Complete Remission after Pseudoprogression in Refractory Classical Hodgkin Lymphoma Treated with Pembrolizumab / 대한내과학회지

Classical Hodgkin lymphoma (cHL) is a highly curable disease, but the prognosis for relapsed/refractory cHL is grave. Pembrolizumab has recently shown impressive effects in patients with relapsed/refractory cHL in a phase Ib study (KEYNOTE-013). This report presents a case of a 17-year-old male with refractory cHL who received multiple chemotherapy regimens and radiotherapies, including brentuximab vedotin. Following both the second and fourth cycles of intravenous pembrolizumab 100 mg (2 mg/kg), positron emission tomography/computed tomography (PET/CT) scan showed progression. However, because performance status and fever improved, treatment was continued, and complete remission was confirmed by PET/CT after eight cycles of pembrolizumab. This case suggests that clinicians need to be aware of the potential for pseudoprogression in patients treated with pembrolizumab.

Extranodal natural killer/T-cell lymphoma with long-term survival and repeated relapses: does it indicate the presence of indolent subtype?

BACKGROUND: Extranodal natural killer (NK)/T-cell lymphoma is a subtype of lymphoma that is derived from NK cells. It is considered as an aggressive form of non-Hodgkin's lymphoma because of frequent relapses and resistance to treatment. Relapsed NK/T-cell lymphoma often follows a fulminant course that is refractory to conventional chemotherapy treatment. METHODS: Several patients with extranodal NK/T-cell lymphoma showed long-term survival in spite of frequent relapses. Thus, the medical records of patients diagnosed with extranodal NK/T-cell lymphoma from 1995 to 2007 were reviewed and assessed. RESULTS: Of the 140 cases reviewed, 6 were selected (4.29%). Each of these patients had a minimum of 3 relapses or disease progression during the follow-up period, and their median overall survival was 66 months (range, 42-89 months). They were grouped according to the atypical clinical behavior observed: (1) repeated relapses or progression (> or =3 times) during follow-up; and (2) long-term survival of more than 40 months, as the longest overall survival median was previously considered at approximately 40 months. The clinicopathological and laboratory characteristics of these patients were similar to those of other extranodal NK/T-cell lymphoma patients. However, 5 of the studied cases involved relatively lower expression of the proliferation-related antigen Ki-67 (<40-50%), indicating less proliferative activity. Clinically, they showed delayed relapse for at least 20 months after the initial complete remission. CONCLUSION: Our observations suggest that the clinical behavior of some extranodal NK/T-cell lymphoma patients differs from the typical clinical course.

Rituximab Plus CHOP for the Treatment of Primary Mediastinal Large B Cell Lymphoma in a Pregnant Woman / 대한내과학회지

A 33-year-old woman developed primary mediastinal large B-cell lymphoma (PMLBCL) during the second trimester of pregnancy. She was immediately treated with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP). After the third cycle of R-CHOP, she delivered a healthy baby by Caesarian section. She was in complete response after she finished all courses of treatment, and the rituximab-containing chemotherapy during pregnancy induced no adverse effect in the fetus. Thus, R-CHOP appears to be an effective, safe treatment option for PMLBCL encountered during the second and third trimesters of pregnancy. To our knowledge, this is the first report of the use of rituximab plus CHOP in a pregnant woman in Korea.

Diffuse Large B-Cell Lymphoma Associated with Chronic Inflammation Manifested as a Soft Tissue Mass: Incidental Discovery on Histological Examination

We report an extraordinary case of diffuse large B-cell lymphoma arising in a cystic necrotic mass in a 35-year-old man who presented with a soft tissue mass at the site of previous surgery. A benign mass was surgically removed 17 years ago, after which a cystic lesion gradually developed at the same site. The resected mass appeared as a thick-walled cyst filled with brown necrotic and hemorrhagic material. On microscopic examination, the cyst wall was primarily necrotic tissue with some aggregates of large atypical lymphoid cells. These atypical cells were diffusely positive for CD20 and showed a high proliferation index, Epstein-Barr virus positivity, and clonal rearrangement of the immunoglobulin gene. His present condition was diagnosed as Epstein-Barr virus-associated diffuse large B-cell lymphoma arising from chronic inflammation. It is important to be aware of the clinical manifestations and histological features of this rare disease in light of diagnosis and treatment.

