Survival Outcomes in Patients with Breast Cancer: Low Volume Single Center Study

Purpose@#Breast cancer is the second most common malignancy in Korean women, and its incidence has increased rapidly. The purpose of this study was to evaluate the treatment outcomes of patients with breast cancer treated at a low volume center. @*Methods@#We retrospectively analyzed 401 patients with stage I-III breast cancer at Chosun University Hospital from January 1998 to December 2013. We reviewed medical records including clinical information and pathologic reports. @*Results@#We found 401 cases of newly diagnosed breast cancer, including 5 (1.2%) male breast cancer patients. According to histological features, there were 43 cases (ductal carcinoma in situ (DCIS): 35 cases [8.7%], lobular carcinoma in situ (LCIS): 8 cases [2.0%]) of non-invasive carcinoma, 350 cases (87.3%) of invasive carcinoma, 2 cases (0.5%) of Paget’s disease, 1 case (0.2%) of malignant phyllodes tumor, 3 cases (0.7%) of sarcoma, and 2 cases (0.5%) of other types. With respect to disease stage, 117 (29.2%) patients were in stage I, 176 (43.9%) in stage II, and 78 (19.4%) in stage III. The type of surgical approaches were breast-conserving surgery (153, 38.2%), modified radical mastectomy (243, 60.6%), wide excision (4, 1.0%), and others (1, 0.2%). Five-year disease-free survival rates were 100% (stage 0), 95.4% (stage I), 91.4% (stage IIa), 75% (stage IIb), 78% (stage IIIa), 50% (stage IIIb), and 59.2% (stage IIIc). Overall survival rates were 100% (stage 0), 96.2% (stage I), 94.3% (stage IIa), 85.4% (stage IIb), 84.8% (stage IIIa), 50% (stage IIIb), and 55.5% (stage IIIc). @*Conclusion@#Although the patients were treated at a low-volume center, their favorable survival outcomes are notable. Further multicenter (low-volume centers) research is warranted.

Factors Influencing Central Neck Lymph Node Metastasis in Patients with Papillary Thyroid Microcarcinoma / 대한내분비외과학회지

PURPOSE: A papillary thyroid microcarcinoma (PTMC) measures 1 cm or less in diameter. The diagnosis, and thus the apparent incidence, of PTMC has recently increased owing to an increase in the detection of subclinical small and low-risk carcinomas with ultrasonography and fine needle aspiration cytology. However, central neck lymph node metastasis (CLNM) can occur in patients with PTMC. We evaluated the factors influencing CLNM in patients with PTMC. METHODS: We reviewed medical records including clinical information and pathologic reports, and analyzed 622 patients with PTMC who underwent thyroid surgery from January 2002 to December 2012. RESULTS: CLNM was detected in 119 patients (19.1%) of the 622 with PTMC. Lymph node metastasis occurred more frequently in males (P=0.025), and those with bilateral tumors (P=0.016), more than two tumors (P=0.035), tumor size greater than 5 mm (P<0.001), and lymphovascular invasion (P=0.024). There were no statistically significant differences in age and capsular invasion. Multivariate analysis showed that significant factors affecting lymph node metastasis included age at operation (odds ratio [OR]=0.647, 95% confidence interval [CI]=0.422∼0.990, P=0.045), sex (OR=0.489, 95% CI=0.268∼0.891, P=0.020), tumor size (OR=3.034, 95% CI=1.761∼5.224, P<0.001), and lymphovascular invasion (OR=15.036, 95% CI=1.450∼155.911, P=0.023). CONCLUSION: Age less than 45 years, male sex, tumor size greater than 5 mm, and lymphovascular invasion were risk factors associated with CLNM.

