A rectal cancer was found in a 67-year-old man with a history of neurofibromatosis type 1. A low anterior resection was performed, and he received concurrent chemoradiation for 6 months. Twelve months after the surgery, a tumor was found at the anastomotic site by positron emission tomography-computed tomography and colonoscopy and was mistaken as anastomotic site recurrence. The tumor was confirmed as an inflammatory myofibroblastic tumor through transanal excision.
Aged ; Colonoscopy ; Colorectal Neoplasms ; Electrons ; Humans ; Myofibroblasts ; Neurofibromatoses ; Neurofibromatosis 1 ; Rectal Neoplasms ; Recurrence

PURPOSE: Various prognostic indicators have been identified for mammary carcinomas, but the issue of their significance remains unsettled. The prognostic impact of c-erb B2, Ki-67 and topoisomerase II alpha expression was investigated in relation to prognostic factors for carcinomas of the breast and to the tumor cell growth fraction. METHODS: One hundred eighteen cases of invasive mammary carcinoma were investigated by immunohistochemical staining for c-erb B2, topoisomerase II alpha, and Ki-67. Clinicopathologic parameters were compared with the expression pattern and incidence of c-erb B2, topoisomerase II alpha and Ki- 67 in invasive mammary carcinoma. RESULTS: C-erb B2 showed significant correlation with topoisomerase II alpha (P<0.05), but others were not significant. Topoisomerase II alpha and Ki-67 index closely paralleled each other, indicating that both reflect the proliferate activity of tumor cells and were associated with high nuclear and histological grade, ER and PR expression (P<0.05). CONCLUSION: These results indicate that ki-67 and topoisomerase II alpha proteins might play a role in tumor progression of breast carcinoma. The Ki-67 and topoisomerase II alpha index may be proliferate factors of breast cancer. In addition, the increase expression of Ki-67 and topoisomerase II alpha and hormone receptor were closely correlated each other, and could be used as factors suggesting poor prognosis in breast carcinoma.
Breast ; Breast Neoplasms ; DNA Topoisomerases, Type II* ; Incidence ; Prognosis

Insulinoma is a functional endocrine tumor arising from the beta cells of islets of Langerhans of pancreas. The only effective treatment of insulinoma was surgical removal of the tumor. Recently, laparoscopic surgery for islet cell tumors of the pancreas is introduced. Laparoscopic enucleation or resection of benign islet tumors results in a shorter hospital recovery and is a good alternative to open surgery We report a case of insulinoma that was treated sucessfully by laparoscopic enucleation.
Adenoma, Islet Cell ; Insulinoma* ; Islets of Langerhans ; Laparoscopy ; Pancreas

Carcinoma of the parathyroid gland is rare, comprising only 0.1% to 5% of all patients with primary hyperparathyroidism. It presents with severe hypercalcemia, bone disease, palpable neck mass, renal involvement and etc. Since the initial operation offers the best chance for cure, preoperative localization and intraoperative recognition of parathyroid cancer are essential. Recently parathyroid imaging has been described with 99mTc-sestamibi as an alternative to 201Tl. This newer agent has many physical and dosirnetric advantages and represents higher detection sensitivity than 201Tl-99mTc subtraction scan. We experienced a 41-year-old man presenting with recurrent hyperparathyroidism in spite of 2 previous operations. In preoperative localization, there was no abnormal uptake in 201Tl-99mTc subtraction scan but 99mTc-sestamibi scan revealed metastatic foci on right cervical area. He was successfully treated with modified radical neck dissection.
Adult ; Bone Diseases ; Humans ; Hypercalcemia ; Hyperparathyroidism ; Hyperparathyroidism, Primary ; Neck ; Neck Dissection ; Parathyroid Glands ; Parathyroid Neoplasms* ; Technetium Tc 99m Sestamibi*

BACKGROUND AND OBJECTIVES: The phenylthiocarbamide (PTC) and 6-n-propylthiouracil (PROP) taste sensitivity varies among individuals. Recently, it is reported that PROP taste responsiveness is associated with carbonic anhydrase 6 (CA6) gene polymorphism. The CA6 gene, a zinc metalloprotein in human saliva, is affected in taste function and might be correlated with gustatory diversity. The aim of this study was to examine whether PTC taste sensitivity and taste disorder is associated with the CA6 gene polymorphism rs2274327 (C/T), rs2274328 (A/C), and rs2274333 (A/G). SUBJECTS AND METHOD: A total of 217 healthy normal subjects were recruited as controls, and 50 taste disorder patients were recruited as experimental group. The polymorphisms of CA6 gene were genotyped by polymerase chain reaction-restriction fragment length polymorphism analysis. All statistical analyses were calculated using the statistical package for the social science software. Haplotypes were estimated by Haploveiw and the PHASE programs. RESULTS: The CA6 gene polymorphisms showed association with taste disorder but not with PTC sensitivity (taster/nontaster). The number of control subjects carrying AA genotype of single nucleotide polymorphism rs2274328 (A/C) in the CA6 gene was higher than the number of the subjects with taste disorder (p=0.048). However, there was no association between controls and taste disorder subjects in the haplotype analysis. CONCLUSION: These data suggest that the CA6 gene polymorphism rs2274328 could affect taste function impairment in patients with taste disorder. This observation requires a further functional study of gustin protein to clarify the association of the CA6 gene polymorphisms with the taste disorder and sensitivity.
Carbon ; Carbonic Anhydrases ; Factor IX ; Genes, vif ; Genotype ; Haplotypes ; Humans ; Lifting ; Phenylthiourea ; Polymorphism, Single Nucleotide ; Saliva ; Social Sciences ; Taste Disorders ; Zinc

