Cancer Research and Treatment

Pathologic Observatiosn and P-glycoprotein Expression in Esophageal Carcinomas Treated with Preoperative chemotherapy: Chang Won Ha, Kyung Ja Cho, Young Mog Shim, Jae Ill Zo, Ja June Jang; J Korean Cancer Assoc. 1994;26(4):529-534.

Abstract PDF: Neoadjuvant chemotherpay of esophageal cancers is recently considered to be beneficial to downstaging of tumors. This study was aimed ta describe morphologic alterations and expression of P-glycoprotein in esophageal cancers after chemotherapy and discuse their clinical sig- nificances. Eleven cases of esophageal cancers which were surgicelly resected l-5 cycles of chemotherapy with C-DDP/VP-16/5-FU(PEF)or C-DDP/5-FU(FP) were reviewed. On microscopic examination, all of ll cases(100%) revealed no major pathologic alterations. Only five cases(45%) showed non-specific partial pathologic responses, histologically observing foreign body reaction, calcification, necrosis, desmoplasia, vascular dilatation, and nuclear anaplasia. The changes were also observed in metastatic tumors in regional lymph nodes. The presence of non-specific pathologic responses and downstaging of tumors did not correlate each other. Immunohistochemically, all of the cases were negative for P-glycoprotein. Our data suggest that PEF or FP neoadjuvant chemotherpay for esophageal cancers is ineffecitive.

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The Prognosis and Expression of p53 , c-erbB-2 in Gastric Cancer Patients: Young Don Kim, Jong Inn Lee, Yong Kyu Kim, Nan Mo Moon, Nam Sun Paik, Dong Wook Choi, Dae Yong Hwang, Ja June Jang, Han Kwang Yang; J Korean Cancer Assoc. 1994;26(4):534-544.

Abstract PDF: Authors studied the ovcrexpression of p53 and c-erbB-2 in 278 gastric cancer patients who were operated in KCCH from 1985 Jan. to 1987 Jan., by immunohistochemical staining using ar- chival paraffin embedded tissue and the possibility of them as prognostic factors. Overall overexpression rate was 39.2% for p53 and 15.1% for c-erbB-2 respectively. There were no dif- ferences in overexpression rate according to sex, age, Borrmann type, depth of tumor, nodal metastasis, growth pattern, lymphatic or venous invasion, tumor size and distant organ metastasis in both p53 and c-erbB-2. The overexpression rate of c-erbB-2 of well or moderately differentiated type and that of Laurens intestinal type were higher than that of paorly differentiated type and diffuse type. Overall cumulative five year survival rates of positive group for p53 and c-erbB-2 were slightly lower than those of negative group, but the differences of them were not significant. However, cumulative five year survival rate of positive group for c-erbB-2 in intestinal type cancer was lower than that of negative group significantly (0. 035I). So, we suggest that c-erbB-2 overexpression could be a prognostic factor in gastric cancer, especially in intestinal type.

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Analysis of Advanced Gastric Cancer Patients Using Computer Program Adopted by Korean Reasrch Association for Gastric Cancer: Hwan Young Yoo, Jin Pok Kim; J Korean Cancer Assoc. 1994;26(4):544-554.

Abstract PDF: Gastric cancer is the most common cancer in Korea, and nowadays, multicenter analysis for the gastric cancer may be necessary to improve the management and survival of the patients with gastric cancers. So, Korean Research Association for Gastric Cancer (KRAGC) adopted a computer program (a database program which is made by Joon Yang Noh, Department of General Surgery, Lee Rha General Hospital) that may be used by surgeona who deal with the gastric cancers. By saving and storing the data of the patients into the computer, using this program, multicenter analysis as well as analysis in a center would be feasible. But each hospital would have collective data with its own data format which is different from that of the pro- gram of KRAGC, by which data compatibility would not be easy. For being some help in data conversion to be compatible with the program issued by the KRAGC, authors analysed the formats of the data file of the program and converted our data (795 cases of gastric cancers operated in 1987 and 1988) format to be fit for the program of the KRAGC, although all the fields could not be matched. The results of analysis of our cases using the program are as follows. 1) Gastric cancers were 1.8 times more prevalent in male and 82.4% of the patients distributed in third to fifth decades. 2) The most common location of gatric cancers was antrum (481 cases, 60.5%), followed by body (280 cases, 35.2%) and gastric cardia (34 cases, 4.3%). 3) The most prevalent cancer stage was IIIb (318 cases, 40.0%). 4) Subtotal gastrectomy was performed most commonly (522 cases, 65.6%), as the curative op- eration. 5) Five year survival rate of the patients was 39.4%.

