Proximal Variation of the Long Thoracic Nerve would be Vulnerable to Injury during an Axillary Dissection

Herein, our experience of a rare variation of the long thoracic nerve during an axillary dissection in a female patient with a breast ductal carcinoma in situ (DCIS) is reported. Her long thoracic nerve was duplicated and united at its proximal and distal parts, respectively. She was a 45-year old female, with microcalcification on her left breast, which had been diagnosed as a DCIS by a stereotactic core needle biopsy. Due to the diffuse distribution of lesions, a mastectomy was performed, with immediate reconstruction using a transverse rectus abdominis muscle (TRAM) free flap. After the mastectomy, an axillary dissection was performed for anastomoses of the free flap to the thoracodorsal vessels, at which point the duplicated variation of the proximal part of the long thoracic nerve was found. This variation is very rare, and would be vulnerable to injury during an axillary dissection. Therefore, surgeons should take care to avoid injury to such a nerve during axillary surgery.

A Case of Riedel's Thyroiditis Associated with a Benign Nodule / 대한내분비외과학회지

Riedels thyroiditis is a rare variant of thyroiditis that is characterized by replacement of the normal thyroid parenchyma by extensive fibrosis. Typically, the thyroid is diffusely involved and a painless, hard anterior neck mass shows clinical features similar to those of anaplastic thyroid carcinoma, that is, a rapidly enlarging, hard, fixed thyroid mass and symptoms such as dysphagia, dysphonia, and dyspnea. We encountered a case of Riedels thyroiditis in a 41-year-old female patient with a longstanding benign thyroid nodule for 6 years; she subsequently presented with a rapidly growing, hard, fixed, thyroid mass mimicking anaplastic thyroid cancer. The clinical features were indistinguishable from those of anaplastic transformation, but open biopsy excluded anaplastic thyroid cancer. After surgery, the final diagnosis of Riedels thyroiditis was made based on typical microscopic findings and immunohistochemical studies. We have reported this case and reviewed the related literature.

The Clinical Significance of Preoperative MRI for Determination of Surgery in Breast Cancer / 한국유방암학회지

PURPOSE: Currently MRI (Magnetic Resonance Imaging) is widely used for the preoperative staging of breast cancer. In this study, we assessed the impact of preoperative breast MRI on the surgical management of breast cancer in women. METHODS: From March 2004 to October 2006, 162 cases were enrolled for preoperative MRI for the staging of breast cancer. The MRI findings and clinicopathological results were investigated and the accuracy of breast MRI was analyzed with respect to the detection of multiplicity, nipple involvement and bilaterality of the breast cancers. RESULTS: For detecting multifocal lesions, the sensitivity and specificity of breast MRI were 100% and 48.5%, respectively, and the results of bresat ultrasound were 100% and 63.4%, respectively. For detecting nipple invasion, the sensitivity and specificity of breast MRI was 80% and 74.6%, and for ultrasound was 33.3% and 86.4%. In 27 cases (16.7%) the type of surgery was changed according to the preoperative MRI findings; however, in only 6 cases were the MRI findings in concordance with the pathological findings of the mastectomy specimen. CONCLUSION: In clinical application of breast MRI for preoperative staging, the decision to undertake surgery for breast cancer based on a MRI findings should be prudent due to its low specificity.

Diagnosis of Non-palpable Breast Lesions with Microcalcification by Upright Add-on Type Stereotactic Vacuum-assisted Biopsy / 한국유방암학회지

PURPOSE: For the accurate diagnosis of non-palpable breast lesions with microcalcification, a localization and biopsy procedure should be performed by using mammography. Recently, a stereotactic vacuum-assisted biopsy has been reported as a convenient and accurate method for a procedure. This study was performed to determine whether the upright add-on type stereotactic biopsy was suitable for the diagnosis of microcalcified breast lesions in Korean women. METHODS: Between April 2002 and March 2003, an upright add-on type stereotactic vacuum-assisted biopsy was performed in 21 cases with microcalcification; that had been categorized from 2 to 5 according to the BI-RADS (Breast Imaging Reporting and Data System). The microcalcified lesions in biopsy specimens were confirmed with tissue mammogram and a pathological review performed. RESULTS: The pathological findings revealed fibrocystic changes in 15 cases, intraductal papilloma in 1 and ductal carcinoma in situ (DCIS) in 5. There were no malignancy among the BI-RADS category 2 & 3 cases, but DCIS was found in 2 (25%) out of 8 BI-RADS category 4 cases, and in all 3 (100%) of BI-RADS category 5 cases. The malignancy detection rate among the cases with microcalcification with a BI-RADS category above 4 was 45.4% (5/11). CONCLUSION: An upright add-on type stereotactic vacuum assisted biopsy is an accurate, safe and very convenient tool for the diagnosis of breast lesions with microcalcification.

