Clinicopathologic factor and Lymphovascular Invasion in Breast cancer / 한국유방암학회지

PURPOSE: Clinicopathologic factors associated with prognosis in breast cancer patients have varied. Among clinicopathologic factors, lymphovascular invasion (LVI) has been suggested to be a significant prognostic indicator for breast cancer. LVI means that cancer cells were found invading the lymphatics in the breast parenchyma adjacent to or well beyond the margin of the invasive tumor, and this can be an indicator of an increased chance that cancer could spread, as is demonstrated by the positive lymph nodes. The objective of this study was to determine whether LVI are associated with other clinicopathologic factors in breast cancer. METHODS: The expression of HER-2, Ki-67, P53, estrogen receptor and progesterone receptor was determined immunohistochemically in 120 breast cancer patients, including 77 patients that demonstrated the absent of LVI and 43 patients with the present of LVI. RESULTS: LVI was noted in 43 patients (35.8%) of the 120 breast cancer patients. Of the 77 patients with absent of LVI, the number of stage III patients (13 patients, 16.9%) was lower than the number of stage I (25 patients, 32.5%) and stage II breast cancer patients (39 patients, 50.6%). Of the 43 patients with absent of LVI, 5 patients (11.6%), 13 patients (30.2%), and 25 patients (58.2%) were in stage I, II, and III, respectively. There was a significant correlation between LVI and the stage (P=0.000). The strong expression (+3) of HER-2 was seen in 17 (39.5%) of the 43 patients in whom LVI was seen and in 15 (19.5%) of the 77 patients in whom LVI was not seen. Overexpression of Ki-67 was noted in 42 (97.7%) of the 43 patients in whom LVI was seen and in 64 (83.1%) of the 77 in whom LVI was not seen. HER-2 and Ki-67 overexpression was significantly associated with LVI (p=0.027 and p=0.018, respectively). LVI did not correlate with the expression of P53, the estrogen receptor status and the progesterone receptor status. There was a strong association of LVI and the lymph node status (p=0.000). Finally, LVI was associated with tumor size (p=0.014) and with the nuclear grade (p=0.022). CONCLUSION: This study demonstrates the potential value of the lymph nodal status, tumor size, stage and nuclear grade for the assessment of lympho-vascular invasion; and the overexpressions of HER-2 and Ki-67 were strong indicators of LVI in invasive ductal carcinoma of the breast.

Expression of Beta-catenin and E-cadherin in Early Gastric Cancer: Correlation with Clinicopathologic Parameters / 대한소화기학회지

BACKGROUND/AIMS: Beta-catenin is known to perform two unrelated functions in cadherin-mediated cell to cell adhesion system and Wnt pathway. Recent studies reported cytoplasmic and nuclear accumulation of beta-catenin by Wnt signaling and/or abnormal Wnt pathway in cancer cells. Nuclear accumulations of beta-catenin have a crucial role in early tumor growth and initiation of invasive growth in gastric cancer. METHODS: We carried out clinicopathological and immunohistochemical studies for beta-catenin, p53, E-cadherin, and Ki-67 in the specimens from 60 early gastric cancer patients who were treated with curative resections. RESULTS: Twenty-five (41.7%) and twenty-nine (48.3%) cases showed a nuclear and cytoplasmic expression of beta-catenin, respectively. There were significant correlations between nuclear expression of beta-catenin and well-differentiated and intestinal type of early gastric carcinoma. Cytoplasmic expression of beta-catenin had significant correlations with nuclear expression of beta-catenin (p=0.011). CONCLUSIONS: Nuclear expression of beta-catenin is significantly influenced by histological grade, Lauren classification and cytoplasmic expression of beta-catenin in early gastric cancer. These findings suggest that nuclear expression of beta-catenin is correlated with early tumorigenesis and initiation of invasive growth in gastric cancer.

