Initial titration with 200 μg fentanyl buccal tablets: a retrospective safety analysis in Korean cancer patients

BACKGROUND/AIMS: Managing breakthrough pain (BTP) is important for many cancer patients because of the rapid onset and unpredictable nature of the pain episodes. Fentanyl buccal tablets (FBTs) are a rapid-onset opioid indicated for BTP management. However, FBT titration is needed to optimize BTP management. In this study, we aimed to evaluate the safety and efficacy of initiating 200 μg FBTs in Korean cancer patients. METHODS: A retrospective analysis of medical records was performed on all advanced cancer patients treated with FBTs for BTP between October 2014 and July 2015. Patients who received initial doses of 200 μg FBTs for at least 3 days and cases in which FBT was available at doses of 200, 400, and 800 μg were included. RESULTS: A total of 56 patients with a median age of 62 years (range, 32 to 80) were analyzed, 61% of whom were male. The median and mean values of morphine equivalent daily doses were 60 mg/day (range, 15 to 540) and 114.8 ± 124.8 mg/day, respectively. The most frequent effective doses of FBT were 200 μg (41 patients, 74%) and 400 μg (12 patients, 21%). Three patients (5%) could not tolerate 200 μg of FBT and discontinued treatment. Nausea, vomiting, somnolence, and dizziness were the most frequent treatment-related adverse events (AEs), and all AEs were grade 1 (mild) or 2 (moderate). CONCLUSIONS: FBT at the initial 200 μg dosage was well-tolerated and effective as a BTP management strategy in Korean cancer patients. Further prospective studies are needed to determine appropriate initiating doses of FBT in Korean patients with opioid tolerance.

Practice Patterns Regarding Multidisciplinary Cancer Management and Suggestions for Further Refinement: Results from a National Survey in Korea / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: This study was conducted to explore the process and operation of a cancer multidisciplinary team (MDT) after the reimbursement decision in Korea, and to identify ways to overcome the major barriers to effective and sustainable MDTs. MATERIALS AND METHODS: Approximately 1,000 cancer specialists, including medical oncologists, surgical oncologists, radiation oncologists, pathologists, and radiologists in general hospitals in Koreawere invited to complete the survey. The questionnaire covered the following topics: organizational structure of MDTs, candidates for consulting, the clinical decision-making initiative, and responsibility for dealing with legal disputes. RESULTS: We collected a total of 179 responses (18%) from physicians at institutions where an MDT approach was active. A surgical oncologist (91%), internist (90%),radiologist (89%),radiation oncologist (86%), pathologist (71%), and trainees (20%) regularly participated in MDT operations. Approximately 55% of respondents stated that MDTs met regularly. In cases of a split opinion, the physician in charge (69%) or chairperson (17%) made the final decision, and most (86%) stated they followed the final decision. About 15% and 32% of respondents were “very satisfied” and “satisfied,” respectively, with the current MDT's operations. Among 38 institutional representatives, 34% responded that the MDT operation became more active and 18% stated an MDT was newly implemented after the reimbursement decision. CONCLUSION: The reimbursement decision invigorated MDT operations in almost half of eligible hospitals. Dissatisfaction regarding current MDTs was over 50%, and the high discordance rates regarding risk sharing suggest that it is necessary to revise the current system of MDTs.

Assessment of nutritional status and prognosis in advanced metastatic cancer / 대한내과학회지

