Clinical Features after Rupture of Hydrogel Breast Implants - MDbP206

PURPOSE: Since the use of silicone-filled breast implants has been restricted, hydrogel has been used an alternative filler as a silicone elastomer shell filled with polysaccharide gel. However, its use has also been restricted since 2000 because of complications due to metabolic fate. The author observed the postoperative findings after implant rupture. METHODS: Among 22 cases with previous augmentation mammoplasty using hydrogel implants that received reoperation in M.D. Clinic from February 2006 to June 2008, 12 cases of implant rupture were included in this study. RESULTS: The mean interval from the previous hydrogel surgery was 7 years ranging from 3 to 9 years. Symptoms were unilateral deflation in 4, unilateral breast edema in 4, unilateral changes in texture in 3 and 1 without any symptoms. There was a significant spread of hydrogel into the surrounding tissue in 2 cases of deflation, 2 cases of edema and 1 asymptomatic case. The most severe spreading occurred 6 years after implant in a patient who had been delivered of a baby 2 months before her visit. The author performed total capsulectomy in 11 cases but was unable to remove all gel in 3 cases of multiple spread. Postoperative complications were mild capsular contracture in 2 patients with incomplete removal of surrounding gel and medial herniation in 1 in multiple spreading after childbirth. CONCLUSION: Rupture of hydrogel breast implants had a high risk of surrounding tissue damage and it is suggested that these implants should not be used for breast augmentation. Patients with hydrogel breast implants should be checked carefully for rupture.

Reduction Mammoplasty-100 Cases by Single Surgeon-MDbP302

PURPOSE: The population of women with macromastia is continuously growing year after year in Korea, and macromastia is a common cause of physical and emotional suffering. This study analyzed the clinical results of 100 cases of reduction mammoplasty by single surgeon. METHODS: The author analysed 100 cases of reduction mammoplasty (200 breasts) operated in M.D. Clinic from Jan 2002 to Sep 2005. The operation techniques were vertical bipedicle flap for 74 cases (74%), inferior pedicle flap for 11 (11%), periareolar round block technique for 9 (9%) and liposuction assisted vertical bipedicle flap for 6 (6%). Patient's age, marital state, number of delivery, weight and height, basal metabolic index (BMI), the amount of removed breast tissue, operation time according to period and operation technique, and complications were studied respectively. Sixty one of cases (61%) were surveyed by phone concerning the improveness of their physical sufferings. RESULTS: The mean age of the cases were 35.8 and the ages ranged from 18 to 57. Forty two of cases (42%) were not married and 48 cases (48%) had not delivered yet. BMI based on body weight and height indicated normal (18.5~23) for 51cases, overweight (23<) for 40 and underweight(<18.5) for 9. The amounts of removed tissue per breast ranged from 85 g to 1,450 g (mean of right side: 305 g, and left side: 301 g). According to operation method, mean amounts of removed tissue were 337 g in vertical bipedicle flap, 540 g in inferior pedicle flap and 145 g in periareolar round block technique. Mean operation time were 4:10, 3:32 in periareolar bound block technique, 3:52 in vertical bipedicle flap and 4:45 in inferior pedicle flap. Because of learning curve and the operation time became shortened. The duration of drainage varied from 1 to 5 days and the mean was 2.5 days. Among the 61 cases that were surveyed by phone, most of them had suffered from physical symptoms preoperatively, and the majority of survey respondents reported improvement in cervical and shoulder pain (92.7%), back pain (89.1%), breast pain (90.5%). Adverse sequelae included infection (3 cases, 3%), hematoma (1 case, 1%), nipple necrosis (2 cases, 2%), decreased nipple sensation (31 cases, 31%), wound dehiscence (5 cases, 5%), hypertrophic scar (11 cases, 11%) and all the cases had a little asymmetry. CONCLUSION: Macromastia becomes common in Korea and we should discuss about reduction mammoplasty for adequate surgery. The cases were varied according to age distribution and marital state. There are several methods for reduction surgery, but the author concluded vertical bipedicle flap method is the best for Korean women.

