Long-Term Survival after T-cell Lymphoblastic Lymphoma Treated with One Cycle of Hyper-CVAD Regimen / Journal of the Korean Cancer Association, 대한암학회지

T-lymphoblastic lymphoma (T-LBL) is a rare form of aggressive non-Hodgkin's lymphoma. The standard approach for management of T-LBL involves intensive multiagent chemotherapy regimens for induction and consolidation phases with central nervous system prophylaxis and a maintenance phase lasting 12-18 months. We report on a case of long-term survival after one cycle of hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone (hyper-CVAD) and high-dose methotrexate. A 30-year-old woman diagnosed with T-LBL with a large mediastinal mass underwent one cycle of hyper-CVAD. Four days after the start of treatment, the mediastinal mass was markedly reduced. Treatment continued with one cycle of consolidation chemotherapy, comprising high-dose methotrexate and high-dose cytarabine. The patient then refused all further chemotherapeutic treatment. Seven years have passed without relapse.

Success Rate and Risk Factors for Failure of Empirical Antifungal Therapy with Itraconazole in Patients with Hematological Malignancies: A Multicenter, Prospective, Open-Label, Observational Study in Korea

We assessed the success rate of empirical antifungal therapy with itraconazole and evaluated risk factors for predicting the failure of empirical antifungal therapy. A multicenter, prospective, observational study was performed in patients with hematological malignancies who had neutropenic fever and received empirical antifungal therapy with itraconazole at 22 centers. A total of 391 patients who had abnormal findings on chest imaging tests (31.0%) or a positive result of enzyme immunoassay for serum galactomannan (17.6%) showed a 56.5% overall success rate. Positive galactomannan tests before the initiation of the empirical antifungal therapy (P=0.026, hazard ratio [HR], 2.28; 95% confidence interval [CI], 1.10-4.69) and abnormal findings on the chest imaging tests before initiation of the empirical antifungal therapy (P=0.022, HR, 2.03; 95% CI, 1.11-3.71) were significantly associated with poor outcomes for the empirical antifungal therapy. Eight patients (2.0%) had premature discontinuation of itraconazole therapy due to toxicity. It is suggested that positive galactomannan tests and abnormal findings on the chest imaging tests at the time of initiation of the empirical antifungal therapy are risk factors for predicting the failure of the empirical antifungal therapy with itraconazole. (Clinical Trial Registration on National Cancer Institute website, NCT01060462)

A Multicenter Retrospective Analysis of the Clinical Features of Pernicious Anemia in a Korean Population

To determine the approximate incidence and clinical features of pernicious anemia in a Korean population, we retrospectively analyzed clinical data for patients with pernicious anemia who were diagnosed between 1995 and 2010 at five hospitals in Chungnam province. Ninety-seven patients were enrolled, who accounted for 24% of patients with vitamin B12 deficiency anemia. The approximate annual incidence of pernicious anemia was 0.3 per 100,000. The median age was 66 (range, 32-98) yr, and the male/female ratio was 1.25. Anemia-associated discomfort was the most common symptom (79.4%), followed by gastrointestinal and neurological symptoms (78.4% and 38.1%, respectively). Pancytopenia was found in 36 patients (37.1%), and autoimmune disorders were found in 15 patients (15.5%). Antibody to intrinsic factor was detected in 62 (77.5%) of 80 patients examined, and antibody to parietal cells was detected in 35 (43.2%) of 81 patients examined. Of the 34 patients who underwent tests for Helicobacter pylori, 7 (12.5%) were positive. The anemia-associated and gastrointestinal symptoms resolved completely in all patients after intramuscular injection of cobalamin, whereas neurological symptoms remained in some. In conclusion, pernicious anemia is less frequent in Koreans than in Western populations; however, the clinical features of this disorder in Koreans do not differ from those of Western cases.

Transformation of CD5-Negative Follicular Lymphoma into CD5-Positive Diffuse Large B-Cell Lymphoma: A Case Report / 대한내과학회지

Diffuse large B-cell lymphoma (DLBCL) is the most frequent subtype of aggressive lymphomas. Approximately 10% of DLBCL cases express CD5 as a surface antigen. CD5-positive DLBCL can occur as the de novo or secondary type. De novo CD5-positive DLBCL arises without previous lymphoproliferative disease, and secondary CD5-positive DLBCL may or may not manifest as Richter syndrome. The transformation of follicular lymphoma (FL) into DLBCL occurs in approximately one-third of all cases. The transformation of CD5-negative low-grade B-cell lymphoma to CD5-positive DLBCL is extremely rare. We report the clinical features of a rare case that presented with a transformation from CD5-negative FL to CD5-positive DLBL over 11 years. This is the second such case published in the English literature.