BACKGROUND: Depletion of nutritional reserves and significant weight loss can lead to an increased risk of morbidity, reduced chemotherapy response, and shorter survival in patients with cancer. Numerous methodologies are used for the assessment of nutritional status. However, it remains unclear which of these tools is the most appropriate in the setting of cancer chemotherapy. The PINI (prognostic inflammatory nutritional index) is a simple scoring system that has been used to evaluate nutritional status and prognosis in critically ill patients. The aim of this study was designed to investigate the relationship between nutritional status after the palliative chemotherapy and prognosis in advanced metastatic cancer. METHODS: This study included 130 patients with ECOG PS (Eastern Cooperative Oncology Group performance status) 1~3 in advanced metastatic cancer following the palliative chemotherapy. ECOG PS, body mass index, alpha 1-acid glycoprotein, C-reactive protein, albumin, prealbumin, transferrin, protein, lactate dehydrogenase, PINI ratio, and survival time were evaluated. RESULTS: In 130 patients, the median age was 57 years. The ECOG PS was 1 68 patients, 2 43, 3 19. The mean value of PINI was PS 1 16.0+/-47.8, PS 2 55.6+/-106.9, PS 3 106.3+/-141.6. The mean survival was PS 1 144.0+/-71.8, PS 2 68.9+/-41.2, PS 3 32.0+/-6.9 days. In the PS 3 group, the mean values of alpha 1-acid glycoprotein, C-reactive protein, and lactate dehydrogenase were significantly higher than in the PS 1 group. In the PS 3 group, the mean values of albumin, prealbumin, and transferrin were significantly lower than in the PS 1 group. The survival time was correlated with the ECOG PS (r=-0.602, p<0.001,), PINI (r=-0.318, p<0.001,), alpha 1-acid glycoprotein (r=-0.265, p=0.002), C-reactive protein (r=-0.345, p<0.001), albumin (r=0.324, p<0.001), prealbumin (r=0.260, p=0.003) and transferrin (r=0.277, p=0.001). CONCLUSIONS: The PINI may be a useful scoring system for the assessment of nutritional status and prognosis in advanced metastatic cancer following palliative chemotherapy, but the ECOG PS is most strong correlation with the survival time.

The Effect of Preoperative Oral Application of Bovine Colostrum on Endotoxemia and TNF-alpha in Abdominal Surgery

PURPOSE: We conducted this study to assess the effect of oral application of bovine colostrum on the plasma endotoxin and TNF-alpha following the abdominal surgery. METHODS: 46 patients who underwent the abdominal surgery were evenly enrolled in a prospective, randomized, double blind and placebo-controlled study. The patients were preoperatively managed by oral application of 20 g of a bovine colostrums or placebo (nonfat dried milk) per a day for 3 days. In both groups, endotoxin was sequentially determined pre-, intra- and postoperatively by a modified limulus amebocyte lysate test. TNF-alpha and CRP were also measured. The clinical course was followed and compared in both groups. RESULTS: The colostrum group showed significantly lower level of endotoxin and TNF-alpha compared to the placebo group. CRP did not differ in both groups. Clinical event did not occur in both group until the discharge. Colostrum group tends to have a lower incidence of fever and leukocytosis without statistic significance. CONCLUSION: Prophylactic preoperative oral application of bovine colostrum lower the plasma level of perioperative endotoxin and TNF-alpha. Further studies were needed for the relation of clinical effect and preoperative oral application of bovine colostrum.

Ovarian Granulosa Cell Tumor presenting as Meigs' Syndrome with elevated CA125

Herein, a rare case of ovarian granulosa cell tumor, presenting as Meigs' syndrome, with elevated carbohydrate antigen 125 (CA125), is reported. A 69-year-old woman was admitted for the investigation of abdominal fullness and dyspnea. A preoperative examination revealed a huge pelvic tumor and an abdominopelvic magnetic resonance image (MRI) assumed ovarian cancer. A chest computed tomography (CT) scan revealed pleural effusion. A laparotomy confirmed the huge mass to be an ovarian tumor. A total abdominal hysterectomy (TAH), with a bilateral salpingo-oophorectomy (BSO) and partial omentectomy, was performed. Although short-term intrathoracic drainage was required, the hydrothorax and ascites rapidly resolved in the postoperative period.

