Prediction of additional axillary metastasis of breast cancer with positive sentinel lymph nodes / 한국유방암학회지

PURPOSE: Axillary lymph node dissection in breast cancer patients with positive sentinel lymph node (SLN) is accepted as a routine procedure. In a significant proportion of women with breast cancer, the SLN is the sole site of regional metastasis. These patients would not be expected to benefit from complete lymph node dissection. The purpose of this study is to determine which factors are associated with additional positive lymph nodes in the axilla of patients who have positive sentinel lymph nodes. METHODS: Between September 2001 and May 2005, we examined 135 cases where the patients underwent a breast conserving operation and a SLN biopsy. There were 34 patients with positive SLN. Univariate analysis was used to identify the clinicopathologic features in the SLN positive patients that can predict metastasis in the nonsentinel lymph nodes (NSLNs). RESULTS: Fifteen patients (44.1%) had metastasis in the NSLNs. There were significant differences in the location of tumors (p=0.018), the nodal status of each patient (p=0.001) and c-erbB2 protein expression (p =0.017) in NSLN metastasis as determined by univariate analysis. CONCLUSION: The location of the breast cancer, nodal status and c-erbB2 expression are of predictive value for NSLN involvement. We suggest that a full axillary lymph node dissection may be considered as a sparing treatment in these situations.

Clinical Analysis of Stage Ib Gastric Cancer

PURPOSE: The aim of this study was to clarify the clinicopathological differences between T1N1M0 and T2N0M0, particularly the survival rates, and the role of chemotherapy in the stage Ib gastric cancer. METHODS: From January 1992 to December 1999, 118 cases were confirmed as having stage Ib gastric cancer in the Korea University Medical Center. Among them 31 patients were classified as being T1N1M0 and the other 87 cases were T2N0M0. The clinicopathological features and the prognosis were evaluated retrospectively. RESULTS: The overall 5-year survival rate of the stage Ib gastric cancer patients was 94%. Overall 5-year survival rates in T1N1M0 and T2N0M0 were 100% and 91%, respectively. Though T1N1M0 group showed better prognosis, there was no significant difference between two groups (P=0.14). D1, D2, and D2+alpha resections were performed in 28 cases (23.7%), 81 (68.6%), and 9 (7.6%), respectively, and there was no difference in the survival rate (P>0.05). The 5-year survival rates were analyzed according to whether or not they had received chemotherapy. There was a 98% 5-year survival rate with those who had chemotherapy and a 90% 5-year survival rate with those who had not had chemotherapy, but there was no significant difference between them (P=0.18). In the T2N0M0 group, the 5 year survival rates of patients with or without chemotherapy were 97% and 86%, respectively, but there was no significant difference (P=0.16). CONCLUSION: Though T1N1M0 group showed a better prognosis than the T2N0M0 group, there was no significant difference between the two groups (P=0.14). There was no significant survival difference between D1, D2, or D2+alpha procedures. It appears that post operative intravenous chemotherapy does not affect the prognosis of stage Ib gastric cancer, and the role of the chemotherapy in patients with T2N0M0 diseases is minimal.

Transforming Growth Factor (TGF)-beta I and TGF-beta Receptor II (TGF-betaRII) Expressions in Intestinal Metaplasia, Adenoma and Carcinoma of the Stomach

