Thyroid Stimulating Hormone Reference Range and Prevalence of Thyroid Dysfunction in the Korean Population: Korea National Health and Nutrition Examination Survey 2013 to 2015

BACKGROUND: No nationwide epidemiological study evaluating the prevalence of subclinical and overt forms of hypothyroidism and hyperthyroidism has yet been conducted in Korea. This study aimed to evaluate the reference range of serum thyroid stimulating hormone (TSH) and the national prevalence of thyroid dysfunctions in Korea. METHODS: Nation-wide cross-sectional data were analyzed from a representative sample of the civilian, non-institutionalized Korean population (n=6,564) who underwent blood testing for thyroid function and anti-thyroid peroxidase antibody (TPOAb) as part of the Korea National Health and Nutrition Examination Survey VI (2013 to 2015). RESULTS: The reference interval of serum TSH in the Korean reference population was 0.62 to 6.68 mIU/L. Based on this reference interval, the prevalence of overt and subclinical hypothyroidism was 0.73% (males 0.40%, females 1.10%) and 3.10% (males 2.26%, females 4.04%), respectively. The prevalence of hypothyroidism increased with age until the age group between 50 to 59 years. Positive TPOAb were found in 7.30% of subjects (males 4.33%, females 10.62%). The prevalence of overt and subclinical hypothyroidism TPOAb-positive subjects was 5.16% and 10.88%, respectively. The prevalence of overt and subclinical hyperthyroidism was 0.54% (males 0.30%, females 0.81%) and 2.98% (males 2.43%, females, 3.59%), respectively. CONCLUSION: The Serum TSH reference levels in the Korean population were higher than the corresponding levels in Western countries. Differences were found in the prevalence of hypothyroidism and hyperthyroidism according to age, sex, and TPOAb positivity. This study provides important baseline information for understanding patterns of thyroid dysfunction and diseases in Korea.

Long-Term Follow-Up Result of Benign Phyllodes Tumor of the Breast Diagnosed and Excised by Ultrasound-Guided Vacuum-Assisted Breast Biopsy / 한국유방암학회지

PURPOSE: Percutaneous removal of benign breast tumors using ultrasound-guided vacuum-assisted breast biopsy (VABB) has been recently regarded as a feasible and safe method without serious complications. The aim of this study was to evaluate the efficacy and safety of the VABB in the treatment of benign phyllodes tumors, and to identify whether or not surgical re-excision is necessary for benign phyllodes tumors diagnosed and excised by VABB. METHODS: From January 2003 to December 2011, a total of 6,923 VABB were performed in 5,434 patients. Out of 6,923 lesions, 53 were benign phyllodes tumors. Among these, 31 lesions, with a follow-up period of longer than 24 months, were enrolled in this study. Ultrasonography follow-up was performed at 3 to 6 month intervals in order to assess recurrence. The mean follow-up period was 75.9+/-13.5 months (range, 24-94 months). RESULTS: The mean patient age at presentation was 31.6+/-9.4 years. The mean size of the lesion was 1.60+/-0.88 cm. The majority of lesions, 74.2% (23 cases), were palpable, and 25.8% (8 cases) were non-palpable. Twenty-two lesions (71.0%) were classified as Breast Imaging Reporting and Data System category 3, and nine lesions (29.0%) were classified as category 4a, by ultrasonography. During the follow-up period, local recurrence developed in one lesion, making the local recurrence rate 3.2%. CONCLUSION: If a benign phyllodes tumor is diagnosed, and sufficiently excised by VABB, observing the clinical course may be considered as an alternative to performing immediate wide local excision; this is the case despite the fact that it would need to be observed for a prolonged period of time.

