PURPOSE: Neoadjuvant chemotherapy is being used increasingly in the treatment of patients with large or locally advanced breast cancer with the aims of downstaging and eliminating micrometastasis. We report a correlation between tumor response to preoperative primary chemotherapy and patient outcome in a series of 73 consecutive patients with breast cancer. METHODS: From Feb. 1991 to Oct. 1998, 73 patients with breast cancer (tumor size>3 cm or clinically axillary node positive) were treated with multimodality therapy, including a sandwich type of chemotherapy, comprised of 3 preoperative cycles and 3 postoperative 3 cycles of FEC or MMM. The median follow-up period was 53 months. RESULTS: The overall objective clinical response rate (complete & partial response) of the primary tumor to chemotherapy was 75.5% (standard UICC criteria). The pathologic complete response rate was 9.6%. The overall 5-year survival rate was 86.8%, and the overall 5-year disease free survival rate was 82.6%. The response rate to chemotherapy declined with increasing tumor size, but there was no relationship between the clinical response to chemotherapy and menopausal status, chemotherapeutic regimen, or histopathologic type. A breast-conserving operation could be done in 64.4% of the patients as a result of a decrease in the tumor size. CONCLUSION: Neoadjuvant chemotherapy allows a breast-conserving operation to be performed more frequently in cases of large or locally advanced breast cancer. The responses to neoadjuvant chemotherapy is a powerful prognostic factor for the overall survival and the disease free survival in breast cancer patients.
Breast Neoplasms* ; Breast* ; Disease-Free Survival ; Drug Therapy* ; Follow-Up Studies ; Humans ; Neoplasm Micrometastasis ; Survival Rate

p27Kip1 has been recognized as a negative regulator of cell cycle. Reduced level of p27 expression is associated with development and aggressiveness of several human tumors. To investigate the role of p27Kip1 on progression of colorectal adenocarcinoma, we studied 40 cases of human colorectal adenocarcinomas for expression of p27Kip1 protein using an immunohistochemical method, and compared these results with known prognostic parameters of colorectal adenocarcinoma. Among 40 cases of colorectal adenocarcinomas, p27Kip1 expression was detected in the nuclei of tumor cells in 14 cases (35%). The expression rate of p27Kip1 protein was significantly lower in the cases with lymph node metastasis (25.8%) than in those without lymph node metastasis (66.6%) (p<0.05). But it did not correlate with other parameters such as tumor size, histologic grade, vascular invasion, and Ki-67 labeling index. The results suggest that reduced expression of p27Kip1 protein plays a role in biologically aggressive behavior of colorectal adenocarcinoma.
Adenocarcinoma* ; Cell Cycle ; Cyclin-Dependent Kinase Inhibitor p27* ; Humans ; Lymph Nodes ; Neoplasm Metastasis ; Prognosis

Lymphagiomas are composed of multiple lymphatic channels lined by benign-appearing endothelial cells. The lisions can occur anywhere in body and extremely rarely affect the colon. But lymphangiomas of the colon have been reported more frequently since the development and widespread use of the colonofiberscope. In the past, most lympangioma have been removed surgically, But now that transendoscopic snare polyectomy is possible, diagnosis by total biopsy constitutes the treatment. In the present paper, we reported the case af colonic lymphangioma in 51-year old woman who underwent endoscopic resection.
Biopsy ; Colon* ; Diagnosis ; Endothelial Cells ; Female ; Humans ; Lymphangioma* ; Middle Aged ; SNARE Proteins

OBJECTIVE: There are two types of spina bifida aperta: cystic type and flat type. Unruptured cystic sac of spina bifida may interfere free leakage of cerebrospinal fluid into amnionic fluid space. Therefore its presence could influence the appearance of the intracranial signs on prenatal ultrasound. The purpose of this study was to define the ultrasound findings causing the appearance of indirect intracranial signs. METHODS: Twenty-one fetuses with spina bifida were evaluated from Jan/1998 to March/2004. Incidence of indirect cranial signs (changes of ventricular width, morphologic change of cerebellum, obliteration of cisterna magna, decreased biparietal diameter and lemon sign) were evaluated according to gestational age at diagnosis, size, location and morphology of the spinal lesion. RESULTS: Meningeal sac was visible in 10 cases (48%), flat form in 11 cases (52%) on prenatal ultrasound. All of the intracranial signs seemed to appear more frequently on flat spina bifida, but there were no statistical significance. CONCLUSION: It seems like that the presence of the sac in spina bifida aperta did not interfere the appearance of intracranial signs on prenatal ultrasound.
Amnion ; Cerebellum ; Cerebrospinal Fluid ; Cisterna Magna ; Diagnosis ; Fetus* ; Gestational Age ; Incidence ; Neural Tube Defects* ; Neural Tube* ; Spina Bifida Cystica ; Spinal Dysraphism ; Ultrasonography

