Umbilical metastasis may be the first presenting sign of the disease, or an indication of a recurrence from a previous malignancy. We recently encountered a 19-year-old woman with advanced ovarian adenocarcinoma whose first sign was having a Sister Mary Joseph's nodule. This patient only presented an umbilical nodule with slight lower abdominal discomfort, without any other subjective symptom. The lesion was fresh red, firm, ulcerating and has 1.5 cm in diameter. A punch biopsy from the lesion revealed metastatic adenocarcinoma and a PET-CT scan showed hypermetabolism on the umbilicus. After a systemic evaluation, she had a laparotomy including right salpingo-oophorectomy, total omentectomy, pelvic and paraaortic lymphadenectomy, appendectomy, and extirpation of the umbilicus. The patient received a postoperative combination of chemotherapy with paclitaxel and carboplatin, and still remains alive. This case demonstrates the importance of careful evaluation of any umbilical lesion and pathologic examination.
Adenocarcinoma ; Appendectomy ; Biopsy ; Carboplatin ; Female ; Humans ; Laparotomy ; Lymph Node Excision ; Neoplasm Metastasis ; Paclitaxel ; Recurrence ; Siblings ; Sister Mary Joseph's Nodule ; Ulcer ; Umbilicus ; Young Adult

The incidence of malignant disease increases in kidney transplant recipients taking immunosuppressive therapy. Extramammary Paget's disease, a very rare dermatologic malignancy, is characterized by frequent recurrences and coexistence with other malignancies. Although skin cancer is the most common malignancy occurring after kidney transplantation, extramammary Paget's disease has not been reported in Korea. In this paper, we report a case of recurrent extramammary Paget's disease after renal transplantation. A 66-year old man, who underwent renal transplantation from a living unrelated donor 15 years ago, was diagnosed to have extramammary Paget's disease 7 years ago. At this admission he was troubled with a pruritic skin lesion in his suprapubic area which previously occurred twice. The recurring Paget's disease was treated with radical resection and coverage. No further recurrences have been developed during the following 12 months until now.
Humans ; Incidence ; Kidney ; Kidney Transplantation ; Korea ; Paget Disease, Extramammary ; Recurrence ; Skin ; Skin Neoplasms ; Unrelated Donors

Primary fallopian tube carcinoma (PFTC) is a rare gynecological cancer that is very difficult to diagnose preoperatively. Here, we report the case of a 66-year-old female patient with PFTC that was diagnosed preoperatively on the basis of the characteristic features on endoscopic ultrasound (EUS) elastography and fine needle biopsy (FNB). EUS showed a sausage-shaped hypoechoic mass, 8 cm in size, with irregular margins and heterogeneous internal echoes extending to both adnexa. EUS elastography revealed that the mass had a blue color pattern, representing hard stiffness, and a heterogeneous green/red color pattern distributed outside the tumor, representing intermediate stiffness. Histopathologic analysis of the FNB and operative specimens confirmed the diagnosis of fallopian tube carcinoma. This is the first reported case of a combined EUS elastography and FNB of an adnexal mass leading to a preoperative diagnosis of fallopian tube carcinoma.
Aged ; Biopsy, Fine-Needle* ; Diagnosis ; Elasticity Imaging Techniques* ; Endosonography ; Fallopian Tube Neoplasms ; Fallopian Tubes* ; Female ; Humans ; Ultrasonography*

OBJECTIVE: Our purpose was to compare the difference and the positivity rate between Preserv Cyt(TM) solution of Thin-Prep(TM) Pap test and Cervical Sampler(TM) of Hybrid Capture II for detecting HPV DNA. METHODS: We collected samples of the cervix by using Preserv Cyt(TM) solution of Thin-Prep(TM) Pap test and a Cervical Sampler(TM) of Hybrid Capture II from ninety one women who screened for cervical carcinoma and precancerous cervical lesions between January 2003 and March 2003. At the same time, we tested the sample using the Preserv Cyt(TM) solution left over with a sample conversion kit. The cut off value for positive test result was above 1 pg/mL. RESULTS: The results of comparing the test using the Preserv Cyt(TM) solution of Thin-Prep(TM) Pap test with the one using Cervical Sampler(TM) showed negative results and 34 patients showed positive results with a significant high kappa coefficient of 0.674. The HPV titer of <1 were considered negative, while the HPV titer of 1 were considered positive. The positive HPV titer results were then subdivided into values of 1-10 and >10. Agreement rates of Preserv Cyt(TM) solution according to the HPV titer of Cervical Sampler(TM) were as follows: 97.7% in values below 1, 96.8% in values above 10, but 17.6% in values 1 to 10. So, the agreement rate was low between Cervical Sampler(TM) and Preserv Cyt(TM) solution in low value of HPV of Cervical Sampler(TM). CONCLUSION: Comparing the test using Preserv Cyt(TM) solution with Cervical Sampler(TM), there was a high correspondence and the Preserv Cyt(TM) solution was facilitated to detection for HPV at a time.
Cervix Uteri ; DNA* ; Female ; Humans*

