Distribution and survival of primary sarcoma in Korea: A single center analysis of 2017 cases

PURPOSE: Distribution and survival of sarcoma in Korea are not well described, after the changing of sarcoma classification on 2013. The researchers investigated the distribution and survival in single center 2017 cases of sarcoma.METHODS: Patients with primary sarcoma, who underwent surgery, were investigated. All cases were collected during a 20 year period (1995–2015) from Samsung Medical Center in Korea. Histopathologic types were classified by World Health Organization (WHO) classification (2013). And overall survival rates were analyzed.RESULTS: Between 1995 and 2015, 2017 patients were collected. The most frequent type of sarcoma was gastrointestinal tumor (15%), followed by liposarcoma (12%), leiomyosarcoma (9%), dermatofibrosarcoma (6%), giant cell sarcoma (6%). The most common primary site of sarcoma was the intra-abdominal area (45%, including visceral area). Extremities accounted for 26% of all cases. Sixteen percent of sarcoma were located in retroperitoneal area. The overall survival rate was 70.4% (median follow-up time, 36.8 months; range, 0.1–261.3 months). The best prognosis was dermatofibrosarcoma (100%, 5-year survival rate). The worst prognosis was angiosarcoma (39.3%). Survival analysis by the primary site demonstrated favor prognosis in extremities than head & neck, chest lesion.CONCLUSION: The researchers reported Korean sarcoma characteristics with using the new WHO classification.

Gastric Duplication Cysts in Adults: A Report of Three Cases

Gastric duplication cyst is a rare congenital anomaly of the gastrointestinal tract and is especially uncommon in adults. Most cases in adults are discovered incidentally on radiological examination or gastric endoscopy. Accurate diagnosis of these cysts before resection is difficult. Differential diagnoses are varied. Malignant transformation of a gastric duplication cyst is very rare. We present three cases of asymptomatic noncommunicating gastric duplication cysts in adults.

Prediction of Complete Necrosis of Hepatocellular Carcinoma Treated with Transarterial Chemoembolization Prior to Liver Transplantation

BACKGROUND/AIMS: Compact lipiodol uptake without enhancement on multiphasic helical computed tomography (CT) has been suggested as a radiologic response criterion in hepatocellular carcinoma (HCC) patients treated with transarterial chemoembolization (TACE) and subsequent partial hepatectomy. However, its usefulness has not been fully investigated in the explanted liver. METHODS: Between 1998 and 2007, 81 patients with HCC underwent 1-9 sessions of TACE followed by liver transplantation (LT). Thirty-nine tumors in 29 patients showed a radiologic response on CT performed prior to LT. The radiologic response criteria and the duration of the response were evaluated to predict total necrosis in the explanted liver. RESULTS: Among the 39 tumors, 34 nodules (87.2%) exhibited total pathological necrosis. While 13 out of 16 tumors (81.3%) with a radiologic response for 6 months or less were completely necrotic, 21 out of 23 tumors (91.3%) with a radiologic response of longer than 6 months showed total necrosis. CONCLUSIONS: Our results suggested that the radiologic response criteria based on serial CT images might be useful for predicting total necrosis of TACE-pretreated HCC in LT.

Carney Triad in an Adult with Aggressive Behavior: The First Case in Korea

Carney triad is a rare syndrome of unknown etiology characterized by having at least two out of three following neoplasms: gastrointestinal stromal tumor, pulmonary chondroma and extra-adrenal paraganglioma. About 100 cases have been reported worldwide. We report a case of Carney triad in a 42-year-old woman presented with a gastrointestinal stromal tumor in the stomach and a malignant functioning paraganglioma in the retroperitoneum that was fatal five years after diagnosis. The gastrointestinal stromal tumor was diagnosed as intermediate-risk of aggressive behavior and diffusely positive for c-kit whereas the retroperitoneal paraganglioma was negative for c-kit. Genetic analyses showed no mutations of KIT, PDGFRA, SDHB, SDHC, and SDHD genes in both tumors. To our best knowledge, this is the first case of Carney triad in Korea.

