Clinical study of multifocal phenomenon for gastric cancer and gastric high-grade intraepithelial neoplasia / 中国肿瘤临床

Objective: To investigate the clinicopathological characteristics and relevance of main and minor lesions of synchronous multiple gastric cancer and gastric high-grade intraepithelial neoplasia. Methods: We retrospectively reviewed 56 patients with synchronous multiple gastric cancer and gastric high-grade intraepithelial neoplasia who had been treated with operation and endoscopic submucosal dissection. Their clinicopathologic characteristics were summarized, and the correlation between main and minor lesions were analyzed. Results: Among the 56 patients, with a mean age of (63.82±11.88) years, 75% were men whereas 25% were women. Twenty-five (44.64%) patients had mucosal atrophy. The depth of tumor invasion in main and minor lesions was mainly stage T1. The size of main and minor lesions showed a positive correlation (r=0.797, P<0.001). The pathologic type of main and minor lesions demonstrated a moderately significant positive correlation (P=0.007). The endoscopic classification between major and minor lesions had a statistically significant consistency (P<0.001). The comparison of location between main and minor lesions showed a correlation: the correlation coefficient of the vertical position was 0.484 (P=0.002) and that of the horizontal position was 0.535 (P=0.007). Main lesions in multifocal gastric cancer or high-grade gastric intraepithelial neoplasia differed from single-focal gastric cancer or high-grade gastric intraepithelial neoplasia in terms of lymphatic metastasis, the TNM stage, and mucosal atrophy. Conclusions: Old men who had lesions combined with mucosal atrophy were considered as the high-risk group among patients with synchronous multiple gastric cancer and gastric high-grade intraepithelial neoplasia. Therefore, clinicians must keep a high grade of suspicion and make careful observations during the endoscopic examination, considering the correlation between main and minor lesions, in order to avoid any misdiagnosis.

Effect of the preoperative Geriatric Nutritional Risk Index on the prognosis of patients with esophageal squamous cell carcinoma after radical resection / 中国肿瘤临床

Objective: To evaluate the prognostic value of the preoperative Geriatric Nutritional Risk Index (GNRI) in patients with esophageal squamous cell carcinoma after radical resection. Methods: Clinicopathological and laboratory data of 315 elderly patients with esophageal squamous cell carcinoma who were older than 60 years and underwent radical resection in Tianjin Medical University Cancer Institute and Hospital from January 2008 to December 2012 were retrospectively analyzed. The GNRI formula was as follows:1.489×serum albumin (g/L)+41.7×(current body weight/ideal body weight). According to the GNRI, patients were divided into the normal and abnormal GNRI groups. The χ2 test was used to analyze the relationship between the GNRI and the clinicopathological char-acteristics of patients. The Kaplan-Meier method was used to analyze the survival rate, and survival analysis was conducted using the Log-rank test. Multivariate survival analysis was conducted using the Cox proportional risk regression model. Results: There were 259 patients in the normal GNRI group (GNRI>98) and 56 patients in the abnormal GNRI group (GNRI≤98). The GNRI was closely correlated with age, tumor location, tumor diameter, serum albumin level, body mass index (BMI), and lymph node metastasis (all P<0.05). The 5-year survival rates in the normal and abnormal GNRI groups were 41.2% and 27.0%, respectively, with statistical significance (P=0.002). Univariate analysis showed that age, tumor diameter, serum albumin level, BMI, GNRI, platelet-lymphocyte ratio, tumor invasion depth, and lymph node metastasis were risk factors for the prognosis of patients with esophageal squamous cell carcinoma (all P<0.05). Multivariate analysis showed that the preoperative GNRI (hazard ratio=0.687, 95% confidence interval: 0.487-0.968, P=0.032) was an independent factor affecting the prognosis of patients with esophageal squamous cell carcinoma. Subgroup analysis showed that the survival rates in the normal GNRI group were significantly higher than those in the abnormal GNRI group (P=0.036 and 0.010, respectively), regardless of lymph node metastasis. Conclusions: The preoperative GNRI is associated with malignant biological behav-ior in elderly patients with esophageal squamous cell carcinoma and can be used as a useful indicator for predicting survival after radi-cal resection.

