Clinical Significance of MMP-2, MMP-9 and HIF-1alpha Expression in Thyroid Micropapillary Cancer

PURPOSE: Papillary Thyroid Microcarcinoma (PTMC) is rapidly increasing due to increased interests in the public health care system and improvements in ultrasonographic instruments and fine-needle-aspiration technique. The aim of this study is to investigate relationships between clinicopathologic features and molecular markers of PTMC and to help in developing therapeutic strategies in PTMC. METHODS: Tissue samples from patients with 38 PTMC and 21 benign thyroid tumors that were operated on from Jan. 2006 to Nov. 2008 were used to make microarrays and immunohistochemical staining for ER-alpha, E-CD, VEGF, MMP-2, MMP-9, and HIF-1alpha were performed. Clinicopathologic features of each immunohistochemical staining group were analyzed retrospectively. RESULTS: There is no immunohistochemistry staining in cases with benign thyroid lesions. The expression rate of ER-alpha, E-CD, VEGF, MMP-2, MMP-9, and HIF-1alpha in PTMC group was 66%, 58%, 82%, 66%, 71% and 63%, respectively. Bilateral tumor was statistically significant (48.0% vs 7.7%, P=0.015) related to MMP-2(+) PTMC group than in MMP-2(-) group. Bilateral tumor (44.4% vs 9.1%, P=0.060) and lymphovascular invasion (25.9% vs 0%, P=0.084) seemed to have greater relation to MMP-9(+) PTMC group than to MMP-9(-) group, but there is no statistically significant difference. Bilateral tumor (50.0% vs 7.1%, P=0.012), lymph node metastasis (45.8% vs 0%, P=0.003) and lymphovascular invasion (29.2% vs 0%, P=0.033) were significantly related to HIF-1alpha (+) PTMC group compared to HIF-1alpha(-) group. CONCLUSION: Our findings suggest that MMP-2, MMP-9 and HIF-1alpha expression could be used as a prognostic marker in PTMC. Larger studies are needed to assess its prognostic value in PTMC.

Analysis of Prognosis in Colorectal Mucinous Adenocarcinoma: A Retrospective Analysis with Peritoneal Fluid

PURPOSE: Although many papers have reported poor prognosis of colorectal mucinous adenocarcinoma, the underlying cause for its unfavorable outcome is yet to be elucidated. In the peritoneal fluid studies, we observed that peritoneal recurrences and cytology positive cases were many times mucinous cancers. On the basis of these observations, mucinous and non-mucinous adenocarcinomas were compared and prognostic factors were studied. METHODS: Five hundred and forty-six patients who underwent surgery for colorectal adenocarcinomas from January 2004 to December 2008 were included. RESULTS: Among the 546 patients, mucinous adenocarcinomas were 30 (5.5%) and non-mucinous adenocarcinomas were 516 (94.5%). Mean age was 55.0 years, which was younger than 63.2 years in non-mucinous colon cancers. They tend to develop in the right colon. Mucinous adenocarcinomas were more advanced in depth of invasion and distant metastasis, but no significant difference in lymph node (LN) metastasis. Peritoneal CEA, CA19-9, and positive cytology were more apparent. Liver and peritoneal metastasis did not show significant increases. Five year survival rates were 82.9% and 91.7% and cancer free survival rates were 42.7% and 68.5% each, respectively, for mucinous and non-mucinous cancers. According to stage, only stage III and IV patients showed differences in cancer free survival and overall survival (P=0.001, 0.040). CONCLUSION: Mucinous adenocarcinomas showed worse prognoses and significant differences in recurrences, but had similar prognoses in early cancers. Although no significant differences were in LN metastasis, dissimilarities were in infiltration depth. Infiltrations led to the increase in free cancer cells and peritoneal fluid tumor markers: ultimately cancer recurrences developed.

