Ellagic Acid Shows Different Anti-proliferative Effects Between the MDA-MB-231 and MCF-7 Human Breast Cancer Cell Lines / 한국유방암학회지

PURPOSE: It has been demonstrated ellagic acid can inhibit tumor growth. However, the mechanism that elicits the anti-proliferative effect of ellagic acid is poorly understood. Our objective in this study was to evaluate the biological activity of ellagic acid by comparing the anti-proliferative effect and the apoptotic pathway of ellagic acid between the 2 human breast cancer cell lines. METHODS: The MCF-7 and MDA-MB-231 human breast cancer cell lines were used as cell models. The anti-proliferstive effect was evaluated by using a MTT assay. The cell cycle was analyzed by flow cytometry. Western blotting was performed to show the expressions of bcl-xL, cytochrome c, surviving, c-fos and pS2. RESULTS: The ellagic acid in the MDA-MB-231 cells showed significant anti-proliferative effects with dose dependent pattern. The anti-proliferative effects in MCF-7 cells were observed in only at a high concentration. Ellagic acid had no effect on the cell cycle in both breast cancer cells. In MDA-MB-231, the expression of bcl-xL was decreased with the decreasing concentration of ellagic acid. The expression of cytochrome c in the cytosol was increased with the decreased expression of bcl-xL. Ellagic acid also decreased the expression of survivin. In the MCF-7 cells, the expressions of bcl-xL and cytochrome c showed no change after treatment with ellagic acid even at a high dose. Ellagic acid was able to induce an up-regulation of c-fos and pS2 protein in MCF-7. CONCLUSION: Ellagic acid has an anti-proliferative effect in the MDA-MB-231 cells. This effect of ellagic acid is through the intrinsic pathway in MDA-MB-231 cells. However, the expression of bcl-xL showed no change in the MCF-7 cells. Ellagic acid has a different anti-proliferative effect between the two human breast cancer cell lines.

Safety and Efficacy of Postoperative Total Parenteral Nutrition (TPN) in Patients after Gastrectomy

PURPOSE: Total parenteral nutrition (TPN) has been widely used in malnourished, critically ill or surgical patients since the 1970's. However, short-term application of TPN after elective gastrointestinal surgery has rarely been studied. The purpose of this study was to evaluate the safety and efficacy of postoperative TPN in patients after gastrectomy. METHODS: Forty seven patients who underwent elective gastrectomy from October 2005 to December 2005 were enrolled in this trial. Twenty two patients (TPN group) received multivitamin-containing TPN (Fulcaliq(R), Terumo, Japan) and 25 patients (control group) received the usual 10% dextrose solution for five days after surgery. Vital signs, body weight and nutritional support-related complications were evaluated on a daily basis. In addition, CBC, LFT, electrolyte, and trace elements were measured four times (preoperatively, POD1, POD 3 and POD 6). RESULTS: Nutritional support-related complications did not develop in the groups studied. Body weight and serum albumin levels were not different in comparisons between the two groups. However, in the TPN group, the total protein level on POD 6 had a tendency to be higher than in the control group. On POD 6, AST and ALT levels were significantly higher in the TPN group, but the total bilirubin and cholesterol levels were significantly higher in the control group. CONCLUSION: Multivitamin-containing TPN appears to be safe and effective for patients, in the short term, after gastric surgery.

Toxicity of Concurrent Adjuvant CMF Chemotherapy and Radiotherapy in Patients with Early Breast Cancer / 한국유방암학회지