Clinicopathologic characteristics and relevance of main and minor lesions of synchronous multiple early gastric cancer and gastric high grade intraepithelial neoplasia / 中华消化内镜杂志

Objective To investigate the clinicopathologic characteristics and relevance of main and minor lesions of synchronous multiple early gastric cancers ( SMEGC) and gastric high grade intraepithelial neoplasia ( GHGIN) . Methods Thirty-two patients with SMEGC or/and GHGIN who were diagnosed and treated with endoscopic submucosal dissection in Nanjing Drum Tower Hospital from July 2012 to September 2016 were enrolled in this study. Their clinicopathologic characteristics were summed up, and the correlation between main and minor lesions on the size, location, endoscopic classification, pathologic type, invasion depth and vascular invasion were analyzed. Results Among the 32 patients, with mean age of 66. 19±7. 46 years, 90. 62％(29/32) were male, 17 cases (53. 3％) had family history of gastric cancer, 25 (78. 13％) had smoking history, and 22 ( 68. 75％) were alcohol users. There were 30 cases ( 93. 75％) and 31 cases ( 96. 88％) with mucosal atrophy and intestinal metaplasia, respectively. The size of main and minor lesions showed a positive correlation (r=0. 4167, P=0. 018). The endoscopic classification of major and minor lesions had no statistical significant consistency ( P=0. 314 ) , but the pathologic type and invasion depth between major and minor lesions demonstrated a moderate significant positive correlation ( P<0. 05 ) . The comparison of location between the main and minor lesions did not show correlation. However, it showed a significant correlation between major lesion which on the upper 1/3 of stomach and minor lesion on the lower 1/3 of stomach ( r=0. 463,P=0. 003) . Further more, when the main lesion was at posterior gastric wall, the minor lesions on lesser curvature were increased, which showed a positive correlation( r=0. 417,P=0. 009) . Conclusion Old-age male with long-term smoking and alcohol history whose lesions combined with surrounding mucosa merger atrophy and intestinal metaplasia are considered as a high risk group in patients with SMEGC or/and GHGIN. Therefore, clinicians must keep high vigilant and make carefully observations on this group of patients during endoscopic examination, and consider the correlation between main and minor lesions to avoid misdiagnosis.

Clinicopathologic characteristics of invasive lobular carcinoma of the breast / 临床与实验病理学杂志

Purpose To investigate the clinicopathological characteristics and the survival outcomes of invasive lobular carcinoma. Methods A retrospective analysis of 98 patients with invasive lobular carcinoma and 530 invasive carcinoma of no special type was performed in order to observe the histological features and the clinical outcomes of invasive lobular carcinoma. Results Median follow-up was 68. 5 months for invasive lobular carcinoma and 67 months for invasive carcinoma of no special type. Invasive lobular carcinoma presented with a larger tumor size, more histopathological grade 2 tumors, increased rate of hormonal receptor positivity, human epider-mal growth factor 2 (HER-2) negativity, and had a lower proliferative index as compared to invasive carcinoma of no special type, more frequently presented with the luminal A subtype (P<0. 001). The classical invasive lobular carcinoma presented with a smaller tumor size, to have a lower histological grade and proliferative index compared to the non-classic type, and more frequently presented with the luminal A subtype, whereas the non-classic invasive lobular carcinoma patients more frequently presented with the luminal B, HER-2 overexpression, or triple negative subtype (P=0. 035). A statistically significant difference in the outcome was observed at un-ivariate analysis for patients with non-classic for disease-free survival (P=0. 043) and for overall survival (P=0. 048), as compared with patients with classical invasive lobular carcinoma. The disease-free survival difference between the invasive lobular carcinoma and the invasive carcinoma of no special type was not significant (P=0. 537), and the overall survival rates were not statistically different between the two groups (P=0. 397). A statistically significant difference of overall survival was observed at multivariate analysis for patients with HER-2 positive and triple negative subtypes versus patients with luminal A invasive lobular carcinoma (P=0. 015, P=0. 016) . Conclusions The outcome of invasive lobular carcinoma is significantly correlated with histological and immunohistochemi-cally defined molecular subtypes. New tailored strategies should be explored in these subgroups of patients with poor outcome.

