Status of Vivax Malaria in the Republic of Korea in 2002 / 감염과화학요법

BACKGROUND: Since 1997, the annual case occurrence of vivax malaria in the Republic of Korea (ROK) has exceeded 1,000 cases. The military has been an important source of the current outbreak. We collected informations about malaria cases (soldiers, veterans and civilians) that occurred in 2002, and analyzed the characteristics of the current outbreak. METHODS: Informations about the day of onset, region, and occupation of malaria cases of soldiers, veterans and civilians were collected through the National Institute of Health. RESULTS: Out of a total of 1,757 cases, 425 cases (24.2%) occurred in the military, 468 cases (26.6 %) among the veterans, and 864 cases (49.2%) among the civilians. Ten-day incidence reached its peak in the late July to the mid August. Areas such as Paju, Ganghwa, Yeoncheon and Cheolwon showed the highest prevalence. CONCLUSION: Presently, the current malaria outbreak appears to be in decreasing phase, however, attention should continuously be paid to prevent further spreading of malaria.

Status of Vivax Malaria in the Republic of Korea in 2002 / 감염과화학요법

BACKGROUND: Since 1997, the annual case occurrence of vivax malaria in the Republic of Korea (ROK) has exceeded 1,000 cases. The military has been an important source of the current outbreak. We collected informations about malaria cases (soldiers, veterans and civilians) that occurred in 2002, and analyzed the characteristics of the current outbreak. METHODS: Informations about the day of onset, region, and occupation of malaria cases of soldiers, veterans and civilians were collected through the National Institute of Health. RESULTS: Out of a total of 1,757 cases, 425 cases (24.2%) occurred in the military, 468 cases (26.6 %) among the veterans, and 864 cases (49.2%) among the civilians. Ten-day incidence reached its peak in the late July to the mid August. Areas such as Paju, Ganghwa, Yeoncheon and Cheolwon showed the highest prevalence. CONCLUSION: Presently, the current malaria outbreak appears to be in decreasing phase, however, attention should continuously be paid to prevent further spreading of malaria.

H rthle Cell Neoplasm of the Thyroid Gland

PURPOSE: H rthle cell neoplasm of the thyroid gland is a rare disease. The reported cases in Korea are not so many; thus, there has been a lack of common therapeutic and prognostic guidance. METHODS: The cases of 15 patients with a H rthle cell neoplasm of the thyroid gland, hospitalized at Seoul National University Hospital from Nov. 1981 to Feb. 1998, were retrospectively reviewed. RESULTS: There were 4 males and 11 females. The ages varied from 23 to 69 years old (mean: 46.3 years old). Among them, 13 had neck masses with a mean size of 3.3 cm (1.2-6.0 cm), and the mean duration of the symptom was 4 years (5 months-8 years). Of the other two, one had laryngeal discomfort for 2 months, and the other one was diagnosed through a fine needle aspiration follow-up. One of the 15 patients had hyperthyroidism whereas the others had euthyroidism. The thyroid scans for 10 of them showed cold nodules. The operations consisted of a unilateral lobectomy in 2 cases, a unilateral lobectomy and isth mectomy in 11 cases, a unilateral lobectomy, isthmectomy and contralateral partial lobectomy in 1 case, and a total thyroidectomy and neck lymph node dissection in the 1 case that was combined with a papillary carcinoma. Thirteen patients (86.7%) had a H rthle cell adenoma, and two of them (13.3%) had a H rthle cell carcinoma. The mean duration of follow-up was 33 months (range 1 month-12 years), and no recurrence or death occurred during the follow-up period. CONCLUSIONS: The incidence of H rthle cell neoplasms is higher in women and the sex ratio is 1:2.8. The incidence of H rthle cell carcinomas among H rthle cell neoplasms is 13.3% (2/15). We found no specific clinical features for differentiating a H rthle cell adenoma from a H rthle cell carcinoma and no factors for adequate operative methods and prognosis due to the rarity of the condition and the short duration of the follow-up. Because of the low incidence of H rthle cell neoplasms and our limited experience, not only co-research of centers but also pathologic research is needed.

