Histopathologic Analysis of BI-RADS Category 4a Breast Lesions Diagnosed by Ultrasonography / 한국유방암학회지

PURPOSE: We analyzed the histopathologic findings of the patients with ultrasongraphic Breast Imaging Reporting and Data System (BI-RADS) Category 4a breast lesions to determine which patient can be excluded from any invasive, diagnostic procedure in the future. METHODS: Of the 180 cases of BI-RADS Category 4a breast lesions that were diagnosed with ultrasonography during a 6 month-period, 132 cases were pathologically confirmed and these were analyzed retrospectively. Four benign cases that did not undergo any further procedure after fine needle biopsy and 6 malignant cases (4.5%) were excluded from this study. RESULTS: Of the 122 cases, 77 cases (63.1%) showed homogeneous benign finding, and 45 cases (36.9%) showed heterogeneous finding that was made up of two or more different pathologic lesions. Fibroadenoma (55.8%) was the most frequent pathologic finding in the cases with homogeneous finding, followed by fibrocystic change (14.3%), and fibrosis (7.8%). The cases with heterogeneous finding presented fibrocystic change (55.5%), microcalcification (48.8%), ductal hyperplasia (42.2%), and fibroadenoma (31.1%) in the order of frequency. CONCLUSION: Lesion with heterogeneous histopathologic nature was the most frequent finding defined as category 4a in breast ultrasonography, followed by fibrodenoma, fibrocystic change, microcalcification, and ductal hyperplasia. Refining more specific ultrasonographic findings of these lesions would guarantee that radiologists exclude more benign lesions from category 4a.

Expression of the Markers for the Mammary Stem Cells and the Cellular Lineages of the Mammary Gland on Ductal Carcinoma In Situ / 한국유방암학회지

PURPOSE: Breast Cancer is an inter-tumoral and intra-tumoral heterogeneous disease. It remains unclear whether this heterogeneity results from different target cells or from different subsets of genetic abnormalities, otherwise from both. We postulated that in addition to genetic cloning, a variety of cells that exist during the defined developmental stages of the human mammary gland could give rise to the heterogeneity of breast cancer. To verify this postulation, we have analyzed pure ductal carcinoma in situ (DCIS) for the expression of the biomarkers that represent the mammary stem cell, the early progenitor cells, and the glandular and myoepithelial cells of the mammary gland. METHODS: We investigated the relationship between the immnuohistochemical expression of the mammary development-associated biomarkers {cytokeratin-18 (CK18), cytokeratin-6 (CK6), alpha-smooth muscle actin (SMA), Wnt-1, Notch 3} and some other factors {the menopausal status, the estrogen receptor (ER) status, the progesterone receptor (PR) status, c-erbB-2, and the number of tumor foci} in 26 cases of DCIS. RESULTS: All 26 cases included in this study showed the positive expressions of CK18 and SMA. The expression of all the markers was not correlated with the menopausal status. The positive expression of CK6 had a statistically significant relationship with a negative estrogen receptor (p=0.014), positive c-erbB-2 (p=0.048), high nuclear grade (p=0.001), and single focus of DCIS (p=0.017). The expression of Wnt-1 and Notch 3 did not have significant correlation with any factors. However, the positive expression of Wnt-1 showed a tendency of a negative ER (p=0.061) and the positive expression of Notch 3 also showed a tendency of a negative ER (p=0.086) and a high nuclear grade (p=0.086). CONCLUSION: The CK6 positive tumor is thought to originate from the more primitive cells compared to the CK6 negative tumor. Unifocality of the CK positive tumor might result from the arrest of differentiation of the original cell after disease affection. DCISs could be categorized into the CK6 positive and negative groups.

