Câncer colorretal de início precoce: uma análise de onze anos das características clinicopatológicas em um centro de saúde terciário / Early-onset colorectal cancer: an eleven-year analysis of clinicopathological characteristics at a tertiary healthcare center

ABSTRACT Background: Early-onset colorectal cancer (EO-CRC) incidence has increased significantly worldwide in recent years, and these individuals frequently have advanced disease at the time of diagnosis. This study examines the clinicopathological characteristics of EO-CRC cases diagnosed at an academic healthcare center in Spain. Methods: A retrospective record review study of patients diagnosed with EO-CRC from 2010 to 2021 was performed. Clinical and pathological data were collected. Results: A total of 101 patients were included. The majority of cases (75.3%) were diagnosed in the age group between 40 and 49 years, specifically within the subgroup of 46-49 years. A family history of colorectal cancer was found in 23% of patients. Left-sided tumors were more common (43.6%), and most patients were diagnosed at advanced stages (34.7% at stage III and 32.7% at stage IV). The majority of patients (94.1%) were symptomatic, with rectal bleeding being the most prevalent clinical presentation. The most frequent histological type was moderately differentiated adenocarcinoma (44.6%). KRAS mutant tumors were found in 18.8% and BRAF mutant tumors in 11.9%. 67.3% had microsatellite stability. Tumor recurrence occurred in 24.8% of the patients, while 27.7% of the patients died. Conclusion: From 2010 to 2021, EO-CRC accounted for 3% of all colorectal cancer cases. To improve early diagnosis and treatment, physicians should maintain a high suspicion of red flag symptoms in young patients. To decrease EO-CRC morbidity and mortality, starting diagnostic screening tests at age 45 should be considered.

RESUMO Contexto: A incidência de câncer colorretal de início precoce (CCR-IP) tem aumentado significativamente em todo o mundo nos últimos anos, e esses indivíduos frequentemente apresentam doença avançada no momento do diagnóstico. Este estudo examina as características clinicopatológicas dos casos de CCR-IP diagnosticados em um centro de saúde acadêmico na Espanha. Métodos: Realizado um estudo retrospectivo de revisão de prontuários de pacientes diagnosticados com CCR-IP de 2010 a 2021. Dados clínicos e patológicos foram coletados. Resultados: Foram incluídos um total de 101 pacientes. A maioria dos casos (75,3%) foi diagnosticada na faixa etária entre 40 e 49 anos, especificamente dentro do subgrupo de 46 a 49 anos. Histórico familiar de câncer colorretal foi encontrado em 23% dos pacientes. Tumores do lado esquerdo foram mais comuns (43,6%), e a maioria dos pacientes foi diagnosticada em estágios avançados (34,7% no estágio III e 32,7% no estágio IV). A maioria dos pacientes (94,1%) apresentava sintomas, sendo o sangramento retal a apresentação clínica mais prevalente. O tipo histológico mais frequente foi adenocarcinoma moderadamente diferenciado (44,6%). Tumores com mutação KRAS foram encontrados em 18,8% e tumores com mutação BRAF em 11,9%. 67,3% apresentavam estabilidade de microssatélites. A recorrência do tumor ocorreu em 24,8% dos pacientes, enquanto 27,7% dos pacientes morreram. Conclusão: De 2010 a 2021, o CCR-IP representou 3% de todos os casos de câncer colorretal. Para melhorar o diagnóstico precoce e o tratamento, os médicos devem manter uma alta suspeita de sintomas de alerta em pacientes jovens. Para diminuir a morbidade e a mortalidade do CCR-IP, a consideração de iniciar exames de triagem diagnóstica aos 45 anos deve ser considerada.

Mismatch repair protein deficiency assessed by immunohistochemistry in sporadic colorectal carcinoma

