Effect of Poloxamer-Based ThermoSensitive Sol-Gel Agent on Upper Limb Dysfunction after Axillary Lymph Node Dissection: A Double-Blind Randomized Clinical Trial / 한국유방암학회지

Purpose@#Restricted shoulder motion is a major morbidity associated with a lower quality of life and disability after axillary lymph node dissection (ALND) in patients with breast cancer.This study sought to evaluate the antiadhesive effect of a poloxamer-based thermosensitive sol-gel (PTAS) agent after ALND. @*Methods@#We designed a double-blind, multicenter randomized controlled study to evaluate the clinical efficacy and safety of PTAS in reducing upper-limb dysfunction after ALND. The primary outcome was the change in the range of motion (ROM) of the shoulder before surgery and 4 weeks after ALND (early postoperative period). Secondary outcomes were shoulder ROM at six months, axillary web syndrome, and lymphedema (late postoperative period). @*Results@#A total of 170 patients with planned ALND were randomly assigned to one of 2 groups (poloxamer and control) and 15 patients were excluded. In the poloxamer group (n = 76), PTAS was applied to the surface of the operative field after ALND. ALND was performed without the use of poloxamer in the control group (n = 79). Relative to the control group, the poloxamer group had significantly lower early postoperative restrictions in total shoulder ROM at four weeks (−30.04 ± 27.76 vs. −42.59 ± 36.79; p = 0.0236). In particular, the poloxamer group showed greater reductions in horizontal abduction at four weeks (−3.92 ± 9.80 vs. −10.25 ± 15.42; p = 0.0050). The ROM of the shoulder at 24 weeks, axillary web syndrome, and lymphedema were not significantly different between the two groups. No adverse effects were observed in either group. @*Conclusion@#We suggest that poloxamer might improve the early postoperative shoulder ROM in patients with breast cancer who have undergone ALND.

Effect of Poloxamer-Based ThermoSensitive Sol-Gel Agent on Upper Limb Dysfunction after Axillary Lymph Node Dissection: A Double-Blind Randomized Clinical Trial / 한국유방암학회지

Purpose@#Restricted shoulder motion is a major morbidity associated with a lower quality of life and disability after axillary lymph node dissection (ALND) in patients with breast cancer.This study sought to evaluate the antiadhesive effect of a poloxamer-based thermosensitive sol-gel (PTAS) agent after ALND. @*Methods@#We designed a double-blind, multicenter randomized controlled study to evaluate the clinical efficacy and safety of PTAS in reducing upper-limb dysfunction after ALND. The primary outcome was the change in the range of motion (ROM) of the shoulder before surgery and 4 weeks after ALND (early postoperative period). Secondary outcomes were shoulder ROM at six months, axillary web syndrome, and lymphedema (late postoperative period). @*Results@#A total of 170 patients with planned ALND were randomly assigned to one of 2 groups (poloxamer and control) and 15 patients were excluded. In the poloxamer group (n = 76), PTAS was applied to the surface of the operative field after ALND. ALND was performed without the use of poloxamer in the control group (n = 79). Relative to the control group, the poloxamer group had significantly lower early postoperative restrictions in total shoulder ROM at four weeks (−30.04 ± 27.76 vs. −42.59 ± 36.79; p = 0.0236). In particular, the poloxamer group showed greater reductions in horizontal abduction at four weeks (−3.92 ± 9.80 vs. −10.25 ± 15.42; p = 0.0050). The ROM of the shoulder at 24 weeks, axillary web syndrome, and lymphedema were not significantly different between the two groups. No adverse effects were observed in either group. @*Conclusion@#We suggest that poloxamer might improve the early postoperative shoulder ROM in patients with breast cancer who have undergone ALND.