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Differentiation of Beign and Malignant Liver Diseases Using Lectin - reactive Alpha - fetoprotein: Woo Sik Jung, Mu Seon Chang, Seung U Sohn, Ki Su Han, Chang Jae Sohn, Byung Chul Yoo, Sang Jae Lee, Sill Moo Park, Young Joo Cha; J Korean Cancer Assoc. 1994;26(4):554-561.

Abstract PDF: Alpha-fetoprotein (AFP) is an oncofetal protein whose serum levels have been investigated for use as a diagnostic marker for hepatocellular carcinoma (HCC) and other tumors. Unfortu- nately serum AFP concentrations of patients having small HCC or benign liver diseases such as chronic hepatitis or liver cirrhosis frequently overlap. Consequently a more specific marker to discriminate HCC from other benign liver diseases is desired. Although total serum AFP concentrations do not often correlate with presence of this diseases, AFP microheterogeneity may be more related to liver disease status. Human AFP carbo- hydrate chain heterogeneity has been investigated using a sensitive method based on lectin-af- finity electrophoresis and antibody-affinity blotting. In the presented study, AFP was differentiated in the serum of HCC and benign liver diseases with elevated serum AFP levels by AFP differentiation 'klt L' using lectin-affinity electrophoresis and antibody-affinity blotting and then 'kit L' was valued in the distinguishing between malignant and benign liver diseases. Twenty patients (10 HCC patients, 6 liver cirrhosis, 2 chronic active hepatitis, 2 acute viral hepatitis) with serum AFP concentrations over 100 ng/ml were included in this study. Serum specimen was diluted to 100 ng/ml of AFP level with a normal serum. Electrophoresis using lectin-containing agarose gel resulted in the separated migration of different types of AFP according to specific reactivities to lectin. Subsequently the AFP on the agarose gel was transferred onto anti-AFP antibody (equinei-coated nitrocellulose membrane using antibody- affinity blotting. It was then allowed to react with anti-AFP antibody (rabbit) and with peroxi- dase-labeled anti-rabbit IgG antibody (gout), forming an immunocomplex on the nitrocellulose membrane. The bands of sample AFP were thus stained by the tetrazolium method, distinguishing them from standard tumor-type AFP. The results were as following. 1) Only Ll band was detected in the serum of l0 patients with benign liver diseases 2) Ll band was detected in the serum of 10 patients with HCC and L3 band was also detected in the serum of 9 patients with HCC. Correlation of data with disease status suggests that the methods can greatly facilitate the discrimination between benign and malignant liver diaeases with elevated serum AFP levels. And then the further study is needed whether the methods is valuable in the conditions with the serum AFP level below 100 ng/mL

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Concurrent Chemoradiotherapy of Locally Advanced Pancreatic Carcinoma and Effects of Hyperthemia: Myung Wook Kim, Kyung Hee Lee, Jae Bok Chung, Jin Sil Sung, Hye Ran Lee, Jin Hyuk Chil, Hyun Cheol Chung, Woo Cheol Kim, Ki Chang Keum, Joo Hang Kim, Jae Kyung Roh, Byung Soo Kim; J Korean Cancer Assoc. 1994;26(4):561-567.

Abstract PDF: The prognosis of pancreati cancer is still poor in spite of advance in surgical treatment and parasurgical adjuvant management. Eighteen patients with histologically confirmed locally advanced adenocarcinoma of the pancreas were received radiation(5000cGy)+5-FU. Patients were treated with 5-FU 200 mg/m IV bolus, 1 hour before irradiation each day. In some patients, within 30 minutes after radiotherapy, hyperthemia was added to above protocol two times weekly. Median survival of total patients was 9.5months. Median survival with RT+ 5-FU was 12.7months from the date of treatment. Median survival with hyperthemia added group was 7.6months, but the survival dif- ference was not significant statistically. The side effects were acceptable. There were no episodes of any life threatening toxicities.

