Clinicopathological Features and Prognosis of Lobular Carcinoma In Situ

Purpose@#According to the American Joint Committee on Cancer’s 8th Edition Manual, lobular carcinoma in situ (LCIS) is no longer considered a malignant disease, although it may be a precursor to the development of breast cancer. The present study aimed to evaluate the clinicopathological features and prognosis of LCIS. @*Methods@#This study retrospectively analyzed clinicopathological features and prognosis data of LCIS among patients who underwent breast surgery at Severance Hospital, Seoul, South Korea from 1991 to 2016. @*Results@#Of the 47 patients, 49 cases of LCIS were confirmed by postoperative pathology. The mean patient age was 48.15±8.34 years. Most patients (81.6%) did not have palpable tumors at diagnosis, and 51.0% showed no microcalcification on mammography. Breast-conserving surgery was performed more frequently than total mastectomy (77.6% vs. 22.4%). The mean tumor size was 1.63±2.11 cm. There were only 3 cases of pleomorphic LCIS. Hormone receptor-positive tumors were noted in 47 cases, however, the hormone receptor status was unknown in the other 2 cases. There were no LCIS recurrences or deaths during the follow-up period (mean 56 months). @*Conclusion@#LCIS is often incidentally diagnosed without clinical symptoms, especially in women aged <50 years. The prognosis of LCIS is excellent in cases that are surgically treated.

Clinicopathological Features and Prognosis of Lobular Carcinoma In Situ

Purpose@#According to the American Joint Committee on Cancer’s 8th Edition Manual, lobular carcinoma in situ (LCIS) is no longer considered a malignant disease, although it may be a precursor to the development of breast cancer. The present study aimed to evaluate the clinicopathological features and prognosis of LCIS. @*Methods@#This study retrospectively analyzed clinicopathological features and prognosis data of LCIS among patients who underwent breast surgery at Severance Hospital, Seoul, South Korea from 1991 to 2016. @*Results@#Of the 47 patients, 49 cases of LCIS were confirmed by postoperative pathology. The mean patient age was 48.15±8.34 years. Most patients (81.6%) did not have palpable tumors at diagnosis, and 51.0% showed no microcalcification on mammography. Breast-conserving surgery was performed more frequently than total mastectomy (77.6% vs. 22.4%). The mean tumor size was 1.63±2.11 cm. There were only 3 cases of pleomorphic LCIS. Hormone receptor-positive tumors were noted in 47 cases, however, the hormone receptor status was unknown in the other 2 cases. There were no LCIS recurrences or deaths during the follow-up period (mean 56 months). @*Conclusion@#LCIS is often incidentally diagnosed without clinical symptoms, especially in women aged <50 years. The prognosis of LCIS is excellent in cases that are surgically treated.

Management of portal hypertension derived from uncommon causes

Portal hypertension can arise from any condition interfering with normal blood flow at any level within the portal system. Herein, we presented two uncommon cases of the portal hypertension and its treatment with brief literature review. A 71-year-old man who underwent right hemihepatectomy revealed a tumor recurrence adjacent to the inferior vena cava (IVC). After radiofrequency ablation (RFA) with lymph node dissection, he was referred for abdominal distension. The abdomen computed tomography scan showed severe ascites with a narrowing middle hepatic vein (MHV) and IVC around the RFA site. After insertion of two stents at the IVC and MHV, the ascites disappeared. Another 73-year-old man underwent right trisectionectomy of liver and segmental resection of the portal vein (PV). After operation, he underwent conservative management due to continuous abdominal ascites. The abdomen computed tomography scan showed severe ascites with obliteration of the left PV. After insertion of stent, the ascites disappeared. A decrease of the pressure gradient between the PV and IVC is one of the important treatment strategies for portal hypertension. Vascular stent is useful in the reduction of pressure gradient and thus, can be a treatment option for portal hypertension.