Cytomegalovirus Esophagitis in Renal Transplant Recipient / 대한이식학회지

Cytomegalovirus (CMV) infection of the gastrointestinal tract can cause serious disease in immunocompromised patients. Recipients of solid organ and bone marrow transplants, persons with malignancies, persons with immune deficiency due to acquired immune deficiency syndrome (AIDS), and those receiving immunosuppressive medication are at risk. When CMV infection of the GI tract causes disease, symptoms include pain, ulceration, bleeding, diarrhea, and perforation. All level of GI tract, from the oropharynx to anus, may be involved. The CMV has been associated with gastric and enteric ulcerations, but infrequently with esophageal infection. Two cases of CMV induced esophagitis have been reported in Korea. We report one recipient of kidney transplant who had esophageal ulceration associated with CMV infection which showed characteristic endoscopic and histologic finding of CMV esophagitis.

Carcinoid Tumor of the Ampulla of Vater

Carcinoid tumors of the ampulla of Vater are extremely rare, and due to their location jaundice in approximately 2/3 of patients. A previously healthy 58-year-old man suffered from indigestion for one year. An abdominal CT and endoscopic ultrasonography showed a relatively well-enhancing mass (2.5 cm in size) at the ampulla of Vater and dilatation of the bile ducts. A duodenoscopy showed a luminally protruding mass, with preserved mucosa, at the ampulla of Vater. So a radical pancreatoduodenectomy was performed. From the operation a 2.3x2.3x2.0 cm-sized submucosal tumor at the ampulla of Vater was found. The cut surface of the tumor had a well circumscribed yellowish fine granular appearance, with a pushing tumor border. Histopathologically the tumor revealed tubular, trabecular and ribbon-like arrangements of tumor cells. The tumor cells had hyperchromatic round nuclei, with coarsely clumped chromatin and indistinct nucleoli. The neoplastic cells were diffusely and strongly immunoreactive for synaptophysin, chromogranin and CD56. We report the experience of a carcinoid tumor at the ampulla of Vater.

Expression of Chk2 and P53 in Sporadic Breast Cancer / 한국유방암학회지

PURPOSE: In response to DNA damage, Chk2 (CHEK2) is involved in cell cycle checkpoint. Chk2 is activated by the upstream ATM kinase and then directly phosphorylate p53 at serine 20. Other substrates for Chk2 are BRCA1, Cdc25A, Cdc25C, mdm2. Germ line mutations of Chk2 have been identified in Li-Fraumeni syndrome with normal p53 alleles. There are few reports on somatic mutations of Chk2 in osteosarcoma, lung cancer, breast cancer, testicular germ cell tumor, ovarian cancer. In this study, we have analyzed 30 breast cancer specimens to understand the relationship of Chk2 and P53 in the pathogenesis of sporadic breast cancer. METHODS: We performed an immunohistochemical studies for Chk2, P53 in the specimens from 30 breast cancer patients. We designed entire intronic primers and searched for Chk2mutations in 7 cases by DNA sequence analysis of the entire coding region. RESULTS: Seven of 30 (23.3%) breast cancers had reduced immuno-expression of Chk2, one of them (1/7, 14.3%) showed a p53 immuno-expression and all of them revealed no Chk2 mutation. CONCLUSION: Expression of Chk2 protein more reduced in breast cancer with no abnormal p53 immuno-expression. No Chk2 mutation was found in all of Chk2 reduced expression, we hypothesize that there may be a posttranscriptional/ posttranslational mechanism (s) in breast caner to downregulate Chk2 protein expression.

Gastrointestinal Autonomic Nerve Tumor (GA NT) in Small Intestine

Gastrointestinal autonomic nerve tumors (GANTs) represent a newly described entity, which are stromal tumors of the gastrointestinal tract, with neuronal differentiation. They are CD117 (c-kit) immunoreactive neoplasms and are often immunoreactive for S100 protein, synaptophysin, and CD34. Ultrastructural examination provides the definitive distinguishing features for diagnosing a GANT. The presence of electron-dense granules, or small vesicles, suggests the presence of postganglionic neurotransmitter vesicles. We experienced a 65-year-old female patient who complained of bloody diarrhea, and a 75-year-old male patient who complained of melena. They were diagnosed with a gastrointestinal stromal tumor by an abdominal CT and operation, and were diagnosed as GANT pathologically. Thus we report two cases of a gastrointestinal autonomic nerve tumor, with a review of the relevant literatures.

