Additional Breast Ultrasound Examinations in Clustered Calcifications: for Improving Diagnostic Performance / 한국유방암학회지

PURPOSE: We wanted to determine whether additional breast ultrasound examinations are needed for patients who have clustered calcifications found by mammography for the detection of breast carcinomas. METHODS: We performed targeted ultrasound examinations in 125 consecutive patients who had clustered calcifications found by mammography. Forty-eight pathologically proven patients with 61 breast lesions were included in this study (26 invasive carcinomas, 10 ductal carcinomas in situ and 25 benign diseases). Two breast radiologists evaluated the mammography and the ultrasound findings and they graded the probability of malignancy by consensus as follows: definitely benign 1, probably benign 2, probably malignant 3, and definitely malignant 4. The diagnostic performance values, including the sensitivity, specificity, accuracy, positive predictive value and negative predictive value, for mammography and additional ultrasound were compared using McNemar's test and receiver operating characteristic (ROC) analysis. On the ROC analysis, areas under the ROC curves (AUC) and 95% confidence intervals (CI) were obtained. RESULTS: The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value for making the diagnosis of breast carcinoma by mammography were 88.9%, 12.0%, 57.4%, 59.3%, and 42.9% and those for additional ultrasound were 94.4%, 64.0%, 82.0%, 79.1%, and 88.9%, respectively. The differences of specificity and accuracy were statistically significant (p=0.0003). On the ROC analysis, ACU were significantly different between mammography (AUC=0.586, 95% CI=0.453-0.711) and ultrasound (AUC=0.823, 95% CI=0.704-0.909) (p=0.003). Clustered calcifications with associated masses or ductal changes on additional breast ultrasound had high frequency of malignancies, 79% or 73%. In addition, 87% of malignant masses were invasive carcinomas and 45% of malignant ductal changes were ductal carcinomas in situ. CONCLUSION: Additional breast ultrasound examinations for the lesions with clustered calcifications on mammography can improve the diagnostic performance and significantly contribute to the specificity and accuracy of a diagnosis of breast carcinoma. In addition, the ultrasound features may predict the pathologic findings such as benignity or malignancy and invasive carcinoma or ductal carcinoma in situ.

The Clinical Significance of Minimal Extrathyroid Extension in Patients with Papillary Thyroid Microcarcinoma / 대한내분비외과학회지

PURPOSE: The prognosis of papillary thyroid carcinoma is determined by such risk factors as old age, male gender, a large tumor size and extrathyroid extension. The aim of this study was to investigate the value of extrathyroid extension for the recurrence of papillary microcarcinoma and its association with the risk factors for papillary thyroid carcinoma. METHODS: We retrospectively studied 167 patients with papillary microcarcinoma and who underwent thyroidectomy from Feb. 2003 to Dec. 2008. Papillary microcarcinoma (PTMC) was defined as a tumor smaller than 1 cm and an extrathyroid extension was identified by the pathological findings. Age, gender, extrathyroid extensions, the operative methods, lymph node metastasis and the MACIS score were analyzed by the appropriate statistical methods. RESULTS: Patients with PTMC showed a lower MACIS score, fewer lymph node metastasis and less extrathyroid extension, as compared to the patients with papillary thyroid carcinoma. Total thyroidectomy and selective lymph node dissection were less frequently done in the patients suffering with PTMC. Analysis of the risk factors showed that PTMC had a close relationship with lymph node metastasis, the extent of surgery and multifocal cancer. The disease free survival rate of the patients with PTMC was statistically related with lymph node metastasis, but not with an extrathyroid extension (P=0.001). CONCLUSION: The patients with PTMC showed less lymph node metastasis and extrathyroid extension as compared to the patients with PTC. Lymph node metastasis of PTMC is an independent factor for disease free survival, but minimal extrathyroid extension is not related with recurrence. PTMC with lymph node metastasis should be regarded as an aggressive large tumor and lymph node dissection should be done.

The Clinical Significance of a Minimal Extra-thyroidal Extension of Papillary Thyroid Cancer for the Recurrence of Regional Cervical Lymph Nodes

