Difference in F-18 FDG Uptake After Esophagogastroduodenoscopy and Colonoscopy in Healthy Sedated Subjects / 대한핵의학회잡지

PURPOSE: We aimed to evaluate the difference in fluorodeoxyglucose (FDG) uptake in sedated healthy subjects after they underwent esophagogastroduodenoscopy (EGD) and colonoscopy procedures.METHODS: The endoscopy group (n = 29) included healthy subjects who underwent screening via F-18 FDG positron emission tomography/computed tomography (PET/CT) after an EGD and/or colonoscopy under sedation on the same day. The control group (n = 35) included healthy subjects who underwent screening via PET/CT only. FDG uptake in the tongue, uvula, epiglottis, vocal cords, esophagus, stomach, duodenum, liver, cecum, colon, anus, and muscle were compared between the two groups.RESULTS: Maximum standardized uptake value (SUVmax) in the tongue, pharynx, larynx, and esophagus did not significantly differ between the endoscopy and control groups. In contrast, mean SUVmax in the whole stomach was 18 % higher in the endoscopy group than in the control group (SUVmax: 2.96 vs. 2.51, P = 0.010). In the lower gastrointestinal track, SUVmax from the cecum to the rectum was not significantly different between the two groups, whereas SUVmax in the anus was 20% higher in the endoscopy group than in the control group (SUVmax: 4.21 vs. 3.50, P = 0.002). SUVmax in the liver and muscle was not significantly different between the two groups. Mean volume of the stomach and mean cross section of the colon was significantly higher in the endoscopy group than in the control group (stomach: 313.28 cm³ vs. 209.93 cm³, P < 0.001, colon: 8.82 cm² vs. 5.98 cm², P = 0.001).CONCLUSIONS: EGD and colonoscopy under sedation does not lead to significant differences in SUVmax in most parts of the body. Only gastric FDG uptake in the EGD subjects and anal FDG uptake in the colonoscopy subjects was higher than uptake in those regions in the control subjects.

A Case of Malignant Melanoma with Zosteriform Skin Metastasis Arising in a Medium-sized Congenital Melanocytic Nevus / 대한피부과학회지

Zosteriform metastasis from malignant melanoma is a rare type of skin metastasis that shows cutaneous lesions including patches, plaques, and nodules along with dermatomes, and thus needs to be distinguished from herpes zoster skin infection. Although some authors have explained the mechanism of zosteriform metastasis, its pathogenesis remains unknown. Herein, we describe an 85-year-old woman with zosteriform metastasis of malignant melanoma arising in a medium-sized congenital melanocytic nevus.

Predictors of Lateral Lymph Node Metastasis in Papillary Thyroid Microcarcinoma: A Retrospective Review / 대한내분비외과학회지

PURPOSE: Cervical lymph node metastasis in patients with papillary thyroid microcarcinoma (PTMC) is associated with an increased recurrence rate and distant metastases. In this study, we analyzed the predictive factors of lateral metastasis in patients with PTMC. METHODS: We retrospectively reviewed the medical records of 1,030 patients with PTMC who underwent thyroidectomy. The clinicopathological characteristics and radiological findings upon ultrasonography (US) and computed tomography (CT) were then analyzed to evaluate the predictability of lateral metastasis of PTMC. RESULTS: The overall rate of lateral metastasis was 3.3% for the 1,030 patients with PTMC. All patients underwent central lymph node dissection (CLND), and 119 of these patients (11.6%) underwent either prophylactic or therapeutic selective neck dissection (SND). Among patients who underwent lateral node evaluation, 28.6% had lateral metastasis. We found that lateral metastasis was associated with larger tumor size, extrathyroidal extension, multiple tumors, bilateral tumors, CLN metastasis, and positive expression of thyroid peroxidase. Positive findings of CLN and lateral metastases on ultrasonography (US) and computed tomography (CT) were significantly associated with lateral metastasis. CONCLUSION: This study demonstrated that, for patients with PTMC, larger tumor size, extrathyroidal extension, multiple tumors, bilateral tumors, CLN metastasis, positive expression of thyroid peroxidase, and positive CLN and lateral metastases identified on US and CT were significantly associated with lateral metastasis. Further studies with a large prospective study and longer follow-up are needed to clarify the predictive value of these factors.

