Pediatric Solitary Castleman's Disease Concurrently Arising from Neck & Axilla

Castleman's disease (CD) is an unusual benign lymphoproliferative disorder of unknown etiology and pathogenesis. It most commonly occurs in the mediastinum, but rarely in the axilla or neck. CD has been rarely reported at pediatric age in Korea. Here we report a 17-month-old male patient with histopathologically proven cervical & axillary CD of the hyline vascular type who presented with a painless axillary palpable mass and was treated with a complete excision of the neck & axilla mass without complication.

Myoid Hamartoma of the Breast with Synchronous Contralateral Breast Cancer: Report of a Case / 한국유방암학회지

Myoid hamartomas of the breast parenchyma are extremely rare, benign breast neoplasms. Only 15 cases of the parenchymal myoid hamartoma of the breast have currently been described in the medical literature written in English. A 46-year-old woman presented with a huge right breast myoid hamartoma and synchronous contralateral left periareolar cancer. We discuss the clinical features, the radiologic findings, the pathologic findings and the management of this type of lesion. Surgeons should be aware that myoid hamartoma is a rare benign tumor, but it can be the cause of a palpable mass in the breast.

Myoid Hamartoma of the Breast with Synchronous Contralateral Breast Cancer: Report of a Case / 한국유방암학회지

Myoid hamartomas of the breast parenchyma are extremely rare, benign breast neoplasms. Only 15 cases of the parenchymal myoid hamartoma of the breast have currently been described in the medical literature written in English. A 46-year-old woman presented with a huge right breast myoid hamartoma and synchronous contralateral left periareolar cancer. We discuss the clinical features, the radiologic findings, the pathologic findings and the management of this type of lesion. Surgeons should be aware that myoid hamartoma is a rare benign tumor, but it can be the cause of a palpable mass in the breast.

Gamma Knife Surgery for Brain Metastases from Breast Carcinoma

PURPOSE: This study was performed to evaluate the feasibility of the Gamma Knife Surgery on the symptomatic control of brain metastasis from breast carcinoma. METHODS: We retrospectively reviewed patients with brain metastases from breast cancer who underwent Gamma Knife Surgery at our hospital, between May 2004 and November 2007. Total 82 metastases were treated with 26 cycles of Leksell gamma knife. Freedom from local recurrence and survival time were analyzed by the Kaplan-Meier method. RESULTS: 17 patients with 82 metastases were treated over 26 Gamma Knife Surgery sessions. The mean time to brain metastases was 41.7 months (8~84), median number was 2.0 (1~10), and median volume was 7.4 cm3 (0.6~25.4). Radiologic response occurred in 84.6%, and the rate of symptom relief was 73.1%. Local brain tumor recurrences were observed in 15.3% and intracranial distant recurrence occurred in 57.7% that occurred within 3.2 months. The median length of survival for all patients was 9.3 months (95% confidence interval, 4.23~9.37 months). CONCLUSION: Gamma Knife Surgery is an effective and feasible treatment for symptomatic control of brain metastases from breast cancer patients who have severe extracranial metastases and short life expectancy.

The Clinical Significance of the Estrogen Receptor beta Expression for Endocrine Therapy in Patients with ERalpha-negative and Progesterone Receptor-positive Breast Carcinoma / 한국유방암학회지

