Primary leiomyosarcoma of gallbladder / 대한외과학회지

Malignant mesenchymalneoplasms of the gallbladder are extremely rare with only 105 cases of primary gallbladder sarcoma having been described. It has a very aggressive behavior and is usually diagnosed at advanced stages. Therefore, curative surgical management may not be possible. We performed a radical cholecystectomy (S4b + S5 segmentectomy), omentectomy and small bowel resection in a 54-year-old patient with locally invasive leiomyosarcoma of the gallbladder. Further studies are needed to confirm the benefit of aggressive treatment for patients with leiomyosarcoma of the gallbladder.

Clinicopathological Characteristics in Invasive Ductal Breast Cancer with Low FDG Uptake in (18)F-FDG PET/CT / 한국유방암학회지

PURPOSE: The aim of this study is to evaluate whether low FDG uptake would be associated with the biological low-aggressiveness of invasive ductal carcinoma. METHODS: The subjects consisted of 124 female patients with primary invasive ductal carcinoma. All the patients were examined with (18)F-FDG PET/CT before neoadjuvant chemotherapy. RESULTS: With regard to histopathologic grading, 117 were histopathologic grade 1 and 2, and 7 were grade 3. Low FDG uptake correlated with well and moderate histopathologic grade (p=0.003) and low (18)F-FDG uptake in invasive ductal carcinoma depended on the presence of axillary lymph node metastases (p=0.014) and small tumor (<2.0 cm, p=0.022). Ki-67 positivity ranged from 0% to 60% (mean 15%). Sixty seven specimens showed low immunoreactivity to Ki-67 antigen (<10% of tumor cells). This revealed a significant correlation between low FDG uptake and Ki-67 (p=0.003). Logistic regression analysis between these factors showed that lower histologic grade, no axillary lymph nodes metastases and low Ki-67 (<10%) were correlated with low FDG uptake. CONCLUSION: Our results demonstrated that an association exists between low FDG uptake and good prognostic factors such as lower histologic grade (1, 2), no axillary lymph node metastases and low Ki-67 (<10%).

Clinicopathological Characteristics in Invasive Ductal Breast Cancer with Low FDG Uptake in (18)F-FDG PET/CT / 한국유방암학회지

PURPOSE: The aim of this study is to evaluate whether low FDG uptake would be associated with the biological low-aggressiveness of invasive ductal carcinoma. METHODS: The subjects consisted of 124 female patients with primary invasive ductal carcinoma. All the patients were examined with (18)F-FDG PET/CT before neoadjuvant chemotherapy. RESULTS: With regard to histopathologic grading, 117 were histopathologic grade 1 and 2, and 7 were grade 3. Low FDG uptake correlated with well and moderate histopathologic grade (p=0.003) and low (18)F-FDG uptake in invasive ductal carcinoma depended on the presence of axillary lymph node metastases (p=0.014) and small tumor (<2.0 cm, p=0.022). Ki-67 positivity ranged from 0% to 60% (mean 15%). Sixty seven specimens showed low immunoreactivity to Ki-67 antigen (<10% of tumor cells). This revealed a significant correlation between low FDG uptake and Ki-67 (p=0.003). Logistic regression analysis between these factors showed that lower histologic grade, no axillary lymph nodes metastases and low Ki-67 (<10%) were correlated with low FDG uptake. CONCLUSION: Our results demonstrated that an association exists between low FDG uptake and good prognostic factors such as lower histologic grade (1, 2), no axillary lymph node metastases and low Ki-67 (<10%).

The Multidrug Resistance-related Protein and P-glycoprotein Expressions, and the Washout Rates of 99mTc-MIBI in Infiltrating Ductal Carcinoma of Breast, Correlation with the Response After Neoadjuvant Chemotherapy / 한국유방암학회지

