Journal of Yeungnam Medical Science

Review article

Octacalcium phosphate, a promising bone substitute material: a narrative review: Jooseong Kim, Sukyoung Kim, Inhwan Song; J Yeungnam Med Sci. 2024;41(1):4-12. Published online May 9, 2023; DOI: https://doi.org/10.12701/jyms.2023.00010

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Biomaterials have been used to supplement and restore function and structure by replacing or restoring parts of damaged tissues and organs. In ancient times, the medical use of biomaterials was limited owing to infection during surgery and poor surgical techniques. However, in modern times, the medical applications of biomaterials are diversifying owing to great developments in material science and medical technology. In this paper, we introduce biomaterials, focusing on calcium phosphate ceramics, including octacalcium phosphate, which has recently attracted attention as a bone graft material.

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Development of Hydroxyapatite Coatings for Orthopaedic Implants from Colloidal Solutions: Part 1—Effect of Solution Concentration and Deposition Kinetics
Bríd Murphy, Mick A. Morris, Jhonattan Baez
Nanomaterials.2023; 13(18): 2577. CrossRef

Case report

Severe congenital neutropenia mimicking chronic idiopathic neutropenia: a case report: Juhyung Kim, Soyoon Hwang, Narae Hwang, Yeonji Lee, Hee Jeong Cho, Joon Ho Moon, Sang Kyun Sohn, Dong Won Baek; J Yeungnam Med Sci. 2023;40(3):283-288. Published online July 28, 2022; DOI: https://doi.org/10.12701/jyms.2022.00353

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Abstract PDF Supplementary Material: Severe chronic neutropenia is classified as severe congenital, cyclic, autoimmune, or idiopathic. However, there is a lot of uncertainty regarding the diagnosis of severe congenital neutropenia (SCN) and chronic idiopathic neutropenia, and this uncertainty affects further evaluations and treatments. A 20-year-old man presented with fever and knee abrasions after a bicycle accident. On admission, his initial absolute neutrophil count (ANC) was 30/µL. He had no medical history of persistent severe neutropenia with periodic oscillation of ANC. Although his fever resolved after appropriate antibiotic therapy, ANC remained at 80/µL. Bone marrow (BM) aspiration and biopsy were performed, and a BM smear showed myeloid maturation arrest. Moreover, genetic mutation test results showed a heterozygous missense variant in exon 4 of the neutrophil elastase ELANE: c597+1G>C (pV190-F199del). The patient was diagnosed with SCN. After discharge, we routinely checked his ANC level and monitored any signs of infection with minimum use of granulocyte colony-stimulating factor (G-CSF), considering its potential risk of leukemic transformation. Considering that SCN can be fatal, timely diagnosis and appropriate management with G-CSF are essential. We report the case of a patient with SCN caused by ELANE mutation who had atypical clinical manifestations. For a more accurate diagnosis and treatment of severe chronic neutropenia, further studies are needed to elucidate the various clinical features of ELANE.

Case Reports

A Case of Pseudolymphomatous IgG4-Related Disease Involving the Maxilla.: Min Jung Kim, Seung Il Bae, Hoon Tae Kim, Young Hoon Hong, Hyun Je Kim, Choong Ki Lee, Mi Jin Gu; Yeungnam Univ J Med. 2013;30(2):128-131. Published online December 31, 2013; DOI: https://doi.org/10.12701/yujm.2013.30.2.128

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Abstract PDF: Immunoglobulin G4 (IgG4)-related disease is an inflammatory condition characterized by IgG4 positive plasma cell infiltration. It can affect any organ in the body and mainly involves the pancreas, liver, biliary tracts, orbits, salivary glands and lymph nodes. It can manifest as an inflammatory pseudotumor. Pseudolymphoma as an inflammatory pseudotumor is a group of benign tumors that exhibit histological and clinical features suggestive of malignant lymphoma. Studies on IgG4-related disease are rarely reported, and no case of the disease that involved the maxillary bone and adjacent soft tissue, except for the skin, has been reported. Therefore, we report herein a case of pseudolymphomatous IgG4-related disease that involved the maxilla, with a literature review.