Context: Globally, colorectal carcinoma (CRC) ranks the third most commonly diagnosed malignant disease, one of the leading causes of cancer deaths. Aims: To study the spectrum of clinicopathological characteristics of sporadic colorectal carcinoma and to assess mismatch repair gene deficiency by the expression pattern of the proteins assessed by immunohistochemistry. Setting and Design: Observational study conducted in a tertiary care hospital in West Bengal. Materials and Methods: Fifty-two surgically resected specimens of CRC received from January 2018 to May 2019 were studied for clinical, morphological, MSI status. Statistical Analysis Used: IBM SPSS 23. Results: A total of 50% of the cases belonged to younger and 50% to the older population, with male predominance being 53.8%. The most common histologic type was adenocarcinoma (88.5%). The majority was found to be well-differentiated carcinoma (50%). The majority cases were of the T3 stage accounting to 38.5%. A total of 24 out of 52 cases (46.15%) had an absent expression of at least one mismatch repair (MMR) protein. A significant correlation was found between the young age group and microsatellite instability (MSI) with a P value of 0.001. A significant association was found between MSI and tumor differentiation with P value of 0.018. A significant association was found between MSH6 and histological type with P value of 0.012. A significant association was found between MSI and tumor stage with P value of 0.032. Conclusions: This study shows a significantly higher number of sporadic colon cancers involving the young age group, and younger cases showed significant association with MSI. This alarming trend needs validation by studies involving larger populations and can be helpful prognostically as well as in formulating chemotherapeutic regimens.

CERVICAL CYTOLOGICAL EVALUATION ASSOCIATED WITH INFERTILITY IN RURAL WOMEN OF LUCKNOW, INDIA

The camps have been organized for rural cervical cancer screening in the villages of Lucknow which offer valuable platform for the detection of infertility in young women and their cytological examination. The cervical cytology has been studied in the cases of infertility to find out if there is any increase in abnormal cytology and compare them with those obtained in fertile women (controls).Since its inception in May 2013, the camps organized were 186 in number and 5682 women attended these camps. Primary infertility was found in 182 and the secondary infertility in 31 women. The incidence of Squamous intraepithelial lesions of cervix (SIL) was found to be 14.8% in women suffering from primary infertility and 16.1% in the secondary infertility cases and was comparable with SIL rate of 17.4% in the controls. Persistent vaginal infections caused by the poor personal genital hygiene practiced by the rural women may be the reason for a high SIL rate in the fertile women. The SIL rate was seen high in the younger women upto 30 years with pain in lower abdomen and erosion cervix in the primary infertility cases while the high SIL rate was seen in 21- 30 years age groups with parity 2 in secondary infertility cases with no SIL seen with symptoms and clinical lesions. Mostly young women upto 30 years of age complained of infertility and showed high SIL rate. These women were referred to the Hospital of Era Medical College, Lucknow for further investigation and treatment.

Mucinous Adenocarcinoma of the Colon in Uganda: A Case Report and Literature Review

Introduction:In Uganda, the Kampala Cancer Registry has reported a steady increase in the incidence of colorectal carcinoma(CRC) over the last few decades. The author reports a case of a 25 year old gentlemanpresenting with bowel obstruction and found to have mucinous adenocarcinoma of the colon. This is followed by a literature review of the clinical and pathological characteristics of young age sporadic colorectal carcinoma (YSCC) and hereditary nonpolyposis colorectal carcinoma (HNPCC).Presentation of Case:This patient presented with a family history of colorectal carcinoma (CRC) and with bowel obstruction. An emergency laparotomy involving a right hemicolectomy was carried out. The postoperative course of this patient was uneventful. Discussion:The typical histological features of mucinous adenocarcinoma of the colon were seen on the resected colon specimen. In addition this study reviews the literature regarding the clinical presentation, pathological characteristics, histology and prognosis of mucinous and medullary carcinoma of the colon.Conclusions:Mucinous adenocarcinoma happens to be the most common histological type of colorectal carcinoma in young adults. In Uganda, low risk young patients withsymptoms should be screened for colorectal lesions. A high index of suspicion should therefore be taken in the diagnosis of colorectal malignancy in these patients