Cathepsin D expression in the tumor cells and juxta-tumoral stromal cells of T1 invasive ductal carcinoma, Nos / 한국유방암학회지

INTRODUCTION: Cathepsin D (CD) is a lysosomal protease that can be used as an important prognostic cytosolic factor for breast cancer. Its over-expression in breast cancer cells and in the host stromal cells in the tumor has been proposed as being a poor prognostic indicator. However, its prognostic value is still being debated. Therefore, CD expression needs to be examined in more relevant subsets of tissue in order to refine its prognostic significance and the clinical applications. METHODS: Regardless of the lymph node status, 110 T1 invasive ductal carcinomas of the breast were immunohistochemically evaluated for the CD expression using rabbit anti-cathepsin D monoclonal antibody. This study separately assessed the expression of CD in the invasive component (IDC), in the in situ component (DCIS), and in the juxtatumoral stromal cells (JTSC). The CD expression level in these three kinds of tissues were correlated with the nuclear grade, ER, PR, c-erb-B2, p53, the N stage, the T stage, and the 5 year metastasis-free survival. RESULTS: Positive CD expression in the JTSC was associated with the T stage (p = 0.001) and the N stage (p = 0.029), whereas positive CD expression in the DCIS and IDC was not. In addition, strong CD expression in the JTSC correlated with the nuclear grade of the invasive component (p = 0.024). In all three components, no statistically significant correlation was found between the biomarker (ER, PR, cerb-B2, p53) and the CD expression. On univariate analysis, positive expression in the JTSC was correlated with a poor 5 year- metastasis free survival (p = 0.007), but the positive expression in the IDC and DCIS was not. CONCLUSION: CD expression of the JTSC could represent the N stage, the T stage, and the nuclear grade of T1 IDC. Whether or not it would have an independent influence on the prognosis of T1 IDC, CD expression in the JTSC is probably an indicator of the tumor virulence. CD expression in the JTSC will provide an important clue for the development of new CD targeted therapies, and it will serve as an important criterion for selecting the appropriate candidates for these future targeted therapies.

Usefulness of Ultrasound Guided Vacuum-Assisted Mammotome Biopsy for Breast Lesion

PURPOSE: The purpose of this study was to determine the accuracy of ultrasound guided vacuum-assisted Mammotome biopsy (UVAMB) for breast lesions. METHODS: Percutaneous biopsies of 564 breast lesions, in 489 patients, using UVAMB were performed between October 2000 and May 2002. The pathological findings of the UVAMB were compared with excisional biopsies, sonographic follow-ups and clinical follow-up findings. We evaluated the complication on immediate post-biopsy and 1 week later using ultrasound. RESULTS: Of the 564 lesions, 108 (19.1%) were diagnosed as malignant by UVAMB, and of 456 benign lesions, 63 were excised. On excision two of the benign lesions were found to be carcinomas. The false negative rate of the UVAMB was 2.7%, and 99 (17.5%) of the 564 biopsies were revealed as hematomas by ultrasound 1 week later. However, almost all of complications were well controlled by conservative management. CONCLUSION: Ultrasound guided vacuum-assisted Mammotome biopsies reduced the possibility of false-negatives and underestimated the disease. The complications of UVAMB were not serious, was proved to be a good biopsy method for small, non-palpable breast lesions.

Breast Cancer Screening of 51,170 Women

PURPOSE: The purpose of this study was to evaluate the efficacy of annual breast screening, which includes a mammography and a clinical physical examination. METHODS: From April 1995 to March 2000, we performed 51,170 annual clinical examinations and mammographies on 26,354 women, who wanted to undergo breast screening, at the breast center. Ninety-five breast cancers were detected during screening, and of these, only 76 breast cancers were operated on. The result were compared with 650 symptomatic breast cancers from the outpatient department (OPD). RESULTS: Of the 51,170 cases screened, the recall rate for further examination was 9.9% (n=5,066), and the biopsy rate was 2.1% (n=1,096). Ninety-five breast cancers were detected; a detection rate of 0.19%. Fourteen breast cancers were detected after more than 2 screening rounds. On the analysis of the medical audit data based on the screening mammographies, the positive predictive value, confirmed when a biopsy from a surgical consultation was recommended (PPV), was 8.6%. Further, 41 cases involving tumors found at stage 0 or I (54%). There were 25 cases of axillary lymph node metastasis (32.9%). These results were compatible with the ideal rates for medical audits, except for PPV and axillary lymph node metastases. The pathologic stages of the screened group were: 0, 22.4%; I, 31.6%; II, 40.8%; III, 5.2%, whereas those of the OPD group were 0, 3.4%; I, 27.4%; II, 52.8%; III, 15.5%, and IV, 0.8%. Early breast cancers were detected more frequently through screening than by the OPD (P<0.05). Breast conservation surgery was carried out on 32.9% (25 cases) from the screened group, but only 12.8% (83 cases) from the OPD group (P<0.05). CONCLUSION: Our breast cancer screening was properly performed. Further, these findings indicate that breast cancer screening using a clinical examination and a mammography is very effective in the early detection of breast cancer.