Long-Term Complete Remission in an Acute Myeloid Leukemia Patient with Isolated Central Nervous System Relapse after Allogeneic Hematopoietic Stem Cell Transplantation.: Myung Jin Kim, Sung Ae Ko, Hyo Jin Jang, Da Eun Jeong, Jeung Min Park, Kyoung Hee Lee, Min Kyoung Kim, Young Kyung Bae, Myung Soo Hyun; Yeungnam Univ J Med. 2012;29(2):96-101. Published online December 31, 2012; DOI: https://doi.org/10.12701/yujm.2012.29.2.96

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Abstract PDF

Allogeneic hematopoietic stem cell transplantation (HSCT) is considered the optimal curative treatment for acute myeloid leukemia (AML), but some patients develop bone marrow relapse due to remnant leukemia, and few patients develop extramedullary relapse without bone marrow relapse. Isolated extramedullary relapse (IMER) is defined as extramedullary relapse without bone marrow relapse. IMER has been reported in various sites, including the skin, soft tissue, and central nervous system(CNS). Isolated CNS relapse is relatively rare and is associated with poor prognosis due to the absence of an optimal treatment for it. Reported herein is a case involving an adult AML woman who suffered from isolated extramedullary relapse in the CNS after allogeneic HSCT. She was treated with intrathecal chemotherapy and whole-brain and spine radiotherapy, followed by systemic chemotherapy. She is currently well, with no evidence of leukemia recurrence for over six years.

Citations

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Post-transplant leukemia relapse in organs: biology. and behavior in 585 reports
Isabel Cunningham
Critical Reviews in Oncology/Hematology.2021; 157: 103170. CrossRef

A Case of Sacral Tuberculosis Mimicking Metastatic Bone Tumor with Elevated CA 19-9.: Kyung Yoon Chang, Kyung Sun Ha, Kyung Seon Park, Eun Hui Sim, Jae Ho Byun; Yeungnam Univ J Med. 2011;28(2):196-201. Published online December 31, 2011; DOI: https://doi.org/10.12701/yujm.2011.28.2.196

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Abstract PDF

A 73-year-old male presented a six-month history of buttock pain radiating into his thigh. The MRI revealed a large enhancing mass lesion involving the sacrum, with extension into the sacral canal. The tumor markers were measured to distinguish skeletal metastasis of carcinoma from primary bone tumor. The CA 19-9 was elevated. Despite the investigation, the primary site of cancer could not be found. Sacral bone biopsy was done. The pathologic examination revealed necrosis, chronic granulomatous inflammation, and multinucleated giant cells, consistent with tuberculosis. Sacral tuberculosis is rare in patients with no history of tuberculosis. Such solitary osteolytic lesions involving the subarticular region of large joints may mimic bone neoplasms and may be called "tuberculous pseudotumors." This case report intends to emphasize that bone tuberculosis should be a differential diagnosis in the presence of atypical clinical and radiological features. As tuberculous lesions may be mistaken for neoplasms, a small amount of fresh tissue should be sent for culture even if clinical diagnosis of a tumor seems likely. Described herein is a case of sacral tuberculosis mimicking metastatic bone tumor with elevated CA 19-9.

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Isolated Sacral Tuberculosis: A Case Report and Review of Literature of this Rare Sacral Pathology
Harshit Arora, Vasudha Sharma, Waryaam Singh, Lavanya Arora, Sumer Singh Nanda, Rajesh Pasricha
EMJ Neurology.2023;[Epub] CrossRef

Three Cases of Fever Unknown Origin with Lymphoproliferative Features and a Unique Pattern of 18-FDG Uptake on the Fusion PET/CT.: Dae Young Yun, Young Hoon Hong, Yong Uk Jung, Myung Jin Oh, Choong Ki Lee; Yeungnam Univ J Med. 2008;25(1):64-71. Published online June 30, 2008; DOI: https://doi.org/10.12701/yujm.2008.25.1.64

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Abstract PDF: Evaluation of a fever of unknown origin (FUO) is complex. Recently, PET scanning has been approved for screening in FUO evaluation. We treated three cases of FUO associated with increased FDG uptake in the bone marrow of the femur and tibia on the fusion PET/CT; all three had the same pattern of uptake. Bone marrow biopsies revealed mature lymphocyte and histiocyte infiltration and myxoid changes in one case, and cortical bone involvement in another case. The cases were all young females who had fever with neutropenia and relative lymphocytosis that lasted for several weeks and then remitted spontaneously. Even though the results of the studies were not diagnostic, the unique uptake pattern on PET/CT and the histology might be related to the cause of the illness and should be studied further to assess the association with classic FUO.