The Relationship between the Serum Intercellular Adhesion Molecule-1 Level and the Prognosis of the Disease in Lung Cancer

BACKGROUND: Adhesion molecules are related to cell-to-cell interaction and inflammatory interaction. In addition, adhesive interactions between tumor cells and adjacent cells and/or extracellular matrix play important roles in the complex process of tumor growth and development. Among these adhesion molecules, expression of intercellular adhesion molecule-1 (ICAM-1) has been identified in colon cancer, bladder cancer, lung cancer, melanoma, pancreatic cancer and hepatocellular carcinoma. In the current study, we analyzed serum ICAM-1 concentrations to investigate the relationship between the serum ICAM-1 level and prognosis in patients with lung cancer METHODS: Serum ICAM-1 was measured in 84 patients with lung cancer according to the pathologic type and clinical stage using the ICAM-1 ELISA kit. The Kaplan-Meier method was used to analyse survival time. RESULTS: There was no difference in serum ICAM-1 concentration among the different stages of lung cancer. Furthermore, there was no difference observed between histologic tumor type with regard to serum ICAM-1 concentration. Although the difference was not significant, the overall survival times of patients with a low serum ICAM-1 concentration ( or=306 ng/mL) in non-small cell lung cancer patients. CONCLUSION: These results suggest that high levels of serum ICAM-1 reflect poor prognosis for patients with non-small cell lung cancer.

A case of small bowel Burkitt's lymphoma in AIDS patient / 대한내과학회지

HIV-infected individuals have a high risk of developing non-Hodgkin lymphoma (NHL). NHL is the second most common malignant disorder associated with HIV infection, the first being Koposi's sarcoma. In the late 1990s, however, NHL became more common than Kaposi's sarcoma in some areas. Historically, AIDS-definding lymphomas have included systemic B-cell NHL (ie, immunoblastic and Burkitt's lymphoma) and primary brain lymphoma. We report a case of small bowel NHL in AIDS patient. A 58-year-old man presented with chronic fatigue and progressive abdominal pain. Gastroduodenal endoscopy shows multiple polypoid lesion on duodenum and diagnosed as Burkitt's lymphoma by histologic finding, immunohistochemical study associated with HIV positive. This is the first report of small bowel NHL from AIDS patients in Korea.

Effect of bovine colostrum on the bacterial translocation and intestinal endotoxemia in 5-fluorouracil treated rats / 대한내과학회지

BACKGROUND: Antitumor drugs such as 5-fluorouracil (5-FU) are known to induce intestinal damages and bacterial translocation. The present studies examined whether or not bovine colostrum protects against gut barrier damage, bacterial translocation and endotoxemia from these antitumor drugs. METHODS: Rat received either no drug, chemotherapy alone (5-FU, 300 mg/kg intraperitoneal injection) or bovine colostrum (4 g/day per os) for 5 days prior to 5-FU and for 5 days afterward. Intestinal permeability, enteric aerobic bacterial counts, serum albumin and protein levels, and pathologic findings of ileum were measured. Bacterial translocation to systemic blood, mesenteric lymph nodes, liver and spleen were measured. Systemic plasma endotoxin levels were quantified by the chromogenic limulus amebocyte lysate (LAL) technique. RESULTS: 5-FU increase intestinal permeability and plasma endotoxin levels, and decreased serum levels of total protein and albumin. Also 5-FU induced bacterial translocation to mesenteric lymph nodes, liver and spleen, not to systemic blood, but did not induce changes of enteric bacterial numbers and mucosal damages of small intestine. Combined administration of bovine colostrum with 5-FU reduced an increase in intestinal permeability and declines in serum albumin and protein levels by 5-FU. Bovine colostrum supplements also reduced bacterial translocation to mesenteric lymph nodes, liver and spleen, and endotoxemia. CONCLUSION: Bovine colostrums may beneficial effects in preventing 5-FU induced gut barrier damage, bacterial translocation and intestinal endotoxemia.