Reduction Mammoplasty is a Functional Operation, for Improving the Quality of Life in Symptomatic Women - MDbP301 / 한국유방암학회지

PURPOSE: Women with huge breasts suffer cervical, shoulder and back pain, breast pain and limitations of their daily activities, and all of this can create a functional disability and poor quality of life. Many patients with huge breasts need a reduction surgery not only for cosmetic purposes but also for functional improvement. METHODS: Fifty reduction mammoplasty cases that were operated in M.D. Clinic from April 2001 to August 2004 were retrospectively reviewed. Patient's age, the amount of removed breast tissue and the method of operation were evaluated, and 38 of these cases were surveyed by phone concerning the changes of their physical symptoms. RESULTS: The mean age of the cases were 37.3, and the ages ranged from 18 to 57. The amounts of removed tissue ranged from 50 g to 605 g (mean of right side: 275 g, and left side: 271 g). Nine cases of Benneli's circumareolar scar technique, 9 cases of inferior pedicle flap (inverted T scar) and 32 cases of circumvertical bipedicle flap were performed. Among the 38 cases that were surveyed by phone, most of them had suffered physical symptoms preoperatively, including cervical and shoulder pain (31 cases, 81.6%), back pain (35 cases, 92%), breast pain (21 cases, 55.3%), submammary rash (24 cases, 63.2%), fatigue (14 cases, 36.8%), headache (15 cases, 39.5%), numbness in hands (6 cases, 15.8%) and depression or nervousness (29 cases, 76.3%). The majority of survey respondents reported improvement in cervical and shoulder pain (100%), back pain (100%), fatigue (100%), headache (100%), breast pain (90.5%), submammary rash (91.7%), depression or nervousness (82.7%). Furthermore, there were additional gains including increased ability to enjoy physical exercise and social activity, improvement in the fit of their clothing and in their self-esteem. Adverse sequelae included scars (21 cases, 55.2%), asymmetry (11 cases, 28.9%), decrease in nipple sensation (13 cases, 34.2%), infection (1 cases, 2.6%) and hematoma (1 cases, 2.6%). CONCLUSION: Huge breast create physical symptoms including cervical and shoulder pain, back pain, breast pain, submammary rash, and other social and psychological problems. Reduction mammoplasty can improve the majority of these symptoms caused by huge breast, and this is an operation to help mend a functional disability.

Immediate Tissue Expander Insertion for Breast Reconstruction Following Mastectomy for Breast Cancer Patients. Our Experience of Breast Surgeon - MDbP 101

PURPOSE: Although breast reconstruction provides some advantages for women following mastectomy, few Korean breast cancer patients currently receive such reconstruction. Routine provision of breast reconstruction requires simplicity and easy availability for the procedure. This paper reports the possibility of performing breast reconstruction by insertion of a tissue expander by the breast surgeon. METHODS: We studied 22 cases of breast cancer patients who were treated in the Breast service of KangNam Cha Hospital. Nine cases were the group of immediate expander insertion and 13 were the group of MRM only. We evaluated age, histopathologic stage, starting time of chemotherapy, operation time, drainage amounts and periods, medication periods, time of discharge and depression score. RESULTS: The mean age of the expander insertion group was 41, which was younger than that of the MRM only group by 3 years. Histopathologic state was better in the expander insertion group and the time for chemotherapy start was almost the same between the two groups. Mean operation time in the expander insertion group was 2 hours and 41 minutes, and it was longer than the MRM only group by 1 hour, but it included additional wasting time to check the results of frozen biopsy. Periods for drainage were longer and amounts were larger, but this only delayed the medication period and time for discharge by two days. There were no other complications and mental suffering was alleviated. CONCLUSION: Tissue expander insertion for breast reconstruction could be offered on a routine basis by breast surgeons without problems. Breast reconstruction will become a more essential process for breast cancer patients to improve the quality of life. It is ideal if the same surgeon participates in both oncology and reconstruction surgery.

Breast Reconstruction Using Saline Implants in a Woman with Poland Syndrome

Poland syndrome is a rare anomaly characterized by a unilateral absence of the pectoral muscles, ipsilateral syndactyly and microdactyly. Associated anomalies include defects of the ipsilateral ribs and costal cartilages, and breast parenchyma in women. Herein, a case of a 22 years old woman is reported. She had no right pectoralis major, ipsilateral breast parenchyma and anterior parts of the ipsilateral 2nd, 3rd, 4th and 5th ribs. Under general anesthesia, a tissue expander was placed laterally between the subcutaneous and intercostal tissues and anteriorly to the pleura. A repeated saline injection via the expander connected port induced tissue expansion. The total amount of injected saline was 550 cc, and the expander was replaced with a 300 cc prefilled saline implant. The other breast was augmented by insertion of a 150 cc saline implant for symmetry as this was requested by the patient. There were no specific complications, with the exception of a persisting ipsilateral axillary wrinkle. To remove this wrinkle, a combined latissimus dorsi flap may be helpful.