PURPOSE: The carcinogenesis of gastric cancer has not been fully elucidated, but several molecular biologic alterations have been found to be related with it. TGF-betaRII mutation, which is one such alteration, has been well documented in gastric cancer, but its expression patterns in cancer and preneoplastic conditions are rarely reported. For that reason, we investigated the roles of TGF-betaI and TGF-betaRII in gastric carcinogenesis by comparing the difference of expression patterns in carcinomas and adenomas of the stomach and intestinal metaplasia by using immunohistochemical staining. METHODS: Twenty-six (26) cases of intestinal metaplasia with chronic atrophic gastritis, 21 cases of the gastric adenoma, and 51 cases of gastric cancers (28 cases of the intestinal type and 23 cases of the diffuse type) were enrolled in this study. All samples were paraffin-embedded and an immunohistochemical staining was performed using the polyclonal antibody to TGF-betaI and TGF-betaRII. Their clinicopathologic features were reviewed retrospectively. RESULTS: In normal gastric tissue and intestinal metaplasia, only the basal portion of the gastric foveola was strongly reactive to TGF-betaRII. In adenomas and well-differentiated intestinal type cancer, all tumor cells were strongly positive to TGF-betaRII, but the tumor cells of poorly differentiated intestinal-type and signet ring cell (diffuse type) cancer showed unresponsive to TGF-betaRII. The TGF-betaI expressions in normal and carcinomatous lesions were similar andshowed a weak positive reaction. TGF-betaI and TGF-betaRII responsive gastric cancer showed less invasive gastric-wall infiltration. In gastric cancer, a significant correlation was present between tumor depth and response to TGF-betaI & TGF-betaRII. CONCLUSION: It is presumed that TGF-betaRII plays an important role in cell differentiation and aggressiveness in gastric cancer and that it may be useful as a prognostic factor.

Comparison of Clinicopathologic Differences of Gastric Cancer Patients between Korean and Germany

PURPOSE: It is well known that big differences in clinicopathologic characteristics and prognosis exist between oriental and western gastric cancer patients. Howevers, few direct comparisons of the two groups have ever been made or reported. Thus, we directly investigated the difference of clinicopathologic characteristics between Korean and Germany gastric cancer patients. METHODS: All resected gastric cancer patients at Korea University Guro Hospital and Technische Universitat Munchen from 1983 to 1990 were enrolled in this study. Their clinicopathologic characteristics were compared retrospectively on the basis of medical records. RESULTS: The mean age of Koreans was 53.3+/-11.6 years, and that of Germans was 62.6+/-11.5 years (P<0.001). The proportion of early gastric cancer patient was not significant (19% vs 16.2%). The tumor was located at the lower 1/3 in 51.4% of Koreans, but in the upper 1/3 in 40.6% of Germans (P<0.001). Larger tumor size, extended lymph node and distant metastasis, and eventual advanced stages were prominant findings among the Germans (P<0.001), and signet ring cell carcinoma was the predominant histologic subtype (46.6%). A distal subtotal gastrectomy was the commonly employed operative procedure in Korea (76.8%), but a total gastrectomy was more favored in Germany (72.9%) (P<0.001). CONCLUSION: Korean gastric cancer patients were younger, and their tumors were more distally located and less advanced in stage. In addition, they had fewer signet ring cell carcinomas. Howevers, prospective studies comparingthe prognoses are warranted to explore the differences between oriental and western gastric cancer patients.

Obstructive Jaundice in Patients with Gastric Cancer

PURPOSE: Although obstructive jaundice is a rare presentation, it is an ominous sign of poor prognosis in patients with gastric cancer. Thus, we investigated the incidence, the clinical features, the pathologic characteristics, the treatment modality, and the prognosis for obstructive jaundice in patients with gastric cancer. METHODS: A retrospective analysis was done for patients with gastric cancer who had presented with obstructive jaundice at Korea University Guro Hospital from January 1988 to December 1998. RESULTS: During that period, 2546 patients were diagnosed with gastric cancer, and obstructive jaundice was revealed in 20 (0.78%). The mean age was 58 13 years, and the sex ratio (male:female) was 5.7:1. Jaundice was the first presentation in two patients, and it developed in the other 18 patients during the follow-up period after the initial operation or chemotherapy. The level of total bilirubin was 16.7 8.1 mg/dl, and the cause of the jaundice was lymph-node enlargement at the porta hepatis. A percutaneous transhepatic biliary drainage (PTBD) was done in 17 patients, and improvement was seen in 13 (76%). The most common site of the obstruction was common hepatic duct (CHD) (60%). Antrally located, moderately differentiated and Borrmann type-III gastric cancers were commonly associated with obstructive jaundice. The mean duration from jaundice to death was 4.6 6.2 month. CONCLUSION: Obstructive jaundice is very rare in patients with gastric cancer and is associated with poor survival. Although the bilirubin level was decreased by a PTBD, the survival was not improved. An extended lymphadenectomy along the hepatoduodenal ligament is necessary to prevent obstructive jaundice due to recurrence particularly, in patients with antrally located, moderately differentiated and Borrmann type-III carcinomas.

