Treatment of Pulmonary Tumor Embolism from Choriocarcinoma: Extracorporeal Membrane Oxygenation as a Bridge through Chemotherapy / Journal of the Korean Cancer Association, 대한암학회지

A 22-year-old woman with a 1-month history of shortness of breath that was treated as a case of tuberculosis and pulmonary embolism was referred to the authors’ hospital. Because of the hemodynamic instability in this patient, venoarterial extracorporeal membrane oxygenation (ECMO) was administered in the intensive care unit. She underwent a pulmonary embolectomy for the treatment of progressive circulatory collapse secondary to a pulmonary embolism. The histopathologic result was consistent with a metastatic choriocarcinoma. Despite the surgical management, persistent refractory cardiogenic shock occurred. Subsequently, the patient was treated with chemotherapy in the presence of ECMO and responded well to chemotherapy. She was discharged after 3 months. This case suggests that metastatic choriocarcinoma should be considered as a differential diagnosis in women of childbearing age presenting with a pulmonary embolism, and ECMO may be beneficial in patients with pulmonary embolism for bridging to surgical embolectomy and chemotherapy.

Lymphoepithelioma-like carcinoma of the uterine cervix

Lymphoepithelioma-like carcinoma (LELC) of the uterine cervix is exceedingly uncommon. We herein report a rare case of cervical LELC. A 45-year-old woman was admitted to gynecology department with vaginal bleeding for one month. Liquid-based cytology revealed atypical endometrial cells, not otherwise specified on her cervix. On a hysteroscopy, an endocervical mass was identified and the pathologic result was consistent with poorly differentiated squamous cell carcinoma. Magnetic resonance imaging and positron emission tomography with 2-deoxy-2-[fluorine-18] fluoro-D-glucose integrated with computed tomography revealed a 3.1-cm endocervical mass without distant metastasis or enlarged lymph nodes. The International Federation of Gynecology and Obstetrics stage was IB1. A radical hysterectomy and bilateral pelvic lymph node dissection were performed. The pathologic diagnosis was a poorly differentiated carcinoma, showing features of LELC. She has been followed for 8 months without adjuvant treatment since the surgery, during which time there has been no evidence of tumor recurrence or metastasis.

Extrauterine epithelioid trophoblastic tumor in hysterectomized woman

Epithelioid trophoblastic tumor (ETT) is a very rare variant of gestational trophoblastic disease (GTD) which arises in reproductive age women with prior gestational history. Although abnormal vaginal bleeding is the most common symptom of ETT, there are no reported pathognomonic symptoms of ETT because of its rarity. ETT is similar to placental site trophoblastic tumor in terms of its slow growing characteristic and microscopic findings. Therefore, it could be misdiagnosed as placental site trophoblastic tumor or other types of GTD. Unlike other types of GTD, primary treatment of ETT is surgical resection because of its chemo-resistant nature. Accordingly, immunohistochemical staining is essential for accurate diagnosis and appropriate treatment. Here, we report a case of a 42-year-old hysterectomized woman with pelvic masses who suffered from abdominal pain. Through laparotomy, tumors were resected completely and they were diagnosed as ETT through immunohistochemical stain. This report provides more evidence about its clinical features, diagnosis, and treatment including a brief review of the literature.

Robotic high para-aortic lymph node dissection with high port placement using same port for pelvic surgery in gynecologic cancer patients / 부인종양

OBJECTIVE: This study reports our initial experience of robotic high para-aortic lymph node dissection (PALND) with high port placement using same port for pelvic surgery in cervical and endometrial cancer patients. METHODS: Between July 2013 and January 2014, we performed robotic high PALND up to the left renal vein during staging surgeries. With high port placement and same port usage for pelvic surgery, high PALND was successfully performed without repositioning the robotic column. All data were registered consecutively and analyzed retrospectively. RESULTS: All patients successfully underwent robotic high PALND, followed by hysterectomy and pelvic lymph node dissection. Median age was 45 years (range, 39 to 51 years) and median body mass index was 22 kg/m2 (range, 19.3 to 23.1 kg/m2). Median operative time for right PALND and left PALND was 37 minutes (range, 22 to 65 minutes) and 44 minutes (range, 36 to 50 minutes), respectively. Median number of right and left para-aortic lymph node by pathologic report was 12 (range, 8 to 15) and 13 (range, 5 to 26). CONCLUSION: With high port placement and one assistant port, robotic high PALND with the same port used in pelvic surgery is feasible to non-obese patients.

