A Case of Ulcerative Trichilemmal Carcinoma / 대한피부과학회지

We report a case of trichilemmal carcinoma in a 82-year-old man who presented an ulcerative tumor. Initially, a crusted mass was observed on the scalp and with subsequent removal of the crust, purulent and ulcerative lesion was seen. After treatment with sensitive antibiotics for 8 days, purulent discharge was markedly decreased in the lesion. Histopathologic findings showed clear cells tumor with trichilemmal keratinization. The tumor cells stained positive to PAS, sensitive to diastase and showed negative findings to CEA, EMA and S-100.

Expression of Urokinase-type Plasminogen Activator(uRA), Plasminogen Activator Inhibitor-1(PAI-1) and nm23 protein, as Prognostic Factors in Epithelial Ovarian Cancer / 대한부인종양콜포스코피학회잡지

The prognosis of ovarian cancer remains poor, and there is a need to identifiy patients who are less likely to respond to treatment, in the hope that the identification of these patients with a poorer prognosis may allow the administration of more intensive or different treatment. But, most clinical and pathological factors were considered to lack satisfactory predictive power. Recently, essential role of protease in tumor cell invasion and metastasis have been elucidated in tumor biology. Urokinase-type plasminogen activator (uPA) and its inhibitor, plasminogen activator inhibitor-1 (PAI-1), play a key role in tumor-associated proteolysis. Thus, the presence of both uPA and PAI-1 modulates the invasive and metastatic phenotype of cancer cells. Genetically, nm23 protein from chromosome 17q may act independently as a metastasis suppressor. The purpose of this study was to determine the relative predictive power of some of those prognostic variables such as uPA, PAI-1 and nm23 protein in a selected group of patients of ovarian cancer. Immunohistochemical staining was used to determine the overexpression of uPA, PAI-1 and nm23 protein. Specimens were rated positive and negative. Then, scored '1' in case of positive for uPA, PAI-1, and negative for nm23, and '0' in case of negative for uPA, PAI-1, and positive for nm23, respectively. The sum of scores were divided into three groups (I, II and III groups), and compared with clinico-pathologic parameters, clinical response, lymph node metastasis, recurrence and 5-year survival rate, retrospectively. In univariate analysis, the positive rate of uPA was 36% (29/80), that of PAI-1 was 35% (28/80), and the negative rate of nm23 was 43% (34/80). The overexpression of uPA was higher in the low-grade tumor (p=0.0053), the overexpression of PAI-1 was positively correlated with the advanced stage of tumor (p=0.0001), more malignant histologic type (serous) of tumor (p=0.0013) and larger residual tumor mass (>2 cm)(p=0.0480). The overexpression of nm23 protein was negatively correlated with advanced stage of tumor (p=0.0068) and low-grade tumor (p=0.011). In scoring system, the number of patients with first group (I: score 0) was 24, II group (score: 1~2) was 49, and III group (score: 3) was 7. The mean age of patients was 46.4 years and mean follow-up time was 59 months. The rate of lymph node metastasis were 16.7%, 37%, and 75% respectively(p=0.0632). With increasing score in each group, the less clinical response rate was found (75% vs 71% vs 29%, p=0.0532). The 5-year survival rate of each group were 70% in I group, 65% in II group, and 14% in III group(p=0.0096). In conclusion, the scoring system using immunohistochemical staining with rating of overexpression uPA, PAI-1 and nm23 protein may be useful as an important and powerful predictive prognostic indicator in patients with epithelial ovarian cancer.

Expression of Urokinase-type Plasminogen Activator(uRA), Plasminogen Activator Inhibitor-1(PAI-1) and nm23 protein, as Prognostic Factors in Epithelial Ovarian Cancer / 대한부인종양콜포스코피학회잡지