Thyroid Lobectomy for Treatment of Well Differentiated Thyroid Cancer Confined to One Lobe / 대한내분비외과학회지

PURPOSE: There has been controversy of the lobectomy for well differentiated thyroid cancer (WDTC). Current guidelines recommend total thyroidectomy for the cancer over 1cm, despite previous report suggesting that the lobectomy provides similar excellent outcomes. The purpose of our study is to report our experience of WDTC treated by thyroid lobectomy. METHODS: We retrospectively analyzed 284 patients with WDTC treated by thyroid lobectomy at department of Surgery in Chosun University Hospital from January 2002 to December 2010. Overall survival (OS) and disease-free survival (DFS) were determined by the Kaplan-Meier method. Factors predictive of recurrence by univariate and multivariate analysis were determined using the χ2 test and Cox proportional hazard model respectively. RESULTS: With a mean follow-up of 60.4 months, OS and RFS for all patients were 97.9% and 96.5% respectively. No patient died due to WDTC. Univariate analysis showed statistically significant differences in recurrence by tumor size (P=0.013) and presence of invasion (P=0.039). However, Multivariate analysis showed no significant difference in local recurrence. CONCLUSION: Patients with WDTC confined to one lobe can be safely treated by lobectomy.

Expression of Cyclin D1, Cytokeratin 7, Cytokeratin 20 and Vimentin in Papillary Thyroid Cancer and Relationship with Patient's Prognostic Factors / 대한내분비외과학회지

PURPOSE: Cyclin D1, cytokeratin(CK)7, CK20 and vimentin play an important role in tumorigenesis and tumor progression. Our aim was to investigate the expression of cyclin D1, CK7, CK20 and vimentin in 138 papillary thyroid cancer and relationship with clinicobiological factors. We also tried to evaluate the value of those as prognostic factors. METHODS: We performed an immunohistochemical assay for cyclin D1, CK7, CK20, and vimentin in 138 papillary thyroid cancer tissue specimens. The correlation between these factors and the clinicobiological parameters was analyzed. RESULTS: In 138 papillary thyroid carcinoma specimens, the expression of cyclin D1, CK7, CK20 and vimentin was seen in 118 cases (85.5%), 133 cases (96.4%), 2 cases (1.4%) and 119 cases (86.2%), respectively. In our cases, there was a significant association among the expressions of cyclin D1, gender and lymph node metastasis. However, no obvious correlation was found between those proteins, age, tumor size, tumor amount, lymph node status and the TNM stage. CONCLUSION: Our results suggested increased cyclin D1 expression was seen in female gender and it may be a useful marker for evaluating lymph node metastasis. However, the clinical utility of cyclin D1, CK7, CK20 and vimentin in thyroid cancer patients has to be further defined by prospective studies with larger sample sizes.

Clinicopathologic Findings of Micropapillary Carcinomas, according to Tumor Size

PURPOSE: Papillary thyroid microcarcinomas (PTMC), which are not palpable and have no clinical symptoms are 1.0 cm or less in diameter. The optimal extent of thyroid tumor resection has been controversial. We investigated clinicopathological findings of PTMC of 5 mm or less in diameter for reasonable therapeutic approach. METHODS: From, Jan. 2002 to Dec. 2006, 366 patients underwent thyroidectomy for thyroid papillary carcinoma at our institution. Among these patients, 62 patients with a mass measuring less than 5 mm and 103 patients with a mass 5 mm to 1.0 cm were selected. We retrospectively reviewed their medical records. RESULTS: There was no significant difference on the clinical characteristics except multifocality. We performed more unilateral lobectomy, near total thyroidectomy with or without neck node dissection in patients with PTMC of less than 5 mm (P=0.13). In permanent biopsy, lymph node metastasis more frequently occurred in patients with PTMC of less than 5 mm (P=0.03). There were no differences in capsular invasion, distant metastasis or recurrence. CONCLUSION: In papillary thyroid microcarcinoma less than 0.5 cm, it is very uncommon for capsular invasion, distant metastasis and locoregional metastasis to exist. The extent of tumor resection may be limited less than near total thyroidectomy for suitable cases, because there was no locoregional metastasis or distant metastasis in the follow-up period. Longer follow-up periods would be required to confirm that limited surgery is sufficient for tumors less than 0.5 cm in size.

