Clinical Significance of Rotter's Nodes in Patients with Breast Carcinomas

PURPOSE: Rotter's nodes are removed in the course of a radical mastectomy, however they are not routinely removed in a modified radical mastectomy and breast conserving surgery, although they can be. Having been relatively ignored, the prognostic value and correlation of Rotter's nodes with axillary nodal status have rarely been reported or systematically studied. The aims of the present study were to assess the frequency and pattern of Rotter's node metastasis in breast cancer patients, and to compare the incidence of axillary lymph node metastasis and Rotter's node. We also investigated the rate of skip metastasis. METHODS: In order to investigate the predictability of axillary node positivity, we compared the status of axillary lymph nodes and the pathological prognostic markers. In 580 consecutive mastectomies performed for breast carcinomas between 1987 and 1999, axillary and Rotter's nodes were routinely dissected and separately sampled during mastectomy. RESULTS: The mean number of axillary lymph nodes and Rotter's nodes were 19.5 and 0.9. Axillary lymph nodes metastases were found in 47.2% of all patients. The frequency of axillary lymph node metastasis and the involvement of a higher level of axillary lymph node were significantly increased with increasing tumor size. However, metastasis at Rotter's nodes did not follow this pattern. Rotter's nodes were anatomically present in 39.8% of patients and an average of 2.3 lymph nodes was found in the interpectoral region. Rotter's metastases were found in 5% of all patients, and 10.6% of those with axillary lymph node metastases. The number of Rotter's nodes metastases was higher as the metastases were found at a higher level (p<0.05). CONCLUSION: The presence of axillary metastases was related to histologic grade, nuclear grade and lymphovascular invasion, but was not related to the mitotic index or perineural invasion. It is apparent that the potential risks from Rotter's and skip metastases were not great in all patients, although the routine excision of Rotter's nodes should be applied to patients with more locally advanced disease (T2-3, N1-N2).

Clinical Significance of Rotter's Nodes in Patients with Breast Carcinomas / 한국유방암학회지

PURPOSE: Rotter's nodes are removed in the course of a radical mastectomy, however they are not routinely removed in a modified radical mastectomy and breast conserving surgery, although they can be. Having been relatively ignored, the prognostic value and correlation of Rotter's nodes with axillary nodal status have rarely been reported or systematically studied. The aims of the present study were to assess the frequency and pattern of Rotter's node metastasis in breast cancer patients, and to compare the incidence of axillary lymph node metastasis and Rotter's node. We also investigated the rate of skip metastasis. METHODS: In order to investigate the predictability of axillary node positivity, we compared the status of axillary lymph nodes and the pathological prognostic markers. In 580 consecutive mastectomies performed for breast carcinomas between 1987 and 1999, axillary and Rotter's nodes were routinely dissected and separately sampled during mastectomy. RESULTS: The mean number of axillary lymph nodes and Rotter's nodes were 19.5 and 0.9. Axillary lymph nodes metastases were found in 47.2% of all patients. The frequency of axillary lymph node metastasis and the involvement of a higher level of axillary lymph node were significantly increased with increasing tumor size. However, metastasis at Rotter's nodes did not follow this pattern. Rotter's nodes were anatomically present in 39.8% of patients and an average of 2.3 lymph nodes was found in the interpectoral region. Rotter's metastases were found in 5% of all patients, and 10.6% of those with axillary lymph node metastases. The number of Rotter's nodes metastases was higher as the metastases were found at a higher level (p<0.05). CONCLUSION:The presence of axillary metastases was related to histologic grade, nuclear grade and lymphovascular invasion, but was not related to the mitotic index or perineural invasion. It is apparent that the potential risks from Rotter's and skip metastases were not great in all patients, although the routine excision of Rotter's nodes should be applied to patients with more locally advanced disease (T2-3, N1-N2).