Breast Carcinoma with Choriocarcinomatous Features: A Case Report / 한국유방암학회지

Nongestational choriocarcinoma differentiation is extremely rare in breast neoplasms. It is characterized by tumor cells similar to chorionic trophoblastic cells, which react with human placental lactogen and human chorionic gonadotropin (hCG). A 56-year-old woman presented with a palpable right breast mass without past history of trophoblastic tumors. An F-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) scan revealed one focus with low accumulation of FDG in the right breast (maximum standardized uptake value, 1.98). The patient underwent a right mastectomy and biopsy of sentinel nodes. Microscopically, the tumor was a typical invasive ductal carcinoma with multiple foci of choriocarcinoma features. Immunohistochemistry showed that the tumor cells resembling choriocarcinoma were positive for hCG antibody, but negative for HER2/neu, estrogen receptor, and progesterone receptor. A pathologic diagnosis of breast carcinoma with choriocarcinomatous features was made. To our knowledge, this is the first report of invasive carcinoma with choriocarcinomatous features and an unusual finding of low accumulation in an F-18 FDG PET/CT scan in Korea.

Undifferentiated Pleomorphic Sarcoma of the Male Breast Causing Diagnostic Challenges / 한국유방암학회지

Undifferentiated pleomorphic sarcoma of the breast are uncommon and often present diagnostic challenges. Herein, we report a case of the undifferentiated pleomorphic sarcoma occurring in the male breast. A 76-year-old man presented with a palpable bean-sized mass in his left breast for two months. Core needle biopsy revealed the presence of atypical cells in a fibrous proliferative lesion, which was removed by wide excision. Based on examination of the excised tumor, the initial pathologic diagnosis was atypical spindle cell lesion with uncertain malignant potential. One year later, the patient returned with a recurrent mass atthe previous surgical site. The mass was again surgically removed using wide excision. Based on histological findings with immunomarkers, the final diagnosis was undifferentiated pleomorphic sarcoma. Undifferentiated pleomorphic sarcoma of the breast can cause genuine diagnostic difficulty and appropriate immunohistochemistry is mandatory for differential diagnosis.

Expression of Leptin, Leptin Receptor, Adiponectin, and Adiponectin Receptor in Ductal Carcinoma In Situ and Invasive Breast Cancer / 한국유방암학회지

PURPOSE: Adipocytokines, such as leptin, resistin, and adiponectin, are associated with obesity and breast cancer. Several studies have indicated that adipocytokines may influence tumor growth or differentiation. The aims of this study were to determine the expression of leptin, leptin receptor (ObR), adiponectin and adiponectin receptor (AdipoR) in human breast cancer, to evaluate their prognostic significance in the breast cancer. METHODS: Specimens from 198 patients with primary breast cancer were enrolled, and representative paraffin tumor blocks were selected for constructing tissue microarrarys (TMA). Immunohistochemical staining for leptin, ObR, adiponectin, and AdipoR was performed using TMA, and the clinicopathologic characteristics were evaluated from the patient's medical records. RESULTS: Stage 0 breast cancer accounted for 41 cases, and 157 cases were invasive cancer. Positive rates of leptin and ObR expression in the ductal carcinoma in situ (DCIS) group were significantly higher than those of the invasive cancer group (97.4% vs. 34.0%, p<0.001; 74.4% vs. 29.8%, p<0.001). However, positive rates of adiponectin and AdipoR expression in the invasive cancer group were significantly higher than those in the DCIS group (53.7% vs. 33.3%, p=0.024; 59.9% vs. 26.3%, p<0.001). High leptin expression was significantly associated with high Ki-67 expression (p=0.016). High adiponectin expression was significantly correlated with smaller tumor size (p=0.001). CONCLUSION: We suggest that losses of leptin and ObR expression could be associated with invasive cancer, whereas high adiponectin and AdipoR expression may be associated with breast cancer invasiveness.