The Clinical Feature of Patients with Thyroid Nodule Combined with Hashimoto's Thyroiditis

PURPOSE: This study investigated the clinical features of patients with thyroid nodule combined with Hashimoto's thyroiditis, and the latter was incidentally detected after surgery. METHODS: The authors retrospectively evaluated 43 patients who were diagnosed with Hashimoto's thyroiditis after thyroidectomy between January 2001 and December 2006 at Chosun University Hospital. RESULTS: All patients underwent ultrasonography for the diagnosis of thyroid nodules. Ultrasonography revealed 16 calcified nodules with ill-defined margins, and these nodules were suspicious for malignancy. On performing preoperative fine needle aspiration, 37 cases were suspicious for malignancy or they were diagnosed as malignancies. All the thyroid nodules were taken for frozen section examination during surgery. On the frozen sections, 19 cases that were suspicious for malignant tumors underwent near total or total thyroidectomy along with central lymph node dissection, whereas 24 cases that were diagnosed as benign tumors underwent near total thyroidectomy or thyroid lobectomy. Based on the histopathological findings, 21 cases were diagnosed as Hashimoto's thyroiditis associated with papillary cancer; the nodules of these 21 cases were on average 0.75 cm, Twenty two cases were diagnosed as Hashimoto's thyroiditis associated with benign tumors, and the nodules of these cases measured on average 1.6 cm. CONCLUSION: Hashimoto's thyroiditis may present with a variety of clinical features, atypical ultrasonographic findings and a high false positive rate on fine needle aspiration. For the cases where Hashimoto's thyroiditis is suspected before surgery, serum antibody tests, ultrasonography and fine needle aspiration should be performed for making the accurate diagnosis of Hashimoto's thyroiditis. For the cases of suspicious malignant tumors, frozen section examination should be performed during surgery to decide on the correct operative procedure.

The Risk Factors Associated with Surgical Site Infection after an Abdominal Operation

PURPOSE: Surgical site infection (SSI) is the most common nosocomial infection in surgical patients, and this accounts for 38% of all patients with nosocomial infections. Despite the advances in techniques and knowledge to prevent infection, SSI remains a significant source of postoperative morbidity and mortality, and it results in a prolonged hospital stay and increased cost. This study aims to assess the incidence of SSI and to identify the risk factors associated with SSI for patients who undergo abdominal operation. METHODS: The data on 347 abdominal operations that were done under general anesthesia from 1 August 2005 to 31 July 2006 was collected and reviewed. RESULTS: The overall incidence of SSI was 4.9%. Comorbidity was the independent risk factor for the development of SSI (P=0.011). The development of SSI was related with the American Society of Anesthesiologists (ASA) preoperative assessment score (P=0.025). The duration of the operation had a statistically significant association with an increased risk of SSI on univariate analysis. The wound classification was not associated with SSI. Staphylococcus aureus was the most frequently isolated organism, and all of the cases were methcillin-resistant Staphylococcus aureus. CONCLUSION: This study demonstrate that comorbidity is a significant independent risk factor for SSI.

Expression of Cyclin D1, Vimentin and Thyroglobulin in Papillary Thyroid Cancer and Its Correlation with Clinicobiological Factors

PURPOSE: An increased expression of cyclin D1 has been observed in several tumors. Vimentin is known to be present in undifferentiated thyroid cancer. The serum thyroglobulin level can be a useful laboratory parameter to detect tumor recurrence in patients suffering with treated, well-differentiated thyroid carcinoma. We performed immunohistochemical assay for the cyclin D1, vimentin and thyroglobulin (Tg) expression in 97 papillary thyroid cancer tissue specimens to investigate their clinical implication for the prognosis of papillary thyroid carcinoma patients. METHODS: Immunohistochemical assays for cyclin D1, vimentin and Tg were performed on 97 consecutive thyroid carcinoma specimens. The correlation between these factors and the clinicobiological parameters weas analyzed. RESULTS: In 97 papillary thyroid carcinoma specimens, the expression of cyclin D1, vimentin and Tg was seen in 64 cases (66.0%), 36 cases (37.1%) and 55 cases (56.7%), respectively. Only the cyclin D1 expression was significantly increased in the larger tumors (P=0.01). However, there was no evident correlation between these factors and gender, age, tumor size, the lymph node status, the TNM stage and the number of tumors. CONCLUSION: An increased expression of cyclin D1 was present in the larger tumors. Overexpression of cyclin D1 seemed to play a role in carcinogenesis and tumor growth. However, the clinical utility of cyclin D1, vimentin and Tg in thyroid cancer patients has to be further defined by prospective studies with larger sample sizes.