A Case of Abdominal Aneurysm due to Streptococcus pneumoniae Infection / 감염과화학요법

Streptococcus pneumoniae has been an important etiologic agent of community-acquired pneumonia, meningitis, and otitis media. S. pneumoniae is also an important cause of bacteremia, especially in a community setting and it may cause intravascular infection. S. pneumoniae has been rarely been reparted to cause mycotic aneurysm and three is no case report on abdominal aneurysm caused by S. pneumoniae in Korea, yet. We experienced a case of abdominal aneurysm caused by S. pneumoniae infection. A 78-year old male with hypertension and diabetes mellitus was transferred to our hospital due to ruptured abdominal aortic aneurysm. Surgical intervention was done for removal of hematoma and vascular anastomosis. Ascending aorta showed atheromatous plaque with dystrophic calcification and thrombus. S. pneumoniae was isolated from the culture of the surgical specimen. After successful treatment with antibiotics for 7 weeks, he has been followed up uneventfully in outpatient clinic for 1 year.

A Case of Abdominal Aneurysm due to Streptococcus pneumoniae Infection / 감염과화학요법

Streptococcus pneumoniae has been an important etiologic agent of community-acquired pneumonia, meningitis, and otitis media. S. pneumoniae is also an important cause of bacteremia, especially in a community setting and it may cause intravascular infection. S. pneumoniae has been rarely been reparted to cause mycotic aneurysm and three is no case report on abdominal aneurysm caused by S. pneumoniae in Korea, yet. We experienced a case of abdominal aneurysm caused by S. pneumoniae infection. A 78-year old male with hypertension and diabetes mellitus was transferred to our hospital due to ruptured abdominal aortic aneurysm. Surgical intervention was done for removal of hematoma and vascular anastomosis. Ascending aorta showed atheromatous plaque with dystrophic calcification and thrombus. S. pneumoniae was isolated from the culture of the surgical specimen. After successful treatment with antibiotics for 7 weeks, he has been followed up uneventfully in outpatient clinic for 1 year.

Intravascular Lymphomatosis Presenting as Fever of Unknown Origin with Peripheral Polyneuropathy / 감염과화학요법

Fever of unknown origin (FUO) is caused by infections (30-40%), neoplasms (20-30%), collagen vascular diseases (10-20%), and numerous miscellaneous diseases (15-20%). The literatures also reveal that 5-15% of FUO cases defy diagnosis, despite extensive studies. Diagnostic advances continuously modify the spectrum of FUO-causing diseases. Modern imaging techniques (e.g., ultrasound, CT scan, MRI) enable early detection of abscesses and solid tumors that used to be difficult to diagnose. But the correct diagnosis can be delayed because the tumor, such as rare hematologic malignancy, is difficult to be detected by various imaging studies. Intravascular lymphomatosis (IVL) is a rare form of non-Hodgkin's lymphoma and generally fatal disease characterized by extensive proliferation of neoplastic mononuclear cells within the lumina of blood vessels. The prognosis is usually extremely poor, with rapid death despite chemotherapy. The diagnosis is most frequently made after biopsy of skin or brain but is often established post mortem. Most patients with IVL present with FUO and nonspecific cutaneous and neurologic manifestations. Peripheral nerve system or pulmonary involvements are not common as initial menifestations. We report a case of intravascular lymphomatosis, presenting as FUO with peripheral polyneuropathy. We made early diagnosis of IVL by video-assisted thoracoscopic lung biopsy. She is improving with good performance after the 4th cycle of chemotherapy till now.