Male Breast Cancer-10 Cases / 한국유방암학회지

PURPOSE: Male breast cancer is a rare type of neoplasm, account for 1 % of all breast tumors. A retrospective review of the clinical and histological characteristics, types of treatment, pathological staging, and adjuvant treatment was completed. The objective of this study was to make an early diagnosis of male breast cancer and reduce the mortality. METHODS: Over a 5-year period, from Oct. 1994 to July 2000, 10 male breast cancer patients were operated on in the breast cancer clinic of the Samsung Medical Center. Their duration of follow up ranged from 6 to 76 months with a mean of 26 months. The clinical and histological characteristics, associations of the risk factors, type of treatment, and results were studied. RESULTS: Their ages ranged from 40 to 67 years with a mean of 51 years, with 5, 3 and 2 cases in their 5th, 6th, and 7th decades, respectively. A palpable breast lump was the most common presenting symptom. A pathological assessment disclosed 8 infiltrating ductal carcinoma, 1 ductal carcinoma in situ, and 1 invasive adenoid cystic carcinoma. The tumor sizes ranged from 0.5 to 3.7 cm (median, 1.9 cm in diameter). Of the 10 patients, there were 3 T1b, 3 T1c, and 4 T2 in the tumor staging. 4 Patients had axillary node involvement (lymph node positivity, 40%), and of these 4, the metastasis involved 2 lymph nodes and more than 3 lymph nodes in 1 and 3 case, respectively. No distant metastasis was observed in any of the patients. Pathological stages of the patients 0, I, IIIA, and IIIB in 1, 5, 1 and 2 cases, respectively. All the patients underwent surgery, 7 with a modified radical mastectomy and 3 with a radical mastectomy, due to gross invasion of the pectoralis major muscle. CONCLUSION: A subareolar palpable breast mass was the most common presenting symptom of the male breast cancer patients. The optimal treatment for male breast cancer patients is a modified radical mastectomy, combined with radiotherapy, chemotherapy, and hormonal therapy, due to the higher hormone receptors positivity.

A Breast Cancer in Premenopausal Women: Pathologic Findings and an Analysis of Prognostic Factor / 한국유방암학회지

PURPOSE: The relationship between menopausal status at diagnosis and the prognosis in breast carcinoma remains uncertain. However, it is widely considered that breast cancer in young women is more lethal than in older patients. We therefore attempted to determine whether menopausal status could be a useful prognostic factor for breast cancer. METHODS: A retrospective study was conducted of premenopausal women who had undergone a definite operation between Jan. 1997 and Dec. 1998 in the Department of Surgery, Samsung Medical Center. Clinical features, histopathologic findings, and prognostic factors were evaluated and compared with those for the equivalent surgical group of postmenopausal women. RESULTS: There were 207 cases (86.3%) of infiltrating ductal carcinomas, 10 (4.2%) of infiltrating lobular carcinomas, 6 (2.5%) of ductal carcinomas in situ, and 16 (6.7%) of special type cancers which showed good prognosis. There were some differences in these incidences from those of the postmenopausal women, but they were not statistically significant (P>0.05). Tumor size and lymph nodal status showed no difference between the two groups (P=0.288), nor were there any significant differences in terms of TNM stage, ER/PR status, nuclear or histologic grade (P>0.05). CONCLUSION: There were little differences in pathologic and prognostic factors between premenopausal and postme no- pausal breast cancer patients. Premenopausal status and young age did not have poorer prognostic factors and were predicted to have not worse prognosis.

Breast Cancer in Third Decade-Does It Really Have a Poor Prognosis? / 한국유방암학회지

PURPOSE: The relationship of the age at diagnosis and the prognosis in breast carcinoma remains controversial. However, it is a widely held belief that breast cancer in young women especially women in the twenties is a disease more lethal than that found in older patients. We attempted to determine whether young age could be a poor prognostic factor for breast cancer. METHODS: A retrospective study was conducted of all women age 30 or younger who had undergone a definite operation from September 1994 to December 1999 in the Department of Surgery, Samsung Medical Center. Clinical features, histopathologic findings, and prognostic factors were evaluated and compared with those for the older group. RESULTS: There were 30 cases (75%) of infiltrating ductal carcinomas in the twenties, which was relatively less than that in the older group (84.8%)(p=0.001). Ductal carcinomas in situ and special types such as mucinous, secretory, and medullary carcinomas and phyllodes tumors were noted more and infiltrating lobular carcinomas less in the younger group than in the older group. Patients in the twenties had smaller tumors (p=0.001) and fewer axillary lymph node metastases (p=0.018) than those in the older group. There were no significant differences between the groups of age 30 or younger and older in terms of the extensive intraductal component (EIC), histologic and nuclear grades, hormonal receptors, p53 mutation rates, and TNM staging (p>0.05). The Nottingham Prognostic Index used to assess the prognosis in breast cancer patients failed to prove the young age as a poor prognostic factor (p=0.133). CONCLUSION:Breast cancer in our study population of women in the twenties did not have a poor prognostic factor. We conclude that age itself is not a poor prognostic factor in patients with breast cancer.