Synchrotron Radiation Imaging of Breast Tissue Using a Phase-contrast Hard X-ray Microscope / 의학물리

Synchrotron radiation (SR) imaging enables us to observe internal structures of biologic samples without staining. In this study, we obtained X-ray microscopic images of human breast tissues with 11.1 KeV hard X-ray microscope of the Pohang light source and used zone plates and phase-contrast technique to get high resolution X-ray images. Hard X-ray microscopic images of fibrocystic change and breast cancer tissues with a spatial resolution of 60 nm were obtained and from these images, we could observe the micro-structures of human breast tissue. Also we analyzed and compared these images, which revealed distinct features of each condition. In conclusion, SR imaging with phase-contrast hard X-ray microscope for medical application, especially in breast disease can give some useful information for clinical research.

Ductal Carcinoma In Situ and Sentinel Lymph Node Biopsy / 한국유방암학회지

PURPOSE: Axillary lymph node status is the strongest prognostic indicator of survival for women with breast cancer. The purpose of this study was to evaluate whether sentinel lymph node biopsy (SLNB) is required in patients with an initial diagnosis of ductal carcinoma in situ (DCIS). METHODS: A retrospective analysis was performed of 78 patients with an initial diagnosis of DCIS between December 2002 and April 2010 and who proceeded to have either SLNB or axillary node dissection performed as part of their primary surgical procedure. The study focused on the rates of axillary node metastasis and the underestimation of invasive carcinoma at an initial diagnosis. RESULTS: Forty-eight patients underwent SLNB and 18 patients underwent axillary node dissection. Only 1 of 66 patients (1.5%) had a positive sentinel lymph node. After definite surgery, the final diagnosis was changed to invasive ductal carcinoma (IDC) in 12 patients and DCIS with microinvasion in 2 patients; 14 of 78 patients (17.9%) were therefore underestimated at preoperative histological examinations. In 35 patients who were diagnosed DCIS by core needle biopsy (CNB), 13 patients (37.1%) were upstaged into IDC or DCIS with microinvasion in the final diagnosis. The statistically significant factors predictive of invasive breast cancer were a large tumor size and HER2 overexpression. CONCLUSION: The rates of SLNB positivity in pure DCIS are very low, and there is continuing uncertainty about its clinical importance. However in view of the high rate of underestimation of invasive carcinoma in patients with an initial diagnosis of DCIS, SLNB appears to be appropriate in these patients, especially in the case when DCIS is diagnosed by a core needle biopsy. In patients with an initial diagnosis of DCIS by CNB, SLNB should be considered as part of the primary surgical procedure, when preoperative variables show a tumor larger than 2.35 cm and with HER2 overexpression.

Evaluation of Phase-Contrast Microscopic Imaging with Synchrotron Radiation in the Diagnosis of Breast Cancer and Differentiation of Various Breast Diseases: Preliminary Results / 한국유방암학회지

