68 and vimentin staining were positive for both specimens. Based on the clinicopathological findings and immunohistochemistry studies, MCAH was diagnosed. To the best of our knowledge, this is the first case report of MCAH occurring in young age and showing two different clinical and histological phases at the same time.
<b><i>Background:</i></b> Because many physicians seem reluctant to recommend splenectomy for elderly patients with immune thrombocytopenia (ITP), we investigated the safety and efficacy of splenectomy and the predictive factors for response in these patients. <b><i>Methods:</i></b> 184 patients with primary ITP were retrospectively analyzed based on age at splenectomy: an elderly group (≥60 years, n = 52) and a younger group (<60 years, n = 132). <b><i>Results:</i></b> There was no difference in the response rate of elderly versus younger patients (80.7 vs. 80.3%, p = 0.466). Relapse (45.2 vs. 22.6%, p = 0.006), complications, and median postoperative stay (9.5 vs. 7 days, p = 0.019) were significantly higher in the elderly group. The 5-year relapse-free survival of responders was 51.8% in the elderly group and 76.3% in the younger group (p = 0.002). Response to any treatment before splenectomy (HR 2.9, 95% CI: 1.24-6.80, p = 0.014) and platelet count on postoperative day 14 ≥200 × 10<sup>9</sup>/l (HR 31.43, 95% CI: 4.15-238.28, p = 0.001) were independent factors for a favorable response. <b><i>Conclusions:</i></b> Age ≥60 years did not influence the response to splenectomy but was associated with increased relapse and postoperative complications. Splenectomy could provide a durable long-term response for elderly ITP patients.
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