Tumor-Infiltrating Lymphocytes in Human Epidermal Growth Factor Receptor 2-Positive Breast Cancer Receiving Neoadjuvant Docetaxel, Carboplatin, Trastuzumab, and Pertuzumab / 한국유방암학회지

Purpose@#The tumor-infiltrating lymphocytes (TILs) expression in breast cancer is a positive prognostic marker for certain breast cancer subtypes. We evaluated the efficacy of dual antihuman epidermal growth factor receptor 2 (HER2) blockade in HER2-positive breast cancer and hypothesized that high TILs tumors are associated with better outcomes. @*Methods@#A total of 176 patients who were treated with neoadjuvant docetaxel, carboplatin, trastuzumab, and pertuzumab (TCHP) between December 2015 and December 2018 were reviewed. They were grouped based on a cut-off value of the stromal TILs grade (≤ 20% TILs, > 20% TILs). @*Results@#In total, 107 patients (60.8%) achieved pathological complete response (pCR).Hormone receptor (HR)-negativity (p = 0.001) and a high TILs grade (p = 0.022) were independent predictors of pCR. Among the HR-negative patients, high TILs tumors were significantly associated with pCR (p = 0.035). @*Conclusion@#HR status and the TILs grade are significantly correlated with pCR in dual anti-HER2 neoadjuvant therapy. The evaluation of the TILs at baseline may be beneficial for predicting pCR in HER2-positive breast cancer.

Tumor-Infiltrating Lymphocytes in Human Epidermal Growth Factor Receptor 2-Positive Breast Cancer Receiving Neoadjuvant Docetaxel, Carboplatin, Trastuzumab, and Pertuzumab / 한국유방암학회지

Purpose@#The tumor-infiltrating lymphocytes (TILs) expression in breast cancer is a positive prognostic marker for certain breast cancer subtypes. We evaluated the efficacy of dual antihuman epidermal growth factor receptor 2 (HER2) blockade in HER2-positive breast cancer and hypothesized that high TILs tumors are associated with better outcomes. @*Methods@#A total of 176 patients who were treated with neoadjuvant docetaxel, carboplatin, trastuzumab, and pertuzumab (TCHP) between December 2015 and December 2018 were reviewed. They were grouped based on a cut-off value of the stromal TILs grade (≤ 20% TILs, > 20% TILs). @*Results@#In total, 107 patients (60.8%) achieved pathological complete response (pCR).Hormone receptor (HR)-negativity (p = 0.001) and a high TILs grade (p = 0.022) were independent predictors of pCR. Among the HR-negative patients, high TILs tumors were significantly associated with pCR (p = 0.035). @*Conclusion@#HR status and the TILs grade are significantly correlated with pCR in dual anti-HER2 neoadjuvant therapy. The evaluation of the TILs at baseline may be beneficial for predicting pCR in HER2-positive breast cancer.

The Importance of Education regarding the Effects of Anticancer Treatment on Fertility and Ovarian Function in the Female Patients with Breast Cancer

OBJECTIVES: Female breast cancer patients generally have limited knowledge regarding issues related to preservation of ovarian function and fertility. The present study aimed to explore the change in the understanding of these issues when female breast cancer patients are educated and counseled about ovarian function and fertility after anticancer treatment.METHODS: One hundred nine young female breast cancer patients completed a questionnaire, which revealed their thoughts and opinions before and after receiving the education about ovarian function and fertility. Their responses were analyzed to determine the impact of the education on their perception and understanding of the aforementioned issues.RESULTS: The objective survey had four main themes: planning and desire for children, degree of baseline understanding of the effects of anticancer therapy on fertility and ovarian function, resultant change in cognition after education about cancer treatment and its relationship with fertility, and need for education regarding the types of therapies received and their effects on subsequent ovarian function and fertility before treatment.CONCLUSIONS: The preservation of ovarian function and fertility is an important factor that must be included in the discussion prior to initiation of anticancer therapy. Although the study results do not have high educational effectiveness or a high satisfaction with education, there is a need for information and education regarding the impact of anticancer treatment on preservation of ovarian function and fertility.

