Large Cell Neuroendocrine Carcinoma of Anal Canal: Report of a Case

A neuroendocrine carcinoma of the anal canal is a very rare entity; however, this type of tumor is known for its aggressive progression and poor prognosis. We describe the case of a 58-year-old female with a neuroendocrine carcinoma arising in the anal canal. The tumor was found in the anal canal with multiple liver metastases. The patient died due to massive liver metastases 11months after diagnosis and operation. For its rarity and clinical significance, we report the case with a review of the literature.

A Prospective Study on the Significance of Peritoneal Washing Cytology as a Diagnostic Modality in Colorectal Cancer

PURPOSE: Free intraperitoneal cancer cells exfoliated from a tumor are considered to be responsible for peritoneal dissemination. Therefore, microscopic evaluation of cells washed from the peritoneal cavity during surgery for various intraabdominal malignancies has been used to detect subclinical intraperitoneal metastases from these tumors. The purposes of this study were to detect intraperitoneal free cancer cells at the time of surgery by using peritoneal washing cytology in colorectal cancer and to evaluate their diagnostic significance. METHODS: During the 29-month period from January 2000 through May 2002, 149 randomly selected patients with primary colorectal cancer without evidence of gross peritoneal metastasis underwent peritoneal washing cytologic analysis before surgical manipulation of the tumor. Peritoneal washing cytology was compared with the pre-existing prognostic factors. RESULTS: Positive peritoneal washing for free cancer cells was found in 19 of 149 patients (12.8%). This positivity was significantly correlated with histologic grade (P=0.002), serosal invasion (P=0.025), lymph node metastasis (P=0.034), Astler-Coller classification (P=0.008), recurrence (P<0.001), and 5-year survival (P<0.001). Cancer-specific survival was significantly associated with histologic grade (P=0.025), peritoneal washing cytology (P<0.001), lymph node metastasis (P<0.001), recurrence (P<0.001), and stage (P= 0.010) in the multivariate analysis. CONCLUSIONS: The presence of free cancer cells was predictive of survival and was an independent prognostic factor. This information may be useful in stratifying patients with colorectal cancer for therapeutic trials, such as intraperitoneal chemotherapy.

Insular (Poorly Differentiated) Carcinoma of Thyroid / 대한내분비외과학회지

Insular carcinoma of the thyroid is a rare thyroid malignancy, and this was named in 1984 by Carcangiu when he described its characteristic histology. Histologically, insular carcinoma is characterized by uniform cells arranged in distinct nests or an insular pattern that contain variable numbers of small follicles. Clinically and morphologically, it is considered to be in an intermediate position between well-differentiated carcinoma of the thyroid (papillary or follicular) and undifferentiated or anaplastic carcinoma of the thyroid. This thyroid malignancy is distinctive, aggressive and often lethal. However, most authors believe it to be an independent entity. The prognosis of this tumor is worse than that of classic differentiated thyroid carcinoma, and most authors advise aggressive therapy, which can achieve pro-longed survival in some cases. We describe here a patient (a 42 years-old woman) who was managed with completion thyroidectomy after unilateral lobectomy of the thyroid with confirmation of the permanent pathology as insular carcinoma. I-131 ablation (175 mCi) was performed on the remnant thyroid tissues after follow-up of I~131 whole-body scanning.

Gastrointestinal Stromal Tumor of the Rectum in a Pediatric

Gastrointestinal stromal tumors are the most common subset of mesenchymal tumors that arise from the gastrointestinal tract. They most commonly arise in the stomach, followed by the small bowel and, rarely, the rectum, esophagus and colon. Gastrointestinal stromal tumors and the specific c-kit protein (CD117)-positive mesenchymal tumors, have been sporadically reported in the rectum. We report here on a 12-year-old boy who underwent low anterior resection of huge gastrointestinal stromal tumor of the rectum. The diagnosis was confirmed by immunohistochemical staining of the tumor. The specimen was revealed to be a polypoid fungating tumor that, measured 6.0 x 6.0 cm in size, which consisted histologically of spindle-shaped cells. The tumor cells were positive for c-kit, vimentin, S-100, desmin, and SMA, although the results of the CD34 test were negative. In general, Gastrointestinal stromal tumors of the rectum predominantly occur between the sixth and seventh decades and they are rarely seen in individuals less than 40 years of age. To the best of our knowledge, our case is the youngest reported patient in the English literature who had as gastrointestinal stromal tumor of the rectum.

