Association of the hepatoid and choriocarcinomatous components in adenocarcinoma of the stomach is extremely unusual and raises a possibility of new approach understand the histogenesis of gastric hepatoid adenocarcinoma. This paper describes a Borrmann type III adenocarcinoma of the stomach with both choriocarcinomatous and hepatoid components in composite tumor pattern in a 50-year-old man. Tubular arrangement of differentiated embryonalcarcinoma was encountered in choricarcinomatous and hepatoid areas, which showed strong immunoreactivity to beta-HCG and AFP, respectively. The findings suggest that gastric adenocarcinoma may have a potential of differentiation toward embryonal carcinoma. from which both choriocarcinoma and hepatoid variant of gastric adenocarcinoma may develop by retrodifferentiation.
Adenocarcinoma

A case of Hodgkin's disease which was complicated by disseminated cryptococcemia terminally is reported. The patient was a 19 year old girl and complained of high fever with shaking chins and dyspnea. In the past history, antituberculous treatment was given using PAS, INH and streptomycin for 2 months under the diagnosis of tuberculous pleurisy and several antibiotics and steroids were also given. On admission, antituberculous treatment was continued and prednisolone was also prescribed. She was discharged 15 days later but was readmitted because of abdominal pain and uncontrolable fever. On the third hospital day, a leftcervical lymphnode biopsy revealed. Hodgkin's disease, paragranuloma type. Endoxan and cobalt 60 irradiation were given to the abdomen. On the sixtieth hospital day, she became irritable and comatose and expired. At autopsy, disseminated Hodgkin's sarcoma was noted involving multiple lymphnodes, esophagus, small and large intestines, pancreas, liver, spleen, diaphragm, lungs, peritoneum, uterus, left ovary and bone marrow. In addition, evidence of cryptococcemia involving kidneys, lungs, heart, brain, pituitary gland and lymphnodes, was noted. A brief review of the literature was also made.
Adult ; Autopsy ; Cryptococcosis/complications* ; Cryptococcosis/pathology ; Female ; Hodgkin Disease/complications* ; Hodgkin Disease/pathology ; Human ; Lymph Nodes/pathology ; Septicemia/etiology*

Based on the assumption that apparent diffusion coefficients (ADCs) define high-risk clinical target volume (aCTVHR) in high-grade glioma in a cellularity-dependent manner, the dosimetric effects of aCTVHR-targeted dose optimization were evaluated in two intensity-modulated radiation therapy (IMRT) plans. Diffusion-weighted magnetic resonance (MR) images and ADC maps were analyzed qualitatively and quantitatively to determine aCTVHR in a high-grade glioma with high cellularity. After confirming tumor malignancy using the average and minimum ADCs and ADC ratios, the aCTVHR with double- or triple-restricted water diffusion was defined on computed tomography images through image registration. Doses to the aCTVHR and CTV defined on T1-weighted MR images were optimized using a simultaneous integrated boost technique. The dosimetric benefits for CTVs and organs at risk (OARs) were compared using dose volume histograms and various biophysical indices in an ADC map-based IMRT (IMRTADC) plan and a conventional IMRT (IMRTconv) plan. The IMRTADC plan improved dose conformity up to 15 times, compared to the IMRTconv plan. It reduced the equivalent uniform doses in the visual system and brain stem by more than 10% and 16%, respectively. The ADC-based target differentiation and dose optimization may facilitate conformal dose distribution to the aCTVHR and OAR sparing in an IMRT plan.
Contrast Media ; Gadolinium ; Glioma/*radiotherapy ; Humans ; Magnetic Resonance Imaging/*methods ; *Radiotherapy Dosage ; Radiotherapy Planning, Computer-Assisted/*methods ; Radiotherapy, Intensity-Modulated/*methods ; Tumor Burden