Mutational Analysis of TTK Gene in Gastric and Colorectal Cancers with Microsatellite Instability / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The TTK gene plays a crucial role in regulation of the mitotic checkpoint. The TTK gene has an A9 mononucleotide repeat in the coding sequences, which harbors mutations in gastric (GC) and colorectal cancers (CRC) with microsatellite instability (MSI). However, there are three more repeats (the A7s) in the coding sequences that have not been analyzed. The aim of this study was to explore whether the three A7s as well as the A9 are altered in GC and CRC, and to find any association of TTK mutation with clinocopathologic characteristics of GC and CRC. MATERIALS AND METHODS: We analyzed exon 5 (A7 and A7) and exon 22 (A9 and A7) which have repeat sequences in 30 GC with high MSI (MSI-H), 15 GC with low MSI (MSI-L), 35 CRC with MSI-H, and 15 CRC with MSI-L, by single-strand conformation polymorphism (SSCP) and DNA sequencing assays. RESULTS: Overall, we detected 23 frameshift mutations in the repeat sequences of TTK in the GC with MSI-H (11/30; 36.7%) and the CRC with MSI-H (12/35; 34.3%), but not in the cancers with MSI-L. The mutations were observed in both A9 and A7 of exon 22, but in neither of the two A7s of exon 5. The mutations consisted of c.2560delA, c.2560dupA, c.2571delA and c.[2560delA(+)2571delA]. All of the mutations were frameshift mutations and would result in premature stops of TTK protein synthesis. There was no significant difference in clinopathologic parameters of the cancers with the mutations. CONCLUSION: Our data indicate that frameshift mutations of TTK are common in both GC and CRC with MSI-H, and that the mutations occur not only in the A9 repeat but also in the A7 repeat. The data suggest that frameshift mutations of TTK might alter cell cycle control in the affected cells and contribute to pathogenesis of cancers with MSI-H.

Postanal Retrieval and Anastomosis in Laparoscopic Rectal Surgery: Report of 3 Cases

Laparoscopic surgery is popular and widely accepted method for colorectal cancer today. Especially in rectal cancer, laparoscopic TME made surgery safe and feasible with good outcome. But there are still some limits and difficulties in resection and anastomosis of low rectal cancer. We combined laparoscopic TME and posterior approach. Surgery was performed in three low rectal cancer patients. They were prepared in supine position and laparoscopic TME to pelvic floor muscles was performed. After changing the patient to Jack-knife position, post-anal median incision (between the external sphincter and coccyx) and distal rectal resection was done. Through this surgical window, proximal stump was retrieved and resected with the safety margin, and anastomosis with leak test was performed. After a drain keeping, patient's position was changed back to supine again and laparoscopic irrigation and inspection of operation field was done finally. In the course of recovery, two patients were uneventful, but the rest with FAP experienced postoperative anastomotic leakage and got perineal resection and permanent ileostomy. According to our experience, posterior approach after laparoscopic TME permit right angle resection of distal rectum which is difficult in laparoscopic transabdominal approach. In addition, manual anastomosis with various instruments, Lembert suture, easy drain keeping, accurate fibrin glue apply can also be achieved. No incision on abdomen adds cosmetic advantage. But frequent position changes, need of patience-demanding intracorporeal mesenteric dissection to anastomotic site, and wound discomfort during sitting position right after the operation remain as challenges to consider and solve.

A Clinical Application of Gasless Endoscopic Thyroidectomy: Clinical Analysis of 300 Cases at a Single Institution

PURPOSE: Endoscopic thyroidectomy has become a widely used operative method due to the recent advances in the operative technique and instruments and its cosmetic superiority. The aim of this study is to evaluate the technical feasibility and potential role of endoscopic thyroidectomy. METHODS: Between December 1999 and December 2006, 300 patients with benign thyroid disease or thyroid cancer were treated by gasless endoscopic thyroidectomy with using the anterior chest wall approach at Uijongbu St. Mary's Hospital. We analyzed that clinicopathological features, the operative time, the operative method and the complications. RESULTS: There were 261 cases of benign disease and 39 cases of malignant tumor. We generally performed lobectomy for benign thyroid disease. For malignant tumor, we performed 14 lobectomies, 6 total (or near total) thyroidectomies, 17 total (or near total) thyroidectomies with central lymph node dissection and 2 total (or near total) thyroidectomies with lateral lymph node dissection. The most frequent pathology in benign disease was nodular hyperplasia, and in malignant disease it was papillary carcinoma. The mean operative time was 122.2 minutes. For the patients with thyroid cancer, the mean operative time for thyroid cancer surgery without lymph node dissection (20 cases) and thyroid cancer surgery with lymph node dissection (19 cases) was 144 and 177 minutes, respectively. There were 34 cases of complication (11.33%) with 11 cases of transient hoarseness, 9 cases of transient hypocalcemia and 1 case of permanent hypocalcemia. CONCLUSION: Endoscopic thyroidectomy is a safe and technically feasible alternative to conventional thyroidectomy in patients with benign disease. In patients with thyroid cancer, we suggest that that endoscopic thyroidectomy can be a good alternative to conventional thyroid surgery in highly selected cases. Larger series and longer follow-up evaluation are necessary to confirm our findings.