Analysis of Chromosome-specific Aneusomy in Breast Tumor by Using Fluorescence in Situ Hybridization

PURPOSE: Several studies have used FISH (fluorescence in situ hybridization) to analyze aneuploids in various solid tumors. FISH, using chromosome-specific, alpha-stellite DNA probes, can be used to detect aneusomy in interphase and/or metaphase cells. The aims of this study were to compare the FISH cen tromere signals from benign breast tumors and to those from breast cancers and to evaluate the clinico pathologic parameters and the aneusomic patterns involving chromosomes 1, 11, and 17 in breast cancers. METHODS: FISH was performed on touch preparations from 15 benign breast-tumor and 29 breast-cancer specimens. The frequency of aneusomy, measured by nondisomy, was determined for chromosomes 1, 11, and 17 through the use of chromosome-specific alpha-stellite DNA probes. The frequency of chromosome- specific aneusomy was then correlated with clinicopathologic parameters, including tumor size, lymph- node involvement, estrogen receptor, and nuclear grade. RESULTS: Only one of the 15 benign breast tumors was shown to be aneusomic for chromosome 1. The other 14 cases of the benign breast tumors showed no evidence of aneusomy for any of the 3 chromosomes. In breast cancers, however, 26 of the 29 cases (90%) were exhibited aneusomy of at least 1 of the 3 chromosomes evaluated and chromosome 1 was most frequently aneusomic (26 of 29 cases (90%)). The present study also suggested a possible correlation between the numeric abnormality of chromosome 1 and estrogen receptor levels. No significant correlations with tumor size, regional lymph-node metastasis, and nuclear grade were observed. CONCLUSION: These findings suggest that chromosome-specific aneusomy is more frequently observed in breast cancers than in benign breast tumors and that aneusomy of chromosome 1 correlates with estrogen receptor levels.

Telomerase Activity in Human Breast Tumors

BACKGROUND: Telomerase is a ribonucleoprotein enzyme that synthesizes telomeric DNA onto the ends of chromosomes, thereby preventing the replication-dependent shortening of those ends. Telomerase activity is detected in a wide range of cancers of various tissues, and its expression may be a critical step in tumor progression. Our objective was to determine if detection of telomerase activity may be an indicator for diagnosis of breast cancer and if any association exists between telomerase activity and prognostic factors of breast cancer. METHODS: Using a polymerase chain reaction-based telomerase activity assay, we examined telomerase activity in 30 breast cancer specimens (2 ductal carcinoma in situ, 28 invasive ductal carcinoma), 25 benign lesions (14 fibroadenomas, 11 fibrocystic diseases), and 24 normal breast tissues (13 adjacent to malignancy, 11 adjacent to benign lesion). RESULTS: Among surgically resected samples, telomerase activity was detected in 23 (77%) of 30 breast cancers. While telomerase activity was not detected in any of the 11 specimens of fibrocystic disease and the 11 normal tissues adjacent to benign lesion, surprisingly low levels of telomerase activity were detected in 5 (36%) of the 14 fibroadenomas and 1 (7%) of the 13 normal tissues adjacent to malignancy. There was no significant difference in expression of telomerase among prognostic factors of breast cancer. CONCLUSIONS: In summary, telomerase activity may be useful in the diagnosis of breast cancer. We found no correlation between telomerase activity and stage, tumor size, or LN status. Mechanisms of telomerase expression are still under investigation; therefore, the significance of telomerase expression in malignant tumors and their progression remains to be determined.