Digital Breast Tomosynthesis Screening

Digital breast tomosynthesis (DBT) has been shown to be a promising imaging technique for breast cancer detection. DBT involves acquisition of a series of images in different planes over a limited angular range, and their subsequent reconstruction into a quasi-three-dimensional breast volume. This reduces the effects of tissue overlap. This review aims to describe the key features of DBT, including technique, results from recent retrospective and prospective clinical studies, and issues with DBT as a screening tool.

Sonographic features that can be used to differentiate between small triple-negative breast cancer and fibroadenoma

PURPOSE: Our study investigated whether any sonographic findings could be useful for differentiating between small triple-negative breast cancer (TNBC) and fibroadenoma. METHODS: This retrospective study was approved by our Institutional Review Board, which waived the requirement for patient consent. From January 2009 to December 2010, the sonographic features of 181 pathologically proven TNBC tumors and 172 fibroadenomas measuring less than or equal to 2 cm in the longest dimension were reviewed and analyzed according to the fifth edition of the Breast Imaging Reporting and Data System (BI-RADS) lexicon. Mean tumor roundness was also measured using in-house software. RESULTS: The median longest lesion dimension was 16 mm (range, 13 to 18 mm) in TNBCs and 13 mm (range, 10 to 16 mm) in fibroadenomas. In comparison to fibroadenomas, small TNBC tumors presented with a higher incidence of irregular shapes (66.9%), noncircumscribed margins (91.7%), hypoechoic echotexture (59.1%), posterior acoustic enhancement (65.2%), and associated features (24.4%). Most TNBCs were classified as BI-RADS category 4 (65.2%) or 5 (28.2%). The mean tumor roundness of small TNBCs was greater than that of fibroadenomas (60%±12% vs. 53%±13%). Multivariate analysis showed that older patient age, irregular shape, nonparallel orientation, posterior acoustic enhancement, associated features, a BI-RADS final assessment category of 4 or 5, and greater tumor roundness were significant independent factors indicative of TNBCs. CONCLUSION: TNBC tumors tend to demonstrate more suspicious sonographic features and greater tumor roundness than fibroadenomas. These features may have the potential to help differentiate between small TNBCs and fibroadenomas.

Current Practices in Breast Magnetic Resonance Imaging: a Survey Involving the Korean Society of Breast Imaging

PURPOSE: To report on the current practices in breast magnetic resonance imaging (MRI) in Korea. MATERIALS AND METHODS: We invited the 68 members of the Korean Society of Breast Imaging who were working in hospitals with available breast MRI to participate in a survey on how they performed and interpreted breast MRI. We asked one member from each hospital to respond to the survey. A total of 22 surveys from 22 hospitals were analyzed. RESULTS: Out of 22 hospitals, 13 (59.1%) performed at least 300 breast MRI examinations per year, and 5 out of 22 (22.7%) performed > 1200 per year. Out of 31 machines, 14 (45.2%) machines were 1.5-T scanners and 17 (54.8%) were 3.0-T scanners. All hospitals did contrast-enhanced breast MRI. Full-time breast radiologists supervised the performance and interpreted breast MRI in 19 of 22 (86.4%) of hospitals. All hospitals used BI-RADS for MRI interpretation. For computer-aided detection (CAD), 13 (59.1%) hospitals sometimes or always use it and 9 (40.9%) hospitals did not use CAD. Two (9.1%) and twelve (54.5%) hospitals never and rarely interpreted breast MRI without correlating the mammography or ultrasound, respectively. The majority of respondents rarely (13/21, 61.9%) or never (5/21, 23.8%) interpreted breast MRI performed at an outside facility. Of the hospitals performing contrast-enhanced examinations, 15 of 22 (68.2%) did not perform MRI-guided interventional procedures. CONCLUSION: Breast MRI is extensively performed in Korea. The indication and practical patterns are diverse. The information from this survey would provide the basis for the development of Korean breast MRI practice guidelines.