Bone destruction is primarily mediated by osteoclastic bone resorption, and cancer cells stimulate the formation and activation of osteoclasts next to metastatic foci. Accumulating evidences indicate that receptor activator of NF-kB ligand (RANKL) is the ultimate extracellular mediator that stimulates osteoclast differentiation into mature osteoclasts. In contrast, osteoprotegerin (OPG) inhibits osteoclast development. In order to elucidate a mechanism for cancer-induced osteoclastogenesis, cells from a human breast cancer line, MDA-MB-231, were directly co-cultured with ST2, MC3T3-E1, or with primary mouse calvarial cells. Osteoclast-like cells and tartarate resistant acid phosphatase (TRAP) activities were then quantitated. We examined these cell lines and samples from breast cancer by RT-PCR for the expressions of OPG and RANKL mRNA. Compared to controls, co-culture of MDA-MB-231 cells with stromal or osteoblastic cells induced an increase in number of osteoclasts and TRAP activities. MDA-MB-231 cells alone or breast cancer samples did not express RANKL mRNA. However, co-culture of these cancer cells with stromal or osteoblastic cells induced RANKL mRNA expression and decreased OPG mRNA expression. These experiments demonstrate that direct interactions between breast cancer and stromal or osteoblastic cells induce osteoclastogenesis in vitro through modulating RANKL expression.
3T3 Cells ; Acid Phosphatase/metabolism ; Animals ; Bone Neoplasms/*metabolism/*secondary ; Breast Neoplasms/*pathology ; Carrier Proteins/*biosynthesis ; Cell Differentiation ; Cell Line, Tumor ; Cells, Cultured ; Coculture ; Culture Media, Conditioned/pharmacology ; Glycoproteins/*biosynthesis ; Human ; Isoenzymes/metabolism ; Male ; Membrane Glycoproteins/*biosynthesis ; Mice ; Mice, Inbred C57BL ; Neoplasm Metastasis ; Osteoblasts/metabolism ; Osteoclasts/metabolism ; Protein Binding ; RNA, Messenger/metabolism ; Receptors, Cytoplasmic and Nuclear/*biosynthesis ; Reverse Transcriptase Polymerase Chain Reaction ; Time Factors

Cytomegalovirus (CMV) pneumonia is a serious opportunistic infection in an immunocompromised host such as an AIDS patient or transplant recipient undergoing immunosuppressive therapy. Diffuse alveolar hemorrhage (DAH) is a relatively uncommon condition and it occurs most often in patients with systemic autoimmune disease. However, various types of infectious pneumonia with Mycoplsma hominis, Stenotrophomonas maltophilia and Pneumocystis jirovecii have been reported to be associated with the development of DAH. The association of CMV infection with the development of DAH has rarely been reported. We experienced a case of DAH associated CMV pneumonia and the patient was successfully treated with the use of antiviral agents and steroids.
Antiviral Agents ; Autoimmune Diseases ; Cytomegalovirus ; Cytomegalovirus Infections ; Hemorrhage ; Humans ; Immunocompromised Host ; Opportunistic Infections ; Pneumocystis jirovecii ; Pneumonia ; Stenotrophomonas maltophilia ; Steroids

A 26-year-old woman had an ovarian Sertoli-Leydig cell tumor (SLCT) associated with an elevated level of serum alpha-fetoprotein (AFP). The tumor had a heterologous element of intestinal-type mucinous epithelium, retiform and intermediately differentiated tubules of the Sertoli cells, and AFP-producing Leydig cells. AFP was demonstrated within the Leydig cells by an immunohistochemical technique. After surgery, the serum AFP level of the patient fell to the normal range. The present case is the first documented case of AFP producing a SLCT of the ovary reported in Korea.
Adult ; alpha-Fetoproteins* ; Epithelium ; Female ; Humans ; Korea ; Leydig Cells ; Male ; Mucins ; Ovary* ; Reference Values ; Sertoli Cells ; Sertoli-Leydig Cell Tumor*

