Long-term follow-up may be needed for pancreaticobiliary reflux in healthy adults / 대한외과학회지

PURPOSE: The reflux of pancreatic enzymes into the biliary tract is associated with chronic inflammation and increases cellular proliferation of the biliary epithelium, leading to biliary carcinoma. The aim of this study is to detect the incidence of occult pancreaticobiliary reflux (OPBR) in patients who underwent elective cholecystectomy. METHODS: Forty-seven patients with symptomatic gallstones who underwent cholecystectomy were recruited for this study. The gallbladder bile samples were obtained from the specimen of gallbladder and the amylase level was measured. The immunohistochemistry of p53, SMAD4 and Ki-67 were performed for the detection of metaplasia and dysplasia. RESULTS: Biliary amylase was higher than the serum amylase in 10 patients (group A, 15,402.66 +/- 33,592.43 IU/L; group B, 13.06 +/- 18.12 IU/L). The mean age was 67.2 years in group A and 51.2 in group B (P < 0.01). The ratio of male to female was 1:2.3 and 1:1.8 in group A and B, respectively (P = 0.297). Eight patients in group A and thirteen patients in group B had inflammation (P = 0.014). The positive results of the Ki-67 test were exhibited in five cases in each group (P = 0.024). CONCLUSION: Results from the study indicate that the age was older, degree of inflammation and positive rate of Ki-67 were higher when OPBR was suspected. In conclusion, the patients with OPBR would need long-term follow-up, because the OPBR can cause dysplasia and the reflux of pancreatic juice may be considered as a risk factor for extrahepatic bile duct carcinoma.

Laparoscopic Resection of a 12 cm Sized Retroperitoneal Schwannoma Adjacent to Retroperitoneal Vital Vessels: Are Large Retroperitoneal Schwannomas Not Suitable for the Laparoscopic Approach?

There are a lot of advantages to laparoscopic surgery, including early recovery, less postoperative pain, better cosmesis, shorter hospital stay and an early return to normal activities because of its minimal invasiveness. So, most surgeons have agreed on these points and have accepted the various indications for laparoscopic surgery. Despite these advantages and the recent advances in laparoscopic surgery, there are few cases using the laparoscopic approach for treating retroperitoneal schwannomas. Laparoscopic resection of a large retroperitoneal schwannoma has some difficulties for tumor retraction, dissecting around the large vessels, and removal of the resected tumor. Sometimes these difficulties may cause complications and a lengthened hospital stay. However, if appropriate methods are used, long hospital stay and complication can be prevented while maintaining the advantages of laparoscopic surgery.

Is Surgical Treatment Necessary after Non-curative Endoscopic Resection for Early Gastric Cancer?

PURPOSE: Additional surgery is commonly recommended in gastric cancer patients who have a high risk of lymph node metastasis or a positive resection margin after endoscopic resection. We conducted this study to determine factors related to residual cancer and to determine the appropriate treatment strategy. MATERIALS AND METHODS: A total of 28 patients who underwent curative gastrectomy due to non-curative endoscopic resection for early gastric cancer between January 2006 and June 2009 were enrolled in this study. Their clinicopathological findings were reviewed retrospectively and analyzed for residual cancer. RESULTS: Of the 28 patients, surgical specimens showed residual cancers in eight cases (28.6%) and lymph node metastasis in one case (3.8%). Based on results of the endoscopic resection method, the rate of residual cancer was significantly different between the en-bloc resection group (17.4%) and the piecemeal resection group (80.0%). The rate of residual cancer was significantly different between the diffuse type group (100%) and the intestinal type group (20%). The rate of residual cancer in the positive lateral margin group (25.0%) was significantly lower than that in the positive vertical margin group (33.3%) or in the positive lateral and vertical margin group (66.7%). CONCLUSIONS: We recommended that patients who were lateral and vertical margin positive, had a diffuse type, or underwent piecemeal endoscopic resection, should be treated by surgery. Minimal invasive procedures can be considered for patients who were lateral margin positive and intestinal type through histopathological examination after en-bloc endoscopic resection.

Is Surgical Treatment Necessary after Non-curative Endoscopic Resection for Early Gastric Cancer?