Intravascular Lymphomatosis Presenting as Fever of Unknown Origin with Peripheral Polyneuropathy / 감염과화학요법

Fever of unknown origin (FUO) is caused by infections (30-40%), neoplasms (20-30%), collagen vascular diseases (10-20%), and numerous miscellaneous diseases (15-20%). The literatures also reveal that 5-15% of FUO cases defy diagnosis, despite extensive studies. Diagnostic advances continuously modify the spectrum of FUO-causing diseases. Modern imaging techniques (e.g., ultrasound, CT scan, MRI) enable early detection of abscesses and solid tumors that used to be difficult to diagnose. But the correct diagnosis can be delayed because the tumor, such as rare hematologic malignancy, is difficult to be detected by various imaging studies. Intravascular lymphomatosis (IVL) is a rare form of non-Hodgkin's lymphoma and generally fatal disease characterized by extensive proliferation of neoplastic mononuclear cells within the lumina of blood vessels. The prognosis is usually extremely poor, with rapid death despite chemotherapy. The diagnosis is most frequently made after biopsy of skin or brain but is often established post mortem. Most patients with IVL present with FUO and nonspecific cutaneous and neurologic manifestations. Peripheral nerve system or pulmonary involvements are not common as initial menifestations. We report a case of intravascular lymphomatosis, presenting as FUO with peripheral polyneuropathy. We made early diagnosis of IVL by video-assisted thoracoscopic lung biopsy. She is improving with good performance after the 4th cycle of chemotherapy till now.

Posttransplant Lymphoproliferative Disorder in Pediatric Liver Transplantation: Samsung Medical Center Experience / 대한소아소화기영양학회지

PURPOSE: In a retrospective study for the pediatric patients who underwent liver transplantation in the past 6 years at Samsung Medical Center, the clinical features of 5 patients with posttransplant lymphoproliferative disorder (PTLD) were analyzed. METHODS: Between June 1996 and June 2002, 41 pediatric patients underwent liver transplantation. Seven of them died in the postoperative period. Thirty-five including one patient who died of PTLD were finally reviewed. Patients were divided into two groups: high risk group, EBV naive recipients of EBV-positive grafts; low risk group, the patients other than those in high risk group. The authors reviewed age at operation, immunosuppressive agent, postoperative duration until diagnosis, postoperative duration until EBV seroconversion, presence of treatment against rejection, and presenting symptoms of PTLD. RESULTS: Five of 41 patients (12.2%) developed PTLD. All of them belonged to high risk group, and the incidence of PTLD in high risk group was 31.3% (5/16). The mean age at operation was 10.8 months old and the mean duration between operation and diagnosis for PTLD was 9.8 months. Primary EBV infection developed after a median of 6 months after transplantation. One patient was diagnosed as laryngeal and gastrointestinal PTLD and the other four, gastrointestinal PTLD. The following symptoms and signs were seen in the patients: anemia (100%), hypoalbuminemia (100%), fever (80%), diarrhea (80%), gastrointestinal bleeding (80%), and anorexia (60%). CONCLUSION: PTLD is one of the major complications after pediatric liver transplantation, especially in the group of high-risk recipients. Anemia, hypoalbuminemia, fever, diarrhea and gastrointestinal bleeding were features that are characteristic of PTLD. The common features of PTLD development were: (i) EBV-positive donors placed into EBV naive recipients, (ii) primary EBV infection about 6 months after transplantation, (iii) young age, about 1 year old at operation, and (iv) the requirement for intensive posttransplant immunosuppression.