Long-term recurrence-free survival in a patient with stage IVB uterine carcinosarcoma / 부인종양

Uterine carcinosarcomas are rare and highly aggressive tumors with a poor prognosis. Due to early metastasis and disease progression, it is known to be far more aggressive than matched grade 3 endometroid endometrial carcinomas. Five-year survival for stage IV is reported to be 10% and overall survival for stage IVB is expected to be very poor. The authors report one case after experiencing long-term survival (over 5 years) for stage IVB carcinosarcoma of uterus. Total abdominal hysterectomy and bilateral salpingo-oophorectomy was performed to 56 year old patient for uterine myoma. On pathology report, uterine carcinosarcoma was diagnosed and image studies were performed. With the impression of stage IVB uterine carcinosarcoma, 6 cycles of chemotherapy (ifosfamide and cisplatin) was conducted as adjuvant. Up to recently (over 5 years), she maintains good performance scale without evidence of tumor recurrence or disease progression.

Benign Metastasizing Leiomyoma with Multiple Lymph Node Metastasis: A Case Report / Journal of the Korean Cancer Association, 대한암학회지

This is a case report about benign metastasizing leiomyoma with multiple lymph node metastasis. A 34-year-old woman received an abdominal myomectomy for a suspicious leiomyoma. On the pathology report, atypical leiomyoma was suspected. Due to the suspicion of multiple lymph node metastasis on pelvis computed tomography (CT) 1 year after the operation, she was transferred to the Samsung Medical Center on October, 2009 for further work up. According to original slide review, it was determined to be a benign leiomyoma with a mitotic count <5/10 high-power fields, little cytological atypia and no tumor cell necrosis. Additional immunostaining was done. Multiple lymph node metastasis and a small lung nodule were identified on positron emission tomogarphy-CT and chest CT. Extensive debulking surgery and diagnostic video-assisted thoracoscopic surgery (VATS) wedge resection were subsequently done. Metastatic lesions were reported to have a histology similar to that of the original mass. VATS right upper lobectomy with mediastinal lymph node dissection was performed because of the pathology result of VATS (adenocarcinoma). She started taking an aromatase inhibitor (Letrozole(R)) and there was no evidence of recurrence of disease on an imaging study and no post-operative complications until recently.

Obstetric and neonatal outcomes after treatment of gestational diabetes mellitus class A1 and class A2 / 대한산부인과학회지

OBJECTIVE: The purpose of this study is to compare the pregnancy outcomes of gestational diabetes mellitus (GDM) class A1 to those of GDM A2. METHODS: We performed a retrospective analysis of 99 women who were diagnosed as GDM during prenatal care and managed until delivery from March 1996 to September 2007. Subjects were grouped into GDM class A1 and class A2. The obstetric and neonatal outcomes were compared between the two groups. RESULTS: There were 57 cases of GDM class A1 and 42 cases of GDM class A2. Hemoglobin A1c level of GDM A2 group was significantly higher than GDM A1 group. We could not find any significant difference in obstetric (body mass index, hypertensive disorder, preterm delivery, preterm labor, preterm premature rupture of membrane) and neonatal outcomes (gestational age at delivery, macrosomia, shoulder dystocia, respiratory distress syndrome, transient tachypnea of neonate, sepsis, Apgar score, congenital anomaly) between the two groups other than increased frequency of cesarean delivery and admission to neonatal intensive care unit in GDM A2 group. CONCLUSION: After proper management, overall pregnancy outcomes of women with GDM class A2 are comparable to those with GDM class A1.