The Natural Course of Biopsy-Proven Isolated Microscopic Hematuria: a Single Center Experience of 350 Patients

The increasing interest in healthcare and health screening events is revealing additional cases of asymptomatic isolated microscopic hematuria (IMH). However, a consensus of the evaluation and explanation of the IMH prognosis is controversial among physicians. Here, we present the natural course of IMH together with the pathological diagnosis and features to provide supportive data when approaching patients with IMH. We retrospectively evaluated 350 patients with IMH who underwent a renal biopsy between 2002 and 2011, and the pathological diagnosis and chronic histopathological features (glomerulosclerosis, interstitial fibrosis, and tubular atrophy) were reviewed. Deterioration of renal function was examined during follow up. The patients with IMH were evaluated for a mean of 86 months. IgA nephropathy was the most common diagnosis in 164 patients (46.9%). Chronic histopathological changes were observed in 166 (47.4%) but was not correlated with proteinuria or a decline in renal function. Ten patients developed proteinuria, and all of them had IgA nephropathy. Three patients progressed to chronic kidney disease with an estimated glomerular filtration rate < 60 mL/min/1.73 m2 but none progressed to end stage renal disease. In conclusion, IMH had a generally benign course during 7-years of observation, although IgA nephropathy should be monitored if it progresses to proteinuria. Future prospective randomized studies may help conclude the long-term prognosis and lead to a consensus for managing IMH.

Risk factors in the progression of BK virus-associated nephropathy in renal transplant recipients

BACKGROUND/AIMS: BK virus-associated nephropathy (BKVAN) is an important cause of allograft dysfunction in kidney transplant recipients. It has an unfavorable clinical course, and no definite treatment guidelines have yet been established. Here, we report our center's experience with biopsy-proven BKVAN and investigate factors associated with its progression. METHODS: From January 2004 to April 2013, 25 patients with BKVAN were diagnosed by biopsy at Seoul St. Mary's Hospital. Of the 25 patients, 10 were deceaseddonor transplant recipients and 15 were living-donor transplant recipients. Three of the patients underwent retransplantation. The primary immunosuppressant used was tacrolimus in 17 patients and cyclosporine in eight patients. RESULTS: BKVAN was observed at a mean duration of 22.8 ± 29.1 months after transplantation. The mean serum creatinine level at biopsy was 2.2 ± 0.7 mg/dL. BKVAN occurred with acute rejection in eight patients (28%). Immunosuppression modification was performed in 21 patients (84%). Additionally, leflunomide and intravenous immunoglobulin were administered to 13 patients (52%) and two (8%), respectively. Allograft loss occurred in five patients (27.8%) during the follow- up period at 0.7, 17.1, 21.8, 39.8, and 41.5 months after the BKVAN diagnosis. Advanced stages of BKVAN, increased creatinine levels, and accompanying acute rejection at the time of BKVAN diagnosis increased the risk of allograft failure. CONCLUSIONS: The clinical outcomes in patients with biopsy-proven BKVAN were unfavorable in the present study, especially in patients with advanced-stage BKVAN, poor renal function, and acute allograft rejection.

Partial Anomalous Pulmonary Venous Return (PAPVR) in a Patient with Sjogren's Syndrome

Pulmonary hypertension (PH) is a rare manifestation in patients with primary Sjogren's syndrome (pSS) and it can occur with or without interstitial lung disease (ILD). Patients with PH and ILD who show signs of exacerbation of dyspnea are commonly assessed for pure PH aggravation, ILD progression or pulmonary infection. However, the presence of congenital cardiac anomalies, such as partial anomalous pulmonary vein return (PAPVR), can also be a cause of dyspnea exacerbation. PAPVR is a rare congenital anomaly that involves drainage of 1 to 3 pulmonary veins into the right-sided heart circulation, resulting in a partial left-to-right shunt. Here we present a case of PAPVR as the cause of PH aggravation in a patient with pSS with accompanying PH.