PURPOSE: Estrogen receptor (ER) is the key therapeutic target in breast cancer. ERbeta has recently been identified to be distinct from ERalpha. In contrast to ERalpha, the functions of ERbeta in breast cancer are still unclear. We sought to determine whether the expression of ERbeta can be used as a predictive marker for endocrine therapy for patients with ERalpha-negative breast cancer. METHODS: Formalin-fixed, paraffin-embedded tumor specimens from 52 patients with ER-/PR+ invasive breast cancer were immunostained for their ERbeta expression. These patients were treated with adjuvant tamoxifen. The results were correlated with various clinicopathological variables and the follow-up data. The expressions of p53 and HER-2/neu were also analyzed and correlated with the ERbeta status. RESULTS: An ERbeta expression was observed in 53.8% (28/52) of the breast cancer samples. There was no correlation between the ERbeta expression and the other clinicopathologic factors (age, tumor size, histologic type, nodal status, histological grade, stage, therapeutic modality, progesterone receptor (PR) expression, p53 expression and HER-2/neu expression). Recurrence was present in 7.7% (2/26) of the patients whose tumors had an ERbeta expression, as compared to the presence of recurrence in 36.4% (8/22) of the patients whose tumors had no ERbeta expression (p<0.05). The patients with ERbeta negative-tumors revealed lower disease free survival rate than those with ERbeta positive-tumors (p<0.05). Of the 52 patients, 10 (19.2%) were p53 positive, and 11 (21.2%) were HER-2/neu positive. No significant correlations were observed between ERbeta and p53 or HER-2/neu. CONCLUSION: These results suggest that ERbeta might be a predictive marker of a response to endocrine therapy in patients with ER-/PR+ invasive breast cancer, although this needs to be confirmed by additional studies.

A Mucocele-Like Tumor of the Breast Associated with Ductal Carcinoma In Situ and Mucinous Carcinoma: A Case Report / 한국유방암학회지

A Mucocele-like tumor (MLT) of the breast is a rare lesion and is pathologically characterized by mucin-filled cysts and extravasated mucin present in the adjacent stroma. Since the first report of an MLT of the breast by Rosen in 1986, an MLT has been considered as part of a diverse spectrum of pathological lesions including benign tumors, atypical ductal hyperplasia (ADH), ductal carcinoma in situ (DCIS) and mucinous carcinomas. We described a case of an MLT of the breast associated with DCIS and a mucinous carcinoma in a 46-year-old female patient who was treated with a left modified radical mastectomy and a sentinel lymph node biopsy. This case supports the concept of a spectrum of pathological lesions for an MLT, including benign lesions, columnar hyperplasia, ADH, DCIS and mucinous carcinomas.

Management of Thyroid Papillary Carcinoma Invading the Recurrent Laryngeal Nerve / 대한내분비외과학회지

PURPOSE: Invasion of the recurrent laryngeal nerve (RLN) by papillary carcinoma of the thyroid gland is rather infrequent. Tumor excision for this patients with invasion of the RLN has been categorized into two groups on the basis of completeness: (1) Resection of the RLN was required for complete excision, and (2) isolation of the RLN from thyroid cancer was mainly performed by sharp dissection to leave as little tumor as possible. Reconstruction of the nerve after complete tumor resection can be added as a supplementary procedure. This study was designed to analyze the clinical characteristics and surgical treatment of thyroid cancer invading the RLN. METHODS: At the Department of Endocrine Surgery of our hospital, 1,426 patients were diagnosed and operated on for papillary thyroid cancer during 36 months, from December 2004 to December 2006. Among them, 49 patients who revealed invasion of the recurrent laryngeal nerve were retrospectively evaluated for their age, gender, preoperative hoarseness and the operative method, change of their postoperative symptoms, radioiodine ablation, the laryngoscopic findings, recurrence and the prognosis. RESULTS: Of the 49 patients, 10 patients had preoperative hoarseness and 13 patients were treated by complete resection. We tried reconstruction of the recurrent laryngeal nerve with using the hypoglossi-recurrent nerve in one case, and with direct end-to-end anastomosis in two cases. The rest of the 36 patients were treated by shaving resection of thyroid and leaving the RLN intact. CONCLUSION: When a surgeon finds papillary carcinoma infiltrating a recurrent laryngeal nerve, regardless of the preoperative symptoms, preservation of the RLN and removal of as much tumor as possible will offer a good result.