PURPOSE: Extra-thyroidal extension has been recognized as a poor prognostic factor for increased regional recurrence risk in papillary thyroid carcinoma, and is known to require treatment that is more aggressive. In the recent UICC TNM 6th Classification, an extra-thyroidal extension was divided into a minimal extra-thyroidal extension (T3) and a massive extra-thyroidal extension (T4). The aim of this study was to investigate the clinical effect of a minimal extra-thyroidal extension of a papillary carcinoma for the recurrence of regional cervical lymph nodes. METHODS: We retrospectively studied 154 patients with papillary thyroid carcinoma where a thyroidectomy was performed from Feb. 2003 to May. 2006 at the Department of Surgery, with the exclusion of 6 patients with a massive extra-thyroidal extension. We divided the cases into a no extra-thyroidal extension group and a minimal extra-thyroidal extension group according to the grading of the extra-thyroidal extension. The grading of the extra-thyroidal extension was based on both pathological findings and intraoperative surgical findings. Clinicopathological factors associated with each group were analyzed by univariate and multivariate analysis. We divided the cases into two groups according to age ( or =45 yrs) and lymph node status (positive, negative), and compared each group with regards to disease free survival according to the grading of the extra-thyroidal extension. RESULTS: By univariate analysis, a minimal extra-thyroidal extension was related to lymph node metastasis, tumor size, mutifocality (P0.05). CONCLUSION: We need to downstage to less than T3 for a minimal extra-thyroidal extension because there is no significant difference in disease free survival according to the grading of an extra-thyroidal extension in patients with papillary thyroid carcinoma.

The Clinicopathologic Significance of a p63 Expression in Invasive Breast Cancer

PURPOSE: p63 is a recently described as p53 homologue. Despite their structural homologies, they have different activities. p63 is a specific myoepithelial cell marker in normal breast tissue and it is expressed in a minority of breast cancers. The aim of this study was to evaluate the prognostic significance of the p63 expression in breast cancer. METHODS: The expression of p63 in breast cancer was determined by performing immunohistochemistry on 350 patients who underwent mastectomy at the Department of Surgery at Korea University Medical Center between January 1992 and September 2004. A retrospective analysis was conducted using the medical records. A tissue microarray was constructed, and immunohistochemical analysis for p63 was performed according to the usual methods. RESULTS: Among 350 patients, 40 (11.4%) showed a p63 expression. There was a significant correlation between p63 and the histologic grade. There were significant correlations of p63 with p53 and HER2/neu, respectively. In the basal type of breast cancer, the p63 expression was significantly higher than in the luminal type of breast cancer. The 5 year disease free survival rates were 69% in the patients with a p63 expression and 76% in the patients without a p63 expression, but there was no statistical difference. CONCLUSION: The present results indicate that a p63 expression is associated with a high grade tumor, a p53 expression and a HER2/neu expression in breast cancer, which are the known poor prognostic factors of breast cancer. Immunohistochemical subtyping shows that the p63 expression is a useful predictor for the basal type of breast cancer. In addition, this study suggests that the p63 expression in the basal type of breast cancer is associated with a poor prognosis.

The Survival Analysis of Immunohistochmically Defined Basal and Luminal Subtype of Breast Cancer

PURPOSE: DNA microarray studies of breast cancer have identified distinct subtypes showing different survivals. The results of DNA microarray revealed the HER2 negative and estrogen receptor (ER) negative subtypes, which were designated as basal or basal-like subtype. The basal subtype can not be manipulated by trastuzumab or the selective estrogen receptor modulator (SERM), but DNA microarrays are not perform in clinical practice. We classified invasive ductal carcinoma (IDC) into the luminal, HER2, basal and negative groups using an immunohistochemical method and evaluated the usefulness of the method in clinical practice. METHODS: A retrospective analysis was conducted using the medical records of 295 patients, diagnosed with IDC of the breast, who subsequently underwent a mastectomy between January 1992 and September 2004. A tissue microarray was constructed and immunohistochemical studies performed for HER2, ER, HER1, c-kit and CK5/6. The breast cancers were divided into four subtypes, which included the HER2 positive, luminal, basal and negative subtypes. The basal subtype was characterized by HER2 negative, ER negative and positive for one of HER1, c-kit or CK5/6. Only the ER positive subtype was designated as a luminal subtype. The survival rates were calculated using the Kaplan Meier methods. RESULTS: The 5 year survival rates of the HER2 positive, luminal and basal subtypes were 80.4, 86.8 and 73.8%, respectively (P=0.1274). The basal subtype was predominant among the patients with poorly differentiated carcinomas (P=0.000). The 5 year overall survival of the basal subtype was lower than that of luminal (P=0.049); the prognosis was also poor in those with an age less than 35 years old, premenopausal and lymph node metastasis. CONCLUSION: The basal subtype was associated with a high histologic grade, and also showed significantly worse prognosis then the luminal subtype, especially in those patients with an age less than 35, premenopausal and lymph node metastasis. The immunohistochemical assay for the basal subtype was helpful in detecting patients with a poor prognostic.

