Purpose: In 2007, the American Society of Clinical Oncology and the College of American Pathologists had established a human epidermal growth factor receptor 2 (HER2) testing guideline, which was updated in 2013 and subsequently in 2018. We assessed the clinical impact of the recent update by comparing the in situ hybridization (ISH) results based on the 2007, 2013, and 2018 guidelines. Methods: We assessed 2 cohorts. The first cohort included 1,161 primary invasive breast cancer (IBC) samples including 18 bilateral IBC cases, with both immunohistochemistry (IHC) and silver-enhanced ISH (SISH) results available for the HER2 status. The second cohort included 160 IBC cases with equivocal HER2 IHC, assessed using SISH. We retrospectively evaluated and compared the HER2 SISH results. Results: There were 22 (1.9%) and 20 (12.5%) cases with altered SISH results according to the 2013 guidelines in cohorts 1 and 2, respectively. As per the 2018 guidelines, final HER2 statuses of 16 (1.4%) and 14 (8.5%) cases changed in cohorts 1 and 2, respectively. The 2013 guidelines increased the positive rate compared to the 2007 guidelines, in both cohorts (0.6% and 6.2%, respectively). Most equivocal cases in cohorts 1 (92.3%) and 2 (100%) as per the 2013 guidelines were reclassified as HER2-negative according to the 2018 guidelines.The 2018 guidelines increased the negative rates (1.3% in cohort 1 and 8.7% in cohort 2) and slightly decreased the positive rates (−0.2% in cohort 1 and −3.1% in cohort 2), compared to the 2013 guidelines. With each update, minor changes in the positive and negative rates were observed in whole breast cancer samples (cohort 1). However, the 2018 guidelines affected previously defined HER2-positive IBC with equivocal IHC results. Conclusion Under the 2013 guidelines, the positive and equivocal cases increased. However, the 2018 guidelines eliminated ambiguous cases by reclassifying them as HER2-negative.

BACKGROUND: The elasticity of the back skin of the rat reduced the tension around wounds during the wound healing process in that region, and thus activates wound contraction. The authors proposed two skin fixation methods using readily available materials to decrease the influence of wound contraction on wound healing and designed an experiment to determine their effects. METHODS: The authors made 36 skin wounds on the backs of 18 rats, and they divided them into three groups. Each group was treated with three different kinds of dressing materials, each with different skin fixing characteristics. Group A was a control group. Group B and group C were dressed by the first and the second skin fixation method. We measured the areas of the wounds post-surgically and calculated the wound area reduction rates. RESULTS: The two skin fixation methods both reduced the effect of wound contraction compared to the control group. Each of the two methods had different outcomes in reducing wound contraction. CONCLUSIONS: The experiment demonstrated significant differences among the wound areas and the wound area reduction rates of the three groups as a result of differences in the degree of wound contraction. To obtain accurate results from wound healing experiments, appropriate skin fixation methods must be adopted.
Animals ; Bandages ; Contracts ; Elasticity ; Rats ; Skin ; Wound Healing

BACKGROUND: Free-flap surgery and skin grafting can be used to reconstruct large facial defects that may result after skin cancer removal by Mohs micrographic surgery (MMS). However, these two methods may produce low postsurgical patient satisfaction with aesthetics, and free-flap surgery may produce an undue burden for the majority of skin cancer patients, who are of advanced age. Hence, the authors examined outcomes of large facial defect reconstruction using multiple flaps. METHODS: Among patients undergoing MMS for skin cancer at Pusan National University Hospital between January 2013 and December 2015, we evaluated 7 patients (2 males, 5 females; average age, 73.14 years) treated for large facial defects from basal cell carcinoma. Based on operative and follow-up records, we investigated the number and type of flaps used, postsurgical complications, and patients' post-surgical satisfaction. RESULTS: Two and 3 types of flaps were used for 5 and 2 patients, respectively. Most frequently used were nasolabial flaps (7 times in 6 patients) and forehead flaps (once in each of 4 patients). The average follow-up period was 14 months, with no complications—including necrosis, hematoma, or wound dehiscence—observed. Post-surgical satisfaction averaged 4.4 out of a maximum of 5 points. CONCLUSIONS: Reconstruction using two or more flaps for large facial defects after skin cancer removal using MMS produced satisfactory outcomes while preventing aesthetic problems. Practitioners should consider using multiple flaps when choosing a reconstruction method for large facial defects following skin cancer removal.
Busan ; Carcinoma, Basal Cell ; Esthetics ; Female ; Follow-Up Studies ; Forehead ; Hematoma ; Humans ; Male ; Methods ; Mohs Surgery ; Necrosis ; Patient Satisfaction ; Skin Neoplasms* ; Skin Transplantation ; Skin* ; Wounds and Injuries