Soluble syndecan-1 at diagnosis and during follow up of multiple myeloma: a single institution study / 대한혈액학회지

BACKGROUND: Syndecan-1 is a heparan sulfate proteoglycan expressed on plasma cells, especially myeloma cells, and can exist in serum as soluble syndecan-1 after shedding from the cell surface. Soluble syndecan-1 has been suggested to promote myeloma cell growth and to be an independent prognostic factor for multiple myeloma. We aimed to evaluate the effect of soluble syndecan-1 levels at the time of diagnosis and during therapy on therapeutic response and prognosis for patients with multiple myeloma. METHODS: We analyzed soluble syndecan-1 levels in 28 patients with multiple myeloma and 50 normal controls, and compared its levels with Durie-Salmon stage and other markers of myeloma. In addition, we evaluated the therapeutic response and determined the 3-year survival rates of these patients. RESULTS: We observed that the median soluble syndecan-1 level in myeloma patients was higher than that in the normal controls (P <0.0001), and the soluble syndecan-1 levels in 21 (75%) patients were higher than the cut-off level (162 ng/mL). Soluble syndecan-1 levels correlated with disease stage, percentage of plasma cells in the bone marrow, beta2 microglobulin level, serum M-component concentration, and creatinine level. The baseline levels of soluble syndecan-1 at the time of diagnosis in the patients who responded to chemotherapy were lower than those in the non-responders (P=0.04); however, the baseline level was not a significant predictor of therapeutic response. The 3-year overall survival rate of the patients with high soluble syndecan-1 levels at the time of diagnosis and 6 months after chemotherapy was lower than the corresponding survival rates of the patients with low levels of soluble syndecan-1; however, the overall survival rate was not statistically significant. CONCLUSION: The use of soluble syndecan-1 has limitations in the diagnosis of multiple myeloma. Soluble syndecan-1 levels correlate with known prognostic factors; however, we could not assess the prognostic value of high levels of soluble syndecan-1 at the time of diagnosis and after chemotherapy.

A Case of Stewart-Treves Syndrome Associated with Disseminated Intravascular Coagulation / 대한피부과학회지

Stewart-Treves syndrome is an angiosarcoma that develops in chronic lymphedematous skin. Kasabach-Merritt syndrome is characterized by the occurrence of disseminated intravascular coagulation (DIC) in combination with benign angiomatous tumors in most cases, but angiosarcoma has also been reported to be associated with DIC in rare cases. Here we report on a case of a 74-year-old woman who had angiosarcoma on a large area of the right trunk and arm around a previous mastectomy site. She developed DIC after laminoplasty, and she finally expired from multiorgan failure 3 months after the initial diagnosis of DIC. Her preoperative laboratory findings were normal, and she did not have any other underlying diseases that were possibly related with the development of DIC, except the large area of angiosarcoma. In conclusion, we report here on a rare case of Stewart-Treves syndrome that co-occurred with DIC and we believe that accurate evaluation of a skin lesion is important for Stewart-Treves syndrome patients who display systemic symptoms.

An overview and preparation of Korean pediatrician according to the expansion of national immunization program coverage / 소아과

National Immunization Program (NIP) in korea is regulated by government for effective prevention of infectious diseases since 1954. But the program is only performed in public health center, so many people had various complaints such as inconvenience to use public center, high cost when vaccinated in private medical organization and lack of speciality and registration etc. In this reason, it was very difficult to raise the vaccination rate to 95 percent, infectious disease preventable rate. With this background national assembly and government try to expand the NIP coverage both public health center and private medical organization with increasing budget from 2009. So in this paper an overview and preparation of Korean pediatrician according to the expanding plan of NIP are described.

A case of primary malignant uterine cervical Non-Hodgkin's lymphoma with breast involvement / 대한내과학회지

Primary lymphoma arising from the uterine cervix has been rarely encountered, and breast involvement is rare because of the relative paucity of lymphoid tissue in the breast. A 32-year-old woman with a primary malignant lymphoma of the uterine cervix and breast involvement is reported. The patient presented with post-coital vaginal bleeding, and punch biopsy of the cervix revealed the diffuse large B cell type of malignant lymphoma. PET-scan was done for staging, and abnormal FDP uptakes were detected in a uterine cervical mass and breast nodule. Ultrasonography-guided needle biopsy was done for the breast mass, and 2 biopsied nodules revealed fibroadenoma and diffuse large B cell lymphoma. The patient (Ann Arbor stage IV) was treated with 6 cycles of combination chemotherapy with CHOP plus rituximab. The patient went into complete remission. Thereafter, 4500cGy pelvic irradiation was done for adjuvant therapy.