Clinical Analysis of Phyllodes Tumor of the Breast

PURPOSE: Phyllodes tumor is a rare fibroepithelial tumor of the breast, first described by Johannes Muller in 1838. Much has been written about phyllodes tumor, but very few widely accepted conclusions about its clinical behavior, treatment modality, and prognosis have been reached. This study aims to analyze the clinical, radiological, and pathological characteristics of phyllodes tumor of the breast. METHODS: The medical records of 41 patients with phyllodes tumor who had been treated between February 1982 and August 1998 at the Department of Surgery, Seoul National University Hospital, were retrospectively reviewed for clinical, radiological and pathological findings, treatment modalities, and follow-up results. RESULTS: Of these 41 cases, there were 28 cases (68.3%) of benign tumors and 13 cases (31.7%) of malignanat tumors. All patients were females, and the mean ages of onset were 33.2 years for benign tumors and 40.8 years for malignant tumors. Most patients, 100% of benign and 92.3% of malignant, presented with a papable mass in the breast. The median duration of illness was 2 months for malignant tumors and 8 months for benign tumors. The tumor size was greater than 10 cm in diameter in 5 cases (38.5%) of malignant tumors and in 3 cases (10.7%) of benign tumors. Only 4 cases were preoperatively diagnosed as having a phyllodes tumor by using radiological and fine needle aspiration cytology. Out of the 10 malignant cases reviewed, 5 cases were confirmed as malignant, and 5 cases were confirmed as borderline phyllodes tumors. Cellularity was moderate or above in all 5 malignant and 5 borderline cases. Atypism above moderate degree was found in 4 of 5 (80%) malignant tumors, in 3 of 5 (60%) borderline tumors, and in 4 of 24 (16.7%) benign tumors. Mitotic counts in all 5 malignant cases were 5 or more per 10 high power field while those in the 5 borderline tumors were 2-5 mitoses per 10 high power field. The most commonly performed operative procedures were a simple mastectomy (50%) for malignant tumors and a simple excision (64.3%) for benign tumors. Post-operative adjuvant therapy was done for 4 cases; out of these, 1 case had been initially diagnosed as a malignant phyllodes tumor, but the diagnosis was changed to a benign phyllodes tumor upon review. Of the 27 follow-up cases, recurrences developed in 3 cases (16.7%) of benign tumors. CONCLUSION: From the above results, there were no specific clinical features for differentiating benign from malignant phyllodes tumor preoperatively; therefore, we cannot help depending on the pathologic findings. Pathologic reviews showed that among several criteria, atypism, cellularity, and mitotic count were the most definite pathologic characteristics in differentiating benign from malignant phyllodes tumor. But much more experience and long-term follow-up may be needed to define optimal treatments and to analyze the prognosis for phyllodes tumors of the breast.

FDG-PET for the Detetection of Recurrent or Metastatic Breast Cancer / 한국유방암학회지

FDG-PET is known to be non-invasive imaging technique, which is capable of identifying primary tumors and metastases with high sensitivity and accuracy. The aim of this study was to evaluate the diagnostic accuracy of whole-body FDG-PET Imaging for the detection of recurrent or metastatic breast cancer after surgery. Whole-body FDG-PET imaging was performed on 27 patients with suspected recurrent breast carcinoma. PET images were evaluated qualitatively for each patients and lesion. FDG-PET scans showed that there were 61 reference sites of malignant or benign lesions in 27 patients. In a patients-based analysis, FDG-PET scans correctly identifie 16 or 17 patients with recurrent or metastatic disease and 8 of 10 without recurrence, resulting in a sensitivity, specificity and accuracy of 94%, 80% and 89%, respectively. In a lesion-based analysis, FDG-PET scans correctly identified 46 of 48 lesion sites with recurrent or metastatic disease and 11 of 13 without recurrence. Overall sensitivity, specificity and accuracy for all lesion sites were 96%, 85% and 93%, respectively. FDG-PET scans revealed unsuspected recurrent or metastatic diseases in 8 of 27 (30%) of patients and 11 of 20 (55%) distant metastatic lesions. In 13 patients, treatment was altered by outcome of the PET scan. We concluded that whole-body FDG-PET scan is a useful diagnostic imaging modality for the detection of recurrent or metastatic breast carcinoma in patients suspected of having recurrent disease after primary surgery.

