Everolimus-induced activation of latent Mycobacterium tuberculosis infection in a patient with metastatic renal cell carcinoma

No abstract available.

Successful treatment of myelodysplastic syndrome and Behcet colitis after allogeneic hematopoietic stem cell transplantation

No abstract available.

Autologous peripheral blood stem cell transplantation with high-dose therapy for anaplastic large cell lymphoma with progressive myelofibrosis / 대한내과학회지

Myelofibrosis is a myeloproliferative neoplasm characterized by abnormal bone marrow megakaryocyte proliferation with reticulin and collagen fibrosis, leukoerythroblastosis, anemia, increased level of serum lactate dehydrogenase and splenomegaly. Myelofibrosis associated with malignant lymphoma is rare and survival rates appear to have been poor. Herein, we describe our experience in a patient who remained in complete remission with high-dose therapy (HDT) with autologous peripheral blood stem cell transplantation (PBSCT) for ALK-negative ALCL presenting with rapidly progressing myelofibrosis.

Nitric oxide and cancer / 대한내과학회지

Nitric oxide (NO) is emerging as a potential anti-cancer agent to overcome tumor cell resistance to conventional therapeutic agents. NO is a short-life molecule produced from L-arginine by the nitric oxide synthase (NOS). There are three isoforms of the enzyme: neuronal NOS (nNOS or NOS1), inducible NOS (iNOS or NOS2), and endothelial NOS (eNOS or NOS3). Each of these isoforms may be expressed in a variety of cell types. The actions of NO are highly variable in oncology revealing both sides of the spectrum as an anti-neoplastic versus a pro-neoplastic agent. The final activity of NO is dependent on its working microenvironment, including the type of cell exposed to NO, the redox state of the reaction, as well as the final intracellular concentration and the duration of exposure to NO. NO donors mimic continuous production of NO in a wide range of time intervals (seconds to days). Thus, multiple biological and (pro- versus anti-) neoplastic responses are elicited from NO donors depending on the half-life and the type of cell exposed to the compound. This paper is a review of the current knowledge of various roles of NO in cancer.

Randomized, Multicenter, Phase III Trial of Heptaplatin 1-hour Infusion and 5-Fluorouracil Combination Chemotherapy Comparing with Cisplatin and 5-Fluorouracil Combination Chemotherapy in Patients with Advanced Gastric Cancer / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Heptaplatin (Sunpla) is a cisplatin derivative. A phase IIb trial using heptaplatin resulted in a 34% response rate with mild nephrotoxicity. We conducted a randomized phase III trial of heptaplatin plus 5-FU compared with cisplatin plus 5-FU in patients with advanced gastric cancer. MATERIALS AND METHODS: One hundred seventy-four patients (heptaplatin, n=88; cisplatin, n=86) from 13 centers were enrolled. The eligibility criteria were as follows: patients with pathologically-proven adenocarcinoma, chemonaive patients, or patients who had received only single adjuvant chemotherapy, and who had a measurable or evaluable lesion. On day 1, heptaplatin (400 mg/m2) or cisplatin (60 mg/m2) was given over 1 hour with 5-FU (1 gm/m2) on days 1~5 every 4 weeks. RESULTS: At the time of survival analysis, the median overall survival was 7.3 months in the 5-FU + heptaplatin (FH) arm and 7.9 months in the 5-FU + cisplatin (FP) arm (p=0.24). Of the FH patients, 34.2% (complete response [CR], 1.3%; partial response [PR], 32.9%) experienced a confirmed objective response compared with 35.9% (CR 0%, PR 35.9%) of FP patients (p=0.78). The median-time-to-progression was 2.5 months in the FH arm and 2.3 months in the FP arm. The incidence of neutropenia was higher with FP (28%) than with FH (16%; p=0.06); grade 3~4 nausea and vomiting were more frequent in the FP than in the FH arm (p=0.01 and p=0.05, respectively). The incidence of increased proteinuria and creatininemia was higher with FH than with FP; however, there was no statistical difference. There were no treatment-related deaths. CONCLUSION: Heptaplatin showed similar effects to cisplatin when combined with 5-FU in advanced gastric cancer patients with tolerable toxicities.

A Giant Hepatic Hemangioma Complicated by Kasabach-Merritt Syndrome: Findings of Tc-99m RBC Scintigraphy and SPECT Including a Total Body Blood Pool Imaging Study / 핵의학분자영상

Kasabach-Merritt syndrome (KMS) consists of thrombocytopenia, microangiopathic hemolytic anemia, and localized consumption coagulopathy that develops within vascular hemangioma. This syndrome may also be associated with occult hemangiomas located at various sites. Tc-99m RBC scintigraphy and SPECT have proven to be reliable for confirming or excluding hemangioma. Total body blood pool imaging study during the scintigraphy also provides a means of screening for occult lesions. The authors report the case of a 29-year-old man who presented with a giant hepatic hemangioma complicated by KMS, and underwent Tc-99m RBC scintigraphy and SPECT including a total body blood pool imaging study.

