PURPOSE: Incidental parathyroidectomy is the most common and unexpected consequence of a total thyroidectomy. It can cause hypocalcemia symptoms such as muscle cramping and even seizures. We conducted this study to compare several factors including the preservation rate of parathyroid glands during both a bilateral axillo-breast approach endoscopic thyroidectomy (BABA) and a conventional open thyroidectomy (CT) for papillary thyroid carcinomas. METHODS: We retrospectively reviewed the medical records of 299 papillary thyroid cancer patients who had a total thyroidectomy between January 2008 and December 2011. We grouped the patients into two groups: BABA (n=70) and CT (n=229). We analyzed age, tumor size, operation time, the number of preserved and removed parathyroid glands, amount and duration of seroma drainage, pain score, hypocalcemia symptoms, and serum total calcium level in both the BABA and CT groups. RESULTS: We observed a younger age (under 45 years old) (P=0.000), smaller tumor size (P=0.000), longer operation time (P=0.000), larger amount of drainage (P=0.000), longer duration of drainage (P=0.007), and larger pain score (P=0.000) in the BABA group. Of the 70 patients that received an endoscopic thyroidectomy, we preserved all four parathyroid glands in 56 patients (78.6%). Of the 229 patients that received an open thyroidectomy, we preserved all four parathyroid glands in 141 patients (61.6%, P=0.004). CONCLUSION: BABA results in more extensive tissue damage over a longer period of time than CT. However, BABA was an excellent method for preserving parathyroid glands when compared with CT for thyroid carcinoma. Thus, it seems to be feasible performing BABA when it matches the indications.
Calcium ; Drainage ; Humans ; Hypocalcemia ; Hypoparathyroidism ; Medical Records ; Methods ; Muscle Cramp ; Parathyroid Glands* ; Parathyroidectomy ; Retrospective Studies ; Seizures ; Seroma ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy*

PURPOSE: Local recurrence is a major concern in patients who have undergone surgery for ductal carcinoma in situ (DCIS). The present study assessed whether the expression levels of hormone receptors, human epidermal growth factor receptor 2 (HER2), and Ki-67, as well as resection margin status, tumor grade, age at diagnosis, and adjuvant hormonal therapy and radiotherapy (RT) are associated with recurrence in women with DCIS. METHODS: In total, 111 patients with DCIS were included in the present study. The invasive and noninvasive recurrence events were recorded. The clinicopathological features; resection margins; administration of hormonal therapy and RT; expression statuses of estrogen receptor (ER), progesterone receptor (PR), and HER2; Ki-67 expression; and molecular subtypes were evaluated. Logistic regression analysis was performed to examine the risk factors for recurrence. RESULTS: Recurrence was noted in 27 of 111 cases (24.3%). Involvement of resection margins, low tumor grade, high Ki-67 expression, and RT were independently associated with an increase in the recurrence rate (p<0.05, Pearson chi-square test). The recurrence rate was not significantly associated with patient age; ER, PR, and HER2 statuses; molecular subtype; and hormonal therapy. CONCLUSION: The results of the present study suggested that the involvement of resection margins, low tumor grade, high Ki-67 index, and the absence of adjuvant RT were independently associated with increased recurrence in patients with DCIS. Future studies should be conducted in a larger cohort of patients to further improve the identification of patients at high-risk for DCIS recurrence.
Breast ; Carcinoma, Ductal* ; Carcinoma, Intraductal, Noninfiltrating* ; Cohort Studies ; Diagnosis ; Estrogens ; Female ; Humans ; Logistic Models ; Mastectomy, Segmental* ; Radiotherapy ; Receptor, Epidermal Growth Factor ; Receptors, Progesterone ; Recurrence ; Risk Factors