PURPOSE: Many patients with early stage breast cancer are currently being treated with both adjuvant chemotherapy (CT) and radiotherapy (RT). We performed this study to assess the toxicity of concurrent adjuvant cyclophosphamide, methotrexate, and 5-fluourouracil (CMF) CT and RT for treating early breast cancer patients. METHODS: Between January 2000 and December 2005, 97 patients with stage I or II invasive breast carcinoma were treated with breast-conserving surgery, and they received 6 monthly cycles of classic oral chemotherapy with CMF. Within day 7 of cycle 1, the patients started 3 dimensional conformal RT (3DCRT) with a stadard dose, followed by a boost. We used the Common Terminology Criteria for Adverse Events v 3.0 to score the level of acute toxicity for CT. The adverse effects of RT were graded according to the Radiation Therapy Oncology Group criteria. RESULTS: The mean age of the patients was 45.8 yr (range:30-64). The most common toxicity was nausea and leukopenia. The dose of chemotherapy was reduced to 80% of the planned dose for 6.2% of the patient. CT was disrupted for 4.1% of the patients. RT was not disrupted for any patient. Grade 3 and 4 neutropenia occurred in 41 (42.3%) patients, but only one patient needed hospitalization due to fever. Grade 3 skin lesions developed during or shortly after RT in 10.7% of the patients. Radiation penumonitis was noted in 15.5% of the patients. The median follow-up time was 38 months. There was no local recurrence and 2 (2.08%) distant metastases during follow-up. CONCLUSION: From the results of our study, we conclude that the concurrent administration of adjuvant CMF CT and RT is associated with a low risk of serious toxicity and this is an acceptable adjuvant regimen for patients with early stage breast cancer.

Postoperative Survival and Prognostic Factors in Breast Cancer : a Single Center Analysis of 4,063 Cases / 한국유방암학회지

PURPOSE: The incidence of breast cancer in Korea has been continuously growing and is now the most common cancer in females. The proportion of early stage cancer was found to have increased. A survival analysis and the establishment of prognostic factors are essential for proper management of breast cancer in Korean. METHODS: 4063 breast cancer cases operated on Seoul National University Hospital between Jan. 1981 and Dec. 2002, were retrospectively analyzed. RESULTS: The median age of the patients was 46, with those in their 5th decade being most prevalent. The ratio of breast conservation to mastectomy was also found to be growing. The overall and disease-free survival rates after breast conservation were equivalent to those after a mastectomy. The overall 5- and 10-year survival rates were 85.9 and 71.2%, and those of the disease-free survival rates were 79.5 and 68%, respectively. From a univariate analysis, The tumor size, lymph node status, nuclear grade, histologic grade, hormonal receptor status, C-erbB2, Bcl-2 and an age 5 cm (HR 2.4 [95%CI 1.15-5.26]) and NG (HR 0.5 [95%CI 0.35-0.93]) were found to be significant prognostic factors. CONCLUSIONS: Since 1991, patients with early breast cancer have progressively increased. To date, there are more patients with early than advanced breast cancer. In addition, BCS has been rapidly increased since 1993. The tumor size, lymph node status, nuclear grade, PR and C-erbB2 were significant prognostic factors of survival in this our study.

Postoperative Survival and Prognostic Factors in Breast Cancer : a Single Center Analysis of 4,063 Cases / 한국유방암학회지

PURPOSE: The incidence of breast cancer in Korea has been continuously growing and is now the most common cancer in females. The proportion of early stage cancer was found to have increased. A survival analysis and the establishment of prognostic factors are essential for proper management of breast cancer in Korean. METHODS: 4063 breast cancer cases operated on Seoul National University Hospital between Jan. 1981 and Dec. 2002, were retrospectively analyzed. RESULTS: The median age of the patients was 46, with those in their 5th decade being most prevalent. The ratio of breast conservation to mastectomy was also found to be growing. The overall and disease-free survival rates after breast conservation were equivalent to those after a mastectomy. The overall 5- and 10-year survival rates were 85.9 and 71.2%, and those of the disease-free survival rates were 79.5 and 68%, respectively. From a univariate analysis, The tumor size, lymph node status, nuclear grade, histologic grade, hormonal receptor status, C-erbB2, Bcl-2 and an age 5 cm (HR 2.4 [95%CI 1.15-5.26]) and NG (HR 0.5 [95%CI 0.35-0.93]) were found to be significant prognostic factors. CONCLUSIONS: Since 1991, patients with early breast cancer have progressively increased. To date, there are more patients with early than advanced breast cancer. In addition, BCS has been rapidly increased since 1993. The tumor size, lymph node status, nuclear grade, PR and C-erbB2 were significant prognostic factors of survival in this our study.