Insular Carcinoma: An Aggressive Subtype of Differentiated Thyroid Neoplasms / 대한내분비외과학회지

PURPOSE: Insular carcinoma is a rare subtype of thyroid cancer which was first described by Carcangiu in 1984. Its aggressiveness is intermediate between well differentiated and anaplastic thyroid carcinoma. But its origin, clinical features and prognosis are not yet clearly understood. We wanted to evaluate the clinical features, histologic characteristics and prognosis of insular thyroid carcinoma. METHODS: We studied 4 cases of insular thyroid carcinoma treated in Samsung Medical Center from March 1996 to April 1998. Age, sex, clinical features, treatment, pathology and follow up findings were reviewed, retrospectively. RESULTS: All patients were female and the mean age was 44 years. Three of all patients complained of anterior neck mass and one patient complained of low back pain and paresthesia of the right thigh. Two patients had metastatic bone lesions at the time of diagnosis. Preoperative fine needle aspiration cytology diagnosed follicular neoplasm in 2 cases and papillary carcinoma in 1. We performed total or completion total thyroidectomy and radioactive iodine therapy in 3 cases and radioactive iodine therapy alone in one. Extrathyroidal invasion, vascular invasion and multicentricity were noted in two cases. All four patients showed recurrence or distant metastasis in follow up over a period of 10 to 31 months and 2 of them died of distant metastasis during this follow up period. CONCLUSION: Insular carcinoma is a special type of thyroid carcinoma with aggressive clinical course. Recurrence and extrathyroidal involvements are common and the prognosis is poorer than other well differentiated thyroid carcinomas.

Insular Carcinoma: An Aggressive Subtype of Differentiated Thyroid Neoplasms / 대한내분비외과학회지

PURPOSE: Insular carcinoma is a rare subtype of thyroid cancer which was first described by Carcangiu in 1984. Its aggressiveness is intermediate between well differentiated and anaplastic thyroid carcinoma. But its origin, clinical features and prognosis are not yet clearly understood. We wanted to evaluate the clinical features, histologic characteristics and prognosis of insular thyroid carcinoma. METHODS: We studied 4 cases of insular thyroid carcinoma treated in Samsung Medical Center from March 1996 to April 1998. Age, sex, clinical features, treatment, pathology and follow up findings were reviewed, retrospectively. RESULTS: All patients were female and the mean age was 44 years. Three of all patients complained of anterior neck mass and one patient complained of low back pain and paresthesia of the right thigh. Two patients had metastatic bone lesions at the time of diagnosis. Preoperative fine needle aspiration cytology diagnosed follicular neoplasm in 2 cases and papillary carcinoma in 1. We performed total or completion total thyroidectomy and radioactive iodine therapy in 3 cases and radioactive iodine therapy alone in one. Extrathyroidal invasion, vascular invasion and multicentricity were noted in two cases. All four patients showed recurrence or distant metastasis in follow up over a period of 10 to 31 months and 2 of them died of distant metastasis during this follow up period. CONCLUSION: Insular carcinoma is a special type of thyroid carcinoma with aggressive clinical course. Recurrence and extrathyroidal involvements are common and the prognosis is poorer than other well differentiated thyroid carcinomas.

A Breast Cancer in Premenopausal Women -Pathologic Findings and an Analysis of Prognostic Factor-

PURPOSE: The relationship between menopausal status at diagnosis and the prognosis in breast carcinoma remains uncertain. However, it is widely considered that breast cancer in young women is more lethal than in older patients. We therefore attempted to determine whether menopausal status could be a useful prognostic factor for breast cancer. METHODS: A retrospective study was conducted of premenopausal women who had undergone a definite operation between Jan. 1997 and Dec. 1998 in the Department of Surgery, Samsung Medical Center. Clinical features, histopathologic findings, and prognostic factors were evaluated and compared with those for the equivalent surgical group of postmenopausal women. RESULTS: There were 207 cases (86.3%) of infiltrating ductal carcinomas, 10 (4.2%) of infiltrating lobular carcinomas, 6 (2.5%) of ductal carcinomas in situ, and 16 (6.7%) of special type cancers which showed good prognosis. There were some differences in these incidences from those of the postmenopausal women, but they were not statistically significant (P>0.05). Tumor size and lymph nodal status showed no difference between the two groups (P=0.288), nor were there any significant differences in terms of TNM stage, ER/PR status, nuclear or histologic grade (P>0.05). CONCLUSION: There were little differences in pathologic and prognostic factors between premenopausal and postme no-pausal breast cancer patients. Premenopausal status and young age did not have poorer prognostic factors and were predicted to have not worse prognosis.