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Expression of Epidermal Growth Fasctor Receptor in Breast Cancer Detected by Immunothistochemical Stain in Breast Cancer: Yong Sung Won, Nam Il Kim, Jung Soo Kim, Hae Myung Jeon, Eung Kook Kim, Jae Kwang Kim; J Korean Cancer Assoc. 1994;26(4):567-576.

Abstract PDF: Recently, several growth factors, growth factor receptors and oncogenes have been investigated to find out their relations and potential roles in the development and progression of human cancers. Among them, epidermal growth factor receptors (EGFR) have been found in normal and malignant human breast tissues. The purpose of this study was to find out the relation between the expression of EGFR and clinical stage, tumor size, estrogen and progesterone receptor status. We used an improved immunohistochemical staining method for identification of EGFR in formalin-fixed paraffin-embedded section of 45 human breast cancer tissues, 10 normal breast tissues around the cancer masses, l2 metastatic lymph nodes, and 10 breast benign tumor tis- sues using monoclonal antibodies against EGFR. The results were as follows: 1) Immunoreactivity of EGFR was in 57.8% (28/45) of breast cancer tissues, in 10.0% (1/10) of noncancerous breast tissues, in 16.7% (2/12) of metastatic lymph nodes, and in 20.0% (2/10) of benign tmor tissues. 2) The immunoreactivity of EGFR was related to clinical stage; positivity of stage I was 60.0 % (3/5), stage II was 6L1% (l8/29), and stage III was 45.5% (5/1 1 ), respectively. 3) The positivity of EGFR was related to tumor size; positivity of tumor size 0-2 cm was 60.0 / (3/5), tumor size 2-5 cm 61.3% (19/31), tumor size > 5 cm was 44.4% (4/9), respectively. 4) The intensity of EGFR immunoreactivity was increased in stage I and II. 5) Expression of EGFR had an inverse relation between both estrogen and progesterone re- ceptor expressions. with above results, authors considered the expression of EGFR may play an important role in early stage of human breast cancer development, growth and proliferation. And according to the relationship between estrogen receptor and progesterone receptor status, EGFR may offer an additional factor in prognosis of breast cancer.

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Ductal Carcinoma In Situ of Breast: Seong Taek Oh, Sang Seol Jung, Ick Myung Kim, In Chul Kim; J Korean Cancer Assoc. 1994;26(4):576-582.

Abstract PDF: Ductal carcinoma in situ(DCIS)has traditionally been considered a very rare form of breast cancer. However, with mammography as a screening tool, the number of cases has increased markedly in western reports. To determine the clinical and histopathological characteristics, the outcomes of 15 women with ductal carcinoma in situ treated at Kangnam St. Mary's Hospital between 1983 and 1993 are studied retrospecitively. The results were as follow: 1) The prevalent rate of DCIS is 2.9%(15 out of 519 cases). 2) Age specific percentage of DCIS shows peak in their 40's. 3) The most initial manifestation is a palpable mass and nipple discharge(12 cases: 80.0%) but in 3 cases mammographic microcalcification is the only abnormal finding. 4) Average extent of the lesion is 29.8mm, ranged from 9mm to 90mm. 5) There is one multicentric and one multifocal disease out of 15 cases respectively. 6) 7 cases(46.7%) have microinvasion which is all comedo type DCIS. 7) The most common pathologic subtype is comedo type DCIS(80.0%, 12 out of 15 cases), fol- lowed by papillo-tubular type. 8) Hormone receptor status in evaluable 4 cases reveals ER(-), PgR(-). 9) Modified radical mastectomy was done in 13 cases(86.7%) and breast preserving surgery was done in 2 cases. 10) One local recurrence has occured(recurrence rate: 6.7%) in the ipsilateral breast at 28 months after modified radical mastectomy who eventually died because of systemic metastasis at the postoperative 3 years. In spite of short fo11ow-up periods, the author conclude that DCIS is regarded as an early stage of malignant disease and its outcome after surgery is good. In the future, as a result of widespread application of screening mammography, the incidence of DCIS could be increased and the tool for selecting aggressive form of DCIS should be developed.

