Adenocarcinoma of Unknown Primary Site

BACKGROUND: Metastatic cancer of unknown primary site occupies 0.5~10% of all diagnosed cancer patients and includes various tumors with diverse responses to systemic chemotherapy. Adenocarcinoma of unknown primary site (ACUPS), the most common subtype, has no standard treatment, rarely responds to conventional treatment and has a poor survival rate. METHODS: The retrospective study was performed to investigate the clinical characteristics and the treatment outcomes of ACUPS. RESULTS: Eighty-one patients with ACUPS diagnosed at Samsung Medical Center from May 1995 to July 1999 were included. The median age was 58 years (range, 29~77). The common sites of metastases were the lymph node, liver, lung and bone in order. In 49 of 81 patients (60.5%), the dominant tumor location was below the diaphragm. The majority of patients (76 of 81) were initially treated with systemic chemotherapy including cisplatin. Responses were evaluable in 70 of 76. Eighteen of 70 patients (25.7%) responded to chemotherapy and complete remission was observed in 6 patients. The overall median survival of 81 patients was 5.6 months. The median survival of the responding patients was 18.3 months but the median survival of the nonresponding patients was 4.6 months (p<0.01). In univariate and multivariate analysis, age, performance status and response to initial chemotherapy were significant prognostic factors for overall survival. CONCLUSION: We observed poor response to the treatment and survival rate in ACUPS, but complete remission and long-term survival were observed in a small number of patients.

Adenocarcinoma of unknown primary site / 대한내과학회지

BACKGROUND: To study clinical characteristics and treatment outcomes of adenocarcinoma of unknown primary site (ACUPS). METHODS: A retrospective analysis of 81 patients who were diagnosed as ACUPS, seen at Samsung Medical Center from May, 1995 to July, 1999, was performed. RESULTS: The median age of the patients was 58 years. The common sites of metastases were the lymph node, liver, lung, bone. In 49 of 81 patients (60.5%), the dominant tumor location was below the diaphragm. The majority of patiens (76 of 81) were initially treated with systemic chemotherapy including cisplatin. Responses were evaluable in 70 of 76. Eighteen of 70 patients (25.7%) responded to chemotherapy and complete remission was observed in 6 patients. The overall median survival of 81 patients was 5.6 months. The median survival of the responding patients was 18.3 months but the median survial of the nonresponding patients was 4.6 months (p<0.01). In univariate and multivariate analysis, age, performance status and response to initial chemotherapy were significant prognostic factors for overall survial. CONCLUSION: Poor survival rate and treatment response were observed in ACUPS but complete response and long-term survival were observed in several patients.

Insular Carcinoma: An Aggressive Subtype of Differentiated Thyroid Neoplasms / 대한내분비외과학회지

PURPOSE: Insular carcinoma is a rare subtype of thyroid cancer which was first described by Carcangiu in 1984. Its aggressiveness is intermediate between well differentiated and anaplastic thyroid carcinoma. But its origin, clinical features and prognosis are not yet clearly understood. We wanted to evaluate the clinical features, histologic characteristics and prognosis of insular thyroid carcinoma. METHODS: We studied 4 cases of insular thyroid carcinoma treated in Samsung Medical Center from March 1996 to April 1998. Age, sex, clinical features, treatment, pathology and follow up findings were reviewed, retrospectively. RESULTS: All patients were female and the mean age was 44 years. Three of all patients complained of anterior neck mass and one patient complained of low back pain and paresthesia of the right thigh. Two patients had metastatic bone lesions at the time of diagnosis. Preoperative fine needle aspiration cytology diagnosed follicular neoplasm in 2 cases and papillary carcinoma in 1. We performed total or completion total thyroidectomy and radioactive iodine therapy in 3 cases and radioactive iodine therapy alone in one. Extrathyroidal invasion, vascular invasion and multicentricity were noted in two cases. All four patients showed recurrence or distant metastasis in follow up over a period of 10 to 31 months and 2 of them died of distant metastasis during this follow up period. CONCLUSION: Insular carcinoma is a special type of thyroid carcinoma with aggressive clinical course. Recurrence and extrathyroidal involvements are common and the prognosis is poorer than other well differentiated thyroid carcinomas.

Insular Carcinoma: An Aggressive Subtype of Differentiated Thyroid Neoplasms / 대한내분비외과학회지

PURPOSE: Insular carcinoma is a rare subtype of thyroid cancer which was first described by Carcangiu in 1984. Its aggressiveness is intermediate between well differentiated and anaplastic thyroid carcinoma. But its origin, clinical features and prognosis are not yet clearly understood. We wanted to evaluate the clinical features, histologic characteristics and prognosis of insular thyroid carcinoma. METHODS: We studied 4 cases of insular thyroid carcinoma treated in Samsung Medical Center from March 1996 to April 1998. Age, sex, clinical features, treatment, pathology and follow up findings were reviewed, retrospectively. RESULTS: All patients were female and the mean age was 44 years. Three of all patients complained of anterior neck mass and one patient complained of low back pain and paresthesia of the right thigh. Two patients had metastatic bone lesions at the time of diagnosis. Preoperative fine needle aspiration cytology diagnosed follicular neoplasm in 2 cases and papillary carcinoma in 1. We performed total or completion total thyroidectomy and radioactive iodine therapy in 3 cases and radioactive iodine therapy alone in one. Extrathyroidal invasion, vascular invasion and multicentricity were noted in two cases. All four patients showed recurrence or distant metastasis in follow up over a period of 10 to 31 months and 2 of them died of distant metastasis during this follow up period. CONCLUSION: Insular carcinoma is a special type of thyroid carcinoma with aggressive clinical course. Recurrence and extrathyroidal involvements are common and the prognosis is poorer than other well differentiated thyroid carcinomas.