Hydrocele of the Canal of Nuck

In females, a small evagination of parietal peritoneum accompanies the round ligament through the inguinal ring into the inguinal canal and is called the canal of Nuck; it is homologous to the process vaginalis in males. If it fails to undergo complete obliteration, an indirect inguinal hernia or a hydrocele of the canal of Nuck can occur. We report three cases of this rare developmental disorder, discuss the CT findings and its use in the diagnosis of a hydrocele of the canal of Nuck.

Clinical Findings of Appendiceal Mucocele

PURPOSE: A mucocele of the appendix is an uncommon pathology, representing 0.2% to 0.3% of all appendix specimens. It is often diagnosed clinically as a result of its ability to cause signs and symptoms similar to those of acute appendicitis. If it is asymptomatic, it is often detected as an incidental finding during ultrasonography, computed tomography, radiographic examination of the gastrointestinal tract, or laparotomy. The purpose of this study was to identify the clinical features of mucocele of the appendix. METHODS: We describe 35 cases of mucocele of the appendix diagnosed at Uijeongbu St. Mary's hospital between January 1993 and December 2006. We analyzed demographic, clinical, and pathologic data of all the cases. RESULTS: A total of 12 males and 13 females with mean age of 54.7+/-14.9 years are described. The peak incidence occurred in the seventh decade (34.3%). Sixteen patients presented with symptoms and signs similar to those found in acute appendicitis. Ten patients complained of a palpable mass, 2 patients complained of non-specific abdominal pain, and 7 patients were asymptomatic. Fourteen cases were diagnosed preoperatively, and 3 cases were discovered incidentally. Pathologic examination revealed mucosal hyperplasia in 20% of the cases, cystadenoma in 71%, and cystadenocarcinoma in 9%. The mean age of cystadenocarcinoma patients was older than the mean age of mucosal hyperplasia patients, and the diameter of the appendix was larger in cystadenoma patients than in mucosal hyperplasia patients. CONCLUSION: The preoperative diagnosis of appendiceal mucocele is very important to make in order to facilitate treatment planning and avoid inadvertent rupture of the mucocele during operation. We recommend more diagnostic studies in cases of suspected mucocele. Mucocele of the appendix must be included in the differential diagnosis of patients with pain in the right iliac fossa, patients older than 40 years of age, patients suffering from long-term symptoms, and patient with a palpable mass in the right iliac fossa.

A Rare Cause of Duodenal Obstruction: Spontaneous Intramural Duodenal Hematoma Caused by a Hemangioma

Small bowel hemangioma is a rare benign lesion, and it usually presents with bleeding or as a leading point of an intussusception. However, obstruction due to intramural hematoma by this lesion is unusual. Intramural hematoma of the duodenum is also an uncommon lesion, and it is usually a complication of blunt abdominal trauma in children and young adults. We present here a case of an intramural hematoma that was caused by spontaneous bleeding of a hemangioma, and this caused duodenal obstruction.