Prognostic Factors for Locally Invasive Papillary Thyroid Carcinomas

PURPOSE: Although papillary thyroid carcinomas are known to have a good prognosis, invasive papillary thyroid carcinomas have different outcomes. There are many studies on the prognostic factors for thyroid carcinomas, but few studies have been performed for invasive papillary thyroid carcinomas. We performed this study to investigate the prognosis and the prognostic factors for invasive papillary thyroid carcinomas. METHODS: We analyzed 184 patients with papillary thyroid carcinomas who had undergone a thyroidectomy between 1985 and 1990, especially for the clinicopathologic entity of an invasive papillary thyroid carcinoma, and made univariate and multivariate analyses for various clinical and pathological factors to evaluate whether they would be of value in estimating the prognosis in papillary thyroid carcinoma patients. RESULTS: In the univariate analysis of the 10-year disease-free survival rate of the overall cases, sex, tumor size, and lymph-node metastasis were confirmed to be significant prognostic factors. In the multivariate analysis, all of these factors were independent significant prognostic factors. Invasive papillary thyroid carcinoma patients, compared to non-invasive papillary thyroid carcinoma patients, were older and more prone to metastasis to cervical lymph nodes. In the univariate analysis of the 10-year disease-free survival rate of patients with an invasive papillary thyroid carcinoma, sex, tumor size, and lymph-node metastasis were significant prognostic factors. However, in the multivariate analysis, sex and tumor size appeared to be independent significant prognostic factors. CONCLUSION: We conclude that invasive papillary thyroid carcinomas have a the tendency to occur in elderly patients and are more prone to metastasis to cervical lymph nodes. The male sex, a tumor size more than 5 cm, and positive cervical-lymph-node metastasis present the worse prognosis. However, a randomized prospective study may be needed to better understand how to manage invasive papillary thyroid carcinomas.

Clinical Analysis of Malignant Pheochromocytoma / 대한암학회지

PURPOSE: There are no specific clinical and histopathologic characteristics of malignant pheochromocytoma and the optimal treatment modality has not been established yet. We analyzed the clinical and histopathologic features of malignant pheochromocytoma and treatment results. MATERIALS AND METHODS: We reviewed the clinical records of 10 patients with malignant pheochromocytoma diagnosed at Seoul National University Hospital from March 1987 to June 1998. RESULTS: Nine of 10 (90%) patients had functional tumors. The biochemical laboratory findings showed elevated 24-hour urine VMA level in nine patients available. The median size of the tumors was 11x11 cm. Six of 10 (60%) patients were initially diagnosed as malignant tumors because of direct invasions to adjacent tissues or distant metastases. On the other hand, remaining 4 patients were initially diagnosed as benign, but the distant metastases developed metachronously after resection of the primary lesion. The median duration between the initial operation and the detection of metastases was 57 months (range: 47~72 months) in these patients. The liver was the most common site of metastases (60%). With regards to the histopathological features, most of the tumors (87.5%) showed capsulation, necrosis and hemorrhage. The findings of lymphatic invasion, angio-invasion, and mitosis were found in 62.5% of the cases. All but 2 patients were initially treated with radical operation for the primary lesions. The disease recurrences or metastases occurred in 7 out of 10 patients. Of these, 4 patients were treated with chemotherapy or interferon- a after recurrences. Overall, the median survival for all patients was 82 months (range: 37~143 months). Two patients is alive and only one patient is alive without recurrence. CONCLUSION: The careful follow-up for at least 5 years and the aggressive multi-disciplinary therapy may be needed for the diagnosis and the management of malignant pheochromocytoma.