Value of Dynamic MR Imaging in the Detection of Pituitary Microadenoma

PURPOSE: To determine whether dynamic or conventional MR imaging is most useful for the detection of pituitary microadenoma. MATERIALS AND METHODS: The study involved 20 patients (M:F=1:19, mean age=37 years) in whom a pituitary microadenoma had been identified. Routine unenhanced coronal T1-weighted MR imaging was followed by dynamic imaging (repetition time/echo time/excitation=200/10/1, 3-mm-thick sections, 256X128 or 256 ma-trix,14X14-cm field of view, scan time=30 or 60 seconds, spin-echo pulse sequence), and contrast-enhanced coronal T1-weighted imaging was then immediately performed. Temporal changes in signal intensity were quantified with manually placed ROIs (regions of interest, circular, 3 mm 2), and tissue contrast between the pituitary gland and microadenoma was calculated. Conspicuity of the tumor margin was graded by three radiologists working independently as either 4 (excellent clear margin), 3 (good clear margin), 2 (relatively clear mar-gin), or 1 (unclear margin). RESULTS: Average peak enhancement of the pituitary gland and microadenoma occurred at 58.5 and 91.5 seconds, respectively. Maximum enhancement of the pituitary gland occurred within 30 to 60 seconds of contrast infusion (signal intensity range: 426-442), but during dynamic MR imaging, the microadenoma showed rela-tively constant enhancement (signal intensity range: 230 -250). Maximal contrast between normal pituitary gland and the microadenoma was seen at 60 seconds or in the first three sequential images. Dynamic MR images were superior to conventional T1-weighted images, with or without contrast infusion, not only in terms of tissue contrast between the pituitary gland and the microadenoma (p=0.0048), but also as regards tumor margin conspicuity (p=0.0035). CONCLUSION: Dynamic MR imaging is a useful technique in the detection of pituitary microadenoma.

Association between Telomerase Activity, Cell Cycle Regulators, and Histopathological Prognostic Parameters in Breast Cancer

PURPOSE: Telomerase is a ribonucleoprotein enzyme that synthesizes telomeric DNA onto the ends of chromosomes, thereby preventing the replication-dependent shortening of those ends. This enzyme is essential for stability of eukaryotic chromosomes and may be necessary for cell immortalization. Telomerase activity is detected in a wide range of cancers of various tissues, and its expression may be a critical step in tumor progression. METHODS: The telomerase activity was measured using a telomeric repeat amplification protocol (TRAP) assay in 65 cases of breast cancers, 9 cases of fibroadenomas, and 7 cases of normal breast tissues. To compare the telomerase activity with cell cycle regulators, we measured the expression of the cyclin D1 and the p53 proteins by using immunohistochemical analysis. To compare the telomerase activity with traditional prognostic indicators, we measured the ER, PR, c-erbB-2 and ki-67 expression by using immunohistochemical analysis. Disease-free survival and overall survival in relation to telomerase activity were studied by using the Kaplan-Meier method. RESULTS: Telomerase activity was detected in 42 (64.6%) of the 65 breast cancers, 4 (44.4%) of the 9 fibroadenomas, and in none of the 7 normal breast tissues. There was no significant relationship between telomerase activity and cell cycle regulators such as cyclin D1 or p53. There was no statistical correlation between telomerase activity and tumor size, lymph nodal status, or histopathological prognostic parameters, such as ER, PR, p53, c-erbB-2 and ki-67, but a significant correlation was found (p=0.006) between telomerase activity and histologic grade. The telomerase activity was not significantly correlated with either the overall survival or the disease-free survival. CONCLUSION: These results suggest that telomerasemay play a role in the malignant transformation of breast tissue and that this enzyme was more activated in cancers of a poor histologic grade. However, the telomerase activity was not related to cell cycle regulators and traditional prognostic parameters. The possible significance of telomerase activity in breast cancer remains open to further investigation.

Clinical Significance of Rotter's Nodes in Patients with Breast Carcinomas / 한국유방암학회지

PURPOSE: Surgical axillary dissection to determine the status of nodes remains as a part of the standard operation in the management of breast cancer. Rotter's nodes are removed in the course of a radical mastectomy but they are not routinely removed in a modified radical mastectomy and breast conserving surgery, although they can be. Having been relatively ignored, the prognostic value and correlation of Rotter's nodes with axillary nodal status have been rarely reported or systematically studied. The aim of the present study was to access the frequency and pattern of Rotter's node metastasis in breast cancer patients, and compare the incidence of axillary lymph node metastasis and Rotter's node. We also investigated the rate of skip metastasis. MATERIALS AND METHODS: To investigate the predicting axillary node positivity, we compared the status of axillary lymph node and pathological prognostic markers. In 580 consecutive mastectomy performed for breast carcinomas between 1987 to 1999, axillary and Rotter's node were routinely dissected and separately sampled during mastectomy . RESULTS: The mean number of axillary lymph node and Rotter's nodes were 19.5 and 0.9. Axillary lymph nodes metastases were found in 47.2% of all patients. Frequency of axillary lymph node metastasis and involvement of higher level of axillary lymph node were significantly increased by increasing tumor size. But metastasis at Rotter's nodes was not following this pattern. Rotter's nodes were anatomically present in 39.8% of patients and average 2.3 lymph nodes were found in the interpectoral region. Rotter's metastases were found in 5% of all patients, and 10.6% of those with axillary lymph nodes metastases. Number of Rotter's nodes metastases were higher as the metastases were found to higher level(P<0.05). CONCLUSION: The presence of axillary metastases were related to histologic grade, nuclear grade and lymphovascular invasion, but not related to mitotic index and perineural invasion. In summary, number of axillary lymph node and metastatic rate of axillary lymph nodes were similar to western reports. It is apparent that potential risk from Rotter's and skip metastases were not great in all patients, but routine excision of Rotter's nodes should be applied to patients with more locally advanced disease.

