Although the efficacy of surgery followed by taxane- and platinum-based systemic chemotherapy has been clearly demonstrated in the standard first-line treatment of epithelial ovarian cancer, the role of radiation therapy for distant lymph node metastasis in patients with epithelial ovarian cancer is not well-established due to a lack of reported studies. We identified four patients who underwent selective adjuvant radiation therapy for neck and para-aortic lymph node lesions after primary debulking surgery between 2020 and 2022, followed by platinum-based chemotherapy for stage 4B high-grade serous ovarian cancer. Through a retrospective review of medical records, we analyzed patient clinicopathologic features, treatment course, and imaging findings. The median age was 49.25 years (range, 46–54 years). All patients had the International Federation of Gynecology and Obstetrics stage 4B disease. Following primary debulking surgery, all patients received weekly paclitaxel-carboplatin chemotherapy and maintenance treatment with poly(ADP-ribose) polymerase (PARP) inhibitors. All patients received selective adjuvant radiation therapy for neck and para-aortic lymph node metastasis before PARP inhibitor maintenance. The median follow-up time was 36.75 months (range, 19–45 months). All patients achieved a complete response. None of the patients experienced disease recurrence or died during the follow-up period. The management of distant lymph node metastasis in patients with epithelial ovarian cancer remains a matter of debate. Selective adjuvant radiation therapy in first-line treatment for ovarian cancer appears to be a feasible approach with maintenance therapy for stage 4B epithelial ovarian cancer.

We report a case of recurrent subacute necrotizing lymphadenitis with pancytopenia in 21-years-old-woman. She was admitted to our hospital 4-years interval with fever and abdominal pain. Laboratory findings of the last admission showed pancytopenia, such as WBC 700/microliter, hemoglobin 6.0mmol/L (9.7g/dL), hematocrit 28.8%, and platelet 54,000/microliter. Abdominal CT showed hepatosplenomegaly, enlarged conglomerated lymph nodes in splenic hilum, lesser sac, celiac root, and paraaortic areas. Bone marrow biopsy showed hypocellular marrow (20%) with increased number of megakaryocyte, myeloid hyperplasia, and hemophagocytic histiocytes suggesting infectious process. We performed exploratory laparotomy, and pathologic finding revealed subacute necrotizing lymphadenitis-Kikuchi disease-. She was recovered on 26th hospital day with conservative treatment.
Abdominal Pain ; Biopsy ; Blood Platelets ; Bone Marrow ; Fever ; Hematocrit ; Histiocytes ; Histiocytic Necrotizing Lymphadenitis ; Hyperplasia ; Laparotomy ; Lymph Nodes ; Lymphadenitis* ; Megakaryocytes ; Pancytopenia* ; Peritoneal Cavity ; Tomography, X-Ray Computed