Hepatoid Adenocarcinoma of the Stomach with Liver Metastasis

A hepatoid adenocarcinoma of stomach, a subtype of gastric cancr, is characterized by a histologic resemblance to a hepatocellular carcinoma and alpha-feto protein production. Another feature is early metastasis to the liver and lymph nodes, thus revealing a poor prognosis. We report a case of a hepatoid adenocarcinoma of the stomach with liver metastasis. A 52-year-old male visited our hospital with a chief complaint of indigestion. Gastroscopic examination showed a Borrmann type-II lesion on the lesser curvature of the antrum. The CT scan showed a suspected advanced gastric cancer with liver metastasis. The serum AFP level was 123 ng/ml. A radical subtotal gastrectomy and a right hemihepatectomy were performed simultaneously. Pathologic examination confirmed the lesion to be confined to the submucosa. The gastric lesion was a hepatoid adenocarcinoma, and the hepatic lesion was a metastatic adenocarcinoma from the stomach. Therefore, he was classified as having stage IV (T1N1M1) gastric cancer. In cases of a hepatoid adenocarcinoma of the stomach, even patients with early gastric cancer can be staged into the poor prognostic group.

Hepatoid Adenocarcinoma of the Stomach with Liver Metastasis

A hepatoid adenocarcinoma of stomach, a subtype of gastric cancr, is characterized by a histologic resemblance to a hepatocellular carcinoma and alpha-feto protein production. Another feature is early metastasis to the liver and lymph nodes, thus revealing a poor prognosis. We report a case of a hepatoid adenocarcinoma of the stomach with liver metastasis. A 52-year-old male visited our hospital with a chief complaint of indigestion. Gastroscopic examination showed a Borrmann type-II lesion on the lesser curvature of the antrum. The CT scan showed a suspected advanced gastric cancer with liver metastasis. The serum AFP level was 123 ng/ml. A radical subtotal gastrectomy and a right hemihepatectomy were performed simultaneously. Pathologic examination confirmed the lesion to be confined to the submucosa. The gastric lesion was a hepatoid adenocarcinoma, and the hepatic lesion was a metastatic adenocarcinoma from the stomach. Therefore, he was classified as having stage IV (T1N1M1) gastric cancer. In cases of a hepatoid adenocarcinoma of the stomach, even patients with early gastric cancer can be staged into the poor prognostic group.

The Clinicopathologic Characteristics of 38 Metaplastic Carcinomas of the Breast / 한국유방암학회지

PURPOSE: Metaplastic carcinomas of the breast (MCBs) are rare diseases. The aim of this study is to evaluate the clinicopathologic characteristics of MCBs and to compare them with those of infiltrating ductal carcinoma (IDC). METHODS: Thirty-eight patients who underwent surgery at Seoul National University Hospital from May 1982 to December 2002 were retrospectively analyzed on the basis of the medical records and the pathology reports. These patients were compared with 3578 IDC patients that we experienced during the same period. RESULTS: The histologic subtypes of MCBs were 7 squamous, 6 matrix-producing, 7 sarcomatous, 4 mixed, 1 osteogenic, and 13 unclassified tumors. The mean tumor size was 4.4+/-3.1 cm. The operations' methods were a modified radical mastectomy in 26 patients, breast conserving surgery in 11 patients and only an incisional biopsy in one patient. Lymph node metastases and distant metastases were detected in 11 (29.7%) and 5 (13.2%) patients respectively. Lymph node metastases of MCBs were significantly lower than that for the IDC group (p = 0.030). Otherwise, the distant metastases were significantly higher than that of the IDC group (p = 0.019). The MCBs group also showed a significantly higher nuclear grade and histologic grade than did the IDC group (p = 0.001, p = 0.001). Estrogen receptor and progesterone receptor positivity was 5.3% and 5.3% respectively, which were significantly lower than that for the IDC group (p < 0.001, p = 0.002). The overall 5 year survival rate was 65% and the 5 year disease-free survival rate was 68%. After exclusion of patients with distant metastasis, the overall survival rates were not significantly different between the two groups (p = 0.291). CONCLUSION: MCB is a rare pathological entity. Compared with IDC, MCB displays a larger size, less lymph node metastasis, more distant metastasis, a higher histologic grade, and less hormone receptor expression. MCB has a poorer overall survival rate, which is probably due to its frequent distant metastasis.