PURPOSE: Clinical staging of gastric cancer appears to be important more and more for tailored therapy. This study aimed to verify the accuracy of clinical T staging in a low-volume institute. MATERIALS AND METHODS: We retrospectively reviewed prospectively collected data of gastric cancer patients who underwent resection. A total of 268 patients of gastric cancer were enrolled from March 2004 to June 2012. These demographics, tumor characteristics, and clinical stages were analyzed for identification of diagnostic value of clinical T staging. RESULTS: The predictive values for pT1 of endoscopy and computed tomography were 90.0% and 89.4%, respectively. In detail, the predictive values of endoscopy for pT1a, pT1b, and pT2 or more were 87%, 58.5%, and 90.6%, respectively. The predictive values of computed tomography for pT1a, pT1b, and pT2 or more were 68.8%, 73.9%, and 84.4%, respectively. The factors leading to underestimation of pT2 or more lesions by gastroscopy were the middle third location, the size greater than 2 cm, and younger age. Those for overestimation of pT1 lesion by computed tomography were male, age more than 70 years, elevated type, and size greater than 3 cm. CONCLUSIONS: Diagnostic accuracy of early gastric cancer was 90%, which is comparable to those of high volume center. In patients with early gastric cancer, limited gastrectomy or minimal invasive surgery can be safely introduced at a low volume center also. However, the surgeon of low-volume institute should consider the accuracy of clinical staging before extending the indication of limited treatment.
Demography ; Endoscopy ; Gastrectomy ; Gastroscopy ; Humans ; Male ; Neoplasm Staging ; Prospective Studies ; Retrospective Studies ; Stomach ; Stomach Neoplasms ; Technology, Radiologic

PURPOSE: Clinical staging of gastric cancer appears to be important more and more for tailored therapy. This study aimed to verify the accuracy of clinical T staging in a low-volume institute. MATERIALS AND METHODS: We retrospectively reviewed prospectively collected data of gastric cancer patients who underwent resection. A total of 268 patients of gastric cancer were enrolled from March 2004 to June 2012. These demographics, tumor characteristics, and clinical stages were analyzed for identification of diagnostic value of clinical T staging. RESULTS: The predictive values for pT1 of endoscopy and computed tomography were 90.0% and 89.4%, respectively. In detail, the predictive values of endoscopy for pT1a, pT1b, and pT2 or more were 87%, 58.5%, and 90.6%, respectively. The predictive values of computed tomography for pT1a, pT1b, and pT2 or more were 68.8%, 73.9%, and 84.4%, respectively. The factors leading to underestimation of pT2 or more lesions by gastroscopy were the middle third location, the size greater than 2 cm, and younger age. Those for overestimation of pT1 lesion by computed tomography were male, age more than 70 years, elevated type, and size greater than 3 cm. CONCLUSIONS: Diagnostic accuracy of early gastric cancer was 90%, which is comparable to those of high volume center. In patients with early gastric cancer, limited gastrectomy or minimal invasive surgery can be safely introduced at a low volume center also. However, the surgeon of low-volume institute should consider the accuracy of clinical staging before extending the indication of limited treatment.
Demography ; Endoscopy ; Gastrectomy ; Gastroscopy ; Humans ; Male ; Neoplasm Staging ; Prospective Studies ; Retrospective Studies ; Stomach ; Stomach Neoplasms ; Technology, Radiologic

Elastography is an imaging modality for the evaluation of tissue stiffness, which has been used for the analysis of superficial organs, such as those of the breast and prostate. The measurement of tissue elasticity has been reported to be useful for the diagnosis and differentiation of tumors, which are stiffer than normal tissues. Endoscopic ultrasonography elastography (EUS-EG) is a promising imaging technique with a high accuracy for the differential diagnosis of solid pancreatic tumors. However, to date EUS-EG has not been used to provide complementary information for biologic behavior of adenxal mass. We report our experience of EUS-EG in a patient with adnexal mass.
Breast ; Diagnosis, Differential ; Elasticity ; Elasticity Imaging Techniques ; Endosonography ; Humans ; Prostate

BACKGROUND/AIMS: The aim of this study was to compare palliative treatments such as chemotherapy, chemoradiotherapy or radiotherapy with best supportive care in patients with inoperable advanced esophageal cancer. METHODS: A total of 67 patients with inoperable advanced esophageal cancer visiting Kosin University Gospel Hospital between January 2000 and July 2010 were included in a retrospective analysis. Patients were categorized as having palliative treatment or best supportive care to compare their prognosis. RESULTS: The median survival was 6.4 months in 67 patients. There was significant difference in median survival between the palliative and best supportive treatment (9.8 months vs. 4.5 months, p=0.01). The patients who underwent palliative treatment had superior 1-year and 3-year overall survival rate than those with best supportive treatment (27%, 10% vs. 5%, 5%, respectively). The 1-year and 3-year overall survival rate of palliative treatment was 18% (1-year overall survival rate) in chemotherapy, 33% (1-year overall survival rate) in radiotherapy, 45% and 9% in concurrent chemoradiotherapy, and 20% and 20% in sequential chemoradiotherapy, respectively. CONCLUSIONS: These results may suggest that palliative treatments are more effective than best supportive care. Further prospective studies are still needed to elucidate beneficial effect of palliative treatments on inoperable advanced esophageal cancer.
Aged ; Aged, 80 and over ; Combined Modality Therapy ; Esophageal Neoplasms/mortality/*therapy ; Female ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Neoplasm Staging ; *Palliative Care ; Prognosis ; Retrospective Studies