Recurrent Pyogenic Cholangitis: Efficacy of Two-Phase Helical CT

PURPOSE: To evaluate the usefulness of two-phase helical CT in patients with recurrent pyogenic cholangitis (RPC) for the detection of acute inflammation and assessment of the degree of portal vein (PV) stenosis as a cause of hepatic parenchymal atrophy. MATERIALS AND METHODS: We retrospectively reviewed two-phase CT findings in 30 patients with RPC diagnosed by CT, ERCP (endoscopic retrograde cholangiopancreatography), and surgery. Two-phase helical CT scans were obtained 30 sec (arterial phase, AP) and 70 sec (portal phase, PP) after the start of IV administration of contrast material. Without prior information, we analyzed periductal parenchymal and ductal wall enhancement during the AP and PP, and the degree of PV stenosis during the PP. Acute inflammation was diagnosed on the basis of symptoms and laboratory findings. To evaluate the relationship between parenchymal atrophy and PV stenosis, the degree of PV stenosis in affected parenchyma was classified as one of three types (mild,75%), as compared with the diameter of normal PV in unaffected parenchyma. RESULTS: Ten of the 30 patients underwent CT during the acute inflammatory stage and 20 during the remission stage. Of the ten patients with acute inflammation, eight (80%) showed transient periductal parenchymal enhancement during the AP (p0.05). There was no significant difference in parenchymal and ductal wall enhancement during the PP between patients with acute inflammation and those who showed remission (p>0.05). Hepatic parenchymal atrophy of the lesion was seen in 24 patients. Among these, PV stenosis was mild in five (21%), moderate in 14 (58%), and severe in five (21%). Degree of PV stenosis correlated closely with severity of parenchymal atrophy during the PP. In six patients without parenchymal atrophy, PV caliber was normal. CONCLUSION: Our results suggest that in patients with RPC, two-phase helical CT is useful for the detection of transient periductal parenchymal enhancement accompanying acute inflammation during the AP, and for assessment of the degree of PV stenosis as a cause of hepatic parenchymal atrophy during the PP.

Gastric Stromal Tumor: Two-Phase Dynamic CT Findings with Water as Oral Contrast Agents

PURPOSE: To evaluate two-phase dynamic CT with water as oral contrast agents in the CT diagnosis of gastric stromal tumors. MATERIALS AND METHODS: We retrospectively reviewed the CT findings in 21 patients with pathologically proven gastric stromal tumors. Six were found to be benign, twelve were malignant, and there were three cases of STUMP (stromal tumor uncertain malignant potential). Two-phase dynamic CT scans with water as oral contrast agents were obtained 60-70secs (portal phase) and 3 mins (equilibrium phase) after the start of IV contrast administration. We determined the size, growth pattern, and enhancement pattern of the tumors and overlying mucosa, the presence or absence of ulceration and necrosis, tumor extent, and lymph node and distant metastasis. The CT and pathologic findings were correlated. RESULTS: All six benign tumors and three STUMP were less than 5.5 cm in size, and during the portal phase showed round endogastric masses with highly enhanced, intact overlying mucosa. Twelve malignant tumors were 4.5-15.5 cm in size (mean, 11.5cm); an endogastric mass was seen in three cases, an exogastric mass in one, and a mixed pattern in eight. On portal phase images the tumors were not significantly enhanced, but highly enhanced feeding vessels were noted in five larger tumors (> 10 cm). All 12 malignant tumors showed ulceration and necrosis, and interruption of overlying mucosa was clearly seen during the portal phase. We were readily able to evaluate tumor extent during this phase, and in ten malignant tumors there was no invasion of adjacent organs. Seven malignant tumors showed air density within their necrotic portion (p<0.05). On equilibrium phase images, all malignant tumors showed heterogeneous enhancement due to necrosis, and poorly enhanced overlying mucosa. CONCLUSION: Dynamic CT during the portal phase with water as oral contrast agents was useful for depicting the submucosal origin of gastric stromal tumors and for evaluating the extent of malignant stromal tumors. Our results suggest that these CT findings may be helpful for differentiating between benign and malignant stromal tumors, and in distinguishing them from other gastric tumors.