BACKGROUND AND OBJECTIVES: Over the past five years, preclinical studies evaluating viral-vector-mediated gene transfer in the treatment of head and neck cancer have reported promising results. The main goal of this study was to evaluate the efficacy of intra-tumoral treatment with DISC virus (defective infectious single cycle herpes virus) carrying a GM-CSF immunomodulatory genes as cancer gene therapy. MATERIALS AND METHOD: Using the SCCVII squamous cell carcinoma model, we determined the in vivo GM-CSF production by ELISA method and evaluated the in vivo effects of DISC-GMCSF on the established tumor model. One of the following preparations was injected every two days to a total of three-doses intratumorally: group I (control): PBS alone, group II: heat inactivated DISC-GMCSF, group III: DISC-GMCSF. To prove the specific anti-tumor response, we analyzed the surface phenotype of tumor infiltrating cells. A flow cytometric analysis was performed using FACScan. RESULTS: Clinically relevant gene transfer could be possible by direct injection of tumors in situ. Intratumoral injection of the DISC-GMCSF (GM-CSF gene transduced defective infectious single cycle herpes virus) resulted in effective in vivo production of cytokines (4,500 pg/0.5 g tumor tissue), but as the progeny of the DISC virus could not be infected by other host cells, the effective cytokine production time seems limited. However, the DISC vector was safe and also allowed to be administered repeated treatments as needed. Effects of DISC-GMCSF injection on tthe established syngeneic tumor model showed the greatest inhibition of tumor growth in the DISC-GMCSF treated group (control vs DISC-GMCSF, p<0.01). In contrast to this, heat inactivated DISC-GMCSF showed no significant tumor suppression effect. It was interesting to note from our in vivo analysis of tumor infiltrating cells that treatment of flank tumors with the DISC-GMCSF virus resulted in a significant increase in the percentage of CD8 positive cells within the tumor (control vs DISC-GMCSF, p<0.05). CONCLUSION: Intratumoral injection of DISC-GMCSF significantly suppressed the tumor growth in established tumor model and induced intratumoral increase in immune effector cells. The results not only confirmed clinically relevant gene transfer but also demonstrated the gene transfer to be an effective anti-cancer therapy.
Carcinoma, Squamous Cell* ; Cytokines ; Enzyme-Linked Immunosorbent Assay ; Genes, Neoplasm ; Genetic Therapy* ; Granulocyte-Macrophage Colony-Stimulating Factor ; Head and Neck Neoplasms ; Hot Temperature ; Phenotype

BACKGROUND AND OBJECTIVES: Although human papillomavirus (HPV) infection has been recognized as having an important role in the pathogenesis of head and neck squamous cell carcinoma (HNSCC), there is no simple and reliable screening test of HPV infection in HNSCC to date. In the present study, we investigated the usability of p16 immunohistochemical staining as a screening test for HPV infection in HNSCC. SUBJECTS AND METHOD: Paraffin blocks were obtained from 45 tonsil SCC patients, who underwent surgery as an initial treatment between 1995 and 2004. Paraffin blocks were also obtained from 20 normal controls. Expression of p16 was investigated immunohistochemically and these results were compared with results of HPV genotyping and the real-time polymerase chain reaction (PCR) assay of viral oncoprotein to validate p16 staining as a reliable diagnostic tool of HPV infection. RESULTS: The expression of p16 was found to be significantly different between tonsil SCC (32/45, 71.1%) and normal control tissues (0/20, 0%)(p<0.05). Among the 45 patients, HPV genotyping and real-time PCR assay were performed in 21 of the 32 p16 (+) patients and in 6 patients of the 13 p16 (-) patients. HPV-16 was detected in 18 (85.7%) out of the 21 p16 (+) patients and in 2 (33.3%) out of the 6 p16 (-) patients. The p16 expression and HPV-16 status was significantly correlated (p<0.05). The two patients who had HPV-16 infection but did not have p16 expression showed an episomal infection or very low viral copy number each. CONCLUSION: The p16 expression may be an useful marker of HPV infection in HNSCC and may be used as a screening test for HPV infection in HNSCC.
Carcinoma, Squamous Cell ; Coat Protein Complex I ; Head ; Human papillomavirus 16 ; Humans ; Immunohistochemistry ; Mass Screening ; Neck ; Palatine Tonsil ; Papillomavirus Infections ; Paraffin ; Real-Time Polymerase Chain Reaction