Breast Cancer in Third Decade-Does It Really Have a Poor Prognosis?

PURPOSE: The relationship of the age at diagnosis and the prognosis in breast carcinoma remains controversial. However, it is a widely held belief that breast cancer in young women especially women in the twenties is a disease more lethal than that found in older patients. We attempted to determine whether young age could be a poor prognostic factor for breast cancer. METHODS: A retrospective study was conducted of all women age 30 or younger who had undergone a definite operation from September 1994 to December 1999 in the Department of Surgery, Samsung Medical Center. Clinical features, histopathologic findings, and prognostic factors were evaluated and compared with those for the older group. RESULTS: There were 30 cases (75%) of infiltrating ductal carcinomas in the twenties, which was relatively less than that in the older group (84.8%)(p=0.001). Ductal carcinomas in situ and special types such as mucinous, secretory, and medullary carcinomas and phyllodes tumors were noted more and infiltrating lobular carcinomas less in the younger group than in the older group. Patients in the twenties had smaller tumors (p=0.001) and fewer axillary lymph node metastases (p=0.018) than those in the older group. There were no significant differences between the groups of age 30 or younger and older in terms of the extensive intraductal component (EIC), histologic and nuclear grades, hormonal receptors, p53 mutation rates, and TNM staging (p>0.05). The Nottingham Prognostic Index used to assess the prognosis in breast cancer patients failed to prove the young age as a poor prognostic factor (p=0.133). CONCLUSION: Breast cancer in our study population of women in the twenties did not have a poor prognostic factor. We conclude that age itself is not a poor prognostic factor in patients with breast cancer.

Clinical Study of Mucinous Breast Carcinomas

PURPOSE: A mucinous breast carcinoma has a better prognosis than an invasive ductal carcinoma, so it is important to differentiate between pure and mixed mucinous carcinomas of the breast because the former has a more favorable prognosis. We investigated the clinical features of mucinous carcinomas of the breast and the differenting characteristics of the two types. METHODS: A retrospective review was done of 31 patients with a mucinous breast carcinoma who had been treated between Sep. 1994 and Aug. 1999 at the Department of General Surgery, Samsung Medical Center. The clinical features and the radiologic and pathologic findings were assessed. The pure type was defined as a carcinoma with a mucin component of 50% or more. RESULTS: The clinical characteristics, including age distributions, symptoms & signs, and tumor locations, were similar to those of other types of breast cancer. Mammo graphy in cases of malignancy showed an ill-defined mass density with pleomorphic or granular calcifications in 8/19 cases (42.1%), an ill-defined mass density without calcifications in 2/19 cases (10.5%), and pleomorphic calcifications only in 1/19 (5.3%) cases. Other findings were indicated as benign: a well-circumscribed mass in 4/19 (21%), smudged or ring-like calcificaitons in 3/19 cases (15.8%), and a negative finding in 1/19 cases (5.3%). Ultrasonography showed well- or ill-defined masses in 14 cases and 7 of those 14 cases (50%) were diagnosed as being malignant. The cytologic findings for 21 cases showed tumor cell clusters with mucous backgrounds. Among those 21 cases, 19 (90.5%) were diagnosed as being malignant. Breast conservation surgery was performed on 10 patients (32.3%) and a modified radical mastectomy on 21 patients (67.7%). Among 31 cases, 21 cases were a pure type, and the rest were a mixed type with an invasive component. Tumor cell nests floated in a profuse extracellular mucin pool. The pure type showed a smaller tumor size (p=0.001) and less nodal metastasis (p=0.047). Early stages (stage IIa or less) were more common in pure type (76.2%) than in the mixed type (40%)(p=0.025), but there were no differences in hormonal status between the two types. CONCLUSION: There were no differences in the clinical characteristics between mucinous and other types of breast carcinomas, but the radiologic findings for mucinous carcinomas were not typical of a malignancy. Cytologic examinations were useful in diagnosing mucinous carcinomas of the breast.Since the tumor sizes were smaller and axillary nodal metastases were rare in pure mucinous carcinomas, it is important to differentiate it from the mixed type.