Long-Term Follow-Up of Refractory Mycosis Fungoides Which Achieved Remission with the Addision of Isotretinoin to Methotrexate and Psoralen Plus Ultraviolat A Therapy

No abstract available.

A Case of Acute Myeloid Leukemia after Adalimumab Treatment in Psoriatic Arthritis

Hematologic malignancies and lymphoproliferative disorders have been reported after using tumor necrosis factor-alpha inhibitor in patients suffering from spondyloarthropathy. Previously reported cases were treated by using infliximab and etanercept. Usually, it takes approximately several months for leukemia or lymphoproliferative disorders to occur after the application of those agents. However, we report a case of acute myeloid leukemia that developed after short term usage of adalimumab in a patient suffering from psoriatic arthritis.

A Case of Severe Bevacizumab-induced Ischemic Pancolitis, Treated with Conservative Management / 대한소화기학회지

Bevacizumab (Avastin(R)) is a monoclonal antibody against the vascular endothelial growth factor (VEGF) receptor that increases the overall survival rate when added to standard chemotherapy regimens in patients with metastatic colorectal cancer. The known toxicities of bevacizumab are hypertension, proteinuria, wound healing complications, arterial thrombosis, bleeding, and gastrointestinal complications. Especially ischemic colitis can rapidly develop into bowel perforation, so an emergency operation often is needed. Recently, a 65-year-old male patient developed ischemic pancolitis after FOLFOX (85 mg/m2 Oxaliplatin, d1;200 mg/m2 Leucovorin, d1;400 mg/m2 5-FU iv bolus, d1-2;and 600 mg/m2 5-FU, d1-2, every two wk) and Bevacizumab combination chemotherapy was administered. However, he recovered after early conservative care without surgery. We report this case with a review of literature.

Pneumatosis Intestinalis with Hepatic Portal Venous Gas in a Hemodialysis Patient / 대한신장학회지

Pneumatosis intestinalis is an uncommon but important condition in which gas is found in a linear or cystic form in the submucosa or subserosa of the bowel wall. It occurs in several clinical settings in adults who have a wide variety of underlying disorders that determine prognosis. Especially, hepatic portal venous gas with pneumatosis intestinalis has been rarely described in chronic dialysis patients. We report a case of 53-year-old man with hemodialysis-dependent end stage renal disease who developed a pneumatosis intestinalis accompanied hepatic portal venous gas. This patient was treated conservatively with intravenous antibiotics, fluid therapy, and oxygen supply without surgical approach.

A Case of Pseudomembranous Colitis in a Juvenile Rheumatoid Arthritis Patient Taking Methotrexate / 대한소화기학회지

Pseudomembranous colitis is mainly caused by antibiotics and Clostridium difficile infection. But conditions such as gastrointestinal surgery, antacid medication, anti-neoplastic agent or immunosuppressive agent which influences the normal flora of colon can induce colitis without the administration of any antibiotics. We experienced a 13 year-old male who was taking low-dose methotrexate for juvenile rheumatoid arthritis complained diarrhea and abdominal pain for 3 weeks. Sigmoidoscopic findings revealed diffuse patch yellowish pseudomembranes on the rectum. Histologic finding was compatible to pseudomembranous colitis. His symptom was improved after stop taking methotrexate and the administration of metronidazole. If a patient treated with immunosuppressive agents or antineoplastic agents complains diarrhea, fever or abdominal pain and has not improved with conservative care, pseudomembranous colitis should be taken into account as a differential diagnosis and prompt treatment is required for better prognosis.