Multiple Metastses to the Small Bowel from Lung Cancer

Metastases from lung cancer to the gastrointestinal tract are not exceptional findings, but their clinical manifestations are rare. We report a new case of multiple metastases to the small bowel from primary lung cancer. A 67 year-old man presented with acute abdominal pain and vomiting. The laboratory investigations were all within normal limits except leukocytosis. Lung radiography was done and it showed infiltration at the right upper lung field without any mass. Abdominal CT-scan demonstrated a small bowel mass with ileoileal intussusception and the patient underwent emergency surgery. The postoperative lung studies and pathological analysis confirmed primary lung cancer with small bowel metastasis.

Amyloid Goiter with Parathyroid Involvement

The amyloid deposition observed in secondary amyloidosis frequently involves the thyroid gland, but rarely is a goiter responsible for this. We report here the pathologic findings of a case of amyloid goiter with involvement of a parathyroid gland in an euthyroid patient. The patient presented with an enlarged thyroid, symptoms of upper airway obstruction and dysphagia.

Perianal Extramammary Paget's Disease Associated with an Anal Duct Adenocarcinoma: A Case Report

Extramammary Paget's disease occurs commonly on the external female genitalia and rarely occurs in the perianal region. Recently, we experienced a case of perianal extramammary Paget's disease associated with an anal duct adenocarcinoma. The patient was a 60-year-old man. The perianal skin lesion was eczematous and encircled the anus. A wide-excision, split-thickness skin graft and temporal T-loop colostomy were performed. Histopathologically, the tumor was a well-differentiated anal duct adenocarcinoma. There was a prominent pagetoid spread of about 6x4 cm. The tumor cell was positive for carcinoembryonic antigen, but the paget cell was negative. The patient was treated with radiation therapy and with single 5-FU chemotherapy six times. Five months later, the perianal region was nearly normal.

Analysis of Prognostic Factors after Surgery for Gallbladder Cancer

PURPOSE: Gallbladder cancer, which is the most common malignancy of the biliary tract, is frequently associated with poor prognosis. The aim of this study was to evaluate outcomes with gallbladder cancer according to the surgical treatment, pathologic stage, and prognostic factors. METHOD: The medical records of 52 consecutive patients with gallbladder cancer treated at our institution from June 1996 through June 2005 were reviewed retrospectively. Survival was analyzed using the Kaplan-Meier method (mean followed period 60 months) and the log-rank test. Prognostic factors were analyzed using Cox regression. RESULTS: Mean patient age was 67 years. Fiftysix percent of patients were female. Twentyeight patients (56%) underwent curative resection (5 simple cholecystectomies and 23 radical cholecystectomies). There were no procedure-related deaths. The Overall 5-year survival was 18%. Patients who underwent curative resection had a higher 5-year survival rate (40%) than patients who underwent palliative surgery (0%; P=0.0001). The palliative surgery, high T stage, positive lymph node metastasis were significant factors predictive of worse survivial. CONCLUSION: The good long-term survival may be achieved by an early diagnosis and radical resection.