BACKGROUND: Many difficulties exist in establishing a treatment plan for slow-flow vascular malformation (SFVM). In particular, little research has been conducted on the surgical treatment of SFVMs. Thus, we investigated what proportion of SFVM patients were candidates for surgical treatment in clinical practice and how useful surgical treatment was in those patients. METHODS: This study included 109 SFVM patients who received care at the authors' clinic from 2007 to 2015. We classified the patients as operable or non-operable, and analyzed whether the operability and the extent of the excision varied according to the subtype and location of the SFVM. Additionally, we investigated complications and self-assessed satisfaction scores. RESULTS: Of the 109 SFVM patients, 59 (54%) were operable, while 50 (46%) were non-operable. Total excision could be performed in 44% of the operable SFVM patients. Lymphatic malformations were frequently non-operable, while capillary malformations were relatively operable (P=0.042). Total excision of venous malformations could generally be performed, while lymphatic malformations and combined vascular malformations generally could only undergo partial excision (P=0.048). Complications occurred in 11% of the SFVM patients who underwent surgery; these were minor complications, except for 1 case. The average overall satisfaction score was 4.19 out of 5. CONCLUSIONS: Based on many years of experience, we found that approximately half (54%) of SFVM patients were able to undergo surgery, and around half (44%) of those patients were able to fully recover after a total excision. Among the patients who underwent surgical treatment, high satisfaction was found overall and relatively few complications were reported.
Capillaries ; Follow-Up Studies ; Humans ; Treatment Outcome ; Vascular Malformations*

PURPOSE: Many surgical methods for reconstruction of orbital floor fracture have been reported, which include subciliary approach, transconjunctival approach, transantral and transnasal endoscopic approach, etc. The purpose of this study is to demonstrate a surgical technique and analyze the results of transnasal endoscopic approach with Foley catheter ballooning without implantation of artificial surgical material through subciliary approach. METHODS: Between February 2007 and November 2010, 29 orbital floor fracture patients, who had no herniated muscles through bone fragments, were treated through transnasal endoscopic approach with Foley catheter ballooning. Under the endoscopic view, the operator identified the opening of maxillary sinus. After widening of the opening using forceps, the operator reduced the fragmented bone with curved suction tip. Thereafter, 18-Fr Foley catheter was inserted. Four weeks after the operation, the catheter was removed. RESULTS: Preoperatively, 6 patients had diplopias, 4 patients had limitations of extraocular motions and 3 patients had enophthalmos. After removal of the Foley catheter 4 weeks after the operation, 2 patients had diplopias, 1 patient had a limitation of extraocular motion, 1 patient has an enophthalmos and 1 patient had numbness on the cheek. These symptoms were resolved about 6 months after the surgery. CONCLUSION: The operative technique of Foley catheter ballooning through transnasal endoscopic approach without implantation of the artificial surgical material through subciliary approach can be considered one of the appropriate techniques for orbital floor fracture.
Catheters ; Cheek ; Diplopia ; Endoscopy ; Enophthalmos ; Floors and Floorcoverings ; Humans ; Hypesthesia ; Maxillary Sinus ; Muscles ; Orbit ; Orbital Fractures ; Suction ; Surgical Instruments