Significance of Akt Expression in Node-negative Breast Cancer

BACKGROUND: Patients with lymph node-negative breast cancer show a 10-year recurrence rate of approximately 20%. In node-negative breast cancer, the prognostic factors are age, menopause, tumor size, hormone receptors, p53, DNA ploidy, Ki-67 index (Ki-67) and c-erbB2. Of these, ErbB2 (the protein of the c-erbB2 gene) is a member of the receptor tyrosine kinase family. Overexpression of ErbB2 is known to regulate cell proliferation, differentiation, growth and apoptosis via the ErbB2/Phosphoinositol 3-Kinase (PI 3-K)/Akt signaling pathway. Therefore, it is important to identify high- risk patients that would benefit from adjuvant therapies related with ErB2. For this purpose, the prognostic relevance of the ErbB2/PI 3-K/Akt pathway was examined in node-negative breast cancer. METHODS: A retrospective analysis was performed on the hospital records of all 72 patients diagnosed with breast cancer, and who underwent surgical treatment between January 1996 and December 2003. Clinicopathological data were compared with the results of immunohistochemical staining using the phospho-specific antibody for the expression of Akt. RESULTS: The mean age of the patient's was 48.6 years. Phospho-Akt (pAkt) was expressed in 24 cases (33.3%), but there was no statistical relationship between pAkt expression and the known prognostic factors of breast cancer. There was no statistical significance in the survival rates between the pAkt positive and negative expression groups (P=0.123). In the ErbB2 positive patients, the expression of pAkt was associated with a shorter disease-free survival (P=0.045), and the disease-free survival was shorter in patients whose tumors expressed pAkt and had a high level of Ki-67 (P=0.040). CONCLUSION: The co-expression of ErbB2 and pAkt positivity implied a poor prognosis in node-negative breast cancer patients, and the co-expression of high Ki-67 and pAkt positivity also revealed a poor prognosis in these patients. These results show that the expression of pAkt could be considered a prognostic marker of node-negative breast cancer with ErbB2 positive expression and high levels of Ki-67.

Endometrial Stromal Sarcoma of the Sigmoid Colon Arising in Endometriosis :A Case Report with a Review of Literatures

Most of malignant tumors arising in ovarian and extraovarian endometriosis are carcinomas. Mixed mullerian tumor and endometrial stromal sarcoma arising in intestinal endometriosis are rarely described, but its clinicopathologic features have not been well characterized. Here we report a case of endometrial stromal sarcoma of the sigmoid colon arising in endometriosis with a review of six additional cases of endometrial stromal sarcoma arising in intestinal endometriosis found in English literatures. The patients ranged in age from 36 to 64 yr. Presenting symptoms were pain, bloody diarrhea, and tenesmus. Some patients had a previous history of endometriosis. Most of the tumors arose in the rectosigmoid colon. The histologic features were the same as their uterine counterpart. No death of disease had been reported. This rare tumor should not be confused with gastrointestinal stromal tumor clinically and histologically.

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.

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.

Factors Influencing the Recurrence of Breast Cancer Following Modified Radical Mastectomy / 한국유방암학회지

PURPOSE: We studied the risk factors for loco-regional recurrence and distant metastasis in patients following treatment of operable breast carcinoma with a modified radical mastectomy. METHODS: 374 breast cancer patients were treated by modified radical mastectomy between 1989 and 1999 at the Department of Surgery, Korea University College of Medicine. The median age of the patients was 48.3 years old. The duration of the mean follow up period was 53.6 months. By reviewing the patients' medical records, we constructed a database cataloguing disease recurrence, age, menstruation, pathology, tumor size, nodal status, stage and the presence of hormonal receptor. Statistical analysis was done by SPSS for Windows 9.0. RESULTS: Of the original 374 patients screened, one was excluded for the development of bone metastasis preoperatively. Within the remaining patients, 61 (16.3%) experienced recurrence following surgery. Among the recurred patients, loco-regional recurrence developed in 27 patients (7.5%) and distant metastases in 33 patients (9.1%). The 5 year survival rate was 90.5% in non-recurred patients, 34.9% in loco- regionally recurred patients and 30.0% in systematically recurred patients respectively (p=0.00). On the multivariate analysis, tumor size (T stage), lymph node status (N stage) and overall pathologic stage were associated with loco-re-gional recurrence and the absence of estrogen receptor was associated with distant metastasis following the mastectomy. CONCLUSION: The risk factors for loco-regional recurrence following modified radical mastectomy were tumor size and nodal status. Moreover, distant metastasis was more frequent in patients lacking estrogen receptor. Due to the poor survival rate of the loco-regionally recurred patients, we should regard local recurrence as a poor prognostic sign.