Evaluation of Mass Screening for Thyroid Cancer

Mass screening for detecting both thyroid and breast cancer in adult women was carried out in Samsung Cheil Hospital between March 31, 1996, and March 31, 1997. The total number of subjects during those 13 months was 3869. At first, the screening was by inspection and palpation using experienced surgeons. Thyroid abnormalities were found in 183 subjects through physical examination but thyroid nodules were identified by thyroid sonography in only 170 patients who were required to undergo a cytologic examination (FNAB). The total number of thyroid cancer cases detected was 23. The detection rate was 0.59%. In contrast, 8 cases of breast cancer were discovered during the same screening, with a detection rate of 0.21%. The size of the thyroid tumor was 2 cm or less in 20 patients (87%). The thyroid cancers detected by mass screening were discovered at an earlier stage and will show a better survival rate. As thyroid cancer can be found at an earlier stage by mass screening, the program is useful for the early detection and early treatment of thyroid cancer.

Breast-Conserving Surgery With or Without Radiation Therapy for Early Breast Cancer

Breast conserving surgery (BCS) with radiation therapy (RT) has been considered an alternative to a radical mastectomy in the surgical treatment of early breast cancer. Breast-conserving therapy (BCT) can achieve a more favorable cosmetic outcome than a mastectomy in patients with early breast cancer. However, it is widely recognized that RT following BCS is an impediment to improve the cosmetic outcome of a BCT-treated breast. If the local recurrence (LR) rate is acceptable and LR can be controlled with salvage surgery, an appropriate conservative surgical procedure without RT will be a reasonable option for some patients with early breast cancer. Between 1990 and 1996, 60 patients were enrolled in a retrospective study to examine whether or not RT could be avoided following conservative surgery in patients with early breast cancer. There was no significant difference in local recurrence rate between the RT and the non-RT groups (6.3% vs 10.7%). The characteristics of suitable BCS without RT would be negative axillary lymph-node metastasis, low nuclear grade, a 1 cm negative resection margin and no lymphatic vessel involvement. In conclusion, breast-conserving surgery without RT is a reasonable option for some patients with early breast cancer.

Telomerase Activity in Human Breast Tumors / 한국유방암학회지

Telomerase is a ribonucleoprotein enzyme that synthesizes telomeric DNA onto the ends of chromosomes. thereby preventing the replication-dependent shortening of these ends. Telomerase activity is detected in a wide range of cancers of various tissues, and its expression may be a critical step in tumor progression. Our objective was to determine if detection of telomerase activity may be an indicator for diagnosis of breast cancer and any association between telomerase activity and prognostic factors of breast cancer. Using a polymerase chain reaction-based telomerase activity assay, we examined telomerase activity in 30 breast cancer specimens (2 ductal carcinoma in situ, 28 invasive ductal carcinoma), 25 benign lesions (14 fibroadenomas, 11 fibrocystic diseases) and 24 normal breast tissues (13 adjacent to malignancy, 11 adjacent to benign lesion). Among surgically resected samples, telomerase activity was detected in 23 (77%) of 30 breast cancers. While telomerase activity was not detected in any of 11 specimens of fibrocystic disease and 11 adjacent normal tissues to benign lesion, surprisingly low levels of telomerase activity were detected in 5 (36%) of 14 fiboadenomas and 1 (7%) of 13 adjacent normal tissues to malignancy. There was no significant difference in expression of telomerase among prognostic factors of breast cancer. In summary, telomerase activity in breast cancer may be useful in diagnosis of breast cancer. We found no correlation between telomerase activity and stage, tumor size or LN status. Mechanisms of telomerase expression are still under investigation; therefore, the significance of telomerase expression in malignant tumors and their progression remains to be determined.