Treatment of Acute Colonic Pseudo-obstruction (Ogilvie's Syndrome) with Intravenous Neostigmine

Acute colonic pseudo-obstruction is a functional disorder that closely mimics a mechanical large-bowel obstruction. Two such patients were treated by pharmacological manipulation of the parasympathetic innervation to the colon with intravenous neostigmine infusion. The two responded to treatment with passage with flatus and stool within several minutes with complete resolution of the symptoms, although the first patient required two additional infusions and the second patient required one additional infusion for subsequent recurrence. Dizziness occurred in one patient, and no other serious side effects were apparent. This pharmacological approach to the management of acute colonic pseudo-obstruction is suggested as an alternative to the other treatment options of colonoscopic decompression or surgery when conservative management has failed.

Gastroduodenostomy after Distal Subtotal Gastrectomy in Gastric Cancer Patients Comparison between manual and stapled anastomosis

PURPOSE: A gastroduodenostomy after a distal subtotal gastrectomy is known to have several advantage over a gastrojejunostomy. However, recently, anastomotic methods using an EEA stapler during a gastro duodenostomy have been developed and have been reported to be superior to manual anastomosis with respect to operative time and complications. Thus, we investigated the differences between a manual and a stapled gastroduodenostomy by comparing the clinicopatholoic features and clinical course. METHODS: From January to October 1999 at Korea University Guro Hospital, a gastroduodenostomy using an EEA stapler was performed on 30 gastric cancer patients after a distal subtotal gastrectomy. From January 1996 to December 1998, a manual anastomosis had been used on 40 patients at the same hospital. A retrospective analysis of these two groups was made with respect to patients, tumor, operation, post operative complications and clinical course. RESULTS: The mean age of the stapled group was older than that of manual group (62.3+/-8.4 vs 53.0+/-10.7 years), and most of the tumors were located at the antrum and the body. In the stapled group, the operative time was significantly shorter than I was in the manual group (205.0+/-20.0 vs 239.6+/-37.3 minutes, p<0.001), and there was no significant difference in the resection margin between the two groups. The time of nasogastric (NG) tube removal was earlier in the stapled group (4.8+/-0.8 vs 5.9+/-2.2 days, p=0.007), but no significant differences were observed with respect to the oral intake and the complication rate between the two groups. Anastomotic stenosis was observed in one case of manual group, but it was not significant. CONCLUSIONS: A gastroduodeno stomy using an EEA stapler has an advantage over conventional manual anastomosis with respect to operation time and NG tube removal, so this method can be employed safely in aged and generally morbid patients to improve the postoperative course.

Mammary Adenomyoepithelioma in Male Patient / 한국유방암학회지

Myoepithelial cells are the normal constituent of mammary gland and the lesions arising from this components are rare and can be divided into three categories. Adenomyoepithelioma, which is one of them, has a characteristics of dual proliferation of epithelial and myoepithelial cells but the biologic behavior of it has not yet been fully understood. Most of the adenomyoepitheliomas are reported in female patients and there are few of male patient reported in English literature. We experienced one case of male adenomyoepithelioma and report the case with review of literature.