The Current Role of Vacuum Assisted Breast Biopsy System in Breast Disease / 한국유방암학회지

The gold standard for breast biopsy procedures is currently an open excision of the suspected lesion. However, an excisional biopsy inevitably makes a scar. The cost and morbidity associated with this procedure has prompted many physicians to evaluate less invasive, alternative procedures. More recently, image-guided percutaneous core-needle biopsy has become a frequently used method for diagnosing palpable and non-palpable breast lesions. Although sensitivity rates for core-needle biopsy are high, it has the disadvantage of histological underestimation, which renders the management of atypical ductal hyperplasia, papillary lesions, and fibroepithelial lesions somewhat difficult. Vacuum assisted breast biopsy (VABB) was developed to overcome some of these negative aspects of core-needle biopsy. VABB allows for a sufficient specimen to be obtained with a single insertion and can provide a more accurate diagnosis and completely remove the lesion under real-time ultrasonic guidance. The advantage of complete lesion removal with VABB is to reduce or eliminate sampling error, to decrease the likelihood of a histological underestimation, to decrease imaging-histological discordance, to decrease the re-biopsy rate, and to diminish the likelihood of subsequent growth on follow-up. In recent years, with the advancement of VABB instruments and techniques, many outcome studies have reported on the use of VABB for resecting benign breast lesions with a curative intent. VABB is highly accurate for diagnosing suspicious breast lesions and is highly successful at treating presumed benign breast lesions. Thus, in the near future, VABB will be routinely offered to all appropriately selected patients.

Is Further Diagnostic Surgery Necessary for the Benign Papillary Lesions that Are Diagnosed by Large Volume Vacuum Assisted Breast Biopsy? / 한국유방암학회지

PURPOSE: There is ongoing controversy regarding the management of papillary lesions that are diagnosed by core needle biopsy (CNB). The development of vacuum assisted biopsy now permits non-operative removal of papillary breast lesions. Our aim was to evaluate whether the papillary lesions diagnosed by vacuum assisted breast biopsy (VABB) can be followed up without further diagnostic excision. METHODS: From January 2003 to July 2009, a total of 4,655 US-guided mammotome excision were performed in 3,714 patients at Kangnam CHA Hospital. Out of 4,655 lesions, 156 lesions were proved to be papillary lesions. Among these, 82 lesions that had histologic findings that were consistent with benign papillary lesions and that were followed up for more than 2 years without further diagnostic surgical excision were collected and retrospectively analyzed. Ultrasonographic follow-up was done at 3-6 month intervals to assess for recurrence. The mean follow up period was 49.6 months. RESULTS: The pathologic diagnoses for the 82 lesions obtained via VABB were benign intraductal papilloma and papillomatosis. Half of the lesions were palpable and 50.0% (41 cases) were nonpalpable. Twenty eight lesions (34.1%) were classified as BIRADS category 3, 50 lesions (61.0%) were category 4A, 3 lesions (3.7%) were category 4B and only 1 lesion (1.2%) was category 5 according to the ultrasound exams. No local recurrence developed during the follow up period that needed surgical re-excision or rebiopsy. None of those diagnosed as benign lesions at VABB were upgraded to a more advanced lesions. CONCLUSION: The benign papillary lesions that are diagnosed and excised by mammotome may not need further diagnostic surgical re-excision if surgeons are sure that the targeted lesions were excised completely.

The Loss of E-cadherin is Associated with the Epigenetic Alteration of CDH1 in Breast Cancer and it is also Associated with an Abnormal beta-catenin Expression in Lobular Carcinoma

BACKGROUND: APC and E-cadherin are the key molecules in the Wnt/beta-catenin pathway. We attempted to define the epigenetic alteration of APC and CDH1 (the E-cadherin gene) and the expression of Wnt-related molecules in human mammary carcinomas. METHODS: Sixty-four mammary carcinomas, including 52 invasive ductal carcinomas (IDCs) and 12 invasive lobular carcinomas (ILCs), were evaluated using methylation-specific PCR and immunohistochemistry. We performed immunohistochemistry for E-cadherin, beta-catenin, APC, Wnt1, cyclin D1, ER, PR and C-erb B2. RESULTS: Hypermethylation of APC and CDH1 was observed in 38 (59%) and 28 (44%) cases, respectively. CDH1 hypermethylation in ILCs was increased compared to that in IDCs (p=0.002) and it was associated with the loss of E-cadherin (p=0.02) and beta-catenin (p=0.042). APC methylation was positively correlated with the ER expression (p=0.021). Abnormal cytoplasmic localization of beta-catenin was found in 10 cases and any expression was not detected in six cases. In ILCs, the E-cadherin or beta-catenin expression was markedly decreased compared to that in IDCs (p<0.001 in both). CONCLUSIONS: Methylation of APC or CDH1 was relatively frequent in mammary carcinomas. The loss of E-cadherin in mammary carcinoma was associated with CDH1 methylation, and abnormal beta-catenin expression was related to the loss of E-cadherin in ILC.