Needle Localization Biopsy of 546 Nonpalpable Breast Lesions

A retrospective review of 546 consecutive female patients who had undergone mammographically controlled needle localizations was performed to assess the effectiveness of the technique and to analyze the number and the characteristics of the criteria malignancies found in this group. Localization biopsy was recommended if one or more of the following criteria were present: evidence of a mass, microcalcifications, parenchymal distortion, and/or spiculation. Of those 546 patients who had undergone specimen mammography after needle localization biopsy, a lesion was detected on 544 cases and missed in 2 cases(0.3%). Fifty-five cancers were detected(10.1%) Histologically, the cancers included 23 invasive and 32 in-situ tumors. The predominant histologic cell type was ductal in origin with only three having lobular characteristics. Postoperative pathologic findings of the lymph nodes showed 3 of the 55 were positive for metastases. In summary, the technique of preoperative needle localization in this series had a 99.7% success rate. The cancer detection rates for a 'mass with a microcalcification', a 'microcalcification', and a 'mass' were 17.0, 14.0, and 5.1% respectively. As a conclusion, needle localization biopsy is a safe and effective method for definitely diagnosing nonpalpable breast lesions.

Needle Localization Biopsy of 546 Nonpalpable Breast Lesions

A retrospective review of 546 consecutive female patients who had undergone mammographically controlled needle localizations was performed to assess the effectiveness of the technique and to analyze the number and the characteristics of the criteria malignancies found in this group. Localization biopsy was recommended if one or more of the following criteria were present: evidence of a mass, microcalcifications, parenchymal distortion, and/or spiculation. Of those 546 patients who had undergone specimen mammography after needle localization biopsy, a lesion was detected on 544 cases and missed in 2 cases(0.3%). Fifty-five cancers were detected(10.1%) Histologically, the cancers included 23 invasive and 32 in-situ tumors. The predominant histologic cell type was ductal in origin with only three having lobular characteristics. Postoperative pathologic findings of the lymph nodes showed 3 of the 55 were positive for metastases. In summary, the technique of preoperative needle localization in this series had a 99.7% success rate. The cancer detection rates for a 'mass with a microcalcification', a 'microcalcification', and a 'mass' were 17.0, 14.0, and 5.1% respectively. As a conclusion, needle localization biopsy is a safe and effective method for definitely diagnosing nonpalpable breast lesions.

Bilateral Breast Cancer

Bilateral breast cancer is not a common clinical problem, and its occurance is not suprising in this paired organ. Bilateral breast cancer is categorized as synchronous or metachronous. We propose to evaluate clinical and biological characteristics in bilateral breast cancer. Previous cancer in one breast is the strongest known risk factor for cancer to develop in the second breast, and a young age at dignosis of a breast cancer and lobular type of tumor are additional risk factors related to bilaterality. Seventeen cases of bilateral breast cancer have been admitted to the department of General surgery, Samsung Cheil general Hospital from 1980 till 1995. We report the analysis of these cases with the references. The incidence of bilateral breast cancer among all case of total breast cancer was 2.1%(17/827). Synchronous breast cancer was 3 cases(0.4%) and metachronous breast cancer was 14cases (1.7%). The median age was 41 years. The mean age at diagnosis of the primary tumor in the metachronous group was 40 years. Among metachronous cases, the mean interval between the treatment of the primary cancer and the detection of secondary cancer was 37months. The clinical stage was 0-I in 12%, II in 50%, III in 32%, and IV in 6% of tumors. The majority of patients (88%) were clinically node positive. Out of a total of 34 tumors, the clinical tumor size Tis-T1 in 8 tumors, T2 in 21 tumors, and T3 in 5 tumors. Histopathologic type of the pimary tumor was the same with the second in 70%(12/17). The location of secondary breast cancer was in the upper outer quadrant in 9 cases, and in the upper medial quadrant of breast in 2 cases. The premenopausal primary cancer was in 50% of the patients, and postmenopausal primary cancer was in 50% of patients for whom this information was available. Median survival period was 57 months, and 5 year survival rate was 80%. Bilateral breast cancers have similar biological features to unilateral breast cancer more freqently than would be predicted by chance alone. The similarity in clinical aspects of unilateral and bilateral breast cancers should be considered in clinical management of patients with breast cancer. Further investigation is required to know these similaritics and differences between unilateral and bilateral breast cancer.