The Clinicopathologic Characteristics of 38 Metaplastic Carcinomas of the Breast / 한국유방암학회지

PURPOSE: Metaplastic carcinomas of the breast (MCBs) are rare diseases. The aim of this study is to evaluate the clinicopathologic characteristics of MCBs and to compare them with those of infiltrating ductal carcinoma (IDC). METHODS: Thirty-eight patients who underwent surgery at Seoul National University Hospital from May 1982 to December 2002 were retrospectively analyzed on the basis of the medical records and the pathology reports. These patients were compared with 3578 IDC patients that we experienced during the same period. RESULTS: The histologic subtypes of MCBs were 7 squamous, 6 matrix-producing, 7 sarcomatous, 4 mixed, 1 osteogenic, and 13 unclassified tumors. The mean tumor size was 4.4+/-3.1 cm. The operations' methods were a modified radical mastectomy in 26 patients, breast conserving surgery in 11 patients and only an incisional biopsy in one patient. Lymph node metastases and distant metastases were detected in 11 (29.7%) and 5 (13.2%) patients respectively. Lymph node metastases of MCBs were significantly lower than that for the IDC group (p = 0.030). Otherwise, the distant metastases were significantly higher than that of the IDC group (p = 0.019). The MCBs group also showed a significantly higher nuclear grade and histologic grade than did the IDC group (p = 0.001, p = 0.001). Estrogen receptor and progesterone receptor positivity was 5.3% and 5.3% respectively, which were significantly lower than that for the IDC group (p < 0.001, p = 0.002). The overall 5 year survival rate was 65% and the 5 year disease-free survival rate was 68%. After exclusion of patients with distant metastasis, the overall survival rates were not significantly different between the two groups (p = 0.291). CONCLUSION: MCB is a rare pathological entity. Compared with IDC, MCB displays a larger size, less lymph node metastasis, more distant metastasis, a higher histologic grade, and less hormone receptor expression. MCB has a poorer overall survival rate, which is probably due to its frequent distant metastasis.

The Relationship between Abnormal Screening Bone Scintigraphy and Bone Metastasis in Breast Cancer Patients / 한국유방암학회지

PURPOSE: In this study we evaluated the significance of false positive screening bone scintigraphy (BS) in primary invasive breast cancer patients. Lymphatic vessel invasion (LVI), estrogen receptor (ER), progesterone receptor (PR), nuclear grade, histology grade, epidermal growth factor receptor (EGFR) and C-erb-B2 values were examined in terms of their abilities to predict the accuracy of abnormal BS. We also examined the incidence of bone metastasis in primary invasive breast cancer patients according to the 1988 and 2003 AJCC classifications. METHODS: A retrospective review was performed on 2,044 primary invasive breast cancer patients that had received BS screening, and who were treated by mastectomy or breast conserving surgery at the Seoul National University Hospital between Jan 1995 and Jul 2003. Abnormal screening BS results were divided into "less suspicious" and "highly suspicious" groups. Patient's stages according to the 1988 AJCC classification were reclassified according to the 2003 AJCC classification. Bone metastasis was confirmed by further radiological examination or follow-up BS. All statistical analyses were two-tailed. RESULTS: The incidences of bone metastasis and an abnormal screening BS result were 1.7% (35/2,044) and 13.8% (283/2,044), respectively. The false positive rate of screening BS was 87.6% (248/283). LVI was the only significant predictive factor of bone metastasis in 283 of the abnormal BS patients (p <.001). c-erb-B2 showed no significance to predict bone metastasis in the "less suspicious" group, but was Bone is the most common site of distant metastasis in invasive breast cancer at the time of primary diagnosis. The vertebrae are the most common sites of bone metastasis and the ribs, skull, sternum and proximal long bones are also frequently involved. Bone metastases affect 8% of patients marginally significant in the "highly suspicious" group (p = .046). ER, PR, nuclear grade, histology grade, and EGFR showed no significance in terms of predicting the accuracy of an abnormal BS result. The incidences of bone metastasis were 0.6, 1.3 and 7.6% in stages I, II and III, respectively, according to the 1988 AJCC classification, while these incidences were 0.6, 0.7 and 5.8% according to the 2003 AJCC classification. CONCLUSION: The use of screening bone scintigraphy as a routine screening test is hard to justify due to its high false positive rate. LVI may be a useful factor in that it predicts the accuracy of an abnormal BS result. The incidences of bone metastasis in stages II and III were lower for the 2003 AJCC staging system.