Detection of Axillary Lymph Node Micrometastasis using RT-PRC Comparison the results of MUC1, Cytokeratin 19 / 한국유방암학회지

One of the most important prognostic factors in breast cancer is presence of axillary lymph node invasion. It is reported that 20-30% of node negative patients with conventional cstaining has a risk of relapse within five years after primary treatment. The status of lymph node can be determined by serial sectioning or immunohistochemical staining, the former was accurate but time consuming, troublesome method and the latter was unsatisfactory in accuracy and objectivity. RT-PCR is sensitive and accurate molecular method and has been used in detecting micrometastasis of lymph node, bone marrow and blood of the cancer patients. We conducted RT-PCR amplification of MUC1, cytokeratin (CK) 19 using total RNA samples of lymph nodes of 40 breast cancer patients and conducted immunohistochemical staining for cytokeratin. The results of histological examination and immunohistochemical staining of cytokeratin were compared with RT-PCR results for the detection of lymph node micrometastasis. Nineteen patients(47.5%) were lymph node positive and twenty one patients (52.5%) were lymph node negative. MUC1 and CK19 were expressed in all lymph node positive patients. Among the node negative patients, 4 cases and 5 cases were expressed MUC1 and CK19 with RT-PCR. But immunohistochemical staining method was ineffective in detecting micrometastasis because lymph nodes of negative node group were not stained for cytokeratin. This study could not rule out the false positivity of RT-PCR, so it should be conducted against variable tumor marker to overcome this fatal defect. We recommend that RT-PCR will be applied in sentinel lymph node for accuate prediction of whole lymph node status and that the patients revealed positive result in RT-PCR should be observed more closely than the other.

Predictors of Axillary Node Metastases in Patients with T1 Breast Carcinoma / 한국유방암학회지

PURPOSE: The incidence of axillary lymph node metatasis in patients with T1 breast carcinoma has been reported by incidence of 6-31%. Axillary node involvement is the single most prognostic factor and a guideline for adjuvant treatment. But the necessity of routine axillary dissection for staging is recently been questioned. We studied to investigate the possibility of using clinicopathologic characteristics to predict axillary node status of T1 breast carcinoma sparing routine axillary dissection. MATERIALS AND METHODS: Five hundreds fourteen patients with T1 breast cancer whose pathological diagnosis were invasive ductal carcinoma NOS, were elligible for this study. All patients underwent axillary dissection by modified radical mastectomy or conservative surgery in the period between Jan. 1990 and Dec. 1998 at department of surgery, Seoul National University Hospital. The clinicopathologic characteristics of primary tumor include age (35>, < or =35), tumour size, unclear grade, histologic grade, hormone receptor status, lymphatic vessel invasion (LVI), and various tumor markers (p53, cerbB2, cathepsinD, bcl-2, and ki67) were evaluated according to lymph node status. RESULTS: Frequency of axillary lymph node matastases in T1 invasive ductal carcinomas was 34% of 514 patients. In about 78% of patients, the size of primary tumors was over 1cm. And the mean number of metastatic lymph node was 3.7. Age35 or less and lymphatic analysis (p=0.004, p<0.001). However, in mulivariate analysis, lymphatic vessel invasion was the only significant predictor for lymph node metastases. CONCLUSIONS: Lymphatic vessel invasion was the only significant predictor for lymph node metastases in T1 invasive breast cacinoma. There is sill limitations to advocate sparing axillary lymph node dissection because of insufficient predictors for axillary lymph node metastases and relatively high incidence of lymph node metastases. New prognostic indicators must be investigated for predicting axillary lymph node status.