Clinicopathologic characteristics of primary IgA nephropathy and relationships with prognosis of 220 patients / 中国综合临床

Objective To analyze the clinical typing, pathological classisfication, and prognosis of primary IgA nephropathy (IgAN).Methods Clinical typing, pathological classisfication and relationship between clinical manifestations and pathological features of 220 cases with IgAN were analyzed in 10 years.Results IgA nephropathy occupied 42.9％ (220/512) of all the patients received renal biopsy at the corresponding time.Asymptomatic abnormal urinalysis was the most common clinical manifestation(39.0％ (86/ 220)), followed by hypertension (17.7％ (39/220)) and recurrent macroscopic hematuria (15.4％ (34/220)).Grade Ⅲ pathological change(29.5％ (65/220)) was the most co mmon,followed by grade Ⅱ (27.3％ (60/ 220)) and grade Ⅳ (18.2％), Grade Ⅰ/Ⅴ were relatively less ((11.4％ (25/220), 13.6％ (30/220)).No correlation could be found between types of deposited immune complex and pathological lesion extent(x2=4.87, P＞0.05).The clinical manifestations were significantly correlated with the severity of glomerular lesions (x2 =13.14,P＜0.05).During the follow-up for 106 patients (mean duration of 23 months), 90 patients(84.9％) had normal renal function and 75 patients(70.8％) had decreased excretion of protein in urine (＜1 g/24 h).Conclusion The clinical typing of primary IgA is correlated with pathological changes.The prognosis of IgA is markedly correlation with the pathological lesion degree.Renal functions will be improved if the different treatments were given according to the different renal pathological features.

The analysis of clinicopathologic characteristics of thyroid cancer:a retrospective study of 1,585 cases / 中国肿瘤临床

Objective:To investigate the incidence trends and clinicopathologic characteristics of papillary thyroid cancer (PTC). Methods:A retrospective analysis was conducting using the following data:3,766 cases with thyroid disease in the People's Hospital of Wuhan University between January 2001 and July 2013;and 977 cases with thyroid cancer in the Hubei Cancer Hospital between Janu-ary 2006 and July 2013. Results:The incidence of thyroid cancer increased significantly since 2008, ranging from 14.94%to 18.10%(P1 cm tumor diameter and multifocal PTC are more likely to be complicated with NLNM.

Extraskeletal myxoid chondrosarcoma:report of 5 cases and review of literatures / 临床与实验病理学杂志

Purpose To explore the clinicopathologic characteristics, pathologic diagnosis and differential diagnosis of extraskeletal myxiod chondrosarcoma. Methods The clinical and pathological features were studied with HE and immunohistochemical staining in 5 cases of extraskeletal myxoid chondrosarcoma, and the related literatures were also reviewed. Results Extraskeletal myxoid chondro-sarcoma was male predominance (4 males: 1 female), and the age ranged from 32 to 62 years with an average of 52 years. Four tumors occurred in thigh and another in chest. Histologically, the neophlasm were composed of round and oval cells. Immunohisto-chemically, the tumor cells were positive for vimentin in five cases, synaptophysin expressed in one case, S-100 showed focal positivity in two cases, but negative for CK, p63, EMA, CD34, SMA in all cases. Molecular genetics detection shows chromosome exchange be-tween number 9 and 22. Conclusion Extraskeletal myxoid chondrosarcoma is a rare tumor which has no special characteristics in clinical and iconography, and its diagnosis mainly depends on the histopathologic features, immunohistochemistry and molecular genet-ics. Extraskeletal myxoid chondrosarcoma grows slowly, but have a high tendency for local recurrence and metastases.