Micropapillary Carcinoma of Breast / 한국유방암학회지

PURPOSE: Micropapillary carcinoma in breast cancer was first described by Petersen in 1993, after which other reports from all over the world described their characteristics. In Korea, this type of carcinoma was first described in 1996. The purpose of our study was to find the clinicopathological characteristics of micropapillary carcinomas from our experiences and to compare the results with those of other studies. METHODS: We analyzed 19 patients, from Dec. 1999 to Dec. 2002, diagnosed with micropapillary carcinomas from postoperative pathological reports retrospectively, compared with 939 patients diagnosed with infiltrating duct carcinoma in the same period. RESULTS: The mean age and tumor size were 46.8 years (range 32~73) and 3.75cm (range 0.5~10.0), respectively. Micropapillary carcinoma showed the larger size (P=0.032) and more frequent rates of lymphovascular invasion (P= 0.007) and metastasis to axillary lymph nodes (P=0.003) than infiltrating duct carcinoma. But, in the T stage-matched analysis, the rates of axillary lymph node metastasis in micropapillary carcinoma and infiltrating duct carcinoma showed no significant differences (T1, T2, T3 : P=0.072, P= 0.080, P=0.575 ). Only in T2 stage, rates of lymphovascular invasion showed more frequent significantly in micropapillary carcinoma (P=0.012). Age, nuclear and histological grades showed no significant differences. The positive expressions of estrogen and progesterone receptors were more frequent in micropapillary carcinoma compared with infiltrating duct carcinoma, while the expressions of the C-erb-B2, p53, Ki-67 and bcl-2 showed no significant differences. CONCLUSION: The micropapillary carcinomas showed more frequent lymphovascular invasion and positive expressions of the estrogen and progesterone receptors in their immunohistochemistry.

The Role of Preoperative Chemotherapy in Patients with Inoperable Metastatic or Locally Advanced Gastric Cancer

PURPOSE: The purpose of this study was to evaluate the treatment result of surgical resection after preoperative chemotherapy in inoperable gastric cancer patients. MATERIALS AND METHODS: We analyzed 18 gastric cancer patients who underwent gastric resection after preoperative chemotherapy because they showed some clinical response to chemotherapy (15 with distant metastasis and 3 with locally advanced lesions). The mean postoperative follow-up period was 15.3+/-15.5 (1~56) months. RESULTS: In 15 patients with distant metastasis, 2 (13.3%) showed complete response (CR), 10 (66.7%) partial response (PR), 2 (13.3%) stable disease (SD), and 1 (6.7%) progressive disease (PD). The clinical response rate was 80.0%. Five subtotal gastrectomies, 4 total gastrectomies, and 6 extended total gastrectomies were performed. Two cases of CR were alive without recurrence for 4 and 26 months, respectively. Mean survival period in PR case was 37.7 months, but 2 cases of SD and 1 case of PD died after 11.7, 17.9, and 0.9 months, respectively. Postoperative survival was significantly associated with the response to chemotherapy (P<0.01). The mean survival period of the 10 patients with a complete resection was 44.1 months, which was significantly better than that of the 5 patients with an incomplete resection (9.8 months, P=0.03). Among 3 patients with locally advanced gastric cancer, 2 cases showed PR to chemotherapy, and complete resection was possible only by gastrectomy for those patients. CONCLUSION: In some selected cases, surgical resection was achievable after preoperative chemotherapy for patients with inoperable metastatic or locally advanced gastric cancer.

