In the cases of infants and children, there is a special form of accidental asphyxia that occurs in an unsafe sleeping environment. Rarely, some infants and children unexpectedly die in the day care centers. This also occurs during the process when teachers put the infants and children to sleep. This analysis was performed on national forensic autopsy cases from January 1, 2001, to October 31, 2022. The 97,402 cases were selected to provide their incident overview, the cause of death and the manner of death. The cases of infants and children asphyxia at day care centers were 43 cases (0.04%). The major cause of death was sudden infants and children death syndrome which included the possibility of accidental asphyxia (31 cases). This was followed by chocking (8 cases), complicated asphyxia (2 cases), smothering (1 case), and positional asphyxia (1 case). Two cases were a result of homicide, 10 cases were accidents, and 31 cases had unknown manner of death. There were four cases of asphyxia that occurred in the process of teachers putting infants and children to sleep. In all cases, there were no specific findings in the autopsy and there were CCTV footage including contact with the day care center teacher while taking a nap. Reporting these results provides information and awareness to social members related with infants and children, specially day care centers, and serves as basis for establishing social systems such as mandatory of CCTVs, helping to reduce the occurrence of similar death on infants and children.

Nicotine is a water-soluble alkaloid extracted from tobacco plants, and most frequently encountered in snuff, chewing tobacco, cigarettes, cigars and pipe tobacco or in a limited number of pesticides. Nicotine overdose or poisoning might be serious or fatal and lead to death; caused by cardiovascular arrest, respiratory muscle paralysis, and/or central respiratory failure due to its toxic effect. Suicide by nicotine ingestion has been rarely reported due to emetic response. We present a case of suicidal nicotine poisoning. A 56-year-old man was found dead and the postmortem examination revealed no injury or disease. We confirmed a high concentration of nicotine in the toxicological test. Through scene investigation, we determined this case as a suicidal nicotine poisoning.

Sarcomatoid carcinoma is a rare malignant tumor that has both malignant epithelial and mesenchymal components.We describe a sarcomatoid carcinoma arising in the right renal pelvis of a 68-year-old man.The dominant component of the tumor was osteosarcomatous, but there were also focal carcinomatous areas.The sarcomatous tumor cells produced abundant osteoid matrix surrounded by osteoblastic cells.The carcinomatous tumor cells consisted of papillary urothelial carcinoma.Immunohistochemical assay showed that the sarcomatous tumor cells were positive for vimentin and negative for cytokeratin.The papillary urothelial carcinoma was positive for cytokeratin and negative for vimentin.After surgery, the patient underwent adjuvant chemotherapy.Four months later, he presented with recurrence in the right subphrenic area and metastasis in the right middle lobe of the lung.

Cytomegalovirus (CMV) infection of the gastrointestinal tract has been reported most frequently in the setting of immunodeficiency. The whole gastrointestinal tract can be affected; however, the small bowel is rarely affected. We report a case of CMV enteritis with jejunal perforation in a 53-year-old woman with a history of chemoradiation therapy for endometrial cancer 8 years previously. At follow-up evaluation, lower abdominal pain, diarrhea and vomiting appeared. Abdominal computed tomography showed intra-abdominal free air in the subphrenic space and porta hepatis. The jejunal segment revealed serosal purulent exudates with a perforation. The resected jejunal segment showed a large geographic ulcerative mucosal lesion. The microscopic findings revealed a diffuse ulcerative mucosal change with a prominent granulation tissue formation and many large atypical vascular endothelial cells and stromal fibroblasts with intranuclear or intracytoplasmic inclusion bodies. These cells were positive for CMV antibody. The final diagnosis was CMV-associated jejunitis with a jejunal perforation.

Splenic hamartoma is a rare benign malformation, composed of an anomalous mixture of normal splenic elements, often found incidentally while working up other complaints or at autopsy. A splenic mass was incidentally found while evaluating the effects of a traffic accident in a 63-year-old woman. Abdominal computed tomography revealed a well-defined splenic mass with rim enhancement. The patient underwent splenectomy. The resected spleen contained a well-defined mass lesion measuring 3.5 cm × 3.0 cm. Microscopic examination revealed disorganized slit-like vascular channels lined by plump endothelial cells without atypia. The cells lining the vascular channels were positive for CD8, CD31, CD34 and vimentin. Endothelial cells that are positive for CD8 are a key feature that differentiates hamartoma from other vascular lesions of the spleen. Although this tumor is very rare, it must be included in the differential diagnosis of splenic mass-forming lesions.