Ex-vivo Sentinel Lymph-node Mapping in Colorectal Cancer

PURPOSE: The presence of lymph-node metastases is one of the most important prognostic factors for patients with a colorectal carcinoma. The sentinel lymph node is the first lymph node that receives afferent lymphatic drainage from a primary tumor, and thus has the highest risk of harboring metastatic disease. METHODS: Twenty-eight patients with an adenocarcinoma of the colon or the rectum were investigated. After resection of the specimen in standard oncologic fashion, the specimen was dissected longitudinally along the antimesenteric border, and methylene blue was injected around the tumor submucosally. After 5 minutes, the mesentery was meticulously examined, and blue-stained lymphatics and lymph nodes were carefully dissected and harvested. RESULTS: Sentinel lymph nodes were identified in all cases. The average number of sentinel nodes identified was 3 (range, 1~6), and the average number of lymph nodes retrieved was 20.8 (range, 6~42). Of the fifteen patients (53.6%) identified to be positive for lymph-node metastasis 10 showed nonsentinel nodal metastasis without sentinel nodal involvement. No additional isolated tumor cells were found by immunohistochemical staining in 13 patients who had no lymph-node metastasis on conventional pathologic examination. CONCLUSIONS: In colorectal cancer, the sentinel-lymph-node sampling method is easy and can be performed for the purpose of finding lymph nodes easily. However, applying the sentinel-lymph-node sampling method for the purpose of minimizing lymph node dissection, as in breast cancer, is not recommended because of the high probability of missing metastasis.

Methylation Patterns of Cancer-Associated Genes in Breast Cancer / 한국유방암학회지

PURPOSE: To investigate the methylation status of cancerassociated genes in breast cancer to assess its use in the diagnosis of breast cancer and the relationship with distinctive clinical and pathological features. METHODS: A total of 29 benign tumors and their adjacent normal tissues as well as 67 malignant tumors and adjacent normal samples, from women undergoing surgery for primary invasive breast carcinoma at Uijongbu St. Mary's Hospital, between March 2003 and March 2005, were used. Eleven candidate genes were chosen; P14, P16, DAPK, MGMT, h-MLH, E-cadherin, RASSF1 , Twist, RAR , HIN-1, and Cyclin D. DNA was extracted from fresh tissues, and methylation specific PCR performed. RESULT: The number of methylated genes was increased in the malignant tissues compared to the benign tumors and adjacent normal tissues. 7 genes; P14, P16, MGMT, RASSF1, Twist, RAR beta and Cyclin D, were more frequently methylated in malignant than benign tumors, with the differences in the p14, p16, and RAR beta genes were statistically significant (p<0.05). In benign tumors, the p16 and HIN-1 genes were the most infrequently (6.9%) and frequently methylated (82.8 %), respectively. In malignant tumors, the h-MLH and RASSF1 genes were most infrequently and frequently methylated genes, respectively. The ubgroup showing methylation of the DAPK gene had a higher nuclear grade and greater progesterone receptor negativity. The group in which the RASSF1 gene was methylated, had greater estrogen receptor (ER) and progesterone receptor (PgR) positivities. The Twist gene was frequently methylated in the subgroup showing higher nuclear and histologic grades. The group with HIN- 1 and cyclin D methylation had a tendency to show greater ER positivity. CONCLUSION: The subgroups showing methylated DAPK and Twist should be more intensely treated and followed up more carefully than those with RASSF1 , HIN-1 and Cyclin D methylation. Gene methylation may be linked to various pathological features of breast cancer; however, this will require confirmation from larger studies.

Methylation Patterns of Tumor Suppressor Genes in Breast DCIS Tumors

PURPOSE: The methylation of tumor suppressor genes has been implicated in the development of breast cancer. However, the role of methylation in the progression of cancer is still unclear. In this study, the methylation stati of nine tumor suppressor genes (p14, p16, DAPK, E-cadherin, RASSF1 alpha, TWIST, RAR beta, HIN-1, cyclin D2) in normal, benign, DCIS and invasive cancer tissues were examined, and the methylation patterns in DCIS and hypermethylated genes investigated to see if a change in the methylation status would lead to the development of cancer and progression to an invasive tumor. METHODS: A total of 96 patients, who underwent surgery between March 2003 and March 2005, were retrospectively studied. DNA was extracted from tumor tissues, and the samples examined for aberrant hypermethylation using methylation-specific PCR (MSP). RESULTS: The total number of methylated genes in each tissue type (normal tissues; 2.97+/-1.74, benign tumors; 4.36+/-1.42, DCIS; 5.73+/-1.35, invasive cancers; 5.42+/-2.05) increased with tumor progression (P<0.001). In benign tumors, HIN-1 (83%) was the most frequently methylated gene, but in DCIS, p14 (100%), RASSF (100%) and TWIST (91%) were frequently methylated. In invasive cancer, RAR beta (60%) and p16 (37%) were frequently methylated compared to the other tissue types. In a multivariate study, TWIST was commonly hypermethylated in DCIS and invasive cancer; whereas, RAR beta and p14 were frequently independently hypermethylated in invasive cancers. CONCLUSION: Methylation induced gene silencing appears to affect multiple genes in breast tissues, which increases with cancer progression. TWIST was hypermethylated in both DCIS and invasive cancers; therefore, it was concluded that methylation of the TWIST promoter may be an early event in the development of breast cancer. The hypermethylations of RAR beta and p16 are useful marker for the progression of a DCIS lesion to invasive cancer. The methylation patterns of tumor suppressor genes in DCIS were similar to those found in invasive cancer, but also showed intermediate levels of methylation between benign tumors and invasive cancers.