Factors Influencing the Recurrence of Breast Cancer Following Modified Radical Mastectomy / 한국유방암학회지

PURPOSE: We studied the risk factors for loco-regional recurrence and distant metastasis in patients following treatment of operable breast carcinoma with a modified radical mastectomy. METHODS: 374 breast cancer patients were treated by modified radical mastectomy between 1989 and 1999 at the Department of Surgery, Korea University College of Medicine. The median age of the patients was 48.3 years old. The duration of the mean follow up period was 53.6 months. By reviewing the patients' medical records, we constructed a database cataloguing disease recurrence, age, menstruation, pathology, tumor size, nodal status, stage and the presence of hormonal receptor. Statistical analysis was done by SPSS for Windows 9.0. RESULTS: Of the original 374 patients screened, one was excluded for the development of bone metastasis preoperatively. Within the remaining patients, 61 (16.3%) experienced recurrence following surgery. Among the recurred patients, loco-regional recurrence developed in 27 patients (7.5%) and distant metastases in 33 patients (9.1%). The 5 year survival rate was 90.5% in non-recurred patients, 34.9% in loco- regionally recurred patients and 30.0% in systematically recurred patients respectively (p=0.00). On the multivariate analysis, tumor size (T stage), lymph node status (N stage) and overall pathologic stage were associated with loco-re-gional recurrence and the absence of estrogen receptor was associated with distant metastasis following the mastectomy. CONCLUSION: The risk factors for loco-regional recurrence following modified radical mastectomy were tumor size and nodal status. Moreover, distant metastasis was more frequent in patients lacking estrogen receptor. Due to the poor survival rate of the loco-regionally recurred patients, we should regard local recurrence as a poor prognostic sign.

Factors Influencing the Recurrence of Breast Cancer Following Modified Radical Mastectomy

PURPOSE: We studied the risk factors for loco-regional recurrence and distant metastasis in patients following treatment of operable breast carcinoma with a modified radical mastectomy. METHODS: 374 breast cancer patients were treated by modified radical mastectomy between 1989 and 1999 at the Department of Surgery, Korea University College of Medicine. The median age of the patients was 48.3 years old. The duration of the mean follow up period was 53.6 months. By reviewing the patients' medical records, we constructed a database cataloguing disease recurrence, age, menstruation, pathology, tumor size, nodal status, stage and the presence of hormonal receptor. Statistical analysis was done by SPSS for Windows 9.0. RESULTS: Of the original 374 patients screened, one was excluded for the development of bone metastasis preoperatively. Within the remaining patients, 61 (16.3%) experienced recurrence following surgery. Among the recurred patients, loco-regional recurrence developed in 27 patients (7.5%) and distant metastases in 33 patients (9.1%). The 5 year survival rate was 90.5% in non-recurred patients, 34.9% in locoregionally recurred patients and 30.0% in systematically recurred patients respectively (p=0.00). On the multivariate analysis, tumor size (T stage), lymph node status (N stage) and overall pathologic stage were associated with loco-regional recurrence and the absence of estrogen receptor was associated with distant metastasis following the mastectomy. CONCLUSION: The risk factors for loco-regional recurrence following modified radical mastectomy were tumor size and nodal status. Moreover, distant metastasis was more frequent in patients lacking estrogen receptor. Due to the poor survival rate of the loco-regionally recurred patients, we should regard local recurrence as a poor prognostic sign.

Mammary Adenomyoepithelioma in Male Patient / 한국유방암학회지

Myoepithelial cells are the normal constituent of mammary gland and the lesions arising from this components are rare and can be divided into three categories. Adenomyoepithelioma, which is one of them, has a characteristics of dual proliferation of epithelial and myoepithelial cells but the biologic behavior of it has not yet been fully understood. Most of the adenomyoepitheliomas are reported in female patients and there are few of male patient reported in English literature. We experienced one case of male adenomyoepithelioma and report the case with review of literature.

Correlation of multidrug resistance gene expression with hestologic grade in locally advanced breast cancer / 대한암학회지

No abstract available.

Breast Mass as a Manifestation of Ectopic Paragonimiasis: A case report

Paragonimus westermani can cause extrapulmonary parasitism in various sites such as abdominal organ, brain, eye, periorbital tissue, heart and pericardium, mediastinum, and subcutaneous tissue. We experienced a case of subcutaneous paragonimiasis involving the breast. The lesion exhibited chronic granuloma with scattered eggs of paragonimus westermani. The adult worm was not found within the lesion which should be disintegrated a year ago by praziquantel treatment. This relatively rare involvement of ectopic paragonimiasis should be differentiated from breast malignancy.