Non-traumatic Small Bowel Perforation: Comparisons of the Clinical Features of 20 Years Ago with Present

The majority of small bowel perforations are caused by an abdominal trauma. However, non-traumatic causes should not be ignored. The etiology of a non-traumatic small bowel perforation is varies and has chronological characteristics. This retrospective study was undertaken to investigate the chronological changes in non-traumatic small bowel perforations over the past twenty years, according to the clinical features, surgical methods, and the prognosis of those with a non-traumatic small bowel perforation. The results of this study showed that the incidence of a bacterial enteritis induced small bowel perforation has significantly decreased, and inflammatory bowel disease or collagen disease has become the major causes of a non-traumatic small bowel perforation. Moreover, geriatric patients over 70 years of age are more vulnerable to a non-traumatic small bowel perforation.

Expression of the PTEN Gene Product in the Invasive Cancer of Breast and Its Relationship with Other Prognostic Factors

PURPOSE: The tumor suppressor gene PTEN is located on chromosome 10q23 and is mutated in a variety of sporadic cancers. The aim of this study is to understand the expression of the PTEN gene product in invasive breast cancer and its relationships with clinicopathologic factors of breast cancer. METHODS: The hospital records and pathologic findings of 57 patients who underwent breast operation due to invasive breast carcinoma between January 1996 and June 2002 were reviewed. We examined the relationships between PTEN expression and various clinicopathologic factors of breast cancer such as age, tumor size, lymph node metastasis, histologic grade, nuclear grade, stage and estrogen, and progesterone receptors. RESULTS: Among the 57 invasive breast cancers, 5 (8.8%) were immunohistochemically negative, and 14 (24.6%) had reduced expression of PTEN. Among clinicopathologic factors, age, tumor size, lymph node metastasis, stage, histologic grade, and estrogen receptor had no correlation with PTEN expression. Nuclear grade and positive progesterone receptor were significant correlated with decreased PTEN expression. However, these results are different from those of other reports showing that negative progesterone receptor was significantly correlated with the decrease of PTEN expression. CONCLUSION: According to other reports, PTEN expression does play some role as a prognostic factor for breast cancer, but the results of our study did not support this hypothesis. Further evaluation and study are required into the role of PTEN as a prognostic factor of breast cancer.

Expression of the PTEN Gene Product in the Invasive Cancer of Breast and Its Relationship with Other Prognostic Factors

PURPOSE: The tumor suppressor gene PTEN is located on chromosome 10q23 and is mutated in a variety of sporadic cancers. The aim of this study is to understand the expression of the PTEN gene product in invasive breast cancer and its relationships with clinicopathologic factors of breast cancer. METHODS: The hospital records and pathologic findings of 57 patients who underwent breast operation due to invasive breast carcinoma between January 1996 and June 2002 were reviewed. We examined the relationships between PTEN expression and various clinicopathologic factors of breast cancer such as age, tumor size, lymph node metastasis, histologic grade, nuclear grade, stage and estrogen, and progesterone receptors. RESULTS: Among the 57 invasive breast cancers, 5 (8.8%) were immunohistochemically negative, and 14 (24.6%) had reduced expression of PTEN. Among clinicopathologic factors, age, tumor size, lymph node metastasis, stage, histologic grade, and estrogen receptor had no correlation with PTEN expression. Nuclear grade and positive progesterone receptor were significant correlated with decreased PTEN expression. However, these results are different from those of other reports showing that negative progesterone receptor was significantly correlated with the decrease of PTEN expression. CONCLUSION: According to other reports, PTEN expression does play some role as a prognostic factor for breast cancer, but the results of our study did not support this hypothesis. Further evaluation and study are required into the role of PTEN as a prognostic factor of breast cancer.