AIMS:Cell adhesion molecule 4 (CADM4) is a novel tumour suppressor. The purpose of this study was to investigate the correlation between its expression and the expression of E-cadherin and Ki-67 in colorectal adenocarcinomas, as well as its effect on patient survival. METHODS:We evaluated CADM4 expression in tissue microarrays of 513 colorectal adenocarcinomas by immunohistochemistry. RESULTS:CADM4 was highly expressed in 210 of the 513 colorectal adenocarcinomas; expression was reduced in 185 cases and absent in the remaining cases. Loss of CADM4 expression was correlated with larger tumour size (6.2±2.1 cm vs 5.3±2.0 cm, p<0.001), mucinous tumour type (61.5% vs 20.9%, p<0.001), lymph node metastasis (31.4% vs 20.9%, p=0.022), higher Dukes stage (25.5% vs 19.6%, p=0.044), poorer differentiation (38.5% vs 18.8%, p<0.001), absence of E-cadherin expression (28.5% vs 16.0%, p=0.007) and presence of Ki-67 expression (27.3% vs 12.3%, p<0.001). In univariable Cox regression analysis, absence of CADM4 expression was associated with poorer overall survival (HR 0.712; 95% CI 0.512 to 0.989, p=0.042) and disease-free survival (HR 0.732; 95% CI 0.546 to 0.981, p=0.037). In multivariate analysis with the Cox proportional hazards model, CADM4 expression was not an independent prognostic factor of overall survival (HR 0.726; 95% CI 0.516 to 1.021, p=0.066) and disease-free survival (HR 0.762; 95% CI 0.563 to 1.033, p=0.080). CONCLUSIONS:Loss of CADM4 expression is relatively frequent in colorectal adenocarcinomas and may play an important role in cancer progression and patient survival.

Purpose Glucose uptake and glycolytic metabolism are enhanced in cancer cells, and increased expression of glucose transporter 1 (GLUT1) has also been reported. The aim of this study was to investigate GLUT1 expression in human breast tissues and invasive ductal carcinomas. Methods We used tissue microarrays consisting of normal breast tissue, ductal hyperplasia, ductal carcinoma in situ, invasive ductal carcinoma, and lymph node metastases. We examined GLUT1 expression in the microarrays by immunohistochemistry, reviewed the medical records and performed a clinicopathological analysis. Results Membranous GLUT1 expression was observed in normal and tumor cells. GLUT1 expression was higher in ductal carcinoma in situ, invasive ductal carcinoma, and lymph node metastasis than in normal tissue and ductal hyperplasia (p=0.002). Of 276 invasive ductal carcinomas, 106 (38.4%) showed GLUT1 expression. GLUT1 expression was correlated with higher histologic grade (p<0.001), larger tumor size (p=0.025), absence of estrogen receptor (p<0.001), absence of progesterone receptor (p<0.001), and triple-negative phenotype (p<0.001). In univariate survival analysis, patients with GLUT1 expression had poorer overall survival and disease-free survival (p=0.017 and p=0.021, respectively, log-rank test). In multivariate survival analysis with the Cox proportional hazards model, GLUT1 expression was an independent prognostic factor of poorer overall survival and disease-free survival (p=0.017 and p=0.019, respectively). Conclusion GLUT1 expression seems to play an important role in malignant transformation, and the glycolytic phenotype in invasive ductal carcinoma may indicate aggressive biological behavior and a worse prognosis.