The Clinical Usefulness of 99mTc-MIBI Scintimammography in Diagnosis of Breast Cancer / 한국유방암학회지

PURPOSE: Imaging studies for the diagnosis of breast cancer such as ultrasonography or mammography, play an essential role; however, it is well known that they have some limitations; the low specificity of ultrasonography and the low sensitivity of mammography, especially in the dense breasts of Korean women. Recently, 99mTc-MIBI scintimammography was introduced for the detection of breast cancer, and showed acceptable results in its diagnostic accuracy. In this study, the clinical usefulness of 99mTc-MIBI scintimammography was evaluated for the determination of a better imaging study for the diagnosis of breast cancer. METHODS: This study included 75 patients with breast masses, and 3 imaging studies were performed; mammography, ultrasonography and 99mTc-MIBI scintimammography and the results compared on the basis of the pathological reports from core needle or excisional biopsies of the patients. RESULTS: From the pathological reports of 75 patients, 45 cases were confirmed as malignant and 30 as benign diseases. Based on the pathological reports, the sensitivities of mammography, ultrasonography and 99mTc-MIBI scintimammiography were 62.2, 88.9, and 86.7%, and the specificites of 3 imaging studies were 90.0, 76.7, and 90.3% respectively. The positive predictive values were 90.3, 85.1, and 92.9% and the negative predictive values were 61.4, 82.1, and 81.8%, respectively. 99mTc-MIBI mammoscintigraphy showed a comparable sensitivity to ultra-sonography, and a similar specificity to mammography, in the diagnosis of breast cancer. CONCLUSION: Clinically, as a primary imaging tool, 99mTc-MIBI mammoscintigraphy showed acceptable results in the diagnosis of breast cancer. Considering the weak points of ultrasonography and mammography, 99mTc-MIBI mammoscintigraphy would be a very useful tool in the diagnosis of breast cancer.

Two Cases of Endometrial Carcinoma in Tamoxifen-treated Breast Cancer Patients in Korea / 한국유방암학회지

Tamoxifen, the representative of selective estrogen receptor modulaor (SERM), has been widely used not only for the treatment of breast cancer, but also for the prevention of the disease. It is well known that some serious side-effects can infrequently occur with long-term use of tamoxifen and endometrial cancer is one of that disasters. According to NSABP B-14 data, the incidence of endometrial cancer among tamoxifen users was 0.16% and the relative risk was increased by 7.2 fold. In Korea, tamoxifen has been also used as primary endocrine therapy for the treatment of many patients with breast cancer. However, there was no formal report about the endometrial carcinoma occurred subsequently after tamoxifen administration so far. Recently, we experienced two cases of endometrial carcinoma occurred after tamoxifen treatment in breast cancer patients in Korea, and report these cases for reminding breast physicians or patients not to ignore this rare, but serious side effect of tamoxifen.

Expression of Vascular Endothelial Growth Factor Correlated with Recurrence in Gastric Carcinomas

PURPOSE: Angiogenesis is essential for tumor growth and metastasis and depends on the production of angiogenic factors that are secreted by tumor cells. Vascular endothelial growth factor (VEGF) is the most significant angiogenic factor and a selective mitogen for endothelial cells. VEGF, also known as the vascular permeability factor, acts on endothelial cells to increase microvascular permeability and directly stimulate the growth of new blood vessels. Several studies have reported that the expression of VEGF is correlated with hematogenous recurrence via angiogenesis in gastric carcinomas. This research evaluated the relationship between the expression of VEGF and hepatic and peritoneal recurrence in gastric carcinomas. MATENRIALS AND METHODS: Thirty specimens resected from patients with primary gastric carcinomas who had undergone curative resections were divided into three group: Group I, early gastric carcinomas without recurrence; Group II, advanced gastric carcinomas with hepatic recurrence; and Group III, advanced gastric carcinomas with peritoneal recurrence. The expression of VEGF and the density of the microvessel count were examined using immunohistochemistry. RESULTS: 1) The expression of VEGF in Group II and Group III (63.2+/-24.3%) was stronger than that in Group I(7+/-4.2%). The expression of VEGF in Group II (76.5+/-13.2%) was stronger than that of the Group III (50+/-14.2%) (P<0.05). 2) The microvessel count in Group II (49.9+/-14.5) was more than that in Group I (8.6+/-2.6) and Group III (29.1+/-18.1) (P<0.05). 3) The microvessel count was increased significantly with increasing the expression of VEGF. CONCLUSION: The expression of VEGF is associated with advanced stomach cancer and hepatic recurrence has a higher expression of VEGF than peritoneal recurrence with neovascularization. Thus the expression of VEGF can be considered to be a useful indicator of recurrence in gastric carcinoma and especially in hepatic recurrence.