Radiographic Findings of Primary Lung Cancer with Delayed Detection on Chest Radiographs

PURPOSE: To analyze the causes of delayed detection of lung cancer on chest radiographs. MATERIALS AND METHODS: We retrospectively reviewed 105 cases in which an initial diagnosis of lung cancer, based on anexamination of plain radiographs, had been missed or misinterpreted. All occurred between October 1993 and April1997. We reviewed the initial chest radiographs and compared the features noted with those seen on later chestradiographs and computed tomographic (CT) images. RESULTS: Undetected lung cancer was identified in 56 patients(56/105, 53.3%) It had been hidden by superim-posed structures (41, 73.2%), overlapped by combined benign diseases(12, 21.4%), or the nodules were subtle(3, 5.4%). Of the 41 lung cancers hidden by a superimposed structure, thecentral type accounted for 29 (70.7%) and the peripheral type for 12 (29.3%). The 29 central type had been hiddenby the left hilum (n=15), the right hilum (n=10), the heart (n=3), or a rib (n=1). The twelve peripheral type werehidden by a rib (n=7), the heart (n=2), the diaphragm (n=2), or the left hilum (n=1). Of the 12 lung cancersoverlapped by combined benign diseases, pulmonary tuberculosis (n=6), pleural effusion (n=4), congestive heartfailure (n=1), and dif-fuse interstitial lung disease (n=1) were present at the time of interpretation. Themisinterpreted lung cancers were identified in 49 patients (49/105, 46.7%) and were seen to be combined withbenign disease (16, 32.6%), or as obstructive pneumonia without a central mass (15, 30.6%), air-spaceconsolidation (7, 14.3%), cavity (7, 14.3%), double lesion (2, 4.1%), or young age below 26 years (2, 4.1%). Ofthe 16 lung cancers misinterpreted as combined disease, pulmonary tuberculosis (n=14) and pleural disease (n=2)had been initially diagnosed. CONCLUSION: Most commonly, lung cancer was missed or misinterpreted because it washidden by a normal structure or combined with a benign disease. Perceptual errors can be reduced by appropriatetechniques and the scrutiny of trouble spots such as the parahilar, retrocardiac, retrodiaphragmatic and costalregions. Errors in the analysis of lung cancer can be reduced by increased awareness of growth patterns anduncommon man-ifestations of the disease.

Lumbar Disc Herniation at High Levels: MRI and Clinical Findings

PURPOSE: To assess the frequency, location, associated MR findings, and clinical symptoms of the high levellumbar disc herniation(HLDH). MATERIALS AND METHODS: A total of 1076 patients with lumbar disc herniation wereretrospectively reviewed. MR images of 41 of these with HLDH(T12-L1, L1-2, L2-3) were analysed in terms offrequency, location, and associated MR findings, and correlated with clinical symptoms of HLDH. RESULTS: Theprevalence of HLDH was 3.8%(41/1076). HLDH was located at T12-L1 level in four patients(10%), at L1-2 level in14(34%), at L2-3 level in 21(51%), and at both L1-2 and L2-3 levels in two. The age of patients ranged from 20 to72 years (mean, 44), and there were 26 men and 16 women. In 11(27%), whose mean age was 32 years, isolated discherniation was limited to these high lumbar segments. The remaining 30 patients had HLDH associated with variableinvolvement of the lower lumbar segments. Associated lesions were as follow : lower level disc herniation(14patients, 34%); apophyseal ring fracture(8 patients, 19%); Schmorl's node and spondylolisthesis (each 6patients, each 14%); spondylolysis(3 patients, 7%); and retrolisthesis(2 patients, 5%). In 20 patients(49%) withHLDH(n=41), there was a previous history. CONCLUSION: Patients with HLDH showed a relatively high incidence ofassociated coexisting abnormalities such as lower lumbar disc herniation, apophyseal ring fracture, Schmorl'snode, spondylolysis, and retrolisthesis. In about half of all patients with HLDH there was a previous history oftrauma. The mean age of patients with isolated HLDH was lower; clinical symptoms of the condition were relativelynonspecific and their incidence was low.

Sequential bronchoscopic findings of endobronchial tuberculosis / 결핵

No abstract available.

A study of lung cancers without demonstrable mass lesions on simple chest X-rays / 결핵

No abstract available.

The role of cyclooxygenase metabolities in the pathogeneticmechanism of endotoxin-induced acute lung injury in domestic pigs / 결핵

No abstract available.

The changes of serum angiotensin converting enzyme activity in lung cancer patients / 결핵

No abstract available.

The role of reactive oxygen free radical in the pathogenetic mechan- ism of endotoxin-induced acute lung injury in domestic pigs / 결핵

No abstract available.

The changes of arterial oxygen saturation during sleep in chronic obstructive pulmonary disease patients / 결핵

No abstract available.