Micropapillary Carcinoma of Breast / 한국유방암학회지

PURPOSE: Micropapillary carcinoma in breast cancer was first described by Petersen in 1993, after which other reports from all over the world described their characteristics. In Korea, this type of carcinoma was first described in 1996. The purpose of our study was to find the clinicopathological characteristics of micropapillary carcinomas from our experiences and to compare the results with those of other studies. METHODS: We analyzed 19 patients, from Dec. 1999 to Dec. 2002, diagnosed with micropapillary carcinomas from postoperative pathological reports retrospectively, compared with 939 patients diagnosed with infiltrating duct carcinoma in the same period. RESULTS: The mean age and tumor size were 46.8 years (range 32~73) and 3.75cm (range 0.5~10.0), respectively. Micropapillary carcinoma showed the larger size (P=0.032) and more frequent rates of lymphovascular invasion (P= 0.007) and metastasis to axillary lymph nodes (P=0.003) than infiltrating duct carcinoma. But, in the T stage-matched analysis, the rates of axillary lymph node metastasis in micropapillary carcinoma and infiltrating duct carcinoma showed no significant differences (T1, T2, T3 : P=0.072, P= 0.080, P=0.575 ). Only in T2 stage, rates of lymphovascular invasion showed more frequent significantly in micropapillary carcinoma (P=0.012). Age, nuclear and histological grades showed no significant differences. The positive expressions of estrogen and progesterone receptors were more frequent in micropapillary carcinoma compared with infiltrating duct carcinoma, while the expressions of the C-erb-B2, p53, Ki-67 and bcl-2 showed no significant differences. CONCLUSION: The micropapillary carcinomas showed more frequent lymphovascular invasion and positive expressions of the estrogen and progesterone receptors in their immunohistochemistry.

Hyalinizing Trabecular Adenoma of Thyroid

The Hyalinizing trabecular adenoma of the thyroid is a uncommon benign neoplasm which is characterized by trabecular growth pattern with hyaline stroma of the basal membrane type. It is often misdiagnosed as papillary carcinoma due to its peculiar cytologic and histologic features such as, nuclear grooving and papillary structures, or as medullary carcinoma due to the hyalinized stroma resembling amyloid. Special stains and immunohistochemical studies are required to make a definite diagnosis. A 34-year old woman was admitted suffering from a left neck mass. Computed tomography showed a 2 cm-sized mass in the left thyroid. Fine needle aspiration cytology suggested papillary carcinoma. Intraoperative frozen section suggested medullary carcinoma, and H&E staining suggested medullary carcinoma. However according to immunohistochemistry which revealed calcitonin negative, the tumor was reviewed and finally diagnosed as hyaline trabecular adenoma. The hyalinizing trabecular adenoma, although uncommon, is certainly worth consideration in order to avoid being misinterpreted as carcinoma on the basis of individual cytologic and histologic features.

The Effect of Adjuvant Therapy for Curatively Resected Extrahepatic Bile Duct Cancer / 대한암학회지

PURPOSE: This study was attempted to evaluate the effect of adjuvant radiotherapy and chemotherapy after curative resection of extrahepatic bile duct cancer. MATERIALS AND METHODS: The authors performed a retrospective analysis of 57 patients with extrahepatic bile duct cancer not involving the hepatic duct confluence and curatively resected at Seoul National University Hospital between 1990 and 1995. Resection margins of all cases were confirmed pathologically as free of cancer cells. Among 57 patients, 29 received adjuvant therapy. Total 4000 cGy of external beam radiation was delivered to each. 5-fluorouracil (5-FU) was administered as a radiosensitizer. After 4 weeks of radiation therapy, 5-FU maintenance chemotherapy was started and given every 4 weeks up to 12 cycles or until evidence of relapse. RESULTS: The overall median survival of 57 patients was 24 months. I- and 2-year overall survival rate was 73.7 and 52.6%. There was no difference in overall survival rate between adjuvant therapy group (n=29) and operation-only group (n 28). We tried to evaluate the effect on survival of adjuvant therapy according to lymph node status. Patients of Tl stage were excluded from analysis. Adjuvant therapy had no survival benefit in the lymph node positive group. But in the lymph node negative group, 1- and 2-year survival rate of patients who underwent adjuvant therapy were 89.5% and 68.4% whereas 1 and 2-year survival rate of patients in operation-only group were 57.9% and 36.8%, which was statistically significant (p=0.0278, 0.0472). And by multivariate analysis, the survival improvement of 1- and 2-year survival rate in adjuvant therapy group was due to adjuvant therapy itself. CONCLUSION: Our trial of external beam radiotherapy combined with 5-FU chemotherapy after curative resection of extrahepatic bile duct cancer did not show improved overall survival. However the 1- and 2-year survival rate of patients with negative lymph node and advanced T stage ( > T 1) were improved in adjuvant therapy group, so adjuvant therapy may give survival benefit to a certain patient group with negative lymph node.

Retroperitoneal Sarcoma / 대한암학회지

PURPOSE: To determine the clinical feature, surgical management of primary and recurrent disease, predictive factors for outcome, and impact of multimodality therapy in retroperitoneal sarcoma. MATERIALS AND METHODS: 60 patients were confirmed pathologically as soft-tissue sarcoma of the retroperitoneum by operation or needle biopsy in Seoul National University Hospital from 1983 to 1995. A retrospective analysis was performed. RESULTS: The abdominal mass was common presenting symptom. Histologically liposarcomas(25%) and leiomyosarcomas(23.3%) were most common, and MFHs(11.7%) and malignant schwannomas(11.7%) followed. The overall 5 year survival rate was 54.6%. Complete resection was possible in 51.7% of patients and strongly predicts outcome (<0.0001). These patients had a median survival of 130 months compared to 20 months for those undergoing partial resection and 9 months for those with unresectable tumors. 11(35%) of completely resected patients have had local recurrence. These patients underwent reoperation when feasible. Complete resection of recurrent disease was performed in 10 patients(90%), with a 42 months median survival time after reoperation. Resection of adjacent organ was performed in 19 patients. 14 of these were completely resected, and showed 100% of 5 year survival rate. Tumor grade was not a significant predictor of outcome. Gender, histologic type, encapsulation, stage, resectability, combined resection were significant prognostic factors by univariate analysis. But resectability was only independent prognostic factor on mutivariate analysis. Radiation therapy and chemotherapy could not be shown to have significant impact on survival. CONCLUSION: Complete resection is the most important prognostic factor of retroperitoneal sarcoma. Extensive and aggressive surgery must be considered including resection of adjacent organs. Multiple resection seems to improve survival in recunent cases.