Reconstruction of Regions Below the Knee Using Island Flaps

PURPOSE: The lower leg often has poor vascularity, proximity to bone, and insufficient soft tissue. The island flaps offer a feasible one stage reconstruction and has a remarkable vascularization and high quality results for soft tissue defect with or without bony problems to occur on regions below the knee. So we reported our experience of island flaps with review of the literatures. METHODS: We reconstructed 29 cases of soft tissue and 2 cases of bony defect on regions below the knee by using various island flaps at our hospital from December, 1991 to January, 2006. We used 2 fibular osteocutaneous island flaps, 15 reverse sural island flaps, 6 extensor digitorum brevis muscular island flaps, 2 medial plantar island flaps, 5 saphenous island flaps, and a dorsalis pedis island flap. RESULTS: Partial necrosis was developed in 4 out of 15 reverse sural island flaps and 1 out of 5 saphenous island flaps, but they were healed with secondary skin graft. There was partial loss of skin graft on the donor sites in 2 cases. CONCLUSION: Island flaps are very useful for reconstruction of regions below the knee because island flaps have good vascularity and less risk of infection. Generous flap size, easy operative technique, lower cost, shorter operative time, and minimal morbidity at the donor site are other advantages. We attained satisfactory results.

The Effect of Induction Chemotherapy Using Docetaxel and Platinum in Treatment Methods of Nasopharyngeal Carcinoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The aim of this study was to determine the efficacy of induction chemotherapy with docetaxel and platinum in patients with nasopharyngeal carcinoma. SUBJECTS AND METHOD: The medical records of 52 patients, who were diagnosed with NPC at our department from January 1995 to December 2005, were reviewed and retrospectively analyzed. Patients were divided into three groups according to treatment methods. Twenty-eight cases treated with induction chemotherapy consisted of docetaxel, platinum and RT, 17 cases treated with induction chemotherapy consisted of 5-FU, platinum and RT, and 7 cases were treated with RT only. A total of 114 chemotherapy cycles were administered to patients and most received 2 cycles. RESULTS: The T stage distribution at the time of diagnosis was 48%, 14%, 15%, and 23% for T1, T2, T3 and T4, respectively. According to the WHO classification, the type I included 11 cases, type II 2cases, and type III 39 cases. The overall 5-year survival rate was 60.6%. According to the treatment modality, only the RT group was 42.9%. In the chemoradiotherapy group, the 5-year survival rates of 5-FU and platinum combination group and docetaxel and platinum combination group were 47.1% and 78.8%, respectively. There was significant difference in survival (p=0.037). There was no difference in sex, age, and N stage with regards to the 5-year survival rate. CONCLUSION: Although no valid conclusions could be drawn because of the small number of patients examined in the present study, we found that induction chemotherapy consists of docetaxel and that platinum may improve the outcome of patients with NPC.

The Surgical Managements for the Stone in the Hilum of the Submandibular Gland / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Transcervical submandibular gland excision has been commonly used for the treatment of stone in the hilum and intraglandular of SMG because of surgical difficulty. This study introduces a surgical approach without unnecessary submandibular or cervical resection. SUBJECTS AND METHOD: 27 patients who had stones in the hilum and internal area of SMG were treated at our department during the past one year. RESULTS: All stones were removed through intraoral approach without transcervical submandibular gland excision for all patients. For 18 patients with poor surgical field, the sublingual gland was removed before the removal of stone. Although a long term follow-up observation was not carried out, SMG hypertrophy was alleviated as time went by. No recurrence had been found so far. Post-surgical complications such as paralysis of the lingual nerve and the hypoglossal nerve were not found. CONCLUSION: This surgical method is a possible choice for the treatment of stones in the hilum and internal area of submandibular gland.

The Utility of Serum PTH Assessment 1 Hour after Total Thyroidectomy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Hypocalcemia is the most frequent complication following total thyroidectomy. This prospective study examines the predictive value of parathyroid hormone (PTH) levels measured 1 hour after surgery. MATERIALS AND METHOD: Twenty-four patients underwent total or near-total thyroidectomy for benign or malignant thyroid tumor in one year. Serum calcium and PTH levels were measured preoperatively and at 1 hour after surgery. RESULTS: All patients were classified into three groups according to hypocalcemic symptoms and postoperative serum calcium levels. A total of 6 (25%) patients were found with hypocalcemia, as demonstrated by clinical and laboratory findings. PTH levels at 1 hour were below normal level (100%) for 6 of the 6 symptomatic hypocalcemia patients, 5 (45%) of the 11 biochemical hypocalcemia patients, and in 1 (14%) of 7 normocalcemic patients (p=0.002). The sensitivity and specificity of postoperative 1 hour PTH assessment to predict symptomatic hypocalcemia were 100% and 66%. The positive and negative predictive rate of postoperative 1 hour PTH assessment to predict symptomatic hypocalcemia were 50% and 100%. CONCLUSION: Parathyroid gland insufficiency is the main determinant of transient hypocalcemia after bilateral thyroid surgery. Low PTH level at 1 hour after surgery is therefore a feasible predictor of postoperative symptomatic hypocalcemia and permanent hypoparathyroidism.