Ga-67 Citrate and Tc-99m MDP Uptake in the Lung and Stomach Associated with Hypercalcemia / 핵의학분자영상

Ga-67 scintigraphy demonstrated increased uptake in the lungs and stomach in a 26-year-old man with hypercalcemia. A primitive neuroectodermal tumor was confirmed by bone marrow examination. Tc-99m MDP uptake in the same locations as Ga-67 revealed by bone scintigraphy was consistent with metastatic calcification. Although the mechanism of Ga-67 uptake in metastatic calcification is not understood, the presence of an inflammatory process is suggested.

Effect of Helicobacter pylori eradication in patients with idiopathic thrombocytopenic purpura: Report of 3 cases / 대한내과학회지

There are several reports suggesting Helicobacter pylori can initiate and perpetuate idiopathic thrombocytopenic purpura (ITP) and eradication of H. pylori can increase the platelet counts, however, the prevalence of H. pylori infection in patients with ITP is similar to that found in the general population and a recovery of thrombocytopenia after H. pylori eradication therapy has not been identified reliably. We report three different cases of H. pylori infected patients with ITP who recovered completely after eradication of H. pylori. The first case was refractory, the second was recurred after conventional treatment for ITP, and the third was treated with H. pylori eradication on first line treatment. We believe that the eradication of H. pylori is useful in some patients with ITP in Korea and well controlled randomized study is necessary for further identification of such population.

F-18 FDG Uptake in an Eosinophilic Liver Abscess Mimicking Hepatic Metastasis on PET/CT Images / 핵의학분자영상

A 61-year-old man had a F-18 FDG PET/CT scan for evaluation of a common bile duct cancer identified on CT. The PET/CT image showed a hypermetabolic mass in the common bile duct, and a focal area of increased F-18 FDG uptake in segment IV of the liver, which corresponded to a hypoattenuated lesion on non-enhanced CT, and was consistent with hepatic metastasis. The patient underwent choledochojejunostomy with hepatic resection, and pathologic findings were compatible with an eosinophilic abscess in the liver. This case demonstrates that F-18 FDG uptake by an eosinophilic abscess can mimic hepatic metastasis in a patient with a malignancy.

Usefulness of F-18 FDG PET/CT in Staging of Peripheral T Cell Lymphoma / 핵의학분자영상

PURPOSE: F-18 FDG PET/CT has excellent sensitivity and specificity for staging non-Hodgkin lymphomas, but to the author's knowledge few studies to date have evaluated FDG PET/CT in peripheral T cell lymphoma. We evaluated the usefulness of F-18 FDG PET/CT in staging of patients with peripheral T cell lymphoma, especially indolent cutaneous T cell lymphomas. MATERIALS AND METHODS: Twenty five patients (M:F=17:8, age 53.7+/-14.8 yrs) with biopsy-proven indolent cutaneous T cell (CL) or noncutaneous T cell lymphomas (NCL) underwent PET/CT scans for staging at baseline. Peak standardized uptake values (p-SUV) of all abnormal foci were measured and compared between cutaneous and noncutaneous lesions. F-18 FDG PET/CT was performed on 6 patients with indolent CL and on 19 patients with NCL. RESULTS: All 6 patients with indolent CL had no significant FDG avidity in the skin despite histologically positive cutaneous lesions. However, FDG avidity appeared in extracutaneous lesions (lymph nodes) in two patients with CL where CT imaging suggested lymphoma involvement (mean p-SUV 4.26+/-0.37 in noncutaneous lesions in CL). In NCL, FDG avidity was demonstrated in all lesions where CT imaging suggested lymphoma involvement (mean p-SUV, 8.52+/-5.00 in noncutaneous lesions in NCL). CONCLUSION: F-18 FDG PET/CT has the limitation of usefulness for the evaluation of the skin in indolent CL. In contrast, F-18 FDG PET/CT is sensitive in staging evaluation of extracutaneous lesions regardless of CL or NCL.