Diverticulitis of the Right Colon: Tips for Preoperative Diagnosis and Treatment Strategy

PURPOSE: The planned therapy of right colonic diverticulitis is very difficult because preoperative diagnosis is uncommon and the method of treatment is usually decided at the time of laparotomy. We retrospectively analyzed the clinical characteristics of right colonic diverticulitis, the clinical distinctions between preoperatively and postoperatively diagnosed patients, the recurrence rate, and the hospital stay by treatment modality. METHODS: Among 104 patients who were treated for right colonic diverticulitis from January 1997 to May 2005, we enrolled 90 patients who had been diagnosed by the operation or a barium enema study (BE), and who had not been lost to follow-up. Patients were divided into three groups based on treatment modality: Group 1 (n=28), conservative management with intravenous antibiotics; Group 2 (n=46), aggressive resection; Group 3 (n=16), appendectomy with intravenous antibiotics. RESULTS: Ultrasound and computed tomography (CT) detected 12 (22.6%) and 21 (87.5%) cases of right colonic diverticulitis, respectively. BE was applied to 45 patients, 28 (62.2%) of them with multiple diverticula. Right colonic diverticulitis was the preoperative diagnosis in 39 patients (43.3%). The length of hospital stay was significantly different between the groups (P<0.001): 4.9+/-3.1 days in Group 1, 7.5+/-3.7 days in Group 2, and 3.8+/-0.9 days in Group 3. Two patients (7.1%) in Group 1, 2 patients (4.3%) in Group 2, and 5 patients (31.3%) in Group 3 had recurrent diverticulitis during the follow-up period (P=0.007). The Kaplan-Meier estimated recurrence rates for Groups 1, 2, and 3 were statistically significantly different (P=0.0086). CONCLUSIONS: To differentiate right colonic diverticulitis from appendicitis, focusing on the peculiar feature in contrast to appendicitis and appropriate utilization of CT are important. If diagnosed preoperatively, uncomplicated right colonic diverticulitis can be managed by conservative management with intravenous antibiotics. If diagnosed intraoperatively, aggressive resection is advocated as the most effective method for decreasing the recurrence rate.

Anaplastic Thyroid Carcinoma with Tumor Thrombus of the Internal Jugular Vein: A Case Report / 대한내분비외과학회지

Anaplastic thryoid carcinomas are very aggressive and lethal solid tumors; they sometimes show microscopic vascular invasions, but they rarely result in tumor thrombus in the internal jugular vein or in the other great veins of the neck. We encountered a 64-year-old woman with anaplastic thyroid carcinoma and a tumor thrombus that extended from the Lt. internal jugular vein to the innominate vein. Palliative total thyroidectomy, modified radical neck dissection and segmental resection of the Lt. internal jugular vein were done, along with removal of the intravascular tumor thrombus. We recommended postoperative radiotherapy and chemotherapy, but the patient refused additional treatments. We report here on this case for which we first experienced anaplastic thryoid carcinoma associated with tumor thrombus of the internal jugular vein.