Clinicopathologic study based on 2 056 cases of pulmonary resection of lung adenocarcinoma / 中华胸心血管外科杂志

Objective The international multidisciplinary lung adenocarcinoma classification was published by IASLC/ ATS/ERS in 2011.This study aimed to explore the clinicopathologic characteristics of lung adenocarcinoma based on IASLC/ATS/ERS classification and validate its clinical diagnostic and therapeutic value.Methods 2 056 cases of surgical resection from Shanghai Chest Hospital were classified according to the new classification and clinical information were retrospectively reviewed.The clinicopathologic characteristics based on new classification were analyzed statistically.Results Our data indicated that women were in high risk of lung adenocarcinoma; The average age of onset was 59-year-old; the female patients were younger than the male patients (58.7 years vs 60.2 years,P ＜ 0.01) ; Average tumor diameter was 2.6 centimeter; right lung was more popular than left and superior lobe than the inferior one.Acinar predominant subtype and papillary predominant subtype were frequently observed.Micropapillary predominant subtype and solid predominant subtype were identified to be more aggressive than other histopathologic subtypes.Most patients were classified as stage Ⅰ(71.7％),which were predominantly stage Ⅰa (53.1％).Conclusion The new classification is superior to reflect the clinicopathologic characteristics of lung adenocarcinoma and satisfy clinical needs,especially contributing to change and update the surgical strategy of early stage lung adenocarcinoma.

Association of Toll-Like Receptor 2 Polymorphisms with Papillary Thyroid Cancer and Clinicopathologic Features in a Korean Population

Toll-like receptors (TLRs) single nucleotide polymorphisms (SNPs) were analyzed in patients with papillary thyroid cancer (PTC; n = 133) and their clinicopathologic features and age-matched controls (n = 321) using direct sequencing. PTC patients were divided into subgroups according to size, number, location, extrathyroidal invasion and lymph node metastasis. The two SNPs of TLR2 gene were not associated with the development of PTC. In clinical analysis, two SNPs were associated with location of cancer (rs3804099, P = 0.032, OR, 0.52; 95% CI, 0.28-0.96 in log-additive model; rs3804100, P = 0.039, OR, 0.46, 95% CI, 0.22-0.96 in codominant1 model; P = 0.018, OR, 0.42, 95% CI, 0.21-0.87 in dominant model; P = 0.011, OR, 0.46, 95% CI, 0.25-0.85 in log-additive model). The allele frequencies of two SNPs also showed significant associations with location of cancer (rs3804099, P = 0.046, OR, 0.57, 95% CI, 0.33-0.99 and rs3804100, P = 0.019, OR = 0.52, 95% CI = 0.30-0.90). However, two SNPs were not associated with the clinicopathologic features of PTC. It is suggested that TLR2 polymorphisms may contribute to the clinicopathologic features of PTC, especially the PTC in both lobes.

Association of Toll-Like Receptor 2 Polymorphisms with Papillary Thyroid Cancer and Clinicopathologic Features in a Korean Population

Toll-like receptors (TLRs) single nucleotide polymorphisms (SNPs) were analyzed in patients with papillary thyroid cancer (PTC; n = 133) and their clinicopathologic features and age-matched controls (n = 321) using direct sequencing. PTC patients were divided into subgroups according to size, number, location, extrathyroidal invasion and lymph node metastasis. The two SNPs of TLR2 gene were not associated with the development of PTC. In clinical analysis, two SNPs were associated with location of cancer (rs3804099, P = 0.032, OR, 0.52; 95% CI, 0.28-0.96 in log-additive model; rs3804100, P = 0.039, OR, 0.46, 95% CI, 0.22-0.96 in codominant1 model; P = 0.018, OR, 0.42, 95% CI, 0.21-0.87 in dominant model; P = 0.011, OR, 0.46, 95% CI, 0.25-0.85 in log-additive model). The allele frequencies of two SNPs also showed significant associations with location of cancer (rs3804099, P = 0.046, OR, 0.57, 95% CI, 0.33-0.99 and rs3804100, P = 0.019, OR = 0.52, 95% CI = 0.30-0.90). However, two SNPs were not associated with the clinicopathologic features of PTC. It is suggested that TLR2 polymorphisms may contribute to the clinicopathologic features of PTC, especially the PTC in both lobes.