Clinical Evaluation between Mandibulotomy and Mandible Sparing Approaches in Oropharyngeal Cancer Operation and Reconstruction

PURPOSE: Mandibulotomy approach and mandible sparing approach are most common methods for oropharyngeal cancer surgery. Good surgical view and convenience of flap inset are advantages of mandibulotomy approach but deformity of mandible contour, postoperative malocclusion and radionecrosis are its limitations. To make up for the limitations, mandible sparing method is commonly performed, but limited surgical view and difficulties of flap inset are the weak points of this approach. The purpose of the study is to compare mandibulotomy and mandible sparing approaches in postoperative complications and progression of the treatment in oropharyngeal cancer operation and reconstruction. METHODS: Single reconstructive microsurgeon operated for oropharyngeal cancer patients with different surgeons of head and neck department who prefer mandibulotomy and mandible sparing approach respectively, and we compared the frequency of postoperative complication, operation time, duration of hospitalization and recurrence rate between two different surgical approaches. RESULTS: Mandibulotomy approach was used in 18 patients and mandible sparing approach was used in 15 patients. In mandibulotomy approach, there happened one case of teeth injury and one case of necrosis of skin and gingiva, but there happened no malocclusion and radionecrosis. In mandible sparing approach, there were 3 cases of fistula and 2 cases of infection which are significantly higher than mandibulotomy approach. There were no significant differences between early regional recurrence and duration of hospitalization. CONCLUSION: In this study we compared two different methods for the surgical approach in oropharyngeal cancer surgery. As mandible sparing approach has difficulties of limited surgical view, it can be used for the limited indications of anterior tongue and mouth floor cancer. Mandibulotomy approach has advantages of good surgical view and convenience of flap inset. In this method preservation of gingival tissue, watertight fashion suture, delicate osteotomy and plate fixation to maintain occlusion are the key points for the successful results.

Correction of Small Eye Opening with Combined Method

PURPOSE: Generally speaking, most of Korean have smaller eyes than those of Caucasian and they have epicanthus with narrow palpebral fissure. It makes external appearance looking dull because the length of the palpebral fissure is short and there is a epicanthus. In case the function of the levator muscle is weak, their eyes look much smaller. Epicanthus and weak levator muscle function make the eyes look dull. The above mentioned, authors want to introduce double eyelid operation, epicanthoplasty, levator plication to extend and lengthen the palpebral fissure. METHODS: From August 2001 to August 2004, there were 138 cases that had double eyelid operation with epicanthoplasty or levator plication. the 69 cases of them had double eyelid operation and epicanthoplasty, the 33 cases of them had double eyelid operation and levator plication and the 36 cases of them had double eyelid operation and epicanthoplasty and levator plication. RESULTS: After the operation, the length and height of the eyelid are improved remarkably, and most of the patients were satisfied. The length of the eyelid is improved 3to5mm(3.4+/-0.5mm) in case of the epicanthoplasty, the width of the eyelid is improved 3 to 4mm (3.1+/-0.3mm) by the levator plication. The length of the eyelid is improved 3to5(3.4+/-0.4mm) and the width is improved 2to4mm(2.9+/-0.5mm) by the epicanthoplasty used levator plication. CONCLUSION: The improvement of the eyelid length is almost the same as epicanthoplasty and levator plication are done simultaneously. But the improvement of the eyelid width is less shorter when epicanthoplasty and levator plication are done simultaneously than the case of levator plication alone. This is because there is a tension influencing on the limitation of widening palpebral fissure to fix the epicanthal tendon. This method is recommendable for the patients who want to have much bigger eyes.