A Clinical Analysis of 100 Cases of Gasless Endoscopic Thyroidectomy

PURPOSE: With recent developments in endoscopic surgery for thyroid tumors, several approaches have been applied to endoscopic neck surgery. Gasless endoscopic thyroidectomy has some advantages over gas insufflating surgery. We evaluated the role of gasless endoscopic thyroidectomies on various thyroid tumors including malignant thyroid tumors. METHODS: We performed thyroidectomies for a total of 195 patients who were admitted to Uijongbu St. Mary's Hospital from November 1999 to February 2002. We compared the clinical data of 100 patients who received gasless endoscopic thyroidectomies with the data of 95 patients who underwent conventional thyroidectomies. Furthermore, we subclassified the 100 patients who received a gasless endoscopic thyroidectomy into two groups, before and after the start of 2001. RESULTS: The analysis of the clinical data showed that an endoscopic thyroidectomy gave superior results with respect to the time of postoperative recovery and cosmetic results. Also, the patients in the second half group showed significantly shorter operation times reduced from 153.4 min. to 128.6 min. and length of hospital stay similarly reduced(3.55 days vs. 5.35 days). CONCLUSION: A gasless endoscopic thyroidectomy is a safe and technically feasible alternative to a conventional thyroi-dectomy in benign and early malignant tumors, and provides good cosmetic results.

A Clinical Review of 332 Cases of Total Thyroidectomy / 대한내분비외과학회지

PURPOSE: Although has become increasingly acceptable to perform total thyroidectomy for bilateral and multiple benign nodules, diffuse toxic goiter, and thyroid cancers, surgeons continue to debate whether the potential benefits outweigh the potential complications of this procedure. The aim of this study was to evaluate the safety, effectiveness and complications of total thyroidectomy for malignant and benign thyroid diseases. METHODS: The medical records from 332 patients who had undergone total thyroidectomy for malignant and benign diseases between January 1990 and December 1999 at St. Mary's Hospital and St. Vincent's Hospital were reviewed retrospectively. RESULTS: Of the 332 patients, 121 had had benign disease and 211 had had carcinomas. Female patients were predominate, being 6.4 times the number of males. The incidence rate by age peaked in the 4th decade for patients. Masses of below 2 cm in diameter were the second most common size (30.8%) and 2 to 5 cm occupied more than half (51%). Of the 211 thyroid carcinomas, histologic types were papillary in 185 patients (87.7%), follicular in 21 (10%), anaplastic in 3 (1.5%), medullary in 1 (0.5%) and lymphoma in 1 (0.5%). Of the 121 benign disease, 71 (58.7%) were benign multiple nodular goiters, 23 (19%) toxic diffuse goiter, and there were 18 cases (14.9%) of Hashimoto thyroiditis and 9 (7.4%) of adenomatous goiter. Among the 211 patients who underwent total thyroidectomy for thyroid malignancy, anterior compartment lymph node dissection was performed in 53 patients (25.1%). Modified radical neck dissection was done in 31 cases, due to suspicions of local lymph node invasion during the operation. Radical neck dissection was done in 10 cases with palpable cervical nodes. The most common complication was early postoperative hypocalcemia 108 (32.5%), most of which was transient and sixty-three percent of which was symptomatic. It usually persisted less than 7 days, and the difference in incidence of post-operative hypocalcemia between benign disease and malignancy was not significant. The other complications were hoarseness (13%), bleeding (3%) and the recurrent laryngeal nerve injury (1.5%). CONCLUSION: Total thyroidectomy can be performed without additional risk compared with subtotal thyroidectomy for bilateral benign and malignant thyroid diseases, if done meticulously.