Relationship between excretion of 51Cr-EDTA and mucositis in patients with 5-FU based chemotherapy / 대한내과학회지

BACKGROUND: Administration of anticancer drugs may damage gastrointestinal epithelium, thereby increasing the permeability of the gastrointestinal mucosa. It is known that intestinal permeability test using 51Cr-EDTA is a useful test to assess the damage of intestine. The aim of this study was to evaluate intestinal permeability in patients who were treated with 5-fluorouracil (5-FU) based chemotherapy and to evaluate the relationship between the excretion of 51Cr-EDTA and the grading of mucositis. METHODS: Twenty eight patients who were treated with 5-FU based chemotherapy were chosen as study cases while 18 healthy volunteers as controls. Intestinal permeability was assessed by measurement of the urinary excretion of 51Cr-EDTA after oral challenge, and the National Cancer Institute common toxicity criteria were used for assessing oral mucositis. RESULTS: All except 3 patients in the chemotherapy group experienced grade 1~3 stomatitis. The median value of intestinal permeability test was significantly higher in the chemotherapy group than in control group (7.61%, range 2.10-22.92 vs 2.17%, range 1.16-2.76, respectively, p<0.001). The grading of oral mucositis did correlate with the urinary excretion of 51Cr-EDTA (p<0.001, r=0.867). CONCLUSIONS: The measurement of 51Cr-EDTA excretion after oral challenge may be a useful test for evaluating the intestinal permeability by chemotherapy induced intestinal mucosal damage. Testing of intestinal permeability using 51Cr-EDTA may be applicable to evaluate the effect of therapeutic trials in patients with chemotherapy induced mucositis.

The Relationship between the serum intercellular adhesion molecule-1 level and the prognosis of the disease in lung cancer / 대한내과학회지

BACKGROUND: Adhesion molecule is related to cell-cell interaction and inflammatory interaction. In addition, adhesive interactions between tumor cells and adjacent cells and/or extracellular matrix are important role in the complex process of tumor growth and develpment. Of these adhesion molecules, expression of intercellular adhesion molecule-1 (ICAM-1) have been identified in colon cancer, bladder cancer, lung cancer, melanoma, pancreatic cancer, hepatocellular carcinoma. In the current study, we analyzed serum ICAM-1 concentrations to investigate the relationship between the sICAM-1 level and the prognosis of the disease in patients with lung cancer METHODS: Serum sICAM-1 was measured in 84 patients with lung cancer according to the pathologic types and clinical staging using ICAM-1 ELISA kit. The Kaplan-Meier method was used to analyse survival time. RESULTS: There was no difference in sICAM-1 concentration among the stage of lung cancer. And no difference was observed among histologic tumor types with regard to sICAM-1 concentration. The overall survival of patients with low sICAM-1 concentration (or=306 ng/mL) in non-small cell lung cancer patients, but no difference was observed in small cell lung cancer patients. CONCLUSION: These results suggest that high levels of sICAM-1 reflect the poor prognosis of patients with non-small cell lung cancer.

The Relationship between Serum VEGF Concentration and Prognosis of Lung Cancer

BACKGROUND: VEGF is an important factor for angiogenesis. Although many previous studies have reported an increased serum VEGF concentration in various malignant tumors, there are few studies on the relationship between serum VEGF concentration and its prognosis. This study investigated whether serum VEGF concentration is a prognostic indicator for lung cancer. METHODS: Using the ELISA kit, we measured the serum VEGF concentrations of 86 patients diagnosed with lung cancer on histologic examination. With a cut-off value of 686 pg/mL, the patients were classified as low-concentration ( or=686 pg/mL, n=28) based on their mean serum VEGF concentration values to compare survival rates, and serum VEGF concentrations for different histologic types and stages. RESULTS: There was no significant difference in serum VEGF concentration based on stage and histologic type between the two groups. Moreover, there was no significant difference in survival rate between the high-concentration and low-concentration groups (p=0.86). CONCLUSION: This study demonstrates that serum VEGF concentration is not associated with the prognosis of lung cancer.