Diagnosis of Acute Appendicitis in the Community Hospital: Validity and Usefulness of Sonography

PURPOSE: To compare the accuracy of initial clinical diagnosis with that of ultrasonography(US) in diagnosingappendicitis and to determine its effect on the care of patients in a community hospital. MATERIALS AND METHODS: One hundred and fifty patients with suspected appendicitis were prospectively examined with US. Prior to this,they had been divided into three groups on the basis of clinical judgement regarding diagnosis and their treatmentplan: Group I : high suspicion (probability > 75%) - urgent surgery indicated ; Group II : equivocal (probability25 - 75%) - in hospital for observation, Group III : very unlikely (probability < 25%)- discharge without furthertesting. In order to determine the validity of these groupings, we calculated the sensitivity, specificity, andaccuracy of sonographic examination, and the likelihood ratios of initial clinical diagnosis. RESULTS: USrevealed a sensitivity of 92%, specificity of 90%, positive predictive value of 95%, negative predictive value of85% and overall accuracy of 91%. The initial clinical impression showed a sensitivity of 70%, specificity of 82%,positive predictive value of 89%, negative predictive value of 58%, and overall accuracy of 74%. Among 79 patientsin the high clinical risk category (Group I), the sensitivity, specificity and accuracy of US were 96%, 89%, and95%, respectively. Among 71 patients in the low- and intermediate- clinical categories (Groups II and III), thesensitivity, specificity, and accuracy of US were 83%, 90%, and 87%. The likelihood ratios were 3.9 in Group I,0.52 in Group II, and 0.15 in Group III. In 32 of 150 patients (21%), the findings of US led to changes in theproposed management plan. CONCLUSION: The overall accuracy of US in the diagnosis of appendicitis wasstatistically superior to that of the clinician's initial impression (p<0.05). In addition, US played an importantrole in making decisions regarding the treatment plan.

Percutaneous Cholecystostomy at the Community Hospital: Value Evaluation

PURPOSE: To assess the role of percutaneous cholecystostomy as a therapeutic maneuver in patients critically ill with acute cholecystitis in community hospitals. MATERIALS AND METHODS: Eighteen patients, 11 with suspected acute calculous cholecystits and seven with acute acalculous cholecystitis underwent emergency percutaneous cholecystostomy. All demonstrated a variety of high risk factors for cholecystectomy: liver cirrhosis (n=2), diabetes mellitus (n=3), cardiac disease (n=3), underlying malignancy (n=2), pulmonary dysfunction (n=1), septic cholangitis (n=5), and old age (n=2). All percutaneous cholecystostomies were performed with ultrasound guidance and preferably using the transhepatic route. RESULTS: All procedures but one were successful, and most cholecystostomies were performed within 5-20 minutes. Technical problems were as follows: guide-wire buckling during catheter insertion (n=2) and procedure failure (n=1). The only major problem was a case of localized bile peritonitis due to procedural failure, but a few minor complications were encountered: catheter dislodgment (n=3), and significant abdominal pain during the procedure (2). After successful cholecystostomy, a dramatic improvement in clinical condition was observed in 16 of 17 patients (94%) within 48 hours. Ten of 16 patients who responded to percutaneous cholecystostomy underwent elective cholecystectomy after the improvement of clinical symptoms, and the remaining six patients improved without other gallbladder interventions. CONCLUSION: Percutaneous cholecystostomy is not only an effective procedure for acute cholecystitis, but also has a definite role in the management of these high-risk patients in community hospitals.

Appendiceal Polyp: A report of two cases

Varying types of polyps could occur in the vermiform appendix. However, it is very unusual. Collins found 57 cases (0.08%) of benign mucosal polyps in the 71,000 cases of appendectomy specimens. There has been no reported case of appendiceal polyp in the literature in Korea. The authors experienced two cases of polyp in the vermiform appendix. The first case was a 51 year-old male patient who received a left hemicolectomy due to colonic polyposis. The second case was a 71 year-old male patient who was treated by appendectomy under the clinical diagnosis of acute appendicitis. The microscopic type of both cases were hyperplastic polyp.