BACKGROUND: Mucinous carcinoma of the breast is an indolent tumors with a favorable prognosis; however, micropapillary features tend to lead to aggressive behavior. Thus, mucinous carcinoma and micropapillary carcinoma exhibit contrasting biologic behaviors. Here, we review invasive mucinous carcinoma with a focus on micropapillary features and correlations with clinicopathological factors. METHODS: A total of 64 patients with invasive breast cancer with mucinous or micropapillary features were enrolled in the study. Of 36 pure mucinous carcinomas, 17 (47.2%) had micropapillary features and were termed mucinous carcinoma with micropapillary features (MUMPC), and 19 (52.8%) had no micropapillary features and were termed mucinous carcinoma without micropapillary features. MUMPC were compared with 15 invasive micropapillary carcinomas (IMPC) and 13 invasive ductal and micropapillary carcinomas (IDMPC). RESULTS: The clinicopathological factors of pure mucinous carcinoma and MUMPC were not significantly different. In contrast to IMPC and IDMPC, MUMPC had a low nuclear grade, lower mitotic rate, higher expression of hormone receptors, negative human epidermal growth factor receptor 2 (HER2) status, lower Ki-67 proliferating index, and less frequent lymph node metastasis (p < .05). According to univariate analyses, progesterone receptor, HER2, T-stage, and lymph node metastasis were significant risk factors for overall survival; however, only T-stage remained significant in a multivariate analysis (p < .05). CONCLUSIONS: In contrast to IMPC and IDMPC, the micropapillary pattern in mucinous carcinoma does not contribute to aggressive behavior. However, further analysis of a larger series of patients is required to clarify the prognostic significance of micropapillary patterns in mucinous carcinoma of the breast.
Adenocarcinoma, Mucinous* ; Breast Neoplasms ; Breast* ; Humans ; Lymph Nodes ; Mucins* ; Multivariate Analysis ; Neoplasm Metastasis ; Prognosis ; Receptor, Epidermal Growth Factor ; Receptors, Progesterone ; Risk Factors

PURPOSE: Valid determination of HER2 status is a prerequisite to establish an adequate treatment strategy for breast cancer patients, regardless of the disease stage. The goal of this study was to examine the feasibility of the newly developed silver-enhanced in situ hybridization (SISH) technique as an alternative to fluorescence in situ hybridization (FISH) for HER2 assay in primary invasive breast cancer. METHODS: FISH and SISH for HER2 amplification were performed using tissue microarray. Both methods were used in 257 consecutive primary breast cancers. RESULTS: HER2 amplification was observed in 62 (23.1%) of a total of 257 breast cancers based on SISH. Of the 257 breast cancers measured using both methods, the results of the two methods were consistent in 248 (concordance, 96.5%; kappa=0.903). When we compared HER2 amplification in the primary tumor with the metastatic lymph nodes of the same patients, HER2 amplification was observed in nine cases (14.0%) out of 64 cases in which HER2 was not amplified in the primary tumors. In contrast, HER2 status was completely preserved in metastatic lymph nodes showing HER2 amplification in the primary tumor. CONCLUSION: These results indicate that SISH can be a feasible alternative to FISH in the clinical setting. In node-positive breast cancer, confirmation of the HER2 status of the metastatic lymph nodes appears to be mandatory, regardless of the HER2 status of the primary tumors.
Breast ; Breast Neoplasms ; Fluorescence ; Humans ; In Situ Hybridization ; Lymph Nodes

Purpose: It is known that as the T stage of a carcinoma progresses, the prognosis becomes poorer. However, there are few studies about factors that affect the prognosis of T4 advanced colon cancer. This study aimed to identify the prognostic factors associated with disease-free survival (DFS) and overall survival (OS) in T4 colon cancer. Methods: Patients diagnosed with stage T4 on histopathology after undergoing curative surgery for colon cancer between March 2009 and March 2018 were retrospectively analyzed for factors related to postoperative survival. Primary outcomes were DFS and OS. Results: Eighty-two patients were included in the study. DFS and OS of the pathologic (p) T4b group were not inferior to that of the pT4a group. Multivariate analysis showed that differentiation (hazard ratio [HR], 4.994; P = 0.005), and laparoscopic surgery (HR, 0.323; P = 0.008) were significant prognostic factors for DFS, while differentiation (HR, 7.904; P ≤ 0.001) and chemotherapy (HR, 0.344; P = 0.038) were significant prognostic factors for OS. Conclusion Tumor differentiation, laparoscopic surgery, and adjuvant chemotherapy were found to be significant prognostic factors in patients with T4 colon cancer. Adjuvant chemotherapy and curative resections by laparoscopy might improve the prognosis in these patients.