Incidence of Malignancy within Cytologically Indeterminate Thyroid Nodules / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES : The optimal management of cytologically indeterminate thyroid nodules is controversial given the variable malignancy rates reported in this patient population. We examined the prevalence of malignancy within cytologically indeterminate atypical and follicular thyroid lesions in an attempt to predict malignancy based on cytologic features. Subjects and METHOD : Cytopathologic reports obtained after fine-needle aspiration biopsy (FNAB) examination of indeterminate follicular thyroid lesions were studied over a 2-year period. The prevalence of malignancy on final pathology was determined in 2 indeterminate cytopathologic categories. RESULTS : A total of 138 records were available (122 women, 16 men). The mean patient age was 45.5+/-13.5 years. All patients underwent surgery and had histopathologic diagnosis. The prevalence of malignancy in atypical and follicular thyroid lesions were 77.7% (42 of 54) and 17.8% (15 of 84), respectively. CONCLUSION : The high prevalence of malignancy within indeterminate atypical and follicular thyroid lesions may necessitate thyroidectomy for patients with indeterminate atypical and follicular lesions on the FNAB examination.

A Large Malignant Peripheral Nerve Sheath Tumor in the Neurofibromatosis Patient: A Case Report

PURPOSE: Malignant peripheral nerve sheath tumors most often arise from the anatomically discernible peripheral nerve or neurofibroma. METHODS: A 55-year-old man had a rapidly growing pedunculated large mass on the sacrolumbar junction for 2 years. He has congenital neurofibromatosis type I. He had multiple caf-au-lait spots and multiple neurofibromas on the entire body. The mass developed from a subcutaneous nodule on the sacrolumbar junction and grew rapidly. The preoperative punch biopsy revealed a malignant peripheral nerve tumor. The mass was completely excised with 1 cm free margin above the deep fascial plane. RESULTS: There was no evidence of recurrence of tumor for 19 months of follow-up examination. CONCLUSION: Malignant peripheral nerve sheath tumor is very rare and has unique feature. We report a successful case of malignant peripheral nerve sheath tumor with the review of the literatures.

Case Study of Secondary Operation in Blowout Fracture for Correction of Implant Displacement

The operative treatment of orbital blowout fracture involves restoration of intra-orbital soft tissue and bony structural integrity. In extensive blowout fracture cases, inadequate dissection inappropriate implant insertion, postoperative edema and subsequent increase of intraorbital pressure may sometimes lead to displace the implant. This case study was performed on 6 patients who underwent secondary blowout fracture operation. After primary blowout fracture reduction operation, we found severely displaced implant in the postoperative computed tomogram study. The most prevalent sites were the posterior portion of the inferior and medial wall. We performed further dissection of the fracture sites and inserted more larger sized implant than before. Then we fixated the implant to prevent postoperative displacement. Among these patients, 3 patients who operated more than 3 months after the first operation, complained residual diplopia and eyeball movement disorder. These clinical cases have troublesome and unique features, so we report our experiences with review of the literatures.

Adenomyoma of Ampulla of Vater or the Common Bile Duct: A Report of Three Cases

Adenomyoma is a rare non-neoplastic lesion of the biliary tract. Here we report on three cases of adenomyoma; one located in the ampulla of Vater and two located in the common bile duct. Although preoperative endoscopic and radiological evaluations could not determine whether lesions were benign or malignant, intra-operative frozen section histologic examinations aided the differential diagnosis. Microscopic features of a lobular gland architecture with basally located nuclei and the absence of desmoplastic stromal reaction were found to be characteristic in frozen and paraffin sections.