A Breast Cancer in Premenopausal Women: Pathologic Findings and an Analysis of Prognostic Factor / 한국유방암학회지

PURPOSE: The relationship between menopausal status at diagnosis and the prognosis in breast carcinoma remains uncertain. However, it is widely considered that breast cancer in young women is more lethal than in older patients. We therefore attempted to determine whether menopausal status could be a useful prognostic factor for breast cancer. METHODS: A retrospective study was conducted of premenopausal women who had undergone a definite operation between Jan. 1997 and Dec. 1998 in the Department of Surgery, Samsung Medical Center. Clinical features, histopathologic findings, and prognostic factors were evaluated and compared with those for the equivalent surgical group of postmenopausal women. RESULTS: There were 207 cases (86.3%) of infiltrating ductal carcinomas, 10 (4.2%) of infiltrating lobular carcinomas, 6 (2.5%) of ductal carcinomas in situ, and 16 (6.7%) of special type cancers which showed good prognosis. There were some differences in these incidences from those of the postmenopausal women, but they were not statistically significant (P>0.05). Tumor size and lymph nodal status showed no difference between the two groups (P=0.288), nor were there any significant differences in terms of TNM stage, ER/PR status, nuclear or histologic grade (P>0.05). CONCLUSION: There were little differences in pathologic and prognostic factors between premenopausal and postme no- pausal breast cancer patients. Premenopausal status and young age did not have poorer prognostic factors and were predicted to have not worse prognosis.

A Breast Cancer in Premenopausal Women -Pathologic Findings and an Analysis of Prognostic Factor-

PURPOSE: The relationship between menopausal status at diagnosis and the prognosis in breast carcinoma remains uncertain. However, it is widely considered that breast cancer in young women is more lethal than in older patients. We therefore attempted to determine whether menopausal status could be a useful prognostic factor for breast cancer. METHODS: A retrospective study was conducted of premenopausal women who had undergone a definite operation between Jan. 1997 and Dec. 1998 in the Department of Surgery, Samsung Medical Center. Clinical features, histopathologic findings, and prognostic factors were evaluated and compared with those for the equivalent surgical group of postmenopausal women. RESULTS: There were 207 cases (86.3%) of infiltrating ductal carcinomas, 10 (4.2%) of infiltrating lobular carcinomas, 6 (2.5%) of ductal carcinomas in situ, and 16 (6.7%) of special type cancers which showed good prognosis. There were some differences in these incidences from those of the postmenopausal women, but they were not statistically significant (P>0.05). Tumor size and lymph nodal status showed no difference between the two groups (P=0.288), nor were there any significant differences in terms of TNM stage, ER/PR status, nuclear or histologic grade (P>0.05). CONCLUSION: There were little differences in pathologic and prognostic factors between premenopausal and postme no-pausal breast cancer patients. Premenopausal status and young age did not have poorer prognostic factors and were predicted to have not worse prognosis.

Infiltrating Lobular Carcinoma of the Breast Comparison with an infiltrating ductal carcinoma

PURPOSE: Infiltrating lobular carcinomas (ILC) represent 5-10% of all breast cancers. Compared to infiltrating ductal carcinomas (IDC), ILC has a trend to be a more indistinct and multicentric form of cancer, thus, they are detected later and are less frequently treated using breast conserving surgery. The objective of this study was to determine the difference between ILC and IDC and the utility of using breast conserving surgery for ILC. METHODS: We studied 26 ILC and 319 IDC patients surgically treated at the Department of Surgery, Samsung Medical Center. Age, size of tumor, mammographic findings, operative method and pathologic findings were analysed retrospectively. For the microvessel count, tumor sections were immunohistochemically stained using CD31 monoclonal antibody, and microvessels were counted at 200 magnification in three separate fields selected from areas of highest vascularity. RESULTS: There were no differences between patients with ILC and IDC with respect to the mean age (45.4 and 47), the mean size of the tumors (2.59 cm and 2.63 cm), the malignant findings on mammography (13/15 (86.6%) and 203/237 (85.7%)(p=0.636)), and the number of breast conservaing surgeries (10/26 (38.5%) and 103/311 (33.1%)(p=0.361)). Axillary nodal metastasis was slightly more common in patients with ILC (15/25, 60%) than in those with IDC (141/284, 9.6%)(p=0.217) but there was no difference in TNM staging. More frequent estrogen receptor expression and less frequent P53 mutations were found in ILC than in IDC. Unlike IDC, there was no association between tumor microvessel density and pathologic stagings in ILC. CONCLUSION: ILC was found in patients of similar age, and the size was not different from that of IDC. The mammographic accuracy in diagnosing malignancy was about the same in ILCas in IDC. Breast conserving surgery can be performed in ILC patients at the same rate as in IDC patients. Microvessel density was not a prognostic factor in ILC patients.