PURPOSE: A significant improvement of imaging using synchrotron radiation (SR) is obtained by introducing phase-contrast technique. This technique provides greatly enhanced contrast and good soft tissue discrimination with high spatial resolution. The aim of this study was to observe microstructures of pathologic breast specimens including invasive breast cancer using phase-contrast technique with SR and to evaluate the feasibility of phase-contrast imaging in clinical application. METHODS: Phase-contrast microscopic image of normal breast tissue and the images of various breast diseases such as fibrocystic change, ductal carcinoma in situ, invasive ductal carcinoma, Paget's disease were obtained using hard X-ray microscopy with an 11.1 keV monochromatic beam from SR source and CsI (TI) scintillation crystal. Zernike phase-shifter was adapted for phase-contrast hard X-ray microscopy. The visual image was magnified 20 times by microscopic objective lens and captured using a full frame charge-coupled device camera. Obtained images were compared with corresponding histopathologic findings in the optical microscopy. RESULTS: The SR images of various breast diseases were obtained with a good contrast and high visibility by phase-contrast technique. It was possible to observe the microstructures with high spatial resolution down to the micron region. The characteristic features of each disease were consistent with the histopathologic findings of corresponding sample and the images of breast cancer and the other diseases were distinct from each other. CONCLUSION: Using phase-contrast technique, SR images of various breast diseases including breast cancer were obtained. These images were comparable with standard histopathologic findings and showed different features for each disease. The results suggest that phase-contrast microscopic imaging with SR has potential as a diagnostic tool and also its clinical application is feasible, especially in breast imaging.

Microarray Analysis of Papillary Thyroid Cancers in Korean

BACKGROUND/AIMS: Papillary thyroid cancer (PTC) is the most common malignancy of the thyroid gland. It involves several molecular mechanisms. The BRAF V600E mutation has been identified as the most common genetic abnormality in PTC. Moreover, it is known to be more prevalent in Korean PTC patients than in patients from other countries. We investigated distinct genetic profiles in Korean PTC through cDNA microarray analysis. METHODS: Transcriptional profiles of five PTC samples and five paired normal thyroid tissue samples were generated using cDNA microarrays. The tumors were genotyped for BRAF mutations. The results of the cDNA microarray gene expression analysis were confirmed by real-time PCR and immunohistochemistry analysis of 35 PTC patients. RESULTS: Four of the five patients whose PTC tissues were subjected to microarray analysis were found to carry the BRAF V600E mutation. Microarrays analysis of the five PTC tissue samples showed the expression of 96 genes to be increased and that of 16 genes decreased. Real-time reverse transcription-polymerase chain reaction (RT-PCR) confirmed increased expression of SLC34A2, TM7SF4, COMP, KLK7, and KCNJ2 and decreased expression of FOXA2, SLC4A4, LYVE-1, and TFCP2L1 in PTC compared with normal tissue. Of these genes, TFCP2L1, LYVE-1, and KLK7 were previously unidentified in PTC microarray analysis. Notably, Foxa2 activity in PTC was reduced, as shown by its cytoplasmic localization, in immunohistochemical analyses. CONCLUSIONS: These findings demonstrate both similarities and differences between our results and previous reports. In Korean cases of PTC, Foxa2 activity was reduced with its cytoplasmic accumulation. Further studies are needed to confirm the relationship between FOXA2 and BRAF mutations in Korean cases of PTC.

Synchrotron X-ray Microscopic Imaging of Thyroid Tissues / 대한내분비외과학회지

PURPOSE: X-ray microscopy with synchrotron radiation will soon be a useful tool for innovative x-ray imaging in clinical and laboratory settings. It enables us to observe the detailed internal structure of human tissue samples with great magnification power and excellent resolution. So, it has the possibility to be used for the clinical and research purposes to investigate thyroid diseases if it can effectively evaluate the various conditions of thyroid tissue. To determine the relation with their optical microscopic features, we compared the synchrotron X-ray images of unstained normal and thyroid cancer tissue samples with the histopathologic findings of their adjacent, stained thyroid tissue sections. METHODS: An x-ray microscope was installed on a 1B2 beamline with a Pohang Light Source, which is a 3rd generation synchrotron radiation facility with an operating energy of 2.5 GeV at Pohang, Korea. The x-ray energy was set at 11.1 keV and the x-ray beam was monochromatized using a W/B4C monochromator. Formalin-fixed 10µm-thick female thyroid tissues from normal cases and carcinoma cases were attached on Kapton film for the imaging. The sample was positioned 25 m away from the beam source. The x-ray image of the sample was converted into a visual image on the CsI (TI) scintillation crystal, and it was magnified 20 times by the microscopic objective lens. After an additional 10 times digital magnification, this visual image was captured by a full frame CCD camera. RESULTS: The monochromated x-ray microscopic images of the female thyroid tissues of the normal cases and carcinoma cases were obtained with good resolution. These synchrotron images showed the normal follicular structures in the normal thyroid tissue sections and the characteristic severe stromal fibrosis with collagen fiber accumulation in the cancer tissue sections. CONCLUSION: Owing to the great magnification and excellent resolution, the synchrotron x-ray microscopic images of the normal and cancerous thyroid tissues showed good correspondence with the histopathologic findings of their adjacent, stained tissue sections. So, the x-ray microscopic imaging of thyoid tissue using synchrotron radiation has good potential for use in various clinical and research settings in the future.