No title available in English / 대한내분비외과학회지

No abstract available.

Occult Papillary Thyroid Carcinoma Analysis: 214 Cases

PURPOSE: Occult papillary thyroid carcinomas (OPC) are defined as tumors measuring 0.5 cm in size. Therefore, we prefer near-total or total thyroidectomy with central lymph node dissection. Early detection and treatment of OPC might be warranted by the routine use of thyroid USG and USG-guided FNA.

The Analysis of Tumor Aggressiveness accord- ing to Tumor Size in Occult Papillary Thyroid Carcinoma

PURPOSE: Occult papillary thyroid carcinomas (OPC) are defined as tumors measuring 0.5 cm. A near-total or total thyroidectomy with a central lymph node dissection is the preferred treatment. The early detection and treatment of OPC might be warranted through the routine use of thyroid USG and USG-guided FNA.

Apocrine Carcinoma of the Breast: A Case Report

Apocrine carcinoma is a rare breast cancer and its frequency is about 0.4% of all breast cancers. Little is known about its clinical behavior and prognosis. To our knowledge, few studies have reported the radiologic appearances of apocrine carcinoma in the breast and there has been no such report from Korea. We describe the sonographic findings of a case of apocrine carcinoma in the breast. The sonographic findings are microlobulated heterogeneous hypoechoic lesion that has a central markedly hypoechoic portion and a peripheral mixture of iso and hypoechgenecity.

Is Surgical Excision Necessary for a Benign Phyllodes Tumor of the Breast Diagnosed and Excised by Ultrasound-guided Vacuum-assisted Biopsy Device (Mammotome)?

PURPOSE: Phyllodes tumors are characterized by a double-layered epithelial component arranged in cleft-like ducts surrounded by a hypercellular spindle-celled stroma. Currently, phyllodes tumors are classified as benign, borderline, or malignant based on microscopic features. The relatively high rate of recurrence is an unsolved management problem. If a malignant phllodes tumor is treated inadequately, it may show a propensity for rapid growth and metastatic spread. However, benign phyllodes tumor are often indistinguishable from fibroadenoma, and can be cured by local surgery. Percutaneous removal of benign breast tumors using the Mammotome system has recently been regarded as a feasible, safe method without serious complications. The Mammotome system has an expanding role in the surgical treatment of benign breast disease, and may further extend its role to the excision of small malignant lesions. The aim of this study was to evaluate the efficacy and the safety of the Mammotome biopsy device in the treatment of benign phyllodes tumor, and to identify whether surgical excision is necessary for benign phyllodes tumors diagnosed and excised by Mammotome. METHODS: From Jan. 2003 to Feb. 2007, a total of 2,751 US- guided mammotome excisions were performed in 2,226 patients at Kangnam Cha hospital. Out of 2,751 lesions, 30 lesions were proved to be benign phyllodes tumors. All lesions were removed using an 8-gauge probe without any residual lesions. Ultrasonographic follow-up was performed at a 3- to 6-month interval to assess recurrence. The mean follow-up period was 33.2 months (max, 51 months; min, 2 months). RESULTS: The mean patient age was 31.4 years. The average size of the lesion was 1.5 cm (SD+0.43 cm). The majority of lesions, 73.3% (22 cases), were palpable, and 26.7% (8 cases) were nonpalpable. Twenty-two lesions (73.8%) were classified as BIRADS category 3, eight lesions (26.7%) were classified as category 4A by ultrasound. During the follow-up period, local recurrence developed in only one patient, making the local recurrence rate 3.3%. No distant metastasis was observed. CONCLUSION: Benign phyllodes tumors found on mammotome excision may not require surgical reexcision if surgeons are sure that the targeted lesions were excised completely and the follow-up ultrasound does not show any residual lesions, especially in small phyllodes tumors, the greatest dimension of which is less than 3 cm.