Castleman's disease is a rare benign lymphoproliferative disorder that frequently affects lymph nodes of the mediastinal thorax and the neck. It very rarely affects the renal sinus. We report a case of Castleman's disease arising in the renal sinus in a 64-year-old man. The patient visited the hospital with the chief complaint of hematuria. Abdominal computed tomography revealed a homogeneous mass in the sinus of the left kidney, radiologically interpreted as a malignant urothelial tumor. Subsequently, nephroureterectomy was performed, after which microscopic examination of the specimen revealed a diffuse lymphoproliferative lesion with reactive lymphoid follicles of various sizes and prominent plasma cell infiltration of interfollicular spaces, highlighted by immunohistochemical staining for CD138. The lesion was diagnosed as Castleman's disease of the plasma cell type. Although preoperative diagnosis of Castleman's disease is difficult and the incidence is exceedingly rare, it should be considered in the differential diagnosis of renal sinus tumors.

ABSTRACT Primary localized amyloidosis of the urinary tract is a rare disease, usually mimicking a malignancy or inflammation in its clinical presentation and in diagnostic imaging studies. We present a case of localized amyloidosis arising in the left upper ureter in a 77‐year‐old man. The patient visited the hospital complaining of painless gross hematuria and dysuria for 1 month. Laboratory examination revealed hematuria only. Urine cytology was unremarkable. Abdominal computed tomography revealed an obstructing mass with calcification in the ureter. The clinical impression was of a ureteral stone or malignancy. A nephroureterectomy was performed. The ureter showed segmental fibrotic thickening with luminal obstruction. Microscopic examination revealed deposition of pale‐eosinophilic amorphous material with calcification and ossification. Congo‐red staining showed amyloid deposits with positive polarizing microscopic findings. Although its incidence is rare, localized amyloidosis should be considered in the differential diagnosis of ureteral tumorous lesions to avoid unnecessary surgery.

Carcinosarcoma of the salivary glands is a rare malignant tumor showing both malignant epithelial and mesenchymal components. Herein, we present a carcinosarcoma of the parotid gland in a 67-year-old man consisting of osteosarcoma and adenocarcinoma components with fine needle aspiration cytological findings. The tumor was composed predominantly of osteosarcoma and small areas of adenocarcinomatous components and a hyalinized nodule reminiscent of pleomorphic adenoma. The tumor showed infiltrative growth features with perineural, lymphatic, and vascular invasion. Despite postoperative adjuvant radiation therapy, multiple metastatic lesions occurred in the both lungs 5 months after surgery. As salivary gland carcinosarcoma has been known to demonstrate highly aggressive behavior, an accurate pathological diagnosis is prerequisite for appropriate treatment.

AIM:To investigate the role of glucose transporter 1 (GLUT1) expression in colorectal carcinogenesis and evaluate the correlation with clinicopathological parameters and apoptosis-activating factor-1 (Apaf-1) expression in colorectal adenocarcinomas. METHODS:We used tissue microarrays consisting of 26 normal mucosa, 50 adenomas, 515 adenocarcinomas, and 127 metastatic lesions.Medical records were reviewed and clinicopathological analysis was performed.RESULTS: GLUT1 expression was absent in normal mucosa and low or moderately apparent in 19 cases (38.0%) of 50 adenomas.However, GLUT1 expression was detected in 423 (82.1%) of 515 adenocarcinomas and in 96 (75.6%) of 127 metastatic lesions.GLUT1 expression was significantly correlated with female gender (P = 0.009), non-mucinous tumor type (P = 0.045), poorer differentiation (P = 0.001), lymph node metastasis (P < 0.001), higher AJCC and Dukes stage (P < 0.001 and P < 0.001, respectively).There was a significant inverse correlation between GLUT1 expression and Apaf-1 expression (P = 0.001).In univariate survival analysis, patients with GLUT1 expression demonstrated poor overall survival and disease-free survival (P = 0.047 and P = 0.021, respectively, log-rank test).CONCLUSION: GLUT1 expression was frequently increased in adenocarcinomas and metastatic lesions.GLUT1 expression was significantly correlated with poorer clinicopathologic phenotypes and survival of patients with colorectal adenocarcinomas.