BACKGROUND: Cases of simultaneous multiple skin cancers in a single patient have become more common. Due to the multiplicity of lesions, reconstruction in such cases is more difficult than after a single lesion is removed. This study presents a series of patients with multiple facial skin cancers, with an analysis of the surgical removal, reconstruction process, and the results observed during follow-up. METHODS: We reviewed 12 patients diagnosed with multiple skin cancers on the face between November 2004 and March 2016. The patients’ medical records were retrospectively reviewed to identify the type of skin cancer, the site of onset, methods of surgical removal and reconstruction, complications, and recurrence during follow-up. RESULTS: Nine patients had a single type of cancer occurring as multiple lesions, while three patients had different skin cancer types that occurred together. A total of 30 cancer sites were observed in the 12 patients. The most common cancer site was the nose. Thirteen defects were reconstructed with a flap, while 18 were reconstructed with skin grafting. The only complication was one case of recurrence of basal cell carcinoma. CONCLUSION: Multiple skin cancers are removed by performing Mohs micrographic surgery or wide excision, resulting in multiple defect sites. The authors emphasize the importance of thoroughly evaluating local lesions surrounding the initially-identified lesions or on other sites when reconstructing a large defect which can not be covered by primary closure. Furthermore, satisfactory results can be obtained by using various methods simultaneously regarding the condition of individual patients, the defect site and size, and the surgeon’s preference.
Carcinoma, Basal Cell ; Follow-Up Studies ; Humans ; Medical Records ; Melanoma ; Mohs Surgery ; Nose ; Recurrence ; Retrospective Studies ; Skin Neoplasms* ; Skin Transplantation ; Skin*

BACKGROUND: Merkel cell carcinoma (MCC) is a rare neuroendocrine malignancy affecting the skin, for which timely diagnosis and aggressive treatment are essential. MCC has most often been reported in Caucasians, and case reports in Asians are rare. This study presents our experiences with the surgical treatment and radiotherapy of MCC in Asian patients. METHODS: We retrospectively reviewed the records of seven MCC patients between 2000 and 2018 from a single institution, and analyzed patient characteristics, tumor characteristics, surgical treatment, sentinel lymph node evaluation, reconstruction, adjuvant radiation therapy, and prognosis. RESULTS: Eight MCC lesions occurred in seven patients, most commonly in the head and neck region. All patients underwent surgical excision with reconstruction. The final surgical margin was 1.0 cm in most cases, and reconstruction was most commonly performed with a split-thickness skin graft. Five patients received adjuvant radiotherapy, and two patients received sentinel lymph node biopsy. During the follow-up period, three patients remained well, two died from other causes, one experienced recurrence, and one was lost to follow-up. CONCLUSIONS: We treated seven Asian MCC patients and our series confirmed that MCC is a very dangerous cancer in Asians as well. Based on our experiences, thorough surgical excision of MCC with histopathological clearance should be considered, with sentinel lymph node evaluation if necessary, followed by appropriate reconstruction and careful postoperative observation. Adjuvant radiation therapy is also recommended for all Asian MCC patients. The results of this case series may provide guidance for the treatment of Asian MCC patients in the future.
Asian Continental Ancestry Group ; Carcinoma, Merkel Cell ; Diagnosis ; Follow-Up Studies ; Head ; Humans ; Lost to Follow-Up ; Lymph Nodes ; Mohs Surgery ; Neck ; Prognosis ; Radiotherapy ; Radiotherapy, Adjuvant ; Recurrence ; Retrospective Studies ; Sentinel Lymph Node Biopsy ; Skin ; Transplants

No abstract available.