A Study of Anal Manometric Finding after Low Anterior Resection of Rectal Cancer

PURPOSE: Low anterior resection, irrespective of anastomotic technique, may be associated with frequent bowel movement and other bowel management difficulties. The aim of this study was to access the anorectal function after low anterior resection of the rectal cancer. METHODS: We studied 28 patients who had mid and low rectal cancer (average 8.3 cm above the anal verge) had undergone low anterior resection using stapling suture devices (average level of anastomosis was 3.8 cm above anal verge) and anal manometry was undertaken 95 times preoperatively (N=28) and 3 month (N=26), 6 months (N=22) and 12 months (N=19) postoperatively from 1992 to 1995 in Korea University Guro Hospital. RESULTS: Maximum resting pressure was reduced after resection (from 64.7 mmHg to 42.7 mmHg, change ?22 mmHg) but gradually increased and returned to preoperative level at 12 months postoperatively. Minimum perceived volume was decreased after operation (from 40.3 ml to 25 ml change of ?15.3 ml) and this change persist at 12 months postoperatively. Rectoanal inhibitory reflex was present in all patient before surgery but disappeared in most of the patient after operation. Reflex returned to normal in 4 of 22 patients at 6 months later and in 7 of 19 patients at 12 months after operation. Maximum squeezing pressure and maximum tolerable volume were not decreased after operation. CONCLUSIONS: Anorectal function (maximum resting pressure, minimum perceived volume and rectoanal inhibitory reflex) was reduced immediately after low anterior resection of rectal cancer. But this functional changes returning to normal at 6 months and most of the patients had good function at 12 months after operation.

Clinicopathologic Characteristics of and Prognosis for Proximal Gastric Carcinomas

PURPOSE: Many epidemiological studies have revealed an increasing tendency for proximal gastric cancer. Furthermore, proximal gastric cancer has been known to have unique characteristics and a poor prognosis in contrast to middle and distal gastric cancer, but the reason have not yet been fully explained. For that reason, we investigated changes in the incidence of proximal gastric cancer, its clinicopathologic characteristics, and its prognosis, and we compared the results with those of other reports and tried to identify the reasons for such phenomena. METHODS: After excluding linitis platisca-type cancer, double primary cancer, and gastric cancer arising from the remnant stomach, we retrospectively analyzed the case histories of 836 patients who had undergone operations for gastric cancer from 1992 to 1997. The cases were divided into a proximal gastric-cancer (PGC) group and a middle and distal gastric-cancer (DGC) group based on the location of the primary tumor. RESULTS: The PGC group included 74 patients (8.9%); 762 patients (91.1%) were in the DGC group. The incidence of proximal gastric cancer was 5.0% in 1992 and 11.6% in 1997. The PGC group has more advanced tumor stages (p=0.001) and more positive lymph-node metastases (p=0.013). The resectability of PGC was 87.8%, and that of the DGC was 92.4%, but these were not significantly different (p=0.169). The overall 5-year survival rate for PGC was 48.4% and that of DGC was 59.0%, but these were also not significantly different (p=0.5776). Comparing the survival rates of two groups for various stages revealed no differences. CONCLUSION: The increasing tendency of proximal gastric cancer was similar those in other reports even though we observed for a shorter periods and the proximal gastric cancers were diagnosed in advanced stages, and probably that was the reason for the poor prognosis. Therefore, if early diagnosis is made and adequate therapy is performed, proximal gastric cancer, in contrast to distal gastric cancer, is not a unique disease entity.

Analysis of Hormone Receptor between IHC and EIA in Breast Cancer / 한국유방암학회지

PURPOSE: This study was prospectively carried out to determine the concordance between the immunohistochemical assay (IHC) and the enzyme immunoassay (EIA) assessing estrogen receptor (ER) and progesteron receptor (PR) in breast cancer tissues. MATERIALS AND METHODS: Breast carcinoma tissues were obtained from 36 patients. Hormonal receptors were determined by IHC assay using polyclonal antimouse antibody and by EIA. The concordance between two methods and the concordance according to in age, tumor size, stage, and lymph node metastasis of breast cancer patient were analyzed. RESULTS: The concordant rate of ER status was 88.9% between IHC and EIA. ER-IHC(+)/EIA(-) were 3 cases and ER-IHC(-)/EIA(+) was 1 cases. ER-positive was 63.9% in IHC and 53.8% in EIA. The concordant rate of PR status was 86.1% between IHC an EIA. PR-IHC(+)/EIA(-) were 4 cases and PR-IHC(-)/EIA(+) was 1 cases. PR-positive was 61.1% in IHC and 52.8% in EIA. There was high concordance (76.2-100%) in age, tumor size, stage, and lymph node metastasis. CONCLUSIONS: There was high concordance between immunohistochemical assay and enzymeimmunoassay determining estrogen and progesteron receptors in the breast cancer. The IHC assay appears to be a resonable substitute for the EIA to determine hormonal receptors.