Medical Treatment for Idiopathic Gynecomastia with Tamoxifen

Purpose@#Gynecomastia is a common condition caused by various factors and characterized by the overdevelopment of the male breast glandular tissue. It can cause pain and discomfort, which may require treatment. This study aimed to evaluate the efficacy of tamoxifen in the treatment of idiopathic gynecomastia. @*Methods@#We retrospectively analyzed the medical records of 101 patients who underwent medical treatment for idiopathic gynecomastia using tamoxifen from January 2005 to December 2018. We examined the clinical characteristics that affected resolution and recurrence. @*Results@#The overall resolution rate of gynecomastia among the patients treated with tamoxifen was 89.1%, and the overall recurrence rate was 15.6%. Large size at diagnosis and longer duration of symptoms were significantly different between patients who experienced resolution and those who did not (p=0.017 and p=0.019, respectively). The dosage of tamoxifen did not affect the resolution rate (p=0.609). None of the clinical characteristics were significantly different between patients who experienced recurrence and those who did not. @*Conclusion@#Our study showed that tamoxifen may be an effective treatment for idiopathic gynecomastia.

Clinicopathological Features of Patients with the BRCA1 c.5339T>C (p.Leu1780Pro) Variant / Journal of the Korean Cancer Association, 대한암학회지

Purpose@#Recent studies revealed the BRCA1 c.5339T>C, p.Leu1780Pro variant (L1780P) is highly suggested as a likely pathogenic. The aim of this study was to evaluate clinicopathologic features of L1780P with breast cancer (BC) using multicenter data from Korea to reinforce the evidence as a pathogenic mutation and to compare L1780P and other BRCA1/2mutations using Korean Hereditary Breast Cancer (KOHBRA) study data. @*Materials and Methods@#The data of 54 BC patients with L1780P variant from 10 institutions were collected and the clinicopathologic characteristics of the patients were reviewed. The hereditary breast and/or ovarian cancer–related characteristics of the L1780P variant were compared to those of BC patients in the KOHBRA study. @*Results@#The median age of all patients was 38 years, and 75.9% of cases showed triple-negative breast cancer. Comparison of cases with L1780P to carriers from the KOHBRA study revealed that the L1780P patients group was more likely to have family history (FHx) of ovarian cancer (OC) (24.1% vs. 19.6% vs. 11.2%, p < 0.001 and p=0.001) and a personal history of OC (16.7% vs. 2.9% vs. 1.3%, p=0.003 and p=0.001) without significant difference in FHx of BC and bilateral BC. The cumulative risk of contralateral BC at 10 years after diagnosis was 31.9%, while the cumulative risk of OC at 50 years of age was 20.0%. Patients with L1780P showed similar features with BRCA1 carriers and showed higher penetrance of OC than patients with other BRCA1 mutations. @*Conclusion@#L1780P should be considered as a pathogenic mutation. Risk-reducing salpingo-oophorectomy is highly recommended for women with L1780P.

Development of an Excel Program for the Updated Eighth American Joint Committee on Cancer Breast Cancer Staging System

PURPOSE: The eighth American Joint Committee on Cancer staging system for breast cancer was recently published to more accurately predict the prognosis by adding biomarkers such as estrogen receptors, progesterone receptors, and human epidermal growth factor receptor 2. However, this system is very complicated and difficult to use by clinicians. The authors developed a program to aid in setting up the staging system and confirmed its usefulness by applying it to theoretical combinations and actual clinical data. METHODS: The program was developed using the Microsoft Excel Macro. It was used for the anatomic, clinical and pathological prognostic staging of 588 theoretical combinations. The stages were also calculated the stages using 840 patients with breast cancer without carcinoma in situ or distant metastasis who did not undergo preoperative chemotherapy. RESULTS: The anatomic, clinical and pathological prognostic stages were identical in 240 out of 588 theoretical combinations. In the actual patients' data, stages IB and IIIB were more frequent in clinical and pathological prognostic stages than in the anatomic stage. The anatomic stage was similar to the clinical prognostic stage in 58.2% and to the pathological prognostic stage in 61.9% of patients. Oncotype DX changed the pathological prognostic stage in 2.1% of patients. CONCLUSION: We developed a program for the new American Joint Committee on Cancer staging system that will be useful for clinical prognostic prediction and large survival data analysis.