BACKGROUND: Kaposi's sarcoma-associated herpesvirus (KSHV) been shown to be associated with human diseases including Kaposi's sarcoma, pleural effusion lymphoma, multicentric Castleman's disease. The IL-6 may both stimulate myeloma growth and prevent apoptosis of malignant plasma cells. Interestingly, viral IL-6(vIL-6), homolog to human interleukin-6(IL-6) in KSHV genome retains biologic activity. Thus, oncogenic role of the KSHV has been proposed as a pathogenesis of the multiple myeloma. We used ISH to determine the frequency of patients with multiple myeloma and plasmacytosis associated with KSHV-infected BM cells in fresh core biopsies and to determine the correlation between KSHV infection and clinical characteristics. METHODS: Bone marrow(BM) biopsy samples from 16 cases of multiple myeloma, 2 cases of monoclonal gammopathy of undetermined significance(MGUS) were obtained from the pathology division of Soon Chun Hyang University Hospital, Seoul, Korea. Biopsy sample of Kaposi's sarcoma for positive control and BM biopsy samples of myelodysplastic syndrome(MDS) and malignant lymphoma for negative control were obtained. Bitinylated probe to KSHV were prepared with the following sequences: 5' to 3' TGCAGCAGCTGTTGGTGTACCACATATCT. and in situ hybridization (ISH) was performed. RESULTS: Among the 18 patients. Two patients were MGUS and among 16 patients with multiple myeloma, 1 in stage IB disease, 1 stage IIB disease, 8 stage IIIA disease, 4 stage IIIB diseases and 2 in variant of multiple myeloma, extramedullary plasmacytoma. Strong positive signal was detected in nuclei and cytoplasm of the malignant cells of biopsy sample from 1 cases of Kaposi's sarcoma by ISH(positive control). Signal was not detected in BM biopsy samples of 7 cases from MDS and malignant lymphoma(negative control). Among 16 patients with multiple myeloma, 15 demonstrated viral positive cells and 2 cases with MGUS also showed viral positive cells by ISH. Signal was detected in nuclei and cytoplasm of stromal cells. Signal was strongly detected in MGUS than multiple myeloma. Positivity of the KSHV was not related with stage of the patients with multiple myeloma. One patients with multiple myeloma was studied at diagnosis and after chemotherapy. After chemotherapy KSHV was not detected. CONCLUSION: In MGUS and multiple myeloma, KSHV infects the stromal cells of BM rather than malignant plasma cells. On the basis of these data, we have supposed KSHV to play a role in transformation from MGUS to multiple myeloma. Particularly, due to the fact that signal of ISH was strongly detected in MGUS and was not detected in one case with multiple myeloma, it was presumed that KSHV was not major role in already advanced multiple myeloma but statistic significance was not demonstrated because of small numbers of cases. Further studies to reveal the correlation of KSHV and pathogenesis of multiple myeloma are needed.
Apoptosis ; Biopsy ; Cytoplasm ; Diagnosis ; Drug Therapy ; Genome ; Giant Lymph Node Hyperplasia ; Herpesvirus 8, Human ; Humans ; In Situ Hybridization ; Interleukin-6 ; Korea ; Lymphoma ; Multiple Myeloma* ; Paraproteinemias ; Pathology ; Plasma Cells ; Plasmacytoma ; Pleural Effusion ; Sarcoma, Kaposi ; Seoul ; Stromal Cells

We report the case of a 77-year-old woman who presented with periumbilical pain from perforation of jejunal diverticula. The patient underwent surgery and multiple jejunal diverticula were found distributed from 30 cm to 60 cm distal to the ligament of Treitz. A segment of the jejunum containing all diverticula was resected and end-to-end anastomosis was performed. The postoperative course was uneventful. The patient continued to do well at last follow-up, 26 months after operation. Diverticulum of the jejunum is uncommon and the majority of patients are asymptomatic. Symptoms indicating diverticulum are few and often nonspecific; they may present either as generalized abdominal pain associated with intestinal disturbances or in more serious case, they can lead to complications requiring emergency surgery. In light of these considerations, we thought it useful to report a case of complicated multiple jejunal diverticula and draw attention to its complications that can be a source of gastrointestinal symptoms.
Abdominal Pain ; Aged ; Diverticulum* ; Emergencies ; Female ; Follow-Up Studies ; Humans ; Jejunum ; Ligaments ; Peritonitis*

The migration of vascular smooth muscle cells (VSMCs) into the intima, an important step in injury-induced neointimal hyperplasia, requires the activation of nuclear factor-kappaB (NF-kappaB) and the consequent up-regulation of matrix metalloproteinase-9 (MMP-9). This study was undertaken to test for a possible effect of alpha-lipoic acid (ALA), a potent inhibitor of NF-kappaB, on MMP-9 expression. ALA inhibited high-glucose- and TNF-alpha-stimulated VSMC migrations in vitro. It also inhibited high-glucose- and TNF-alpha-induced increases in MMP-9 expression. The activity of MMP-9-promoter constructs with mutations in the NF-kappaB binding site was not inhibited by ALA, indicating an involvement of the NF-kappaB signaling pathway in the ALA-specific inhibition of MMP-9. These data suggest the possibility that ALA may be useful for the prevention of neointimal hyperplasia after angioplasty, by inhibiting the NF-kappaB/ MMP-9 pathway, especially with hyperglycemia.
Thioctic Acid/*pharmacology ; Rats, Sprague-Dawley ; Rats ; Promoter Regions (Genetics)/genetics ; NF-kappa B/*metabolism ; Muscle, Smooth, Vascular/cytology/drug effects/metabolism ; Matrix Metalloproteinase 9/genetics/*metabolism ; Male ; Gene Expression/*drug effects/*genetics ; Cells, Cultured ; Cell Movement/drug effects ; Animals

