No abstract available.
Animals ; Ascorbic Acid* ; Cyclosporine* ; Rats* ; Vitamins*

PURPOSE: Ductal carcinoma in situ (DCIS) of the breasts is a heterogeneous group of lesions with diverse malignant potentials and controversial treatment options. This study was planned to investigate the patterns of clinicopathologic parameters and tumor markers related to biological aggressiveness and to make treatment decisions available based on a variety of these parameters. METHODS: We reviewed forty cases of DCIS treated at Pusan Paik Hospital from March 1992 to July 2002. Clinicopathologic features such as age, chief complaint, mammographic finding, tumor size, histologic subtype, and operation type were analysed, and the expression of ER, PR, p53, C- erbB-2, cathepsin D, bcl-2, MIB-1 and CD34 were evaluated using immunohistochemical methods. RESULTS: The size of the tumor was less than 1.5 cm in 16 (44.4%) cases, 1.5 cm to 4 cm in 17 (47.2%) cases, and more than 4 cm in 3 (8.3%) cases. There were 11 (27.5%) cases of the comedo subtype and 29 (72.5%) cases of the noncomedo subtype. Nuclear grade was divided into low (8 cases, 20.0%), intermediate (20 cases, 50.0%), and high (12 cases, 30.0%). According to Van Nuys' classification, there were 25 (62.5%) cases, 4 (10.0%) cases, and 11 (27.5%) cases of group I, II, and III, respectively. The groups presenting as mass on mammogram had no significant relationship with those presenting as microcalcification in terms of tumor size, histologic subtype, nuclear grade, and Van Nuys classification. The expression rates of PR, p53, C-erbB-2, cathepsin D, and bcl-2 were 32.4%, 67.6%, 35.1%, 29.7%, 67.6%, and 45.9%, respectively. High MIB-1 labelling index (LI) and high microvessel density were observed in 8.1% and 32.4%, respectively. The group presenting as mass on mammogram showed higher ER (P=0.0276) and PR (P=0.102) expression, compared with the microcalcification group. Positive ER and PR were associated with low nuclear grade (P=0.0233, 0.1727), while positive p53 and C-erbB-2 and high MIB-1 LI correlated with Van Nuys' group III (P=0.0637, 0.0532). Positive ER correlated with positive PR (P=0.0581) and negative C-erbB-2 (P=0.0642). In addition, there were positive associations between PR and bcl-2 expression (P=0.0939), between p53, C-erbB-2 (P<0.0001) and high MIB-1 labelling index (P= 0.0785), and between cathepsin D and high microvessel density (P= 0.0151). CONCLUSION: Clinico-pathologic evaluation of tumor size, histologic subtype, nuclear grade, and Van Nuys classification can help predict more aggressive immunophenotypes of DCIS. Positive p53 and C-erbB-2 and high MIB-1 is associated not only with more aggressive clinical behavior and more advanced histologic features of DCIS, but also with negative ER, PR, and bcl-2. Our results support the clinical relevance of combining both clinico-pathologic factors and biologic tumor markers for determining the treatment modality in DCIS patients.
Biomarkers, Tumor* ; Breast* ; Busan ; Carcinoma, Ductal* ; Carcinoma, Intraductal, Noninfiltrating ; Cathepsin D ; Classification ; Humans ; Microvessels

