Primary Malignant Teratoma with a Primitive Neuroectodermal Tumor Component in Thyroid Gland: A Case Report

Teratomas comprise the most common extragonadal germ cell tumors in childhood. Most teratomas involving the thyroid are benign and occur in children. However, the adult cases reported are mostly malignant and commonly arise in the thyroid. We report a case of a 31-yr-old female with a huge neck mass. Pathologic examination revealed it to be malignant teratoma composed of primitive neuroepithelial tissue with primitive neural tubes and loose myxoid to fibrous immature mesenchymal stroma. The patient underwent extensive evaluation of the thyroid gland with computed tomography (CT) scan and positron emission tomography (PET) scan, which revealed no evidence of metastatic disease. She underwent total thyroidectomy with bilateral modified radical neck dissection, intensive chemotherapy and radiotherapy. At 22-months of follow-up, the patient has remained euthyroid and showed no evidence of recurrence. This is the first case, to our knowledge, of malignant thyroid teratoma with a exuberant primitive neuroectodermal tumor component in Korea.

The Clinical Characteristics and Predictive Factors of Stage IV Breast Cancer at the Initial Presentation: A Review of a Single Institute's Data / 한국유방암학회지

PURPOSE: The aim of this study is to evaluate stage IV breast cancer at the initial presentation by the review of a single institute' data. We also tried to figure out the factors to predict stage IV breast cancer. METHODS: We reviewed the prospectively collected database of 1,424 consecutive patients with primary breast cancer at the National Cancer Center in Korea from October 2000 to January 2005. RESULTS: The proportion of stage IV breast cancer was 2.7% (38/1,424). The median tumor size of the stage IV patients was 4.1 cm. The most common metastatic site was bone (47.4%) followed by lung (44.7%) and liver (36.8%). Metastases were found in 0.9% (6/672) of the T1 tumors, 2.4% (13/535) of the T2 tumors, 8.3% (4/48) of the T3 tumors, and 27.1% (13/48) of the T4 tumors (p or =2 cm) (p=0.026), positive lymph node status (p104 IU/L) (p=0.013), aspartate transferase (>40 IU/L) (p=0.003) and CA15-3 (>32 U/mL) (p=0.025). CONCLUSION: Our study showed that the factors to predict distant metastasis of breast cancer were large size of tumor, positive lymph node status, elevated alkaline phosphatase, aspartate transferase and CA15-3. Therefore breast cancer patients with those clinical characteristics should be carefully evaluated to detect distant metastasis.

Outcome of Hepatic Resection for Hepatocellular Carcinoma Patients

PURPOSE: This study was conducted to evaluate the effects of a partial hepatic resection for a hepatoma, to elucidate the recurrence patterns and to identify the prognostic factors, as the standard treatment option for the selected hepatocellular carcinoma (HCC) patients. METHODS: Retrospective analysis was performed on 201 HCC patients who underwent hepatic resection in Korea Cancer Center Hospital (KCCH) from September 1987 to August 2001. They consisted of 158 men and 43 women whose median age was 51 years (range: 24~73) and median follow-up period was 76.3 months. Statistical analysis was performed using the Kaplan-Meier method, Log-rank test and Cox regression hazard model using SPSS 10.0 for Windows. RESULTS: Three patients died without discharge due to 2 hepatic failures and one multiple organ failure. Therefore, the in-hospital mortality rate was 1.5% (3/201). The 5 year overall survival rate and disease free survival rate were 56.3% and 42.8%, respectively. Eighty patients developed recurrences at various sites, of which remnant liver was the most common site (60.8%) and 3 year survival rate after a recurrence was 24.7%. The independent prognostic factors for overall survival rate were venous invasion, multiplicity, TNM stage, an ICG-R15 and transfusion. CONCLUSION: Partial hepatic resection plays a significant role for selected HCC patients and is regarded as an effective treatment modality with acceptable mortality. However, postoperative recurrence still remains a unresolved crux. A recurrence amenable to retreatment should be detected through a diligent follow-up study. For the high risk patients, further study including adjuvant therapy is needed to reduce the recurrence rate.

Clinical Significance of the Colorectal Polyps

The aim of this study was to investigate the association of colorectal polyps with carcinoma of the colon and rectum. METHODS: Between January 1995 and December 1998, 203 consecutive patients with 423 colorectal polyps retrospectively documented at the Department of General Surgery and College of Medicine in Dongguk University. RESULTS: The peak age group of the colorectal polyp was in the fifth decades (33.5%). The proportions of malignant polyps were as follows: for size, 5.2% of polyps less than 1.0 cm and 19.5% of polyps larger than 1 cm (P0.05); for number of polyp, 4.5% in cases of single polyp and 25.0% in cases of multiple polyps (P<0.05); for underlying histology, 9.2% in cases of tubular adenoma and 19.2% in cases of villous adenoma (p<0.05). The presence of distal adenomatous polyp was increased the risk of presence of the proximal adenomas (59.7%), whereas the presence of hyperplastic polyp did not (16.7%). CONCLUSIONS: The malignant potential of colorectal polyps are correlated with size, histologic type, morphologic shape, multiplicity and distal location. The presence of hyperpalstic polyp should not be indication for colonoscopy because they are not associated with proximal adenoma when adjusting for patient characteristics and presence of distal adenoma.

Three Cases of Abdominal Actinomycosis

Actinomycosis is a chronic, granulomatous suppurative disease caused by Actinomyces species. Actinomyces is an anaerobic, gram positive organism that requires special techniques for culture and isolation. Actinomycosis is characterized by formation of multiple abscesses, draining sinuses, abundant granulations (sulfur granule) and dense fibrous tissue. The three major clinical presentations include the cervicofacial, thoracic, and abdominal regions. Since A. israelii is a normal inhabitant of the oral cavity, to make a definitive diagnosis it must be recovered from closed tissue spaces, draining sinuses, or abscesses, or it must be shown to be invasive in histopathologic sections. The drug of choice is penicillin. Because of the dense fibrous tissue surrounding the colonies of organisms and the concentration of organisms in clusters, high doses of pharmacologic agents must be used for long periods, and radical surgical excision should accompany antibiotic therapy if possible. We report three cases of abdominal actinomycosis, preoperatively impressed as appendicitis and pelvic abscess, which was diagnosed by a histological study of operative specimens. The possible pathogenic mechanisms causing clinical symptoms are discussed.