Objective: The purpose of this study is to determine the risk of breast cancer on women at menopause from postmenopausal hormone therapy using Korea's national health checkup and insurance data.Method: Using the national health checkup and insurance data provided by the National Health Insurance Service (NHIS), we selected women who were over 40 years and confirmed to have menopause during the interview from 2003 to 2011. These women were followed up for breast cancer until December 31, 2019. The control group was defined as women who never used hormone drug during from 2003 to 2019, and the Menopausal Hormone Therapy (MHT) group was defined as women who used menopausal hormone drug for over 6 months. Menopausal hormone drugs were classified tibolone, combined estrogen plus progestin by manufacture (CEPM) (Estradiol Hemihydrate/Drospirenone, Estradiol Hemihydrate/Drospirenone, Estradiol Hemihydrate/Norethisterone Acetate, Cyproterone Acetate/Estradiol Valerate, Estradiol Hemihydrate/Norethisterone Acetate, Estradiol Valerate/Norethisterone Acetate), estrogen (Conjugated Estrogens, Estradiol Valerate, Estradiol Hemihydrate), combined estrogen plus progestin by physician (CEPP) (Estrogen + Progesterone Micronized, Medroxyprogesterone Acetate, Dydrogesterone), Topical estrogen (Estradiol Hemihydrate patch or gel). The variables that may affect breast cancer were adjusted, such as age, body mass index, socioeconomic status, region, Charlson Comorbidity Index, parity, age at menarche, age at menopause, smoking, alcohol, physical exercise, period from menopause to inclusion time. Results: The control group, the tibolone group, CEPM group, the oral estrogen group, CEPP group, and the topical estrogen group were 920,783, 165,222, 107,088, 45,609, 5,633, and 1,729, respectively. In the Cox proportional hazard analysis with adjusted variables, the risk of breast cancer increased in CEPM group. {Hazard ratio [HR] 1.439, 95% confidence interval (CI) 1.374-1.507} However, there were no increase in the risk of breast cancer in the tibolone group, oral estrogen group, CEPP group and the topical estrogen group. (HR 0.968, 95% CI 0.925-1.012) (HR 1.002, 95% CI 0.929-1.081) (HR 0.929, 95% CI 0.75-1.15) (HR 1.139, 95% CI 0.809-1.603) There was no difference in the risk of breast cancer even with doubling the amount of tibolone used. (Over 5 mg: HR 1.306, 95% CI 0.326-5.226) The risk of breast cancer was lower in those in their 50s and 60s than in their 40s. (50s: HR 0.956, 95% CI 0.906-1.008) (60s: HR 0.846, 95% CI 0.776-0.922) As BMI increased, the risk of breast cancer increased. (25-29.9: HR 1.126, 95% CI 1.085-1.169) (30 or more: HR 1.356, 95% CI 1.258-1.462) There was an increased risk of breast cancer when menstrual age was 13 years or older. (HR 1.157, 95% CI 1.109-1.419) A history of smoking increased the risk of breast cancer (HR 1.254, 95% CI 1.109-1.419), and drinking history was not associated with breast cancer. Also, as the inclusion period from menopause increased, the risk of breast cancer decreased. (5-9 years: HR 0.918, 95% CI 0.879-0.959) (10 years or more: HR 0.846, 95% CI 0.791-0.904) Conclusion CEPM increased the risk of breast cancer. However, tibolone, oral estrogen, CEPP, and topical estrogen were not associated with breast cancer. The risk of breast cancer did not differ depending on the dose of tibolone.

Purpose: Adjuvant chemotherapy (AC) is recommended for patients with stage II colorectal cancer with adverse features. However, the effect of adjuvant treatment in elderly patients with high-risk stage II colorectal cancer remains controversial. This study aimed to investigate the oncologic outcomes in elderly high-risk stage II colorectal cancer patients who underwent curative resection with or without AC. Methods: Patients aged over 70 years having stage II colorectal adenocarcinoma with at least 1 adverse feature who underwent radical surgery between 2008 and 2017 at a single center were included. We compared recurrence-free survival (RFS) and overall survival (OS) between patients who received more than 80% of the planned AC cycle (the AC+ group) and those who did not receive it (the AC− group). Results: The AC+ and AC– group contained 46 patients and 50 patients, respectively. The log-rank test revealed no significant intergroup differences in RFS (P = 0.083) and OS (P = 0.122). In the subgroup of 27 patients with more than 2 adverse features, the AC+ group (n = 16) showed better RFS (P = 0.006) and OS (P = 0.025) than the AC− group. In this subgroup, AC was the only significant factor affecting RFS in the multivariate analysis (P = 0.023). AC was significantly associated with OS (P = 0.033) in the univariate analysis, but not in the multivariate analysis (P = 0.332). Conclusion Among elderly patients with stage II high-risk colorectal cancer, the AC+ group did not show better RFS or OS than the AC− group. However, selected patients with more than 2 adverse features might benefit from AC.

