Uterine papillary serous carcinoma (UPSC) is an aggressive form of endometrial cancer characterized by a high recurrence rate and poor prognosis. We report a case of a 58-year-old post-menopausal woman with an abdominal wall metastasis in stage IA UPSC. After surgical staging, she did not receive additional adjuvant therapy. An egg sized palpable mass developed in the right lower abdomen after 8 months. Both Abdominopelvic computed tomography (CT) and positron emission tomography (PET)-CT revealed a metastatic lesion in the abdominal wall. Hence, surgical excision was performed. The pathological findings showed metastatic UPSC with clear resection margin. After the diagnosis of UPSC metastasis in the abdominal wall, she received chemotherapy utilizing paclitaxel and carboplatin. After 3 years, no evidence of recurrence was found. Therefore, we suggest that even when UPSC is confined to the endometrium without lymph node metastasis and without lymphovascular invasion, chemotherapy should be considered as a postoperative adjuvant therapy.
Abdomen ; Abdominal Wall* ; Carboplatin ; Diagnosis ; Drug Therapy ; Endometrial Neoplasms ; Endometrium ; Female ; Humans ; Lymph Nodes ; Middle Aged ; Neoplasm Metastasis* ; Ovum ; Paclitaxel ; Positron-Emission Tomography ; Postmenopause ; Prognosis ; Recurrence

Mutations in the tumor suppressor p53 gene are the most frequently observed genetic lesions in human cancers. It seems that wild type p53 does significant role on growth and differentiation of normal cells, Mutations and allelic loss of the p53 gene are thought to be a cause of tumor development and to be correlated with the prognostic factors in various human cancers such as breast, ovary and lung cancer. Mutant p53 proteins have a prolonged half-life and can be detected by immunohistochemistry. In case of GTD(gestational trophoblastic disease), although the mutation of p53 gene mutation was revealed to be very rare, the overexpression of p53 in immunohistochemical staining has been reported in wide range of discrepancy and its role or prognostic significance in GTD is uncertain. This study is performed to define the status of p53 overexpression in GTD and to evaluate the correlations between p53 overexpression and prognostic factors of GTD. THE RESULTS WERE AS FOLLOWS: 1. p53 overexpression was detected in none of normal placental tissue, in 58.3%(14/24) of hydatidiform mole, in 15%(6/8) of invasive mole, in 75%(3/4) of choriocarcinoma, and in 100%(1/1) of placental site trophoblastic tumor, and showed significant difference between normal placenta and GTD. We could not find any difference of the p53 overexpression between benign group(H-mole) of GTD and malignant one(invasive mole, choriocarcinoma, and placental site trophoblastic tumor) 2. In H-mole, low-risk group showed significantly higher prevalence of p53 overexpression than high-risk group did. In malignant group, there is no difference in the prevalence of p53 overexpression between early(FIGO stage I) and late(II- IV)stage-diseases, but the prevalence of p53 overexpression of low-risk group is slightly higher than that of high-risk group although we failed to find statistical significance. In conclusion, the high prevalence of p53 overexpression in GTD suggests that p53 may have a certain role in the pathogenesis of GTD or at least represent generalized DNA damage or genetic instability of GTD. And the higher prevalence of p53 overexpression in low-risk group suggests that accumulation of wild-type p53 may be related with favorable prognosis in GTD.
Breast ; Choriocarcinoma ; DNA Damage ; Female ; Genes, p53 ; Gestational Trophoblastic Disease* ; Half-Life ; Humans* ; Hydatidiform Mole ; Hydatidiform Mole, Invasive ; Immunohistochemistry ; Loss of Heterozygosity ; Lung Neoplasms ; Ovary ; Placenta* ; Pregnancy ; Prevalence ; Prognosis ; Trophoblastic Tumor, Placental Site ; Trophoblasts