PURPOSE: Numerous non-invasive imaging methods for evaluating the chemotherapy response of breast cancer patients are currently being explored. The aim of present study was to investigate whether the washout rates (WRs) of 99mTc-MIBI could predict the response to chemotherapy in patients suffering with infiltrating ductal carcinoma using the expressions of multidrug resistance-related protein (MRP) and P-glycoprotein (Pgp). METHODS: From May 2002 and March 2004, the patients were randomly and consecutively selected according to the results of immunohistochemical analyses of breast carcinoma specimens before the administration of neoadjuvant chemotherapy. A total 45 infiltrating ductal carcinomas in 45 female patients were selected and they were separated into three groups: group A consisted of tumors with both negative Pgp and MRP expressions (n=15); group B consisted of the tumors that were positive for either a Pgp expression or a MRP expression (n=15); group C consisted of the tumors that were positive for both Pgp and MRP expressions (n=15). All the patients were referred for double phase 99mTc-MIBI mammoscintigraphy after the injection of 925 MBq of 99mTc-MIBI to calculate the WR. The tumor response was evaluated after completion of neoadjuvant chemotherapy. The tumor response was classified as a complete or partial response (the responder group) and stable or progression (the non-responder group). All the patients underwent surgery. RESULTS: The response rate of group C was lower than that of the other groups, but the difference was not statistically significant (p=0.283). The WR of non-responder group was lower than that of the responder group, although the difference was not statistically significant (p=0.674). The washout rates of group C was the highest than other groups and the difference was statistically significant (p=0.001). CONCLUSION: In conclusion, the WR of 99mTc-MIBI is helpful for in vivo determination of both the Pgp and MRP expressions for infiltrating ductal carcinoma of the breast.

Genomic DNA Aberration Profiles in Paraffin-Embedded Breast Tumor Using Array-CGH on c-erbB-2 Overexpression

PURPOSE: Array-CGH is the technique for detecting multiple chromosomal abnormalities in the genomic DNA with using a single procedure. Compared with conventional CGH, there are many advantages for array-CGH such as high resolution, simplified image analysis and high throughput, and its oligo-strategy allows a genome based design. We analyzed the gene aberrations in breast cancer patient to discover the other genomic aberrations that are associated with c-erbB-2 amplification. METHODS: 10 cases of breast cancer patients, considering its c-erbB-2 status of the paraffin embedded tissues, were analyzed with performing array-CGH. RESULTS: The repeated aberrations in whole cases were found in 78 loci, of which repeatedly gained in 1p36.33, 19p13.13, and lost in 14q32.33, 4q32.3, 10p15.3, 14q21.1. The unsupervised dendrogram couldn't show significant classifier for its limited case number. Each tissue from one bilateral breast cancer patient showed a different aberration pattern. There were no BRCA1, 2 aberrations in this study. The concordance was 100% between the IHC and the a-CGH. By the supervised clustering on the c-erbB-2 factor, 18 aberrations (gained in 17q12-21.1, 17q12, 17q21.1, 17q11.2 and lost in 22q11.1, 15q11.2) were found in c-erbB-2 (+) group with the permutation t-test. The repeated aberrations of c-erbB-2 (+) group were found in 170 loci, of which repeatedly gained in 17q12, 17q21.1 and lost in 14q32.33, 22q11.1. CONCLUSION: Although the number of cases was small, performing a-CGH with paraffin embedded breast cancer tissue was a useful technique for rapidly identifying DNA aberrations with high throughput, and this technique showed significant aberrations for some clinical variables.

Multicentricity of Papillary Thyroid Carcinoma in Contralateral Lobe: A comparison of preoperative ultrasonographic findings with those of postoperative histopathologic examination

PURPOSE: Total thyroidectomy can be recommended for patients with bilateral thyroid cancer. Sometimes, it is difficult to preoperatively detect multicentric foci in the contralateral lobe. The aim of this retrospective study is to determine the incidence of multicentricity in the contralateral lobe of papillary thyroid carcinoma (PTC) and to evaluate the diagnostic value of preoperative ultrasonography for multicentricity. METHODS: From January 1997 to December 2001, 93 patients with PTC underwent ultrasonography before total thyroidectomy. Ultrasonographic findings of multicentric foci in contralateral lobes were compared with histopathologic examination. RESULTS: Forty-four (47.3%) of the 93 patients were presumed bilateral PTC ultrasonographically, but 24 (25.8%) were confirmed histopathologically to have multicentricity in the contralateral lobes. Sensitivity and specificity of ultrasonography were 79.2% and 63.8%, respectively. False positive was 26.9%, consisting of 11 patients with benign diseases, 10 with normal glands, and 4 with intrathyroidal extension of PTC. False negative was 5.4%, which were all microcarcinoma with mean size of 0.3 cm. Ultrasonographic accuracy was 72.0%, but this was decreased to 35.3% in the cases of PTC combined with benign diseases. Clinical factors, except extrathyroidal invasion of PTC, were not related to multicentricity. CONCLUSION: Preoperative ultrasonography in PTC patients has a limited diagnostic value for multicentric foci within contralateral lobes, due to the technical variation of ultrasonography, combined benign diseases and diagnostic inaccuracy for micronodules.