Original Articles

Results of Maxillary Sinus Lift and Maxillary Sinus Floor Elevation with Osteotome for Endosseous Implant Placement: Mi-Ryoung Kim, Byung-Rho Chin; Yeungnam Univ J Med. 2007;24(2 Suppl):S463-471. Published online December 31, 2007; DOI: https://doi.org/10.12701/yujm.2007.24.2S.S463

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Abstract PDF: Background
：Dental implantation has become predictable treatment for dental prosthodontics. But maxillary posterior jaw region is often complicated by the pneumatization of the maxillary sinus and physiological resorption of the alveolar bone. When this occurs, the residual bone between the floor of the sinus and the crestal ridge is inadequate for the placement of implants. The sinus lift and sinus floor elevation with osteotome procedures provide a way to increase the amount of available bone and to allow the placement of longer implants. Materials & methods：We studied 26 patients requiring the implant placements and the maxillary sinus elevation simultaneously from 1996 to 2007 in our clinic. Twenty were males and six were females, aged from 25 to 73 (mean=52.3). Fourteen patients had medical compromised states; angina pectoris, diabetes, hypertension, hepatitis, Penicillin allergy. All of the patients didn’t show any pathologic findings clinically or radiographically. We studied the success and survival rate of implants and factors increasing the osseointegrating capacity of implants.
Results
：The success rate of osseointegration of implants with the maxillary sinus lift was 94%. The success rate of osseointegration of implants with the maxiilary sinus floor elevation used osteotome was 100%. At least 6 months after loading on implants, the survival rate of implants with the maxillary sinus lift was 82.3% and the survival rate of implants with the maxillary sinus floor elevation used osteotome was 100%. Autogenous bone graft and adequate residual bone height (>6mm) increased survival rate of implants.
Conclusion
：Successful implant placement with maxillary sinus lift and maxillary sinus floor elevation used osteotome mainly depends on sufficient residual bone height, healthy maxillary sinus, autogenous bone graft.

Factors Affecting Bone Mineral Density in Premenopausal Women: Myeong-Sook Lee, Pock-Soo Kang, Kyeong-Soo Lee; Yeungnam Univ J Med. 2007;24(2 Suppl):S330-339. Published online December 31, 2007; DOI: https://doi.org/10.12701/yujm.2007.24.2S.S330

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Abstract PDF

Purpose：The purpose of the study was to determine factors affecting bone mineral density among premenopausal women aged over 45 years old and make a contribution to preventing osteoporosis among postmenopausal women. Materials and Methods：A total of 133 women enrolled in the study and completed a self-administered questionnaire that measured results of bone mineral density exam and biochemical exam, demographic characteristics, smoking and drinking, physical activities and reproductive characteristics.
Results
：The results of the study are summarized as follows: Of total subjects, 20.2% showed a reduction on bone mineral density. Age was the most important factor predicting bone mineral density level. A frequent intake of meat rather than vegetables had a significant impact on bone mineral density. Women with a menstruation cycle shorter than 28 days showed significantly high bone mineral density. Multiple regression analysis revealed a correlation between age and risk of osteoporosis. The explainability for variables was 16%.
Conclusion
：It is necessary to develop programs designed to help women in their 30s to maintain the maximum bone density and prevent osteoporosis after menopause.

Citations

Citations to this article as recorded by

Problems with Bone Health and the Influencing Factors of Bone Mineral Density in Women across the Life Cycle
Nami Chun, Hyunju Chae
Korean Journal of Women Health Nursing.2015; 21(1): 43. CrossRef
Factors related to Osteopenia in Community People
Sung Hey Kim, Young Hee Lee
Journal of Korean Public Health Nursing.2015; 29(2): 177. CrossRef
The Bone Mineral Density Impact Factors of Adult Women before the Menopause - based on the National Health and Nutrition Examination Survey -
Kyung-Hee Kim, Jung-Hee Lee, Jin-Dong Yeo
Journal of the Korean Society of Radiology.2015; 9(3): 147. CrossRef
Effects of Body Weight Control Behaviors on Bone Mineral Density in Korean Young Adult Women
Chae Weon Chung, Suk Jeong Lee
Korean Journal of Women Health Nursing.2013; 19(1): 57. CrossRef