A carcinoid tumor of the stomach is a neuroendocrine tumor originating from enterochromaffin cells in the submucosa of the stomach and has no specific clinical symptoms. They are uncommon, accounting for no more than 0.3% of all gastric tumors. However, this frequency has increased markedly due to endoscopic screening. Herein, the case of a 47-year-old man with a polypoid lesion (2 cm diameter) detected on endoscopic examination is reported. It was diagnosed as a carcinoid tumor before an operation. Although the tumor size was slightly larger than 2 cm in diameter, the lesion was treated by wedge resection as there was no lymph node involvement or other distant metastasis. The postoperative has course was uneventful. The patient has continued to do well for over 15 months of follow up.
Carcinoid Tumor* ; Enterochromaffin Cells ; Follow-Up Studies ; Humans ; Lymph Nodes ; Mass Screening ; Middle Aged ; Neoplasm Metastasis ; Neuroendocrine Tumors ; Stomach*

Occupational asthma has been defined airway inflammation, hyperresponsiveness, and reversible airway obstruction related to exposure in workplace. Several drugs can cause asthma by inhalation during the manufacture. We report a case of cephalosporin induced occupational asthma which had not been reported in Korea yet. A 28 year-old male, an laboratorian, developed paroxysmal cough, dyspnea and chest tightness for four months. He has handled powder of cephalosporins and its precursors for thirty months. His symptoms used to be worsened during and shortly after his work and subsided several hours after work. When he visited our hospital, he denied such symptoms and revealed no abnormality on physical examinations. Skin prick test revealed positive result for ceftriaxone, ACT and 7-ACA, but negative for the other antibiotics. Bronchial provocation with 7-aminocephalosporanic acid elicited a single early response. In this case, the patient showed a positive bronchial provocation test to 7-aminocephalosporanic acid and a positive skin prick test to 7-ACA, aminocephalosporanic thiazine, ceftriaxone. We presumed that pathogenic mechanism of cephalosporin-induced asthma may be an IgE-mediated allergic reaction by the strong positive reaction in skin test. But further studies will be necessary to evaluate exact pathogenesis of cephalosporin-induced asthma.
Adult ; Airway Obstruction ; Anti-Bacterial Agents ; Asthma ; Asthma, Occupational* ; Bronchial Provocation Tests ; Ceftriaxone ; Cephalosporins ; Cough ; Dyspnea ; Humans ; Hypersensitivity ; Inflammation ; Inhalation ; Korea ; Male ; Physical Examination ; Skin ; Skin Tests ; Thorax

PURPOSE: In locally advanced head and neck cancer, radiation therapy is currently unsatisfactory because the end result is often limited regional disease control and survival. A clinical study was carried out to compare the effectiveness between the radiation therapy and the combined chemotherapy and radiation therapy. MATERIALS AND METHOD: Thirty-six patients with previously untreated, locally advanced squamous cell carcinoma of the head and neck were treated with radiotherapy alone and combined chemo-radiotherapy. Induction chemotherapy was administered 2~3 cycles, consisting of intravenous cisplatin (100 mg/m2 on day 1) and 5-fluorouracil (1000 mg/m2/day for 5 days as a continuous infusion) every 4 weeks followed by 7~8 weeks of radiation therapy for a total dose of 60~75 Gy. RESULTS: 1) Among 36 locally advanced head and neck cancer, 17 patients received radiation therapy alone and 19 patients received combined chemo-radiotherapy, respectively. 2) Response rate was 47% (complete response 29%, and partial response 18%) in radiation therapy group and 79% (complete response 37%, and partial response 42%) in combined chemo-radiotherapy group (p<0.05). 3) In median survival, radiation therapy group was 13 months and combined chemo- radiotherapy group was 15 months. Both groups were not significantly different (p>0.05). 4) Treatment related mortality was not noted, but the toxic effects were seen on the half cases of the both groups. Grade II toxicities were similar between the two arms. CONCLUSION: Combined chemotherapy and radiation therapy was more effective in local control but not superior in survival than radiation therapy alone. Continuous evaluation and identification of proper sequence for the therapeutic modality is supposed to prolong the survival of patients.
Arm ; Carcinoma, Squamous Cell ; Cisplatin ; Drug Therapy* ; Fluorouracil ; Head and Neck Neoplasms* ; Head* ; Humans ; Induction Chemotherapy ; Mortality ; Neck ; Radiotherapy