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A Study on the Value of Serum Phosphohexose Isomerase ( PHI ) as a Tumor Marker: Kek Ryong Lee, Sang Soon Kim; J Korean Cancer Assoc. 1994;26(4):582-591.

Abstract PDF: To evaluate the diagnostic validity of glycolytic enzyme phosphohexose isomerase(PHI) as a serum tumor marker, especially for the stomach cancer, authors prospectively checked the serum PHI in 97 malignant patients of gastrointestinal, hepato-biliary-pancreas and breast tu- mors prior to primary treatment for 16 months and analyzed them according to stage and com- pared with other tumor markers (CEA, AFP, CA19-9, CA50, CA15-3, TPA, serum Ferritin). To assess the specificity, serum PHI activities were measured in 21 patient' with inflammation and benign diseases and 10 ulcer patients. 26 control groups were all screened by CBC, LFT and RFT as well as serum PHI. The obtained results revealed that the elevated serum level of other tumor markers (CEA, AFP, CA19-9, CA50, serum Ferritin) in gastrointestinal cancer patients was lesser than 34%, but PHL was elevated in 53.Z% (P<0.05). Especially in stomach cancer, serum elevation of other tumor markers was lesser than l6%, but PHI was elevated about 46% (P<0.05). And these results showed no corelation strictly increased serum level according to stage. In breast cancer, the diagnostic sensitivity of PHI was low (14.3%). In conclusion, even though PHI revesled higher sensitivity in GI cancer diagnosis than any other tumor markers, PHI lacked the specificity compared with inflammation, benign and ulcer diseases snd did not reflect the radicality of gastric tumor. Nevertheless, it suggests that serum PHI can be used for the screening of stomach cancer, and diagnosis of recurrence as a tumor marker.

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Antigen Receptor Gene Rearrangement Patterans of Acute Lymphoblastic Leukemia - Preliminary study of detection of residual leukemic cells using polymerase chain r: Kyung Sam Cho, Young Il Kim, Seon Hee Kim, Si Young Kim, Hwi Joong Yoon; J Korean Cancer Assoc. 1994;26(4):591-599.

Abstract PDF: 1) Background: Polymerase chain reaction (PCR) is a highly sensitive method to detect minimal residual disease (MRD). Although leukemia-specific translocations are detected only in minority of patients with acute lymphoblastic leukemia (ALL), several investigators developed methods to detect MRD by PCR, based on preferential usage of specific genetic elements, the limited number of VB and JB elements of T cell receptor (TCR) delta gene, and assembled V regions of immunoglobulin (Ig) gene containing re1atively conserved base sequences. 2) Methods: We evaluated antigen receptor gene rearrangement patterns of leukemic cells from ALL patients by southern blot technique, as a baseline study for the detection of MRD using PCR. 3) Results: Rearrangements of Ig heavy chain, TCR beta, gamma and delta chain gene were found in 68%, 68%, 64%, 9B% of patients respectively. So thern analysis of HindIII digests with JBS16 probe showed Vδ[Jδ] rearrangement in only 4 cases. 4) Conclusion: Heavy chain gene rearrangement is more suitable target for the application of PCR than TCR delta gene rearrangements for detection of MRD in ALL.

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Atrial Natriuretic Peptide Inhibits the Growth of HeLa Cells: Han Kwang Yang, Yoshinobu Ohsaki, Bruce E . Johnson; J Korean Cancer Assoc. 1994;26(4):599-607.

Abstract PDF: Natriuretic peptide, HeLa cells, c-GMP, growth

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Effect of Steroid Hormone on the Expression of Cytokine Genes in the Peritoneal Macrophages of Mouse: Jong Suk Oh, Gi Young Im, Jin Jeong, Sun Sik Chung, Hyun Hul Lee; J Korean Cancer Assoc. 1994;26(4):607-618.