A Kimura's disease developing during follow up period after remission of lymphoma / 대한내과학회지

The presented case is a 43-year-old male with a painless mass in the right neck for two weeks. Excisional biopsy was performed under the clinical impression of malignant lymphoma, because he experienced lymphoma 32 months ago. Histopathologically, it shows hyperplasia of small blood vessels and lymphoid cells with eosinophilic infiltration, so it was diagnosed as Kimura's disease. This seems to be the first reported case of Kimura's disease developed during follow up period after remission of lymphoma.

Efficacy of Combination Chemotherapy with Paclitaxel and Cisplatin in Patients with Advanced Non-Small Cell Lung Cancer / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: To evaluate the efficacy and toxicity of the combination therapy of paclitaxel and cisplatin in advanced, non-small cell, lung cancer patients MATERIALS AND METHODS: Between December 1997 and September 2001, 37 patients with advanced, non-small cell, lung cancer were enrolled in this study. Patients were treated with paclitaxel (135 mg/m2, 24 hr infusion) and cisplatin (75 mg/m2). The treatments were repeated every 4 weeks. RESULTS: Among the 37 patients enrolled, 21 were treated with paclitaxel and cisplatin as a first-line and 16 patients as a second-line. The median age of the patients was 59. In the first-line group, 10 had stage IIIB and 11 had stage IV, non small cell lung cancer. Of 21 patients in first-line treatment group that could be evaluated, objective responses were observed in 6 patients (response rate: 28.6%, CR: 4.8%, PR: 23.8%). The mediansurvival duration for patients was 48 weeks. With the second-line group, 3 patients showed a partial response (response rate: 18.7%) to treatment, with median survival duration of 44 weeks. Grade 3-4 leukopenia was observed in 27.1% of the first-line, and 23.6% in second- line, treatment groups. CONCLUSION: Combination chemotherapy, with paclitaxel and cisplatin, in non-small cell lung cancer has acceptable toxicities in both first and second-line treatment groups. In terms of efficacy, no superior response was shown for either group. More randomized studies, with a larger group of patients, are required to prove the true efficacy.

The relationship between the serum concentration of VEGF and the prognosis of lung cancer / 대한내과학회지

BACKGROUND: Vascular endothelial growth factor (VEGF) is an important regulator of angiogenesis and vascular permeability. Increased serum VEGF concentrations (sVEGF) have been reported in various types of human cancer. In the current study, we assessed sVEGF to investigate the relationship between the sVEGF level and the prognosis of patients with lung cancer. METHODS: sVEGF was measured by enzyme-linked immunosorbent assay (ELISA) in 86 patients with lung cancer. Patients were divided into two groups according to 686 pg/mL of mean sVEGF (Low sVEGF group: sVEGFor=686 pg/mL, n=28). We analyzed the association of sVEGF according to the pathologic types and clinical staging, and compared the survival rates in two groups. RESULTS: There was no significant difference of sVEGF among the stages and pathologic types of lung cancer. And no difference was observed between overall survival rates of both groups regard to sVEGF (p=0.86). CONCLUSION: These results suggest that sVEGF may not be a good marker for prognosis of lung cancer, especially in the advanced cases.