Review Article

Osteoimmunology: Daewon Jeong; Yeungnam Univ J Med. 2007;24(2 Suppl):S270-276. Published online December 31, 2007; DOI: https://doi.org/10.12701/yujm.2007.24.2S.S270

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Abstract PDF

Bone is the only solid organ and serves as a mechanical support and a reservoir of minerals. Bone homeostasis is achieved by the balance between bone-forming osteoblasts and bone-resorbing osteoclasts. Osteoblasts, which are derived from mesenchymal stem cells, secrete bone matrix proteins and promote mineralization. Otherwise, osteoclasts are derived from hematopoietic stem cells (HSC) that are capable of differentiating into all immune cells and resorb bone matrix by acid decalcification and proteolytic degradation. Osteobalsts and osteoclasts are an important role in the regulation of HSC niche and development, showing that bone remodeling was linked to hematopoietic regulation. Long-lived memory T and B cells and bone cells coexist in the bone marrow reservoir as well as activated T cells that mediate adaptive immune system and osteoclasts that regulate bone turnover share a common molecules that are essential for their development and differentiation. In addition, activated T cell-expressed RANKL directly stimulates osteoclastogenesis. Accumulating evidence indicates that there is the interplay between the immune-related cells and bone remodeling-related cells. This review will discuss the osteoimmunology, an interdisciplinary approach to understanding the cross-talk between bone and the immune cells.

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The Study on the Korean and Western Medical Literatures for Aging and Skin Aging
Jung-Min Han, Woo-Shin Ko, Hwa-Jung Yoon
The Journal of Korean Oriental Medical Ophthalmology and Otolaryngology and Dermatology.2014; 27(1): 45. CrossRef

Original Article

Results of Maxillary Sinus Elevation for Endosseous Implant Placement.: Sang Deuk Chun, Bo Yeon Jung, Seung Eun Lee, Hong Sik Yoon, Byung Rho Chin; Yeungnam Univ J Med. 2003;20(2):169-176. Published online December 31, 2003; DOI: https://doi.org/10.12701/yujm.2003.20.2.169

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Abstract PDF: BACKGROUND
Although dental implantation has become widespread and acceptable treatment for dental prosthodontics, maxillary posterior jaw region is often complicated by the pneumatization of the maxillary sinus and physiological resorption of the alveolar bone. When this occurs, the residual bone between the floor of the sinus and the crestal ridge is inadequate for the placement of implants. The sinus elevation procedure provides a way to increase the amount of available bone and to allow the placement of longer implants. MATERIALS & METHODS: We studied 11 patients requiring the implant placements and the maxillary sinus elevation simultaneously from 1996 to 2003 in our clinic. Nine patients were males and two patients were females, aged from 39 to 72(mean=51.6). Four patients had medical compromised states; angina pectoris, diabetes, hypertension, hepatitis. Patients didn't show any pathologic findings clinically or radiographically. We studied the success and survival rate of implants, factors increasing the osseointegrating capacity of implants. RESULTS: The success rate of osseointegration of implants was 93%. At least 6 months after loading on implants, the survival rate of implants was 78.5%. Autogenous bone graft and adequate residual bone height(>6mm) increased survival rate of implants. CONCLUSION: Successful implant placement with maxillary sinus elevation mainly depends on sufficient residual bone height, healthy maxillary sinus, autogenous bone graft.

Review

The Role of Thallium-201 Scintigraphy in Bone and Soft Tissue Tumor.: Duk Seop Shin; Yeungnam Univ J Med. 2003;20(2):117-128. Published online December 31, 2003; DOI: https://doi.org/10.12701/yujm.2003.20.2.117

