Research advances in thermal ablation for lung cancer / 中国胸心血管外科临床杂志

@#Although surgical resection remains to be the best treatment strategy for stageⅠnon-small cell lung cancer (NSCLC), percutaneous thermal ablation offers an important option for patients who are unable to undergo surgical resection. Currently, there are three main thermal ablation methods used in the treatment of lung cancer, including radiofrequency ablation (RFA), microwave ablation (MWA) and argon-helium cryoablation (AHC). With the improvement of technique and the accumulation of experience in the treatment of lung cancer, some limitations are disclosed in the initial application of RFA, such as heat sink effect, skin burns and rapid carbonization. These shortcomings have been overcome in the development of MWA and AHC. The feasibility and safety of thermal ablation for the treatment of lung cancer has been demonstrated and its efficacy has been significantly improved (especially for the tumour diameter≤3 cm). This article will focus on the application and recent research developments of these ablation techniques in the treatment of lung cancer.

Insight Into Complete Blood Count In Malignancies

It is very well known that the tumor-host interaction is not limited to the tumor microenvironment but to also alter the entire physiological process to help the development and progression of cancer. Our immune system does not escape from the clutches of the cancer, i.e altered hematological parameters can influence the progression of cancer and vice versa. With this in mind we conducted this study in the Department of Pathology MMC&RI with an attempt to reveal the pattern of complete blood count in malignancies and their difference in localized and metastatic cancer. All the cases included in this study were the ones referred to Cytopatholgy, and diagnosed with cancer. There was significant statistical correlation between the various hematological parameters and the metastatic cancers implying their use to predict the tumor behavior

Systemic Therapy for Advanced and Metastatic Colon Cancer / 대한소화기학회지

Colon cancer is one of the three most common cancers in both men and women in Organization for Economic Cooperation and Development countries. Approximately one-quarter of colon cancer patients have a metastasis at the time of diagnosis, and systemic therapy is used in many of them as a first line therapy. In addition to existing cytotoxic drugs, target therapy has been introduced in colon cancer and immunotherapy has shown clinical benefits in the treatment of metastatic colon cancer. The purpose of this review was to briefly summarize the National Comprehensive Cancer Network guidelines for systemic therapy in colon cancer with special reference to targeted agents and novel agents.

Eyelid Mass as Initial Presentation of Breast Cancer: A Case Report

PURPOSE: We report a case in which eyelid mass was the initial presentation of breast cancer. The diagnosis of breast cancer was made after lid biopsy. CASE SUMMARY: A 41-year-old female patient presented with a painful mass on the left lower lid after 1 month. There was a pinkish mass in the lateral portion of the tarsal conjunctiva, and computed tomography revealed a mass with an irregular margin on the lower lid connected to the left lacrimal gland. Biopsy was performed at the tarsal conjunctiva of the left eye, and histopathologic examination was suggestive of malignant epithelial cell neoplasm, especially metastatic carcinoma in the breast. The patient was diagnosed as having invasive ductal cancer, for which she is currently receiving chemotherapy. CONCLUSIONS: Metastases to the eyelid are very rare, accounting for less than 1% of all malignant eyelid lesions. We report a patient who presented with an eyelid mass as the initial presentation of breast cancer, which was diagnosed with metastatic breast cancer.

Small Bowel Metastatic Cancer Observed With Double Balloon Enteroscopy in a Patient With a Past History of Multiple Cancers

Small bowel tumors are very rare and generally malignant. As a result of the anatomical location and nonspecific manifestations of small bowel tumors, they are very difficult to diagnose. Balloon-assisted enteroscopy is a relatively noninvasive method compared to surgical resection, and allows for real-time observation, tissue confirmation with biopsy, and interventional procedures. Here, we report the case of a 69-year-old woman with a small bowel metastatic carcinoma observed with double balloon enteroscopy (DBE). She had a history of multiple cancers including ovarian cancer, bladder cancer, and breast cancer. The antegrade DBE procedure was performed before surgery for biopsy tissue confirmation. The patient underwent small bowel resection, and the final diagnosis was the same as that determined by preoperative biopsy. The final diagnosis was metastatic small bowel cancer originating from a cancer of the breast. This is the first detailed report of the preoperative diagnosis of small intestinal metastatic breast cancer by DBE.