Second-look ultrasonography for MRI-detected suspicious breast lesions in patients with breast cancer

PURPOSE: The purpose of this study is to evaluate the use of second-look ultrasonography (US) for investigating additional suspicious lesions detected on preoperative staging magnetic resonance imaging (MRI) for breast cancer. METHODS: Between September 2008 and August 2010, 1,970 breast MRIs were performed at our medical institution for the evaluation of breast cancer before surgery. Second-look US was recommended for 135 patients with 149 suspicious lesions, following the MRI interpretation, and 108 patients with 121 lesions were included in this study. The detection rate on second-look US, according to the lesion type, diameter, and histopathological outcome, was analyzed. RESULTS: Of the 121 lesions considered in this study, 97 (80.2%) were diagnosed on MRI as masses and 24 (19.8%) as non-mass-like lesions; 105 lesions (86.8%) were correlated and 16 (13.2%) were not correlated with the findings of second-look US. Of the 105 correlated lesions, 29 (27.6%) were proven to be malignant and 76 (72.4%) were benign. Although a greater number of large malignant lesions were correlated on second-look US than small benign lesions, there was no statistically significant difference according to lesion diameter or type, as seen on MRI or pathology. CONCLUSION: We have concluded that second-look US is a useful diagnostic tool for lesions incidentally detected on breast MRI, as in this study, it could identify 86.8% of the MRI-detected breast lesions.

Concurrent Gonadotropin-Releasing Hormone Agonist Administration with Chemotherapy Improves Neoadjuvant Chemotherapy Responses in Young Premenopausal Breast Cancer Patients / 한국유방암학회지

PURPOSE: This study aimed to determine the oncologic efficacy of gonadotropin-releasing hormone (GnRH) agonist treatment concurrent with chemotherapy in a neoadjuvant setting. METHODS: A retrospective analysis was performed on 332 cases of invasive breast cancer in patients who were <40 years old at diagnosis and received GnRH agonists concurrent with neoadjuvant chemotherapy (GnRH agonist group) or neoadjuvant chemotherapy alone (neochemotherapy-alone group) from December 2010 to September 2014. Pathologic complete response rates (pCR) and Ki-67 changes were evaluated between the two groups. RESULTS: Median age was 32+/-3.9 and 36+/-3.0 years in the GnRH agonist group and neochemotherapy-alone group, respectively (p<0.001). After adjustment for tumor size, grade, lymph node metastasis, hormone receptor (HR) status, and chemotherapy regimen, the GnRH agonist group exhibited a higher pCR rate with an odds ratio (OR) of 2.98 (95% confidence interval [CI], 1.37-6.34) and a greater decrease in Ki-67 expression after treatment (p=0.05) than the neochemotherapy-alone group. For HR-negative tumors, the GnRH agonist group showed a higher pCR rate (multivariate OR, 3.50; 95% CI, 1.37-8.95) and a greater decrease in Ki-67 expression (p=0.047). For HR-positive breast cancer, the pCR rate, change in Ki-67 index, and clinical response were higher, and preoperative endocrine prognostic index scores were lower, in the GnRH agonist group, but these did not reach statistical significance. CONCLUSION: Concurrent administration of GnRH agonists during neoadjuvant chemotherapy improved pCR rates and suppressed Ki-67 expression, especially in HR-negative tumors.

Complex Hemangioma of the Breast: Case Report, with Imaging Findings

Vascular tumors in the breast are rare, and most can be classified as being either angiosarcomas or hemangiomas. Hemangiomas are benign vascular tumors that are usually identified incidentally. Here, we are reporting on a case of a complex hemangioma of the breast, and describing the mammography, ultrasonography, and magnetic resonance imaging findings for this patient.

Median sacral artery injury during percutaneous mechanical disc decompression using Dekompressor(R) / 대한마취과학회지

No abstract available.

Median sacral artery injury during percutaneous mechanical disc decompression using Dekompressor(R) / 대한마취과학회지

No abstract available.