Analysis of Clinicopathological Factors Affecting Local Recurrence of Colorectal Cancer after Curative Resection

PURPOSE: Local recurrence after curative resection of colorectal cancer has an important influence on both survival and quality of life. The ability to predict local recurrence after a curative resection of colorectal cancer may be useful for an intensive follow-up program and for a decision on adjuvant radiation or chemotherapy. The aim of this study was to analyze the factors affecting the incidence of local recurrence after a curative resection of colorectal cancer. METHODS: A retrospective review of 390 patients who had a curative resection for a primary colorectal cancer by a single surgeon at the Department of Surgery, Inha University Hospital, between June 1996 and July 2002 was done. The medical records of patients diagnosed with a local recurrence were reviewed. Local recurrence was defined as any recurrence within the field of resection, regardless of the presence or absence of distant metastasis, that was diagnosed by using colonoscopy with biopsy and/or radiologic imaging. RESULTS: Local recurrences were detected in 40 patients (10.3%). The gender distribution of patients with local recurrence was 24 males and 16 females with a mean age of 59.8 years. The median time to local recurrence was 15 months. The most common site of local recurrence was the anastomosis site, followed by a regional lymph node, the pelvicoperineal area, and the presacral area. Local recurrence was related to the depth of the primary tumor (P=0.027), lymphatics or vascular invasion (P=0.003), perineural invasion (P= 0.000), nodal status (P=0.000), and distant metastasis (P= 0.002). However, there was no statistically significant relation between local recurrence and primary tumor location (P=0.053), primary tumor size (P=0.982), tumor differentiation (0.256), and preoperative CEA level (P=0.481). CONCLUSIONS: The depth of the primary tumor, lymphatics or vascular invasion, and perineural invasion were significant clinicopathologic factors of local recurrence, but tumor location, tumor size, tumor differentiation, and preoperative serum CEA level were not.

Change of Anorectal Function after Low Anterior Resection for Rectal Cancer

PURPOSE: The anorectal function after a low anterior resection for rectal cancer recovered progressively by 6 12 months after the operation, but the mechanisms and the recovery process are not well understood. The aim of this study was to correlate postoperative anorectal function after low anterior resection with physiologic parameters. METHODS: Sixty-seven patients who underwent a low anterior resection for rectal cancer were studied. The control group was consisted of normal persons. Anorectal physiologic studies were conducted for 6 months postoperatively by using defecographys, anorectal manometry and electomyogram of pudendal nerve. RESULTS: The postoperative anorectal function was gradully improved with time. Defecograms showed that the resting, squeezing, and straining anorectal angles were not significantly increased. Anorectal manometry showed that the threshold volume and the urgency volume were not significantly decreased but the maximal tolerable volume was decreased remarkably. The maximal resting pressure significantly decreased but the maximal squeezing pressure were not. The pudendal nerve electromyograms were not significantly different between the two groups. The patients were divided by based on the anastomosis level. The short anastomosis group showed more impairment in the urgency volume and the maximal resting pressure than that of the long anastomosis group. CONCLUSION: The neorectal volume and the level of anastomosis were important for changes in the anorectal function after a low anterior resecton. Gradual improvement of symptoms resulted from a resected rectal adapted to a neorectal volum.

A Case of Normal Full Term Delivery after Afrenalectomy for Cushing's Syndrome in a Pregnant Patient / 대한내분비학회지

We experienced a case of Cushings syndrome due to adrenal adenoma associated with pregnancy 23th week in a 26 year old female patient. On physical findings, hypertension, moon face, hirsutism, abdominal striae and buffalo hump were noticed. Laboratory findings showed increased serum cortisol, increased 24 hours-urinary cortisol, and decreased plasma ACTH. Abdominal MRI demonstrated 4 cm sized in long diameter, well marginated, and ovoid-shape right adrenal mass. Unilateral total adrenalectomy was performed at the 23th week of pregnancy and the mass it was confirmed to benign adrenal adenoma. Steroid replacement therapy was continued with 7.5 mg prednisolone during remaining pregnancy. At the 38th week of pregnancy, labor was developed and she delivered healthy female weighing 2.5 kg through normal vaginal delivery without complication. Pregnancy rarely occurs in patients with Cushings syndrome. We think she was the first case in Korea who had normal 38th week transvaginal delivery after adrenalectomy in adrenal Cushings syndrome during pregnancy.