PURPOSE: We compared the safety of the double-stapling method with that of the hand-sewn method when performing a Billroth I anastomosis (BI) after a radical subtotal gastrectomy. METHODS: Fifty-three (53) patients who received a BI with stapler from February 1998 to April 1999 were compared with 24 patients who received a BI with the hand-sewn method from January 1996 to December 1998. All the patients were divided into three groups according to the type of reconstruction: Group 1 (n=42), double- stapling method, Group 2 (n=11), anastomosis through posterior gastric wall, and Group 3 (n=24), hand- sewn method. The length of the greater curvature, lesser curvature, and proximal margin and the number of resected lymph nodes were compared for radicality, and the incidence of complications was reviewed. ANOVA and the chi-square test were used for the statistical analysis. RESULTS: The mean ages were 55.2+/-10.8, 59.8+/-9.7, and 54.7+/-11.9 years for groups 1, 2, and 3, respectively. The sex ratios were 2.2:1, 1.2:1, and 1.4:1. The lengths (cm) of the greater curvature were 17.2+/-2.5, 18.4+/-2.5, and 18.6+/-3.3, and the lengths of the lesser curvature were 10.4+/-1.5, 10.9+/-1.6, and 10.7+/-2.1; however, the differences were not statistically significant (p>0.05). The lengths of the proximal resection margin were 5.4+/-2.5, 8.2+/-3.3, and 6.0+/-3.2 (p<0.05), and the numbers of resected lymph nodes were 25.3+/-8.3, 19.1+/-5.8, and 32.+/- 13.7 (p<0.01). We experienced no complication in any group, except one case of leakage in the hand-sewn group. CONCLUSION: The double-stapling technique is a safe operative method in BI after a radical subtotal gastrectomy with its very low complication rate. Especially, the so- called Tornado method is a more useful method since it doesn't need a gastrotomy in the remnant stomach.
Gastrectomy* ; Gastric Stump ; Gastroenterostomy* ; Humans ; Incidence ; Lymph Nodes ; Sex Ratio ; Stomach Neoplasms ; Tornadoes

PURPOSE: We compared the safety of the double-stapling method with that of the hand-sewn method when performing a Billroth I anastomosis (BI) after a radical subtotal gastrectomy. METHODS: Fifty-three (53) patients who received a BI with stapler from February 1998 to April 1999 were compared with 24 patients who received a BI with the hand-sewn method from January 1996 to December 1998. All the patients were divided into three groups according to the type of reconstruction: Group 1 (n=42), double- stapling method, Group 2 (n=11), anastomosis through posterior gastric wall, and Group 3 (n=24), hand- sewn method. The length of the greater curvature, lesser curvature, and proximal margin and the number of resected lymph nodes were compared for radicality, and the incidence of complications was reviewed. ANOVA and the chi-square test were used for the statistical analysis. RESULTS: The mean ages were 55.2+/-10.8, 59.8+/-9.7, and 54.7+/-11.9 years for groups 1, 2, and 3, respectively. The sex ratios were 2.2:1, 1.2:1, and 1.4:1. The lengths (cm) of the greater curvature were 17.2+/-2.5, 18.4+/-2.5, and 18.6+/-3.3, and the lengths of the lesser curvature were 10.4+/-1.5, 10.9+/-1.6, and 10.7+/-2.1; however, the differences were not statistically significant (p>0.05). The lengths of the proximal resection margin were 5.4+/-2.5, 8.2+/-3.3, and 6.0+/-3.2 (p<0.05), and the numbers of resected lymph nodes were 25.3+/-8.3, 19.1+/-5.8, and 32.+/- 13.7 (p<0.01). We experienced no complication in any group, except one case of leakage in the hand-sewn group. CONCLUSION: The double-stapling technique is a safe operative method in BI after a radical subtotal gastrectomy with its very low complication rate. Especially, the so- called Tornado method is a more useful method since it doesn't need a gastrotomy in the remnant stomach.
Gastrectomy* ; Gastric Stump ; Gastroenterostomy* ; Humans ; Incidence ; Lymph Nodes ; Sex Ratio ; Stomach Neoplasms ; Tornadoes