A case of typhlitis developed after anticancer chemotherapy in a patient with solid tumor / 대한내과학회지

Typhlitis is a necrotizing enterocolitis of the cecum, ascending colon and terminal ileum. Typhlits has been reported in the severely neutropenic patients and likely results from a combination of neutropenia and defects in the bowel mucosa related to cytotoxic chemotherapy. This disease is most common in patients with leukemia who have undergone intensive myeloablative chemotherapy. Presumptive diagnostic criteria for typhlitis include fever, abdominal pain and tenderness, and radiologic evidence of right-sided colonic inflammation in patients with neutropenia. Recently, this disease is also reported in patients with solid tumor due to increasing challenges of high dose chemotherapy. We report a case of typhlitis developed in the circumstance of neutropenia induced by chemotherapy in a patient with malignant testicular tumor.

Epidemiological study of clonorchiasis and metagonimiasis along the Geum-gang (River) in Okcheon-gun (County), Korea

The endemic status of clonorchiasis and metagonimiasis along the Geum-gang (River) in Okcheon-gun (County) in Korea was examined. From February to December 2000, stools of total 1,081 inhabitants living in 5 villages were examined. Each stool specimen was examined by both the cellophane thick smear method and the formalin-ether sedimentation technique. Egg-positive cases were further analyzed by Stoll's egg-counting technique, and praziquantel was administered to positive cases. The egg-positive rates for Clonorchis sinensis and Metagonimus species were 9.3% and 5.5%, respectively, and the double infection rate was 3.5%. The numbers of eggs per gram (EPG) of feces of C. sinensis and Metagonimus sp. were 918 +/-1.463 and 711+/-947, respectively. The egg-positive rates for C. sinensis and Metagonimus sp. in the riverside area were 14.2% and 8.4%, respectively, which were significantly higher than those of the inland area (3.2% and 1.7%, respectively). The egg-positive rates of C. sinensis and Metagonimus sp. in males (16.7% and 10.0%) were significantly higher than those of females (3.5% and 1.8%). However, there were no significant differences of EPG values between localities and sexes. The prevalence of clonorchiasis and metagonimiasis in this survey was significantly lower than that in the previous reports. However, there is still a high prevalence of infection with C. sinensis and Metagonimus sp. in this region, especially in the riverside area.

Cutaneous Metastasis from Prostatic Carcinoma

Prostatic carcinoma is one of the most common malignancies in males of western countries but it is a rare malignancy in Korea. If it occurs, it commonly metastasizes to other organs. In-spite of its high incidence of distant metastasis, the cutaneous metastasis of the prostatic carcinoma is very rare and seems to have a poor prognosis. A 67-year-old man presented multiple nontender nodules on the skin of the right thigh and had episodes of multiple metastases from prostatic carcinoma to the lungs and bones. Histopathologic findings of the skin showed atypical cells infiltration at the dermis. Immunohistochemical staining for prostate specific antigen showed a positive reaction, therefore, we reached the diagnosis of cutaneous metastasis from prostatic carcinoma.

A Case of Systemic Lupus Erythematous (SLE) with Graves' Desease and Idiopathic Thrombocytopenic Purpura (ITP) / 대한내분비학회지

Autoimmune diseases are occasionally associated with other autoimmune diseases in the same patients. Autoimmune Graves' disease has been associated with systemic rheumatic diseases including systemic lupus erythematosus (SLE). And Graves' disease associated with idiopathic thrornbocytopenic purpura (ITP) has been reported many times in Korea. There is a special relationship between SLE and ITP, both of which are autoimmune diseases. Some patients with thrombocytopenic purpura, labeled as idiopathic at the onset, later develop a classical course of SLE, suggesting that ITP may be an early manifestation of SLE. The relationships among these three conditions and their pathogenesis are poorly undemtood, and the coexistence of these diseases at the same time has been reported very rarely, but it may be very probable that there are some relationships among them. We report a case of SLE associated with Graves' disease and ITP treated well by imunosup-pressive agent who had been suffering from recurrence by conventional treatments (antithyroid medication, corticosteroid, subtotal thyroidectomy and splenectomy).

A Case of Primary Parathyroid Carcinoma with full-brown Symptom / 대한내분비학회지

Primary hyperparathyroicism is a state of hypersecretion of PTH by the parathyroid. The etiology has not been established. The three possible etiologies of piimary hyperparathyroidism and incidences are adencena(83%), hyperplasia(15%), and carcinoma(1~2%). Parathyroid carcinoma usually presents in the fourth decades. The hallmark preoperative signs are hypercalcemia(serum calcium 15mg/dl). Palpable neck mass and bane and renal disease. Patients may present with multiple signs and syrnptoms, including recurrent nephrolithiasis, peptic ulcers, mental change, less frequently, extensive bone resorption. However, with greater awareness of the disease and wider use of screening tests, including blood calcium determinations, the diagnosis is frequently made in patients who have no symptoms and minimal, if any, signs of the disease ather than hypercalcemia and elevated levels of parathyroid Hormone. An 38-years-old woman was admitted to the hospital due to pain on the left knee joint. We experienced full-brown symptom pertaining to hyperpara- thyroidism. Thus we report a case herein and also discuss clinical anifestation, histologic features and treatment.