Endocrine Tumors of the Pancreas Secreting Multiple Hormones / 대한내분비학회지

BACKGROUND: Endocrine pancreas tumor is a rare disease which incidence is less than 2% of all pancreatic tumors. But it comprises various types of tumor and usually secretes several hormones from one type of tumor although the patient with this tumor complains of sole symptom associated with only one hormone. The mechanism and clinical significance of multiple hormone secretion in the endocrine pancreas tumom are not yet clearly defined. METHODS: We analyzed retrospectively the clinicopathologic features of 20 cases which were operated at Seoul National University Hospital during the period between February 1989 and May 1998. RESULTS: The most common tumor was insulinoma (13 cases) and the second most common tumor was nonfunctioning tumor (6 cases). There was one case of somatostatinoma. Most of the patients with insulinoma complained of neuroglycopenic symptoms. There were 9 cases (45.0%) in which the tumors secreted more than two kinds of hormones, 7 cases in insulinoma, 2 cases in nonfunctioning tumors. Whether the tumor secreted multiple hormones was detected by the method of immunohistochemical staining. Though the tumors secreted more than two kinds of hormones, the patients with the tumors complained of symptoms which were associated with the cell type most strongly stained by immunohistochemical method. Whether or not the tumors secreted multiple hormones was not associated with the pathologic features such as tumor size, histologic patterns of the tumor, status of tumor cell differentiation and malignancy. CONCLUSION: From this results, we suggest that endocrine tumors of the pancreas secreted multiple hormones not by the mechanism of dedifferentiation from already differentiated endocrine cells but by the mechanism of neogenesis of multipotent islet stem cells. Since the relationship between the function of multiple hormone secretion in the endocrine pancreas tumors and islet stem cell would be significant, further study should be needed to find out the function of stem cells and application of stem cells to clinical use.

A Case of Black Adrenocortical Adenoma Causing Cushing's Syndrome with Contralateral Nonfuncioning Adenoma / 대한내분비학회지

We report herein the case of a 38-year-old woman with Cushings syndrome caused by bilateral adrenocortical adenomas. The adrenal tumor on the left side hypersecreted cortisol and no findings of cortisol hypersecretion from the adrenal tumor on the right side were observed on bilateral adrenal vein samplings. Both adrenal tumors were resected and histologically without any findings of nodular hyperplasia. The left adrenal tumor was histologically diagnosed as a so-called black adenoma. These data imply that the adrenal adenomas developed primarily from the adrenal gland itself, and that one of the tumors was well differentiated and secreted excess hormones, while the other remained in cell proliferation without hypersecretion.

Bilateral Breast Cancer

One of the most important issues in breast cancer is the possibility of developing a new second carcinoma in the opposite breast. In order to evaluate the clinical and histopathologic characteristics of bilateral breast cancer, we retrospectively reviewed the clinical records of 23 bilateral breast cancer patients from among the 1136 women with invasive breast cancer treated in our Departmentbetween January 1989 and December 1995. Tumors were grouped into those simultaneously detected or detected within 6 months of each other, in both breasts (synchronous, 8/23) and those detected more than 6 months (metachronous, 15/23). The mean interval in the metachronous cancers was 55 months. Among the previously reported risk factors for bilateral breast cancer, such as onset at an early age, lobular histology, family history, and multicentricity, family history was the only statistically significant factor in our study(p<0.01). The most frequent histologic type of tumor was an invasive ductal carcinoma and the most frequent tumor location was the outer upper quadrant, as in unilateral breast cancer. The concordance rate of the histologic types and the location of both tumors was 60.9% and 39.1%, respectively. According to the AJCC classification, the most common pathologic stage was IIA. For tumors detected by mammography alone, the pathologic stage of the tumors was lower and the percentage of in situ lesions was higher than for those detected by physical examination. In conclusion, in breast cancer patients with a family history of breast cancer, the possibility of contralateral breast cancer should be considered more carefully, and close mammographic follow up and the concept of mirror image may be helpful in early detection of contralateral breast cancer.

Analysis of Postoperative Survival and Prognostic Factors in Breast Cancer

We reviewed 723 breast cancer patients treated between Jan. 1981 and Dec. 1991 at the Department of Surgery, Seoul National University Hospital. Survival curves were constructed using the life table method. The significance of the differences in the survival patterns was determined by the log-rank test in univariate analysis, by the Cox proportional hazards regression test in multivariate analysis. Distribution of the patients and the survival rate between this patients and 802 breast cancer patients from Jan. 1970 to Dec. 1988 were compared using paired sample t-test. The mean age of the patients was 46.9 years, and the most prevalent age group was the 5th decade. The distribution of patients according to the tumor stage showed no meaningful change from our previous study. The overall 5-year and 10-year survival rate were 80.1%, 68.4% respectively. On univariate analysis, tumor size, lymph node status, number of lymph node metastasis and stage were found to influence survival significantly. On multivariate analysis, tumor size(p=0.0004), lymph node status (p=0.0231) were found to be significant prognostic factors. In conclusion, the increased proportion of early stage breast cancer patients, although not statistically significant, seems to account for the slight improvement of the overall survival compared to that of our previous study. The tumor size and the lymph node status were potential prognostic factors on survival, a result which is as that of our previous study.