PURPOSE: Histopathological classification of invasive breast carcinoma with its earliest phases is fraught with pitfalls. We were willing to clarify the biology and clinicopathological features of microinvasive carcinoma which is not fully understood in comparison with those of in situ cancer. Particular attention is paid to identifying the novel markers which can be representative of the microinvasive carcinoma. METHODS: From January 1986 to December 1996, a total of 72 microinvasive carcinomas, defined as in situ carcinomas with invasion present in less than 10% of the histological section, were found out. Their paraffin blocks were chosen for immunohistochemical staining against four molecules. RESULTS: Microinvasive carcinoma was greater in primary tumor size (2.66?0.17cm vs 2.21?0.19cm, P=0.045) and metastatic axillary nodes (0.21?0.25 vs 0.06?0.16, P=0.019) than DCIS. In terms of nuclear grade(P=0.198) and comedo type(P=0.562), there was no statistical significance between microinvasive carcinoma and DCIS. Among three primary tumor features(size, comedo component, and nuclear grade), the tumor size> or =2.5cm had marginal significance affecting the incidence of axillary node metastasis in microinvasive carcinoma(P=0.081). Of investigational prognostic factors, determined by immunohistochemical staining, p53 expression was observed more frequently in microinvasive disease entity from in situ to invasive from than DCIS(P=0.031). CONCLUSION: Microinvasive carcinoma is thought to be transitional disease entity from in situ to invasive form. The microinvasive carcinoma of 2.5cm could be indication for axillary node dissection. In addition, p53 mutation might play a important biological role in progression from noninvasive to invasive form and these results provide further evidence that p53 mutation could have potential use as a molecular marker.
Biology ; Breast Neoplasms ; Carcinoma, Intraductal, Noninfiltrating ; Classification ; Incidence ; Neoplasm Metastasis ; Paraffin

A radioisotope first pass study was done on patients over a period of 1 to 15 years (average 4.6 years) after repair for ventricular septal defect or arterial septal defect with a left to right shunt. The age of the patients ranged from 6 to 32 years (average 14.2 year) at the time of the study. The total work of exercise and the right and left ventricular ejection fraction(EF) were evaluated at rest and after exercise. The results were compared with the preoperative hemodynamic findings and with the age of patient at the time of the operation. 1) When the total work of exercise was divided with the maximal exercise capacity of the normal individual corresponding to the patients' height and body surface area (the percentage of total work), it were very low with the average of 40% of normal. There was no sexual difference, but the percentage of total work of exercise had significant correlation with the patients' age at the time of operation (r = -0.52,p<0.01) and post-exercise left ventricular ejection fraction (LVEF)(r = -0.39,p<0.05). 2) LVEF at rest had some correlation with the preoperative mean pulmonary arterial pressure (r = -0.29, p = 0.05), but showed no relationship with Qp/Qs or Rp/Rs ratios. The right ventricular ejection fraction (RVEF) at rest had no relations with the preoperative hemodynamic findings with maximal workload. 3) The post-exercise RVEF showed linear correlation with the preoperative Rp/Rs ratio (r = -0.49,p<0.005), and mean pulmonary arterial pressure (r = -0.37,p<0.05). The post-exercise LVEF had no significant correlation with any preoperative hemodynamic factors. 4) When greater than 5% increase in ventricular EF after exercise is considered normal, the group with the normal right and left ventricular responses (n = 11) showed normal preoperative Rp/Rs ratio (7.6 +/- 4.1). In the group with normal left, but abnormal right ventricular response (n = 9) and the group with abnormal biventricular response (n = 11), both demonstrated incremental increase in Rp/Rs ratio (20.1 +/- 11.3, 26.3 +/- 19.8 respectively). Normal right, but abnormal left ventricular reaction (n = 2) was noted in patients with residual aortic valvular insufficiency and residual ventricular septal defect. In conclusion, post-operative ventricular response was much more sensitive and informative than that of ventricular function at rest and to detect subclinical cardiac dysfunction. Post-exercise RVEF was closely correlated with preoperative pulmonary vascular hemodynamics, while post-exercise LVEF seemed to be a majo determinant of working capacity after repair.
Adolescent ; Adult ; Child ; Child, Preschool ; Exercise Test ; *Exertion ; Female ; Heart Defects, Congenital/*physiopathology/radionuclide imaging/*surgery ; Human ; Infant ; Male ; *Stroke Volume