Is Mammotome Excision Feasible for Benign Breast Mass Bigger than 3 cm in Greatest Dimension?

PURPOSE: The aim of this study was to evaluate that a surgeon can safely remove all sonographic evidence of masses in the breast grater than 3.0 cm in greatest dimension using the 8 g hand held Mammotome (MT). METHODS: From Jan. 2003 to Mar. 2005, a total of 1,368 US-guided MT excision were performed in 1,112 patients at Kangnam Cha hospital. Of these 1,368 lesions 28 lesions with BI-RADS category 3 features by ultrasonography were included in this study. Ultrasonographic follow-up were performed on 3~6 months later to assess residual tissue and scarring. RESULTS: Mean patient age was 32.0 years (range 20~55 years). The average size of lesion was 3.5 cm (SD+-0.43 cm). All of the lesions were palpable and all of the specimens were benign. Most common pathologic features were fibroadenoma (75.0%) and breast abscess (14.3%). Mean time required to perform mammotome procedures was 12.2+/-8.2 minutes and mean number of cores removed were 35.1+/-30.2 pieces. No bleeding or infections occurred postoperatively and most complications were mild and anticipated. CONCLUSION: This study demonstrates that percutaneous removal of big breast benign mass above 3 cm in diameter using The MT system is feasible, effective and safe method for the therapeutic management with minimal morbidity without any additional procedures.

The Usefulness of Additional Bilateral Whole Breast US with Negative Mammographic Results in Asymptomatic Women

PURPOSE: We wanted to evaluate the clinical utility of performing bilateral whole breast US as a subsequent diagnostic method along with mammography in asymptomatic women. MATERIALS AND METHODS: From May 2002 to Dec 2004, we conducted 3998 examinations on 3638 patients with negative findings on the clinical examination and negative mammographic results, and those breast tissues having a BI-RADS category 2, 3, or 4 density were further evaluated by performing bilateral whole breast US. The patients' age distribution ranged from 24 to 66 years (mean age: 43.6 yrs). The abnormalities were compared with core or vacuum assisted core biopsy, operations, and follow up US. For the normal cases, we used the clinical notes and the statistical data from the Korean Central Cancer Registry. RESULTS: For 3998 examinations of 3638 women who were examined with bilateral whole breast US, pathologic confirmations were available for 433 patients and follow-up data were available for 35 patients. The sensitivity, specificity, the positive predictive value and the cancer detection rate of using additional whole breast US were 50, 92.6, 0.6 and 0.5, respectively. The two cancers that were detected only on US were minimal breast cancer. CONCLUSION: Although all the breast cancers that were detected only on US were minimal breast cancers, performing bilateral whole breast US revealed a low cancer detection rate and a high false positive. Therefore, further studies will be needed to investigate the role of US as a screening tool.

Excision of benign breast tumor by an Ultrasound-Guided hand held Mammotome biopsy device / 한국유방암학회지

PURPOSE: The mammotome (MMT) biopsy is a new surgical technique that is a minimally invasive, image guided procedure, and it requires just one small incision and there is no need for multiple insertions in the breast. The aim of this study was to evaluate the efficacy and the safety of the MMT biopsy device for percutaneous removal of breast masses with using ultrasound guidance. METHODS: From Jan. 2003 to Mar. 2005, a total of 1368 US-guided excisional MMT biopsies were performed in 1112 patients at Kangnam Cha Hospital. Those lesions with BI-RADS category 3 and 4a features by USG examination were included in this study. Lesions below 1.0 cm were removed by an 11 G probe, and lesions above 1.0cm were removed by an 8 G probe. Ultrasonographic follow-ups were performed 3-6 months later to assess the residual tissue and scarring. RESULTS: The mean patient age was 36 (range: 14-76) years. The average size of lesion was 1.14 cm (SD = 0.63 cm). Among the patients, 67.3% had nonpalpable lesion and 32.7% had palpable tumor. The majority of the specimens (98.3%) were benign. Most of benign specimens (77.7%) consisted of fibroadenoma and fibrocystic changes, although 23 lesions (1.7%) were malignant. The mean MMT procedure time was 6.2+/-3.9 minutes and the mean number of cores removed was 14.8+/-9.8. No serious bleeding or infection occurred postoperatively. CONCLUSION: This study demonstrates that percutaneous breast biopsy using the MMT system may be feasible and effective method for the diagnostic and therapeutic management of benign breast lesions with minimal morbidity. Complete MMT excision may be safely performed for the lesions those are less than 3 cm in size. A breast surgeon can use MMT instead of open or core needle biopsy for the initial biopsy of breast lesions.