Genetic Profile of Young Chinese Patients with Lung Adenocarcinoma / 中国肺癌杂志

BACKGROUND@#Occurrence at a younger age has been demonstrated to be associated with a distinct biology in non-small cell lung cancer. However, genomics and clinical characteristics among younger patients with lung adenocarcinoma remain to be determined. Here we studied the potentially targetable genetic alterations by next-generation sequencing (NGS) assay in young Chinese patients with lung adenocarcinoma.@*METHODS@#Eighty-nine surgically resected lung adenocarcinoma tissue samples from patients aged less than 45 years were collected with informed consent from all patients. Targeted NGS assays were used to identify actionable genetic alterations in the cancer tissues. Additionally, the genomic and clinical pathologic characteristics of 95 patients with lung adenocarcinoma who received NGS testing over the same period were analyzed retrospectively.@*RESULTS@#The frequencies of targetable genetic alterations in 184 patients with lung adenocarcinoma were analyzed by defined age categories, which unveiled a distinctive molecular profile in the younger group, aged less than 45 years. Notably, higher frequency of anaplastic lymphoma kinase (ALK) and human epidermal growth factor receptor 2 (HER2) genetic alterations were associated with young age. However, a reverse trend was observed for kirsten rat sarcoma viral oncogene (KRAS), serine/threonine kinase 11 (STK11) and epidermal growth factor receptor (EGFR) exon 20 mutations, which were more frequently identified in the older group, aged more than 45 years. Furthermore, concurrent EGFR/tumor protein p53 (TP53) mutations were much more prevalent in the younger patients (81.6% vs 44.9%), which might have a poor response to treatment with EGFR-tyrosine kinase inhibitor (EGFR-TKI).@*CONCLUSIONS@#NGS assay revealed a distinctive genetic profile in younger patients with adenocarcinoma. High frequency of concurrent EGFR/TP53 mutations was found in the younger patients, which especially warranted personalized treatment in this population.

Progress on breast cancer research in patients aged 25 years and younger / 中国肿瘤临床

Breast cancer in younger patients exhibits stronger invasiveness and poorer outcomes compared with that in elders. Cut-off for young age remains unclear, and its basis as prognostic factor representing a continuous variable requires further investigation. Preg-nancy-associated breast cancer in young patients also possesses unique biological features. In this review, we define breast cancer di-agnosed in patients below 25 years old as very young breast cancer and summarize recent studies based on genetic factors, clinicopa-thology, prognostic characteristics, and pregnancy-associated breast cancer to assist in management of very young breast cancer pa-tients.

Characteristics for Ischemic Stroke in 18–30 Years Old Patients, Multicenter Stroke Registry Study / 이화의대지

OBJECTIVES: Although there have been several reports that described characteristics for young age stroke, information regarding very young age (18–30 years old) has been limited. We aimed to analyze demographic factors, stroke subtype, and 3-month outcome in acute ischemic stroke patient who have relatively very young age in multicenter stroke registry. METHODS: We evaluated all 122 (7.1%) consecutive acute ischemic stroke (within 7 days after symptom onset) patients aged 18 to 30 from 17,144 patients who registered in multicenter prospective stroke registry, 1997 to 2012. Etiology was classified by Trial of Org 10172 in Acute Stroke Treatment criteria. Stroke severity was defined as National Institutes of Health Stroke Scale (NIHSS) and stroke outcome was defined by modified Rankin scale (mRS) at 3 months after index stroke. RESULTS: The mean age of all included patients was 25.1±3.7 years and 76 patients (62.2%) were male. The median NIHSS at admission was 4. Considering stroke subtype, 37 patients (30.3%) had stroke of other determined etiology (SOD), 37 (30.3%) had undetermined negative evaluation (UN) and 31 (25.4%) had cardioembolism (CE) were frequently noted. After adjusting age, sex and variables which had P<0.1 in univariable analysis (NIHSS and stroke subtype), CE stroke subtype (odds ratio, 4.68; 95% confidence interval, 1.42–15.48; P=0.011) were significantly associated with poor functional outcome (mRS≥3). CONCLUSION: In very young age ischemic stroke patients, SOD and UN stroke subtype were most common and CE stroke subtype was independently associated with poor discharge outcome.

Isolated Focal Cortical Infarction in a Patient with Churg-Strauss Syndrome

No abstract available.

Mid-Term Results of Oxford Medial Unicompartmental Knee Arthroplasty in Young Asian Patients Less than 60 Years of Age: A Minimum 5-Year Follow-up