Ultrasonographic and Pathologic Findings of Dermatofibrosarcoma Protuberans of the Breast: A Case Report

Dermatofibrosarcoma protuberans (DFSP) is a rare, malignant soft tissue tumor. It arises from the dermis, however, a few lesions are known to infiltrate into deeper layers. It commonly occurs on the trunk and extremities, but rarely involves the breast. We report a case of a 43-year-old woman who had histologically proven DFSP of the breast, with emphasis on ultrasonographic findings and pathological features. In our case, the ultrasonographic features of DFSP revealed an ovalshaped hypoechoic mass in the dermis of left breast with surrounded by increased levels of echogenic subcutaneous fat. This ultrasonographic finding correlated with pathologic features of infiltration of tumor cells into the subcutaneous fat. No previous study reported this feature of DFSP associated with the breast.

Urinary Bladder Injury During Colonoscopy Without Colon Perforation

We report a case of urinary bladder perforation during colonoscopy. A 67-year-old female, who had undergone a transabdominal hysterectomy for uterine myomas 15 years ago, visited the emergency department with complaint of abdominal pain after a screening colonoscopy. Laparoscopic examination revealed severe adhesion between the sigmoid colon and the urinary bladder. The urinary bladder wall was weakened, and several perforation sites were found. The surgery was converted to a laparotomy. After a thorough examination, we performed primary repair for the perforation sites, followed by an omentopexy.

Distress and Quality of Life for Breast Cancer Survivors during Follow-Up Periods in Korea

PURPOSE: Few studies have reported postdiagnosis differences in distress and quality of life (QOL) for breast cancer (BC) survivors. Here we investigated the differences in distress and QOL for BC survivors in Korea, during follow-up. METHODS: Completed questionnaires were collected from 179 BC survivors in 2013. Functional Assessment of Cancer Therapy-Breast was administered to measure the distress and Distress Thermometer and Problem List was administered to measure the QOL. RESULTS: The mean QOL score was 96.69 (standard deviation, ±20.33). Seventy-nine patients (44.1%) with distress-test scores >4 were assigned to the severe distress group. The patient group with higher family income had high QOL score (p=0.008). In addition, QOL scores were significantly higher in patients who lived longer after diagnosis (p=0.016). Patients at high TNM stage had low QOL scores (p=0.006). Furthermore, older patients tended to have high distress scores (p=0.028). Based on duration of the postdiagnosis period, we divided the patients into two groups. Seventy patients had a postdiagnosis period <2 years; 109 patients, postdiagnosis period ≥2 years. Distress score of the under-2-year group (4.26±2.73) was significantly higher (p=0.044) than that of the longer-than-2-year group (3.47±2.42). CONCLUSION: BC survivors showed improvement in physical well-being, emotional well-being, and functional well-being domain of QOL over time. However, social well-being and BC subscale score were only slightly improved over time. It is possible that cancer patients' supporting programs are focused on the recently diagnosed patients or those currently undergoing treatment. Therefore, more support should be made available to long-term BC survivors.

The Korean guideline for breast cancer screening

Breast cancer is the second most common malignancy among Korean women. The 2002 National Cancer Center screening guideline breast cancer was revised via an evidence-based approach to provide medical personnel with a standard protocol of screening breast cancer. There is moderate-level evidence that biennial screening mammography in asymptomatic women aged 40 to 69 reduces breast cancer mortality, while low-level evidence suggests that screening mammography in women 70 years or older does not reduce breast cancer mortality. The committee concluded that the current evidence is insufficient to assess the benefits and harms of either ultrasonography or clinical breast examination as screening modalities for breast cancer. Future researches about the benefits and harms of the National Breast Cancer Screening Program in Korea are strongly required because the characteristics of breast cancer in Korea are different from those in the West, especially regarding dense breast. In conclusion, the committee recommends biennial screening mammography in asymptomatic women aged 40 to 69 years (grade B recommendation). The committee recommends selective screening mammography in women 70 years or older according to individual risk and preference (grade C recommendation). The committee neither recommends nor opposes ultrasonography and clinical breast examination as screening modalities (grade I recommendation). Symptomatic and high-risk women, however, should be offered complementary measures including ultrasonography and clinical breast examination under clinical supervision.

