PURPOSE: To evaluate the prognostic significances of angiogenesis and bc1-2, and association of each other, we investigated the correlation of microvessel count for angiogenesis and bcl-2 expression in breast cancer. MATERIALS AND METHODS: We analysed immunohistochemistry staining from paraffin blocks in a series of 145 women with breast cancer. Immunohistochemical staining to detect factor VIII-related antigen highlighted the microvessels within primary invasive breast carcinoma. Using light microscopy, we counted microvessels per 200X field in the most active areas of neovascularization. To determine the bcl-2 immunoreactivity, we used a monoclonal antibody directed against the bcl-2 protein. RESULTS: The median of microvessel count (MVC) was 31.5, and the proportions of tumors with low and high MVC were 51% and 49%. Eighty (55.2%) cancers showed the bcl-2 immunoreactivity in the cytoplasm. The microvessel count were correlated with lymph node status (p <0.001), tumor size (p=0.001), and lymphatic invasion around tumor (p=0.009). bcl-2 expressions were corelated with estrogen receptor positivity (p<0.001) and progesterone recepter positivity (p=0.029). The microvessel counts were negatively correlated with bcl-2 expression (p=0.006). CONCLUSION: This study suggest that the angiogenesis which was investigated by micro- vessel counts was negatively correlated with bcl-2 expression.
Breast Neoplasms* ; Breast* ; Cytoplasm ; Estrogens ; Female ; Humans ; Immunohistochemistry ; Lymph Nodes ; Microscopy ; Microvessels ; Paraffin ; Progesterone ; von Willebrand Factor

Research is a search of knowledge through delicate pursuit, observation and experiment for the recovery and interpretation of information. Recently, the number of basic research articles has markedly increased, but the number of clinical and research articles by surgeon has fallen, this is important difficulty. In order to obtain the answer for this problem, we must review historical achievements of surgery. In the ancient era, the surgeon's role in the medical advances was making of medical record through observation of abnormal findings of body and invention of new therapeutic tool. Thus surgeon was also a philosophy doctor in this era. After the Renaissance, medicine has begun to teach and practice in the school and improving the method of modern medical research. In recent year, remarkable advances in modern technology has made the surgeons who are actively working in clinical materials difficult to perform the modern research. So it is time for surgeons to reeducate and restudy of recent basic science and organize scientific peoples such as surgeons,internal medicinist,oncologist and basic scientists etc. Surgical research has made and will make vital contributions throuhgh the organization of talented persons to careers in research, financial support and basic scientists.
Aptitude ; Financial Support ; Humans ; Inventions ; Medical Records ; Philosophy

Among the enzymes which are responsible for basement membrane breakdown, matrix metalloproteinases (MMP) form a family of neutral proteases that are regulated at the levels of gene transcription, proenzyme activation by the cleavage of protein, and the inhibition of the active enzyme by tissue inhibitors of matrix metalloproteinases (TIMP). Recent reports have demonstrated that the expression of these proteolytic enzymes are elevated in several solid tumors and that it can be associated with invasiveness and poor prognosis. We examined the expression of MMP-2, MMP-9, TIMP-1 and TIMP-2 by immunohistochemistry in 160 cases of infiltrating ductal carcinoma. And we compared these data with the established prognostic parameters - tumor size, nodal status, clinical stage, hormonal receptor status, microvessel density, and TGF-beta1 expression in order to evaluate how MMP and TIMP expression are associated with breast cancer progression and prognosis. Microvessel density in invasive breast carcinoma was significantly correlated with tumor size and recurrence (p<0.05). The immunohistochemical expression of TGF-beta1 was significantly associated with tumor size, lymph node metastasis, and clinical stage (p<0.05). The microvessel density was significantly correlated with TGF-beta1 expression in more than 50% of tumor cells. The immunohistochemical expression of MMP-2 and MMP-9 were significantly correlated with nodal metastasis and absence of immunoreactivity for estrogen and progesterone receptors. The immunohistochemical expression of TIMP-1 was inversely correlated with clinical stage and microvessel density while that of TIMP-2 was inversely correlated with clinical stage (p<0.05). Small size of tumor, presence of progesterone receptor, highly differentiated histologic grade, and absence of immunoreactivity for MMP-9 were significantly associated with higher survival rate, but in multivariate analysis only tumor size and MMP-9 expression appeared to affect survival independently.
Basement Membrane ; Breast Neoplasms* ; Breast* ; Carcinoma, Ductal ; Estrogens ; Humans ; Immunohistochemistry ; Lymph Nodes ; Matrix Metalloproteinases ; Microvessels ; Multivariate Analysis ; Neoplasm Metastasis ; Peptide Hydrolases ; Prognosis ; Receptors, Progesterone ; Recurrence ; Survival Rate ; Tissue Inhibitor of Metalloproteinase-1 ; Tissue Inhibitor of Metalloproteinase-2 ; Transforming Growth Factor beta1