PURPOSE: The purpose of this study was to evaluate the efficacy of unicompartmental knee arthroplasty (UKA) in young active Asian patients by analyzing clinical outcomes, complications and survival rates. MATERIALS AND METHODS: Eighty-two knees were evaluated with a minimum follow-up of 5 years after Oxford phase 3 UKA in patients less than 60 years of age at the time of surgery. Their mean age was 54.7 years (range, 44 to 59 years). The mean follow-up period was 8.9 years (range, 5.3 to 12 years). Kaplan–Meier survivorship analysis was used to estimate implant survival. RESULTS: Including 3 bearing dislocations, 1 medial tibial collapse and 1 lateral osteoarthritis, the total complication rate was 6.1% (5/82). Of the 3 cases of bearing dislocation, 2 cases were resolved by replacing with a thicker bearing and 1 case was converted to total knee arthroplasty (TKA) due to repeated dislocation. The two knees with a medial tibial collapse and a lateral osteoarthritis were converted to TKA. The 10-year cumulative survival rate using Kaplan-Meier survival method was 94.7% (95% confidence interval: 88.7%–100%). CONCLUSIONS: Oxford medial UKA was reliable and effective in young active Asian patients providing good clinical results and survival rate in the mid-term follow-up.

Clinical Outcomes of Endoscopic Submucosal Dissection in Patients under 40 Years Old with Early Gastric Cancer

BACKGROUND/AIMS: The clinicopathologic features of gastric cancer in young patients are different from those of older patients. However, endoscopic submucosal dissection (ESD) is performed regardless of age. The purpose of this study was to characterize younger patients (≤40 years) who underwent ESD for early gastric cancer (EGC) and analyze the results of ESD. MATERIALS AND METHODS: From January 2006 to June 2014, 55 patients aged 40 years or younger with newly diagnosed EGC underwent ESD at two tertiary hospitals. The clinicopathologic features of EGC and clinical outcomes of ESD in these young patients were reviewed retrospectively. RESULTS: A total 55 patients with 57 EGC lesions underwent ESD. Female sex, superficial flat or depressed lesions, and undifferentiated histology were more common in younger patients than in older patients in our institutional ESD cohort. The en bloc resection rate was 92.7% and the complete resection rate was 94.5%. Although there was a high proportion of undifferentiated cancer in the younger patient group, the curative resection rate was 72.7%. Among 15 patients with non-curative resection, 4 patients underwent additional surgery and 1 patient underwent argon plasma coagulation at the ESD ulcer margin. Eight patients were placed under close surveillance without additional treatment, and no recurrent tumors developed, with a median follow-up period of 37.2±23.6 months. CONCLUSIONS: Younger EGC patients who underwent ESD showed the typical characteristics seen in younger patients with gastric cancer. ESD in younger EGC patients showed comparable outcomes to those in patients with undifferentiated EGC in general.

The prognosis in cases of hepatocellular carcinoma after hepatectomy: young patients versus older patients

BACKGROUNDS/AIMS: Hepatocellular carcinoma (HCC) is uncommon in young adults and the prognosis of these patients is still unclear. In this retrospective study, we compared the clinicopathological characteristics and outcomes of young patients with HCC with those of older patients with HCC. METHODS: We retrospectively reviewed the clinicopathological characteristics of a total of 1,124 patients with HCC who underwent hepatectomy at our institution between 2006 and 2010. Patients < or =40 years of age at the time of HCC diagnosis were classified in the younger group. RESULTS: One hundred and three patients (9.2%) were classified in the younger group. whereas, 1021 patients were classified in the older group. The incidences of hepatitis B virus infection, alpha-fetoprotein (AFP) levels, and indocyanine green retention test were all higher in younger patients than in older patients (p<0.05). Disease-free survival and overall survival were longer in older patients than in younger patients, without statistical significance. In younger patients, increased levels of protein induced by vitamin K antagonist-II (PIVKA-II) and alkaline phosphatase, portal vein tumor thrombosis, and intrahepatic metastasis were all predisposing factors for tumor recurrence after hepatectomy. CONCLUSIONS: Although the AFP levels were higher in younger patients with HCC than in older patients with HCC, disease-free survival and overall survival after liver resection were not significantly different between the two groups.