Usefulness of cyfra 21-1 as a tumor marker of lung cancer / 대한내과학회지

BACKGROUND: Cytokeratins are epithelial markers whose expressions are not lost during malignant transformation. The utility of cytokeratin fragment (Cyfra) 21-1, a new tumor marker, was investigated in 110 patients with lung cancer. The aims of this study were to confirm sensitivity of Cyfra 21-1 in detecting non-small cell cancer, to assess the potential relationship between Cyfra 21-1 and disease stage of the lung cancer. METHODS: We measured serum levels of four tumor marker (NSE, CEA, SCC Ag, Cyfra 21-1) in 110 patients with lung cancer. The measurement of serum level of Cyfra 21-1 was performed with a cut off value of 3.3 ng/mL. An immunoradiometric assay was used to detect a fragment of the cytokeratin 19. The patients were grouped according to the stage of the disease and tumor type. RESULTS: Overall sensitivity of Cyfra 21-1 was relatively high (51.8%) than others tumor markers. Sensitivity of this marker was especially high for adenocarcinoma (63.2%) and squamous cell carcinoma (54.1%). In contrast, sensitiviy of Cyfra 21-1 was relatively low for small cell lung carcinoma (40.0%). Serum levels of Cyfra 21-1 were higher in advanced nonsmall cell lung cancer than early stage disease. CONCLUSION: We conclude that Cyfra 21-1 is a sensitive tumor marker of nonsmall cell lung cancer, especially adenocarcinoma and also may be a useful adjunctive marker for disease monitoring.

Clinical efficacy of various tumor markers in medical screening / 대한내과학회지

BACKGROUND: Many tumor markers have been investigated for early diagnosis of the malignancy, yet they were turned out to be inappropriate for the purpose. This study was carried out to investigate the efficacy of tumor markers. METHODS: Employing radioimmunoassay, CEA, AFP, CA19-9, PSA, CA125 were done in 31,389 patients(20,878 males, 10,511 females) who visited our medical screening center from Jan. 1 1997 to Dec. 31 1997. RESULTS: Total mean value of CEA is 1.90+/-1.37 ng/mL(male: 2.17+/-1.37, female: 1.37+/-0.86). Male showed significantly higher level of CEA. Only 2 subjects had values over 25 ng/mL, and one was diagnosed to have stomach cancer but the other did not. Total mean value of AFP is 2.46+/-6.47 ng/mL (male: 2.32+/-3.55 ng/mL, female: 2.73+/-10.06 ng/mL). Female showed significantly higher level of measured AFP. One had AFP value over 400 ng/mL and was diagnosed of hepatoma. Total mean value of CA19-9 is 11.48+/-7.61 ng/mL,(male: 10.9+/-26.78 ng/mL, female: 12.61+/-8.97 ng/mL). Female showed significantly higher CA19-9. 65 subjects (male: 31, female: 34) showed measured CA19-9 level over 37 ng/mL. 5 subjects had values over 100 ng/mL and 1 subject was diagnosed of pancrease cancer. Total mean value of PSA is 0.79+/-1.88 ng/mL. 90 subjects showed measured PSA level over 4 ng/mL and mean value in this group was 10.92 ng/mL. 54 subjects were older than age 50. 4 out of 90 subjects were diagnosed of prostate cancer. Total mean value of CA125 is 13.08+/-10.93 ng/mL. 160 subjects showed measured CA125 level over 35 ng/mL. 19 subjects had value over 100 ng/mL and none of the malignancy was detected. CONCLUSION: Tumor markers are inappropriate measures for screening of malignancy.

Etoposide and cisplatin combination chemotherapy in extensive stage small cell lung cancer / 대한내과학회지

BACKGROUND: Small cell lung cancer (SCLC) disseminates early and has poor prognosis. However, SCLC is highly chemosensitive, thus chemotherapy has been established as the primary mode of treatment. This study evaluated the efficacy and toxicity of etoposide in combination with cisplatin in the treatment of extensive stage small cell lung cancer. METHODS: Thirty four patients (28 males, 6 females) with previously untreated extensive stage small cell lung cancer were treated with etoposide at a dose of 100 mg/m2, IV on days 1-3 with cisplatin at 100 mg/m2, IV on day 1. The median age was 63 (range 41~80). This combination chemotherapy was administered every 3-4 weeks. Response rate, response duration, survival, and toxicity were evaluated. RESULTS: The response rate was 50%. The median survival time was 29 weeks. The median response duration was 17.2 weeks in responders. The toxicity was acceptable. CONCLUSION: This study illustrated that the combination of etoposide and cisplatin is effective in the treatment of extensive stage small cell lung cancer, and can be administered with acceptable toxicity. Although this study was not designed to be a formal comparative trial, the efficacy and toxicity observed with this regimen were found to be comparable to previous reports.