Thyroid Carcinoma in Patients Less Than 20 Years of Age at Diagnosis: Clinicopathologic Characteristics / 대한내분비외과학회지

PURPOSE: This study determined the clinicopathologic characteristics in young patients with thyroid carcinoma. METHODS: We retrospectively reviewed the records of 39 patients who were <20 years of age when diagnosed between January 1985 and December 2008. RESULTS: The mean age was 17.28 years (range, 4~20 years). There were 33 females and 6 males, with a mean follow-up period of 110 months (range, 1~263 months). The initial surgery consisted of total thyroidectomy in 29 patients (74%), and lobectomy and isthmectomy in 10 patients (25%). The mean size of the tumors was 2.56 cm (range 0.4~7 cm), and 31 (79%) of 39 patients had perithyroidal tissue invasion. Papillary and follicular carcinoma was reported in 31 (79%) and 6 patients (15%), respectively. Three patients had a recurrence and no patients had progression of metastasis at the time of diagnosis. CONCLUSION: Further collaborative studies are needed to refine the surgical approach, particularly the extent of lymph-node dissection, radioactive iodine dosing, and clinical approach.

The Clinicopathologic Characteristics of Patients with Gastric Carcinoid Tumor

PURPOSE: We wanted to analyze the clinicopathologic characteristics of patients with gastric carcinoid tumor, which is a rare gastric tumor (less than 2% of all gastric tumors). MATERIALS AND METHODS: We reviewed all the carcinoid patients who were treated from 1996 to 2006. The clinicopathologic characteristics, the treatment modalities and the survival rates were retrospectively analysed. RESULTS: There were 8 type I patients and 10 type III patients, but there were no type II patients. The mean age of onset for type I was 47.75 years and that for type III was 57.90 years. More type III patients were female, but the gender ratio of type I patients was equal at a ratio of 1:1. There were 4 cases of solitary tumor, which were all T1 except for one case, and there was neither distant metastasis nor lymph node involvement for the type T1 cases. In the 13 patients who had no metastasis, 5 underwent endoscopic mucosal resection and 8 underwent surgery, and their combined 5 year survival rate was 92.3%. For the 5 cases who had metastastses, their mean survival was 22 months and especially, 3 of them underwent palliative surgery and their median survival were 24 months (95%, +/-6.52). CONCLUSION: Higher incidence of type III gastric carcinoid tumor and less multiplicity in type I gastric tumor were identified in our study compared with previous reports. For the type III cases, there were some noteable differences compared with the Western country's survival rate for the patients who underwent palliative surgery, so physicians must pay close attention to the definite clinicopathologic characteristics of gastric carcinoid patients.

The Clinicopathologic Characteristics of Neuroendocrine Tumor of the Stomach

PURPOSE: The goal of this study was to review the clinicopathologic characteristics of neuroendocrine tumor (NET) of the stomach. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 13 patients who were diagnosed with neuroendocrine tumor from January 1999 to August 2007 at Kosin Medical Center; 4,159 gastric cancer patients were treated surgically during the same time. The average follow up period was 14.3 months. RESULTS: The majority of 13 patients were men (male-female ratio: 11:2) and the average age of patients with NET was 59.4 years (range: 42~72 years). The presenting symptoms were mostly epigastric pain and soreness. The tumor was limited to the mucosa or submucosa in two cases, and the tumor extended beyond the muscle layer in 11 cases. The mean size of the tumor was 7.0 cm, ranging from 0.7 cm to 15 cm. The type of the NEC (according to the WHO classification) was type 3 for eight patients, type 4 for four patients and type 1 for one patient. Regional lymph node metastasis was noted in 11 patients. Four cases showed recurrence of disease and the site of recurrence included liver in two patients, multiple organs (including the peritoneum and lung) in one patient and multiple organs (including liver, pancreas and duodenum) in one patient. The recurrent cases were type 3 and type 4 and the average survival period of the recurrent patients was 12.8 months. CONCLUSION: The majority of neuroendocrine tumors of the stomach were at an advanced stage at the time of diagnosis. These tumors frequently recurred in the liver and they have a poor prognosis.