A Experimental Study of PTEN (Phosphatase and Tensin) Role in Mesothelioma / 대한흉부외과학회지

BACKGROUND: Conventional treatment for mesothelioma is largely ineffective. We evaluated the novel approach of adenoviral gene transfection of PTEN gene in mesothelioma cancer cell lines, inflammatory and epithelial subtype, which are sensitive to adenoviral p53. MATERIAL AND METHOD: Binary adenoviral PTEN and LacZ (Ad/GT-LacZ and Ad/GV16) vectors were used for transduction of the mesothelioma cell lines, REN (p53 sensitive). Protein levels were determined by Western blotting assay. Apoptosis was assessed by fluorescence-activated cell sorter analysis of subdiploid populations. Cell viability was determined with the XTT assay. Statistical analysis was performed with analysis of variance and the Student t test. RESULT: 72 hours after the treatment of adenoviral PTEN gene, cell killing were 32.9% for REN compared to control cell (2.5%) at MOI of 20. Also we observed the over-expression of proapoptotic protein, bax and decreased expression of bcl-2 protein in REN cells. But the expression of BCL-xl, Bak, Bad proteins were not altered. CONCLUSION: Adenovirus Pten-mediated overexpression of the Bax gene induces apoptosis and decreased cellular viability in p53-sensitive mesothelioma cells. These data suggest that the transfection of PTEN gene may represent a alternative gene therapy strategy to treat mesothelioma.

Brain Metastasis from Papillary Carcinoma of the Thyroid

Papillary thyroid carcinomas are the most common type of thyroid malignancy, and have more excellent prognosis compared to other types of thyroid malignancy, with rare occurrences of distant metastasis. The most frequent sites for distant metastases are the lungs and bones, but brain metastases are extremely rare, with a frequency of only 0.1~5% in reported series. Hence we report a patient with a papillary thyroid carcinoma metastasis to the right parietal lobe of brain, the lung, the left chest wall and right acetabulum, with a review of the literature.

A Comparison of Safety between the Operative and Nonoperative Management of Traumatic Liver Injury

PURPOSE: The aim of this study was to evaluate the safety of the nonoperative management of traumatic liver injuries. METHODS: The medical records of 67 patients, with traumatic liver injury, between January 1998 and December 2001, were reviewed retrospectively, with respect to the cause of injury, combined injury, hemodynamic stability, amount of transfusion, liver injury grade, length of hospital stay and complications. RESULTS: Of the 67 patients, 30 were treated operatively (Group A), and 37 nonoperatively (Group B). The initial systolic blood pressure in Group A was significantly lower than that in Group B (81.33+/-23.00 vs 108.10+/-20.66 mmHg, P<0.001). The amount of transfusion for hemodynamic stability were 2.83 and 0.89 units (P<0.01), and the mean total transfusion requirement and injury grade were 10.30 and 1.29 units (P<0.001). 3.63+/-0.99 and 2.48+/-1.12 (P<0.001) for Groups A and B. The duration of intensive care unit stay in Group A was significantly shorter than that of Group B (6.70+/-6.12 vs. 3.13+/-4.00 days, P<0.01), but there was no difference in total length of hospital stay. The complication rates in Groups A and B were 63.3 and 21.8%, respectively (P<0.01), and the most common complications were respiratory problems, such as pleural effusion, pneumonia, atelectasis and pulmonary edema. Five patients in Group A died, 2 from hypovolemic shock, and one each from disseminated intravascular coagulation, multiple organ failure, and respiratory failure, but no patients in Group B died. CONCLUSION: Nonoperative management is safe for hemodynamically stable patients with traumatic liver injury, regardless of the injury severity, but close observation and frequent physical examinations must be adhered to.

Giant Liposarcoma Arising in the Mesentery

A liposarcoma is the most common soft tissue sarcoma in adults with an incidence of betwen 9.8 and 16% of all soft tissue sarcomas. Among the various histological types, a dedifferentiated liposarcoma has rarely been reported. We experienced a case of a giant 7 kg dedifferentiated liposarcoma arising in the mesentery of a 57-year old male patient. Abdominal computed tomography showed a huge lipoid mass occupying the whole abdomen. A surgical excision was carried out. Histologically, the tumor was composed of a well-differentiated liposarcomatous area and a leiomyosarcoma-like dedifferentiated area. The authors reviewed the prognostic factors and treatments for a liposarcoma.