Excision of Benign Breast Disease by Ultrasound-Guided Vacuum Assisted Biopsy Device (Mammotome)

PURPOSE: The mammotome biopsy is a new surgical technique that is a minimally invasive, image guided procedure, requiring just one small incision and without the need for multiple insertions in the breast. The aim of this study was to evaluate the efficacy and the safety of mammotome biopsy device in the percutaneous removal of breast masses using ultrasound guidance. METHODS: From Jan. 2003 to sept. 2004, a total of 1003 US-guided excisional mammotome biopsy were performed in 827 patients at Kangnam Cha hospital. Lesions with BI-RADS category 3 and 4a features by ultrasonography were included in this study. Lesions below 1.0 cm were removed by 11 gauge probe, and lesions above 1.0 cm were removed by 8 gauge probe. Ultrasonographic follow-up were performed on 3~6 months later to assess residual tissue and scarring. RESULTS: Mean patient age was 36.2 years(range 14-75 years). The average size of lesion was 1.21cm (SD+- 0.43cm). The majority of lesions, 63.5%, were nonpalpable and 36.5% were palpable. The majority of specimens (99.2) were benign. Most of benign specimens (75.7) consisted of fibroadenoma and fibrocystic changes. 8 lesions (0.8%) were malignant. Mean time required to perform mammotome procedures was 6.4+/-3.9 minutes and mean number of cores removed were 14.2+/-7.9 pieces. No bleeding or infections occurred postoperatively. CONCLUSIONS: This study demonstrates that percutaneous breast biopsy using mammotome system is feasible, effective and safe method for the diagnostic and therapeutic management of benign breast lesions with minimal morbidity. And it allows for the complete excision of the lesions less than 3 cm in size. A breast surgeon can use Mammotome to replace open biopsy and core needle procedure for the initial biopsy of breast lesions.

Male Breast Cancer-10 Cases / 한국유방암학회지

PURPOSE: Male breast cancer is a rare type of neoplasm, account for 1 % of all breast tumors. A retrospective review of the clinical and histological characteristics, types of treatment, pathological staging, and adjuvant treatment was completed. The objective of this study was to make an early diagnosis of male breast cancer and reduce the mortality. METHODS: Over a 5-year period, from Oct. 1994 to July 2000, 10 male breast cancer patients were operated on in the breast cancer clinic of the Samsung Medical Center. Their duration of follow up ranged from 6 to 76 months with a mean of 26 months. The clinical and histological characteristics, associations of the risk factors, type of treatment, and results were studied. RESULTS: Their ages ranged from 40 to 67 years with a mean of 51 years, with 5, 3 and 2 cases in their 5th, 6th, and 7th decades, respectively. A palpable breast lump was the most common presenting symptom. A pathological assessment disclosed 8 infiltrating ductal carcinoma, 1 ductal carcinoma in situ, and 1 invasive adenoid cystic carcinoma. The tumor sizes ranged from 0.5 to 3.7 cm (median, 1.9 cm in diameter). Of the 10 patients, there were 3 T1b, 3 T1c, and 4 T2 in the tumor staging. 4 Patients had axillary node involvement (lymph node positivity, 40%), and of these 4, the metastasis involved 2 lymph nodes and more than 3 lymph nodes in 1 and 3 case, respectively. No distant metastasis was observed in any of the patients. Pathological stages of the patients 0, I, IIIA, and IIIB in 1, 5, 1 and 2 cases, respectively. All the patients underwent surgery, 7 with a modified radical mastectomy and 3 with a radical mastectomy, due to gross invasion of the pectoralis major muscle. CONCLUSION: A subareolar palpable breast mass was the most common presenting symptom of the male breast cancer patients. The optimal treatment for male breast cancer patients is a modified radical mastectomy, combined with radiotherapy, chemotherapy, and hormonal therapy, due to the higher hormone receptors positivity.