PURPOSE: To evaluate the clinical results of a unilateral balloon kyphoplasty for the treatment of osteoporotic vertebral compression fractures (VCFs). MATERIALS AND METHODS: Twenty patients, 23 cases of osteoporotic VCFs who failed to respond to nonoperative treatments and who were confirmed by a consultant radiologist, were enrolled in this study. Times between injury and operation varied from 2 weeks to 2 months. All patients except two (18 female, 2 male patients), were female, and mean patient age was 71.7 (58-82) years. Follow-ups were conducted at least 12 months (12-27, mean 18.3). All patients underwent unilateral balloon kyphoplasty. Roentgenographic assessments were perform to evaluate fractured vertebra restoration and reduction loss. A ten-point visual analogue scale was used to measure pre- and postoperative pain severity. RESULTS: Preoperative anterior, middle and posterior heights of vertebra bodies were 57.8%, 66.1% and 85.3% of normal at presentation and these increased to 76.2%, 80.1%, 88.7% respectively at immediately after operation and at last follow-up, heights of each portion were 74.4%, 78.6%, 87.3%. Mean preoperative kyphotic angles of 17.6 degrees at presentation improved to 8.9 degrees at immediately after operations and to 9.1 degrees at last follow-ups. Loss of reduction was 1.8%, 1.5%, 1.4% and 0.2 degrees. Mean pain scores were 8.5 before surgery, 2.5 immediately after operations and 2.7 at last follow-ups. Statistical analysis showed a significant decrease in kyphotic angle (p=0.03) but VAS scores were no different (p=0.056). Anterior, middle and posterior body height was decreased with a statistical significance between two period (p<0.001). PMMA leakage occurred in 3 cases, but they did not cause neurologic deficits. CONSLUSION: Balloon kyphoplasty using a unilateral approach is a good treatment method for osteoporotic vertebral compression fractures and an alternative to the substitute bilateral approach.
Body Height ; Consultants ; Female ; Follow-Up Studies ; Fractures, Compression* ; Humans ; Kyphoplasty* ; Male ; Neurologic Manifestations ; Osteoporosis ; Pain, Postoperative ; Polymethyl Methacrylate ; Spine

Carcinoid is the most common tumor in the appendix and most often occurs in young patient. A case of mesoappendiceal invasion of carcinoid of appendix in presented and the literature review for indications for right hemicolectomy. A 38-year-old man was admitted to hospital after 3 day with right lower quadrant pain. The appendectomy was performed. At gross pathologic examination the appendix measured 7.5 cm in length and 1.6 cm in diameter. The serosal surface is congested and covered with yellow white fibrinoid material. The cut surface revealed a focal thickening of wall, measured 0.7 x 0.5 cm at 2 cm from tip of the appendix. Light microscopy revealed a typical carcinoid tumors infiltrating periappendiceal fat tissue. The patient was readmitted 4 weeks postoperatively for an elective right hemicolectomy. At exploratory laparotomy, there were no palpable lymph nodes. Exploration of the distal ileum, small bowel, and remaining abdomen did reveal any other carcinoid tumors.
Abdomen ; Adult ; Appendectomy ; Appendix ; Carcinoid Tumor* ; Estrogens, Conjugated (USP) ; Humans ; Ileum ; Laparotomy ; Lymph Nodes ; Microscopy

The first case of chyle ascites in childhood was reported by Morton in 1683. Its reported incidence varies between 1 in 50,000 to 100,000 in hospital admissions. The clinical picture is similar to that of acute diffuse peritonitis, and is most commonly mistaken as perforated appendicitis. Paracetesis, if performed, is the most useful diagnostic option. Treatment modalities fall into four areas-: Exploratory laparotomy with either direct ligation or drainage, A medium chain triglyceride diet, NPO and hyperalimentation or Venoperitoneal shunting. An 11-years old boy was admitted with RLQ pain. He had diffuse abdominal guarding. The initial diagnosis was perforated appendicitis, and appendectomy was performed. During the operation, the abdomen was found to contain 750cc of a thin, milky fluid. It was later diagnosed as chyle ascites. The small bowel mesentery and transverse colon were thickened and edematous, with a pale white subserosal exudate. The laboratory analysis of the ascites was as follows-: protein 4.6 g/dL, albumin 3.0 g/dL, triglyceride 700 mg/dL, cholesterol 113 mg/dL, glucose 209 mg/dL, LDH 848 U/L, and amylase 32 U/dL, with a pH of 9.0. An appendectomy was performed, and two drains placed in the pelvic cavity. In the postoperative-work-up from the abdominal CT scan, the results were normal. The patient-recovered and was discharged without complication 21 days postoperatively.
Abdomen ; Amylases ; Appendectomy ; Appendicitis* ; Ascites* ; Child ; Cholesterol ; Chyle* ; Colon, Transverse ; Diagnosis ; Diet ; Drainage ; Exudates and Transudates ; Glucose ; Humans ; Hydrogen-Ion Concentration ; Incidence ; Laparotomy ; Ligation ; Male ; Mesentery ; Peritonitis ; Tomography, X-Ray Computed ; Triglycerides

PURPOSE: Sulphomucin is secreted by immature foveolar cells of the stomach and is expressed in gastric adenocarcinomas. Carcinoembryonic antigen (CEA) is well known to be expressed in gastric adenocarci nomas and is correlated with the cellular differentiation of gastric adenocarcinomas. However, at the moment, there are no conclusions about the relationships between the expression of sulphomucin and pathological classifications. METHODS: This study was designed to determine the significance of expression of sulphomucin and CEA in advanced gastric adenocarcinomas. Also, these two factors were compared with established clinicopathological prognostic factors. Thirty-two paraffin-embedded surgical specimens of gastric adenocarcinomas were obtained from January 1993 to December 1995 and were selected for study. The expressions of sulphomucin and CEA were studied by using the Spicer method and immunohistochemical staining with CEA 2-7 monoclonal antibody. RESULTS: The expressions of sulphomucin and CEA were positive in 9 (28%) cases and 25 (78%) cases, respectively. There was a significant correlation between sulphomucin expression and histologic differentiation (p<0.05). However, the expression of CEA was correlated with neither clinopathological factors nor sulphomucin expression. CONCLUSION: These results suggest that expressions of sulphomucin are well correlated with cellular differentiations of advanced gastric adenocarcinomas.
Adenocarcinoma* ; Carcinoembryonic Antigen ; Classification ; Noma ; Stomach