Abstract PDF: Macrophages have been known to produce monokines and to involve to the cytotoxic activity against microorganisms or tumor cells. Using murine peritoneal macrophages the effect of interferon-r(rIFN), lipopolysaccharide (LPS), 1,25 dihydroxy-vitamin D,(DHVD,) or dexamethasone alone or in combination was as- sessed on the expression of interleukin-1 and tumor necrosis factor, the production of nitric oxide (NO) and the tumoricidal activity against lymphocytic leukemic cell L1210. The results were as follows; 1) The activity of interleukin-1 was increased in the murine peritoneal macrophages treated with combination of rIFN and LPS, compared with control cells and the cells treated with each agent alone, and decreased by adding DHVD or dexamethasone. 2) The activity of tumor necrosis factor in the combined rIFN and LPS-treated cells was increased in comparison with the cells treated with each agent alone. It was not affected in the combined rIFN and LPS-treated cells by adding DHVD, while being considerably decreased by adding dexamethasone. 3) The expression of tumor necrosis factor mRNA was significantly increased in the combined rIFN and LPS-treated cells. By the addition of DHVD, the expression was a little decreased, while being considerably decreased by adding dexamethasone. 4) The production of NO was significantly increased in the cells treated with combination of rIFN and LPS, compared with the cells treated with each agent alone. By the addition of DHVD the production amount of NO in the combined rIFN and LPS-treated cells wasnt changed, however by the addition of dexamethasone the production was suppressed. 5) The tumoricidal activity of cells was significantly increased in the rlFN and LPS-treated cells, compared with the single agent-treated cells. This increased activity wasnt changed by the addition of DHVDhowever, suppressed by the addition of dexamethasone. These results indicate that DHVD slightly affects the expression of cytokine genes and the tumoricidal activity against murine lymphocytic leukemic cell LI210 in murine peritoneal macrophages, while dexamethasone considerably suppresses them.

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Methotrexate , Vinblastine , Doxorubicin and Cisplatin: Jin Soo Chung, Hyeon Hoe Kim, Chong Wook Lee; J Korean Cancer Assoc. 1994;26(4):618-626.

Abstract PDF: A study was performed to evaluated the effect of M-VAC(methotrexate, vinblastine, doxorubicin and cisplatin) chematheraty for advanced transitional cell carcinoma of the urinary tract. During July 1987 to June 1993, sixty eight patients with histologically proven advanced transitional cell carcinoma were treated with M-VAC chemotherapy at Seoul National University HospitaL Amang them, 43 patients with index lesions who received more than 2 cycles of chemotherapy, and were adequately followed up were analyzed for M-VAC chematherapy. Thirty nine patients were men and 4 women with the median age of 59 years. They were followed for 9 to 61 months with the median of 27 months after completion of chemotherapy. Of 43 eligible patients, complete remission was found in 9 patients(20.9%) and partial remis- sion in 1 l(25.6%), showing 46.5% of overa11 response rate. The overall median survival of the 43 patients were 14 months. In 9 patients with complete remission, the median duration of remis- sion was more than 20 months and median survival was more than 25 months with the two year survival rate of 100%. In 11 patients with partial remission, the median duration of remission was 11 months and median survival was 19 months with the one year survial rate of 81.8% and two year survival rate of 30%. The median survial of the 23 nonresponders was 10 months, with one and two year survival rate of 39.1% and 4.8%. Of the l4 patients with lymph node metastasis without any distant metastasis, 7 patients(50%) showed complete remission and another 3 patients(21.4%) showed partial remission, with the overall response rate of 72.4%. In con- trary, of the 29 patients with distant metastasis with or without nodal metastasis, the overall response rate was 34.5% including complete remission of only in 2 patients(6.9%). Toxicity was not negligible. Myelosuppression was observed in 58.1% of the patients, sepsis in 11.6/, renal toxicity in 48.8% and mucositis in 39.5%, but chemotherpy related death was not observed. M-VAC chemotherapy is apparently beneficial in patients with advanced transitional cell carcinoma of the urinary tract, especially with nodal metastasis, despite significant toxicity.