Arsenic (As) is a well-known human carcinogen and its dietary exposure has been found to be the major route of entry into general population. This study was performed to assess the body levels of As and their associated factors in Korean adults by analyzing total As in urine. Urine and blood samples were collected from 580 adults aged 20 years and older, who had not been exposed to As occupationally. Demographic information was collected with the help of a standard questionnaire, including age, smoking, alcohol intake, job profiles, and diet consumed in the last 24 hrs of the study. Total As, sum of As(III), As(V), monomethylarsonic acid (MMA), dimethylarsinic acid (DMA), in urine was determined using atomic absorption spectrometer involving hydride generation method. The geometric mean concentration of total As in urine was 7.10 microg/L. Urine As was significantly higher in men (7.63 microg/L) than in women (6.75 microg/L). Age, smoking, alcohol consumption, and job profiles of study subjects did not significantly affect the concentration of As in urine. No significant relationship was observed between body mass index (BMI), Fe, and total cholesterol in serum and urinary As. Urine As level was positively correlated with seaweeds, fishes & shellfishes, and grain intake. A negative correlation between urinary As level and HDL-cholesterol in serum and meat intake was observed. Overall, these results suggest that urinary As concentration could be affected by seafood consumption. Therefore, people who frequently consume seafood and grain need to be monitored for chronic dietary As exposure.
Absorption ; Adult ; Aged ; Alcohol Drinking ; Arsenic ; Arsenicals ; Body Mass Index ; Cacodylic Acid ; Edible Grain ; Cholesterol ; Diet ; Female ; Fishes ; Humans ; Life Style ; Male ; Meat ; Occupations ; Surveys and Questionnaires ; Seafood ; Shellfish ; Smoke ; Smoking

PURPOSE: The sentinel lymph node (SLN) biopsy was recently introduced into the treatment of early breast cancer. However, there have been varying degrees of success in identifying the SLNs. Lymphatic mapping in breast cancer performed solely by intraparenchymal injection of blue dye remains an accepted method of identifying SLNs, largely because of its simplicity. This article describes the technical aspect and improved results of combined peritumoral and subareolar injection of isosulfan blue dye. METHODS: From Jan. 2000 to Jul. 2000, 55 patients with breast cancer (size<5 cm and clinically negative axillary nodes) were enrolled for SLN biopsy by peritumoral and subareolar injection of 1% isosulfan blue dye. And all patients underwent a complete axillary dissection. RESULTS: The identification rate of SLN was 96.4% (in 53 of 55 patients). Of these 53 patients, 11 patients (20.8%) had positive SLNs and 42 patients had negative SLNs. In 42 patients with negative SLNs, one patients was found to have disease on complete dissection, for a false-negative rate of 8.3% (1/12). CONCLUSION: Compared with other series of blue dye- directed lymphatic mapping, the present study of peritumoral plus subareolar plexus dye-only injection demonstrates a high SLNs localization rate and rapid learning curve. On the basis of these results, it is expected that subareolar lymphatic plexus is the central route to sentinel lymph nodes and the optimal way to perform dye-only lymphatic mapping of the breast.
Biopsy ; Breast ; Breast Neoplasms ; Humans ; Learning Curve ; Lymph Nodes* ; Sentinel Lymph Node Biopsy

It suggested that localized fibrous tumor of the pleura originated from a primitive submesothelial mesenchymal cell. The criteria used for a judgment of malignancy were high cellularity and mitotic activity(more than four mitotic figures per 10 high-power fields), pleomorphism, hemorrhage, and necrosis. This 62 years female was admitted with dyspnea and cough. Chest X-ray and CT scan showed a huge mass in right thorax. A 23X18X12 cm, 2 Kg sized mass was excised, and it was collase the right lower lobe and right middle lobe and was adhered to the diaphragm. Pathologically, the tumor was composed high cellularity, fascicle of the spindle cells, and high mitotic numbers(27 mitosis/10HPF). Immunohistochemically, it was positive for vimentin and CD34. This tumor was diagnosised to the malignancy localized fibrous tumor. We experience a case of pleural malignant fibrous tumor and report this case with the review of literature.
Cough ; Diagnosis ; Diaphragm ; Dyspnea ; Female ; Hemorrhage ; Humans ; Judgment ; Necrosis ; Pleura ; Pleural Neoplasms ; Solitary Fibrous Tumor, Pleural* ; Solitary Fibrous Tumors* ; Thorax ; Tomography, X-Ray Computed ; Vimentin