The Clinical Characteristics and Outcomes of Barrett's Cancer at a Single Institution in Korea / 대한소화기내시경학회지

BACKGROUND/AIMS: The prevalence of Barrett's esophagus might also be changing along with changes in the epidemiology of GERD, and the incidence of Barrett's cancer is expected to increase even more. The aim of this study is to evaluate the clinicopathologic features and outcome of the patients with Barrett's cancer and who were seen at a single institution over a period of 13 years. METHODS: The records of 39 patients with the esophageal adenocarcinoma and who were treated at Samsung Medical Center from January 1995 to August 2008 were reviewed. Among them, 11 patients (28%) with histologically-confirmed Barrett's cancer were included in the study. The clinicopathological features, endoscopic manifestations and treatment outcome were evaluated. RESULTS: The male to female ratio was 10:1. The mean age was 64 years. Most of the patients were diagnosed with Barrett's cancer after 2000, and there were three such patients (27.3%) in 2008. The frequent chief complaints were epigastric pain (27.3%) and chronic acid reflux symptom (18.2%). Three patients (27.3%) were detected incidentally during screening endoscopy. The macroscopic types based on the endoscopic findings were as follows: 4 lesions with a type IIa appearance (36.4%) and 2 with a type IIb appearance (18.2%). The mean tumor size was 1.2 cm at the longest dimension and 0.8 cm at the shortest dimension. Tumor was located in the mucosal layer in six cases (54.5%) and the 5 cases (45.5%) showed submucosal invasion. Lymph node metastasis was found in one case (9.1%). All the cases underwent surgery, except one case for which the tumor was removed by endoscopic submucosal dissection. There was no recurrence during the follow up period. CONCLUSIONS: As the incidence of Barrett's cancer is increasing, a standard surveillance program that includes the endoscopic biopsy method, the grading system for the dysplasia and the treatment modality should be established.

A Case of Pulmonary Endometriosis Resected by Video-Assisted Thoracoscopic Surgery / 결핵

Catamenial hemoptysis is a rare condition caused by thoracic endometriosis that presents as tracheobronchial or pulmonary endometriosis. While hormonal treatment may cause virilization and sterility, due to the antiestrogenic effect, its surgical removal via thoracotomy is a particularly invasive procedure and is not recommended as the first choice treatment in young woman. Successful surgical removal by video-assisted thoracoscopic surgery (VATS) has recently been reported, and may be indicated for young patients who at some stage would like to become pregnant. Herein, a case of a 25-year-old unmarried woman with catamenial hemoptysis, cured by VATS, is reported.

Clinical Characteristics of Recurred Patients with Stage I ,II Non-Small Cell Lung Cancer / 결핵

BACKGROUND: Five year survival rate of postoperative stage I non-small lung cancer(NSCLC) reaches to 66%. In the remaining one third of patients, however, cancer recurs and overall survival of NSCLC remains dismal. To evaluate clinical and pathologic characteristics of recurred NSCLC, we studied patterns and factors for postoperative recurrence in patients with staged I, II NSCLC. METHOD: A retrospective analysis was performed in 234 patients who underwent radical resection for pathologic stage I, II NSCLC. All patients followed for at least one year were included in this study. RESULTS: 1) There were 177 men and 57 women. The median age was 63. The median duration of follow up was 732 days (range 365~1,695 days). The overall recurrence rate was 26.5% and the recurrence occurred at 358.8 +/- 239.8 days after operation. 2) The age of recurred NSCLC patients were higher (63.2 +/- 8.8 years) than that of non-recurred patients (60.3 +/- 9.8 years)(p=0.043). The recurrence rate was higher in stage II (46.9%) than in stage I (18.8%, p<0.001) NSCLC. The size of primary lung mass was larger in recurred (5.45 +/- 3.22 cm) than that of non-recurred NSCLC (3.74 +/- 1.75 cm, p<0.001). Interestingly, there were no recurrent cases when the resected primary tumors were less than 2cm. 3) Distant recurrence was more frequent than locoregional recurrence (66.1% vs. 33.9%). Distant recurrence rate was more frequent in female and adenocarcinoma. Brain metastasis was more frequent in patients with adenocarcinoma than squamous cell carcinoma (p=0.024). CONCLUSION: The tumor size and stage were two important factors for recurrence. Considering that distant brain metastasis was more frequent in patients with adenocarinoma, prospective study should follow to evaluate the effectiveness of preoperative brain imaging.