Asymptomatic Adult Choledochal Cyst

PURPOSE: Surgical strategies for an adult choledochal cyst are influenced by the Todani-type, and the existence of a combined malignancy. This study was conducted to evaluate the characteristics of asymptomatic an adult choledochal cyst that influence the surgical strategy. METHODS: Fifty-seven adult patients (age> or =16 years) received an operation for a choledochal cyst, at the Samsung medical center, between Aug. 1995 and Jul. 2003. Asymptomatic patients were defined as those diagnosed incidentally with a choledochal cyst, who had no symptoms related with a choledochal cyst. Evaluation of PBM (pancreaticobiliary maljunction) was available in 38 patients with a proper cholangiogram. RESULTS: There were 15 and 42 asymptomatic and symptomatic patients, respectively. The mean-age (38 years-old) and gender-ratio (M: F=14: 43) were no different between the two groups. In preoperative blood tests, the titers of aspartate aminotransferase (AST), alanine aminotransferase (ALT) and alkaline phosphatase (ALP) were slightly higher in the symptomatic group, but were still around the upper normal limit. The total bilirubin, amylase and CA19-9 levels were no different between the two groups. The operations in the symptomatic group required longer times and greater transfusion volumes than the asymptomatic group (4.5 vs. 3.5 hrs and 0.24 vs. 0 units, respectively). The proportion of the Todani-types, types of PBM, incidence of malignancy and gallstones were no different between the two groups. Seven malignancies, 3 common bile duct cancers and 4 gall bladder cancers, were found, and an age >40 years was the only risk factor of a combined malignancy. CONCLUSION: There was no considerable difference to influence the surgical strategy between the asymptomatic and symptomatic choledochal cyst patients. However, old patients, especially over 40, may need a more aggressive surgical therapy.

The Significance of an Open Bladder Neck in the Evaluation of the Female Stress Urinary Incontinence / 대한산부인과학회잡지

OBJECTIVE: To determine the prevalence of an open bladder neck in women with stress urinary incontinence and to assess its clinical and urodynamic significance. METHODS: To evaluate the presence of an open bladder neck, a total of 356 women with stress incontinence were evaluated by static cystourethrography (CUG). An open bladder neck is a finding defined as the appearance of contrast medium in the proximal urethra at resting state (like a 'beak') without overt leakage. We classified the patients into two groups according to the presence of an open bladder neck on static CUG and compared 13 clinical parameters between the two groups. RESULTS: The open bladder neck finding was observed in 192 (53.9%) patients. Open bladder neck was more common in higher symptom grade, older age, more delivery history, greater bladder neck descent, and estrogen depleted patients. There was a significantly higher rate of intrinsic sphincteric deficiency (ISD) in the open bladder neck-positive group (37.5%) than the open bladder neck-negative group (23.2%) (p=0.01). The average abdominal leak point pressure (ALPP) of women with open bladder neck (82.8 cmH2O) was lower than that of women without open bladder neck (96.4 cmH2O) (p=0.003). CONCLUSION: The open bladder neck on static CUG has clinical and urodynamic significance. Although it is not diagnostic of ISD, the finding may reflect functional deficiencies of intrinsic sphincter. One should consider this parameter when evaluating patients, especially in the equivocal zone of ALPP 61-90 cmH2O.

Well-Differentiated Hepatocellular Carcinoma: Triple-Phase Helical CT Findings

PURPOSE: To determine the imaging characteristics of well-differentiated hepatocellular carcinomas (HCCs), as seen at triple-phase helical CT. MATERIALS AND METHODS: Thirty-eight well-differentiated HCCs in 29 patients who underwent surgical resection comprised our study population. Triple-phase helical CT images were obtained at 30 seconds, 70 seconds, and 3 minutes after contrast injection, and HCCs were divided into four groups according to their size: smaller than 1 cm (n=12), 1-2 cm (n=15), 2-4 cm (n=8), and larger than 4 cm (n=3), The enhancement patterns of HCCs at triple-phase helical CT were retrospectively analysed. RESULTS: In the smaller than l cm group, the most common enhancement pattern at all three phases was iso-attenuation (n=8; 67%). In the 1-2 cm group, iso-attenuation (n=10; 67%) was most common during the arterial phase and slightly low attenuation during the portal and equilibrium phases while in the 2-4 cm group, high attenuation (n=6; 75%) was most common during the arterial and portal phases, and low attenuation during the equilibrium phase (n=6; 75%). Two (67%) of three cases in the larger than 4 cm group demonstrated low, including fatty, attenuation. The detection rate was 33% (4/12) in the smaller than 1 cm group, 87% (13/15) in the 1-2 cm group and 100% (11/11) in the 2-4 cm and larger than 4 cm groups. CONCLUSION: At triple-phase helical CT, the enhancement patterns of well-differentiated HCCs were diverse, and the detection rate of those larger than 1 cm was 92% (24/26).

Interpretation of simple X-ray film

No Abstract Available.