Endobronchial Ultrasound-guided Transbronchial Needle Biopsy for Diagnosis of Mediastinal Lymphadenopathy in Patients with Extrathoracic Malignancy

Mediastinal lymphadenopathy associated with extrathoracic malignancy or a metastasis of unknown origin (MUO) requires pathological verification. Surgical exploration or endoscopic ultrasound-guided fine needle aspiration is limited to application. We investigated the effectiveness of endobronchial ultrasound-guided transbronchial needle biopsy (EBUS-TBNA) for evaluating mediastinal lymphadenopathy in patients with an extrathoracic malignancy. We retrospectively analyzed data from 59 patients who underwent EBUS-TBNA with a core biopsy because of a suspected mediastinal metastasis between September 2008 and August 2010. All patients had previously been diagnosed with an extrathoracic malignancy (n = 39, 66.1%) or a suspected MUO without a thoracic lesion (n = 20, 33.9%). A total of 88 lymph nodes was analyzed. EBUS-TBNA findings indicated malignancies in 34 patients (57.6%). The EBUS-TBNA sensitivity and specificity for the detection of mediastinal malignancy in patients with a previous extrathoracic malignancy were 96.3% and 100%, respectively. For MUO patients without a thoracic lesion, the sensitivity and specificity were 61.5% and 100%, respectively. The overall sensitivity and specificity were 81.0% and 100%, respectively (P = 0.053). EBUS-TBNA is a safe and effective modality for evaluating mediastinal lymphadenopathy in patients with a previous extrathoracic malignancy or a MUO without a thoracic lesion. The application of this diagnostic tool is likely to have significant clinical implications.

Metastatic Pathologic Fractures in Lower Extremities Treated with the Locking Plate / 대한골관절종양학회지

PURPOSE: The skeleton is commonly affected by metastatic cancer. The purpose of this study was to evaluate the results of treating metastatic pathologic fractures in lower extremities using locking plates. MATERIALS AND METHODS: Between 2004 and 2010, we evaluated 12 patients (13 cases) of metastatic pathologic fractures in lower extremities, treated with the locking plate. Mean patient age was 62.2 years (range, 50-81 years), the locations of the fractures were; proximal femur in 2 cases, femoral mid-shaft in 3, distal femur in 3, proximal tibia in 4, and distal tibia in 1 case. The interval to wheelchair ambulation, pain relief and complications were evaluated. Additionally, we assessed operation time and postoperative blood loss. RESULTS: Mean time from operation to wheelchair ambulation was 3.2 days (range, 1-6 days). Mean VAS scores improved from a preoperative score of 8.1 points (range, 7-9 points) to a score of 2.7 points (range, 2-4 points) at 1 week postoperatively. No early complications associated with surgery were encountered. Mean operation time was 88.4 minutes (range, 70-105 minutes), and mean postoperative blood loss was 246.5 ml (range, 130-320 ml). CONCLUSION: Internal fixation of metastatic pathologic fractures using a locking plate in the lower extremity can be an effective treatment option in the meta- or diaphyseal area of long bones with massive bony destruction or poor bone stock by offering early ambulation, pain relief and low postoperative complications.

A case of advanced gynecologic pelvic tumors showing the diagnostic utility of HPV analysis / 부인종양

Gynecologic malignancies may have similar histological characteristics. This may lead to difficulties in determining the origin of the cancer and to distinguish a synchronous neoplasm from a metastatic cancer in advanced cases. Recently, we treated a 59-year-old patient with adenocarcinoma of the uterine cervix, endometrium, fallopian tubes, and ovaries. It was difficult to determine whether the cancer was a single origin metastatic cancer or a synchronous neoplasm. The patient was finally diagnosed with metastatic cancer that originated from the uterine cervix by human papillomavirus (HPV) test. Here we report the case and briefly review of the medical literature.