Lymphangioleiomyoma (LAM) is a rare benign tumor characterized by a disorganized smooth muscle cell proliferation within the walls of pulmonary, mediastinal, and retroperitoneal lymphatic vessels. The mesenteric LAM is a quite unusual presentation. A 47-year-old woman was admitted to our hospital with a 7-year history of abdominal mass. A computed tomography showed a well marginated mass with soft tissue attenuation. Laparoscopic excision was performed. The specimen revealed a well circumscribed dark cystic mass. The cut surface showed a thin walled cystic tumor with haphazardly distributed trabeculated septa. Microscopically, the tumor showed variable sized ectatic spaces lined by flattened endothelial cells and surrounded by epithelioid or spindle-shaped cells. The lining cells were positive for D2-40, CD31, and CD34. The surrounding cells were positive for alpha-smooth muscle actin and human melanoma black-45. The final diagnosis was a solitary LAM arising in the mesentery. The patient showed an uneventful postoperative course for 10 months.

Background and aim: The purpose of this study was to investigate the role of serum response factor (SRF) expression and to evaluate its correlation with various clinicopathological parameters in colorectal adenocarcinomas. Methods: We used tissue microarrays consisting of 24 normal mucosa, 50 tubular adenomas, 496 adenocarcinomas, and 128 metastatic lesions. Results: The expression of SRF was rare in normal colonic mucosa with a mean expression score of 0.67 ± 0.17. Tubular adenomas had a mean expression score of 2.48 ± 0.31, adenocarcinomas 2.82 ± 0.13 and lymph node metastases 2.82 ± 0.36. Interestingly, SRF expression was high in distant metastases with a mean expression score of 4.83 ± 0.43. The mean SRF expression was increased significantly early in the normal-adenoma-carcinoma sequence and again in distant metastases. The positive SRF expression was strongly correlated with non-mucinous tumor type (P < 0.001). Moderately and poorly differentiated adenocarcinomas had higher mean expression scores than well-differentiated adenocarcinomas (2.88 ± 0.13 vs 1.33 ± 0.32) (P= 0.015). There were significant associations between SRF expression and expression of p53 (P= 0.034) and Ki-67 (P= 0.001). Conclusions: Our results suggest that SRF expression may be the early event of normal-adenoma-carcinoma sequence of colorectal cancer, especially in adenomatous change of colonic mucosa and may play an important role in distant metastasis of colorectal cancers.

The aims of this study were to clarify the distribution and spread pattern of metastatic nodes and to evaluate the importance of the number, ratio, and location of positive nodes in ampullary adenocarcinoma. We analyzed the clinicopathologic data and survival of 52 patients who received curative pancreatoduodenectomy for ampullary adenocarcinoma between June 1994 and May 2009. Metastatic lymph nodes were found in 32 (61.5%) patients. The median number of evaluated nodes and positive nodes were 26 (range 10-60) and two (range 1-15), respectively. The most commonly involved nodes were the posterior pancreaticoduodenal nodes (26 patients) followed by the anterior pancreaticoduodenal nodes (11 patients). No positive hepatoduodenal and common hepatic artery nodes were found. In univariate analysis, number of positive nodes, and their ratio and location were significantly associated with survival. Only the factor of three or more metastatic nodes had the independent power in predicting a poor outcome in multivariate analysis (P < 0.001). Ampullary adenocarcinoma first spreads to the posterior pancreaticoduodenal nodes and then the anterior nodes. The number of positive lymph nodes, rather than their ratio and location, independently affects survival after curative resection in patients with ampullary carcinoma.

Non small cell lung cancer (NSCLC) frequently metastasizes to brain, bone, liver, and adrenal glands. While an autopsy of NSCLC reveals some cases of metastasis to the kidney, clinical detection of renal metastases is extremely rare. Furthermore, metastases to the kidney usually present as multifocal or bilateral lesions and solitary renal metastases are usually suspected to be renal cell carcinoma. We now report a case of asymptomatic solitary renal metastasis from a primary squamous cell carcinoma, which was detected by routine surveillance with abdominal CT after curative surgery.

A primitive neuroectodermal tumor (PNET) is a highly malignant tumor in children and young adults, and extremely rare in the spine. We report a case of a primary epidural peripheral PNET of the lumbar spine. The present extremely rare case of primary epidural peripheral PNET of the lumbar spine illustrates the unexpected occurrence and should be included in differential diagnoses for patients with spinal tumors.