PURPOSE: MMPs are involved in the degradation of the extracellular matrix, which is an important step in tumor invasion and metastasis. Among the MMPs, a positive correlation between the expressions of MMP-2 and MMP-9, and the aggressive behavior of breast carcinomas has been reported, but the role of the MMP-2 and MMP-9 expressions in DCIS is still not known. Angiogenesis has a crucial role in tumor growth and metastasis. The aim of this study was to investigate the relationships between the expressions of the MMPs, the angiogenic factor (VEGF) and the microvessel density (MVD) in a ductal carcinoma in situ (DCIS) of the breast. METHODS: 42 cases of DCIS, diagnosed at the Busan Paik Hospital, between 1992 and 2002, were the subjects of this study. The rates of MMP-2 and 9 expressions and VEGF were evaluated using immunohistochemistry, and the MVD was measured by CD 34 immunohistochemical staining. The statistical analyses between the expressions of MMP-2, MMP-9 and VEGF and the MVD, patient's age (more than 50 years old, less than 50 years old), histological subtype (comedo or non-comedo) and nuclear grade (I, II, III), and their correlation were exained. RESULTS: The expressions of MMP-2 and MMP-9 were noted in 20 (47.6%) and 22 (52.4%) of the 42 cases, respectively. There were no significant relationships between the expressions of MMP-2 and MMP-9 and the patient's age and histological subtype, but the expression rate of MMP-9 showed an increased tendency in cases with nuclear grades II and III compared with the cases with nuclear grade I (P=0.0863), but no significant difference between the MMP-2 expression and the nuclear grades was noted. The VEGF was expressed in 47.6% of the cases, and the mean MVD was 21 per x200 field, with 13 (30.9%) of the 42 cases showing increased MVD. The VEGF expression rate showed an increasing tendency in the cases younger than 50 years old (P= 0.1011), but no significant differences according to the histological subtype and nuclear grades were seen. There were no relationships between the MVD and the clinico-pathological factors. The MVD showed an increasing tendency in cases with a non-comedo histological type compared to the comedo type (P=0.0536). No positive correlation between the expression of VEGF and MVD was noted. No significant relationship between expressions of MMP-2 and VEGF and the MVD were seen, but the rate of MMP-9 expression was significantly higher in the VEGFpositive cases (P=0.0293), however, no relationship between MMP9 expression and MVD was found. CONCLUSION: The expressions of MMP-2 and MMP-9 in DCIS are suggestive of their involvement in the development of breast cancers. However, with non-invasive lesions, and the positive correlation between the MMP-9 and VEGF expressions and the nuclear grades, means that the expression of MMP-9 may represent the biological behavior of DCIS, but the role of MMP-2 expression is still uncertain in the development of breast carcinomas.
Angiogenesis Inducing Agents ; Breast Neoplasms ; Breast* ; Busan ; Carcinoma, Intraductal, Noninfiltrating* ; Extracellular Matrix ; Immunohistochemistry ; Matrix Metalloproteinases ; Microvessels* ; Neoplasm Metastasis ; Vascular Endothelial Growth Factor A*

A case of rare symptomatic cerebellopontine angle lipoma treated by surgical decompression is described. In this 28-year-old male with intermittent facial pain 17 years, a mass was noted in the right cerebellopontine angle on C-T and MRI. Partial removal of the mass was made for decompression of the lesion from the trigeminal nerve root entry zone. The surgical biopsy results was lipoma. This represents, to our knowledge, the first lipoma in the cerebellopontine angle reportes in the Korean literature.
Adult ; Biopsy ; Cerebellopontine Angle* ; Decompression ; Decompression, Surgical ; Facial Pain ; Humans ; Lipoma* ; Magnetic Resonance Imaging ; Male ; Neuroma, Acoustic ; Trigeminal Nerve ; Trigeminal Neuralgia*

Accessory spleen can be mistaken as a gastric subepithelial mass, and may not be differentiated in CT or endoscopic ultrasonography (EUS). A gastric subepithelial mass was detected on routine endoscopy in a 39-year old woman with history of splenectomy. In subsequent CT and EUS, the subepithelial mass was located on the fourth layer of the stomach. To make a definite diagnosis, EUS-guided fine needle aspiration (FNA) was performed, and a splenic tissue was demonstrated in histologic examination. EUS-guided FNA can be beneficial in the diagnosis of accessory spleen which mimics a gastric subepithelial mass.
Adult ; Antigens, CD34/metabolism ; Biopsy, Fine-Needle ; Endosonography ; Female ; Gastroscopy ; Humans ; Immunohistochemistry ; Splenic Diseases/pathology ; Stomach Neoplasms/*diagnosis/pathology ; Tomography, X-Ray Computed

Stricture frequently occurs after endoscopic submucosal dissection (ESD) for superficial esophageal carcinoma with near- or whole-circumferential mucosal defects, and post-ESD stricture is difficult to treat and usually requires multiple sessions of endoscopic balloon dilatation. Intralesional steroid injection has previously been used to prevent stricture; however, there have been few experiences with this method after near- or whole-circumferential ESD. We present a case of a single session of intralesional steroid injection performed immediately after near-circumferential ESD to prevent post-ESD stricture. After a follow-up period of 6 months, the patient showed good outcome without dysphagia.
Constriction, Pathologic* ; Deglutition Disorders ; Dilatation ; Esophageal Neoplasms* ; Esophageal Stenosis ; Follow-Up Studies ; Humans ; Injections, Intralesional