Influence of Fine Needle Aspiration Cytology and Frozen Section on the Management of Follicular Carcinomas

PURPOSE: Fine needle aspiration cytology (FNA) and frozen section (FS) have been extremely valuable tools in the evaluation of thyroid nodules. However, in follicular carcinomas, it is often difficult to distinguish between a benign and a malignant lesion. The aims of this study were to evaluate the characteristic clinicopathologic findings and sensitivities of FNA and FS examination in the diagnosis of follicular carcinomas and to delineate the influence of preoperative and intraoperative clinicopathologic findings and the prognostic factors on the extent of surgery. METHODS: The cases of 33 patients who had undergone thyroid surgery and who had been histologically diagnosed as having follicular thyroid carcinomas were reviewed for age, sex, laboratory findings, FNA findings, frozen-section results, extent of surgery, completion thyroidectomy, and coexistent pathology. RESULTS: There were 28 women and 10 men (2.3:1 ratio) whose ages ranged from 14 to 75 years with a mean of 40.8 years. The mean follow-up was 27.2 months. The most prominent sign was an asymptomatic palpable anterior neck mass, which was present in 29 (87.8%) cases. Fine needle aspiration cytology was performed in 31 patients, revealing a follicular neoplasm in 16 patients (sensitivity=51.6%), an adenomatous goiter in 6 (19.4%), a papillary carcinoma in 5 (16.1%), and an anaplastic carcinoma in 1 (3.2%); the specimens were inadequate in 3 patients (9.7%). Among the 32 patients having an intraoperative frozen sections, only 7 patients (sensitivity=21.2%) were correctly diagnosed as having cancer. The diagnoses were deferred (reported as a follicular neoplasm) in 21 patients (65.6%) and were changed from benign at frozen section to malignant on final diagnosis in 4 patients (12.6%). Among the 21 patients diagnosed as having a follicular neoplasm on frozen section, 10 patients (47.6%) were treated with a subtotal thyroidectomy, 6 patients (28.6%) with a total thyroidectomy taking into consideration the gross findings at operation and prognostic factors such as AGES and AMES to reduce the incidence of a completion thyroidectomy.Only 5 patients (23.8%) underwent a lobectomy followed by a reoperation (a completion thyroidectomy). CONCLUSION: Fine needle aspiration cytology and frozen section results are not good indicators in making the decision regarding the extent of the thyroidectomy. A definitive decision to avoid a completion thyroidectomy should be made during the initial operation based on gross findings, frozen-section results, and prognostic factor such as age, tumor grade, tumor size, and the presence of extracapsular spread or distant metastasis.

Solid and Papillary Neoplasm and Nonfunctioning Islet Cell Tumor: Differential Diagnosis and Study of Histopathogenesis by Immunohistochemical Staining

PURPOSE: Solid and papillary neoplasms and nonfunctioning islet cell tumors are both rare pancreatic tumors, and their clinical and pathological features are similar which makes it hard to differentiate between them. Because both tumors have different prognoses, it is important to have precise diagnosis. The etiology of solid and papillary neoplasm is not precisely known. The role of sexual hormone has been debated as this tumor occurs mostly in women. METHODS: We retrospectively reviewed the medical records of 13 patients with solid and papillary neoplasm and 11 patients with nonfunctioning islet cell tumors who had been treated by surgical resection between October 1994 and May 1999 at Samsung Medical Center. Immunohistochemical stainings were performed for neuron-specific enolase (NSE), chromogranin, somatostatin, alpha 1-antitrypsin, estrogen (ER), and progesterone (PR) receptors. RESULTS: The average ages of the patients with solid and papillary neoplasms and nonfunctioning islet cell tumors were 39.5 and 47.8 respectively. The male to female ratio was 2 to 11 and 6 to 5, respectively and solid and papillary neoplasms were more common in women. CT showed a cystic mass in 76.9% (10/13) of the solid and papillary neoplasm patients and 20% (2/10) of nonfunctioning islet cell tumor patients. Lymphadenopathy was noted in 0% (0/13) of the solid and papillary neoplasm cases and in 50% (5/10) of the nonfunctioning islet cell tumor cases, and calcifications were present in 46.2% (6/13) and 0% (0/10) of those cases, respectively. The solid and papillary neoplasms were located most commonly inthe tail of the pancreas (7 cases), and nonfunctioning islet cell tumors were located most commonly in the head of the pancreas (5 cases). No malignancies were detected in the solid and papillary neoplasms. Seven cases of the nonfunctioning islet cell tumors (63.6%) were malignant. Both solid and papillary neoplasms and nonfunctioning islet cell tumors stained positive for NSE and alpha 1-antitrypsin in all cases and they were chromogranin positive in 25% (3/12) and 100% (10/10) and somatostatin positive in 25% (3/12) and 60% (6/10) of the cases, respectively. A solid and papillary neoplasm stained positive for ER in 1 case and for PR in 5 cases. However, only 1 case of a nonfunctioning islet cell tumor stained positive for PR. CONCLUSION: A nonfunctioning islet cell tumor is more malignant tumor than a solid and papillary neoplasm, and age, presence of cysts, lymphadenopathy, calcification, and chromogranin staining can all be used for differential diagnoses of these tumors. Both the solid and papillary neoplasms and the nonfunctioning tumors are thought to originate from a stem cell capable of differentiating into endocrine cells. The sexual hormone seems to have a role in the development of solid and papillary neoplasms.