Herpes Zoster Ophthalmicus in Patients Younger than 50 Years Versus 50 Years and Older

PURPOSE: To study the clinical course of herpes zoster ophthalmicus (HZO) and to compare the demographics, treatments, and outcomes in patients under 50 years of age versus patients 50 years of age or older at the time of diagnosis. METHODS: A retrospective chart review was performed of 102 patients who were diagnosed with HZO between January 1, 2008 and December 31, 2010. Baseline demographics and clinical characteristics between patients with an onset of HZO under the age of 50 years and patients with an onset of HZO at the age of 50 years or older were compared. RESULTS: Similar numbers of patients were affected with HZO in the younger and older age groups (n = 44, 43.1%, vs. n = 58, 56.9%). The mean +/- SD of age was 50.6 +/- 21.8 years (range, 3-89 years) and the most common decade of HZO onset was between 50 and 59 years. Gender and disease laterality were not statistically different between the 2 groups. No significant difference was found regarding the presence of any ocular manifestation between the groups; however, anterior uveitis was more frequent in the younger patients (p = 0.04). The number of patients with immunosuppressive therapy was higher in the younger age group (p = 0.01). CONCLUSIONS: HZO-affected patients under the age of 50 years and older than 50 years were equally distributed, with the most common decade of onset between the age of 50 and 59 years. Younger patients had a higher incidence of anterior uveitis and immunosuppressive therapy due to underlying systemic diseases.

Clinicopathological features and prognostic factors of breast can-cer in women aged under 25 years:a report of 77 cases / 中国肿瘤临床

Objective:To improve the recognition, appropriate diagnosis, and treatment of breast cancer in women aged 25 years or less through their clinicopathological features, diagnosis, treatment, and prognosis. Methods:The clinicopathological data from 77 patients with breast cancer treated in our hospital between January 1995 and January 2010 were retrospectively reviewed. The correla-tion between age, lactation, tumor size, axillary node status, surgical approach, pathological stage, indicators of immunohistochemistry treatment modality, and prognosis was analyzed using statistical software. Results:All patients were female, and their average age was 22.94 ± 1.94 years. The diagnosis depended on pathological examination. In the follow-up visits, recurrence or metastasis was found in 27 patients, of which 18 died . The median overall survival was 39 months, and the median progression-free survival was 36 months. The 3 year overall survival rates of stagesⅠ,Ⅱ,Ⅲ, andⅣwere 100%, 92.44%, 59.97%, and 0, respectively. The 5 year overall sur-vival rates of the four stages were 100%, 86.84%, 59.97%, and 0, respectively. Univariate factor analysis showed that tumor size, axil-lary lymph node status, surgical approach, pathological stage, and estrogen receptor were impact factors, whereas lactation, progester-one receptor, human epidermal growth factor receptor-2, p53, molecular subtyping, chemotherapy, and radiotherapy were not. Cox mul-tivariate analysis showed that axillary lymph node status was an independent prognostic factor for breast cancer in women aged 25 years or less. Conclusion:Breast cancer in young women is rare and has unique characteristics in biological behaviors, diagnosis, prognosis, and other factors. Axillary lymph node status was an independent prognostic factor. The crucial factors in the treatment were diagnosis and on time and early-stage treatment.

Retinal arterial occlusions in the young: Systemic associations in Indian population.

Purpose: To determine the systemic associations in retinal arterial occlusions (RAO) in young Indian individuals less than 40 years of age. Materials and Methods: Case records of 32 patients (35 eyes) of less than 40 years, with non-traumatic RAO were analysed. All patients underwent detailed ophthalmic and systemic evaluation including hemogram, lipid profile, coagulation profile, vasculitis screening, carotid Doppler, echocardiogram. Results: In the study 21 were males and 11 were females. The age ranged from 11-39 years (Mean 27.6 ± 8.43). Nine (28%) patients were below 20 years of age. Among 35 eyes, 28 (80%) had central retinal artery occlusion (CRAO), three (8.6%) had branch retinal artery occlusion (BRAO), two (5.7%) each had cilio-retinal (CLAO) and hemi-retinal artery occlusion (HRAO). Vision ranged from no perception of light to 20/20. On systemic evaluation, in 21 (65.6%) patients a hypercoagulable state was responsible for the RAO. Conditions leading to a hypercoagulable state included hyperhomocysteinemia (21.9%), hyperlipidemia (15.6%), anticardiolipin antibody (6.2%), antiphospholipid antibody (6.2%), polycythemia, thrombocytosis, protein S deficiency, use of oral contraceptives and renal disorder (3.1% each). Six (18.7%) patients had cardiac valvular defects. Vasculitis screening was positive in three (9.4%) patients. Two (6.2%) had isolated systemic hypertension. In two (6.2%) patients no abnormality could be detected. Conclusion: The systemic associations of RAOs in the Indian population were distinctly different from those reported in the Western population. Hyperhomocysteinemia was the commonest association found. Whereas associations reported in the Western population such as cardiac abnormalities, coagulation disorders, hemoglobinopathies and oral contraceptive use were uncommon.