Predictive Factors for Nipple-areola Invasion in Patients with Breast Cancer

PURPOSE: After the first subcutaneous mastectomy with nipple preservation in 1974 at the Nottingham Breast Clinic in United Kingdom, many studies have shown that skin-sparing mastectomy (SSM) with the preservation of the nipple-areola complex (NAC) is an oncologically safe procedure with good cosmetic outcomes in selected mastectomy patients. However, the clinical indications for NAC preservation have not yet been precisely defined. This study was performed to investigate the predictive factors for NAC-based neoplastic involvement to determine the indications for NAC preservation. METHODS: A retrospective study of 198 patients with invasive breast cancer who underwent modified radical mastectomy (MRM) at the Department of Surgery at Chonnam University Hospital from April of 2004 to April of 2006 was performed. Patients with bilateral breast cancer were excluded from the study. The predictive factors analyzed for NAC involvement were the hormone receptor status, tumor size, tumor localization, multiplicity, axillary lymph node status, nuclear grade, tumor-nipple distance (TND), and lymphovascular invasion (LVI). RESULTS: The overall frequency of malignant NAC involvement was 19 out of the 198 patients (9.5%) as determined by definitive histology. Significant differences were found for tumor size (P=0.015), axillary lymph node status (P=0.008), TND (P=0.044), and LVI (P=0.014). There were no significant differences for the hormone receptor status, multiplicity, nuclear grade, and localization. CONCLUSION: Although the sample size in this study was small, the findings suggest that the clinical contraindications for NAC preservation should include tumors >2.4 cm, a positive axillary lymph node status, TND <4 cm, and positive LVI. NAC preservation can be offered in selected patients after preoperative or intraoperative evaluation of the tumor size, axillary node status, TND, and LVI.

Predictive Factors Related to Lymph Node Metastases in Patients with Papillary Thyroid Microcarcinomas Less than 5 mm in Size / 대한내분비외과학회지

PURPOSE: Papillary thyroid cancer is the most common histological type of malignancy that originates from the thyroid. The disease has an excellent prognosis, despite characteristically being associated with lymph node metastases. According to the World Health Organization, a papillary thyroid microcarcinoma (PTMC) is defined as papillary carcinoma measuring ≤1 cm in the greatest dimension. We present the clinico-pathological features and investigate predictive factors related with lymph node metastases in patients with papillary thyroid microcarcinomas less than 5 mm in size. METHODS: Between January 2003 and June 2005, 75 patients underwent surgical treatment for thyroid papillary cancer less than 5 mm in size at the Department of Endocrine Surgery at our hospital. We analyzed the age of patients, gender, presence of symptoms, multifocality, combined thyroid disease, tumor size, capsular invasion, presence of a lymph node metastasis, tumor location, operative method and postoperative complications by use of Pearson's chi-squared test. RESULTS: Lymph node metastases most frequently occurred in patients with a lateral neck mass at presentation (p=0.004). Patients with capsular invasion of the thyroid showed a high rate of lymph node metastases (p=0.027). In patients with combined thyroid disease such as thyroiditis, more lymph node metastases were observed (p=0.018). CONCLUSION: Preoperative symptoms at presentation (especially a lateral neck mass) and tumors with capsular invasion had a high potential to cause lymph node metastases. Factors such as a lateral neck mass, capsular invasion, and combined thyroiditis may be predictive of a lymph node metastasis and are helpful in the determination of proper treatment.

Bone Mineral Density in Postsurgical Thyroxine Replacement / 대한내분비외과학회지

PURPOSE: Bone turnover is increased in patients suffering with hyperthyroidism, and this results in osteoporosis. Especially after total thyroidectomy for the treatment of thyroid papillary cancer, it is necessary to pay attention to osteoporosis because we must treat these patients with suppressive thyroxine therapy. METHODS: Among the patients who underwent endocrine surgery of Chonnam National University, 110 cases had taken thyroxine for more than one year. We analyzed them on the basis of their medical record. The study consisted of women between 45 and 74 years of age who were treated with thyroxine for more than one year, who had total thyroidectomy performed for thyroid papillary carcinoma and who taken thyroxine for 12~142 months (mean: 53 months). We measured the bone mineral density at the lumbar spine and the femoral neck with using dual energy X-ray absorptiometry. RESULTS: The bone mineral density of the lumbar spine and femur neck was significantly reduced with the increasing the duration of thyroxine medication. Yet this was not significant after adjusting by age. There was correlation between the TSH levels and bone mineral densities. CONCLUSION: After total thyroidectomy, it may be necessary to evaluate the bone mineral density of the patients who were treated with suppressive thyroxine and also to warn them about osteoporosis.