Characteristics of the Posterior Aortic Wall Motions in M-mode Echocardiogram of the Patients with Various Valvular Heart Diseases

To observe the characteristics of the posterior aortic wall motions of the patients with various valvular heart diseases the aortic root echocardiogram of the 60 patients with various valvular diseases were examined. 15 cases in each group of patients with mitral stenosis, mitral insufficiency, mitral stenoinsufficiency or aortic insufficiency. Thirty normal subjects were served as a control group. In each, the total amplitude of the aortic posterior wall motion(OV), the amplitude of the motion evented at atrial systole(AV), AV/OV ratio, atrial emptying index(AEI), left atrial and aortic root dimensions (LAD and AOD), and LAD/AOD were measured. The results were as follows ; 1) The AV was significantly increased in mitral stenosis(P<0.01) and decreased in mitral insufficiency(P<0.05) compared with control group. 2) The OV was increase in mitral insufficiency and aortic insufficiency(p<0.01, p<0.05), but decreased in mitral stenosis(p<0.05). 3) The AV/OV was increased in mitral stenosis(p<0.01) and decreased in mitral insufficiency and aortic insufficiency(p<0.01). 4) The AEI was decreased in all patient groups(p<0.01) and LAD was increase in all compared with control group(p<0.01). 5) The AOD was increased only in aortic insufficiency(p<0.01). 6) The LAD/AOD ratio was increased in all patient groups(p<0.01).

A Clinical Study of Hypotensive Effect of Tripamide(Normonal(R)) in Essential Hypertension

The hypotensive effect of tripamide(Normonal(R)) were evaluated in 31 cases of essential hypertension. Fifteen to thirty mg of tripamide per day were administered continuously for 8 weeks. The results were as follows; 1) The systolic blood pressure was significantly lowered from 175+/-15 mmHg(Mean+/-SD) before treatment to 144+/-17 mmHg after treatment(p<0.01), and the diastolic blood pressure was significantly lowered from 106+/-11 mmHg before treatment to 90+/-12 mmHg after treatment(p<0.01). 2) The systolic blood pressure was lowered 20 mmHg or more in 25 out of 31 cases(80.7%), and the diastolic blood pressure was decreased 10 mmHg or more in 25 out of 31 cases(80.7%) at the end of 8 weeks treatement. 3) There was no significantl differences in the level of SGOT, serum cholesterol, serum electrolytes(Na+, K+, Cl-), BUN, creatinine and urinc acid before and after treatment with tripamide. 4) In most cases the subjective symptoms disappeared or became easier after tripamide treatment. 5) Profound weakness was developed in 2 cases during tripamide administration.

Effect of Atenolol on Left Ventricular Function in Essential Hypertension

This study was made to evaluate the effect of oral atenolol, a cardioselective beta-adrenergic blocking agent without intrinsic sympathomimetic activity, on left ventricular function in patient with essential hypertension. Atenolol, 100mg/day, was given to 11 hypertensive patients for 4 weeks, and its effects on arterial pressure, pulse rate, left ventricular dimensions and ejection phase indices of myocardial performance were examined by echocardiography. Echocardiographic studies were performed before treatment and after 4 weeks of atenolol therapy. Arterial pressure fell form 145/90 mmHg to 138/84mmHg after 4 weeks. Pulse rate fell significantly from 69/min to 58/min(p<0.05). Left ventricular end-diastolic and end-systolic dimensions and mean rate of circumferential fiber shortening(mVcf) did not change significantly. Ejection fraction increased significantly from 0.66 to 0.72(p=0.01). This results indicate that atenolol in the resting state has no depressant effect on left ventricular function in patients with essential hypertension.

Multiple Primary Malignant Neoplasms: A case of double primary malignant cancer / 대한소화기내시경학회지

This is a case report of double primary malignant cancer occurred aynchronously in the stomach and lymphoid tissue, We report this case with review of literatures about the criteria, age distribution, predisposing factor, inidence, immunity and susceptibility of the primary malignant neoplasms. This case was a 59-year-old man who had Hodgkins disease and tubular adenocarcinoma, of the stomach. The diagnoais was verified histologically, Although multiple primary neoplaas are rare, the possibility of that must be conaidered seriously, And its hereditary predisposition and other predisposing factor muat be researched with enthuaiasm.