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Electron Beam Therapy for the skin Cancer: Ki Mun Kang, Ihl Bohng Choi, Baik Kee Cho, Su Mi Chung, In Ah Kim, Kyung Sub Shinn; J Korean Cancer Assoc. 1994;26(4):626-631.

Abstract PDF: Purpose
This study was designed to determine the efficacy of electron beam therapy in skin cancer. Materials and Methods: From January l988 to March 1993, sixteen patients diagnosed as skin cancer of the face were treated by electron beam therapy at St. Marys HospitaL There were 8 men and 8 women. The median age was 62 years and the range 45 to 80 years. Twelve (75%) patietns had basal cell carcinoma, and 4(25%) patients had squamous cell carcinoma. According to American Joint Committee(AJC) classification, 12(75%) patients had Tl, and 4(25%) patients had T2. The median radiation dose was 5570 cGy in 5-7 weeks (range; 3980-7000 cGy). The median follow-up was 25.5 months with a range of 6 to 68 months. Results: The overall local control rate was 93.8% (15/16). By histologic classification, the local control rate was 91.7%(11/12) for basal cell carcinoma and 100%(4/4) for squamous cell carcinoma. The local control rate was 100%(12/12) for Tl, and 75%(3/4) for T2, Treatment induced complication was observed in 6.2%(l/16). Cosmetic outcomes were excellent to good in 93.8/(15 /16) of patients. Conclusion: For the skin cancer, especially in the face, electron beam therapy was a safe and effective modality and offered excellent cosmesis.

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Preoperative Chemotherapy in Wilms Tumor: Chuhl Joo Lyu, Byung Soo Kim, Woo Hee Jungn, Chang Ok Suh, Seung Kang Choi, Eui Ho Hwang; J Korean Cancer Assoc. 1994;26(4):631-637.

Abstract PDF: From l988, the use of preoperative chemotherapy for selected Wilms tumor was adopted at Yonsei Cancer Center. Between 1988 and 1992, 10 children has given preoperative chemotherapy. During that period, 21 children with Wilms tumor underwent primary nephrectomy(postop- erative treatment group). The criteria for preoperative chemotherapy were (a) initial surgical removal is excessively hazardous to patient (b) inoperable because of large size or extent of disease (c) patient with vena cava or atrial extension (d) radiologic evidence of extensive local invasion of adjacent or- gans or distant metastasis. After preaperative treatment, the tumor size was markedly(>50%) reduced in five patients. In all patients, nephrectomy was performed safely without rupture of tumor. Except stage IV patients, the dawnstaging may reduced the use of radiotherapy during ad)uvant treatment. The 3-year survival rate for patients with preoperative chemotherapy was 80%. The survival of the preoperative chemotherapy group was similar to that in the postoperative treatment group(2-year survival rate; 80% vs 84%). But there was a higher rate of local recurrence in preoperative chemotherapy group. We conclude that preoperative chemotherapy is the effective method of treatment in the selected cases of Wilms tumor.

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Radiotheraphy of Chondrosarcoma of Bone - A review of 12 cases -: Charn Il Park, Won Dong Kim; J Korean Cancer Assoc. 1994;26(4):637-642.

Abstract PDF: Twelve patients with chondrosarcoma of bone who were treated with radiotherapy at the Seoul National University Hospital between 1979 and 1992 were reviewed. Of the 12 patients, 9 patients were classified with grade I or II chondrosarcoma and 3 patients with mesenchymal or dedifferentiated chondrosarcoma. 3 patients received radiotherapy alone and 9 patients received surgery and postoperative radiotherapy. Tumor doses ranged from 54 Gy to 70 Gy. With a median follow-up of 30 months, three patients died: two with uncontrolled local disease and one with distant metastasis. The remaining 9 patients(75%, 9/12) showed the long-term survival after radiotherapy, which suggests that radiotherapy may be contributed to improve the local control or cure rate in the management of chondrasarcoma of the bone.

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Hereditary Breast Cancer : Report of three families: Hwan Young Yoo, Sun Whe Kim, Jae Gahb Park, Kuk Jin Choe; J Korean Cancer Assoc. 1994;26(4):642-650.