Clinical Analysis of Macrocalcifications Accompanying a Thyroid Nodule: A Comparative Study with Microcalcifications / 대한내분비외과학회지

PURPOSE: The clinical value of macrocalcifications as an indicator that predicts malignancy of thyroid nodules is controversial. The purpose of this study was to investigate additional ultrasonographic findings accompanying macrocalcifications for predicting malignancies in thyroid nodules. METHODS: Between January 2005 and April 2008, 315 patients who had thyroid nodules with FNAB resulting in suspicious malignancies underwent thyroidectomy at the Wallace Memorial Baptist Hospital. Three hundred fifteen nodules, which were confirmed to be papillary thyroid carcinoma, and 192 nodules, which were confirmed to be benign, were reviewed retrospectively. We analyzed the malignancy rates according to calcification patterns and US findings of the associated solid nodules. RESULTS: Among the 165 papillary thyroid carcinomas with microcalcifications, 161 accompanied solid nodules, and 4 were found with microcalcifications, but without solid nodules. Of the 161 papillary thyroid carcinomas with microcalcifications and solid nodules, 85.7% showed signs suggestive of malignancy. The remaining 14.3%, where only microcalcifications were present, showed indications of predicting malignancy. When solid nodules were found with macrocalcifications, there were indicators of predicting malignancy (100%). Also, for situations in which benign nodules were accompanied by solid nodules, 29% had signs of predicting malignancy. For situations in which benign nodules did not accompany solid nodules, 21% showed suspicious signs of predicting malignancy, but were all confirmed as benign. CONCLUSION: CFor nodules that accompany microcalcifications, there can be indicators that predict malignant conditions separate from other opinions that accompany microcalcifications. However, for macrocalcifications, it would be more effective to set up future treatment plans based on ultrasonographic features of solid nodules accompanying calcifications rather than the calcification itself.

Synchrotron Radiation Imaging of Female Breast Tissues Using Phase Contrast Technique / 한국유방암학회지

PURPOSE: X-ray microscopy with synchrotron radiation might be a useful tool for novel x-ray imaging in the clinical and laboratory settings. This technique provides detailed images of internal structures non-invasively. It also has the potential to resolve some of the limitations of conventional breast imaging. We evaluated high resolution synchrotron imaging of breast tissues from normal breasts and breasts with fibroadenomas and cancer. METHODS: A new x-ray microscope was installed on the 1B2 beamline of a Pohang Light Source, at a third generation synchrotron radiation facility in Pohang, Korea. The phase contrast x-ray energy was set at 6.95 keV and the x-ray beam was monochromatized by a W/B4C monochromator. Formalinfixed or unfixed female breast tissue from normal breast as well as breasts with fibroadenomas and carcinoma were attached onto the Kapton film. The sample was positioned 25 m away from the beam source. The x-ray image of the sample was converted into a visual image on the CsI (TI) scintillation crystal, and magnified 20 times by the microscopic objective lens. After an additional 10 fold digital magnification, this visual image was captured by a full frame CCD camera. RESULTS: The monochromated x-ray microscopic images of female breast tissue from normal breast, fibroadenoma and carcinoma cases were evaluated. The total magnifying power of the microscope was x200. This synchrotron radiation imaging enabled us to observe detailed structures of breast tissue without sample preparation such as staining or fixation. CONCLUSION: Using monochromated synchrotron radiation, the x-ray microscopic images of the normal breast and breasts with fibroadenomas and cancer were obtained. From the images obtained, the x-ray microscopic imaging of breast tissue with synchrotron radiation appears to have great potential for clinical and research purposes such as oncology studies, early detection of cancer and as an aid to the pathological diagnosis in the future.