BACKGROUND: The histopathological classification of an invasive breast carcinoma in its earliest phases is fraught with pitfalls. We wanted to clarify the biology and the clinicopathological features of a microinvasive carcinoma, which are not fully understood, by comparing then with those of an in-situ cancer. Particular attention was paid to identifying the novel markers which might be representative of a microinvasive carcinoma. METHODS: From January 1986 to December 1996, a total of 72 microinvasive carcinomas, defined as in-situ carcinomas with invasion present in less than 10% of the histological section, were found. Their paraffin blocks were chosen for immunohistochemical staining against four molecules. RESULTS: Microinvasive carcinomas had a greater primary-tumor size (2.66+/-0.17 cm vs 2.21+/-0.19 cm, p=0.045) and a larger number of metastatic axillary nodes (0.21+/-0.25 vs 0.06+/-0.16, p=0.019) than DCIS (Ductal carcinoma in situ). In terms of nuclear grade (p=0.198) and comedo type (p=0.562), there were no statistical significances between microinvasive carcinomas and DCIS. Among three primary- tumor features (size, comedo component, and nuclear grade), a tumor size> or =2.5 cm had a marginal significance affecting the incidence of axillary-node metastasis in microinvasive carcinomas (p=0.081). Of the investigational prognostic factors determined by using immunohistochemical staining, p53 expression was observed more frequently in microinvasive tumors than in DCIS (p=0.031). CONCLUSION: A microinvasive carcinoma is thought to be transitional disease entity between the in-situ to the invasive forms. In spite of the marginal statistical significance of the result a microinvasive carcinoma larger than 2.5 cm could be an indication for axillary-node dissection. In addition, p53 mutation might play an important biological role in the progression from a noninvasive to an invasive form. Also the results provide further evidence that p53 mutation might have potential use as a molecular marker.
Biology ; Breast Neoplasms ; Carcinoma, Intraductal, Noninfiltrating ; Classification ; Incidence ; Neoplasm Metastasis ; Paraffin

PURPOSE: The prognostic significance of lymph node (LN) micrometastasis in gastric cancer remains contro versial. We therefore investigated the clinicopathologic factors related to LN micrometastasis and evaluated the clinical relevance of micrometastasis with regard to urrence. MATERIALS AND METHODS: A total of 1083 LNs from 39 patients with pT2N0 gastric cancer and who underwent curative resection in 1993 were further immunohistochemically stained using an anti-cytokeratin Ab cocktail (AE1-AE3). RESULTS: Micrometastases were found in 3.9% (42/1083) of the resected LNs and 53.8% (21/39) of the patients with pT2N0 gastric cancer. LN micrometastasis was found to be significantly related with histologic differentiation. The recurrence rate of gastric cancer was higher in patients with LN micrometastasis (31.6%) than in those without (6.3%), with a borderline significance (p=0.074). In uni variate analysis, patients with LN micrometastasis had a shorter 5-year disease-free survival (65%) than those without LN micrometastasis (87%) (p=0.075). In multivariate analysis, multiple LN micrometastasis was associated with a poor prognosis, but with a borderline significance (p=0.069, Risk ratio 4.815) CONCLUSION: We were able to identify LN micrometastases missed on routine H-E staining, using an immuno histochemical technique. Our results suggest that LN micrometastasis is associated with the recurrence of pT2N0 gastric cancer.
Disease-Free Survival ; Humans ; Lymph Nodes* ; Multivariate Analysis ; Neoplasm Micrometastasis* ; Odds Ratio ; Prognosis ; Recurrence ; Stomach Neoplasms*

PURPOSE: This study was designed to investigate the correlation between the clinicopathologic characteristics and the recurrence pattern of gastric cancer and to define survival difference according to treatment modality after diagnosis of recurrence. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 4184 patients who had undergone radical surgery for primary gastric cancer from 1986 through 1996. Clinicopathologic factors were analyzed for the relationship of each factor with the pattern of recurrence. And the survival after diagnosis of recurrence was compared among the treatment modalities. RESULTS: Recurrence pattern was confirmed in 1141 patients. Loco-regional recurrence occurred in 291 patients (20.1%), peritoneal recurrence in 383 (26.5%), distant recurrence in 290 (20.1%), and mixed recurrence in 177 (12.3%), respectively. Early recurrence (less than 2 years) occurred in 767 (69.3%), intermediate recurrence (2~5 years) in 286 (25.8%), and late recurrence (more than 5 years) in 54 (4.9%). In multivariate analysis, T stage, N stage, size of tumor and perineural invasion were independent prognostic factors for recurrence. Median survival from diagnosis of recurrence was 24.2 months in the curative operation group, 7.7 months in the chemotherapy group, 7.1 months in the non-curative operation group and 3.3 months in the conservative treatment group, respectively (p=0.000). CONCLUSION: The clinicopathological analysis of recurrent gastric cancer showed recurrent patterns and prognostic factors. Curative resection is suggested to have survival benefit in recurrent gastric cancer patients, although it was possible in patients with limited extent of disease.
Diagnosis ; Drug Therapy ; Humans ; Medical Records ; Multivariate Analysis ; Recurrence ; Retrospective Studies ; Stomach Neoplasms*