Regulation of Sodium-iodine Symporter Expression by Retinoic Acid in Thyroid Cancer Cell Lines / 대한내분비외과학회지

PURPOSE: Response to radioiodine therapy for thyroid cancer is related to the loss of sodium-iodine symporter protein caused by dedifferentiation of thyroid cancer cells. So we aimed to study mRNA expression of CD97, dedifferentiation marker, and sodium-iodine symporter after retinoic acid treatment according to retinoids receptor status. METHODS: Thyroid cancer cell lines; ARO, FRO, NPA, TPO, and FTC133 were prepared. 5µM of all trans retinoic acid were administered to each cell lines and then expression of m RNA for retinoids receptors (RARα, RARβ, RARγ, RXRα, RXRβ, RXRγ), CD97, and Sodium-Iodine symporter by RT-PCR. RESULTS: RARs and RXRs were differently expressed in each cell line. After retinoic acid treatment, relative density of retinoic acid receptor mRNA were increased by time dependently in each cell line except TPO cell line. Expression of CD97 also was decreased in every cell lines (P<0.001). Retinoic acid increased expression of sodium-iodine symporter only in FTC133 cell line (P<0.001), and TSH or forskolin did not enhance NIS expression by retinoic acid. RARβ and RXRγ were expressed only in FTC 133cell line before treatment. Induction of sodium-iodine symporter by retinoids disappeared after RARβ specific antagonist LE135 or pan RXR antagonist PA452 administration. CONCLUSION: Retinoic acid reduced expression of CD97 in five thyroid cancer cell lines. However, retinoic acid could restore sodium-iodine symporter expression in only FTC 133 cell line specifically containing RARβ and RXRγ. Restoration of sodium-iodine symporter expression by retinoic acid is related to RARβ and RXRγ expression.

Analysis of Hypoparathyroidism after Thyroid Surgery / 대한내분비외과학회지

PURPOSE: Transient hypocalcemia is frequently observed after thyroid operation for most cases. The symptoms are recovered through calcium administration, but some patients suffer from permanent hypocalcemia. METHODS: We analyzed the medical records of 723 cases who underwent thyroidectomy from Mar 2001 to Dec 2002. Hypocalcemia is defined as case of decreased ionized calcium, and hypoparathyroidism as case of decreased PTH for more than 1 year or decreased ionized calcium despite of administration of calcium more than 1 year. RESULTS: Out of 723 cases of operation; 139 cases (19.2%) were presented with hypocalcemia after operation. But patients with hypocalcemic symptoms were only 67 cases (9.3%) and with hypoparathyroidism were 15 cases (2.1%). On the basis of operation range, hypocalcemia and hypoparathyroidism were observed more frequently in case of total thyroidectomy (46.9%) than in the cases of operation less than total thyroidectomy (53.1%). Out of total patients, 285 cases(39.4%) were benign while 438 cases (60.6%) were malignant histologically. Hypocalcemia were observed from 22 benign cases and 117 malignant cases, indicating significant difference between the two groups of patients (P <0.001). 2 benign cases and 13 malignant cases had hypoparathyroidism, also indicating significant difference between two groups of patients (P=0.037). In cases of extrathyroidal extension, more frequent hypocalcemia (P<0.004) and hypoparathyroidism were observed (P=0.048). On lo gistic analysis, total thyroidectomy (P=0.004) and extrathyroidal extension (P=0.048) constituted independent risk factor for immediate hypocalcemia and completion thyroidecotmy (P=0.018) and extrathyroidal extension (P=0.037) for permanent hypoparathyroidism. CONCLUSION: Postoperative hypocalcemia is affected substantially by the extent of thyroidectomy. Therefore close attention is necessary to check and preserve parathyroid glands in case that extent of surgery is more than total thyroidectomy.