A Case of a Solid and Papillary Epithelial Neoplasm of the Pancreas Associated with Malignant Change / 대한소화기내시경학회지

The solid and papillary epithelial neoplasm of the pancreas is a relatively uncommon disease. It accounts for approximately 1 to 2 percent of all exocrine pancreatic tumors. This benign or low grade malignant tumor is reported to occur predominantly in young women and rarely in men. Recurrence and development of metastasis after resection are found only in a small fraction of the general population. A case is herein reported involving a solid and papillary epithelial neoplasm of the pancreas which extensively spread to nearby organs, in a 34 year-old man. Chief complaints were black stool. Physical examination revealed tenderness on the left upper quadrant of the abdomen. Esophagogastroduodenoscopy revealed multiple cardiac variceal bleeding. Abdominal sonography and CAT scan findings showed a huge lobulated mass on the left upper quadrant area with an internal necrotic portion. Surgical findings showed determined a splenic vein tumor thromboembolus, portal vein involvement, distal stomach involvement, and multiple colonic invasion. Therefore, distal pancreatectomy, wedge resection of the stomach, splenetomy, segmental resection of the transverse colon, and excision of the mass were all performed. Pathologic examination revealed a solid and papillary epithelial neoplasm in the pancreatic tail with a marked dilated splenic vein filled with tumor thromboembolus. The patient has been under chemotherapy since then, and is being closely observed.

A case of pulmonary epithelioid hemangioendothelioma / 대한내과학회지

Epithelioid hemangioendothelioma(EH) is a rare vascular tumor of low-grade malignancy. It was previously described as intravascular bronchioloalveolar tumor (IVBAT). But electron microscopic study and immunohistochemical staining results have proved endothelial origin. Patients are usually asymptomatic and the tumors are found incidentally on routine chest X-rays. Most patients show a slowly progressive clinical course, even though some patients occasionally die as results of respiratory failure or extrathoracic complications. Confirmative diagnosis is made through thoracoscopic or open-lung biopsy. There is still no effective therapeutic modality for pulmonary EH. We have experienced a 55-year-old woman whose simple chest x-ray film revealed bilateral multiple small nodules. The nodules were histopathologically and immunohistochemically diagnosed as primary epithelioid hemangioendothelioma of the lung. The possibility of metastatic disease was excluded thorough clinical, laboratory and radiological studies. Comparison of radiographic chest film taken 3 years ago showed no significant progression of the pulmonary nodular lesions. Conservative management was instituted and careful 4 months follow-up showed no significant changes.

Primary Lymphoma of Bone Combined with Pancytopenia / 대한혈액학회지

Primary lymphoma of bone, first described by Parker and Jackson in 1939, is derived from bone marrow reticuloendothelial systems. It is uncommon neoplasm representing only 5% of all extranodal non-Hodgkin's lymphoma. Primary bone non-Hodgkin's lymphoma is characterized by initial symptoms of bone pain with associated single or multiple radiological bone lesions, with or without local soft tissue swelling, pathologic fractures,or regional/distant metastasis. Isolated bone marrow non-Hodgkin's lymphoma is rare, and determining the diagnosis difficult. The common features are fever, abnormal liver function, pancytopenia, polyserositis, neurologic symptoms, opportunistic infections, and a short, fatal course. Treatment includes surgery, radiotherapy, and chemotherapy depending on multiple factors, including histopathologic type of tumor, stage of disease, location of the lesion, and extent of osseous involvement. Five year survival rate is above 80%, when treated by combined radiation & chemotherapy. We experienced a patient who admitted to our department of Internal Medicine. She had mutiple bone pain, general weakness and diagnosed as primary lymphoma of the bone with severe pancytopenia. Her presentation, treatment, and clinical progress were discussed.