Internal Hernia in Adult Patients: Transmesenteric Hernia and Internal Hernia through a Defect of the Broad Ligament

An internal hernia is a rare disease that causes bowel obstruction. It is difficult to diagnose because the symptoms and the signs are the same as those for other obstructive diseases of the bowel. Early diagnosis and management are essential, and early surgical management may reduce complications such as ischemia, and strangulation. We experienced two cases of internal hernias. One patient underwent a laparotomy, and had a transmesenteric defect with a herniated and strangulated small bowel segment. The other patient underwent a laparoscopic surgery, and we found that the left broad ligament had a focal defect with a herniated small bowel segment. An internal hernia is an uncommon disease, and its differentiation from other obstructive diseases of the bowel is difficult. However, the clinician should consider that the internal hernia might be the cause of the bowel obstruction, especially in patient with no previous history of intra- abdominal surgery. Early diagnosis can improve the clinical outcome through early surgery.

Epidermoid Cyst in Hepatoduodenal Ligament

A 39-year-old man was admitted to our hospital because of an intermittent, epigastric, abdominal pain and abdominal bloating. Magnetic resonance Cholangiopancreatography (MRCP) showed a 4x6 cm sized heterogenous cystic mass in the hilum of the liver. The mass seemed not to have originated from the liver, but was rather located at the anterior portion of the inferior vena cava and the caudate lobe, and superior to the head of the pancreas. The common bile duct (CBD) was displaced laterally by the mass, but the other biliary tree was normal. A presumptively diagnosed hematoma or high- protein mucous component filled cystic mass was later proved to be a large mass located in the hepatoduodenal ligament on laparotomy, and was completely removed by meticulous dissection. The histopathological diagnosis confirmed an epidermoid cyst.

Clinical Analysis of an Acute Intestinal Obstruction with a Paraduodenal Hernia

PURPOSE: A paraduodenal hernia is an uncommon congenital disease that manifests as an intestinal obstruction, which may lead to strangulation and, subsequently, result in gangrene of the intestine. In this retrospective study, 12 paraduodenal hernia cases were evaluated and the clinical prognostic factors investigated. METHODS: Paraduodenal hernias leading to intestinal obstructions were noted in 12 patients. The patients were retrospectively evaluated with respect to signs and symptoms. The laboratory and radiological findings, type of operation, time elapsed between the onset of symptoms and laparotomy and postoperative complications and hospital stays were also reviewed. The relationships between clinical factors and outcomes were also statistically evaluated. RESULTS: In our series, postoperative short bowel syndrome was encountered in one patient (case 1) with bowel strangulation, but there were no mortalities. The time elapsed between the onset of symptoms and laparotomy was found to be longer in the patients with strangulation than in those without (6.8+/-4.5 day versus 4.1+/-3.6 day). Additionally, the postoperative hospital stay was longer in those patients with strangulation (24.4+/-11.6 day versus 15.3+/-7.7 day), but the relationship was not statistically significant (P=0.283 and 0.130, respectively). CONCLUSION: Since the preoperative diagnosis of a paraduodenal hernia is very difficult, due to the lack of specific signs and symptoms, the postoperative complications can only be decreased with early surgical intervention in those patients with an acute intestinal obstruction. Although the postoperative morbidity and mortality were not correlated with any of the factors evaluated in this study, further study will be needed to evaluate the significance of the time elapsed between the onset of symptoms and a laparotomy as a prognostic factor.

Deep Vein Thrombosis after Surgery for Gastrointestinal Cancer: Incidence and Correlation with Risk Factors

PURPOSE: Deep vein thrombosis (DVT) is recognized as a common complication in surgical patients in western countries, and especially for high risk patients. However there is little informations on the incidence and risk factors of DVT after gastrointestinal cancer surgery in Korea. The aim of this study is to evaluate the incidence and risk factors of DVT after gastrointestinal cancer surgery that is performed without antithrombotic prophylaxis. METHOD: From August 2003 to February 2004, 107 patients who underwent gastrointestinal cancer surgery were evaluated prospectively. Hypercoagulability studies were done before the operation or before any blood transfusion, and the other clinical risk factors were also examined. All the patients were examined between the 5th and 10th postoperative day with duplex ultrasonographic assessment of both lower extremities. RESULT: DVT was found in 8 patients (7.5%) and two patients had symptomatic DVT. Five patients showed thrombi in there calf veins, two patients in the popliteal vein, and one patient in the iliac vein. The DVT group showed a significantly higher incidence of hyperhomocysteinemia than non-DVT group. There was no statistically significant difference between the DVT and non-DVT group according to other risk factors. CONCLUSION: The incidence of DVT after intra-abdominal cancer surgery in Koreans is significantly lower than for the patients in western countries. Considering the lower rate of proximal DVT, routine prophylaxis for DVT appears to be unwarranted in Koreans before and after intra-abdominal cancer surgery. Finally we did not identify a correlation between DVT and the so-call risk factors except for hyperhomocysteinemia. It would be interesting to perform further studies to clarify the association between hyperhomocysteinemia and DVT in cancer patients.

