Paraffin Granuloma Associated with Buried Glans Penis-Induced Sexual and Voiding Dysfunction

A paraffinoma is a type of inflammatory lipogranuloma that develops after the injection of an artificial mineral oil, such as paraffin or silicon, into the foreskin or the subcutaneous tissue of the penis for the purpose of penis enlargement, cosmetics, or prosthesis. The authors experienced a case of macro-paraffinoma associated with sexual dysfunction, voiding dysfunction, and pain caused by a buried glans penis after a paraffin injection for penis enlargement that had been performed 35 years previously. Herein, this case is presented with a literature review.

Early rehabilitation program in postmastectomy patients: a prospective clinical trial

The purpose of this study was to determine whether 20 patients who received an early postmastectomy rehabilitation treatment program showed more improvement in range of shoulder motion and functional activities than 13 patients who received instruction for exercise only. Data were obtained at preoperatively, three days after operation, at discharge and at postdischarge one month for each patient on parameters such as range of motion of the ipsilateral shoulder joint, upper extremity circumferential measurements, as well as 10 elements of shoulder function. Postoperatively, both groups showed an increased range of motion of the shoulder joint and improved functional activities, but the group that received postoperative rehabilitation management had a better range of shoulder motion and less difficulty in five items for functional assessment. This study also showed that an early rehabilitation program did not increase postoperative complications. We concluded that an early rehabilitation program or intensive instruction program only by a well-trained physical therapist or physiatrist was beneficial to postmastectomy patients in regaining the function and range of shoulder motion, and significantly better in a rehabilitation group.

Study for Mammographic Patterns of Korean Breast Cancer / 한국유방암학회지

BACKGROUND: In Korea, the incidence of breast cancer is relatively lower than in western country, but it is in increasing slope. However the mammographic patterns of Korean breast cancer patients are not well known. METHODS: The authors collected the clinical and radiologic data from new breast cancer patients between January 1992 and December 1997, and analysed the mammographic pattern. RESULTS: Of the 418 patients, the age-specific incidences were 153 (37.0%) for 40 to 49 years of age, 99 (23.9%) for 30 to 39 years, 81 (19.6%) for 50 to 59 years, 55 (13.3%) for 60 to 69 years, 14 (3.3%) for over 70 years, and 12 (2.9%) for 20 to 29 years. According to the TNM staging system, there were 2 (0.6%) with stage 0, 102 (24.9%) with stage I, 147 (35.9%) with stage IIA, 72 (17.6%) with stage IIB, 85 (20.8%) with stage IIIA, 1 (0.2%) with stage IV. The non-palpable lesions were 7.5% on physical examination. According to Wolfe's classification, there were 78 (19.0%) for N1, 78 (19.0%) for P1, 133 (32.4%) for P2, and 122 (29.7%) for DY pattern. On mammography, lumps were found in 312 cases (75.8%). Among mammographic lumps, 51.9% was not clearly defined margin. The mammographic calcifications were found in 48.3% of all patients. In the distribution of calcification, 20.6% was diffuse type and 79.4% was localized type. The size of calcifications was variable in 92.9% and the shape of calcifications was amorphous pattern in 85.6%. We could not suspect cancer in 14.7% of patients on mammography, and 10.1% of patients on ultrasound examination. CONCLUSION: We believe that these baseline mammographic data of Korean breast cancer patients may contribute to the accurate diagnosis of breast cancer, but more data will be needed.

Expression of c-erbB2 and HLA-A2 in Breast Cancer Patients / 한국유방암학회지

PURPOSE: Oncogene c-erbB2 produces a transmembrane protein similar in structure to the tyrosine kinase family. Overexpression of c-erbB2 is known to lower the survival rate of breast cancer patients. c-erbB2 protein is an important antigen for tumor specific cytotoxic T lymphocytes induction that is dependent on its presentation as stably complexed with HLA-A2. In 1997, Nistico P reported low frequency of c-erbB2 proto-oncogene overexpression in HLA A2 positive breast cancer patients. And then in this study, correlation of HLA-A2 and the c-erbB2 expression was investigated in breast cancer patients. MATERIALS AND METHODS: HLA-A DNA typing by locus-specific generic PCR and by hybridization with sequence-specific oligonucleotide probes (SSOP) was performed on peripheral blood lymphocytes from 52 breast cancer patients (a PCR-SSOP typing method, involving a PCR amplification in conjunction with digoxigenin labelled sequence-specific oligonucleotide probes). To determine c-erbB2 expression, immunohistochemistry from paraffin-embedded tissues in a series of 47 patients with available tissue blocks was performed by use of rabbit anti-human c-erbB2 oncoprotein (DAKO, Glostrup, Denmark). And then we statistically analyzed the relation between the expressions of HLA-A2 and c-erbB2 in breast cancer patients. RESULTS: 29 out of 52 patients (55.8%) were HLA-A2 positive. 23.4% (11out of 47 patients) of breast cancer patients overexpressed c-erbB2. The patients with c-erbB2 overexpression showed lower estrogen receptor positivity compared to those without c-erbB2 overexpression (10.5%, vs 33.3%). HLA-A2 positive patients showed 18.5% (5/27) of overexpression and HLA-A2 negative patients showed 30.0% (6/20) of c-erbB2 overexpression (p=0.283). CONCLUSIONS: We observed no correlation between HLA-A2 and prognostic factors in breast cancer such as tumor size, axillary nodal status. However, our results showed a tendency without statistical significance between HLA-A2 and high frequency of c-erbB2 overexpression. More accumulation of patients will be needed for better conclusions.

The Predicition of Axillary Lymph Node Metastasis in T1 Breast Cancer / 대한암학회지

PURPOSE: The axillary lymph node status is the most important prognostic factor in breast cancer. The axillary node dissection is usually performed in infiltrating brcast cancer for the information of therapeutic decision and prediction of prognosis. But this procedure may result in lymphedema of affected upper extremity nearly about 25%, increased axillary drainage, sensory abnormality and pain. Many researches are focussed to find the patients group who do not need axillary dissection according to the status of tumor size, patient age, hormonal receptor and histologic grade. MATERIAL AND METHODS: We evaluated the axillary lymph node status in patients with tumor size less than 2 cm in diameter and thein correlation of other prognostic factor. We reviewed 127 women with histologically diagnosed infiltrating ductal carcinoma of breast who were treated by one surgeon at Yongdong Severance Hospital, Yonsei University College of medlcine between 1991 and 1996. RESULTS: Five patients (3.9%) had Tla lesion (<5 mm), 24 patients (18.9%) had Tlb tumors (6-10 mm), and 98 cases (77.2%) had Tlc lesion (11-20 mm). The average numbers of axillary lymph nodes dissected were 14.2. We found that smallcr tumor size, good histologic grade, estrogen receptor positivity, old age (over 50 years) showed a tendency of decreased axillary node metastasis but without statistical significance. CONCLUSION: There are possibility of finding subset with low risk of axillary lymph node metastasis in small sized tumor with addition of good prognostic indicators such as good histologic grade, hormonal receptors and old age.

Overexpression of c-erbB2 and Its Relationship with Chemotherapy in Breast Cancer / 대한암학회지

PURPOSE: c-erbB2 encodes 185 kDa oncoprotein with tyrosine kinase activity and has homology to the epidermal growth factor receptor. c-erbB2 proto-oncogene is found to be overexpressed in approximately 20 to 30% of primary breast cancer and has been associated with poor prognosis and lower response to conventional chemotherapy. MATERIALS AND METHODS: We perfonned a study on 40 infiltrating ductal breast cancers treated with primary surgery and adjuvant chemotherapy. We investigated c-erbB2 expression by immunohistochemistry in paraffin-embedded tissue using polyclonal antipeptide antibody(DAKO). We evaluated the relationships between its expression and the results after over 6 cycles of adjuvant chemotherapy including cyclophosphamide, methotrexate and 5-FU. RESULTS: The median age at diagnosis was 43 years and the median follow-up time was 47.3 months. Thirteen(32.1%) of 40 patients showed the c-erbB2 overexpression in the external domains of protein. There were no correlations among c-erbB2 amplification and other prognostic factors such as hormonal receptors, histologic grade and tumor size. Estrogen receptor and progesterone receptor showed tendency of inverse correlation with c-erbB2 overexpression but it was not statistically significant(p>0.05). c-erbB2 positive patients showed shorter disease free survival compared to c-erbB2 negative patients in univariate analysis(p0.05). CONCLUSION: These findings suggest that overexpression of c-erbB2 may be a marker of poor response to adjuvant chemotherapy with CMF regimen and may be an indicator of more aggressive therapy.

The Prediction of Axillary Lymph Node Metastasis in T1 Breast Cancer / 한국유방암학회지

PURPOSE: The axillary lymph node status is the most important prognostic factor in breast cancer. The axillary node dissection is done are usually performed in infiltrating breast cancer for the information of therapeutic decision and prediction of prognosis. But this procedure results in lymphedema of affected upper extremity nearly about 25%, increased axillary drainage, sensory abnormality and pain. Many researches are focussed to find the patients group who do not need axillary dissection according to the status of tumor size, patient age, hormonal receptor and histologic grade. MATERIAL AND METHODS: We evaluated the axillary lymph node status related with tumor size less then 2 cm in and the correlation of other prognostic factor. We reviewed 127 women with histologically diagnosed infiltrating ductal carcinoma of breast who were treated by one surgeon at YongDong Severance Hospital, Yonsei University College of medicine between 1991 and 1996. RESULTS: Five patients (3.9%) had T1a lesion (< 5 mm), 24 patients (18.9%) had T1b tumors (6-10 mm), and 98 cases (77.2%) had T1c lesion (11-20 mm). The average numbers of dissected axillary lymph nodes were 14.2 We found that small tumor size, good histologic grade, estrogen receptor positivity, old age (over 50 years) showed tendency of decreased axillary node metastasis but without statistical significance. CONCLUSIONS: There are possibility of finding subset with low risk of axillary lymph node metastasis in small size tumor with addition of good prognostic indicators such as good histologic grade, hormonal receptors and old age.

Immunohistochemical Expression of c-erbB2, c-erbB3 and c-erbB4 Protein in Breast Cancer / 한국유방암학회지

Breast cancer is the third leading cause of cancer related deaths in Korean women. Members of the erbB receptor family, the EGF receptor and c-erbB2, c-erbB3 and c-erbB4, are commonly over-expressed in human breast cancer and there is a high correlation with an aggressive breast cancer phenotype and poor patient prognosis. Since the over-expression of the EGF receptor and c-erbB2 suggested that signalling of erbB receptors may contribute to the development and progression of breast cancer, we investigated the correlation of clinicopathological factors and the immunohistochemical expression of c-erbB2, c-erbB3 and c-erbB4. To determine the c-erbB immunoreactivity, we used Rabbit anti-human c-erbB2 oncoprotein (DAKO, Denmark), mouse monoclonal c-erbB3(RTJ.2 Santa Cruz) and rabbit polyclonal antibody c-erbB4(Santa Cruz) directed against each c-erbB protein by immunohistochemistry from paraffin-embedded tissue in a series of 190 women with breast cancer. About 25.8%(49 out of 190 patients) of breast cancers overxpressed c-erbB2, and 40.0%(76 out of 190 patients) and 18.9%(36 out of 190 patients) overxpressed c-erbB and c-erbB4, respectively. Poor histologic grade showed tendency of positive correlation of the positivity of c-erbB2 and 3 but without statistical significance and no correlation with c-erbB4. We observed positive correlations among c-erbB2, c-erbB3 and c-erbB4 expression.(p0.05) and lymph node status(p>0.05) were not related with c-erbB family expression. The expressions of c-erbB2, c-erbB3 and c-erbB4 showed no survival benefit or no disease free benefit compared to c-erbB family negativity in univariate analysis (Kaplan-Meier life table analysis). Our results suggest that c-erbB2, c-erbB3, and c-erbB4 may regulate the growth of breast cancer by the interactions of these family of growth factor receptor that are dependent of hormonal control.

Overexpression of c-erbB2 and its Relationship with Chemotherapy in Breast Ccancer / 한국유방암학회지

Purpose c-erbB2 encodes 185 kDa oncoprotein tyrosine kinase activity and has homology to the epidermal growth factor. c-erbB2 proto-oncogene is found to be overexpressed in approximately 20 to 30 % of primary breast cancer and has been associated with poor prognosis and lower response to conventional chemotherapy. Materials and methods We performed a stedy on 40 infiltrating ductal breast cancer treated with primary surgery and adjuvant chemotherapy. We investigated c-erbB2 expression by immunohistochemistry in paraffin-embedded tissue using polyclonal antipeptide antibody (DAKO). We evaluated the relationships between its expression and the results after over 6 cycles of adjuvant chemotherapy including cyclophosphamide, methotrexate and 5-FU. Results The median age at diagnosis was 43 years and the median follow-up time was 47.3 months. Thirteen (32.1%) of 40 patients showed the c-erbB2 overexpression in the external domains of protein. There were no correlations among c-erbB2 amplification and other prognostic factors such as hormonal receptors, histologic grade and tumor size. Estrogen receptor and progesterone receptor showed tendency of inverse correlation with c-erbB2 overexpression but it was not statistically significant (p>0.05). c-erbB2 positive patients showed shorter disease free survival compared to c-erbB2 negative patients in univariate analysis (p0.05). Conclusion These findings suggest that overexpression of c-erbB2 may be a marker of poor response to adjuvant chemotherapy with CMF regimen and may be an indicator of more aggressive therapy.

The Significance of DNA Flow-cytometry in Breast Cancer / 대한암학회지

PURPOSE: To evaluate the relationship between nuclear DNA contents and prognostic factors and survival in breast cancer patients. MATERIALS AND METHODS: We determined nuclear DNA content from 91 paraffin-embedded malignant breast tumors and evaluated relationship between DNA nuclear content and well-known prognostic indicators of breast cancer and the survival of the patients by statistical analyses. RESULTS: Twenty nine (34.5%) of the 91 tumors examined were diploid, and the remainder (65.5%) contained one or more aneuploid clones. S-phase fraction (SPF) ranged from 1.4 to 68.3% (median 11.2%) and it was higher in aneuploidy tumors than in diploid tumors (p<0.05). Positive axillary lymph nodes were found in 72.7% of the patients who had a tumor with a high SPF (above the median 11.2%) and in 27.3% of those with tumor with low SPF (below median) (p<0.05). The overall survival rate was 96.1% in DNA diploid and 87.6% in DNA aneuploid tumors, showing that DNA ploidy had no prognostic significance in breast cancers. The actuarial survival rates were 96.4% and 86.3% for low and high SPF, respectively (p=0.28). The patients with high SPF showed high disease free survival rate compared to the patients with low SPF but the difference had no statistical significance. CONCLUSION: Our results indicate DNA aneuploid tumors were more prevalent in breast cancer patients with high SPF or lymph node metastasis and larger patient accumulation with longer follow-up period will be helpful to identifiy the relationship between flow- cytometrical analysis and prognosis.

Experience with 132 Cases of Breast Conservation Surgery

Recently, "Breast Conserving Therapy" (BCT) in the early-stage breast cancer has spread rapidly in Korea, as is in western world. For the evaluation and the standardization of BCT in Korea, a randomized study of 132 patients with breast cancer who received BCT was performed. Of the 401 patients with breast cancer who were admitted to Yongdong Severance Hospital from Feb. 1991 to Jan. 1996, 116 patients with stage I/II breast cancer and 15 patients with ductal carcinoma in situ (DCIS) had BCT and 173 patients with stage I/II breast cancer received modified radical mastectomy (MRM). In order to evaluate the BCT, the clinicopathologic features, locoregional recurrence, distant metastasis, actuarial overall survival rate and disease-free survival rate were analyzed during the follow-up period (a minimum of 1 month, a maximum of 58 months and a mean of 32 months). The results are as follows : 1) Three out of the 116 BCT patients with stage I/II and 5 out of 173 MRM patients with stage I/II had locoregional recurrence. 2) For BCT, the actuarial overall survival rate was 94.9% and disease-free survival rate was 87.6%; however, for MRM, the actuarial overall survival rate was 96.6% and the disease-free survival rate was 83.9%. Hence, there was no statistically significant difference between BCT and MRM. 3) Patient with DCIS who had BCT experienced neither locoregional recurrence nor distant metastasis. 4) All patients were good to excellent in their cosmetic appearance. In conclusion, BCT can be a good alternative surgical treatment modality and can substitute for MRM with the patients with early-stage breast cancer, including DCIS, in Korea. However, further follow up study will be needed to assess the long term results.

A Clinical Study of 500 Cases of Breast Cancer / 대한암학회지

PURPOSE: We investigated the clinical characteristics of breast cancers and its significance. MATERIAL AND METHOD: We evaluated the clinical characteristics of 500 women with breast cancer who were diagnosed and treated by one surgeon between March 1991 and August 1996. RESULTS: The median age was 46.7 years and the most common age group was 40's. The presenting symptoms for most patients were palpable mass (75.2%) followed by abnormal mammographic findings (8.4%), pain (6.3%) and nipple discharges (4.7%), and the duration of symptoms was less than 1 month in 41.4%. Fifty three percent of the 500 cases had T2 lesion (size; 2 to 5 cm). With the increase of tumor size, overall and disease free survival rates (OS, DFS) were decreased. Surgical treatment consisted of modified radical mastectomy (52.8%) and partial mastectomy (33.6%) The most common stage was II (42.3%) and the early breast cancer (stage 0, I, II) was 388cases (78.1%) and the stage were inversely correlated with DFS and OS. The positivity of axillary lymph node was 39.3% and the number of the metastatic lymph nodes was inversely correlated with DFS and OS. The pathologic types were infiltrating ductal carcinoma (83.0%), ductal carcinoma in situ (12.8%), infiltrating lobular carcinoma (1.2%), lobular carcinoma in situ (0.4%) and Paget's disease (2.0%). ER positivity was 48.9% and PR 46.9%. ER positive patients showed survival benefit compared to ER negative patients. The common sites of distant metastases were lung, bone and liver. CONCLUSIONS: Our patients with breast cancer were younger than those of western and showed the impacts on survival according to the lymph node status,tumor size.

Correlations of bcl-2 expression with clinicopathological features in breast cancer

To evaluate the prognostic significance of bcl-2, we investigated the correlation of bcl-2 expression with the established indicators of prognosis and tumor behavior in breast cancer. This study included a patient group of 91 histologically diagnosed female breast carcinomas. To determine the bcl-2 immunoreactivity, we used a monoclonal antibody directed against the bcl-2 protein by immunohistochemistry from paraffin-embedded tissue in a series of 91 women with breast cancer. Interpretable DNA histograms were obtained from 84 patients. The median age at diagnosis was 45.5 years and the median follow-up time was 30.5 months. Forty-eight (52.7%) cancers showed the bcl-2 immunoreactivity in the cytoplasm. The nonneoplastic portion of ductal epithelial cells and normal lymphocytes were usually stained with bcl-2 antibody. Estrogen receptors (ER)(p 0.05) and DNA ploidy (p > 0.05) were not related with it. The bcl-2 positive patients showed longer survival (p 0.05), nuclear grade (p > 0.05), ER status (p > 0.1) and PR status(p > 0.1) were not reliable indicators for overall survival except histologic grade (p < 0.05). Our results suggest that bcl-2 expression may be related to hormonal regulation and tumor differentiation in breast carcinoma. Larger patient study groups with a longer follow-up period will be helpful to clarify the prognostic significance of bcl-2.

Clinicopathological Correlation of Bcl-2 and p53 Immunohistochemistry in Breast Cancer / 대한암학회지

PURPOSE: Bcl-2 and p53 are known to act as a regulator of apoptosis in breast cancer and we evaluated the significance of these gene expressions and correlation with prognostic factors in breast cancer. MATERIALS AND METHODS: In order to investigate the expression of Bcl-2 and p53, we analyzed immunochemistry staining from paraffin blocks in a series of 80 women with breast cancer. Expression was then compared with the established indicators of prognosis. RESULTS: Bcl-2 positivity was 45% and p53 was 32.2%. No relationships could be observed between bcl-2 and node status,tumor size and also between p53 and node status, differentiation,tumor size. Strong positive relationships were seen between bcl-2 and estrogen receptor (ER) (p<0.0001), progesterone receptor (PR) (p<0.001). p53 also showed relationships with ER and PR (p<0.05) Histologic (p<0.05) and nuclear grade (p<0.05) showed relationships with bcl-2 but not with p53. Inverse relationship was noted between p53 and ER, PR (p<0.05). Inverse relationship was also found between bcl-2 and p53 expression (p<0.001). CONCLUSION: This study suggest that there may be a possibility that bcl-2 and p53 expressions can affect tumor growth and prognosis in breast cancer patients.

Periampullary cancer and whipple's operation

No abstract available.