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Abstract PDF: Thallium-201 scintigraphy is used to discriminate the malignant bone tumor from the benign by qualitatively and quantitatively, and to predict the response of preoperative chemotherapy in osteosarcoma, by comparing the changes of thallium uptake ratio after chemotherapy to the tumor necrosis ratio. Thallium-201 scintigraphy scan should be done prior to surgical biopsy. PICKER Prism 2000 gamma camera with high resolution parallel hole collimator is usually used for scanning. The patient is injected with 2-3mCi of Tl-201 and the early phase is checked in 30 minutes and delayed phase in 3 hours. The scan images are visually evaluated by a blinded nuclear medicine physician. We could evaluate true positive, true negative, false positive and false negative by the comparison of results with those of biopsy, and calculate positive and negative predictive value(%), sensitivity(%), specificity(%) and diagnostic accuracy(%). For the quantitative analysis of thallium uptake, we drew the region of interest on the tumor side and contralateral normal side as mirror image, and calculated the uptake ratio with dividing the amount of gamma count in tumor side by normal side. We could calculate the percent changes of thallium uptake ratio in early and delayed phase, and compare them to the ratio of tumor necrosis. Thallium-201 scintigraphy proved as useful imaging study to discriminate malignant bone tumor from benign, but had exception in giant cell tumor and low grade malignant bone tumors. We can use T1-201 scan to differentiate the benign from the malignant tumor, and to evaluate the response of preoperative chemotherapy or radiotherapy, and to determine the residual tumor or local recurrence. For the better result, we need to have a more detail information about false positive cases and a more objective and quantitative reading technique.

Original Articles

The Relationship Between Body Composition and Bone Mineral Density in Postmenopausal Women.: Jin Wook Chae, Il Hoe Kim, Woo Sung Kwon, Keun Mi Lee, Seung Pil Jung, Yong Moon; Yeungnam Univ J Med. 2003;20(1):53-61. Published online June 30, 2003; DOI: https://doi.org/10.12701/yujm.2003.20.1.53

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Abstract PDF

BACKGROUND
Body weight is an important factor that influence the bone density in postmenopausal women except estrogen dificiency. However, different results are reported about the relationship between body composition and bone density in the postmenopausal women. We have studied the relationship between age, body weight, body mass index (BMI), waist hip ratio (WHR), muscle mass, fat mass, fat free mass and bone density. MATERIALS AND METHODS: We have studied 127 persons of postmenopausal women who visited university medical center and examined the inbody 3.0 and Dual Energy X-ray Absorptiometry (DEXA) from Jan, 2001 to Jun, 2002. they didn't have any disease and didn't received hormone therapy, osteoporosis therapy or other medication that influence the bone density. RESULTS: The numbers of study subjects is total 127 persons. Mean age is 56.9+/-5.14, mean weight is 59.3+/-8.7 kg, mean BMI is 25.37+/-3.16 (kg/m2), mean fat mass is 20.02+/-5.05 kg, mean muscle mass is 37.49+/-4.50 kg, mean fat free mass is 39.80+/-4.70, mean BMD is 0.828+/-0.148 (g/cm2). In the result of linear regression analysis, age, height, weight, muscle mass, fat free mass, fat mass, BMI are significant determinants of BMD. In stepwise multiple regression analysis, age is the most significant determinant of BMD and besides age, fat free mass is the most significant determinant of BMD among body composition. CONCLUSION: In postmenopausal women, age, height, weight, BMI, muscle mass, fat free mass, fat mass are significant determinants of BMD and besides age, fat free mass is the most significant determinant of BMD among the body composition. So, diet and exercise that increase fat free mass will contribute to bone density increment.

Citations

Citations to this article as recorded by

Problems with Bone Health and the Influencing Factors of Bone Mineral Density in Women across the Life Cycle
Nami Chun, Hyunju Chae
Korean Journal of Women Health Nursing.2015; 21(1): 43. CrossRef
Association between bone mineral density and remaining teeth in postmenopausal women
Kyeong-Soo Lee, Chang-Suk Kim
Journal of Korean society of Dental Hygiene.2014; 14(3): 319. CrossRef
Association of Anthropometric and Biochemical Factors with Bone Mineral Density in Korean Adult Women Data from the Fourth (2008~2009) and Fifth (2010~2011) Korea National Health and Nutrition Examination Surveys (KNHANES IV & V)
Soon-Nam Choi, Kwang-Hyun Jho, Nam-Yong Chung
Journal of the Korean Dietetic Association.2014; 20(3): 157. CrossRef
A Study of Factors Influencing the Bone Mineral Density on Premenopausal Women: Using the 2011 Korean National Health and Nutrition Examination Survey Data
Young-Mi Chun, Sun-Hee Lee
Journal of the Korea Academia-Industrial cooperation Society.2013; 14(12): 6246. CrossRef
Factors Associated with Bone Mineral Density in Korean Postmenopausal Women Aged 50 Years and Above: Using 2008-2010 Korean National Health and Nutrition Examination Survey
Son-Ok Mun, Jihye Kim, Yoon Jung Yang
Korean Journal of Community Nutrition.2013; 18(2): 177. CrossRef