PURPOSE: The axillary lymph node status is the most important prognostic factor in breast cancer. The axillary node dissection is done are usually performed in infiltrating breast cancer for the information of therapeutic decision and prediction of prognosis. But this procedure results in lymphedema of affected upper extremity nearly about 25%, increased axillary drainage, sensory abnormality and pain. Many researches are focussed to find the patients group who do not need axillary dissection according to the status of tumor size, patient age, hormonal receptor and histologic grade. MATERIAL AND METHODS: We evaluated the axillary lymph node status related with tumor size less then 2 cm in and the correlation of other prognostic factor. We reviewed 127 women with histologically diagnosed infiltrating ductal carcinoma of breast who were treated by one surgeon at YongDong Severance Hospital, Yonsei University College of medicine between 1991 and 1996. RESULTS: Five patients (3.9%) had T1a lesion (< 5 mm), 24 patients (18.9%) had T1b tumors (6-10 mm), and 98 cases (77.2%) had T1c lesion (11-20 mm). The average numbers of dissected axillary lymph nodes were 14.2 We found that small tumor size, good histologic grade, estrogen receptor positivity, old age (over 50 years) showed tendency of decreased axillary node metastasis but without statistical significance. CONCLUSIONS: There are possibility of finding subset with low risk of axillary lymph node metastasis in small size tumor with addition of good prognostic indicators such as good histologic grade, hormonal receptors and old age.
Breast Neoplasms* ; Breast* ; Carcinoma, Ductal ; Drainage ; Estrogens ; Female ; Humans ; Lymph Nodes* ; Lymphedema ; Neoplasm Metastasis* ; Prognosis ; Upper Extremity

PURPOSE: To evaluate the relationship between the hormonal receptor status and the mammographic finding in breast cancer, thus to disclose whether the mammorgraphic findings would be the prognostic predictor or not. MATERIALS AND METHODS: Fifty breast cancer patients with hormonal receptor assay were included in this study. Hormonal status and mammographic findings were evaluated to disclose the relationship between the two variables. RESULTS: Among 26 positive estrogen receptor(ER) patients, 23 cases showed spioulations, 4 cases with increased parenchymal densities, 15 cases with calcifications, and 18 with mass-like lesions. Among 25 positive progesterone receptor(PR) patients, 22 cases showed spiculations, 6 with increased parenchymal densities, 12 with calcifications, 17 with mass-like lesions. Among 24 negative ER patients, 10 showed spiculations, 9 increased parenchymal densities, 12 calcifications, and 13 mass lesions. Among 25 negative PR patients, 17 showed spiculations, 8 increased parenchymal densities, 15 calcifications, and 13 mass lesions. CONCLUSION: Spiculation in mammography could related to the high incidence of positive estrogen receptor.
Breast Neoplasms* ; Breast* ; Estrogens ; Humans ; Incidence ; Mammography ; Progesterone

