Desmoplastic Small Round Cell Tumor of the Mediastinum: A case report / 대한흉부외과학회지

Desmoplastic small round cell tumor (DSRCT) is rare and a recently described, poorly differentiated malignant tumor and it usually presents with widespread intra-abdominal involvement. We report a case of DSRCT arising form the mediastinum which was treated with multimodality anticancer therapy in 15 year-old girl.

Surgical Treatment of Cardiac Tumor / 대한흉부외과학회지

BACKGROUND: Tumors of the heart are uncommon. The aim of this study is to review our clinical experience and outcome of surgical treatment of cardiac neoplasm. MATERIAL AND METHOD: From March 1990 to December 2005, 35 patients (14 males and 21 females) with mean age of 52.4 years underwent surgical treatment of cardiac neoplasm. The clinical and pathologic data were analyzed retrospectively. Surgical treatment consisted in complete resection of the tumor in all cases but 1 patient who was left ventricular fibroma received biopsy only. RESULT: Thirty cases were benign and five cases were malignant tumor. Benign tumors were myxoma (29 cases) and fibroma (1 case). Five malignant tumors were osteosarcoma, hepatocellular carcinoma, renal cell cancer, yolk sac tumor, and unclassified myxoid spindle cell type sarcoma. There were no operative mortality in benign cases and twenty seven cases of myxoma were followed up for 8 months to 15 years without recurrence. But four patients of malignant tumor were expired within six months after operation. CONCLUSION: Left atrial myxomas are most common benign neoplasm. Surgical treatment is effective for the benign cardiac tumors but prognosis is poor in patients with malignant cardiac tumors.

Clinical Outcomes of Corrective Surgical Treatment for Esophageal Cancer / 대한흉부외과학회지

BACKGROUND: Clinical outcomes of esophageal cancer have not been satisfactory in spite of the development of surgical skills and protocols of adjuvant therapy. We analyzed the results of corrective surgical patients for esophageal cancer from January 1992 to July 2002. MATERIAL AND METHOD: Among 129 patients with esophageal cancer, ths study was performed in 68 patients who received corrective surgery. The ratio of sex was 59 : 9 (male : female) and mean age was 61.07+/-7.36 years old. Chief complaints of this patients were dysphagia, epigastric pain and weight loss, etc. The locations of esophageal cancer were 4 in upper esophagus, 36 in middle, 20 in lower, 8 in esophagogastric junction. 60 patients had squamous cell cancer and 7 had adenocarcinoma, and 1 had malignant melanoma. Five patients had neoadjuvant chemotherapy. RESULT: The postoperative stage I, IIA, IIB, III, IV patients were 7, 25, 12, 17 and 7, respectively. The conduit for replacement of esophagus were stomach (62 patients) and colon (6 patients). The neck anastomosis was performed in 28 patients and intrathoracic anastomosis in 40 patients. The technique of anastomosis were hand sewing method (44 patients) and stapling method (24 patients). One of the early complications was anastomosis leakage (3 patients) which had only radiologic leakage that recovered spontaneously. The anastomosis technique had no correlation with postoperative leakage, which stapling method (2 patients) and hand sewing method (1 patient). There were 3 respiratory failures, 6 pneumonia, 1 fulminant hepatitis, 1 bleeding and 1 sepsis. The 2 early postoperative deaths were fulminant hepatitis and sepsis. Among 68 patients, 23 patients had postoperative adjuvant therapy and 55 paitents were followed up. The follow up period was 23.73+/-22.18 months (1~76 month). There were 5 patients in stage I, 21 in stage 2A, 9 in stage IIB, 15 in stage III and 5 in stage IV. The 1, 3, 5 year survival rates of the patients who could be followed up completely was 58.43+/-6.5%, 35.48+/-7.5% and 18.81+/-7.7%, respectively. Statistical analysis showed that long-term survival difference was associated with a stage, T stage, and N stage (p <0.05) but not associated with histology, sex, anastomosis location, tumor location, and pre and postoperative adjuvant therapy. CONCLUSION: The early diagnosis, aggressive operative resection, and adequate postoperative treatment may have contributed to the observed increase in survival for esophageal cancer patients.

Activity of Matrix Metalloproteinase-2 and its Significance after Resection of Stage I Non-small Cell Lung Cancer / 대한흉부외과학회지

BACKGROUND: Matrix metalloproteinase-2 (MMP-2) is a class of proteolytic enzymes that digest collagen type IV and other components of the basement membrane. It plays a key role in the local invasion and the formation of distant metastases by various malignant tumors. The aim of this study was to evaluate the activity of MMP-2 and its significance as a prognostic marker in resected stage I non-small cell lung cancer (NSCLC). MATERIAL AND METHOD: In this study we obtained fresh-frozen samples of tumor and non-tumor tissues from 34 patients with stage I NSCLC who underwent resection without preoperative radiotherapy or chemotherapy. After the extraction of total protein from tissue samples, MMP-2 activities were assessed by gelatin-substrate-zymography. The activities were divided into the higher or lower groups. RESULT: The MMP-2 activities were higher in tumor tissues than in non-tumor tissues. The MMP-2 activity of non-tumor tissues in recurrent group was higher than in non-recurrent group (p<0.01). Also the patients with higher MMP-2 activity of non-tumor tissues showed poor 5 year survival (p<0.01). CONCLUSION: This result indicates that the higher level of MMP-2 activity in the non-tumor tissue is associated with the recurrence and survival after the resection of stage I NSCLC. Therefore, MMP-2 activity in the non-tumor tissue could be used as a potential prognostic marker for the resected stage I-NSCLC.