Diallyl Disulfide from Garlic Induces Apoptosis through a Caspase Dependent Pathway in Human Breast Cancer Cell Line, MCF-7

PURPOSE: Diallyl disulfide (DADS), an organosulfur compound in garlic, has been reported to be effective in inhibiting the growth of several human tumor cell lines. The aim of this study was to determine whether DADS induced growth inhibition in MCF-7 breast cancer cell lines and to understand the molecular mechanism by which DADS acts. METHODS: MCF-7 cell lines were incubated with various concentrations of DADS for various time intervals and the cytotoxicity was determined by MTT assay. We examined the changes of intracellular proteins related to apoptosis, such as bcl-2, bax and PARP in cells treated with DADS. To study the expression level of bcl-2 and bax, which serve as modulators of apoptosis, we performed RT-PCR and western blot analysis. RESULTS: MCF-7 cells treated with DADS led to the suppression of viability and proliferation in both a time and concentration dependent manner. Microscopic observation revealed typical features of apoptosis in the DADS-treated cells, further verified in nuclear DAPI staining. Flow cytometry analysis with FITC-annexinV and propidium iodide (PI) demonstrated that the apoptotic cell population with AnnexinV /PI increased dramatically from ~0.8% to ~75% after 24h exposure to 500nM DADS in MCF-7 cells. Cellcycle analysis demonstrated that the number of apoptotic cells increased with the increasing time of the DADS treatment. Additionally, thermore, we investigated the effects of DADS on apoptosis related gene expression in MCF-7 cells. PARP cleavage was markedly increased in the DADS treated cells with time. This result indicated that DADS induced the caspase-dependent apoptotic pathway. We also found down-regulation of bcl-2, however no significant change of Bax expression was observed after DADS treatment. CONCLUSION: Taken together, these results indicate that DADS induces apoptosis by activating a caspase pathway involving the activation of Bcl-2 but not of Bax. Our findings suggest chemotherapeutic potentials of DADS in human breast cancer.

The Antiproliferating Effect of Diallyl Disulfide from Garlic on the Human Breast Cancer Cell Line (MCF-7) / 한국유방암학회지

PURPOSE: Diallyl disulfide (DADS), an organosulfur compound in garlic, has been reported to be effective in inhibiting the growth of several human tumor cell lines. The aim of this study was to determine whether DADS induced growth inhibition in MCF-7 breast cancer cell lines and to understand the molecular mechanism by which DADS acts. METHODS: MCF-7 cell lines were incubated with various concentrations of DADS for various time intervals and the cytotoxicity was determined by MTT assay. We examined the changes of intracellular proteins related to apoptosis, such as bcl-2, bax and PARP in cells treated with DADS. To study the expression level of bcl-2 and bax, which serve as modulators of apoptosis, we performed RT-PCR and western blot analysis. RESULTS: MCF-7 cells treated with DADS led to the suppression of viability and proliferation in both a time and concentration dependent manner. Microscopic observation revealed typical features of apoptosis in the DADS-treated cells, further verified in nuclear DAPI staining. Flow cyto-metry analysis with FITC-annexinV and propidium iodide (PI) demonstrated that the apoptotic cell population with AnnexinV+/PI- increased dramatically from ~0.8% to ~75% after 24h exposure to 500 microM DADS in MCF-7 cells. Cell cycle analysis demonstrated that the number of apoptotic cells increased with the increasing time of the DADS treatment. Additionally, thermore, we investigated the effects of DADS on apoptosis related gene expression in MCF-7 cells. PARP cleavage was markedly increased in the DADS treated cells with time. This result indicated that DADS induced the caspase-dependent apoptotic pathway. We also found down-regulation of bcl-2, however no significant change of Bax expression was observed after DADS treatment. Conclusion: Taken together, these results indicate that DADS induces apoptosis by activating a caspase pathway involving the activation of Bcl-2 but not of Bax. Our findings suggest chemotherapeutic potentials of DADS in human breast cancer.

