Two Cases of Bone Metastasis from Follicular Thyroid Carcinoma Several Years after Initial Thyroidectomy / 대한내분비외과학회지

A 78-year-old woman presented with epigastric discomfort with nausea, and an abdominal CT revealed a rib mass and gall bladder polyp. She had had a subtotal thyroidectomy of a 4.2×3 cm-sized follicular thyroid carcinoma 19 years ago. The rib mass was excised and its histological examination showed a metastatic carcinoma from a follicular thyroid carcinoma. One month later we carried out a completion thyroidectomy, and we will perform radioactive ablation with ¹³¹I. A 64-year-old woman presented to our clinic for leg motor weakness and we found a T7 pathologic fracture by X-ray and MRI. She had had a left thyroid lobectomy for a minimal invasive follicular thyroid carcinoma measuring 4 cm at the greatest diameter. Anterior-decompression and fusion were carried out, and histological examination showed a metastatic lesion from the thyroid. Then we performed a completion thyroidectomy and 131I radioactive ablation one month later. Radioactive ablation should be performed for large-sized follicular carcinomas to prevent recurrences.

PCNA Expression as a Prognostic Factor in Papillary Thyroid Carcinoma / 대한내분비외과학회지

PURPOSE: Assessment of the proliferative ability of cancer cells is necessary not only for the biologic characterization of tumors, but also for the selection of treatment and evaluation of prognosis. Recently, there have been several studies examining the proliferative activity of various malignant tumors using immunohistochemical methods. PCNA is a nuclear protein related to the cell cycle and found with high expression in proliferative tissues, including cancers. METHODS: In our study, to evaluate whether PCNA expression was useful as a prognostic factor in patients with papillary thyroid carcinoma, we quantitated the immunohistochemical expression of PCNA in the formalin-fixed paraffin embedded tissue from 55 patients with papillary thyroid carcinoma and correlated the results with established clinicopathologic parameters. RESULTS: The results were as follows. 1) PCNA expression in papillary thyroid carcinoma did not correlate with the age, sex or metastatic L/N activity of the patient, nor with the size, invasion, or recurrence of the tumor. 2) There was a close relationship between the expression rate of PCNA in thyroid tumor cells and that in metastatic L/N cells (p=0.056, in p<0.1). 3) The expression of PCNA in the metastatic L/N (+) group was higher than in the metastatic L/N (+) group (p=0.045). CONCLUSION: It is suggested that PCNA expression is not an appropriate prognostic factor in papillary thyroid carcinoma.

A Study on the Tolerability of Early Postoperative Feeding in Patients with Colorectal Cancer

BACKGROUND: Resolution of postoperative ileus has traditionally been the moment at which bowel function returns. The re-start of postoperative oral feeding usually occurs after that. Recently, many reports have been published on early postoperative feeding in patients operated on laparoscopically and even in patients receiving a laparotomy. The aim of this study was to scrutinize the validity of early postoperative feeding. METHODS: Fiftyfour colorectal cancer patients who had undergone radical resective surgery for cure were included in this study and were divided into two group. Group 1 included 32 patients who were fed in a traditional manner. Group 2 consisted of 22 patients who received a regular diet on the first postoperative day. The mean age was 62, the male-to-female ratio was 1.2:1. Thirteen tumor were located on the right side colon, 4 on the left side colon, 10 on the rectosigmoid, 27 on the rectum. Operative methods were 13 right hemicolectomies, 4 left hemicolectomies, 19 low anterior resections, and 18 abdominoperineal resections. The possible problems associated with early oral feeding were well understood by the patients and consents were obtained. Immediately after the operation, the nasogastric tube was removed in the operation room, and The time of complete recovery from anesthesia was 3 to 5 hours later. At that time, liquid drink was given; then, liquid food or blended food was allowed. RESULT: Early oral intake was tolerable in 14 patients out of 21 (67%); in 8 patients a nasogastric tube was reinserted due to severe nausea, vomiting, and/or abdominal distension. All those minor problems were resolved after reinsertion of the nasogastric tube and returning to the traditional method. In one patient, who had a received a low anterior resection, a serious complication, anastomatic leakage, developed. Early oral intake was not thought to be the exact cause of the leakage, but it made the problem more complicated. A huge amount of feces soiled the peritoneal cavity and the already dissected retroperitoneum. CONCLUSIONS: The tolerability of early postoperative oral intake was 67%. In the remainder of patients, all the minor problems except one, were relieved by simply returning to the traditional method. However, early postoperative oral intake should be used with caution for patients who experience difficulty with anastomosis or have an intraoperative technical breakdown and in whom the possibility of leakage exists.

Expression of p53 and c-erbB-2 Proteins as a Prognostic Factor in Patients with Gastric Carcinomas

Gastric cancer is not only one of the most common cancers in the world but also one of the most important malignant tumors in terms of incidence in Korea. In spite of it's clinical significance, the mechanism of malignant transformation in the stomach has not yet been well characterized. Recent studies disclosed enormous data suggesting that the p53 protein and the c-erbB-2 proto-oncogene have a critical role in the tumorogenesis of gastric cancer. More recently, the expression of the p53 protein has been associated with increased proliferative activity, but serves as a poor prognostic indicator in the case of patients for whom aggressive adjuvant therapy is required. Amplification of the c-erbB-2 oncogene has also been reported in gastric cancer. In the case of breast cancer, it has been demonstrated that no close correlation exists between the c-erbB-2 expression and the prognosis. However, no reports describe the relation between c-erbB-2 expression, p53 expression, PCNA expression and the prognosis for patients with gastric cancer. So this study was done to evaluate the expression of the p53 and c-erbB-2 and to assess the prognostic value in patients eith gastric cancer. The results are as follows: 1) The overall expression rates for p53 and c-erbB-2 were 38% and 20%, respectively. 2) There was no close relation between the expression rate of p53 and the tumor size, the Borrmann type, the nodal involvement, distant metastasis, Ming's classification, or Lauren's classification. The expression rate of p53 was closely related the tumor stage. 3) The expression rate of p53 in tumors which expressed PCNA was higher than that in tumors which did not express PCNA (p5 cm) was higher than that in small tumors(0.05). 6) The overall cumulative 5-year survival rate in the positive expression group for c-erbB-2 was lower than that in the negative group and the difference was statistically significant(p<0.05). In conclusion, it is suggested that p53 expression can not used as a prognostic factor for gastric cancer, but c-erbB-2 may be such a prognostic factor.