Infiltrating Lobular Carcinoma of the Breast Comparison with an infiltrating ductal carcinoma

PURPOSE: Infiltrating lobular carcinomas (ILC) represent 5-10% of all breast cancers. Compared to infiltrating ductal carcinomas (IDC), ILC has a trend to be a more indistinct and multicentric form of cancer, thus, they are detected later and are less frequently treated using breast conserving surgery. The objective of this study was to determine the difference between ILC and IDC and the utility of using breast conserving surgery for ILC. METHODS: We studied 26 ILC and 319 IDC patients surgically treated at the Department of Surgery, Samsung Medical Center. Age, size of tumor, mammographic findings, operative method and pathologic findings were analysed retrospectively. For the microvessel count, tumor sections were immunohistochemically stained using CD31 monoclonal antibody, and microvessels were counted at 200 magnification in three separate fields selected from areas of highest vascularity. RESULTS: There were no differences between patients with ILC and IDC with respect to the mean age (45.4 and 47), the mean size of the tumors (2.59 cm and 2.63 cm), the malignant findings on mammography (13/15 (86.6%) and 203/237 (85.7%)(p=0.636)), and the number of breast conservaing surgeries (10/26 (38.5%) and 103/311 (33.1%)(p=0.361)). Axillary nodal metastasis was slightly more common in patients with ILC (15/25, 60%) than in those with IDC (141/284, 9.6%)(p=0.217) but there was no difference in TNM staging. More frequent estrogen receptor expression and less frequent P53 mutations were found in ILC than in IDC. Unlike IDC, there was no association between tumor microvessel density and pathologic stagings in ILC. CONCLUSION: ILC was found in patients of similar age, and the size was not different from that of IDC. The mammographic accuracy in diagnosing malignancy was about the same in ILCas in IDC. Breast conserving surgery can be performed in ILC patients at the same rate as in IDC patients. Microvessel density was not a prognostic factor in ILC patients.

Clinical Application of Sentinel Node Biopsy in T1 or Less Breast Cancers. Is it Effective or Feasible?

BACKGROUND: Sentinel node biopsy has emerged recently as an alternative to routine axillary node dissection in predicting axillary nodal metastasis, and various studies have shown its effectiveness in patients with breast cancer. However, there have been some controversies in clinical application because of its high false negative rate. METHODS: One hundred forty patients with breast cancer underwent operative management in consideration of the results of sentinel node biopsies at the department of surgery, Samsung Medical Center, between Sep. 1995 and Jul. 1998. Sixty-three patients with tumor sizes of T1 or less were retrospectively evaluated. Intraoperative lymphatic mappings using vital blue dye and using a combination of vital dye and a 99mTc-antimony sulphide colloid were performed for 53 patients and 10 patients, respectively. RESULTS: Patient's ages were in the third decade for 2 patients (3.2%), in the fourth decade for 18 (28.6%), in the fifth decade for 18 (28.6%), in the sixth decade for 13 (20.6%) and in the seventh decade for 12 (19.0%). An infiltrating ductal carcinoma was observed in 51 patients (81.0%), an intraductal carcinoma in 8 (12.6%), a medullary carcinoma in 2 (3.2%), an infiltrating lobular carcinoma in 1 (1.6%) and a mucinous carcinoma in 1 (1.6%). Sentinel node was detected in 42 of the 53 patients (79.2%) evaluated with vital blue dye only and in 10 of the 10 patients (100%) evaluated with a combination of vital dye and a 99mTc-antimony sulphide colloid. Among the group of T1 or less, the sensitivity rates of vital dye and the combination were 81.8% and 100% and their accuracies of them were 95.2% and 100%, respectively. The false negative rates for all cases were 12.2% and 8.3%, respectively, but they were decreased to 6.1% and even 0% for the group of T1 or less. CONCLUSIONS: The detection rate and the accuracy of sentinel node biopsy were enhanced in patients with T1 or less breast cancer. If a combination of vital dye and a radioisotope is used, sentinel node biopsy may be applied clinically in limited patients such as those with T1 or less breast cancer.