Indication of Bone Marrow Aspiration in Acute Idiopathic Thrombocytopenic Purpura in Children.: Won Duck Kim, Jeong Ok Hah; Yeungnam Univ J Med. 2001;18(2):239-245. Published online December 31, 2001; DOI: https://doi.org/10.12701/yujm.2001.18.2.239

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Abstract PDF: BACKGROUND
Acute idiopathic thrombocytopenic purpura(ITP) is one of the common hematologic disorders in children. Bone marrow aspiration(BMA) is often performed in children with acute ITP to rule out leukemia, aplastic anemia or other hematologic diseases. However, whether BMA is needed in children with typical clinical and hematological features of acute ITP have been questioned. This study was performed to examine the proper indication of BMA in acute childhood ITP. MATERIALS AND METHODS: The medical records and BMA reports of children with the provisional diagnosis of acute ITP were reviewed from January 1984 to December 2000. Patients were divided into two groups, one with typical and another with atypical clinical and hematological features of acute ITP. Typical acute ITP group was characterized by the history of previous viral infection, well being appearance, no hepatosplenomegaly, no lymphadenopathy, normal Hb, WBC, neutrophil count and peripheral blood smear except thrombocytopenia. A platelet count of 50x109/L or lower was the cutoff level. RESULTS: Total 120 children with the provisional diagnosis of acute ITP were included. One hundred eighteen of them were confirmed to have acute ITP by BMAs. Of these, 66 had typical and 54 had atypical features. All of typical features and 52 of 54 with atypical features of acute ITP were confirmed to have acute ITP by BMAs. Two patients with atypical features of acute ITP were diagnosed as aplastic anemia and myelodyspalstic syndrome, respectively, by BMAs. CONCLUSION: This study concludes that BMA is not needed for the children with typical features of acute ITP but it is needed for the children with atypical features of acute ITP to rule out other hematologic disorders.

Case Reports

A Case of Telangiectatic Osteosarcoma of the Skull Base.: Yong Jin Kim, Hoon Kyu Oh; Yeungnam Univ J Med. 1999;16(2):364-368. Published online December 31, 1999; DOI: https://doi.org/10.12701/yujm.1999.16.2.364

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Abstract PDF: A rare case of telangiectatic osteosarcoma of the sphenoid bone was reported. The patient was a 27-year-old male and had suffered from left eye protrusion and diplopia for three months. Radiologically, a lobulated osteolytic lesion was located between sphenoid and left temporal bone. Pathologically, the tumor had multiloculated blood filled cystic vascular spaces and osteoid formation by malignant spindle osteoblast cells. The differential diagnosis of this rare entity from aneurysmal bone cyst was important radiologically and pathologically. This case is the second case of telangietatic osteosarcoma of the sphenoid bone followed by a case of Whitehead RE and Melhem ER in 1998.

A Clinicopathologic Review of Eight Cases of Chondroblastoma.: Joon Hyuk Choi, Hae Jeong Choi, Mi Jin Ku, Dae Hong Suh, Duk Seop Shin, Kil Ho Cho; Yeungnam Univ J Med. 1998;15(2):359-370. Published online December 31, 1998; DOI: https://doi.org/10.12701/yujm.1998.15.2.359

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Abstract PDF: Eight cases of chondroblastoma were studied by analyzing the clinical and pathologic findings. The age of eight cases ranged from 17 to 38 years old(median age, 22.7 years old). The tumors developed in the femur (3 cases), patella (2 cases), tibia( 1 case), fibula (1 case), and ulna (1 case). The mean diameter of tumors was 4.0 cm (range, 1.5 to 8.0 cm). Grossly, tumors showed grayish brown solid area with foci of secondary aneurysmal bone cyst. Histologically, the tumor cells were round or polygonal in shape with nuclear groove. And there were chondroid differentiation(7 cases), mitosis(3 cases), calcific deposits(3 cases), secondary aneurysmal bone cyst(4 cases), hemosiderin deposits(4 cases), necrosis(3 cases), vascular invasion(1 caes) and foamy histiocytes and cholesterol cleft(1 cases). All cases showed no metastasis to lymph node and distant organ. Seven cases (87.5 %) were immunoreactive for S-100 protein. None were immunoreactive for cytokeratin.

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