Ductal Carcinoma In Situ in a Fibroadenoma

BACKGROUND: A fibroadenoma is a common benign breast tumor with little potential for malignancy. There are, however, increasing numbers of reports that it is associated with a certain increase in breast cancer. METHODS: We reviewed the medical records of 4 patient's who were diagnosed as intraductal carcinoma within a fibroadenoma. RESULTS: The patient's age were relatively young (32, 36, 52, and 36 years), and the tumor presented as a lump of recent onset in 3 patients and as an abnormal mammography in one patient. None of the patients could be diagnosed as having malignancy by using mammography, ultrasonography, or cytologic examination. However, a radiologic study showed microcalcifications in the masses in two patients, and cytological examination demonstrated atypical cells in three patients. Breast-conservation surgery was performed in two patients; a wide excision was used in one and a localization & excision in the other. Pathologic features were ductal carcinomas in situ within fibroadenomas in all. Estrogen and progesteron receptors were all positive. CONCLUSION: Possibility of malignancy should be excluded in patients with a fibroadenoma, especially when microcalcifications are observed within the mass or atypical cells are suspected based on cytologic examination. Fine needle aspiration cytology, ultrasonography and even excisional biopsy should be performed to evaluate the possibility of malignancy in these patients.

Insular Carcinoma: An Aggressive Subtype of Differentiated Thyroid Neoplasms / 대한암학회지

PURPOSE: Insular carcinoma is a rare subtype of thyroid cancer which is first described by Carcangiu in 1984. It is intermediate in aggressiveness between well differentiated and anaplastic thyroid carcinoma. But its origin, clinical features and prognosis are not yet clearly understood. We wanted to evaluate the clinical features, histologic characteristics and the prognosis of the insular thyroid carcinoma. MATERIALS AND METHODS: We studied 4 cases of insular thyroid carcinoma treated in Samsung Medical Center from March 1996 to April 1998. Age, sex, clinical features, treatment, pathology and follow up findings were reviewed, retrospectively. RESULTS: All patients were female and mean age was 44 years. Three of four patients complained anterior neck mass and one patient complained low back pain and paresthesia of right thigh. Two patients had metastatic bone lesions at the time of diagnosis. Preoperative fine needle aspiration cytology could diagnose follicular neoplasm in 2 cases and papillary carcinoma in 1. We performed total or completion thyroidectomy and radioactive iodine therapy in 3 cases and radioactive iodine therapy alone in one. Extra- thyroidal invasion, vascular invasion and multicentricity was noted in two cases. All four patients showed recurrence or distant metastasis in follow up period of 10~31 months and 2 of them died of distant metastasis. CONCLUSION: Insular carcinoma is a special type of thyroid carcinoma with aggressive clinical course. Recurrence and extrathyroidal involvements are common and the prognosis is poorer than other well differentiated thyroid carcinoma.

Breast Cancer in a Fibroadenoma: Review of 3 Cases / 한국유방암학회지

BACKGROUND: Fibroadenoma is a common benign breast tumor that has a rare malignancy rate. However, various studies reported that it is associated with a certain increase in breast cancers. CASES: We report three cases of malignancy arising from a breast fibroadenoma. They were 32, 36 and 52 years old and presented with a lump of recent onset. Any one of mammography, ultrasonography and cytologic examination could diagnose malignancy exactly. But cytological examination demonstrated atypical cells with fibroadenoma in two cases. Wide excision was performed in two cases and localization & excisional biopsy was performed in an occult case. Pathologic report of the cases revealed them as DCIS in a fibroadenoma. CONCLUSION: Possibility of malignancy cannot be excluded in fibroadenomas especially in case with calcifications within the mass in the radiological study or with atypical cells presented in the cytology. Cytology and ultrasonogram should be used to evaluate fibroadenomas. If there are any suspicion of malignancy, excisional biopsy should be performed to confirm the benign state.

Huge Cystosarcoma Phyllodes: A case report

A case of huge cystosarcoma phyllodes is presented. A 45-year-old female visited our clinic because she had had a mass in the right breast for two and a half years. She had performed breast mass excisions at the same site on 2 different occasions, 5 and 3 years ago. The tumors consisted of benign phyllodes, and there had been necrosis with a foul odor in half of the mass surface. A total mastectomy was performed due to the large size (30x22 cm), the recurrent nature and a fear of malignancy. The tumor was somewhat incompletely well-encapsulated and was adherent to the pectoralis major. Pathologic findings revealed that the tumor was made up of malignant cystosarcoma phyllodes.

A Case of Gastric Strongyloidiasis Diagnosed by Endoscopic Biopsy / 대한소화기내시경학회지

Korea Strongyloidiasis is a parasitic disease caused by Strongyloides stercoralis which exists in two forms : the free living and parasitic forms. It exists in warm, moist climate in areas where there is frequent fecal contamination of the soil. After cutaneous invasion by the filariform larvae, petechial hemorrage, pruritus, papular rashes, edema, and urticaria occur. Infection commonly occurs in the proximal intestine of the gastrointestinal (G-I) tract but may extend from the stomach to the anus. Once the worm is established in the small intestine, the physical findings may include epigastric tenderness to palpation. The mucosal biopsy is an inefficient way of making the diagnosis because the worm is found in the biopsy specimen in only 2% of patients. Gastric strongyloidiasis is rare. We experienced a case of gastric strongyloidiasis diagnosed by the endoscopic biopsy and serologic test for parasite specific IgG antibody by micro-ELISA.