Purpose: It is known that as the T stage of a carcinoma progresses, the prognosis becomes poorer. However, there are few studies about factors that affect the prognosis of T4 advanced colon cancer. This study aimed to identify the prognostic factors associated with disease-free survival (DFS) and overall survival (OS) in T4 colon cancer. Methods: Patients diagnosed with stage T4 on histopathology after undergoing curative surgery for colon cancer between March 2009 and March 2018 were retrospectively analyzed for factors related to postoperative survival. Primary outcomes were DFS and OS. Results: Eighty-two patients were included in the study. DFS and OS of the pathologic (p) T4b group were not inferior to that of the pT4a group. Multivariate analysis showed that differentiation (hazard ratio [HR], 4.994; P = 0.005), and laparoscopic surgery (HR, 0.323; P = 0.008) were significant prognostic factors for DFS, while differentiation (HR, 7.904; P ≤ 0.001) and chemotherapy (HR, 0.344; P = 0.038) were significant prognostic factors for OS. Conclusion Tumor differentiation, laparoscopic surgery, and adjuvant chemotherapy were found to be significant prognostic factors in patients with T4 colon cancer. Adjuvant chemotherapy and curative resections by laparoscopy might improve the prognosis in these patients.

The areola is a rare location for squamous cell carcinoma (SCC) because sunlight exposure, the main risk factor for SCC, is unusual on it. Acantholytic SCC (ASCC) is a rare histologic variant of SCC, characterized by pseudoglandular appearance with acantholytic tumor cells. A 59-year-old male presented a painful erythematous papule on his right areola. He had a history of psoralen ultraviolet A phototherapy for psoriasis in his 20s. Biopsy revealed an epithelial tumor and pseudoglandular structures with acantholytic tumor cells. In immunohistochemistry, cytokeratin 5/6, epithelial membrane antigen, and p63 were positive, while cytokeratin 7, carcinoembryonic antigen, S-100, and estrogen and progesterone receptors were negative. Periodic acid-Schiff stain was negative. Ki-67 labeling index was 79.7%. The final diagnosis was ASCC of the areola. After wide local excision, recurrence have not been reported. Here, we report a case of ASCC on the areola, focusing on its rare histologic variant and uncommon location.

PURPOSE: This study analyzed factors affecting local recurrences in AGES low risk papillary thyroid carcinomas (PTCs). METHODS: The clinical records of 89 patients who underwent thyroidectomy because of PTC were reviewed. Seventy patients had belonged to low risk PTC according to the AGES classification scheme. The clinical data of these patients concerning disease recurrence was analyzed considering age, gender, operative methods, tumor size, lymph node (LN) metastasis, postoperative radioactive iodine scan (RI scan ¹³¹I), and Synthyroid® intake. RESULTS: Of the 70 patients, 56 were female (80%). Thirtyseven patients underwent total thyroidectomy with central neck LN dissection and 33 patients underwent partial thyroidectomy with ipsilateral central neck LN dissection. Mean tumor size was 2 cm (0.4~6 cm) and 31 patients had LN metastasis. Levels were <1µg/L in all patients who underwent total thyroidectomy but were 1~10µg/L in patients who received partial thyroidectomy thyroglobulin. Local recurrencein AGES low risk papillary carcinomas was significantly associated with tumor size >2 cm (P=0.030) and partial thyroidectomy (P=0.045). There was no significant association between local recurrence and age, gender, extrathyroidal extension, LN metastasis, RI scan ¹³¹I, or Synthyroid® intake. CONCLUSION: Partial thyroidectomy and tumor size >2 cm are significantly associated with local recurrence in AGES low risk papillary thyroid carcinomas.
Carcinoma, Papillary ; Classification ; Female ; Humans ; Iodine ; Lymph Nodes ; Neck ; Neoplasm Metastasis ; Recurrence* ; Thyroglobulin ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy