Silibinin Enhances Ultraviolet B-Induced Apoptosis in MCF-7 Human Breast Cancer Cells / 한국유방암학회지

PURPOSE: Chemotherapies for breast cancer generally have strong cellular cytotoxicity and severe side effects. Thus, significant emphasis has been placed on combinations of naturally occurring chemopreventive agents. Silibinin is a major bioactive flavonolignan extracted from milk thistle with chemopreventive activity in various organs including the skin, prostate, and breast. However, the mechanism underlying the inhibitory action of silibinin in breast cancer has not been completely elucidated. Therefore, we investigated the effect of silibinin in MCF-7 human breast cancer cells and determined whether silibinin enhances ultraviolet (UV) B-induced apoptosis. METHODS: The effects of silibinin on MCF-7 cell viability were determined using the MTT assay. The effect of silibinin on PARP cleavage, as the hallmark of apoptotic cell death, and p53 protein expression in MCF-7 cells was analyzed using Western blot. The effect of silibinin on UVB-induced apoptosis in MCF-7 cells was analyzed by flow cytometry. RESULTS: A dose- and time-dependent reduction in viability was observed in MCF-7 cells treated with silibinin. Silibinin strongly induced apoptotic cell death in MCF-7 cells, and induction of apoptosis was associated with increased p53 expression. Moreover, silibinin enhanced UVB-induced apoptosis in MCF-7 cells. CONCLUSION: Silibinin induced a loss of cell viability and apoptotic cell death in MCF-7 cells. Furthermore, the combination of silibinin and UVB resulted in an additive effect on apoptosis in MCF-7 cells. These results suggest that silibinin might be an important supplemental agent for treating patients with breast cancer.

Risk Factors and Clinical Outcomes of Incidental Parathyroidectomy during Thyroid Surgery / 대한내분비외과학회지

PURPOSE: Incidental resection of parathyroid gland is not uncommon during thyroid surgery and may occur even in experienced thyroid surgeons. The aim of this study was to investigate the incidence, risk factors, and clinical relevance of incidental parathyroidectomy during thyroid surgery. METHODS: A retrospective review of patients who underwent thyroid surgery between January and December 2008 was carried out. Pathologic reports were reviewed for the presence of parathyroid tissue in resected thyroid specimen. Two groups of patients were studied: a group with incidental parathyroidectomy (Group A) and without incidental parathyroidectomy (Group B). RESULTS: Three hundred and thirty-four thyroid surgery were performed: 194 total thyroidectomies, 18 near- or subtotal thyroidectomies, 44 lobectomies, 23 endoscopic total thyroidectomies, 55 endoscopic lobectomies. Of these, 265 patients (79.3%) were preformed for malignant disease. Incidental parathyroidectomy occurred in 30.5% (102/334) of thyroid surgery. Risk factors for incidental parathyroidectomy included malignant pathology (P<0.001), operation method (P<0.001), lymph node dissection (P<0.001), and extrathyroidal invasion (P=0.001). Biochemical hypocalcemia was defined as a serum calcium levels less than 8.4 mg/dL. Symptomatic hypocalcemia was defined as patient had tingled sense or spasm of muscle and need to add more calcium replacement. In group A, 86 patients (93.5%) had a biochemical hypocalcemia (P=0.001). Symptomatic hypocalcemia developed in 35.3% (36/102) of group A, compared to 20.7% (48/232) in group B (P=0.005). CONCLUSION: Malignant pathology, total thyroidectomy, lymph node dissection, and extrathyroidal invasion were associated with a significantly higher risk of incidental parathyroidectomy during thyroid surgery. Incidental parathyroidectomy resulted in biochemical and symptomatic postoperative hypocalcemia. This study suggests that incidental parathyroidectomy may be a potential complication; therefore, parathyroid glands should be identified and preserved with more meticulous inspection during thyroid surgery.

The Prevalence of Ovarian Cancer in Korean Women at High-Risk for Hereditary Breast-Ovarian Cancer / 한국유방암학회지

PURPOSE: Few studies have reported ovarian cancer risks in Korean patients with the BRCA1/2 mutation. We investigated the prevalence of ovarian cancer in Korean women at high risk for hereditary breast-ovarian cancer (HBOC) syndrome and reviewed the clinicopathological factors of ovarian cancer. METHODS: Female subjects who were enrolled in the Korean Hereditary Breast Cancer study were included. The questionnaire included a personal and family history of cancer. The BRCA1/2 mutation and CA-125 level were tested at the time of enrollment. A transvaginal ultrasonogram (TVUS) was recommended for subjects with an elevated CA-125 level. RESULTS: A total of 1,689 patients were included. No ovarian cancer was newly diagnosed by CA-125 level or TVUS during the enrollment. The prevalence of ovarian cancer was 1.71% in BRCA1/2 mutation carriers and 0.39% in non-carriers. Among 11 patients with ovarian cancer, five had the BRCA1 mutation and one had the BRCA2 mutation. The most common histopathological type was serous cystadenocarcinoma. No difference in clinicopathological findings between BRCA1/2 mutation carriers and non-carriers was observed. CONCLUSION: The prevalence of ovarian cancer was 58-fold elevated in women at high-risk for HBOC syndrome and 146-fold elevated in the BRCA1 subgroup, compared with the Korean general population. Further investigation with a long-term follow-up is required to evaluate BRCA1/2 gene penetrance.

Survey of Psychosocial Problems Facing Breast Cancer Survivors after Undergoing a Mastectomy and Their Awareness of Breast Reconstruction / 한국유방암학회지

PURPOSE: Breast reconstruction in patients who have undergone a mastectomy is performed less frequently in Korea than in Western countries. The aim of this study was to investigate the psychosocial problems related to a mastectomy and awareness of reconstruction after a mastectomy in breast cancer survivors. METHODS: From March to April 2010, 252 patients who underwent a mastectomy were recruited for this survey. The questionnaire included sociodemographic characteristics of patients, psychosocial problems related to mastectomy, and reasons not to receive breast reconstruction. RESULTS: Patients had difficulty going to a public bath (70.3%) or going to a swimming pool or the beach (74.6%). More than half of patients answered that their physical activity had decreased due to persistent shoulder or arm pain after the mastectomy. The most common psychological problem that patients experienced was distress over the loss of charm as a woman (66.8%), followed by considering themselves disabled (62.0%), and worries about recurrence (59.4%). The most common reason not to receive a breast reconstruction was the high cost of the operation (59.4%), followed by anxiety about complications (46.7%). Only 16.2% of patients reported that they did not receive enough information about reconstruction from their doctor. Of 229 patients, 43.7% would consider undergoing breast reconstruction in the future. CONCLUSION: Breast cancer survivors who underwent a mastectomy suffered from various psychosocial problems, and high cost was a major reason for not undergoing breast reconstruction. Broader health insurance coverage should be provided for breast reconstruction in breast cancer survivors.

Clinical Outcome of Magnetic Resonance Imaging-Detected Additional Lesions in Breast Cancer Patients / 한국유방암학회지

PURPOSE: The aim of this study was to investigate the clinical outcome of additional breast lesions identified with breast magnetic resonance imaging (MRI) in breast cancer patients. METHODS: A total of 153 patients who underwent breast MRI between July 2006 and March 2008 were retrospectively reviewed. Thirty-three patients (21.6&) were recommended for second-look ultrasound (US) for further characterization of additional lesions detected on breast MRI and these patients constituted our study population. RESULTS: Assessment for lesions detected on breast MRI consisted of the following: 25 benign lesions (73.5&), two indeterminate (5.9%), and seven malignant (20.6%) in 33 patients. Second-look US identified 12 additional lesions in 34 lesions (35.3%) and these lesions were confirmed by histological examination. Of the 12 lesions found in the 11 patients, six (50.0%) including one contralateral breast cancer were malignant. The surgical plan was altered in 18.2% (six of 33) of the patients. The use of breast MRI justified a change in treatment for four patients (66.7%) and caused two patients (33.3&) to undergo unwarranted additional surgical procedures. CONCLUSION: Breast MRI identified additional multifocal or contralateral cancer which was not detected initially on conventional imaging in breast cancer patients. Breast MRI has become an indispensable modality in conjunction with conventional modalities for preoperative evaluation of patients with operable breast cancer.

Is Hashimoto's Thyroiditis Associated with the Prognostic Factors of Papillary Thyroid Carcinoma? / 대한내분비외과학회지

PURPOSE: In recent studies, the presence of lymphocytic infiltration in patients with papillary thyroid carcinoma (PTC) was reported to be associated with a favorable prognosis. The prognostic significance of Hashimoto's thyroiditis (HT) in patients with PTC remains unclear. The aim of our study was to determine the frequency and prognostic significance of HT in patients with PTC. METHODS: From January 2005 to December 2007, 367 patients who underwent thyroid surgery for PTC were included in this study. They were divided into two groups: Group A (n=71; 19.4%) included the patients diagnosed as having PTC with HT and Group B (n=296; 80.6%) included the patients who had PTC without HT. The clinicopathologic features between Groups A and B were retrospectively reviewed via the medical records. RESULTS: Lymph node metastasis was less frequent in Group A than that in Group B (25.5% versus 41.0%, respectively, P=0.033). However, both groups had similar clinicopathologic features in terms of age, gender, the tumor size, multifocality, extrathyroidal invasion, the TNM stage and the AMES and MACIS scores. Also, the operative method did not differ significantly between the two groups. CONCLUSION: These results suggest that the presence of HT is not associated with the prognostic factors of PTC.

The Pure and Follicular Variants of Papillary Thyroid Carcinoma: A Comparative Study of the Clinicopathologic Features / 대한내분비외과학회지

PURPOSE: Pure papillary thyroid carcinoma (PPTC) and the follicular variant of papillary thyroid carcinoma (FVPTC) are the most common subtypes of papillary thyroid carcinoma (PTC). The aim of this study was to investigate if there are any differences in clinicopathological features of these two subgroups. METHODS: We performed a retrospective chart review of patients who were treated for PPTC and FVPTC between September 2003 and April 2008. Four hundred fifty patients were shown to have PPTC (91.8%) and forty (8.2%) had FVPTC after a histologic review. The two groups were compared in terms of the clinicopathologic features and the results of preoperative ultrasonography (USG), the fine needle aspiration cytology (FNAC), the frozen section biopsy and the surgical treatment. RESULTS: The tumor size was significantly larger in the FVPTC group than in the PPTC group (1.47 cm versus 1.08 cm, respectively P=0.024). However, both groups had similar clinicopathologic features in terms of age, gender, capsular invasion, multifocality, lymph node metastasis, the MACIS score and the TNM stage. Further, the operative method did not differ between the two groups. The sensitivities of USG and frozen section biopsy for diagnosing FVPTC were significantly lower than those for PPTC (53.85% versus 72.95%, respectively, P=0.045, 81.58% versus 97.25%, respectively, P=0.049). CONCLUSION: The FVPTC group presented with a larger tumor size, and the clinicopathologic features of the FVPTC group did not significantly differ from those of the PPTC group. Although further studies with longer follow-up are required, these results suggest that the patients in both groups should be treated identically.

Inflammatory Myofibroblastic Tumor of the Breast

Inflammatory myofibroblastic tumor (IMT) is an uncommon tumor which is composed of spindle cells admixed with mature plasma cells and inflammatory cells. IMT is most common in the lungs and in various organs. However, it is very rare in the breast. According to the organ, there are many clinical and histological characteristics. Breast IMT usually shows developed, movable nontender mass. Radiological findings of IMT are similar to primary breast malignancy. For accurate diagnosis, histologic correlation is needed. IMT is a benign lesion and excision is the treatment of choice, but wide local excision and negative resection margin is needed due to its tendency for recurrence. Understanding of the entity and its mimicry can be helpful in avoiding any unnecessary surgical procedures, such as mastectomy with or without lymph node dissection. Herein, the case of a 29-year-old woman found to have IMT of the breast. The patient underwent a wide local excision. The gross, microscopic and immunohistochemical findings were consistent with the diagnosis of IMT of the breast.

Poland's Syndrome: Report of a Case / 한국유방암학회지

Poland's syndrome is characterized by hypoplasia or absence of the breast of nipple, hypoplasia of subcutaneous tissue, absence of the costosternal portion of the pectoralis major muscle, absence of the pectoralis minor muscle, and absence of costal cartilage or ribs. The syndrome involves a spectrum of conditions ranging from simple absence of pectoralis major muscle and breast to the defects noted by Poland as well as brachysyndactyly, ectromelia. Furthermore, there have been reports of Poland's syndrome associated with malignancies such as leukemia, malignant lymphoma,(1) and leiomyosarcoma.(2) We have experienced a 22-year-old woman presenting with asymmetric breast and abnormal position of nipple and accessory breast suggested Poland's syndrome. Treatment consisted of tissue expansion of hypoplastic breast and free nipple graft and excision of accessory breast. The purpose of the study was to review the present knowledge of Poland's syndrome and literature.