The Experiences of Performing Sentinel Lymph Node Biopsies with the Use of Methylene Blue Dye in Patients with Invasive Breast Carcinoma / 한국유방암학회지

PURPOSE: Isosulfan blue has been traditionally used as a tracer to map the lymphatic system during identification of the sentinel lymph node (SLN). However, this vital dye is difficult to obtain in Korea. Radioisotopes such as technetiumlabeled sulfur colloid or albumin colloid are also expensive and complex to use. The purpose of this study is to evaluate usefulness of a sentinel lymph node biopsy (SLNB) using methylene blue dye in breast cancer patients. METHODS: We evaluated the sentinel node mapping experience using methylene blue dye from July 2003 to January 2007. Fifty-eight patients with clinical T1-T2 breast cancer without palpable axillary lymph nodes were enrolled. All SLNs were submitted for intraoperative frozen section and hematoxyline and eosin (H & E) stain analysis. For the negative SLNs, serial sections of each SLN specimen were examined by permanent H & E staining and by immunohistochemical techniques (IHC) using cytokeratin. Regardless of the results of a frozen section for the SLNs, a backup level II or III axillary lymph node dissections (ALND) was performed. RESULTS: Of the 58 patients that underwent a SLNB using methylene blue dye, an SLN was identified in 56 patients (96.6%), and metastatic SLNs were detected in 14 cases. Axillary lymph node metastasis found in 18 out of 58 patients. Thus, the false negative rate for a SLNB was 22.2% (4/18). Two patients had a micrometastasis (pN1mi) and two patients had clusters of isolated tumor cells (pN0[i+]) that were identified in the SLNs by IHC with the additional use of cytoketatin. The sensitivity, specificity, and accuracy of the SLNBs were 77.8%, 100%, and 92.9%, respectively. The false negative rate improved with the accumulation of experience for performing a SLNB (12.5% vs 30.0%). The sensitivity, specificity, positive predictive value, and accuracy of preoperative ultrasonography (USG) for an axillary lymph node metastsis were 50.0%, 95.5%, 81.8% and 81.0% respectively. CONCLUSION: Based on our initial experience, methylene blue dye is safe, inexpensive, and a readily available tracer for the SLN mapping, and it could be an effective alternative to the use of isosulfan blue dye for accurately identifying SLNs in early breast caner patients. We expected that the findings of preoperative USG could serve as useful adjuncts to a SLNB.

Primary Ectopic Mediastinal Goiter Combined with Papillary Microcarcinoma of the Cervical Thyroid Gland / 대한내분비외과학회지

True primary mediastinal ectopic goiters are quite rare, and they occur in less than 1% of all goiters. We report here on a case in which a primary mediastinal ectopic goiter was accompanied with papillary microcarcinoma of the cervical thyroid. The mediastinal ectopic goiter was not connected to the cervical thyroid and its blood was supplied from intrathoracic vessels, which necessitated a thoracotomy or sternotomy for removal rather than a standard cervical collar incision. We performed total thyroidectomy for the papillary microcarcinoma of the cervical thyroid gland and transsternal removal for the mediastinal goiter; this resulted in a favorable outcome.