Ruptured Solitary Splenic Metastasis of Gastric Cancer after Gastric Cancer Operation

Solitary malignant splenic metastasis is uncommon and usually occurs in association with widely disseminated metastatic disease. Splenic metastasis usually occurs late in the disease course, with widespread involvement of other organs and rarely shows any presenting symptoms. Virtually all primary tumors have been known to metastasize to the spleen. The common ones include melanoma, lung, breast and ovary cancer, but metastasis from gastric cancer is very rare. When solitary spleen metastasis is suspected in a clinical setting, aggressive treatment is indicated such as splenectomy followed by combined modality treatment to prevent dissemination of the disease. We experienced a case of solitary spleen metastasis and rupture after gastric cancer operation and reviewed the associated literatures.

The Expression of NIS and Pendrin in Thyroid Cancer Tissues with Real Time RT-PCR / 대한내분비외과학회지

PURPOSE: It has not been clearly investigated how iodine can be trapped from the extracellular space into thyroid follicular cells, the defective iodide-trapping mechanism appears to be an early and constant feature during oncogenic transformation of thyroid cells. In recent studies, NIS and pendrin are associated with the trapping process. Thus, in order to reveal this uncertain relationship, each of the quantitative expressions of NIS and pendrin in various thyroid tissues were evaluated by real time RT-PCR. METHODS: This study included 63 patients who had undergone thyroidectomy in Uijongbu St. Mary's hospital from Jan. 2000 to Jan. 2003. 13 cases of normal thyroid, 17 cases of hypofunctioning thyroid adenomas, and 33 cases of thyroid cancer were examined. The thyroid cancer group was further divided into high and low risk group according to the AMES score, and the NIS and pendrin levels were compared between the two groups. Real time RT-PCR was conducted with the extracted RNAs, using GAPDH as the control. RESULTS: As for pendrin, its expression was decreased by 7% in the thyroid adenoma group compared with that of normal thyroid, while there was a 59% decrease in thyroid cancer cases. NIS expression was decreased by 20% in the thyroid adenoma group, and a 40% decrease was found in thyroid cancer group. Due to the impediment of pendrin in both high and low risk group of thyroid cancer, there was a 19% decrease in the high risk group compared with the low risk group. As for the impediment of NIS in the high risk group, an increase of 30% was found. However, no statistical significance was shown (P=0.344 vs P=0.688). CONCLUSION: According to this study, it can be inferred that the decrease in the expressions of NIS and pendrin are related to tumorigenesis of thyroid cancer. Also, further research is needed to reveal the cause of genetic transformation, as well as the value of utilization of NIS and pendrin as tumor markers.

The First Case of Intraperitoneal Bronchogenic Cyst in Korea Mimicking a Gallbladder Tumor

We present a case of an intraperitoneal bronchogenic cyst located at inferior surface of the liver, next to the gallbladder which clinically mimicked a gallbladder tumor. This is the first case reported in Korea, and we offer reviews of the related literatures. A 48-yr-old woman was admitted to our hospital because of intermittent abdominal pain in right upper quadrant. Computed tomography showed a large mass alongside the gallbladder. During laparotomy, the mass showed an ovoid cystic nature, which was attached to the normal gallbladder and liver bed. Cyst excision with cholecystectomy was performed, and histopathological examination revealed a bronchogenic cyst. Most bronchogenic cysts have a benign nature, but malignant changes have also been reported. Therefore, if a cystic tumor in the abdomen is suspected during preoperative diagnosis, a bronchogenic cyst should be considered in the differential diagnosis.