Magnetic Resonance Imaging of Breast Cancer Patients with BRCA Mutation

PURPOSE: To evaluate the MRI findings of breast cancer with BRCA mutation. MATERIALS AND METHODS: We collected information of the breast cancer patients who underwent the test for BRCA gene mutation as well as preoperative breast MRI from January 2007 to December 2010. A total of 185 patients were enrolled; 33 of these patients had BRCA mutations and 152 patients did not. Among them, a total of 231 breast cancers were detected. Images of the 47 breast cancers with BRCA mutation and of the 184 breast cancers without mutations were evaluated to compare the morphologic and enhancement features on MRI. RESULTS: With MR imaging, there were no significant difference in morphologic characteristic between two groups. However, enhancement pattern in the group with BRCA mutation were more likely to have persistent enhancement (p < 0.233), and LN metastasis was more common in breast cancers without BRCA mutation. Breast cancers with BRCA 2 mutation tend to show more persistent enhancement pattern than BRCA 1 mutation. CONCLUSION: In breast cancer patients with BRCA mutation, MRI didn't show significant difference in morphologic characteristics, however breast cancers with BRCA gene mutation carriers tend to have benign morphologic features on MRI, such as Type 1 kinetic curve enhancement.

Cerebral Artery Dissection: Spectrum of Clinical Presentations Related to Angiographic Findings / 신경중재치료의학

PURPOSE: Cerebral arterial dissections are recognized as a common cause of stroke. However, few studies have reported on the distribution of cerebral arterial dissection and angiographic pattern related to the presenting clinical symptom pattern. We analyzed the distribution of cerebral artery dissection along with angiographic and clinical presenting a pattern as depicted on angiograms. MATERIALS AND METHODS: From January 2000 to January 2007, 133 arterial dissection patients admitted to our institutes were retrospectively reviewed. The characteristic angiographic findings of all cerebral arteries were carefully evaluated on 4-vessel angiograms. The male-female ratio was 77: 56 and the mean age was 51 years. According to the angiographic finding depicting the location of the dissection plane in the arterial wall, we categorized to steno-occlusive, aneurysmal, combined and unclassifiable pattern. In each dissection pattern, we evaluated presenting symptoms and presence of infarction or hemorrhage. RESULTS: The most common symptom on presentation was headache (47%), followed by motor weakness of arm or leg (31%), dysarthria/aphasia (19%) and vertigo (16%). The most common angiographic pattern was steno-occlusive (46%), followed by combined (steno-occlusive and aneurismal) (27%) and aneurysmal (22%) patterns. Steno-occlusive pattern was most commonly related to infarction (33/61, 54%) in contrast that aneurysmal pattern was most frequently related to subarachnoid hemorrhage (SAH) (7/29, 24%). The most frequent abnormality in patients with dissection of the intradural vertebral arteries including posterior cerebral artery (PCA) was SAH (23/70, 33%), followed by infarction. Infarction was the most common abnormality in patients with the extradural and intradural carotid arteries, and the extradural vertebral artery. CONCLUSION: In contrast that the extradural arterial dissections tended to result in ischemia with steno-occlusive pattern, the intradural arterial dissections tended to result in SAH with aneurysmal type, especially in the vertebral artery. Dissection requires combined analysis of angiographic pattern and type of stroke depending on the location.

CT guided Epidural Steroid Injection / 신경중재치료의학

PURPOSE: CT guided epidural steroid injection (ESI) is not commonly used for the management of lumbar pain in Korea. Therefore, we evaluated a short term improvement as defined by the scale of pain after CT guided ESI. MATERIALS AND METHODS: We prospectively followed 29 consecutive patients (average age, 62 years; range, 38-78 years; 10 men, 19 women) with lumbar radiculopathy for a minimal follow-up period of 1 month. The intensity of radicular pain was scored by the patient on the visual analog scan (VAS), from 0 (no pain) to 10 (maximal intensity). Scores before and after the procedure were compared by using the Wilcoxon signed-rank test for paired values. Pain relief was classified as "0" when the pain was completely resolved or had diminished, "1" for not changing, "2" for an increase in pain. RESULTS: The mean VAS scores were 8 (range, 2-10) before and 5 (range, 1-10) 1 month after the procedure, with significant pain relief (p < .001). Pain relief was divided as 0 in 21 patients (72%), 1 in 8 patients (28%) without anyone of grade 2. There was no procedure-related complication except one patient with temporary left side weakness and sensory change which lasted 1-2 hours and subsided thereafter propably due to temporary route compression caused by previous postoperative adhesion or inadvertent intrathecal injection. CONCLUSION: Good pain relief can be expected after CT guided ESI. CT guided ESI may have some difficulties in postoperative patient with metal devices or adhesion.

Angiographically Negative Acute Arterial Upper and Lower Gastrointestinal Bleeding: Incidence, Predictive Factors, and Clinical Outcomes

OBJECTIVE: To evaluate the incidence, predictive factors, and clinical outcomes of angiographically negative acute arterial upper and lower gastrointestinal (GI) bleeding. MATERIALS AND METHODS:From 2001 to 2008, 143 consecutive patients who underwent an angiography for acute arterial upper or lower GI bleeding were examined. RESULTS: The angiographies revealed a negative bleeding focus in 75 of 143 (52%) patients. The incidence of an angiographically negative outcome was significantly higher in patients with a stable hemodynamic status (p < 0.001), or in patients with lower GI bleeding (p = 0.032). A follow-up of the 75 patients (range: 0-72 months, mean: 8 +/- 14 months) revealed that 60 of the 75 (80%) patients with a negative bleeding focus underwent conservative management only, and acute bleeding was controlled without rebleeding. Three of the 75 (4%) patients underwent exploratory surgery due to prolonged bleeding; however, no bleeding focus was detected. Rebleeding occurred in 12 of 75 (16%) patients. Of these, six patients experienced massive rebleeding and died of disseminated intravascular coagulation within four to nine hours after the rebleeding episode. Four of the 16 patients underwent a repeat angiography and the two remaining patients underwent a surgical intervention to control the bleeding. CONCLUSION: Angiographically negative results are relatively common in patients with acute GI bleeding, especially in patients with a stable hemodynamic status or lower GI bleeding. Most patients with a negative bleeding focus have experienced spontaneous resolution of their condition.

Protective Effect of Cariporide(R) against Ischemia/Reperfusion Injury in Rat Kidney / 대한신장학회잡지

BACKGROUND:Cytoprotective effect of Na+/H+ exchanger type 1 (NHE1) inhibitors has been studied in ischemic/reperfusion (IR) injury. The aim of this study was to evaluate the renoprotective effect and the mechanism of NHE1 inhibitor (Cariporide(R)) on IR injury of rat kidney. METHODS:IR injury was produced by clamping both renal arteries and then rats were treated with intravenous (IV) Cariporide(R) (0.5 or 1.0 mg/kg) in Sprague-Dawley rats. The effects of Cariporide(R) treatment on subsequent IR injury were evaluated in terms of renal function, tubular injury, inflammatory cytokines (IL-1beta, TNF-alpha), apoptosis, and the expression of MAPKs. RESULTS:BUN and serum creatinine increased after IR injury compared with sham-operated controls. However, treatment with Cariporide(R) significantly reduced BUN and serum creatinine. IR injury caused severe destruction of renal tubular cells in the outer medulla, but treatment with Cariporide(R) decreased the tubular damage. Treatment with Cariporide(R) also significantly decreased the expression of IL-1beta and TNF-alpha mRNA compared with IR injury. Apoptotic cell death was increased with I/R injury, but was significantly decreased in kidneys treated with Cariporide(R). At molecular basis, caspase 3 protein decreased more in Cariporide(R)-treated group than in IR injury group. The expression of MAPKs significantly increased with IR injury compared with sham- operated controls. However, kidneys treated with Cariporide(R) showed further increase of ERK expression compared with IR injury, but showed a significant decrease of JNK expression. CONCLUSIONS:NHE1 inhibitors, Cariporide(R), partially prevented IR injury-induced acute renal failure by the mechanism involving apoptosis, inflammation and MAPKs.