Chest Wall Muscle Changes after a Mastectomy: Findings of Chest CT

BACKGROUND: Chest CT after a mastectomy in breast cancer patients is usually performed to detect recurrence or metastasis. It is essential for surgeons and radiologists to know the appearance of the chest wall in a postmastectomy state. Especially, muscle atrophies of the chest wall, such as that of the pectoralis major muscle, indicate whether modified radical mastectomy (MRM) was properly performed or not. METHODS: We performed a retrospective analysis of chest wall changes in mastectomy patients with follow-up chest CT findings to evaluate the results of MRMs. The medical records and CT findings of chest wall atrophy for a total 38 patients who were treated at Kangnam St. Mary's Hospital, the Catholic University of Korea, were reviewed. The mean age was 58.3 yeras, and the interval between operation and follow-up CT was 6.6 years. The operations performed were a radical mastectomy (RM) in 3 patients and a MRM in 35 patients: Patey in 28 patients, Auchincloss in 6 patients, and Scanlon in 1 patient. RESULTS: In the RM, muslce atrophies were noted at the m. subscapularis in 3 patients (100 %), the m. serratus anterior in 2 patients (66.7%) and the m. lattisimus dorsi in 1 patient (33.3%). In MRM, the Patey and Auchincloss operations showed m. pectoralis major atrophies in 22 patients (78.8%) and 5 patients (83.3%) respectively. Additionally m. pectoralis minor atrophy was noted in all 6 patients (100%) who underwent the Auchincloss operation. However, there was no muscle atrophy in patients who received scanlon operation. CONCLUSIONS: These results suggests that lateral pectoral nerve injury is the main cause of m. pectoralis major atrophy in MRM. The scanlon operation which preserves the nerve by dividing of pectoralis minor m. at its origin is a suitable operation for chest-wall muscle preservation. We hope that by the future study, we can confirm the best way of preventing chest-wall muscle atrophy in MRMs.

Chest Well Muscle Changes after A Mestectomy Findings of Chest CT / 한국유방암학회지

BACKGROUND: Chest CT after a mastectomy in breast cancer patients is usually performed to detect recurrence or metastasis. It is essential for surgeons an radiologists to know the appearance of the chest wall in a postmastectomy state. Especially, muscle atrophies of the chest wall, such as that of the pectoralis major muscle, indicate whether the modified radical mastectomy (MRM) was properly performed or not. MATERIALS AND METHODS: We performed a retrospective analysis of chest wall changes in mastectomy patients with follow-up chest CT finding to evaluate the results of MRMs. The medical records and CT findings of chest wall atrophy for a total of 38 patients who were treated at Kangnam St. Mary's Hospital, the Catholic University of Korea, were reviewed. The mean age was 58.3 years, and the interval between operation and follow-up CT was 6.6 years. The operations performed were a radical mastectomy (RM) in 3 patients and a MRM in 35 patients: Petey in 28 patients, Auchincloss in 6 patients, and Scanlon in 1 patient. RESULTS: In the RM, muscle atrophies were noted at the m, subscapularis in 3 patients (100%), the m. serratus anterior in 2 patients (66.7%), and the m. lattisimus dorsi in 1 patient (33.3%). In MRM, the Patey and Auchincloss operations showed m. pectoralis major atrophies in 22 patients (78.8%) and 5 patients (83.3%) respectively. Additionally m. pectoralis minor atrophy was noted in all 6 patients (100%) who underwent the Auchincloss operation. However. there was no muscle atrophy in patients who received Scanlon operation. CONCLUSIONS: These results suggest that lateral pectoral nerve injury is the main cause of m. pectoralis major atrophy in a MRM. The Scanlon operation which preserves the serve by dividing the pectoralis minor m. at its origin is a suitable operation for chest-wall muscle preservation. We hope that by the future study, we can confirm the best way of preventing chest-wall muscle atrophy in MRMs.

The Expression of c-erbB-2 and CD44 Gene in Breast Cancer / 대한암학회지

PURPOSE: There are some controversial opinions on the prognostic value of metastasis- associated tumor markers in breast cancer. Out of them, the overexpression of c-erbB-2 proto-oncogene or CD44 gene has been debated on their activities in promoting metastatic potential. MATERIALS AND METHODS: To detennine the relationship between expression of these genes, and, clinicopathological parameters and disease outcomes including relapse and survival, 48 archival paraffin-embeded breast-cancer tissues were stained using monoclonal antibody against each gene product by immunohistochemical staining method, and the result was analyzed. RESULTS: The positive expression rates of c-erbB-2 and CD44 genes were 45.8% and 18.8%, respectively. The expression rates of both genes were 14.6% and 50% of cases showed no expression of either gene. Except the statistically significant positive correlation between CD44 and tumor size (P=0.003), the expression of c-erbB-2 or CD44 expression had no significant relationship with tumor size, stage, lymph node status, and disease recurrence (P>0.05). In the positive expression cases for CD44, disesase-free survival (DFS) and overall survival (OS) in months were shorter than the negative ones (53+/- 8 vs. 64+/-5 and 67+/-8 vs. 77+/-5 S.E.). And, the c-erbB-2 positive cases had longer OS than the negative ones (78+/- 6 vs. 71+/- 6). The OS of positive co-expression cases with the c-erbB-2 and CD44 was shorter than that of one-gene expression ones (66+/- 6 vs. 75+/-7). Thus the OS result observed in the expression of c-erbB-2 alone was reversed in the co-expression study. Though these results had no statistically significant level (P> 0.05). CONCLUSION: We suggest a question if there is any interaction or dependency between c-erbB-2 and CD44 expression in view of disease process including OS. Finally, further randomised controlled studies are advisable for the reproducible and significant results.