PURPOSE: Cancer tissue may display a wide spectrum of expression phenotypes of epithelial-mesenchymal transition (EMT)-related proteins. The purpose of this study was to investigate the clinical significance of EMT phenotypes in breast cancer. METHODS: We evaluated the expression pattern of the EMT-related proteins E-cadherin and fibronectin in samples from 1,495 patients with invasive breast carcinoma (IBC) on tissue microarrays using immunohistochemistry to investigate the clinical significance of EMT phenotypes in IBC. EMT phenotypes were divided into complete type (E-cadherin-negative/fibronectin-positive), incomplete type (hybrid type, E-cadherinpositive/fibronectin-positive; null type, E-cadherin-negative/fibronectin-negative), and wild-type (E-cadherin-positive/fibronectin-negative). We analyzed the correlation of EMT phenotype with clinicopathological factors and patient survival. RESULTS: Loss of E-cadherin was observed in 302 patients (20.2%), and fibronectin was expressed in the cancer cells of 354 patients (23.7%). In total, 64 (4.3%), 290 (19.4%), 238 (15.9%), and 903 (60.4%) samples were categorized as complete, hybrid, null, and wild-type, respectively. The complete EMT phenotype exhibited significant associations with young age (p=0.017), advanced pT (p<0.001) and pN (p<0.001) stages, higher histological grade (p<0.001), lymphovascular invasion (p<0.001), and triple negativity (p<0.001). Patients with complete and hybrid EMT phenotypes had poorer overall survival (OS) and disease-free survival (DFS) than those with the wild-type phenotype (OS, p=0.001; DFS, p<0.001). In multivariate analysis, the hybrid EMT phenotype was an independent prognostic factor for DFS in patients with IBC (p=0.032). CONCLUSION: EMT phenotypes exhibited significant associations with clinicopathological factors indicating aggressive biologic behavior and poor outcome in patients with IBC.
Breast Neoplasms* ; Breast* ; Cadherins ; Disease-Free Survival ; Epithelial-Mesenchymal Transition* ; Fibronectins ; Humans ; Immunohistochemistry ; Multivariate Analysis ; Phenotype* ; Prognosis

PURPOSE: The aims of this study were to evaluate the clinicopathologic characteristics and the prognosis of patients with estrogen receptor negative/progesterone receptor positive (ER-/PR+) breast cancer. METHODS: One thousand five hundred seventy patients were stratified according to ER/PR phenotype and our study focused on the ER-/PR+ phenotype. The clinicopathologic characteristics and the prognosis of patients with the ER-/PR+ phenotype were compared with those of patients with ER+ (ER+/PR- or ER+/PR+) breast cancer. RESULTS: The mean age at diagnosis was 47.1 years (range, 20-88) and the mean follow-up was 65.2 months. The horjmone receptor phenotype was ER-/PR+ in 75 cases (4.8%) and ER+ (ER+/PR+ or ER+/PR-) in 917 cases (58.4%). A patient age <50 (p=0.001), a high histologic grade (p=0.004) and C-erbB2 overexpression (p=0.006) were more frequent for the patients with the ER-/PR+ tumors. There was a significant difference between the two groups for the mean age (p<0.001). The 5 year and 10 year disease-free survival (DFS) rates of the ER-/PR+ group were 67.2% and 55.3%, respectively, and those of the ER+ group were 84.9% and 73.1%, respectively (p<0.001). The 5 year and 10 year overall survival (OS) of the ER-/PR+ group were 82.4% and 62.6%, respectively, and those of ER+ group were 93.4% and 83.3%, respectively (p=0.001). In the under 50 year old patients, the 5 year DFS and OS of the ER-/PR+ group were 67.5% and 85.8%, respectively, and those of ER+ group were 86.3% and 95.8%, respectively. There were significant differences between two groups for the DFS and OS (p<0.001). CONCLUSION: ER-/PR+ tumors have more aggressive clinicopathologic features than ER+ tumors. Furthermore, in the under 50 year old patients, ER-/PR+ tumors showed a worse prognosis than did the ER+ tumors. Consequently, treatment modality and the prognosis of the patients with ER-/PR+ tumors probably need to be altered from those of the patients with ER+ tumors.
Breast ; Breast Neoplasms ; Disease-Free Survival ; Estrogens ; Follow-Up Studies ; Humans ; Phenotype ; Progesterone ; Prognosis ; Receptors, Progesterone