The Usefulness of Preoperative Ultrasonography on Decision of Operative Extent in Patients with Papillary Thyroid Microcarcinoma / 대한내분비외과학회지

PURPOSE: Usually papillary microcarcinoma (PMC) grows very slowly with a good prognosis, although it frequently metastasizes to regional lymph nodes and shows multiple tumor formation in the thyroid. Therefore, how to treat papillary microcarcinoma has been controversial. Recently several studies reported that some ultrasonographic features may potentially reflect the biological aggressiveness of a lesion. We investigated which ultrasonographic findings can reflect aggressive characteristics and whether US can helpful in selecting the appropriate surgical treatment of PMC. METHODS: We retrospectively reviewed the preoperative ultrasonographic findings and pathologic risk factors of 68 patients who had undergone surgical treatment for PMC at the Wallace Memorial Baptist Hospital from January 2004 to December 2005. RESULTS: The incidences of multifocality, extrathyroidal extension, and lymph node metastasis of PMC were 42.6%, 48.5% and 20.6%, respectively. The Mean sizes of PMC were no significant differences according to age, multifocality, extrathyroidal extension, lymph node metastasis, stage and AMES risk group, and tumor size more than 5 mm was not linked to pathologic prognostic factors. Cases demonstrating multiple nodules in the unilateral or bilateral lobes, as well as those with fine strong calcifications in the tumor on US, were directly linked to multifocality on pathologic finding. US is insensitive technique for detecting lymph node metastasis and it's sensitivity was only 14.3%, but it's positive predictive value and specificity were high (100%). CONCLUSION: The date suggested that complete surgery with appropriate nodal dissection should be performed in patients with PMC which their US demonstrating multiple nodules in the unilateral or bilateral lobes, fine strong calcifications echoes in tumor and US-detected node metastasis.

Combined Multimodality Treatment including Surgery / 한국유방암학회지

An ipsilateral supraclavicular lymph node recurrence of breast cancer after surgery has been considered a predecessor to distant metastases. There still is a debate as to whether breast carcinoma patients with the isolated supraclavicular lymph node recurrence should be considered to have disseminated disease or if aggressive treatment, with curative intent, is justified. We report two cases of an isolated ipsilateral supraclavicular lymph node recurrence following modified radical mastectomy, and multimodality treatments with modified radical neck dissection, systemic chemotherapy and involved field radiotherapy. These patients have lived without locoregional recurrence or distant metastases for 3 and 2 years, respectively. Conclusively, we recommend aggressive combined multimodality treatments, including surgery, such as modified radical neck dissection or complete excision of the involved lymph nodes, systemic chemotherapy, and involved field radiotherapy, in patients with isolated supraclavicular lymph node recurrence, but with no other evidence of distant metastases.

Prevalence and Clinical Features of Thyroid Incidentaloma Detected by Screening Ultrasonography in Asymtomatic Healthy Women

PURPOSE: High resolution ultrasonography has made it possible to detect many non-palpable small nodules in thyroid gland. We investigated the prevalence and clinical features of non-palpable thyroid nodule and carcinoma discovered incidentally at screening ultrasonography in healthy women. METHODS: A retrospective review was undertaken on the previous healthy asymptomatic 1, 714 women where selected to undergo screening ultrasonography for the detection of the presence of non-palpable thyroid nodules from January 2004 to December 2004. The aims of study were to define the prevalence of thyroid nodule and carcinoma in healthy asymptomatic women and to access the extent of disease in patients with malignant nodule by surgery. RESULTS: Of the 1, 714 subject, thyroid nodule were detected in 822 (48.0%) women with their prevalence increasing with the increasing age of patients. The malignant detection rate based on the USG-guided fine-needle aspiration (USGFNA) results, including both suspicious and malignant groups, was 2.8% (48/1, 714) of all subjects. 38 of 50 patients with malignant, suspicious or indeterminate cytology underwent surgery and all of them were confirmed to have papillary carcinoma on histological results. In 38 patients with papillary thyroid carcinoma, the average size of tumors was 0.87+/-0.33 cm, a range of 0.3 to 1.5 cm, multifocal tumors were found in 50% (19/38), bilaterality was found in 44.7% (17/38), extrathyroidal extension was observed in 50.0% (19/38), and regional lymph node metastasis was found in 29.4% (5/17). CONCLUSION: High resolution ultrasonography detected a high percentage (48%) of nonpalpable thyroid nodules. Characteristics of thyroid nodules on ultrasonography can be used to decision of optimal management strategies. Total thyroidectomy with lymph node dissection may be suitable in patients with non-palpable papillary thyroid carcinoma due to its high incidence of extrathyroidal extension, bilaterality and regional lymph node metastasis.