The Expression of c-erbB-2 and CD44 Gene in Breast Cancer / 한국유방암학회지

There are some controversial opinions on the prognostic value of metastasis-associated tumor markers in breast cancer. Out of them, the overexpression of c-erbB-2 proto-oncogene or CD44 gene has been debated on their activities in promoting metastatic potential. To determine the relationship between expression of both genes, and, clinicopathological parameters and disease outcomes including relapse and survival, 48 archival paraffin-embedded breast-cancer tissues were stained using monoclonal antibody against each gene product by immunohistochemical staining method, and the result was analyzed. The positive expression rates of c-erbB-2 and CD44 genes were 45.8% and 18.8%, respectively. The co-expression rates of both positives and both negatives were 14.6% and 50.0%, respectively. Except the statistically significant positive correlation between CD44 and tumor size (P=0.003), the expression rates of c-erbB-2 and CD44 had no significant relationship with tumor size, stge, lymph node status, and disease recurrence (p>0.05). In the positive expression cases for CD44, disease-free survival (DFS) and overall survival (OS) in months were shorter than the negative ones (53+/-8 vs. 64+/-5 and 67+/-8 vs. 77+/-5 S.E.) And, the c-erbB-2 positive cases had longer OS than the negative ones (78+/-6 vs. 71+/-6). The OS of positive co-expression cases with the c-erbB-2 and CD44 was shorter than that of one-gene expression ones (66+/-6 vs. 75+/-7). So the OS result observed in the expression of c-erbB-2 alone was reversed in the co-expression study. Though these results had no statistically significant level (p>0.05), we suggest a question that if there is any interaction or dependency between c-erbB-2 and CD44 expression in a view of disease process including OS. Finally, further randomized controlled studies are advisable for the reproducible and significant results.

Combined Chemoradiation of Advanced Pancreatic Cancer / 대한암학회지

PURPOSE: This study was designed to evaluate the survival rate and prognostic factor of patients with advanced pancreatic cancer who received chemoirradiation. MATERIAL AND METHODS: From March 1993 to November 1995, twenty patients with unresectable pancreatic cancer were treated at the Department of Therapeutic Radiology, St Mary's Hospital, Catholic University Medical College. There were 11 men and 9 women. Age at diagnosis ranged from 34 to 75 years. All patient were treated according to a protocol consisting of 40 Gy external radiation by split course concomitant with intravenous 5-fluorouracil (5-FU) 500 mg/m2 given in a bolus injection 4 hours before radiatian on each of the first 3 days of each treatment course. Among them, 5 patients received incomplete radiotherapy. The follow-up period ranged from 1.3 to 29 months. RESULTS: In all the patients, median survival is 5.0 months and one and two-year overall survival rate was 34.3% and 25.8%, respectively. Median survival was 9.0 months and one-year survival rate was 33.3% in 15 patients with complete radiotherapy. The significant prognostic factors were stage, tumor location, and completion of chemoradio- therapy(p < 0.05). CONCLUSION: A combination of radiotherapy and chemotherapy resulted in improved median survival. However, the significant prognostic factars affecting survival rate in this analysis need to be verified further through randomized trial.

Non-surgical Treatment for Osmidrosis Axillae by Electrocoagulation of Sweat Glandular Layer

Osmidrosis is a symptom of foul odor at the axillae due to bacterial decomposition in apocrine sweat gland. It usually developed at puberty or adolescence and cause ruined clothing and negative social life. Complete removal of sweat gland from axillae is an essential of treatment. Various methods of surgical treatment were applied for osmidrosis axillae but nobody can easily obtain perfect result and escape from many surgical complications such as bleeding, skin necrosis, scar contraction and recurrence 4).Recently author tried new non-surgical method for removal of sweat gland with excellent results, and introduce it with literature.

Serial clinical analysis and survival rate of 900 patients treated for malignant gastric tumor

No abstract available.

A computer program for retrieving the Journal of the Korean Surgical Society

No abstract available.

Synchronous gastric cancer and adrenocortical carcinoma

No abstract available.

Bilateral breast carcinoma / 대한암학회지

No abstract available.