Pheochromocytoma Clinically unsuspected pheochromocytoma

PURPOSE: Pheochromocytoma is a catecholamine-secreting tumor that arises from the chromaffin cells of the sympathoadrenal system and presents with the typical symptoms of palpitation, diaphoresis, head ache, and hypertension. Some pheochromocytoma may be discovered during computed tomography of the abdomen while evaluating the abdomen and may be clinically unsuspected before surgery. The aim of this study was to analyze the clinical presentation of pheochromocytoma and to identify the charac teristics of clinically unsuspected pheochromocytomas. METHODS: From June 1995 to October 1999, 34 histopathologically confirmed pheochromocytomas were diagnosed at Samsung Medical Center, Seoul, Korea. The records of all 34 patients, who had undergone a surgical resection for pheochromocytoma and paraganglioma, were reviewed for demographic information, presenting signs and symptoms, bio chemical profiles that led to the laboratory diagnosis of pheochromocytoma, tumor localization studies, associated diseases, preoperative preparation, surgical procedures, and tumor pathology. RESULTS: The most prominent symptoms of pheochromocytomas was palpitation, which was present in 21 (62%) of the 34 cases. Hypertension, headache, and sweating were in 18 (53%), 17 (50%), and 9 (27%) patients, respectively. In 14 (41%) of the 34 patients, the pheochromocytoma were incidentally found exhibiting none of the typical symptoms. Eight (24%) were clinically unsuspected and were undiagnosed prior to surgery. A preoperative diagnosis of either retroperitoneal or pancreatic mass was made in six cases (18%), and a diagnosis of a nonfunctioning adrenal mass was made in two (6%). These eight patients underwent surgery without any preoperative pharmacological treatment. Sporadic cases accounted for 85% of the patients (29 patients), and associated conditions included MEN 2A in four (12%) and MEN 2B in one (3%).The sensitivities of the urinary evaluation were metanephrine 85%, norepinephrine 81%, epinephrine 73%, and vanillylmandelic acid (VMA) 73%. The combination of urinary metanephrine and VMA had a diagnostic sensitivity of 92%. The sensitivities of the localization modalities were CT 100%(33/33), MRI 100% (3/3). USG 94.8% (18/19), MIBG 70% (7/10). Four of the 8 patients who received no preoperative preparation and 10 of the 26 patients who received phenoxybenzamine daily for at least 2 weeks) had intraoperative hypertension or arrythmia. One patient received a laparoscopic adrenalectomy. The rest of the patients underwent surgery through open transabdominal incision. The mean tumor diameter of the malignant pheochromocytomas was 10.8 cm (range from 4.5 to 16 cm), and that of the benign pheochromocytoma was 6.1 cm (range from 3 to 10 cm) showing marked differences between two groups. This suggests that malignant tumors tend to be larger than benign tumors. Of the 4 malignant cases, recurrent disease occurred at the site of the original tumor in 1 patient, metastasis didnt occur in any case. CONCLUSION: High index of suspicion for a pheochromocytoma must be maintained in patients with retroperitonal and abdominal masses or isolated hypertension and in patients with multiple endocrine neoplasms. The readily available, sensitive assays for plasma and urinary catecholamines and their me tabolites and the newly developed modern imaging techniques, such as CT and I-131-MIBG, when used together, may help inmaking correct diagnosis of pheochromocytoma in patients without paroxysmal symptoms or hypertension.