PURPOSE: Sulphomucin is secreted by immature foveolar cells of the stomach and is expressed in gastric adenocarcinomas. Carcinoembryonic antigen (CEA) is well known to be expressed in gastric adenocarci nomas and is correlated with the cellular differentiation of gastric adenocarcinomas. However, at the moment, there are no conclusions about the relationships between the expression of sulphomucin and pathological classifications. METHODS: This study was designed to determine the significance of expression of sulphomucin and CEA in advanced gastric adenocarcinomas. Also, these two factors were compared with established clinicopathological prognostic factors. Thirty-two paraffin-embedded surgical specimens of gastric adenocarcinomas were obtained from January 1993 to December 1995 and were selected for study. The expressions of sulphomucin and CEA were studied by using the Spicer method and immunohistochemical staining with CEA 2-7 monoclonal antibody. RESULTS: The expressions of sulphomucin and CEA were positive in 9 (28%) cases and 25 (78%) cases, respectively. There was a significant correlation between sulphomucin expression and histologic differentiation (p<0.05). However, the expression of CEA was correlated with neither clinopathological factors nor sulphomucin expression. CONCLUSION: These results suggest that expressions of sulphomucin are well correlated with cellular differentiations of advanced gastric adenocarcinomas.
Adenocarcinoma* ; Carcinoembryonic Antigen ; Classification ; Noma ; Stomach

PURPOSE: Safe and effective surgical treatment of peptic ulcer perforations is fundamental to achieve favorable outcomes. We present laparoscopic single figure of eight suturing omentopexy for perforated duodenal ulcer and review associated clinical outcomes. This is a new formulaic surgical technique for laparoscopic omentopexy. METHODS: Laparoscopic single figure of eight suturing omentopexies for perforated duodenal ulcer were completed in 15 consecutive patients between April 2008 and November 2017 at Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea. Using prospectively collected data, we performed an observational study on an intention-to-treat basis. RESULTS: The mean age of the 15 patients who underwent laparoscopic repair was 41.7±13.9 years. The perforation site was the anterior duodenal bulb in all patients. The median perforation size was 5 mm (range: 3~8 mm). The mean operation time was 66.7±19.6 minutes. There was no evidence of leakage from the omentopexy site clinically or in the postoperative upper gastrointestinal series. One patient (6.7%) experienced the postoperative complication of pneumothorax. There were no cases of postoperative mortality or reoperation within 30 days after surgery. The median time to tolerance of regular diet was 6 (range: 4~9) days. The median postoperative hospital stay was 7 days (range: 5~11 days). CONCLUSION: Laparoscopic single figure of eight suturing omentopexy can be a viable option in the surgical management of perforated duodenal ulcer in selected patients without surgical risk factors. Laparoscopic single figure of eight suturing omentopexy is safe and easy to perform, and may therefore reduce operation time.
Diet ; Duodenal Ulcer ; Humans ; Korea ; Laparoscopy ; Length of Stay ; Mortality ; Observational Study ; Peptic Ulcer Perforation ; Pneumothorax ; Postoperative Complications ; Prospective Studies ; Reoperation ; Risk Factors ; Seoul

Schwannoma commonly arises from Schwann cells of the neural sheath, and is rare in the groin region. Here, we describe a vaginal schwannoma incidentally detected by magnetic resonance imaging (MRI) in a patient with thigh pain. A 43-year-old woman presented with thigh pain with burning and tingling sensations in the medial aspect of her left thigh. MRI revealed a mass lesion of heterogeneous intensity 5.2 x 5.7 cm in the left vaginal wall. The mass was resected and histology revealed schwannoma.
Adult ; Burns ; Diagnosis* ; Female ; Groin ; Humans ; Magnetic Resonance Imaging ; Neurilemmoma* ; Schwann Cells ; Sensation ; Thigh* ; Vaginal Neoplasms

Endometrial cancer is the most common malignancy of the female genital tract. The cancer spreads by direct extension, transtubal dissemination, lymphatic dissemination, and/or by hematogenous spread, usually results in lung metastasis, but may less commonly involve liver, brain, and bone. Here, we describe a patient with stage IA endometrial cancer who developed liver recurrence 17 months after surgery.
Brain ; Endometrial Neoplasms ; Female ; Humans ; Liver ; Lung ; Neoplasm Metastasis ; Recurrence