Prognostic Significance of Peritumoral Vascular Invasion in Patients with Invasive Breast Cancer / 한국유방암학회지

PURPOSE: Multiple clinical, biological, and pathologic factors correlate with the outcomes in patients with invasive breast cancer. The utility of a peritumoral vascular invasion (PVI) as an additional prognostic indicator has been poorly defined. The aim of this study was to determine if the presence or absence of PVI can be used to help assess the survival and recurrence. METHODS: An invasion of the vascular space (lymphatic and/or blood vessel) by a tumor, as assessed on routine hematoxylin and eosin sections, was investigated in a 146 women with primary operable invasive breast carcinoma. The presence of PVI was compared with the established prognostic factors such as age, tumor size, axillary lymph node involvement, histological grade, hormonal receptor status, and expression of c-erb B2, Ki-67 and p53. Survival analysis was performed using Kaplan-Meier method and log-rank test. RESULTS: PVI was found in 35.6% of cases and was significantly associated with an increasing tumor size (P=0.033) and metastatic axillary lymph nodes (P=0.012). The 5 year disease free survival (DFS) and overall survival (OS) were significantly lower in the patients with PVI than without PVI (P=0.0431 and 0.0445, respectively). In multivariate analysis, the axillary lymph node status (P=0.001), the tumor size (P=0.044) and PVI (P=0.050) were significant independent prognostic factors for the DFS. In the node- negative breast cancer group and in the node-positive breast cancer group, the 5 year DFS and OS were lower in the patients with PVI than in those without, but this did not show significant difference. CONCLUSION: Cox multivariate analysis showed that PVI is a strong prognostic factor for patients with operable invasive breast cancer and an independent prognostic factor for a recurrence. A histological assessment of PVI can provide prognostic information on primary operable invasive breast carcinoma and might be helpful in making a clinical decision.

Clinical, Pathologic and Immunohistochemical Features of Phyllodes Tumor of the Breast / 한국유방암학회지

The histological distinction between benign and malignant phyllodes tumors (PT) is often difficult and arbitrary. We analyzed clinical, histological features and expressions of Ki-67 and p53 using immunohistochemistry and estimate its significance in assessing the grade of malignancy and in predicting the clinical behavior of these tumors on 20 cases of PT of the breast (11 benign, 3 low-grade malignancy and 6 high-grade malignancy). Statistically significant differences between benign, low-grade malignant, and high-grade malignant PT by size of tumor, cellular atypism, stromal cellularity, margin of tumor, and number of mitotic figures. The mean labeling index (LI) of Ki-67 in high-grade malignant PT (9.6+/-9.6) was three-fold higher than that in benign PT (2.7+/-2.2), but this difference was not statistically significant (P=0.074). None of the benign PT were positive for p53, whereas 2 of 3 low-grade malignant and 3 of 6 high-grade malignant PT were positive for p53. Statistically significant differences in the pattern of p53 expression existed among the benign, low-grade malignant, and high-grade malignant lesions (P=0.018). Ki-67 LI and p53 expression were associated with numbers of mitotic figure, but were not associated with metastasis (P=0.546 and 0.216). Increased p53 immunoreactivity is present in high-grade and low-grade malignant PTs in contrast to benign PTs, and malignant PT had a higher Ki-67 LI than benign PT. Thus, p53 and Ki-67 expression may assist in distinguishing benign from malignant PT in diagnostically difficult cases.