Clinical and Histopathological Analysis of Reoperation Cases in Breast Conserving Surgery

PURPOSE: The residual microscopic carcinoma after breast conserving surgery is the most important risk factor of local recurrence. As local recurrences usually develop around resected margins, it is ge nerally accepted that every effort should be made to achieve negative margins intraoperatively, and the presence of microscopically positive margins requires reexcision. Interestingly, sizable percentage of reexcisions results in a specimen free of residual tumor, and may not contribute to disease control, but do add morbidity, cost, and possibly compromise cosmetic result. The goal of our study was to identify which clinico-pathologic factors were associated with positive resection margin, and to identify the variables associated with no residual carcinoma on reexcision or total mastectomy specimens. METHODS: From Sepember 1994 to July 1999, 322 breast conserving surgery were performed on breast cancer patients at the Department of General Surgery, Samsung Medical Center. Among them, 13 patients had positive surgical margins and were treated with reexcision (reexcising the previous lumpectomy cavity with a margin of 1-2 cm of normal tissue) or total mastectomy. RESULTS: The factors associated with positive resection margins were large tumor size, the presence of extensive intraductal component (EIC), and suspicious mammographic microcalcifications without mass density. Six (46.3%) of these reoperation cases for positive margins were negative for residual tumor. The factors correlating with no residual carcinoma on reexcision or mastectomy specimens were small histologic primary tumor size and only one positive resection margin rather than 2 or more positive margins. CONCLUSION: The patients with above-mentioned factors associated with positive resection margins should be treated with more wide local excision or total mastectomy to avoid a second surgical procedure. If the patients with only one positive margin and small tumor size refuse second operation, they could be treated with irradiation only sparing an additional surgical procedure.

Clinical Study of Mucinous Breast Carcinomas

PURPOSE: A mucinous breast carcinoma has a better prognosis than an invasive ductal carcinoma, so it is important to differentiate between pure and mixed mucinous carcinomas of the breast because the former has a more favorable prognosis. We investigated the clinical features of mucinous carcinomas of the breast and the differenting characteristics of the two types. METHODS: A retrospective review was done of 31 patients with a mucinous breast carcinoma who had been treated between Sep. 1994 and Aug. 1999 at the Department of General Surgery, Samsung Medical Center. The clinical features and the radiologic and pathologic findings were assessed. The pure type was defined as a carcinoma with a mucin component of 50% or more. RESULTS: The clinical characteristics, including age distributions, symptoms & signs, and tumor locations, were similar to those of other types of breast cancer. Mammo graphy in cases of malignancy showed an ill-defined mass density with pleomorphic or granular calcifications in 8/19 cases (42.1%), an ill-defined mass density without calcifications in 2/19 cases (10.5%), and pleomorphic calcifications only in 1/19 (5.3%) cases. Other findings were indicated as benign: a well-circumscribed mass in 4/19 (21%), smudged or ring-like calcificaitons in 3/19 cases (15.8%), and a negative finding in 1/19 cases (5.3%). Ultrasonography showed well- or ill-defined masses in 14 cases and 7 of those 14 cases (50%) were diagnosed as being malignant. The cytologic findings for 21 cases showed tumor cell clusters with mucous backgrounds. Among those 21 cases, 19 (90.5%) were diagnosed as being malignant. Breast conservation surgery was performed on 10 patients (32.3%) and a modified radical mastectomy on 21 patients (67.7%). Among 31 cases, 21 cases were a pure type, and the rest were a mixed type with an invasive component. Tumor cell nests floated in a profuse extracellular mucin pool. The pure type showed a smaller tumor size (p=0.001) and less nodal metastasis (p=0.047). Early stages (stage IIa or less) were more common in pure type (76.2%) than in the mixed type (40%)(p=0.025), but there were no differences in hormonal status between the two types. CONCLUSION: There were no differences in the clinical characteristics between mucinous and other types of breast carcinomas, but the radiologic findings for mucinous carcinomas were not typical of a malignancy. Cytologic examinations were useful in diagnosing mucinous carcinomas of the breast.Since the tumor sizes were smaller and axillary nodal metastases were rare in pure mucinous carcinomas, it is important to differentiate it from the mixed type.