Histologic Study on Reperfusion Liver after the Revascularization through the Portal Vein or Hepatic Artery Following Heterotopic Partial Liver Transplantation in Rats

PURPOSE: The technique of partial liver transplantation from a living donor was developed to expand the donor pool. However such small grafts may not only be functionally inadequate for the recipient, but will also sustain injury characterized by cholestasis and histological features of ischemia after implantation. Damage to partial liver grafts after reperfusion is frequently observed but the mechanism of injury remains unclear. Injury to partial liver grafts may be related to changes in portal blood flow. In this study, we investigated the histologic changes of the reperfusion of livers after revascularization through the portal vein or hepatic artery following heterotopic partial liver transplantation in rats. METHODS: Inbred Lewis partial liver were transplanted to inbred Brown Norway rats heterotopically in three groups. The first group of transplants, Group I (Portal vein group, n=3) was reperfused firstly through the portal vein. The second group, Group II (Hepatic artery group, n=3) was firstly reperfused through the hepatic artery. The third group, Group III (Control, n=1) was sham-operated. After reperfusion, the liver grafts were procured and fixed in formalin. The reperfusion livers were studied using immunohistochemical staining and in-situ RT PCR. RESULTS: In the H&E staining of the reperfusion livers there were no differences between groups I and II. Using immunohistochemical staining of TNF,R, FAS L, caspase 8 and in-situ RT PCR (NOS mRNA, TNF,R mRNA, FAS mRNA), the hepatic artery first reperfusion liver showed more damage than the portal vein first reperfusion liver. TUNEL staing showed severe apoptosis in hepatic artery reperfusion liver. CONCLUSION: The expression of the apoptosis molecular markers was more prominent in the reperfused liver performed with initial revascularization using the hepatic artery, rather than portal vein. These findings may be due to fact that the high oxygen blood in the hepatic artery is stressful to the reperfusion liver. The routinely used portal vein first revascularization technique decrease reperfusion injury to the graft when compared to hepatic artery first revascularization.

Postoperative Serum Thyroglobulin in Patients with Papillary Thyroid Carcinoma / 대한내분비외과학회지

PURPOSE: Postoperative serial serum thyroglobulin (Tg) measurements on levothyroxine (L-T4) therapy in patients with differentiated thyroid carcinoma (DTC) is known to be useful in monitoring tumor progression or regression. The objective of this study was to evaluate the significance of serum Tg levels on L-T4 therapy after surgery. METHODS: To determine the basal serum Tg levels on L-T4 therapy after surgery in patients with DTC, Tg levels during the initial 2 year-period after surgery were analyzed retrospectively in 37 patients who had undergone a total thyroidectomy for papillary thyroid carcinoma with (Group 2) or without (Group 1) palpable cervical lymph node metastasis. The Tg levels had been measured 1 to 4 times for each patient with total of 53 and 35 times in Group 1 and Group 2 respectively. RESULTS: The basal Tg levels in Group 1 were all less than 4 ng/mL with 79.3% less than 2 ng/mL, and those in Group 2 were all less than 9 ng/mL with 71.4% less than 2 ng/mL. CONCLUSION: The data suggests that the postoperative serum Tg level of 10 ng/mL can be a useful reference value in long-term follow-up after total thyroidectomy for patients with DTC.