A Case of Colonic Mucinous Adenocarcinoma in 19-year-old Male Patient

Colorectal cancer is rare in teenagers, especially without known risk factors. Colon cancer in young age is more likely to be diagnosed at advanced-stage, to present unfavorable tumor histology such as mucinous carcinoma, and poor outcome. We report a case of sporadic mucinous adenocarcinoma of the colon in a 19-year-old male patient without any risk factors. He complained of severe left abdominal pain that developed 1 month ago. He had a distended abdomen with severe tenderness on the left lower quadrant. A distal descending colon mass causing mechanical obstruction was observed on abdominal computed tomography. Emergency colonoscopy showed a large, fungating mass obstructing the lumen at 40 cm from the anal verge. Biopsy of the colonic mass suggested a mucinous adenocarcinoma. After decompression by colonic stent, the patient was transferred to the general surgery department for left hemicolectomy. The lesion was confirmed to be a mucinous adenocarcinoma (7.0x4.5 cm). For hereditary nonpolyposis colorectal cancer evaluation, immunohistochemical staining for MLH1 and MSH2 was normal. Reverse transcription polymerase chain reaction analysis did not detect microinstability in any of the markers tested. The patient had no familial history of cancer. Mucinous adenocarcinoma has high frequencies of poor differentiation, advanced tumor stage, loss of mismatch repair gene expression, and increased MUC2 expression. A mucinous histology is considerably more frequent in children and adolescent than in adults. Adequate invasive study is also necessary for young age patients.

The Third Generation Alumina-on-Alumina Bearing Total Hip Arthroplasty in Patients Under the Age of Forty: A Minimum Five-Year Follow Up Study / 대한정형외과학회잡지

PURPOSE: We investigated the results of the third generation alumina on alumina bearing total hip arthroplasty in patients under the age of forty. MATERIALS AND METHODS: Fifty patients (57 hips) under the age of forty, who had uncemented total hip arthroplasty using third generation alumina bearing, between April 2000 and March 2006 were observed. The group consisted of 24 men and 26 women. The average age at the operation was 30.3 years (18-39 years). The average follow up period was 8.0 years (5-11 years). The most common cause for surgery was rheumatoid arthritis. We assessed the clinical and radiological results and postoperative complications. RESULTS: The mean Harris hip score at the last follow-up was 96 points on average. There was no inguinal pain. However, there were two hips of which the patient was experiencing thigh pain. One hip with squeaking was observed. We could observe the stable bony fixation of implants in all hips. There were no aseptic loosening and no osteolysis around the implants. Postoperative complications included one hip with nonunion of trochanteric osteotomy and one hip with dislocation. There were no ceramic fractures, no postoperative infections and no revisions. CONCLUSION: We observed the favorable clinical and radiographic outcomes of the third generation alumina on alumina total hip arthroplasty in patients under the age of forty. However, in the case of squeaking, a longer term follow-up is needed.

Analysis of risk factors related to the metastatic potential of renal cell carcinoma in young patients / 中国综合临床

ObjectiveTo retrospectively analyze the relationship between clinicopathological,biological characteristics and the outcome of renal cell carcinoma(RCC) and evaluate the risk factors related to metastasis in young patients.MethodsThe data of 83 RCC patients younger than 40-year-old, treated from January 1986 to December 2007 in Tianjin Cancer Hospital,were analyzed retrospectively.The complete follow-up data of the 83 cases were collected.The operative methods included partial and radical surgery.Clinical staging were consistent with the 2004 UICC TNM classification criterion.The histological sections were reviewed.Various biological factors including VEGFR-1, VEGFR-2, VEGFR-3, PDGFR-α, PDGFR-β, c-kit and PCNA were tested by immunohistochemistry staining.The adjuvant radiation therapy, chemotherapy and immunotherapy after operation were carried out on the basis of pathological and biological features.The 83 cases were divided into two groups according to metastasis and non-metastasis status within 5 years.The prognosis related factors including clinical factors, pathological and biological factors were evaluated.Chi-square test was used for the analysis of 5-years metastasis status; and multivariate analysis was carried out using Cox proportional hazards models to assess the independent effect of the metastasis factors (the test standard α = 0.05).ResultsThe 5-year follow-up data showed that the metastasis rate in the 83 cases was 16.87％ (14/83).The Chi-square test results indicated that the patients with clinical stage Ⅲ and grade 3 had the highest metastasis rate (57.14％ and 78.57％respectively,x2 =38.042, x2 = 9.820; Ps ＜ 0.01) .The VEGFR-3 and PCNA positive expression rates were 92.86％ and 85.71％ respectively in metastasis group.The metastatic risk of early stage patients was 3.444 times as much as the advanced stage patients.ConclusionThe young patients with clinical advanced renal cell carcinoma had worse outcome.The stage,grade, VEGFR-3 and PCNA expression were the risk factors correlated with the metastasis risk for young RCC patients.TNM stage was an independent predictive risk factor of metastasis in young patients.