Validation of Risk Assessment Models for Predicting the Incidence of Breast Cancer in Korean Women / 한국유방암학회지

PURPOSE: The Gail model is one of the most widely used tools to assess the risk of breast cancer. However, it is known to overestimate breast cancer risk for Asian women. Here, we validate the Gail model and the Korean model using Korean data, and subsequently update and revalidate the Korean model using recent data. METHODS: We validated the modified Gail model (model 2), Asian American Gail model, and a previous Korean model using screening patient data collected between January 1999 and July 2004. The occurrence of breast cancer was confirmed by matching the resident registration number with data from the Korean Breast Cancer Registration Program. The expected-to-observed (E/O) ratio was used to validate the reliability of the program, and receiver operating characteristics curve analysis was used to evaluate the program's discriminatory power. There has been a rapid increase in the incidence of breast cancer in Korea, and we updated and revalidated the Korean model using incidence and mortality rate data from recent years. RESULTS: Among 40,229 patients who were included in the validation, 161 patients were confirmed to have developed breast cancer within 5 years of screening. The E/O ratios and 95% confidence intervals (CI) were 2.46 (2.10-2.87) for the modified Gail model and 1.29 (1.11-1.51) for the Asian American Gail model. The E/O ratio and 95% CI for the Korean model was 0.50 (0.43-0.59). For the updated Korean model, the E/O ratio and 95% CI were 0.85 (0.73-1.00). In the discriminatory power, the area under curve and 95% CI of the modified Gail model, Asian American Gail model, Korean model and updated Korean model were 0.547 (0.500-0.594), 0.543 (0.495-0.590), 0.509 (0.463-0.556), and 0.558 (0.511-0.605), respectively. CONCLUSION: The updated Korean model shows a better performance than the other three models. It is hoped that this study can provide the basis for a clinical risk assessment program and a future prospective study of breast cancer prevention.

Characteristics of the Germline MEN1 Mutations in Korea: A Literature Review / 대한내분비외과학회지

PURPOSE: Multiple endocrine neoplasia type 1 (MEN-1) is an autosomal dominant disease caused by the MEN1 germline mutation. We reviewed previous reports in order to summarize the characteristics of germline MEN1 mutation in Korea. METHODS: We retrieved the relevant literature regarding MEN1 germline mutation in Korea using the Pubmed (http://www.pubmed.org/) and Koreamed (http://www.koreamed.org/) databases from 2000 to 2012. We evaluated the pedigree of the patients in order to exclude the same, repeated families. We collected all data on the types of mutations and clinical characteristics. RESULTS: There were nine studies with 12 cases of MEN1 mutations in Korea. Two cases were sporadic MEN-1. C.196_200dupAGCCC was reported in three families. There were six cases of frameshift mutation, three cases of missense mutation, two cases of nonsense mutation, and one case of splice site mutation. Five mutations were novel mutations not previously reported. CONCLUSION: We summarized the characteristics of germline MEN1 mutations in Korea. Genetic testing of MEN1 is rare in Korea; however, it will be useful in preclinical diagnosis and genetic counseling.

Bromocriptine-Treated Giant Lactating Adenoma: A Case Report with Imaging Findings

Lactating adenoma is a benign breast disease that occurs during pregnancy or lactational periods. Here we report on a case of rapidly enlarging lactating adenoma in a 28-year-old postpartum woman, which was mistaken for a malignant breast tumor. Treatment with bromocriptine resulted in a rapid reduction of the mass, suggesting that bromocriptine could be used for shrinking lactating adenoma and to facilitate surgical removal. We describe its imaging findings, including ultrasonographic findings with correlative histologic features, confirmed by surgical excision.