Primary Gastric Lymphoma:Clinicopathologic Review and Prognostic Factors

BACKGROUND: Primary gastric lymphoma is a rare neoplasm that represents 1~4% of all gastric malignancies. The optimal treatment of primary gastric lymphoma remains controversial. This study was designed to examine the prognostic significance of various clinicopathologic factors in patients with gastric lymphoma and to evaluate the role of surgery in the treatment of gastric lymphoma. METHODS: Retrospective study of 71 cases of primary gastric lymphoma which had been undergone laparotomy at the Department of Surgery, Seoul National University Hospital from Jan. 1982 to Dec. 1996 was performed. The authors reviewed clinicopathologic factors of patients and evaluated their prognostic significance. RESULTS: 1) The mean age of the patients was 50 years, and the most prevalent ages occurred in the 6th & the 7th decade. The ratio of males to females was 1.3:1. 2) The presenting symptoms and signs on admission were epigastric abdominal pain & discomfort, weight loss, anorexia, indigestion, and abdominal mass in decreasing order of frequency. 3) The diagnostic accuracy of the gastrofiberscopic biopsies was 67.1% preoperatively. 4) The most common pathologic type was diffuse histiocytic type (57.1%) in Rappaport classification, and diffuse large cell type (47.1%) in NCI Working formulation classification. 5) The distribution of stages according to modified TNM classification was 47.9% stage I, 36.6% stage II, 11.3% stage III, and 4.2% stage IV. 6) Overall, a potentially curative resection was performed in 92.9% of the cases. Treatment modalities included surgery (S), chemotherapy (CT), and radiotherapy (RT) in the following proportions: 33.8% only S, 53.5% S CT, 11.3% S RT, and 1.4% S CT RT. 7) The overall 5-year survival rate was 78.9%. The 5-year survival rates according to stage were 94.1% in stage I, 80.4% in stage II, 30.0% in stage III and 0% in stage IV.

A Clinical Analysis of Parotid Tumors

A clinical analysis was done for 141 patients with parotid tumors who had been admitted to and treated at the Department of Surgery, Seoul National University Hospital over a period of 15 years from January 1981 to December 1995. Of these 141 cases, there were 123 cases of benign tumors and 18 cases of malignant tumors. The results were as follows ; 1) Sex distribution revealed a preponderance of females with a ratio of 1.4 : 1. When only malignant tumors were considered, males were predominant with a ratio of 1.6 : 1. 2) Benign tumors were prevalent in the 3rd & the 4th decades while malignant tumors were prevalent in the 4th & the 5th decades. 3) The chief complaint was a palpable mass in all the cases and facial nerve palsy was accompanied with 22% of malignant cases. 4) The mean size of the mass was 3.5 cm in diameter. 5) The mean duration of illness was 4.9 years with a duration of 1 year being seen in 28% of the benign tumor cases and in 44% of the malignant tumor cases. 6) The most commonly performed operative procedures were a superficial lobectomy(56%) for benign tumors and a total parotidectomy(67%) for malignant cases. And 76% of all benign tumors and 89% of all malignant tumors were treated with a superficial lobectomy or a more extensive operation. 7) According to the histopathological findings, benign tumors were present in 123 cases(87%) and malignant tumors in 18 cases(13%). The most common benign tumor was pleomorphic adenoma(80%) and the most common malignant tumor was mucoepidermoid carcinoma(50%). 8) In the 5 recurrent cases, previous operations were enucleation(4 cases) and biopsy only(1 case). 9) The postoperative complications developed in 51 cases(36%), including 33 cases(23%) of facial nerve palsy and 9 cases(6%) of Frey's syndrome. Facial palsy was permanent in 7 cases(5%). 10) Of the 94 follow-up cases, recurrences developed in 6 cases(7%) of benign tumors and 6 cases (50%) of malignant tumors.