FLT3 Internal Tandem Duplication in Acute Myeloid Leukemia with Normal Karyotype

BACKGROUND: The presence of FLT3 internal tandem dupulication (FLT3/ITD) in patients with acute myeloid leukemia (AML) with normal karyotype was investigated in order to evaluate its clinical and prognostic significance. METHODS: The FLT3/ITD was studied by PCR assay in bone marrow samples obtained from 123 patients at diagnosis. Ninety patients who received intensive induction chemotherapy were evaluated. RESULTS: Of total 123 patients, forty-seven (38.2%) demonstrated the aberrant FLT3/ITD. Patients with FLT3/ITD had significantly higher leukocyte counts at presentation than did patients without FLT3/ITD (P=0.04). By multivariate analysis, the FLT3/ITD was an independent prognostic factor of leukemic-free survival (LFS) (P=0.01) in AML patients with normal karyotype. CONCLUSION: This study demonstrated that the presence of the FLT3/ITD was a significant factor for poor prognosis in AML patients with normal karyotype.

Multifocal Calcifications of the Falx Cerebri and Dura Presenting as Hot Spots in the Skull on Bone Scintigraphy / 핵의학분자영상

A 49-year-old woman with invasive ductal carcinoma of the right breast underwent Tc-99m MDP bone scintigraphy for an evaluation of skeletal metastases. Multiple focal hot spots in the midline and left frontoparietal skull region were observed. The plain radiographs revealed the typical findings of the calcification of the falx cerebri and dura. These findings might be mistaken for metastases of the skull in cancer patients. Therefore, a radiographic correlation is essential when multifocal hot spots in the skull are observed in cancer patients.

Unexpected Uptake of Tc-99m MIBI in Thymic Carcinoma: Ring-like Appearance / 핵의학분자영상

A 59-year-old man with thymic carcinoma underwent Tc-99m MIBI myocardial SPECT, and Tc-99m MIBI uptake in the mass was unexpectedly found in a planar image. SPECT images of the thorax showed an increased uptake area with central photon deficiency (a ring-like appearance), which reflected central tumor irreversible ischemia or progressing necrosis with peripheral viable tumor tissue.

Biparietal Thinning Showing Typical Bilateral Photon Defects on Bone Scintigraphy and SPECT / 핵의학분자영상

A 68-year-old man with small cell carcinoma of the lung and adenocarcinoma of the prostate underwent Tc-99m MDP bone scintigraphy for the evaluation of skeletal metastases. Bilateral symmetrical photon defects in both parietal bones of the skull were observed. The radiographs of the skull demonstrates biparietal thinning in the same area of the abnormality identified on bone scintigraphy. Although these findings in cancer patients can be mistaken for skeletal metastases, the symmetry and location of the photon defects are generally indicative of biparietal thinning.

A case of recurred malignant melanoma of the stomach and peritoneum / 대한내과학회지

Malignant melanoma may spread through the lymphatic channels or via the bloodstream. The lung, liver, bone and brain are common sites of hematogenous metastases. Malignant melanoma that has recurred to the stomach or peritoneum is not common. An 83-year old male patient was admitted to the Department of Oncology due to abdominal distension; 13 years ago, the patient had previously received a complete surgical resection for malignant melanoma of the right heel. According to a computed tomography (CT) scan of the abdomen, peritoneal carcinomatosis was suggested. Under a gastrofiberoscopic examination, two small sized polyps with central umbilication were found on the midbody of the stomach. The gastric polyps were histopathologically confirmed as metastatic melanoma. We report a rare case of metastatic malignant melanoma that has recurred to the stomach and peritoneum 13years after its initial diagnosis.

Recurrent Pneumomediastinum and Subcutaneous Emphysema Complicating Chronic Graft versus Host Disease after Allogeneic Bone Marrow Transplantation

Several noninfectious pulmonary complications can be associated with chronic graft versus host disease (GVHD). Obstructive airway disease can be a clinical feature of chronic GVHD and the histopathology reveals characteristic lesions of bronchiolitis obliterans. Bronchiolitis obliterans is an obstructive pulmonary disorder affecting the small airways, and it was first described as a late complication of allogeneic bone marrow transplantation (BMT). Spontaneous pneumomediastinum and subcutaneous emphysema can occur in the setting of severe bronchiolitis obliterans and only rarely are they the first sign of such disease. We describe here a case of a 27-year old woman who developed recurrent pneumomediastinum and subcutaneous emphysema that were secondary to the bronchiolitis obliterans that complicated chronic GVHD after allogeneic BMT.