Status of margins and the size of the lesion are independent prognostic factors of ductal carcinoma in situ (DCIS). Histologic grading of DCIS and expression of biologic marker also appear to act as prognostic factors. However, DNA ploidy analysis using flow cytometry in the DCIS and atypical ductal hyperplasia (ADH) has been rarely reported, and the biologic behavior of ADH is unknown. We performed immunohistochemical staining and DNA ploidy analysis using flow cytometry on 45 cases of pure DCIS without microinvasion and 34 cases of ADH to compare the expression of biologic markers and DNA ploidy patterns according to the histologic grade of DCIS, to evaluate the usefulness of the Van Nuys classification, and to investigate the biologic behavior of ADH and low grade DCIS. A total of 41.9% of DCIS and 32.1% of ADH were detected mammographically in asymptomatic patients. The most common subtype of the high grade DCIS was comedo type (56.3%), while the low and intermediate grade DCIS were cribriform type. Expression of ER, c-erbB-2 and Ki-67 proliferative index (PI) was significantly associated with nuclear grade and histologic grade of DCIS. Expression of c-erbB-2 was also significantly correlated with presence of necrosis. In low grade DCIS, Ki-67 PI was significantly higher than ADH. A total of 63.6% of DCIS and 70% of ADH were diploidy and 15.9% of DCIS was aneuploidy. There was no aneuploidy in ADH. No significant association was noted between DNA ploidy and histologic grade or nuclear grade. However, in high grade DCIS, the frequency of aneuploidy was high. In conclusion, histologic grading of DCIS employing nuclear grade and necrosis is a useful tool accounting for biologic behavior. High grade DCIS and comedo DCIS impart aggressive biologic behavior and suggest a higher possibility of local recurrence or progression to invasive carcinoma. In the differential diagnosis of ADH and low grade DCIS, the use of Ki-67 PI and DNA ploidy analysis by flow cytometry will be helpful for accurate diagnosis and prediction of biologic behavior.
Aneuploidy ; Biomarkers* ; Breast* ; Carcinoma, Ductal* ; Carcinoma, Intraductal, Noninfiltrating* ; Classification ; Diagnosis ; Diagnosis, Differential ; Diploidy ; DNA* ; Flow Cytometry ; Humans ; Hyperplasia* ; Immunohistochemistry ; Necrosis ; Ploidies* ; Recurrence

Status of margins and the size of the lesion are independent prognostic factors of ductal carcinoma in situ (DCIS). Histologic grading of DCIS and expression of biologic marker also appear to act as prognostic factors. However, DNA ploidy analysis using flow cytometry in the DCIS and atypical ductal hyperplasia (ADH) has been rarely reported, and the biologic behavior of ADH is unknown. We performed immunohistochemical staining and DNA ploidy analysis using flow cytometry on 45 cases of pure DCIS without microinvasion and 34 cases of ADH to compare the expression of biologic markers and DNA ploidy patterns according to the histologic grade of DCIS, to evaluate the usefulness of the Van Nuys classification, and to investigate the biologic behavior of ADH and low grade DCIS. A total of 41.9% of DCIS and 32.1% of ADH were detected mammographically in asymptomatic patients. The most common subtype of the high grade DCIS was comedo type (56.3%), while the low and intermediate grade DCIS were cribriform type. Expression of ER, c-erbB-2 and Ki-67 proliferative index (PI) was significantly associated with nuclear grade and histologic grade of DCIS. Expression of c-erbB-2 was also significantly correlated with presence of necrosis. In low grade DCIS, Ki-67 PI was significantly higher than ADH. A total of 63.6% of DCIS and 70% of ADH were diploidy and 15.9% of DCIS was aneuploidy. There was no aneuploidy in ADH. No significant association was noted between DNA ploidy and histologic grade or nuclear grade. However, in high grade DCIS, the frequency of aneuploidy was high. In conclusion, histologic grading of DCIS employing nuclear grade and necrosis is a useful tool accounting for biologic behavior. High grade DCIS and comedo DCIS impart aggressive biologic behavior and suggest a higher possibility of local recurrence or progression to invasive carcinoma. In the differential diagnosis of ADH and low grade DCIS, the use of Ki-67 PI and DNA ploidy analysis by flow cytometry will be helpful for accurate diagnosis and prediction of biologic behavior.
Aneuploidy ; Biomarkers* ; Breast* ; Carcinoma, Ductal* ; Carcinoma, Intraductal, Noninfiltrating* ; Classification ; Diagnosis ; Diagnosis, Differential ; Diploidy ; DNA* ; Flow Cytometry ; Humans ; Hyperplasia* ; Immunohistochemistry ; Necrosis ; Ploidies* ; Recurrence