PURPOSE: Survivin is an inhibitor of apoptosis protein and it is overexpressed in most human cancers. Recent data demonstrated that survivin-HSP90 complex regulate apoptosis. We assessed expression of survivin and HSP90 by using immunohistochemistry with colorectal cancer tissue and correlate it with clinicopathologic prognostic parameters. METHODS: Using immunohistochemistry, survivin and HSP90 expression were evaluated on paraffin sections of fifty-six colorectal carcinomas. Various clinicopathologic parameters including histologic differentiation grade, T-stage, nodal metastasis, stage were obtained from pathologic records. RESULTS: Survivin expression were observed in 30 cases (53.6%). The expression of survivin showed no statistically significant correlation with histologic differentiation grade, T-stage, nodal metastasis, stage. HSP90 expression were observed in 31 cases (55.4%). The expression of HSP90 showed a statistically significant correlation with histologic differentiation grade (P=0.035) and stage (P=0.017). There were a significant correlation between survivin expression and HSP90 expression (P=0.018). CONCLUSION: Survivin and HSP90 was expressed in colorectal cancer. The expression of HSP90 correlates with histologic differentiation grade, stage. The above results suggest that HSP90 could be a prognostic marker of poor outcome in colorectal carcinoma.
Apoptosis ; Colorectal Neoplasms* ; Humans ; Immunohistochemistry ; Inhibitor of Apoptosis Proteins ; Neoplasm Metastasis ; Paraffin

BACKGROUND: Telomeres are repetitive DNA fragments at the termini of chromosomes functioning as stabilizing elements of the DNA. A ribonucleoprotein polymerase, called telomerase, is responsible for the synthesis of such telomeric repeats in embryo and germ cells. During ontogenesis of most normal human somatic cells, there exists a physiological telomerase repressing mechanism. In contrast, malignant cells are characterized by an unlimited progressive potential. Certain physiological agents, such as all-trans retinoic acid (ATRA), 13-cis retinoic acid (13-cisRA), 1alpha-25 dihydroxy vitamin D3 (VD3) and cytosine arabinoside (Ara-C), promote further differentiation of leukemic cells into mature granulocytes and monocytes and subsequently undergo apoptosis. METHODS: To determine if a potential linkage is present between telomerase regulation and the differentiation of malignant hematopoietic cells, the changes in telomerase activity during the maturation of HL-60 cells induced by ATRA, 13-cisRA, VD3 and Ara-C were investigated. RESULTS: Differentiating agents induce HL-60 cells to differentiate into CD11b+ granulocytes and monocyte/macrophages, respectively. Approximately 98% of HL-60 cells acquired the expression of CD11b+ antigen after ATRA, 13-cisRA or Ara-C treatment for 5 days. After 1 day treatment with differentiating agents, no significant difference in telomerase activity was shown between untreated and treated HL-60 cells. A dramatic inhibition of telomerase activity occurred at 3 days treatment of ATRA compared to untreated HL-60 cells. Longer treatment for 5 days with differentiating agents resulted in further decrease of telomerase activity. However, telomerase activity in HL-60 cells was decreased slightly by the VD3 or Ara-C treatment, even though for 5 days. No evidence of differentiation and slight decrease of telomerase activity were observed in ATRA-treated K-562 cells for 5 days. These decrease of telomerase activity were dependent on the incubation time and dose. CONCLUSION: These data clearly show the role of telomerase activity during the differentiation of HL-60 cells. This in vitro model can be useful for studies of the mechanisms controlling telomerase activity and in the search for physiological telomerase modulators.
Apoptosis ; Cholecalciferol ; Cytarabine ; DNA ; Embryonic Structures ; Germ Cells ; Granulocytes ; HL-60 Cells* ; Humans ; Monocytes ; Ribonucleoproteins ; Telomerase* ; Telomere ; Tretinoin