A 51-year-old man visited the tertiary-care hospital with a 2-week history of dizziness and dyspnea on exertion. The initial hemoglobin level was 5.8 g/dL, without any history of hematochezia or melena. The esophagogastroduodenoscopy (EGD) was normal. During colonoscopic preparation, the patient experienced hematochezia and became hypotensive. On angiography, no extravasation of contrast media was observed. A CT scan with angiography showed a small high-density area in the jejunal lumen, suggesting extravasation of the contrast media. Capsule endoscopy was performed, and oozing bleeding was suspected in the proximal to mid jejunum. The patient was referred to our hospital. Repeated EGD and CT enterography did not reveal any significant bleeding. An antegrade double balloon endoscopy was performed, and an approximately 2-cm-sized submucosal tumor with ulceration and a non-bleeding exposed vessel was observed in the mid jejunum. The presumed diagnosis was jejunal gastrointestinal stromal tumor. The mass was surgically resected, and the final histopathological diagnosis was arteriovenous malformation.
Arteriovenous Malformations/*diagnosis/pathology ; Capsule Endoscopy ; Diagnosis, Differential ; Gastrointestinal Hemorrhage ; Gastrointestinal Stromal Tumors/diagnosis ; Humans ; Jejunum/*pathology ; Male ; Middle Aged ; Tomography, X-Ray Computed

Chromoendoscopy using Lugol's iodine solution is widely used to improve the detection of esophageal dysplasia or early squamous carcinoma. Although the solution helps to notice esophageal lesions and to delineate the lesions more clearly, it can cause mucosal irritation leading to retrosternal pain and epigastric discomfort infrequently. We report a case of acute gastric mucosal injury after application of Lugol's solution during chromoendoscopy in a 63-year-old woman.
Carcinoma, Squamous Cell ; Endoscopy ; Female ; Humans ; Iodides ; Iodine ; Middle Aged ; Mucous Membrane

BACKGROUND/AIMS: The Barrett's esophagus is confirmed by performing a biopsy when the gastroesophageal junction (GEJ) and Z-line do not coincide. In Japan, the GEJ is at the distal end of the palisading vessel while Western countries define it as the proximal tip of the gastric fold. However, there is little data on the prevalence of an endoscopic Barrett's esophagus and the inter-observer variation. METHODS: Four experienced endoscopists reviewed the endoscopic still images of 111 consecutive patients. The level of inter-observer agreement was expressed as a kappa value. RESULTS: The average percentage of patients with an endoscopically confirmed esophagus was 34.2%. The level of inter-observer agreement was substantial (kappa=0.698). CONCLUSIONS: The prevalence of an endoscopic confirmed Barrett's esophagus was high, and the inter-observer variation was substantial when the GEJ was defined as the distal end of the palisading vessel. Considering the low incidence of esophageal adenocarcinoma and the risk of hemorrhage from a biopsy, a more specific marker is needed in this high-risk group.
Adenocarcinoma ; Barrett Esophagus* ; Biopsy ; Esophagogastric Junction ; Esophagus ; Hemorrhage ; Humans ; Incidence ; Japan ; Observer Variation* ; Prevalence*

The apprenticeship-based training method (ABTM) is highly effective for gastrointestinal (GI) endoscopic training. However, the conventional ABTM has significant issues. Although many supplementary training methods (TMs) have been developed and utilized, they cannot entirely replace the ABTM, which remains the major TM strategy. Currently, new TM construction is crucial and necessary due to financial constraints, difficulty of obtaining sufficient training time due to patient safety-related regulations, and catastrophic damage caused by disasters such as the coronavirus disease 2019 pandemic. The simulator-based TM (SBTM) is widely accepted as an alternative to the ABTM, owing to the SBTM’s advantages. Since the 1960s, many GI endoscopy training simulators have been developed and numerous studies have been published on their effectiveness. While previous studies have focused on the simulator’s validity, this review focused on the accessibility of simulators that were introduced by the end of 2021. Although the current SBTM is effective in GI endoscopic education, extensive improvements are needed to replace the ABTM. Incorporating simulator-incorporated TMs into an improved ABTM is an attempt to overcome the incompleteness of the current SBTM. Until a new simulator is developed to replace the ABTM, it is desirable to operate a simulator-integrated and well-coordinated TM that is suitable for each country and institution.