Bilateral adrenal pheochromocytoma with a germline L790F mutation in the RET oncogene / 대한외과학회지

About ten percent of pheochromocytomas are associated with familial syndrome. Hereditary pheochromocytoma has characteristics of early onset, multifocality and bilaterality. We experienced a case of 44-year-old man with bilateral pheochromocytoma without evidence of medullary thyroid cancer. Genetic test detected a L790F germline mutation of RET oncogene. The author found a necessity for genetic tests in cases of young-age, bilateral pheochromocytoma.

Estimating the Risks and Benefits of Tamoxifen for Prophylactic Breast Cancer Chemoprevention in Korea / 한국유방암학회지

PURPOSE: According to the National Surgical Adjuvant Breast and Bowel Project P1 (NSABP-P1) study, tamoxifen can prevent 49% of invasive breast cancers in patients who have a 5-year risk of 1.67% or more. Because tamoxifen is associated with both adverse effects (endometrial cancer, stroke, pulmonary embolism) and protective effect (fracture prevention), it is necessary to weigh the risks and benefits of using tamoxifen for prevention in Korean women. This study weighed those risks and benefits. METHODS: Data were reviewed on the incidences of breast cancer, hip fracture, endometrial cancer and stroke in the absence of tamoxifen treatment in Korean women. We also reviewed NSABP-P1 data on the effects of tamoxifen on these outcomes. A risk-benefit index was calculated according to age and specific risk of breast cancer. Sensitivity analyses were performed with assumptions regarding the effects of tamoxifen. RESULTS: Compared to U.S. women, the numbers of hip fractures and endometrial cancers were lower, but the number of strokes was much higher. The net benefit of tamoxifen was reduced with increasing age because of a high risk of stroke in older women. Older Korean women had more risk than benefit from tamoxifen chemoprevention. Only women younger than age 40 had a positive risk-benefit index with an average 5-year risk of breast cancer in Korea. Sensitivity analysis showed that this result was robust. CONCLUSION: Women under the age 40 had more benefit than risk from tamoxifen chemoprevention. Tamoxifen chemoprevention should be limited to Korean women younger than age 40.

Estimating the Risks and Benefits of Tamoxifen for Prophylactic Breast Cancer Chemoprevention in Korea / 한국유방암학회지

PURPOSE: According to the National Surgical Adjuvant Breast and Bowel Project P1 (NSABP-P1) study, tamoxifen can prevent 49% of invasive breast cancers in patients who have a 5-year risk of 1.67% or more. Because tamoxifen is associated with both adverse effects (endometrial cancer, stroke, pulmonary embolism) and protective effect (fracture prevention), it is necessary to weigh the risks and benefits of using tamoxifen for prevention in Korean women. This study weighed those risks and benefits. METHODS: Data were reviewed on the incidences of breast cancer, hip fracture, endometrial cancer and stroke in the absence of tamoxifen treatment in Korean women. We also reviewed NSABP-P1 data on the effects of tamoxifen on these outcomes. A risk-benefit index was calculated according to age and specific risk of breast cancer. Sensitivity analyses were performed with assumptions regarding the effects of tamoxifen. RESULTS: Compared to U.S. women, the numbers of hip fractures and endometrial cancers were lower, but the number of strokes was much higher. The net benefit of tamoxifen was reduced with increasing age because of a high risk of stroke in older women. Older Korean women had more risk than benefit from tamoxifen chemoprevention. Only women younger than age 40 had a positive risk-benefit index with an average 5-year risk of breast cancer in Korea. Sensitivity analysis showed that this result was robust. CONCLUSION: Women under the age 40 had more benefit than risk from tamoxifen chemoprevention. Tamoxifen chemoprevention should be limited to Korean women younger than age 40.

Epidermoid Cyst of the Spleen Presenting as Acute Abdominal Pain

Splenic epidermoid cyst is a rare disease affecting the spleen. We report a 24-year-old male who presented with acute abdominal pain. Computed tomography scan of the abdomen revealed a huge cystic lesion of the spleen. At laparotomy, a huge cyst was found arising from the low pole of the spleen. It was removed by splenectomy. Histopathological findings were consistent with splenic epidermoid cyst.