Abstract PDF: Hereditary breast cancer (HBC) is known to comprise about 5% of all breast cancers. HBC is also known to have early age of onset, be usually bilateral, snd have genetic heterogeneity and verticaI transmission by autosomal dominant pattern. Authors experienced three Korean families with hereditary breast cancer, sa hereby report the cases. A 71-year old female patient (proband of family SNU-Bl) visited our clinic with the chief complaint of upper outer quadrant mass in right breast. She had the past medical history of right nephrectomy four years ago due to renal cell carcinoma. On family history patients younger sister died with uterine cancer. Patients daughter had modified radical mastectomy due to breast cancer at the age of 36 years. Other family members had no specific medical history. The second family (SNU-B2) had three breast cancer patients associated with gastrointestinal tract cancer patients; they occurred between sisters. Their father died with advanced gastric cancer at the age of 67 years, and two elder brothers of the sisters had lung cancer and rectal cancer, each. Other family member had no specific medical history. The third family (SNU-B3) involves twenty-five-year old female patient (proband of SNU- B3) who visited our clinic due to the bilateral breast masses. Mammography and subsectuent fine needle aspiration cytology revealed that both breast mass contained malignant cells. Uterine mass and mutiple solid and cystic left ovarian masses were found by pelvic ultrasonography. On family history, Patients mother had had metachronous bilateral breast cancers at the premenopausal age and died of multiple metastases, and patients sister was found ta have breast cancer. She discharged without treatment by her wilL With the progress of molecular biology, genetic meohanisms of HBC will be found. As HBC has different diagnostic and therapeutic implications, and careful history taking can reveal this entity, it may be the surgeonss responsibility to detect HBC.

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Invasive Thymoma Metastasizing to Supraclavicular Lymph Node - A case report -: Weon Seo Park, Kyeong Cheon Jung, Chul Woo Kim, Seong Hoe Park; J Korean Cancer Assoc. 1994;26(4):650-657.

Abstract PDF: Malignant thymoma is classified into two groups as type I and II according to the clinical features and histologic characteristics. The type I malignant thymoma is called as invasive thymoma and this group of thymoma can invade to mediastinum, lung and cervical lymph node. The type II malignant thymoma is known as thymic carcinoma and categorized inta true malignant tumor which can metastssize to distant organs. However, new disease entity well differentiated thymic carcinoma" was established by some authors based on the histologic features. We have recently experienced a case of invasive thymoma which metastasized to supraclavicular lymph node. The histologic findings of this case showed the same features of well differentiated thymic carcinoma described previously. We report this case with emphasis to pathological examination and immunohistologic characteristics. A 46-year-old male patient admitted because of recurrent and combined pneumonia. Norcardia, pseudomonas, acinetobacter, and Staphylococcus:cus aureus were found in the pleural effusion and sputum. The pneumonic consolidation was found in both lung field and empyema was noted in the left lung field. Multiple lymph nodes were palpable in the left supraclavicular areas. Biopsy was done with the clinical impression of malignancy. Two lymph nodes were excised, measuring 1.0 cm and 0.8 cm respectively. Microscopica11y thge lymph node was replaced with lobulated mass composed of epithelial cells and lymphocytes. The epithelial cells were round to ovoid and had small round eosinophilic and prominent nucleoli. Perivascular palisadng and perivascular spaces, which was described as organoid differentiation of well differentiated thymic carcinoma, were frequently found. The epithelial components were positive to CAM 5.2(anti-cytokeratin antibody). The lymphocytes were positive to JLl and CD45RO, and negative to CD45RB and L26(CD20, pan-B). In conclusion, the tumor showed features of thymoma histologically and immunohistocbemically. Later, it was proved that the patient had experienced thymectomy due to myasthenia gravis six years ago. The pathological features of the excised thymoma were aame as metastatic supraclavicular mass. We conclude that careful examination to search for capsular invasion is needed in thymoma to rule out invasive thymoma. Additionally, anti-JLI monoclonal antibody is useful for the diagnosis of the thymoma, since it is expressed only in the immature cortical thymocytes.