Atypical presentation of pediatric bipolar mood disorder : two case reports

Objective: This case reports highlight atypical presentation of pediatric bipolar mood disorder. Pediatric bipolar disorder is said to be a rare condition with some distinct differences from adult bipolar disorder. Despite the ongoing controversy regarding its exact typology, pediatric bipolar mood disorder is being reported in the form of case reports and in systematic research. Pediatric bipolar disorder is difficult to diagnose because its presentation of symptoms overlaps considerably with conduct problems, and ADHD (attention deficit hyperkinetic disorder). Methods: We report two cases which met a diagnosis of pediatric mood disorder where the presentation of symptoms was unique and atypical. Results: The cases are presented so that they help to raise pertinent questions regarding phenomenology, duration, episodic nature of the illness and management of this important group of disorders. Conclusion: Pediatric bipolar disorder should be viewed with seriousness and pediatric mania should be given importance in the assessment of the typology, prognosis and management of this important group of childhood disorder.

A Case of Pulmonary Thromboembolism with JAK2 Mutation / 결핵및호흡기질환

The incidence of pulmonary thromboembolism increases with age. The risk factors of pulmonary thromboembolism include surgery, malignancy, obesity, lupus anticoagulants, and vascular conditions such as deep vein thrombosis. Thromboembolism in younger patients or in unusual locations, the possibility of primary thrombophilic conditions should be considered. Primary thrombophilic states include myeloproliferative disorders (MPD). JAK2 V617F mutation is found commonly in patients diagnosed with MPD, in 90~95% of polycythemia vera (PV) and in 50~60% of essential thrombocytosis (ET) patients. Sometimes the JAK2 V617F mutation is found in cases without MPD. The relationship between JAK2 V617F mutation and thrombosis has not been defined. Recently, clinical evidence suggests that this mutation may be variably associated with thrombosis. We present one case of pulmonary thromboembolism in a young patient, who was positive for the JAK2 V617F mutation and did not have MPD.

Clinicopathologic Characteristics of Endometrial Adenocarcinomas in Young Women

BACKGROUND: Despite an increased incidence of endometrial carcinomas in young Korean women, clinicopathologic characteristics and treatment outcomes have not been analyzed. METHODS: We investigated clinicopathologic characteristics of endometrial carcinoma in 48 women who were under the age of 40 in order to determine treatment guideline. RESULTS: According To The Criteria Of The Korean Society For Obesity, 70.8% Of Study Patients Were Overweight Or Obese, With An Average Body Mass Index (Bmi) Of 26.0 kg/m2. Twelve Patients Received Progesterone Treatment Only, And 6 Of Them Later Had Successful Pregnancies. The Histologic Subtype Was Endometrioid Adenocarcinoma In All Patients. Figo Stages Were 1A(41.7%), 1B(47.1%), II (2.8%), IIB2.8%), IIIA(2.8%), And IIIC (2.8%). Figo Grades Were Grade 1 (79%) Or 2 (21%). The Average Depth Of Invasion, Excluding Stage 1a, Was 4.6 Mm In The Hysterectomy Specimens. Two Patients Were Given Post-operative Radiation Treatment And 4 Were Treated With Chemotherapy. All But One Case Had An Uneventful Postoperative Course During Follow-up. CONCLUSIONS: A majority of endometrial carcinomas in young Korean women were associated with an early FIGO stage, favorable histologic subtype and grades, and a good prognosis. Progesterone treatment with close observation was a successful treatment option in a selected group of young patients.