Peritoneal Expression of Vascular Endothelial Growth Factor in Rat with Peritonitis / 대한신장학회잡지

BACKGROUND: Ultrafiltration failure resulting from increased peritoneal vascular permeability during peritonitis is a major problem in CAPD patients. However, the mechanism of increased peritoneal permeability during peritonitis has not been clearly determined. We studied changes in the peritoneal permeability and the expression of vascular endothelial growth factor(VEGF), which is known to increase vascular permeability, in the peritoneal tissues of rats with peritonitis. METHODS: After implanting peritoneal dialysis catheter to 20 Sprague-Dawley rats and performing peritoneal equilibration test(PET), rats were divided into control group(n=7) and peritonitis group(n=13). One ml of saline or Staphylococcus aureus(1X10(9) colony forming unit/mL) was injected intraperitoneally to control or peritonitis group for five days, and PET was repeated. Peritoneal transport rates of glucose and total protein were measured, and macrophages infiltration and VEGF expression in peritoneal tissues were examined by immunohistochemical stain. RESULTS: Peritoneal transport rates of glucose and total protein were significantly increased in peritonitis group compared with control group, suggesting that peritonitis increased peritoneal transport rates of both low and high molecular weight solutes. The peritoneal tissues of peritonitis rats showed profuse infiltration of macrophages in the submesothelial space, submesothelial widening and denudation of mesothelial cells. While VEGF was slightly expressed in peritoneal mesothelial cells in control rats, it was intensively stained not only in the peritoneal mesothelial cells but also in the infiltrated macrophages in the submesothelial space in peritonitis rats. CONCLUSION: Peritonitis increases peritoneal vascular permeability and VEGF expression in peritoneal mesothelial cells and infiltrated macrophages in the submesothelial space. These data suggest that VEGF may play a role in the increased peritoneal permeability during peritonitis.

A Case of Type 1 Renal Tubular Acidosis Accompanying Renal Stone and Nephrocalcinosis Caused by Hypocitraturia / 대한신장학회잡지

Renal stone and nephrocalcinosis are common clinical manifestations of type 1 renal tubular acidosis. In normal state, citrate plays the most critical role in suppressing stone formation as it combines with calcium. In type 1 RTA, increased reabsorption of citrate in proximal tubule results in low citrate excretion, which precipitates renal stone formation. We report a case of type 1 RTA accompanying renal stone and nephrocalcinosis caused by hypocitraturia. A 16-year-old male patient who had renal stone and nephrocalcinosis showed hypocitraturia. Incomplete type 1 RTA was proved as the cause of hypocitraturia by bicarbonate and ammonium loading test in the patient.

Three Cases of the Gastric Carcinoid Tumor Combined with the Gastric Adenoma / 대한소화기내시경학회지

Carcinoid tumor in the stomach is neuroendocrine tumor originated from enterochromaffin cells in submucosa in the stomach. It is very rare, account for 0.3% of gastric tumor. It is likely to be demonstrated with other tumor in the stomach simultaneously, such as adenocarcinoma. According to paper published in Korea, it is only 4 cases that gastric carcinoid combined with other gastric tumors have been reported. But there has been no reports of gastric carcinoid combined with gastric adenoma, such as our cases. We report 3 cases of gastric carcinoid tumor combined with atypical adenoma, with review of paper presented.

A Case of Empyema Thorax and Intraabdominal Abscess caused by Nocardiac Species / 대한신장학회잡지

Nocardiosis is a disease caused by the Nocardia species, a kind of aerobic Actinomycetes, gram positive organism that was acid fast when stained with the modified 7iehl-Neelsen method. And, this disease is an important opportunistic infection in immunosuppressed patients, SLE, Cushing's disease, Sarcoidosis, AIDS and organ transplantation patients. Most nocardial infection is acquired by inhalation of the organism and may develop a disseminated infection, especially, central nervous system infection, subcutaneous abscess. We experienced a case of Nocardiosis in renal transplant recipient invading pleural and aMominal cavity. So we report this case with the review of the relevant literatures.