Metastatic cancer stem cells and anti-metastasis strategies / 中国肿瘤生物治疗杂志

Cancer stem cells (CSC) are capable of self-renewal and can proliferate into a heterogeneous bulk with cancer progeny population, which is the main reason for recurrence and metastasis of cancer. Metastatic cancer stem cells (MCSC) have the properties of CSC and the ability of metastasis. Metastasis happens at both the late and early stages of tumorigenesis. MCSC are different from CSC in origin, epithelial-mesenehyrnal transition (EMT), mesenehymal-epithelial transition (MET), and microenvironment of target organs (niche), etc. Therefore, MCSC is the foundation of cancer metastasis. Anti-metastasis strategies include killing CSC, blocking EMT and MET of CSC, inhibiting MCSC adhesion to microvessels, and destroying MCSC dependent-niche. This review introduces the possible sources, biological features of MCSC, the possible breakthrough in MCSC research, and MCSC-targeted anti-metastasis strategy, hoping to provide reference for researches about tumor metastasis mechanisms and anti-metastasis strategies.

A case of inguinal lymph node squamous cell carcinoma of unknown origin, accompanied with carcinoma in situ of cervix / 부인종양

Metastatic Cancer of Unknown Primary Site (CUP) accounts for approximately 3-5% of all malignant neoplasms. CUP represents a heterogeneous group of metastatic tumors for which no primary site can be detected following a thorough medical history, careful clinical examination, and extensive diagnostic work-up. Several authors have reported poor prognosis of this malignancy, because there is no consensus on diagnostic guidelines and optimal therapy. Historically, chemotherapy has been the cornerstone of treatment for patients with CUP. We experienced a case of inguinal lymph node squamous cell carcinoma of unknown origin, accompanied with carcinoma in situ of the cervix. We report this case with a brief review of the literatures.

A Case of Colonic Metastatic Malignant Melanoma of Unknown Origin / 대한소화기내시경학회지

A metastatic melanoma to the gastrointestinal tract is observed in 1.5~4.4% of all melanoma patients. However, colonic and rectal involvement is less common. A 72-year-old woman was admitted due to abdominal pain and poor oral intake for 20 days. She had a 3 x 4 cm-sized mass on her right inguinal area 4 month ago, which was diagnosed as a malignant melanoma of the inguinal lymph node on excision biopsy. A large exophytic mass with an irregular ulcerlated, whitish patch, erythematous surface was observed in the hepatic flexure during colonoscopy. A histology diagnosis of a metastatic melanoma was made by an optical microscopy examination of the biopsies obtained during the colonscopy, and palliative right hemicolectomy was performed on account of a potential intestinal obstruction. We report a case of a metastatic melanoma of the colon with a review of the relevant literature.

A Case of Metastatic Lung Cancer Presenting with Isolated Hypoglossal Nerve Palsy

The peripheral hypoglossal nerve palsy is caused by carotid aneurysm, vascular entrapment, local infection, trauma, neck radiation, and tumors in the neck, retropharyngeal spaces, and basilar area of skull. A basilar skull lesion may rarely involve the hypoglossal nerve alone. We report a 58-year-old man with isolated hypoglossal nerve palsy due to metastasis of lung cancer at the skull base.

Percutaneous Vertebroplasty in a Patient with an Osteolytic Spinal Metastatic Tumor: A case report / 대한마취과학회지

Percutaneous vertebroplasty was first introduced in 1984. It allows reduction in pain and strengthening of bone. Main indications for this procedure are an osteoporotic compression fracture, hemangioma or a malignant spine tumor. Metastases to the vertebrae are not rare and often painful. Radiation therapy results in delayed (10 14 days) pain relief and minimal bone strengthening. Surgical procedures require significant postoperative recovery and have associated morbidity and mortality. However, a percutaneous vertebroplasty in patients with an osteolytic spinal metastatic tumor results in quick (1 3 days) disappearance of pain, vertebral consolidation, and spinal stability. We encontered a patient with severe back pain due to an osteolytic spinal metastatic tumor that had not responded to radiation therapy but which responded successfully to pain relief by a percutaneous vertebroplasty.