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Small Cell Carcinoma with Two Paraneoplastic Syndromes: Dong Il Park, You Hern Ahn, In Soon Kim; J Korean Cancer Assoc. 1994;26(4):657-665.

Abstract PDF: The production of hormones by nonendocrine tumors with resultant clinical syndromes secondary to hormone excess is a well-recognized concomitant of neoplasia. Approximately 15 hormones have been reported to be ectopically secreted by more than 20 different tumor types. Although small cell carcinoma of the lung produces a wide variety of peptide hormones including ADH, ACTH and related fragments, calcitonin and serotonin, ectopic production of ADH and corticotropin are seen most frequently. The simultaneous presence of both syndromes has been reported in the literature only several occasians. We experienced a case of small cell carcinoma of the lung with two paraendocrine syndromes. A 53-year-old man was seen at the nephrology department of Hangyang University Hospital on Jan#. 29, 1994. His history was significant for 3 months of hunger pain, peripheral edema and muscle weakness. He had no history of previous illness except for l month duration of mild hypertension. On physical examination, 3 cm sized right supraclavicular lymph node was palpable with a blood pressure of 150/l00 mmHg. He had no truncal obesity or abnormal skin pigmentation. Initial laboratory studies showed the following values: sodium, 109 mEq/l: potassium, 3.7 mEq/l; chloride, 91 mEq/l; bicarbonate, 22.5 mEq/l; glucose, 229 mg/dl. A diagnosis of the SIADH was considered because of the hyponatremia and the euvolemic status of the patient. The serum osmolarity was 233 mosm/kg with a less-than dilute urine osmolarity of 260 mosm/kg & 24-hour urinary sodium excretion was 104 mEq/day. Results of thyroid studies were within normal limits. The biopsy of right supraclavicular lymph node revealed metastatic small cell carcinoma. A diagnosis of ectopic ACTH production was persued to explain the development of hypertension, hyperglycemia and peripheral edema. 24-hour urine for free cortisol level was 186 pg/day (normal 10~80pg/day) & an AM ACTH level (281 pg/ml, normal, 20~100 pg/ml) was high in the presence of high cortisol level (25.69 ug/dl). Results of computed tomography of the chest showed a small mass in the right lower lobe with invasion to right inferior pulmonary vein and left atrium along with metastatic lesions in the left lobe of the liver.

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A Case of Pleomorphic Laryngeal Rhabdomyosarcoma in an Adult: Choong Won Lee, Yeong Mook Kim, Jeong Youl Oh, Jeong Suk Choi, Soon Chul Hwang, Ok Ji Paik; J Korean Cancer Assoc. 1994;26(4):665-670.

Abstract PDF: Rhabdomyosarcoma (RMS) is malignant tumor and develops from the embryonal mesenchyme which give rise to striated muscle. Laryngeal localization of RMS is extremely rare. Cel- lular differentiation may be very different in this tumor and attempts have been made to correlated the morphological patterns with clinical course. A 39-year-old male suffered from hoarseness and dyspnea, visited to the department of inter- nal medicine, Wallace Memorial Baptist Hospital. Local excisional biopsy under indirect laryn- goscopy was done. A biopsy with review and compare it with previous reports.

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A Case of Infantile ( Desmoid - type ) Fibromatosis: Doo Sun Lee, Byung Yong Jung; J Korean Cancer Assoc. 1994;26(4):670-677.

Abstract PDF: Infantile(desmoid-type) fibromatosis, which represents the childhood counterpart of musculoaponeurotic fibromatosis(abdominal or extra-abdominal desmoid), usually arises as a solitary mass in skeletal muscle or in the adjacent fascia, aponeurosis, or periosteum. It chiefly affects children from birth to 5 years of age and shows considerable variations in its morphological appearacne that range from primitive mesenchymal forms to lesions that closely resemble adult desmoids except for the less uniform pattern and greater degree of cellularity. This tumor is a rare benign, but potentially locally aggresive lesion that is best treated by wide local resection. It has been confused with congenital fibrosarcoma and other soft tissue malignant tumors. One case of infantile fibromatosis affecting left gluteal region is reported.

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