Comparisons of clinicopathologic characteristics and prognostic factors between squamous cell carcinoma and adenocarcinoma of the uterine cervical cancer patients underwent radical hysterectomy and pelvic lymphadenectomy / 부인종양

OBJECTIVE: To compare clinicopathologic characteristics and prognostic factors between squamous cell carcinoma (SCC) and adenocarcinoma (AC) of the uterine cervix. METHODS: We reviewed medical records and pathologic reports of 568 patients with SCC and 78 patients with AC who underwent radical hysterectomy and pelvic lymphadenectomy from January 1988 to December 2004. We analyzed clinicopathologic factors and 5-years survival rate (5-YSR), and than compared 5-YSR between SCC and AC according to clinicopathologic factors. RESULTS: At the stage I, the incidence of AC (82.0%) was more than SCC (69.6%) and at the stage II, the incidence of SCC (30.4%) was higher than AC (18.0%). The rate of lymph-vascular space invasion was higher in SCC (28.2%) than AC (15.4%). The 5-YSR was not different between SCC (85.7%) and AC (86.9%). In multivariate analysis, depth of invasion, resection margin, pelvic lymph node metastasis were independent prognostic factors in SCC and FIGO stage, pelvic lymph node metastasis were independent prognostic factors in AC significantly. At the 5-YSR between SCC and AC, the prognosis of AC (50.0%) was poorer than SCC (78.0%) in the case of the one pelvic lymph node metastasis (p=0.0632). CONCLUSION: The FIGO stage and lymph-vascular space invasion were significant different in clinicopathologic characteristics between SCC and AC. The prognosis of AC was poorer than SCC in the case of the one pelvic lymph node metastasis (p=0.0632). But, the overall 5-YSR was not different between SCC and AC.

Papillary Thyroid Microcarcinoma: Clinicopathologic Characteristics and Treatment Strategy

PURPOSE: The clinical importance of papillary microcarcinoma (PTMC) is debatable. Because PTMC is being diagnosed with increasing frequency, it is important to describe the clinical and histological characteristics that confer aggressive behavior to this cancer. This study was carried out to evaluate the clinical and histological characteristics of PTMC and to determine an appropriate treatment strategy for such cases. METHODS: From Jan. 2000 to Dec. 2005, 1,255 patients with small papillary carcinoma, which measured less than 2.0 cm in its greater dimension, underwent total thyroidectomy at our institution. Among these patients, 633 (50.4%) had a thyorid carcinoma less than or equal to 1 cm in diameter (Group A). The clinicopathologic features and treatment outcome of these patients were evaluated and compared with the remaining 622 cases (49.6%) (Group B). RESULTS: For the patients with PTMC (Group A), there were 70 men and 563 women with a median age of 44 years (range; 12~86). During a mean follow-up of 32.5+/-18.2 months, 6 patients (0.9%) developed locoregional recurrences and 3 patients (0.5%) showed distant metastases. There was no disease-related mortality in both groups. The disease of group B was more likely to show extracapsular invasion (P 1 cm), some PTMCs show aggressive clinical behavior and locoregional recurrence. The treatment of PTMC should be individualized based on its tumor risk profiles and the clinical presentations. Moreover, performing close follow-up is essential, especially for those patients who present with cervicolateral lymph node metastases.