Regression of Extensive Colonic Extranodal Marginal Zone B Cell Lymphoma after Treatment with Rituximab

We report here on a case of colonic extranodal marginal zone B-cell lymphoma of the mucosa-associated lymphoid tissue (MALT) in a 17-year-old male with a history of selective IgA deficiency. The colonoscopic findings showed prominent lymphoid hyperplasia along the terminal ileum and multiple ulceroinfiltrative nodular lesions at the transverse colon and rectum. Immunohistochemically, an extensive infiltration by a CD20-positive lymphoid cell population that displayed a prominent lymphoepithelial structure was detected. Multiple hypermetabolic lymph nodes were found in the cervical, axillary, mediastinal and abdominal regions, in addition to the colon, by performing PET-CT. After administering rituximab weekly for 4 weeks, he had significant regression of the colonic lesions and the lesions in multiple lymph nodes. He remains progression free 10 months after finishing the treatment. This case report demonstrates the potential efficacy of rituximab as a single therapeutic agent for patients with colonic extranodal marginal zone B-cell lymphoma, and even for a patient with an extensive disease status.

Randomized, Multi-center Phase II Trial of Docetaxel Plus Cisplatin Versus Etoposide Plus Cisplatin as the First-line Therapy for Patients with Advanced Non-Small Cell Lung Cancer / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: We prospectively conducted a multi-center, open-label, randomized phase II trial to compare the efficacy and safety of docetaxel plus cisplatin (DC) and etoposide plus cisplatin (EC) for treating advanced stage non-small cell lung cancer (NSCLC). MATERIALS AND METHODS: Seventy-eight previously untreated patients with locally advanced, recurrent or metastatic NSCLC were enrolled in this study. The patients received cisplatin 75 mg/m2 on day 1 and either docetaxel 75 mg/m2 on day 1 or etoposide 100 mg/m2 on days 1 to 3 in the DC or EC arm, respectively, every 3 weeks. RESULTS: The objective response rate was 39.4% (15/38) and 18.4% (7/38) (p=0.023) in the DC and EC arms, respectively. The median time to progression (TTP) was 5.9 and 2.7 months (p=0.119), and the overall survival was 12.1 and 8.7 months (p=0.168) in the DC and EC arms, respectively. The prognostic factors for longer survival were an earlier disease stage (stage III, p=0.0095), the responders to DC (p=0.0174) and the adenocarcinoma histology (p=0.0454). The grades 3 and 4 toxicities were similar in both arms, with more febrile neutropenia (7.9% vs. 0%) and fatigue (7.9% vs. 0%) being noted in the DC arm. CONCLUSION: DC offered a superior overall response rate than does EC, along with tolerable toxicity profiles, although the DC drug combination did not show significantly improved survival and TTP.

A Case of Improved Menetrier's Disease after the Eradication of the Helicobacter pylori and Long Term Treatment with Proton Pump Inhibitor / 대한소화기내시경학회지

Menetrier's disease is a protein losing hypertrophic gastropathy characterized by hypoproteinemia, and often is associated with the development of gastric cancer. Though the cause of Menetrier's disease has been unknown, the association with Helicobacter pylori was reported. A 30-year-old man was hospitalized for the evaluation of progressive dyspepsia for 2 years, hypoproteinemia, and recently aggravated epigastric pain with weight loss. Gastroscopy revealed prominent folds and multiple variable sized polypoid eminence in the body and antrum with positive CLO test. Histological findings revealed gastritis with erosions and foveolar hyperplasia. Any other diseases causing protein losing enteropathy were excluded. After the eradication of the H. pylori and long term treatment with proton pump inhibitor, clinical, endoscopic, and biochemical resolution ensued. Thus, we suggest that H. pylori eradication should be tried in patients with Menetrier's disease before invase treatment modalities such as surgical resection.

A case of the paratesticular rhabdomyosarcoma in the young adult / 대한내과학회지

This paratesticular rhabdomyosarcoma is more frequent in children than in adult. Paratesticular rhabdomyosarcoma accounts for approximately 7% of all rhabdomyosarcomas and is the most common soft tissue sarcoma in childhood, with an annual incidence of four to seven cases per million. The rhabdomyosarcoma originated from paratesticular region is considered to have a good prognosis in comparison with othe rhabdomyosarcomas, despite of the high frequency of retroperitoneal lymph node invasion. This superficial site allows rapid diagnosis and consequently often complete resection of the tumor. The multidisciplinary treatment of paratesticular rhabdomyosarcoma has improved control of the disease with a 2-year survival of 80%. Especially, The outcome for patients with localized paratesticular rhabdomyosarcoma is excellent with the use of the new regimen rather than traditional regimen composed of alkylating agent: an alkylating-free and anthracycline-free regimen is adequate treatment for low-risk patients. We report a case of paratesticular rhabdomyosarcoma of embryonal type in a 17-year-old male who presented left scrotal swelling without tenderness. The diagnosis was confirmed by biopsy. After left radical orchiectomy and hemiscrotectomy, he received VA (Vincristine/Actinomycin-D) chemotherapy.