Clinical Analysis of 329 Cases of Total Gastrectomy / 대한암학회지

PURPOSE: This study was designed to evaluate the safety including the morbidity and mortality of total gastrectomy and combined organ resection, to examine the survival rate and the prognostic factors of gastric cancer following the total gastrectomy and to assess the prognostic predictability of new UICC staging system after surgery in gastric cancer patients. MATERIAL AND METHOD: To evaluate demographic features, clinical presentations, preoperative diagnostic accuracy, postoperative complications and prognostic factors, we analyzed 329 patients who underwent the total gastrectomy or the total gastrectomy with combined resection for gastric malignancy at KCCH from Jan. 1990 to Dec. 1993 retrospectively. RESULTS: The early postoperative complication rates of overall patients and combined resection group were 9.1% and 8.9%. Mortality of these were 0.9% and 1.1%(p>0.05). The overall 5YSR was 52.8% and there was no significant differrence in the survival rate between the total gastrectomy only group and the combined resection group. The accuracy of preoperative UGIS and abdominal CT for determiantion of resectability were over 80%. The depth of invasion and lymph node metastasis were independent prognostic factors. CONCLUSION: The total gastrectomy with combined resection should be considered when indicated, because the postoperative morbidity and mortality is low and long term survival is expected. The new UICC staging system seems to be good to predict prognosis in gastric cancer patients.

Clinical Analysis of Typical Medullary Carcinoma of the Breast / 대한암학회지

PURPOSE: Medullary carcinoma of the breast is an uncommon subtype of infiltrating ductal carcinoma and its incidence in different series ranges between 2% and 8% of all breast canoers. The histopathologic criteria for medullary carcinoma of the breast used by most pathologists today were delineated by Ridolfi et al. in 1977. The criteria of typical medullary carcinoma include all of followings: 75% or more of syncytial growth pattern, microscopically completely circumscribed, no intraductal component, moderate to marked diffuse mononuclear stromal invasion, nuclear grade 1 or 2. Medullary carcinoma has a more favorable prognosis than usual invasive breast cancer. MATERIALS & METHODS: To determine clinical characteristics of this tumor, the medical records of 15 women with typical medullary carcinoma treated at KCCH between 1985 and 1996 were reviewed retrospectively. RESULTS: The incidence of typical medullary carcinoma in KCCH was 0.51%(15/2946) of all breast cancers. Age ranged from 27 to 56 years and mean age was 40.1 years. The peak age group was 4th decade(46.6%), followed by 5 th decade(40%). Most of the patients were premenopausal status(14/15). The major clinical manifestation of all patients was a palpable mass. Twelve patients were investigated for ER status, but all were negative. Preoperative fine needle aspiration cytology was checked in 6 patients, all cases showed positive findings for malignancy. The mean size of tumor was 3.01 cm in diameter and the rate of lymph node positivity was 40%(6/15). There was one case of systemic recurrence at 38 months after operation and the patient expired at 3 months after detection of recurrence. The others were alive without evidence of disease for mean follow-up period of 64.7 months. CONCLUSIONS: The mean age of the patients of medullary carcinoma was relatively younger than that of the patients with other usual invasive breast cancer. The incidence of medullary carcinoma in this study was slightly lower than western series. Medullary carcinoma showed good prognosis, even if estrogen receptors were negative, but to determine clinical characteristics of Korean medullary carcinoma of the breast, multicenter data should be collected.

Clinical Analysis of Ductal Carcinma in Situ and Microinvasive Carcinoma of the Breast / 한국유방암학회지

BACKGROUND: In the past, the diagnosis of ductal carcinoma in situ (DCIS) was rare, but today the incidence of DCIS has become much more frequent, particularly in patients who underwent mammographic screening. The management of patients with DCIS has become a major clinical dilemma. It has become increasingly difficult to justify the routine use of mastectomy for patients with DCIS, because its natural history is uncertain and breast-conserving therapy (BCT) is currently used for the treatment of many patients with invasive breast cancer. METHODS: To investigate the incidence, clinicopathologic features and the outcome of treatment of DCIS and microinvasive carcinoma (MIC), the medical records and pathology slides of 91 patients with DCIS and MIC who had been treated at KCCH between 1983 and 1996 were reviewed retrospectively. Median follow-up period was 69.4 (4-158) months. RESULT: The results were as follewd; 1) The inciednce was 2.72% (91/3,343) and had been increasing (2.1% in 1980s and 3.3% 1990s). 2) The mean age was 44.2 years and peak age group was fifth decade. 3) The most common clinical features was a palpable mass (69%), followed by nipple discharge, MMG abnormality and Paget's disease in decreasing order of frequency. 4) According to the pathologic classification of Schwartz, comedo type was the most common (32%), followed by cribriform (23%), papillay (20%), mixed (11%), solid (9%) and micropapillary type (5%), 5) There were 58 cases (69%) of pure DCIS and 16 cases (17.5%) of MIC. In 17 case (18.5%) the presence of microinvasion was equivocal or could not be assessed. 6) There were no significant differences between DCIS and MIC in terms of mean age (44.5 years vs 43.8 years), mean tumor size (2.15 cm vs 2.25 cm), the frequency of comedo type (29% vs 36%), lymph node metastasis (0% vs 6%) and multicentricity (3.3% vs 3.0%). However, the palpable mass was more common in MIC than DCIS (82% vs 62%, p<0.05). 7) 75 patients (82%) were treated with mastectomy and 16 patients were treated with breast conserving surgery. 8) Bedsides 2 cases of systemic recurrence among MIC, there was no case of recurrence or disease-associated death during the period of follow-up. CONCLUSIONS: The incidence of DCIS and MIC showed increasing tendency primarily due to the increasing use of screening mammography. Even though the rates of BCT has been increasing, MRM was still the most common procedure for the treatment of DCIS and MIC. The outcome of treatment, in terms of recurrence or survival, was very excellent and almost the same for both groups of pure DCIS and MIC. More long-term follow-up and multicenter study seems to be neccessary to identify the differences in clinical features and outcome between pure DCIS and MIC in Korea.

Clinical Analysis of Surgically Treated Primary Gastric Lymphoma / 대한암학회지

PURPOSE: The incidence of primary gastric lymphoma is a relatively rare and is 2~5% of all gastric malignant lesion. Because of its rarity, there are few report in Korea. Therefore, to elucidste the clinicopathological characteristics and prognosis of primary gastric lymphoma and to investigate MALT(Mucosa-associated lymphoid tissue) lymphoma, we studied in primary gastric lymphoma. MATERIALS & METHODS: we evaluated retrospectively primary gastric lymphoma patients who underwent gastric resection from Jan. 1990 to Dec. 1994 in KCCH. RESULTS: There were 20 patients with primary gastric lymphoma and the incidence is 0.54% of all gastric malignant lesion. Abdominal pain, primarily epigastric, was the most common presenting complaint and the most common location was the distal third of the stomach. The overall 5-year survival rate was 71%. Factor significantly influencing 5-year survival rate was the serosal invasion. Age, gender, tumor size, histologic grade, nodal status and Ann-Arbor staging system did not influence survival. CONCLUSION: So,we suggest that the depth of invasion should be included in staging system of gastric lymphoma because Ann Arbor staging system might be inadequate when applied to primary gastric lymphoma. Also, we suggest that the multicenter study should be performed to elucidate the characteristics of Korean gastric lymphoma because of its low incidence.