Giant Liposarcoma Arising in the Mesentery

A liposarcoma is the most common soft tissue sarcoma in adults with an incidence of betwen 9.8 and 16% of all soft tissue sarcomas. Among the various histological types, a dedifferentiated liposarcoma has rarely been reported. We experienced a case of a giant 7 kg dedifferentiated liposarcoma arising in the mesentery of a 57-year old male patient. Abdominal computed tomography showed a huge lipoid mass occupying the whole abdomen. A surgical excision was carried out. Histologically, the tumor was composed of a well-differentiated liposarcomatous area and a leiomyosarcoma-like dedifferentiated area. The authors reviewed the prognostic factors and treatments for a liposarcoma.

Thyroid Hemiagenesis

Thyroid anomaly are rare embryological condition. The failure of the development of one lobe leading to unilateral agenesis is the rarest of all the thyroid anomalies, The cause of unilateral agenesis is unknown. Thyroid hemiagenes is common in females (3: 1) with the left lobe being absent. The common disease in the remaining lobe is a benign adenoma, a multinodular goiter, hyperthyroidism, chronic thyroiditis, and rarely carcinoma. The most common pathology involved in thyroid hemiagenesis is hyperthyroidism. This report the case of a 57-year-old woman with a right thyroid hemiagenesis.

Bilateral Breast Carcinoma after Treatment with Immunosuppressant

Bilateral breast cancer developed in a 45-year-old woman who received a renal transplant followed by immunosuppression with Cyclosporine. She underwent a left modified radical mastectomy, and right breast conserving surgery, with both axillary lymph nodes being dissect. Few cases have been reported on breast cancer associated with renal transplantation. Although a causal relationship with immunosuppression therapy and breast carcinoma was not implied, a heightened awareness of the possible coexistence of immunosuppression therapy and breast carcinomas are necessary.

A Case Report of Proliferative Myositis in Pectoralis Major Muscle

Proliferative myositis is very rare and was first described as a specific entity in 1960 by Kern. Proliferative myositis is a benign reactive condition that appears as a rapidly growing mass in the proximal muscles of the extremities of adults. Proliferative myositis can be confused with sarcoma clinically as well as microscopically. Proliferative myositis is a bizarre, self-limiting fibroblastic proliferation, the presence of very large basophilic cells with vesicular nucleoli and very prominent nucleoli which resemble ganglion cells or rhabdomyoblast, the cause of which is unclear. The symptoms are non-specific and the diagnosis always rests on a histological examination of the tissue. Local excision is curative and recurrence or metastasis has not been reported even when the abnormal tissue has not been completely excised. The authors report a case of Proliferative myositis in a 59-year-old male.

A Clinical Significancy of Evoked Thrill Test in the Arteriovenous Fistula

PURPOSE: Arteriovenous fistula at the wrist has remained the procedure of choice for long-term chronic hemod ialysis since its development by Brecia and Cimino in 1966. Thrombosis is the most common cause of early failure after arteriovenous fistula procedure, should be reconized preoperatively or intraoperatively, but no consensus exits regarding the ideal preoperative or intraoperative screening method for access surgery. We describe a simple intraoperative maneuver that can be used to detect proximal stenotic vein segments. METHODS: From September 1998 to September 1999, a total of 117 arteriovenous fistulas were performed for permanent hemodialysis in patients with chronic renal failure. Of them, a intraoperative evoked thrill test was performed in 61 patients (A group), in 56 patients (B group or control group) was not. RESULTS: Early failure rate (<30 days) was 12.5% in A group, 9.8% in B group or control group. In this study, the specificity and positive predictive value of the evoked thrill test was 100%, indicating that this maneuver is highly accurate in predicting early failure. CONCLUSION: Evoked thrill test is a simple and useful intraoperative method for improving the patency rate of autologous arteroiovenous fistula.