PURPOSE: The aim of this study was to observe the clinical features of a bezoar-induced small bowel obstruction and to investigate the role of abdominal computed tomography (CT) in establishing the diagnosis. METHODS: We retrospectively reviewed 20 cases of bezoar-induced small bowel obstruction in our hospital from 1996 to 2010. RESULTS: Thirteen patients (65%) had a history of abdominal surgery. Nine patients (45%) were diagnosed with a bezoar before surgery, seven patients were diagnosed by using abdominal CT, and two patients were diagnosed with a small bowel series. Abdominal CT was performed in 15 patients, and the diagnostic accuracy was 47% (7/15). Surgery revealed ten bezoars in the jejunum and 11 in the ileum. Two patients had bezoars found concurrently in the stomach. Spontaneous removal took place in two patients. An enterotomy and bezoar extraction was performed in 15 patients. Fragmentation and milking, a small bowel resection, and a Meckel's diverticulectomy were performed in one patient each. Early operative treatment was possible (P = 0.036) once the bezoar had been diagnosed by using abdominal CT. There tended to be fewer postoperative complications in patients who were diagnosed with a bezoar by using abdominal CT, but the result was not statistically significant (P = 0.712). CONCLUSION: A preoperative diagnosis of bezoar-induced small bowel obstruction by using clinical features was difficult. Increased use of abdominal CT led to a more accurate diagnosis and to earlier surgery for bezoar-induced small bowel obstructions, thereby reducing the rate of complications.
Bezoars ; Humans ; Hypogonadism ; Ileum ; Jejunum ; Milk ; Mitochondrial Diseases ; Ophthalmoplegia ; Postoperative Complications ; Retrospective Studies ; Stomach

PURPOSE: Patients with triple-negative breast cancer (TNBC) are known to carry an increased risk of distant metastasis and poor survival. The principal objective of this study was to investigate survival after brain metastases in patients with TNBC. METHODS: The authors retrospectively evaluated clinical data obtained from 66 patients who had been diagnosed with breast cancer and brain metastasis from 2003 to 2009. Estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth receptor-2 (HER2) statuses were determined via immunohistochemical staining. TNBCs were defined as those that were ER-negative, PR-negative, and HER2-negative. The time interval from initial diagnosis to brain metastasis and overall survival after brain metastasis was evaluated via the Kaplan-Meier method. RESULTS: Twenty four (40.0%) of 60 patients were diagnosed with TNBC. The clinicopathologic characteristics did not differ between the TNBC and non-TNBC patients. The disease-free survival durations of the TNBC and non-TNBC subjects were 17.9 and 25.6 months, respectively (p=0.135). The time intervals from initial diagnosis to brain metastasis were 25.5 and 43.7 months, respectively (p=0.027). The time intervals from distant metastasis to brain metastasis were 8.4 and 19.5 months, respectively (p=0.006). Overall survival durations from brain metastasis to death were 4.3 and 7.6 months, respectively (p=0.046). CONCLUSION: Patients with TNBC were more likely to develop brain metastasis earlier, and exhibit poor overall survival. Triple receptor status may be utilized as a prognostic marker for breast cancer patients with brain metastasis.
Brain ; Breast ; Breast Neoplasms ; Disease-Free Survival ; Estrogens ; Humans ; Neoplasm Metastasis ; Receptors, Progesterone ; Retrospective Studies

Metastatic septic bacterial endophthalmitis is a rare but potentially devastating, serious disease. Endophthalmitis arising from Klebsiella pneumoniae liver abscess has been reported with diabetes mellitus as a major associated condition in Taiwan, but is rarely seen in patients without diabetes. There is often a delay in diagnosing endogenous bacterial endophthalmitis, particularly when there is no evidence of a primary infection or ocular infection is initial manifestation of sepsis. We report a non-diabetic patient with sepsis with right eye discomfort. Five days after admission, blood culture grew K. pneumoniae. Abdomen computerized tomography scan confirmed the presence of multiloculated liver abscess in right lobe. Despite intensive treatment, systemic and intravitreal antibiotics, liver abscess was resolved completely, but visual outcome was very poor. Physicians should be alerted to endogenous endophthalmitis in patients with Klebsiella septicemia, especially in diabetics with pyogenic liver abscess complains of ocular symptoms.
Abdomen ; Anti-Bacterial Agents ; Diabetes Mellitus ; Endophthalmitis* ; Eye Infections ; Female ; Humans ; Klebsiella pneumoniae* ; Klebsiella* ; Liver Abscess* ; Liver Abscess, Pyogenic ; Liver* ; Pneumonia ; Sepsis ; Taiwan