Analysis of resectability and survival in pancreatic cancer patients with vascular invasion / 대한내과학회지

BACKGROUND: One of the major limitations of curative resection in pancreatic cancer patients is local tumor extension to the mesenteric vessels. Thus, the purposes of our study were (1) to assess the clinical value of contrast enhanced spiral CT in predicting the resectability and survival of pancreatic cancer patients with suspicious vascular invasion and (2) to assess the influence of curative resection on survival in these patients. METHODS: Forty cases of the pancreatic cancer patients who were suspected of having involvement of adjacent large vessels and subsequently underwent operation with curative intent were enrolled in this study. Resectability and survival were correlated with CT findings such as segment length, degree of encasement, type and number of vessel involved. Survival rate was compared between curative and palliative resection groups. And survival was also compared between resected and non-resected groups. RESULTS: Of the 40 patients with adenocarcinoma of the pancreas, 14 patients had curative resections, and 26 patients had palliative resections. The probability of curative resection was higher in patients with segment length less than 2 cm, compared with those with more than 2 cm. However, there was no difference in survival between two groups. There were no differences of resectability and survival according to the degree of encasement, type and number of vessel involved. There were no difference in survival between curative and palliative resection groups, and between resected and non-resected groups. CONCLUSION: A survival benefit is not achieved by curative resection in pancreatic cancer patients with vascular invasion. So other non-operative treatments should be considered as effective tools prior to resection in these patients.

Factors Affecting Intraoperative Electroencephalographic Changes during Carotid Endarterectomy

BACKGROUND: Continuous electroencephalographic (EEG) monitoring is a widely used method of operative surveillance during a carotid endarterectomy. It is widely accepted that intraoperative EEG changes are closely related with increased risk of postoperative stroke. If there are factors affecting EEG changes on preoperative evaluations, they may be helpful in predicting postoperative neurologic deficits, selecting patients, and, furthermore, reducing morbidity. METHODS: We reviewed the cases of 47 patients who received a CEA from January 1995 to August 1997. There were 10 cases of intraoperative EEG changes. Dividing the 47 cases into two groups (10 cases of positive EEG changes vs. 37 cases of negative EEG changes), we compared several factors between the two groups, such as patient's characteristics (age, history of smoking, and presence of hypertension, diabetes, or heart disease), operative indication (asymptomatic, TIA, stroke), carotid lesions (site, extent of stenosis, presence of ulceration, stenosis of the contralateral carotid artery), and carotid angiographic findings. RESULTS: In the aspect of patient's characteristics, operative indications, and carotid lesions, there were no statistically significant differences between the two groups. In the carotid angiogram, the contralateral carotid angiogram is the only one statistically useful (p<0.001) in predicting intraoperative EEG changes, with a negative predicting value of 100%. The existence of collaterals in the vertebral angiograms showed differences in frequency between the two groups, but this was statistically not significant. CONCLUSION: The preoperative carotid angiogram might be considered as a useful evaluation for predicting intraoperative EEG changes. If more data are accumulated, the other factors should reviewed again. Recently, positron emission tomography (PET) and transcranial doppler (TCD) have been performedin some patients. We think that these studies, in conjunction with the carotid angiogram, will be more helpful as more data are accumulated.

High-Resolution PACS Work station: Diagnostic Performance and Comparison with Laser-Printed CR Films in Chest Diseases

OBJECTIVES: To compare the diagnostic performance of a high-resolution picture archiving and communications system (PACS) workstation directly interfaced with computed radiography(CR) with laser-printed CR films in chest diseases. MATERIALS AND METHODS: Chest radiographs with (n=91) and without (n=25) abnormalities were included. Atotal of 100 abnormalities from 91 radiographs consisted of irregular lines, pneumothoraces, nodules and consolidations (25 of each). Laser-printed hard copies with dynamic range compression (DRC) were produced. InPACS, soft copies of 1760 X 2140 X 10 bits CR images were displayed on 1536 X 2048 with 8 bit gray-scale monitors.The performance of four observers was compared between laser-printed hard copies and CR images displayed on a workstation according to receiver operating characteristic analysis. RESULTS: Overall, no significant difference sin observer performance were observed between laser-printed hard copies and CR images displayed on a workstation(p=.2454). Even though statistically not significant, the former was slightly superior to the latter for lesions of irregular lines, pneumothoraces, and consolidations, whereas for nodules, the latter was slightly better than the former. CONCLUSION: The diagnostic performance of a high-resolution PACS workstation in chest radiographs is acceptable and comparable to CR hard copies printed with DRC processing mode.

Spontaneous Perforation of Small Bowel Lymphoma Causing Massive Pneumoperitoneum: A case Report

The gastrointestinal lymphoma is a well known entity for bleeding or perforation during treatment, but spontaneous perforation is not common. We report the CT findings of an unusual case of small bowel lymphoma which presented with massive pneumoperitoneum following spontaneous perforation.