Surgical Management of Primary Cardiac Tumor: Early and Late Results / 대한흉부외과학회지

BACKGROUND: Primary cardiac tumors are rare disease and they present nonspecific symptom. They are divided in benign and malignant tumors and require surgical therapy and/or additional therapy. MATERIAL AND METHOD: From March 1995 to March 2003, twenty one patients were diagnosed as having primary cardiac tumors. We analysed them retrospectively in terms of various perioperative factors and early and late results. RESULT: 6 men and 15 women and their average age was 45.44+/-18.76. Pathology revealed eighteen benign (fourteen myxoma, two fibroelastoma, one hemangioma and one paraganglioma) disease and three malignant (one angiosarcoma, one mesothelioma and one myxofibrosarcoma) disease. There was one (myxoma) operative mortality and three late death (hemangioma, angiosarcoma and mesothelioma) during additional therapy and follow up. CONCLUSION: Surgical treatment of primary cardiac tumor is important and sometimes additional therapy is required but the prognosis of malignant cardiac tumor is still very poor.

Expression of Hypoxia-inducible Factor-1alpha in Esophageal Squamous Cell Carcinoma: Relationship to Prognosis and Tumor Biomarkers / 대한흉부외과학회지

BACKGROUND: Tissue hypoxia is a characteristic of many human malignant neoplasms, and hypoxia inducible factor-1 (HIF-1) plays a pivotal role in essential adaptive response to hypoxia, and activates a signal pathway for the expression of the hypoxia-regulated genes, resulting in increased oxygen delivery or facilitating metabolic adaptation to hypoxia. Increased level of HIF-1alpha has been reported in many human malignancies, but in esophageal squamous cell carcinoma, the influence of HIF-1alpha on tumor biology, including neovascularization, is not still defined. MATERIAL AND METHOD: The influence of HIF-1alpha expression on angiogenic factors, correlation between the tumor proliferation and HIF-1alpha expression, interaction of HIF-1alpha expression and p53, and correlation between HIF-1alpha expression and clinicopathological prognostic parameters were investigated, using immunohistochemical stains for HIF-1alpha, VEGF, CD34, p53, and Ki-67 on 77 cases of resected esophageal squamous cell carcinoma. RESULT: HIF-1alpha expression in cancer cells was found in 33 of 77 esophageal squamous cell carcinoma cases. The 33 cases (42.9%) showed positive stain for HIF-1alpha. High HIF-1alpha expression was significantly associated with several pathological parameters, such as histologic grade (p=0.032), pathological TMN stage (p=0.002), the depth of tumor invasion (p=0.022), regional lymph node metastasis (p=0.002), distant metastasis (p=0.049), and lymphatic invasion (p=0.004). High HIF-1alpha expression had significant VEGF immunoreactivity (p=0.008) and Ki-67 labeling index (p<0.001), but was not correlated with microvascular density within tumors (p=0.088). The high HIF-1alpha expression was correlated with aberrant p53 accumulation with a marginal significance (p=0.056). The overall 5-year survival rate was 34.9%. The survival rate of patients with a high HIF-1alpha expression was worse than that of patients with low-expression tumors (log-rank test, p=0.0001). High HIF-1alpha expression was independent unfavorable factors although statistical significance is marginal in multivariate analysis. CONCLUSION: It is suggested that (1) high HIF-1alpha expression in esophageal squamous cell carcinoma is associated with tumor hypoxia, or with genetic alteration in early carcinogenesis and progressive stages, (2) high HIF-1alpha expression may be associated with intratumoral neovascularization through HIF-VEGF pathway, and (3) high HIF-1alpha expression is associated with poor prognosis in patients with esophageal squamous cell carcinoma and may play a role as biomarker for regional lymph node metastasis.

Mucoepidermoid Carcinoma of the Lung: A case report / 대한흉부외과학회지

Mucoepidermoid carcinoma of the lung is extremely rare. This rare tumor arise beyond the carina, usually main stem bronchi, but occasionally in lobar or segmental airways. This tumor presents with symptoms of bronchial irritation or obstruction. Distant metastasis is an uncommon, therefore complete surgical resection is the treatment of the choice. The prognosis of this tumor correlates with the histologic grade of the tumor. We experienced a case of mucoepidermoid carcinoma arising from the right middle lobe, which was treated with the right middle lobectomy, with good result. We report this case and follow-up of the patient.