A Clinical Analysis of Surgical Treated Thyroid Incidentaloma / 대한내분비외과학회지

PURPOSE: An incidentaloma is a tumor that is found incidentally without clinical symptoms. This study was carried out to evaluate the clinicopathologic characteristics and to offer the optimal diagnostic and therapeutic strategies for surgical treated thyroid incidentaloma. METHODS: We reviewed the medical records of 139 consecutive patients who were operated on for incidentally detected thyroid nodules from January 2000 to June 2005, and we retrospectively investigated the clinicopathologic characteristics, preoperative diagnostic methods, operative methods and histologic diagnosis of surgical treated thyroid incidentaloma. RESULTS: The male-to-female ratio was 1:9.7 (13:126) and the mean age was 45.8 years. The mean tumor size was 1.27 cm and 122 cases (87.8%) were 1.5 cm or less in diameter. 138 patients underwent ultrasonography and 34 patients (24.6%) were diagnosed with malignant nodules. US-guided fine needle aspiration cytology (FNAC) was performed in 118 patients and 42 patients (35.6%) were diagnosed with papillary carcinoma. According to postoperative histologic diagnosis, 70 cases (50.3%) were adenomatous goiter, 14 cases (10.2%) were follicular adenoma and 54 cases (38.8%) were papillary carcinoma. Among the papillary carcinoma, capsular invasion were presented in 3 cases (5.6%) and lymph node metastasis were presented in 5 cases (9.3%). According to the TNM staging, 33 cases (61.1%) were stage I, 16 cases (29.6%) were stage II, and 5 cases (9.3%) were stage? By the AMES scoring system, 2 cases (3.7%) were in the high risk group. CONCLUSION: Although most patients with incidental thyroid carcinomas were low stage, their clinicopathologic characteristics were similar to those of general thyroid carcinoma. Therefore, high risk patients with thyroid incidentaloma should have active diagnostic methods performed such as FNAC for confirming the presence of carcinoma.

Gastrointestinal Stromal Tumor of Rectum: A Reoport of 7 Cases

PURPOSE: Gastrointestinal stromal tumors (GISTs) are rare. The aim of this study is to investigate and describe the clinicopathologic characteristics of rectal GISTs. METHODS: We retrospectively analyzed the medical records of seven patients who underwent surgery for GIST of the rectum from 1998 to 2003. RESULTS: Male and female patients were two and five respectively. The mean age was 55 years (range, 41~72 years) at the time of diagnosis. The median follow-up period was 23 months (range, 7~75 months). The chief complaints were hematochezia, constipation and anal pain. Curative resections were done in all cases. Abdominoperineal resection was done in five cases and transanal excision was done in one case. In one case, Hartmann's operation with prostatectomy was done. The mean size of tumor was 6.6 cm (1~12 cm). The pathologic feature of all cases were spindle cell type. The mitotic count shown > or =5 in 50 high power field was identified in four cases and that shown < or =5 in 50 high power field in three cases. Adjuvant radiation therapy was done in four cases. Two local recurrences occurred on 54 month and 23 month later after surgery, respectively. CONCLUSION: In cases of GIST of the rectum, the common symptom was same as other rectal tumors. Immuonhistiochemical staning of c-kit is helpful for differential diagnosis. Curative surgical resection should be done for treatment.

Neuroendocrine Carcinoma of the Stomach

PURPOSE: The aim of this study was to investigate the histopathologic characteristics and the clinical outcome of neuroendocrine carcinoma of the stomach. METHODS: The medical records of 16 patients diagnosed with neuroendocrine carcinoma between 1990 and 2001 at the Department of Surgery, Yonsei University College of Medicine were reviewed. RESULTS: There were 13 male and 3 female patients. The mean age at the time of diagnosis was 62.8 years. The presenting symptoms were epigastric pain or postprandial abdominal discomfort in ten patients, melena in two, and weight loss in one, the remaining three were diagnosed incidentally. Ten patients had a tumor in the upper or middle one third of the stomach and the remaining six patients had a tumor in the distal one third. The mean size of the tumor was 5.3 cm, ranging from 2 cm to 9 cm. The tumor extended beyond the serosa in ten patients (invading the pancreas in one patient), and was limited to the muscle layer proper in five patients, and to the submucosal layer in only one patient. Regional lymph node metastasis was noted in 11 patients. Tumor cells extended to the perigastric lymph nodes in 5 patients and the extra-perigastric lymph nodes in 6 patients, including paraaortic lymph nodes metastasis in 2 patients. Liver metastasis was present in one patient. Seven patients were alive without any evidence of recurrence at a mean follow-up of 75.7 months (range 9~125), and one other was alive with a recurrent disease in the peritoneal cavity. The remaining eight patients died of disease recurrence or progression at an average of 10.6 months after diagnosis. CONCLUSION: Neuroendocrine carcinoma of the stomach is more likely to develop in the male and is usually found at an advanced stage at the time of diagnosis. It also has a tendency to infiltrate deeply into the gastric wall with frequent regional lymph node metastasis. Neuroendocrine carcinoma is a peculiar histologic subtype of gastric cancer which takes an aggressive clinical course.