Clinicopathological significance of nuclear PTEN expression in colorectal adenocarcinoma Aims: Tumour suppressor phosphatase and tensin homologue (PTEN) is an important negative regulator for the PIP3/Akt signalling pathway that promotes cell proliferation and inhibits apoptosis. Inactivation of PTEN by mutation, deletion and promoter hypermethylation has been demonstrated in a range of cancers. The aim was to investigate whether the loss of nuclear PTEN protein expression correlates with conventional clinicopathological parameters and patient survival. Methods and results: Immunohistochemistry staining for PTEN was performed on a tissue microarray of 19 samples of normal colonic mucosa, 14 adenomatous polyps, 482 adenocarcinomas and 56 metastatic lymph nodes. All 19 normal colonic mucosa samples (100%) were positive and 12 (85.7%) out of 14 adenomatous polyps were positive for PTEN. However, only 241 (50.0%) of the 482 colorectal adenocarcinomas and 26 (46.4%) of the 56 metastatic lymph nodes were positive for PTEN. Loss of PTEN expression was related to defective mismatch repair protein expression and colonic localization rather than rectal localization. On univariate survival analysis, patients with PTEN- adenocarcinoma revealed a poor overall and disease-free survival (P = 0.030 and P = 0.046, respectively). On multivariate analysis, a significant difference was observed in patients with stage II cancer that was not observed in other stages. Conclusions: Nuclear PTEN expression gradually decrease during the normal-adenoma-adenocarcinoma-metastasis sequence, which suggests an important role for PTEN in carcinogenesis. Moreover, loss of nuclear PTEN expression was a marker of poor clinical outcome in patients with stage II colorectal cancer.

Pulmonary epithelial-myoepithelial carcinoma is a rare low-grade malignant neoplasm that has the characteristic histologic features, epithelial and myoepithelial differentiation, similar to the salivary gland counterpart. This tumor is thought to arise from bronchial submucosal glands distributed throughout the lower respiratory tract. We recently experienced a case of epithelial-myoepithelial carcinoma of the bronchus in a 61-year-old man. Computed tomography of his chest revealed an endobronchial mass in the bronchus of the left lower lobe. The lobectomy specimen showed a solitary endobronchial mass, measuring 2.3 cm in greatest diameter. Histologically, the tumor was composed of variable proportions of epithelial and myoepithelial cells. The epithelial cells represented an inner layer of duct-like structures and the outer clear cell layer was myoepithelial-type cells. The epithelial cells were positive for pancytokeratin and the clear myoepithelial cells were positive for vimentin, alpha-smooth muscle actin and S-100 protein. Finally our diagnosis was epithelial-myoepithelial carcinoma of the bronchus.

BACKGROUND/AIMS Periampullary adenocarcinoma has either intestinal- or pancreatobiliary-type of differentiation. These types and perineural invasion have been shown to have prognostic relevance. The influences of histologic type and perineural invasion on recurrence and survival in ampullar of Vater carcinoma still need to be assessed. METHODOLOGY We reviewed and analyzed the clinicopathologic data, surgical outcomes, recurrence and survival of 49 patients who received curative pancreatoduodenectomy for ampulla of Vater carcinoma at Hanyang University Hospital between July 1994 and June 2008. RESULTS Twenty patients experienced recurrence, and the 5-year overall survival rates were 53.1%. Perineural invasion as well as tumor grade, T stage, lymph node metastasis, and lymphatic invasion were associated with survival (p < 0.05). The group positive for perineural invasion had a high recurrence rate (56.5% versus 28.0%) and a low 5-year survival (39.1% versus 68.0%) compared to those of the negative group. Pancreatobililary-type had a higher recurrence rate (58.3% versus 36.1%) and a lower 5-year survival rate (33.3% versus 61.1%) in comparison to intestinal-type. However, histologic type was not a statistically significant factor (p > 0.1). CONCLUSIONS Perineural invasion is a significant factor for survival. Histologic type has no significance as a prognostic factor despite differences between the two subgroups.