Clinical Application of Sentinel Node Biopsy in T1 or Less Breast Cancers. Is it Effective or Feasible?

BACKGROUND: Sentinel node biopsy has emerged recently as an alternative to routine axillary node dissection in predicting axillary nodal metastasis, and various studies have shown its effectiveness in patients with breast cancer. However, there have been some controversies in clinical application because of its high false negative rate. METHODS: One hundred forty patients with breast cancer underwent operative management in consideration of the results of sentinel node biopsies at the department of surgery, Samsung Medical Center, between Sep. 1995 and Jul. 1998. Sixty-three patients with tumor sizes of T1 or less were retrospectively evaluated. Intraoperative lymphatic mappings using vital blue dye and using a combination of vital dye and a 99mTc-antimony sulphide colloid were performed for 53 patients and 10 patients, respectively. RESULTS: Patient's ages were in the third decade for 2 patients (3.2%), in the fourth decade for 18 (28.6%), in the fifth decade for 18 (28.6%), in the sixth decade for 13 (20.6%) and in the seventh decade for 12 (19.0%). An infiltrating ductal carcinoma was observed in 51 patients (81.0%), an intraductal carcinoma in 8 (12.6%), a medullary carcinoma in 2 (3.2%), an infiltrating lobular carcinoma in 1 (1.6%) and a mucinous carcinoma in 1 (1.6%). Sentinel node was detected in 42 of the 53 patients (79.2%) evaluated with vital blue dye only and in 10 of the 10 patients (100%) evaluated with a combination of vital dye and a 99mTc-antimony sulphide colloid. Among the group of T1 or less, the sensitivity rates of vital dye and the combination were 81.8% and 100% and their accuracies of them were 95.2% and 100%, respectively. The false negative rates for all cases were 12.2% and 8.3%, respectively, but they were decreased to 6.1% and even 0% for the group of T1 or less. CONCLUSIONS: The detection rate and the accuracy of sentinel node biopsy were enhanced in patients with T1 or less breast cancer. If a combination of vital dye and a radioisotope is used, sentinel node biopsy may be applied clinically in limited patients such as those with T1 or less breast cancer.

Secretory Carcinoma of the Breast: 4 Cases

BACKGROUND: A secretory carcinoma is one of the least common carcinomas of the breast. Most studies of this carcinoma have been single case reports or separate analyses of the problem in either children or adults. METHODS: We studied 4 female patients treated in Samsung Medical Center from Nov.1994 to Dec. 1998. All of them were diagnosed as having a secretory carcinoma by using pathologic examination. RESULTS: All patients were female and they were 21, 29, 49, and 69 years of age. The initial symptom in two cases was a palpable mass. One patient presented with nipple discharge, but a palpable mass was found during the physical examination. The other carcinoma was detected on screening mammography. Mammography and ultrasonography suggested malignancy in three cases. One case was preoperatively misinterpreted as an intraductal papilloma. Preoperative ultrasonography-guided core biopsy performed in one case was diagnosed as a secretory carcinoma. All the patients were in a relatively early stage, stages IIb, I, I, and I. Estrogen receptors were negative in three and positive in one, but progesteron receptors were negative in all four cases. Postoperative courses were good, and there have been no recurrence or side effects yet. CONCLUSIONS: A secretory carcinoma is a rare condition of the breast, but the prognosis seems to be favorable with a mortality rate lower than that of the usual breast cancer. Exact diagnosis with preoperative aspiration cytology and biopsy will make it possible to perform more conservative surgery.