Breast Cancer Screening of 13,791 Women by Physical Examination and Mammography

This study is to clarify the efficacy of breast cancer screening by physical examination and mammography and to compare the diagnostic outcome of breast cancers detected by screeening with that of breast cancers found at out-patient clinic. Between March 1995 and July 1996, A total of 13,791 women were screeened for breast cancer annually by physical examination and mammography at Samsung Cheil Hospital Breast Center and 20 breast cancers were detected. In the same period, another 166 breast cancers were found at out-patient clinic. These two groups of breast cancers were analyzed and compared. Of those 13,791 screened women, the recall rate for further examination was 9.8%(n=1,350) and the biopsy rate was 1.06%(n=146) respectively. Twenty breast cancers were detected so that the breast cancer detection rate was 0.15%. T-stages of screened group were T0;25%, T1;55%, T2;15% and T3;5%, while those of out-patient clinic cases were T0;4.8%, T1;43.4%, T2;44.6%, T3;7.2%.(p<0.05). Axillary lymph node metastasis was negative in 80% of screened group but in 59% of out-patient clinic cases.(p<0.05). Pathological stages of screened group were; stage0;25%, stageI;40%, stageII;35% and those of out-patient clinic cases were stage0;4.8%, stageI;24%, stageII;56%, stageIII;14.4%, stageIV;1.2%(p<0.05). Early breast cancers were significantly more frequent in the patients detected by screening at breast center than those of out-patient cilinic cases. The breast conservation surgery was done in 40% of screened group but only in 12.7% of out-patient clinic cases(P=0.00029).This study indicated that the efficacy of breast cancer screening by physical examination and mammography was significant for the early detection of breast cancers.

Response of the Sympathetic System During and After Fiberoptic Gastroscopy / 대한소화기내시경학회지

Cardiovascular changes induced by a variety of physiological, surgical or emotional stresses are associated with increased sympathetic nervous system activtity. Sympathetic stimulation lowers the ventricular resistance in patients with ischemic heart disease. Thus sympathoadrenal aetivation may play role in sudden cardiac death. We measured the catecholamine levels just before and after fiberoptic gastroscopy, The results were as follows: 1) Though there was no statistical significance, plama catecholamine levels tends to increase during and after fiberoptic gastroscopy. 2) Significant changes in mean blood pressure did not occur during and after fiberoptic gastroscopy. 3) Before fiberoptic gastroscopy, norepinephrine level of three hypertensive patients were lower than the levels of studied patients, But during and after fiberoptic gastroacopy, norepinephrine level increased by 3 times. 4) The highest norepinephrine level was 847 pg/ml and epinephrine level was 110 pg/ml. Though sympathetic response was enhanced by fiberoptic gastroscopy, norepinephrine level did not increase up to the level shown in myocardial infarction or severe exercise.

Duodenal Perforation due to Foreign Body Swallow / 대한소화기내시경학회지

A 23 year old female patient swallowed a tooth brush about one month prior to admission. She has been felt discomfort in epigastrium and dull aching pain recently around umbilicus. Upper gastrointestinal X-Ray and gastroduodenoscopic examination disclosed that a full size, yellow tooth brush is lodged transversely in the stomach and duodenal bulb, Endoscopic remova.l was tried and failed because of impaction of the both ends into mucosa. The tooth brush was removed by gastrotomy under general anesthesia. The free end of the brush handle penetrated the duodenal bulb wall and the impaction of the tip prevented the leakage of duodenal contents before removal. Though the primary method of the gastroduodenal foreign body is endoscopic, if sharp end of the forei body seems to be impacted into the gastrointestinal wall, and if it retained same position for long duration, it should not tried to remove by force fo prevention of leakage and resulting peritonitis. Surgical removal may be safer method in these cases.