PURPOSE: Additional surgery is commonly recommended in gastric cancer patients who have a high risk of lymph node metastasis or a positive resection margin after endoscopic resection. We conducted this study to determine factors related to residual cancer and to determine the appropriate treatment strategy. MATERIALS AND METHODS: A total of 28 patients who underwent curative gastrectomy due to non-curative endoscopic resection for early gastric cancer between January 2006 and June 2009 were enrolled in this study. Their clinicopathological findings were reviewed retrospectively and analyzed for residual cancer. RESULTS: Of the 28 patients, surgical specimens showed residual cancers in eight cases (28.6%) and lymph node metastasis in one case (3.8%). Based on results of the endoscopic resection method, the rate of residual cancer was significantly different between the en-bloc resection group (17.4%) and the piecemeal resection group (80.0%). The rate of residual cancer was significantly different between the diffuse type group (100%) and the intestinal type group (20%). The rate of residual cancer in the positive lateral margin group (25.0%) was significantly lower than that in the positive vertical margin group (33.3%) or in the positive lateral and vertical margin group (66.7%). CONCLUSIONS: We recommended that patients who were lateral and vertical margin positive, had a diffuse type, or underwent piecemeal endoscopic resection, should be treated by surgery. Minimal invasive procedures can be considered for patients who were lateral margin positive and intestinal type through histopathological examination after en-bloc endoscopic resection.

The Comparison between Laparoscopic Wedge Resection and Open Wedge Resection for Gastric Gastrointestinal Stromal Tumors / 대한내시경복강경외과학회지

PURPOSE: A laparoscopic wedge resection is increasingly being used for gastrointestinal stromal tumors of the stomach. The aim of this study is to evaluate the safety and the feasibility of laparoscopic wedge resection compared to conventional open wedge resection. METHODS: Fifty-six patients who underwent laparoscopic wedge resection (LW group, n=32) or open wedge resection (OW group, n=24) for gastric submucosal tumor, between January 2005 and December 2007, were enrolled in this retrospective study. RESULTS: here were no significant differences in the patients' clinicopathological datas between the two groups. Although there were no significant difference in the operation time and the postoperative morbidity, the time to the first oral intake (1.2+/-1.5 vs. 1.5+/-0.6 days, p=0.015), the duration of hospital stay (3.4+/-0.7 vs. 5.5+/-0.8 days, p<0.001), and the number of analgesic use (2.2+/-0.9 vs. 4.0+/-1.2 times, p<0.001) were shorter or lower in the LW group than in the OW group. Among the LW group, three patients with endophytic growth pattern underwent intraoperative gastroduodenoscopy to identify the precise location of the tumor. CONCLUSION: Laparoscopic wedge resection is a safe and feasible treatment option for gastrointestinal stromal tumors. In addition, appropriate approach should be utilized according to the size, the location, and the growth pattern of the tumor.

Rebamipide-induced downregulation of phospholipase D inhibits inflammation and proliferation in gastric cancer cells

Rebamipide a gastroprotective drug, is clinically used for the treatment of gastric ulcers and gastritis, but its actions on gastric cancer are not clearly understood. Phospholipase D (PLD) is overexpressed in various types of cancer tissues and has been implicated as a critical factor in inflammation and carcinogenesis. However, whether rebamipide is involved in the regulation of PLD in gastric cancer cells is not known. In this study, we showed that rebamipide significantly suppressed the expression of both PLD1 and PLD2 at a transcriptional level in AGS and MKN-1 gastric cancer cells. Downregulation of PLD expression by rebamipide inhibited its enzymatic activity. In addition, rebamipide inhibited the transactivation of nuclear factor kappa B (NFkappaB), which increased PLD1 expression. Rebamipide or PLD knockdown significantly suppressed the expression of genes involved in inflammation and proliferation and inhibited the proliferation of gastric cancer cells. In conclusion, rebamipide-induced downregulation of PLD may contribute to the inhibition of inflammation and proliferation in gastric cancer.