Patellar metastasis from Squamous Cell Carcinoma of the Larynx: A Case Report / 대한정형외과학회잡지

Metastatic tumors of the patella are rare, espicially metastasis of the head and neck carcinoma to the patella is exceedingly rarer still. We experienced a case of patellar metastatic cancer from laryngeal squamous cell carcinoma and report the clinical, radiographic and pathologic findings in detail.

Orbital tumor from renal cell carcinoma

Orbital tumors are rare. Age specific incidence of primary malignant orbital tumor is approximately 2 per 1 million population until the 6th decade, 4 per 1 million in those older than 60 and 10 per 1 million in those older than 80 years. Approximately 1-13 percent of all orbital tumors are metastatic in nature. The most common primary cancers that metastasize to the orbits are breast, prostate gland and lung. In a series of 100 patients with orbital metastasis, only 5 patients had primary cancer from the kidney. We report a case of an orbital tumor which turned out to be a metastasis due to a renal cell carcinoma from the contralateral kidney. (Author)

Analysis of 38 Cases of Metastatic Cancer of Ovary / 대한암학회지

PURPOSE: The relative ftequency of ovarian metastases from various organs reported in literature varies with geographic distribution. To our knowledge, there has been no comprehensive report on the subject of metastatic cancer to the ovary in Korea, so we tried to evaluate the clinical characteristics of them. MATERIALS AND METHODS: We reviewed the files of the Department of Pathology from January 1988 to December 1997 in Seoul National University Hospital and obtained 38 cases diagnosed as metastatic cancer to ovary. We retrospectively reviewed the patients' records and evaluated the clinical characteristics, treatment modalities and clinical outcome. RESULTS: The mean age of patients was 43.7 years (range: 19-63) and the most common symptom was pelvic pain (21.1%). The origins of primary cancer were as follows in the order of frequency: stomach (65.8%), colon (13.2%), unknown (10.5%), hematologic malignancy (7.9%) and lung (2.6%). The most common pathologic findings were metastatic adenocarcinoma in 34 cases (89.5%), among which 14 cases (36.8%, 14/38) were Krukenberg tumor. The origins of primary cancer were diagnosed preoperatively in only 18 cases (47.4%). Eleven patients (28.9%) received surgery only, while 27 patients (71.1%) received both surgery and adjuvant chemotheiapy. For all patients, the median survival was 17 (range: 11-23) months and the overall 3-year survival rate (3YSR) was 28.6%. There were no significant differences in 3YSR according to primary tumor sites, status of ovarian involvement, pathologic finding, diagnostic time and treatment modalities. CONCLUSION: Although the overall survival rate and clinical factors which might affect survival were similar to previous reports from Westem countries, the most common origin of primary cancer was different.

DIAGNOSTIC SIGNIFICANCE OF BONE MARROW EXAMINATION AND ROUTINE HEMATOLOGIC PARAMETERS IN METASTATIC CANCER OF BONE MARROW / 解放军医学杂志

This paper reports 51 patients with malignant tumors (male 38, female 13). Tumor cells were found by microscopic examination of marrow aspirate smear in 21 of them. Among the patients with positive marrow smear for tumor cells, most of them had anemia, thrombocytopenia, and leucoerythrobla-stosis in peripheral blood and elevated levels of alkaline phosphatase, lactate dehydrogenase and eryth-rocyte sedimentation rate. The results showed that bone marrow examination and some hematologic parameters are of value in the diagnosis of metastatic cancer of the bone marrow. If it is necessary, marrow clot section, marrow biopsy, bone roentgenogram and bone scan should be carried out in order to further ascertain the diagnosis.