Clinical Application of Sentinel Node Biopsy in T1 or less Breast Cancers Is it Effective or Feasible? / 한국유방암학회지

BACKGROUND: Sentinel node biopsy has emerged recently as an alternative to routine axillary node dissection in predicting the axillary nodal metastasis and various studies habe shown its effectiveness in patients with breast cancer. However there have been some controversies in clinical application because of high false negative rate. MATERIALS AND METHODS: One hundred and forty patients with breast cancer underwent operative management in consideration of the results of patients with breast cancer underwent operative management in consideration of the results of sentinel node biopsy at department of surgery in Samsung Medical Cancer between Sep. 1995 and July 1998. Sixty-three patients with tumor size of T1 or less were retrospectively evaluated. Intra-operative lymphatic mapping using vital blue dye was performed in 53 patients and using combination of vital dye and 99mTc-antimony sulphide colloid in 10 patients. RESULTS: patients ages were in the third decade in 1 patients (3.2%), in the forth decade in 18 (28.6%), in the fifth decade 18 (28.6%), in the sixth decade in 13 (20.6%) and in the seventh decade in 12 (19.0%). The patients had infiltrating ductal carcinoma in 51 patients(81.0%), intraductal carcinoma in 8 (12.6%), medullary carcinoma in 2 (3.2%), infiltrating lobular carcinoma in 1 (1.6%) and mucinous carcinoma in 1 (1.6%). Sentinel node was detected in 42 of 53 patients (79.2%) evaluated with vital blue dye only and 10 of 10 (100%) evaluated with combination of vital dye and 99mTc-antimony sulphide colloid. Among the group of T1 of less, each sensitivity rates of vital dye and combination were 81.8% and 100% and accuracy of them were 95.2% and 100% respectively. Each false negative were 12.2% and 8.3% in total cases but they were decreased to 6.1% and even 0% in the group of T1 or less. CONCLUSION: The detection rate and accuracy of sentinel node biopsy were enhanced in patients with T1 or less breast cancer. If the combination of vital dye and radioisotope is used, sentinel node biopsy may be applied clinically in limited patients such as T1 or less breast cancer.

Telomerase Activity in Invasive Breast Cancer / 대한암학회지

No abstract available.

Pancreatic Mucinous Ductal Ectasia A clinical study of four patients

Four cases of mucinous ductal ectasia of the pancreas are presented, along with a review of the literature. Mucinous ductal ectasia is a clinicopathologic entity characterized by dilation and filling of the main pancreatic duct or its side branches with thick, viscid mucus, leading to recurrent acute pancreatitis or symptoms that mimic chronic pancreatitis. Three of the patients were male (M:F=3:1) and the patients were 54~74 years old. The symptoms of two patients were abdominal pain and they had a frequent admission history due to pancreatitis. One patient had jaundice, and one patient presented no symptoms. In all of the patients, the tumor was located in the read of the pancrease and the size of tumor was about 3 cm. A total pancreatectomy was performed, and three pancreatico-duodenectomy were performed. The pathologic report revealed that two cases were malignant and two cases were borderline malignant. The tumor marker did not correlate with the presence of malignancy. Because mucinous ductal ectasia is recognized as a premalignant disease, the treatment of choice is pancreatic resection.

A Case of Pulmonary Intravascular Lymphomatosis / 결핵

Intravascular lymphomatosis(IVL) which was first described by pfleger and Tappeiner in 1959 is rare malignancy characterized by neoplastic proliferation of lymphoid cell lineage within the vascular lumen with little or no adjacent parenchymal involvement. Its usual sites of involvement are central nervous system and skin or infrequently heart, lungs, pancreas, liver, spleen, kidney, adrenal glands, genitourinary tract, and bone marrow. Pulmonary involvement of IVL is not common. Symptoms of pulmonary involvement include dyspnea, cough and fever. Radiologicially, the disease is manifested with diffuse interstitial infiltrates. We report a recently experienced case of pulmonary intravascular lymphomatosis which was manifested with fever and chest pain.

An immunohistochemical evaluation of c-erbB-2 expression in epithelial ovarian cancer / 대한산부인과학회잡지

No abstract available.