Surgical Treatment of Differentiated Thyroid Cancer

BACKGROUND: There is considerable controversy about the surgical treatment of patients with differentiated thyroid cancer. METHODS: A retrospective study of 45 patients who received surgical treatment during the 1-year period from January to December 1996 at Pusan National University Hospital was performed. RESULTS: The age of the patients ranged from 14 to 72 years (mean age, 42.6 years). Eighteen patients (40.0%) were at the age of 45 years or older. There were 40 women and 5 men. Forty patients (88.9%) had papillary carcinomas and 5 patients (11.1%) had microinvasive follicular carcinomas. Papillary carcinomas had been documented in 36 patients (80.0%). Thirty-seven patients (82.2%) were treated by a total thyroidectomy, including all the patients at the age of 45 years or older. Regional lymph node dissections were performed in 36 patients (80.0%) along with a total thyroidectomy: central node dissection in 25 patients (55.6%) and central and lateral node dissection in 11 patients (24.4%). Frozen- section examinations were required in 25 patients (55.6%). The primary tumors were larger than 1.0 cm in 42 patients (93.3%). Extrathyroidal extensions of the tumors were noted in 14 patients (31.1%). Of the 35 patients with papillary cancer who were treated by a total thyroidectomy, 10 patients (28.6%) had bilateral diseases. Regional lymph-node metastases were proved in 20 patients (44.4%): central node metastasis in 11 patients (24.4%), lateral node metastasis in 7 patients (15.6%), and central and lateral node metastasis in 4 patients (8.9%). Two patients (4.4%) had lung metastases. The TNM stage groupings were as follows: Stage I, 60.0%; Stage II, 13.3%; Stage III, 24.4%; and Stage IV, 2.2%. The incidences of permanent hypoparathyroidism and accidental recurrent nerve injury following a total thyroidectomy were 2.7% and 0.0%, respectively. There were no operative deaths. CONCLUSIONS: The authors conclude that a total thyroidectomy with routine central neck node dissection is the treatment of choice for patients with papillary thyroid cancerous tumors larger than 1.0 cm at the age of 45 years or over.

Locoregional Recurrence in Papillary Thyroid Carcinoma / 대한암학회지

PURPOSE: The author performed this study to find factors influencing the locoregional recurrence in papillary thyroid carcinoma (PTC) with reference to the adequacy of initial treatment. MATERIALS AND METHODS: Records of 13 patients who had received a surgical therapy for locoregional recurrence of PTC at Pusan National University Hospital between January 1993 and December 1996 were analyzed retrospectively. RESULTS: Twelve patients received the surgery after initial recurrence, while one patient after the 2nd recurrence. At the time of initial surgical therapy, mean age of patients was 51.4 years; 10 patients (76.9%) were female; PTC was documented preor intraoperatively in 3 patients (23.1%); 1 patient (7.7%) had a combined preoperative ultrasonography and computed tomography (CT) of the neck; mode of operation was lobectomy in 9 patients (69.2%), total thyroidectomy in 2 patients (15.4%) and total thyroidectomy with neck dissection in 2 patients (15.4%). At the time of second surgical therapy, pattem of recurrence was regional in 7 patients (53.8%), combined locoregional in 4 patients 30.8%) and local in 2 patient (15.4%); mode of operation was complete thyroidectomy with neck dissection in 9 patients (69.2%), neck dissection in 2 patients (15.4%), and local excision in 2 patients (15.4%). Final outcome of patients (mean follow-up period, 2.8 years) was successful in 6 patients (46.2.%). CONCLUSION: The data suggest that many cases of locoregional recurrence in PTC occur as a consequence of poor initial therapy. A combined thyroid ultrasonography and neck CT is recommended as a routine preoperative check during initial therapy. The author believes that a total thyroidectomy is the surgical procedure of choice, which facilitates postoperative I therapy.

Experimental Microangiographic Study in Normal Rabbit Liver

PURPOSE: Microangiography is an experimental radiologic technique for evaluation of the morphology and the function of small vessels. The purpose of this study is to introduce a good microangiographic technique and to present the microangiographic appearance of normal hepatic vascular pattern. MATERIALS AND METHODS: Five white rabbits weighing 2.5-2.9Kg were objected. Polyethylene catheters were inserted in portal vein and then in IVC. Heparin mixed normal saline (2cc/1000cc) was infused through portal vein and blood was drained to IVC. Barium suspension was infused via the catheter placed in portal vein untill the liver surface showed satisfactory finding in barium filling. The liver was removed and this preparation was fixed in 10% formaline for 7 days. After fixation, the liver was sectioned on 1-2mm thickeness. The slices were radiographed on high resolution plate using Faxitron. H-E staining of liver tissue was also done. RESULTS: The microbrium was well distributed in all small vessels without filling defect. And we could find the hexagonal shaped classic liver Iobule, in which the central vein was located at central portion and portal vein at periphery. The enlargement was showed numerous sinusoids, but there was less dye in the central portion of Iobule, but the central vein was well filled by microbarium. The peripheral portion of Iobule was well filled with microbarium. So, we could find diamond shaped liver acinus, in which central vein was located at priperal portion and the center of liver acinus was terminal portal vein that growed out from a small portal space. The three acini made the complex acinus and acinar agglomerate was composed of three or four complex acini. CONCLUSION: It is considered that the liver acinus pattern of Rapparport is more acceptable on microangiography than the classic concept of hepatic Iobule.