Inframammary Fold Creation in Breast Reconstruction

Nowadays breast reconstruction with autologous tissues after radical mastectomy is commonly performed, and a natural inframammary fold in the reconstructed breast is considered to be an essential aspect of symmetrical breast shape and location. Total of 104 patients underwent breast reconstruction with free TRAM flap and formation of inframammary fold with free TRAM breast reconstruction was done in 79 patients. No suture fixation for inframammary fold were done in 19 patients. 27 patients(24.0%) were made of inframammary fold with absorbable suture, 52 patients (50.0%) underwent inframammary fold creation with nonabsorbable suture. There were 4 cases(16.0%) of displacement of reconstructed breast and 2 cases(8.0%) of partial disruption of inframammary fold in the group of no suture. There were 2 cases(7.4%) of displacement of reconstructed breast and 3 cases(11.1%) of partial disruption of inframmamary fold in the fixed group with absorbable suture. There was only 1 case(1.9%) of partial disruption of inframammary fold fixed with nonabsorbable suture group. Therefore, we could speculate that the reinforcement of ligamentous structure for making the definite inframammary fold is necessary, and the area of the inframammary fold should not be undermined in immediate breast reconstruction as much as possible in order to preserve the zone of adherence. If the fold is disrupted during the mastectomy, it should be re-created with the non-absorbable sutures. Nonabsorbable suture fixation seemed to be more stable than absorbable suture. Preoperative marking and design are very important to make the symmetrical shape and location of inframammary fold in both of immediate and delayed reconstruction of breasts.

Photographical Analysis of Crow's Feet Pattern According to Sex and Age in Korean

It is well known that crow's feet are caused by hyperkinetic facial muscles. Recently, rejuvenation in this area has been improved enormously by radical approach and various combined adjuvant surgery. And many articles regarding with the various applicable treatment modalities are published every year. Actually, there are various types of crow's feet, but treatment method of crow's feet doesn't have to be different according to their types. Therefore, we tried to analyze the pattern of crow's feet among Korean people and classified them by age and sex. Total of 256 volunteer people were inspected and photographed. We took pictures of oblique view of periorbital area showing primary gaze and smiling feature. Pictures which show poor quality or any disagreement of opinions from three plastic surgeons were excluded. Finally, 160 pictures were collected and classified. The crow's feet lines were classified as four patterns; i.e., central upper, central, central lower and combined pattern. The "central upper pattern" is shown among those with wrinkle lines only in the upper eyelid skin down to the lateral canthus. The "central pattern" is categorized in those who exibit wrinkles only in the lateral canthal area, and the "central-lower pattern" is recognized to have wrinkling on the lower lid and upper cheek area. The "combined pattern" is defined as patients exhibiting crinkling of their lateral canthal skin from the lower lateral brow across the upper eyelid, through the lateral canthus, and across the lower eyelid, upper cheek junction with horizontal and perpendicular wrinkles crossing over. In this study, the most common pattern of the wrinkle pattern was the combined type. In thirties and fourties, central- lower pattern was more common in men. In women, the type of central and central-upper pattern showed nearly equal frequency. However, over the age of 50-year's, combined pattern was common in both sex. For maintenance of a long-lasting and natural outcome we should recognize the diversity of facial expression among indivisuals and render the treatment accordingly. This observations could also be applied to the injection technique of botulinum toxin for the facial rejuvenation.

Perineal Reconstruction with the Perineal Perforator Based Island Flap

Perineal area is composed of compact structures of urogenital organs and anus requiring a more sophisticated selection of flap and reconstruction. For achieving better outcome then conventional flap surgery, we use the perineal perforator based island flap for its reconstruction. After locating the perforator by Doppler, the flaps were designed according to the defect or expected vaginal orifice. The flaps were elevated bilaterally as island pattern. Finally defect or neovagina was reconstructed with inconspicious linear scar hidden in the inguinal crease. Five cases were performed with the perineal perforator based island flap. There were 3 cases of vulvar cancer, 1 case of transsexualism, and 1 case of ambiguous genitalia because of congenital adrenal hyperplasia. Operative results were satisfactory with good contouring and less prominent donor scar, when they were compared with other flap reconstructions such as latissimus dorsi perforator flap, groin flap, gracilis myocutaneous flap etc. The perineal perforator based island flap is highly recommended with the advantages of easy flap elevation, good rotation arc, and appropriate flap thickness for contouring. Compared with other conventional flaps, it can be selected as a good option for moderate defect of perineal area.