Clinicopathologic Characteristics and Prognosis of Endometrial Cancer: A study of 56 Cases / 대한산부인과학회잡지

OBJECTIVES: This study was performed to evaluate the clinicopathologic characteristics and prognosis of uterine endometrial cancer to identify risk factors of the therapeutic and prognostic values. METHODS: This retrospective study was based on medical records including operation records and pathologic reports of 56 patients who underwent surgical treatment with histologically proven endometrial cancer at Kyung-Hee University Medical Center from Sep. 1979 to Aug. 2001. The survival of patients was determined by description of last follow up date in medical records. If more than 3 months passed from last follow up date, we used mail and phone call to identify the status of patients. Univariate analysis was carried out to compare the importance of prognostic variables. RESULTS: The mean age of these patients was 52.4 years, the most common presenting symptom was abnormal vaginal bleeding (91.1%). All except 2 cases of papillary serous carcinoma (3.6%) and 1 case of clear cell carcinoma (1.8%) were endometrioid adenocarcinoma (94.6%). And there are 6 cases of endometrial carcinoma with squamous differentiation. The grades were classified into grade 1 (53.6%), grade 2 (26.8%), grade 3 (19.6%). The FIGO surgical stages were classified into stage\\'a5\\'b0 (55.4%), stage \\'a5\\'b1 (7.1%), stage \\'a5\\'b2 (30.4%), stage \\'a5\\'b3 (7.1%). Most of the patients (87.5%) were treated by surgery only or surgery followed by adjuvant radiotherapy. The overall 5 years survival rate (5YSR) was 65.6%: The FIGO surgical stage \\'a5\\'b0 83.3%; stage \\'a5\\'b1 66.7%; stage \\'a5\\'b2 37.5%; stage \\'a5\\'b3 33.3%. Recurrent case was only one case. The age, parity, and preoperative Pap test were not significant prognostic factors. The depth of myometrium invasion (p<0.05), FIGO surgical stage (p<0.05), peritoneal cytology (p<0.05) and lymph node metastasis (p<0.05) were significant prognostic factors by univariate analysis. CONCLUSIONS: Although the number of patients was not enough, the depth of myometrial invasion, FIGO surgical stage and lymph node metastasis seemed to be significant prognostic factors of uterine endometrial cancer.

Clinicopathologic characteristics of early gastric cancer in Korea

Gastric cancer is the most common cause of cancer related death in Korea. Early gastric cancer (EGC), confined to mucosa or submucosa, regardless of lymph node metastasis, is known to have a favorable prognosis. From 1976 to 1995, four thousand nine hundred and twenty eight gastric cancer patients underwent operation at the Severance Hospital, Yonsei University, College of Medicine, Seoul, Korea. Of these, 1,117 patients (22.6%) were diagnosed as EGC and underwent curative operation. Clinicopathologic characteristics were reviewed and survival data was analyzed. The proportion of EGC has increased during the last two decades, from 14.9% during 1976-1985 to 25.8% for 1986-1995. EGC has a wide age distribution range from the thirties to the sixties, with highest incidence in the sixties. The male to female ratio is 1.8:1, without any significant change in last two decades. Most lesions are located in the lower third of stomach (52.3%), and the lesser curvature (52.2%) was the most frequent site in the transverse axis. Macroscopically, the depressed type was the most common (66.1%) followed by the elevated, flat and mixed types, in that order. Tumor confined to the mucosa layer was seen in 52.5%, and lymph node involvement in 11.7%. The depth of tumor invasion correlated with tumor size and regional lymph node involvement. On histopathologic examination, signet ring cell type accounted for 29.6% of all EGCs. Overall 5-year survival rate was 92.7% and the presence of lymph node metastasis significantly affected survival (84.6% versus 96.2%) (p<0.05). In conclusion, the proportion of EGC, in terms of the gastric cancers operated upon, has been increasing in Korea over the last two decades. The introduction of active diagnostic approaches and diagnostic modalities could improve early diagnosis and the cure rate of gastric cancer in Korea.