Gastric Glomus Tumor

Gastric glomus tumors are rare submucosal lesions that originate from the modified smooth muscle cells of the glomus body. They usually present as a submucosal tumor on endoscopy and a heterogeneous hypoechoic tumor in the third or fourth sonographic layer of the gastric wall on endoscopic ultrasonography. So they are often confused with other submucosal tumors such as gastrointestinal stromal tumor, schwannoma, and leiomyoma. Immunohistochemistry helps in differentiating glomus tumors from other submucosal tumors. The treatment of choice for these tumors is complete surgical resection. Most of the gastric glomus tumors are essentially benign in nature, so preoperative recognition of this lesion may spare the patient a more extensive resection. Herein, we present three cases of gastric submucosal tumor that were treated by a laparoscopic wedge resection and confirmed as glomus tumor on final pathology.

A Case of Coincidental Gonadoblastoma and Dysgerminoma in 45X/47XYY Mosaic Turner Variant / 대한산부인과학회지

45X/47XYY mosaicism is a very rare sex chromosomal disorder with limited clinical information. We experienced an unusual mosaic syndrome in a 16-year old woman with a phenotypic female, short stature, and immature secondary sexual characteristics. We performed both gonadectomy and found a gonadoblastoma in one gonad and dysgerminoma in another gonad.

A Case of Recurrent Endometriosis with Rectal Invasion / 대한산부인과학회지

Rectal invasion of endometriosis is unusal condition, since it represents an invasion of previously normal bowel by hormone-dependent nonmalignant cell from uterus of the same patient. It is estimated that the incidence of endometriosis is about 8-15% of reproductive women, of whom 3-34% show intestinal invasion of rectosigmoid colon, appendix, ileum, and cecum in order of decreasing frequency. We experienced a case of recurrent endometriosis with rectal invasion in 34-year-old female who had previously endometriosis. She had rectal bleeding with severe anemia and abdominal pain with palpable mass in cul-de-sac. We present the case with a brief review of literature.

Treatment of Conjunctival-Corneal Intraepithelial Neoplasia with Topical Mitomycin C

PURPOSE: To evaluate the therapeutic effect of topical mitomycin C (MMC) on the diffuse conjunctival-corneal intraepithelial neoplasia (CCIN). METHODS: Three patients histopathologically confirmed the conjunctival-corneal intraepithelial neoplasia (CCIN) received topical drop of 0.04% MMC four times daily for 2 to 4 weeks. Ocular complications and recurrence were evaluated under slit lamp biomicroscope. RESULTS: One case received topical drop of 0.04% MMC four times daily for 2 weeks and two cases of CCIN received for 4 weeks in the same manner. These lesions were completely regressed and did not recur under slit lamp biomicroscope during the follow-up of 18 months, 6 months, and 5 months, respectively. Other complications except superficial punctate keratitis and conjunctival injection did not develope and visual acuities have been improved. CONCLUSIONS: It appears that the application of topical MMC alone could be a primary effective treatment for diffuse conjunctival-corneal intraepithelial neoplasia (CCIN).

Immunohistochemical Study on Expression of the p53 Protein in Medulloblastoma/PNET / 대한암학회지

PURPOSE: The present study explores the expression rate of p53 mutation and the correlation between the expression of p53 protein and prognostic factors in medulloblastoma/ PNET (primitive neuroectodermal tumor). MATERIALS AND METHODS: We studied retrospectively 24 patients with medulloblastoma/ PNET, who were admitted in Dong-A University Hospital, Pusan National University Hospital and Inje University Pusan Paik Hospital from 1988 to 1995. Detection of p53 mutations was made by immunohistochemical staining of p53 protein on paraffin- embedded tissues. The correlation between the expression of p53 protein and prognostic factors was evaluated by the Spearman correlation analysis. RESULTS: p53 protein was expressed in 6 of 24 patients (25%). In 20 patients who could be evaluated for metastasis, 16 patients of M0, 1 patient of M1 and 3 patients of M2 were grouped by M stage, and the expression of p53 was detected in 1 of 16 M0 group (6.3%) and 3 of 3 M2 group (100%). p53 expression was significantly related to the M stage of medulloblastoma/PNET (r=0.73, p<0.001). The detection of p53 was not significantly associated with T stage, cellular differentiation and the relapse rate of medulloblastoma/ PNET. CONCLUSION: The immunohistochemical detection rate of p53 protein in medulloblastoma/ PNET was 25%. The expression of p53 protein was significantly related to the M stage, with higher expression rate in M2 group of medulloblsatoma/PNET.