The prognosis of ovarian cancer remains poor, and there is a need to identifiy patients who are less likely to respond to treatment, in the hope that the identification of these patients with a poorer prognosis may allow the administration of more intensive or different treatment. But, most clinical and pathological factors were considered to lack satisfactory predictive power. Recently, essential role of protease in tumor cell invasion and metastasis have been elucidated in tumor biology. Urokinase-type plasminogen activator (uPA) and its inhibitor, plasminogen activator inhibitor-1 (PAI-1), play a key role in tumor-associated proteolysis. Thus, the presence of both uPA and PAI-1 modulates the invasive and metastatic phenotype of cancer cells. Genetically, nm23 protein from chromosome 17q may act independently as a metastasis suppressor. The purpose of this study was to determine the relative predictive power of some of those prognostic variables such as uPA, PAI-1 and nm23 protein in a selected group of patients of ovarian cancer. Immunohistochemical staining was used to determine the overexpression of uPA, PAI-1 and nm23 protein. Specimens were rated positive and negative. Then, scored '1' in case of positive for uPA, PAI-1, and negative for nm23, and '0' in case of negative for uPA, PAI-1, and positive for nm23, respectively. The sum of scores were divided into three groups (I, II and III groups), and compared with clinico-pathologic parameters, clinical response, lymph node metastasis, recurrence and 5-year survival rate, retrospectively. In univariate analysis, the positive rate of uPA was 36% (29/80), that of PAI-1 was 35% (28/80), and the negative rate of nm23 was 43% (34/80). The overexpression of uPA was higher in the low-grade tumor (p=0.0053), the overexpression of PAI-1 was positively correlated with the advanced stage of tumor (p=0.0001), more malignant histologic type (serous) of tumor (p=0.0013) and larger residual tumor mass (>2 cm)(p=0.0480). The overexpression of nm23 protein was negatively correlated with advanced stage of tumor (p=0.0068) and low-grade tumor (p=0.011). In scoring system, the number of patients with first group (I: score 0) was 24, II group (score: 1~2) was 49, and III group (score: 3) was 7. The mean age of patients was 46.4 years and mean follow-up time was 59 months. The rate of lymph node metastasis were 16.7%, 37%, and 75% respectively(p=0.0632). With increasing score in each group, the less clinical response rate was found (75% vs 71% vs 29%, p=0.0532). The 5-year survival rate of each group were 70% in I group, 65% in II group, and 14% in III group(p=0.0096). In conclusion, the scoring system using immunohistochemical staining with rating of overexpression uPA, PAI-1 and nm23 protein may be useful as an important and powerful predictive prognostic indicator in patients with epithelial ovarian cancer.

A Changing Pattern of Isotope Scan of the Midline Ectopic Thyroid: A Case Report

A 17 month-old girl presented in the pediatric clinic on November 27th, 1990 with a neck mass. The mass was 2 cm in diameter, firm in consistency and movable on the upper pole of the thyroid cartilage in the midline. The technetium thyroid scan showed a hot reactivity at the compatible site of the mass, but no other radioactivity in either site of the normal thyroid positions. At her second visit on January 23th, 1996, the mass had enlarged up to 3.5cm in diameter in the same location of the neck. The follow up thyroid scan revealed a walnut sized, snowman-like radioactivity. One of the snowman-like double images seemed to be a lingual ectopic thyroid and the other a midline ectopic thyroid remnant in the infrahyoid level. This interpretation was supported by the computed tomography of the neck, which showed a ligual mass in the foramen cecum area and an another mass in the anterior comis-sure of the larynx in the mildline. Thyroid function test was normal except a slightly increased TSH. As a result of this changing pattern of thyroid radioactive images, a case of a lingual thyroid as well as another midline ectopic thyroid tissue at the infra hyoid level is reported.

A Case of Tuberous Sclerosis Complex Developing with Subependymal Giant-Cell Astrocytoma and Hydrocephalus

The subependymal giant-cell astrocytoma, a key feature of the tuberous sclerosis complex, has been reported in patients without obvious features of this condition. The tumor is a rare cerebral glioma that characteristically arise in the wall of lateral ventricle and as an intraventricular mass, causing hydrocephalus by obstruction of the foramen of Monro. We experienced a case of tuberous sclerosis in 9-year-old male patient who presented typical clinical manifestations and cortical tuber, subependymal giant-cell astrocytoma developing with hydrocephalus. Diagnosis was confirmed by brain CT and MRI. We applied surgical resection to remove the mass. Brief review and related literatures were also presented.