Epidermoid Cyst of the Spleen Presenting as Acute Abdominal Pain

Splenic epidermoid cyst is a rare disease affecting the spleen. We report a 24-year-old male who presented with acute abdominal pain. Computed tomography scan of the abdomen revealed a huge cystic lesion of the spleen. At laparotomy, a huge cyst was found arising from the low pole of the spleen. It was removed by splenectomy. Histopathological findings were consistent with splenic epidermoid cyst.

Spontaneous Retroperitoneal Hemorrhage from Ruptured Suprarenal Artery Aneurysm

Retroperitoneal hemorrhage from a ruptured suprarenal artery aneurysm is very rare. We report on a 34-year-old man who underwent selective angiography for diagnosis and treatment of retroperitoneal hemorrhage for suprarenal artery aneurysm. The patient made a full recovery with no evidence of further hemorrhage.

The Impact of Primary Tumor Resection on the Survival of Patients with Stage IV Breast Cancer / 한국유방암학회지

PURPOSE: The main treatment for stage IV breast cancer is currently systemic therapy. Surgical resection of the primary tumor is usually done for treating the tumor-related complications. Recent studies have suggested that surgery may improve the long-term survival of stage IV breast cancer patients. We evaluated the impact of the primary surgical resection site on the survival of stage IV breast cancer patients. METHODS: We reviewed the records of the stage IV breast cancer patients who were treated at Seoul University Hospital between April 1992 and December 2007. The tumor and clinical characteristics, the type of treatments and the overall survival were compared between the surgically versus nonsurgically treated patients. RESULTS: Of the 198 identified patients, 110 (55.8%) received surgical excision of their primary tumor and 88 (44.2%) did not. The mean survival was 67 months vs. 42 months for the surgically treated patients vs. the patients without surgery, respectively (p=0.0287). On a multivariate analysis with using the Cox model and after adjusting for the estrogen receptor status, visceral metastases, the number of metastatic sites and trastuzumab treatment, surgery was an independent factor for improved survival (hazard ratio, 0.55; 95% confidence interval, 0.31-0.97; p=0.041). CONCLUSION: Surgical resection of the primary tumor in stage IV breast cancer patients was independently associated with improved survival. Randomized prospective trials are needed to firmly recommend surgical resection of the primary tumor in stage IV breast cancer patients.

The Impact of Primary Tumor Resection on the Survival of Patients with Stage IV Breast Cancer / 한국유방암학회지

PURPOSE: The main treatment for stage IV breast cancer is currently systemic therapy. Surgical resection of the primary tumor is usually done for treating the tumor-related complications. Recent studies have suggested that surgery may improve the long-term survival of stage IV breast cancer patients. We evaluated the impact of the primary surgical resection site on the survival of stage IV breast cancer patients. METHODS: We reviewed the records of the stage IV breast cancer patients who were treated at Seoul University Hospital between April 1992 and December 2007. The tumor and clinical characteristics, the type of treatments and the overall survival were compared between the surgically versus nonsurgically treated patients. RESULTS: Of the 198 identified patients, 110 (55.8%) received surgical excision of their primary tumor and 88 (44.2%) did not. The mean survival was 67 months vs. 42 months for the surgically treated patients vs. the patients without surgery, respectively (p=0.0287). On a multivariate analysis with using the Cox model and after adjusting for the estrogen receptor status, visceral metastases, the number of metastatic sites and trastuzumab treatment, surgery was an independent factor for improved survival (hazard ratio, 0.55; 95% confidence interval, 0.31-0.97; p=0.041). CONCLUSION: Surgical resection of the primary tumor in stage IV breast cancer patients was independently associated with improved survival. Randomized prospective trials are needed to firmly recommend surgical resection of the primary tumor in stage IV breast cancer patients.