Ductal Carcinoma In Situ in a Fibroadenoma

BACKGROUND: A fibroadenoma is a common benign breast tumor with little potential for malignancy. There are, however, increasing numbers of reports that it is associated with a certain increase in breast cancer. METHODS: We reviewed the medical records of 4 patient's who were diagnosed as intraductal carcinoma within a fibroadenoma. RESULTS: The patient's age were relatively young (32, 36, 52, and 36 years), and the tumor presented as a lump of recent onset in 3 patients and as an abnormal mammography in one patient. None of the patients could be diagnosed as having malignancy by using mammography, ultrasonography, or cytologic examination. However, a radiologic study showed microcalcifications in the masses in two patients, and cytological examination demonstrated atypical cells in three patients. Breast-conservation surgery was performed in two patients; a wide excision was used in one and a localization & excision in the other. Pathologic features were ductal carcinomas in situ within fibroadenomas in all. Estrogen and progesteron receptors were all positive. CONCLUSION: Possibility of malignancy should be excluded in patients with a fibroadenoma, especially when microcalcifications are observed within the mass or atypical cells are suspected based on cytologic examination. Fine needle aspiration cytology, ultrasonography and even excisional biopsy should be performed to evaluate the possibility of malignancy in these patients.

Insular Carcinoma: An Aggressive Subtype of Differentiated Thyroid Neoplasms / 대한암학회지

PURPOSE: Insular carcinoma is a rare subtype of thyroid cancer which is first described by Carcangiu in 1984. It is intermediate in aggressiveness between well differentiated and anaplastic thyroid carcinoma. But its origin, clinical features and prognosis are not yet clearly understood. We wanted to evaluate the clinical features, histologic characteristics and the prognosis of the insular thyroid carcinoma. MATERIALS AND METHODS: We studied 4 cases of insular thyroid carcinoma treated in Samsung Medical Center from March 1996 to April 1998. Age, sex, clinical features, treatment, pathology and follow up findings were reviewed, retrospectively. RESULTS: All patients were female and mean age was 44 years. Three of four patients complained anterior neck mass and one patient complained low back pain and paresthesia of right thigh. Two patients had metastatic bone lesions at the time of diagnosis. Preoperative fine needle aspiration cytology could diagnose follicular neoplasm in 2 cases and papillary carcinoma in 1. We performed total or completion thyroidectomy and radioactive iodine therapy in 3 cases and radioactive iodine therapy alone in one. Extra- thyroidal invasion, vascular invasion and multicentricity was noted in two cases. All four patients showed recurrence or distant metastasis in follow up period of 10~31 months and 2 of them died of distant metastasis. CONCLUSION: Insular carcinoma is a special type of thyroid carcinoma with aggressive clinical course. Recurrence and extrathyroidal involvements are common and the prognosis is poorer than other well differentiated thyroid carcinoma.

Radio-Guided Parathyroidectomy for Primary Hyperparathyroidism: Three cases

Although primary hyperparathyroidism is a rare disease in Korea, the incidence is increasing gradually due to increased concern and the development of laboratory and imaging techniques. Previous radiological imaging studies for localization of a parathyroid adenoma have been generally unreliable. Recently, preoperative administration of Tc-99m sestamibi has improved detection of parathyroid adenomas. Combining preoperative administration of the sestamibi radionuclide with an intraoperative gamma probe can identify the exact location of a parathyroid adenoma successfully and facilitate a safe and efficient operation under local anesthesia. Limited exploration provides a better cosmetic result while decreasing the potential complications of bilateral exploration. Also, an obvious indication for radio-guided para thyroid surgery with a minimal approach may well be the high-risk patient who cannot tolerate a general anesthestic or an extensive surgical approach. We report three cases of primary hyperparathyroidism which were successfully treated with intraoperative radio-guided parathyroid surgery. These parathyroid surgery can be enhanced especially in the future, when and if an efficient and cost-effective intraoperative PTH assay becomes available.