Deep Vein Thrombosis Casused by Congenital Absence of Inferior Vena Cava Combined with Hyperhomocysteinemia Due to C677T Methylenetetrahydrofolate Reductase Homozygos Mutation

We present a case of suprarenal & infrarenal absence of inferior vena cava combined with hyperhomocysteinemia in a 39-year-old woman who presented with symptoms of deep venous thrombosis. The patient has also C677T methylenetetrahydrofolate reductase homozygous mutation. Deep vein thrombosis has multifactorial etiology involving both genetic and acquired factors. Absence of inferior vena cava is a rare congenital anomaly, but recently it was confirmed as important risk factor for the development of deep vein thrombosis especially young person. Hypercoagulability by the hyperhomocysteinemia with suggested tendency to venous stasis mediated by agenesis of inferior vena cava must have caused the deep vein thrombosis in our patient. To our knowledge, such an association has not been reported. Clinical features and prognosis of this entity are discussed.

The Expression of CD44s, CD44v5, CD44v6, p27(kip1) in Colorectal Carcinoma

PURPOSE: In treating colorectal carcinoma, metastasis and recurrence are the most important problems encountering after a curative resection of the tumor. Therefore, understanding the mechanism of the disease progression and being able to predict the likelihood of recurrence is very important. METHODS: In this study, 56 colorectal carcinoma cases were reviewed. Immunohistochemical staining on CD44s, CD44v5, CD44v6, and p27(kip1) were performed to determine the expression level of the protein, the patient's clinical findings and the pathophysiology. RESULTS: 1) CD44v5 showed a positive response in 47 (83.9%) out of 56 cases. By analyzing the Astler-Coller classification and the invasion of the lymphatic system, the value expressed was significantly high. 2) p27(kip1) showed a positive response in 35 (62.5%) out of 56 cases. As the disease progressed, there was a significant decrease according to analysis of Astler-Coller classification, and the invasion of the lymph node and lymphatics. The relationship showed an inverse correlation as the disease progressed. 3) For the CD44s and CD44v6, analysis by the Astler-Coller classification, the histological pattern, lymph node metastasis, invasion of the lymphatic system and the depth of the invasion, were not significantly different. CONCLUSION: CD44v5 and p27(kip1) have a relationship with tumor progression, and is a valuable marker for prognosis. In particular, CD44v5 appeared to be involved in tumor progression where the tumor cells invaded the lymphatic system.

Correlation of beta-catenin and p53 Protein Expression with Clinico-pathologic Characteristics of Colorectal Cancer

PURPOSE: Both the beta-catenin and p53 play a crucial role in the process of colon carcinogenesis. The expression of beta-catenin and/or p53 has been reported to be associated with pathologic features of tumor and prognosis of patients. In addition, several recent studies have suggested a close biological association between p53 expression and nuclear beta-catenin level. We analyzed the pathologic variables and p53 expression according to the intra-nuclear beta-catenin expression in colon cancer to make such assumptions more clear since they are still controversial issues. METHODS: The expressions of beta-catenin, p53 and Ki-67 protein in colon cancer were determined by immunohistochemical staining. The relationship between these protein expressions and tumor characteristics was statistically analyzed. RESULTS: The intra-nuclear beta-catenin accumulation was not associated with any of the pathological variables including lymph node metastasis and tumor differentiation, but it was correlated with higher level of Ki-67 proliferation index (P=0.006) and negative staining of p53 (P=0.015). Positive p53 staining was significantly associated with lymph node metastasis (P=0.006), lymphatic invasion (P=0.03) and venous invasion (P=0.02). CONCLUSION: These results support the suggestion that intra-nuclear accumulation of beta-catenin may regulate the p53 activity in colorectal cancer. In addition, positive staining of p53 may be used as a valuable prognostic indicator since it was strongly associated with lymph node metastasis, lymphatic and venous invasion.