A Clinical Analysis of Metastatic Tumors to the Thyroid Gland

PURPOSE: Previous reports have suggested that metastatic tumors to the thyroid gland are rare, with a poor prognosis, but many of their clinicopathological characteristics are still to be revealed. Herein, our clinical experiences are reviewed. METHODS: The medical records for all patients pathologically diagnosed with metastatic tumors to the thyroid gland, between January 1986 and June 2003 at the Seoul National University Hospital were reviewed. The cases of direct invasion from adjacent tissues, and lymphoma or leukemia involving the thyroid gland, were excluded. The clinicopathological characteristics and survival rate of 11 eligible patients were evaluated. RESULTS: The incidence rate of all the malignant thyroid tumors was 0.46%. The mean age at diagnosis was 44.75+/-11.73 (33~61) years, and the male to female ratio was 4: 7. The most common presenting symptom was a neck mass (n=7). The common primary tumor sites were the lung (n=3) and breast (n=2). The mean follow-up period was 5.17+/-4.71, ranging from 0 to 13 months. Six of the ten patients that could be followed-up, died within 16 months. The females (P=0.04), some primary cancer sites, such as the breast, kidney and lung (P=0.04), and those having undergone a thyroidectomy (P=0.01) showed better survival rates. CONCLUSION: The incidence of metastatic tumors to the thyroid gland was very rare, and those tumors showed a very poor prognosis. There were various primary tumor sites, but the lung and breast were relatively more common. The females and some primary cancer sites, such as the breast, kidney and lung, showed better survival rates. Active surgical treatment might lead to a better prognosis.

A Clinical Analysis of Metastatic Tumors to the Thyroid Gland

PURPOSE: Previous reports have suggested that metastatic tumors to the thyroid gland are rare, with a poor prognosis, but many of their clinicopathological characteristics are still to be revealed. Herein, our clinical experiences are reviewed. METHODS: The medical records for all patients pathologically diagnosed with metastatic tumors to the thyroid gland, between January 1986 and June 2003 at the Seoul National University Hospital were reviewed. The cases of direct invasion from adjacent tissues, and lymphoma or leukemia involving the thyroid gland, were excluded. The clinicopathological characteristics and survival rate of 11 eligible patients were evaluated. RESULTS: The incidence rate of all the malignant thyroid tumors was 0.46%. The mean age at diagnosis was 44.75+/-11.73 (33~61) years, and the male to female ratio was 4: 7. The most common presenting symptom was a neck mass (n=7). The common primary tumor sites were the lung (n=3) and breast (n=2). The mean follow-up period was 5.17+/-4.71, ranging from 0 to 13 months. Six of the ten patients that could be followed-up, died within 16 months. The females (P=0.04), some primary cancer sites, such as the breast, kidney and lung (P=0.04), and those having undergone a thyroidectomy (P=0.01) showed better survival rates. CONCLUSION: The incidence of metastatic tumors to the thyroid gland was very rare, and those tumors showed a very poor prognosis. There were various primary tumor sites, but the lung and breast were relatively more common. The females and some primary cancer sites, such as the breast, kidney and lung, showed better survival rates. Active surgical treatment might lead to a better prognosis.

Two Cases of Teenage Gastric Cancer Patients

Recently, we experienced two advanced gastric cancer (AGC) patients younger than 17 years of age. The first case was a 15-year, 2-month-old male who had suffered from epigastric soreness for 5 weeks. His grandfather died of gastric cancer at 39 years of age. Under the diagnosis of AGC, he underwent a total gastrectomy with D2 lymph node dissection. There was no evidence of distant metastasis. Pathologic examination revealed a 4.5x4 cm, signet ring cell adenocarcinoma with subserosal invasion and with metastasis in 9 of 42 regional lymph nodes (T2bN2M0). The second case was a 17-year, 11-month-old male who had suffered from epigastric pain for 2 years without familial clustering. Under the diagnosis of AGC, he underwent a distal subtotal gastrectomy with D2 lymph node dissection. There was no evidence of distant metastasis. Pathologic examination revealed a 3x2 cm, signet ring cell adenocarcinoma with subserosal invasion and with metastasis in 9 of 45 regional lymph nodes (T2bN2M0). The two patients have been alive without recurrence for 27 months and 4 months, respectively. Even among teenagers, patients with abdominal complaints should be subjected to a thorough examination of the gastrointestinal tract.