DNA ploidy analysis using flow cytometry was performed on sixty six cases of phyllodes tumor of the breast including benign, low grade and high grade malignant phyllodes tumor. The rate of aneuploidy was 41.2% in high grade malignant phyllodes tumor and 4.8% in benign phyllodes tumor. No aneuploidy was noted in low grade malignant phyllodes tumor. The recurrence rate according to DNA ploidy pattern revealed 16.7% of aneuploidy and 7.7% of diploidy. In the aneuploid cases, the DNA index of high grade malignant phyllodes tumor was higher than benign phyllodes tumor. Morever, in diploid cases, %SG2M were significantly higher in high grade malignant phyllodes tumor. Therefore, we conclude that DNA ploidy analysis as well as histologic characteristics such as cellularity, pleomorphism of stromal cells and mitoses is useful parameters in the diagnosis, recurrence and prognostic predictors of phyllodes tumor.
Aneuploidy ; Breast* ; Diagnosis ; Diploidy ; DNA* ; Flow Cytometry ; Mitosis ; Phyllodes Tumor* ; Ploidies* ; Prognosis ; Recurrence ; Stromal Cells

Recently therapeutic efficacy of stomach cancer was greatly improved due to early diagnosis and irnproved diagnostic and therapeutic modalities. Especially in early gastric cancer, 5 year survival rate is near 100%. Recarrence of early gastric cancer after curative surgery is rarely reported. Recently authors experienced one case of recurrent stomach cancer arising from remmnant stomach 14 years after gastrectomy of EGC type I(m), so we reports it here with review of literatures.
Early Diagnosis ; Gastrectomy* ; Stomach Neoplasms* ; Stomach* ; Survival Rate

PURPOSE: We investigated the clinical characteristics of breast cancers and its significance. MATERIAL AND METHOD: We evaluated the clinical characteristics of 500 women with breast cancer who were diagnosed and treated by one surgeon between March 1991 and August 1996. RESULTS: The median age was 46.7 years and the most common age group was 40's. The presenting symptoms for most patients were palpable mass (75.2%) followed by abnormal mammographic findings (8.4%), pain (6.3%) and nipple discharges (4.7%), and the duration of symptoms was less than 1 month in 41.4%. Fifty three percent of the 500 cases had T2 lesion (size; 2 to 5 cm). With the increase of tumor size, overall and disease free survival rates (OS, DFS) were decreased. Surgical treatment consisted of modified radical mastectomy (52.8%) and partial mastectomy (33.6%) The most common stage was II (42.3%) and the early breast cancer (stage 0, I, II) was 388cases (78.1%) and the stage were inversely correlated with DFS and OS. The positivity of axillary lymph node was 39.3% and the number of the metastatic lymph nodes was inversely correlated with DFS and OS. The pathologic types were infiltrating ductal carcinoma (83.0%), ductal carcinoma in situ (12.8%), infiltrating lobular carcinoma (1.2%), lobular carcinoma in situ (0.4%) and Paget's disease (2.0%). ER positivity was 48.9% and PR 46.9%. ER positive patients showed survival benefit compared to ER negative patients. The common sites of distant metastases were lung, bone and liver. CONCLUSIONS: Our patients with breast cancer were younger than those of western and showed the impacts on survival according to the lymph node status,tumor size.
Breast Neoplasms* ; Breast* ; Carcinoma, Ductal ; Carcinoma, Intraductal, Noninfiltrating ; Carcinoma, Lobular ; Disease-Free Survival ; Female ; Humans ; Liver ; Lung ; Lymph Nodes ; Mastectomy, Modified Radical ; Mastectomy, Segmental ; Neoplasm Metastasis ; Nipples ; Survival Rate