Three Cases of Heterotopic Pancreas of the Stomach / 대한소화기내시경학회지

Heterotopic panereas is pancreactie tissue occuring outside its normal anatomical location and without any connection and normal pancreas and it is a developmental anormaly. The most commen site is stomach(esp. greater curvature of the antrum), duodenum and jejunum, In majority of cases heterotopic pancreas does not produce symptoms. When it produces complications, the symptoms depend on the site of lesion and the size of mass. Pathologically, the heterotopic pancreatic tissue is subject to all the lesions found in the normally placed pancreas. Tbe smooth broad base intramural defect with central niche ie typical radiologic fiadings of heterotoPic pancreas. Gastrofiberscopy revealed a small round, submucosal projection with a central umblication. The lesions are frequently confused with polys, lymphoma, in.tramural neoplasm and gastric uleer. Accurate diagnosis may prevent needless surgical procedures. Three cases of heterotopic pancreas of stomach were reported and the pertinent literature were reviewed briefly.

Gastric Polyps / 대한소화기내시경학회지

Gastric polyp is a cinical term without any pathological significance. lt referes merely to any benign, mucosal lesions that protrudes in to the gastric lumen, but conventlonaily it includes a malignaiit lesion which seems to be degenerated from benign one. (continue...)

Intestinal perforation due to infection of Sparganum mansoni

In May 1974, authors encountered a 37 year old Korean male who was suffering from very serious condition of acute abdomen. On exploratory laparotomy, a ruptured granulomatous mass in the proximal portion of the ileum showing extensive inflammatory and gangrenous changes was found and about 4 ft. long of the bowel was resected. From the honey-combed fibrous capsules in the mass, four plerocercoid larvae, spargana, measuring about 3 to 7 cm in lengths were extirpated. The patient had a past history of having eaten the raw flesh of a snake as a tonic about 7 months prior to admission. Four cases of intra-abdominal sparganosis reported previously in Korea and the present case were discussed briefly. Snakes and frogs in Korea are very important second intermediate hosts for the 1arva, Sparganum stage. It is most preferable that the habitual ingestion of the raw fleshes of them should be avoided in this country.

Gastric Carcinoma(An eleven year review of 792 cases)

Statistical analysis of 792 cases of gastric carcinoma is reported. Materials were collected from the medical record room during the 11 year period from Jan. 1955 to Dec. 1965. Diagnosis of gastric carcinoma was established by pathologic examination of the resected specimen, by lymph node biopsy, and by physical and X-ray findings. The age of peak incidence was in the 5th decade. The male to female ratio was 3:1. In the order of frequency, the symptoms and signs which were the most prominent and common were epigastric pain or discomfort, indigestion, anorexia, a palpable mass, weight loss, and epigastric tenderness. More than 50% of the patients had symptoms for less than 6 months. About 70% of the patients and hypochlorhydria on gastric analysis. More than 60% of the carcinomas were located in the prepyloric region. Regional lymph-node metastasis was present in 76% of the cases. In order of frequency this occurred in the omentum, celiac nodes, liver, pancreas, and mesocolon. There was a 56.4% operability and 58.8% resectability. The most common postoperative complication was wound infection. There were 9 operative deaths which made a 3.4% mortality for cases resected, and 2% mortality for all cases coming to surgery. The five year survival rate was 12.9% for all cases coming to surgery, but was increased to 22.2% for patient having a total gastrectomy and 24.2% for patients having a subtotal gastrectomy. 12.0% of patients having gastrectomy in which there were positive nodal metastases survived five years, but, when metastasis was not noted the patients who had had a gastrectomy survived at a rate of 45.5% for five years. The surgical result was influenced by several fastors other than the presence or absence of metastases to the lymph nodes. These factors included the grade of the tumor microscopically, the presence or absence of serosal involvement, and the pathologic type of the tumor. It is our opinion that our surgical results, which are poor when compared with those in the literature, are due mainly to the fact of a late diagnosis. Some of the patients were so far-advanced as to be questioned as to their being candidates for surgery. Most of the patients come to the surgeon simply because of their symptoms and signs which have developed beyond the point of tolerance, or because of family pressures to come for treatment. This study revealed that the resectability rate, and the surgical results improved year by year. This fact explains why the early diagnosis is so very important. It is felt keenly that education of the public and increased alertness on the part of both patients and physicians is needed. This is particularly true when the patient is over 40 years of age, complains of indigestion, epigastric pain or discomfort. Each of these patients should have a complete check-up. Once the chance for cure of the disease has passed it is difficult to do more than a palliative procedure.