Two Cases of Primary Small Cell Carcinomas of the Stomach

Primary small-cell carcinomas of the stomach are rare and aggressive malignancies with poor survival rates. Preoperative diagnosis is difficult and a standard treatment is not yet established. We have recently experienced two cases of a primary small-cell carcinoma of the stomach. The first case was a 65-year-old man with epigastric soreness. Endoscopic biopsy showed an adenocarcinoma. He underwent a radical subtotal gastrectomy with D2 lymph-node dissection. Pathology revealed a collision tumor of a small- cell carcinoma and an adenocarcinoma with submucosal invasion and with metastasis in 20 out of 48 lymph nodes (T1N3M0). The second case was a 64-year-old man with epigastric soreness. Endoscopic biopsy revealed a small-cell carcinoma. There was no evidence of a primary tumor in the lung. A radical subtotal gastrectomy with D2 lymph-node dissection was performed. Pathology showed a pure small- cell carcinoma with proper muscle invasion and with metastasis in 1 out of 36 lymph nodes (T2aN1M0).

Clinicopathologic Features of Poorly Differentiated (Insular) Carcinoma of Thyroid

PURPOSE: Well-differentiated carcinomas of the thyroid run an excellent clinical course. However 10~20% of thyroid carcinomas showed poor clinical outcomes. Insular carcinomas are an uncommon thyroglobulin-producing neoplasm, which show intermediate prognosis between well-differentiated carcinomas and undifferentiated anaplastic carcinomas, and their clinicopathologic features are poorly understood. Therefore, we aimed to investigate the clinicopathologic features and the prognosis of insular thyroid carcinomas. METHODS: We reviewed 10 patients who underwent an operation due to an insular thyroid carcinoma at Seoul National University Hospital between January 1990 and December 2001. Their clinicopathologic features and follow-up findings were retrospectively reviewed and compared. RESULTS: Four male and six female patients are reviewed, with a mean age of 54.8+/-6.4187, ranging from 37 to 69 years. Pathologically, eight of the tumors consisted of pure insular carcinoma and the others showed a papillary carcinoma as the major component and a minor insular component. The mean tumor size was 4.53 cm (4.53+/-1.4288 cm). An extrathyroidal extension was present in 7 cases and a vascular invasion in 6. Distant metastasis and local relapse of the regional lymph node were seen in 9 patients. Comparing the survivor and expired groups, all the male patients were in the expired group, and the mean tumor size was larger in the expired group (5.46 cm vs. 3.6 cm). But these differences were not statistically significant. CONCLUSION: Our study revealed that insular carcinomas have distinctive clinicopathologic features, and recognition of this histologic variant is important and significant for management of these unique tumors.

Hyalinizing Trabecular Adenoma of Thyroid

The Hyalinizing trabecular adenoma of the thyroid is a uncommon benign neoplasm which is characterized by trabecular growth pattern with hyaline stroma of the basal membrane type. It is often misdiagnosed as papillary carcinoma due to its peculiar cytologic and histologic features such as, nuclear grooving and papillary structures, or as medullary carcinoma due to the hyalinized stroma resembling amyloid. Special stains and immunohistochemical studies are required to make a definite diagnosis. A 34-year old woman was admitted suffering from a left neck mass. Computed tomography showed a 2 cm-sized mass in the left thyroid. Fine needle aspiration cytology suggested papillary carcinoma. Intraoperative frozen section suggested medullary carcinoma, and H&E staining suggested medullary carcinoma. However according to immunohistochemistry which revealed calcitonin negative, the tumor was reviewed and finally diagnosed as hyaline trabecular adenoma. The hyalinizing trabecular adenoma, although uncommon, is certainly worth consideration in order to avoid being misinterpreted as carcinoma on the basis of individual cytologic and histologic features.