Splenic metastasis resulting from solid tumors is a rare event, and it is most often diagnosed at the time of autopsy. In those cases of widely disseminated cancer, splenic involvement may be fairly common, but solitary splenic metastasis in the absence of other metastases is exceedingly rare. The reported primary malignancies of patients with splenic metastases include lung, colorectal, endometrial, ovarian, thyroid, pancreatic, gastric cancers and most commonly, melanoma. The author report here on a case of 55- year-old male who was found to have a solitary splenic metastasis 12 months after undergoing a left upper lobectomy for stage Ib (pT2N0M0) adenocarcinoma of the lung and he was then treated by splenectomy.
Adenocarcinoma ; Autopsy ; Humans ; Lung Neoplasms ; Lung* ; Male ; Melanoma ; Neoplasm Metastasis* ; Splenectomy ; Splenic Neoplasms ; Stomach Neoplasms ; Thyroid Gland

Carcinoid tumors are slow growing neoplasms that arise from enterochromaffin cells, with malignant potential, and those of the duodenum are rare neoplasms, with an incidence of 2.0~8.9% of all gastrointestinal carcinoid tumors. Duodenal carcinoid tumors rarely manifest gastrointestinal symptoms and carcinoid syndrome. A healthy 43 year old woman was admitted due to an incidentally detected duodenal mass during regular health screening. An abdominal CT scan and UGI series showed a polypoid mass at the second portion of the duodenum without bowel dilatation. The duodenoscopic finding was a carcinoid tumor, which was proven by immunohistochemical staining. A pylorus- preserving pancreatoduodenectomy was performed and a 2.5x2.2 cm sized submucosal tumor found at the second portion of the duodenum, with two periduodenal lymph node enlargements. Immunohistochemical staining showed that the tumor cells to have positive reaction for NSE, chromogranin and synaptophysin. Herein, our experience of a malignant duodenal carcinoid tumor is reported.
Adult ; Carcinoid Tumor* ; Dilatation ; Duodenum ; Enterochromaffin Cells ; Female ; Humans ; Incidence ; Lymph Nodes ; Mass Screening ; Pancreaticoduodenectomy ; Synaptophysin ; Tomography, X-Ray Computed

PURPOSE: The prognosis after potentially curative resection for stage IV gastric cancer, according to the 5th edition of AJCC/UICC classification, is poorly understood. The aim of this study was to evaluate the feasibility of the curative resection in patients with stage IV gastric cancer, which were considered potentially curable cases. METHODS: From November 1991 to June 1996, 91 patients were confirmed as having stage IV gastric cancer at Seoul Boramae Municipal Hospital. Of these 91 patients, 30 who were potentially curative resected including at least D2 type lymph node dissections were reviewed retrospectively. The average numbers of totally dissected and positive lymph nodes were 43.0 (range: 26~74) and 23.1 (range: 2~47), respectively. RESULTS: The overall 1-, 2-, and 5-year survival rates of patients were 60.0%, 36.7%, 13.3%, respectively. In comparison with stage IIIb (N=20), no significant difference in survival rate was observed (P=0.1178). In univariate analysis, we found that the presence of a recurrence (P=0.0121) and a P (positive lymph nodes)/R (total dissected lymph nodes) >0.6 were correlated with poor survival rates. Long- survivors (N=12, more than 24 months postoperatively) had a tendency to be younger, less recurrent (P=0.017) and less involvement of histological perineural invasion (P=0.028). CONCLUSION: The results of the present study indicate that stage IV patients without distant metastasis may indeed be cured by potentially curative surgery.
Classification* ; Gastrectomy* ; Hospitals, Municipal ; Humans ; Lymph Node Excision ; Lymph Nodes ; Neoplasm Metastasis ; Prognosis ; Recurrence ; Retrospective Studies ; Seoul ; Stomach Neoplasms* ; Stomach* ; Survival Rate ; Survivors

PURPOSE: The nodal staging of the 5th edition of the Union Internationale Contra la Cancer (UICC) TNM classification in 1997 was changed based on the number of metastatic lymph nodes. We attempted to classify nodal status according to the number of involved lymph nodes and compare with the nodal staging of the 5th UICC TNM classification in order to evaluate the rationality of the new nodal staging system. METHODS: The authors retrospectively analyzed 427 patients with gastric cancer who underwent curative resection from 1993 to 1996 at the Department of Surgery, Korea University College of Medicine. Cumulative survival rates were calculated by the Kaplan-Meier method. The difference between each nodal status was evaluated by the log rank test and the generalized Wilcoxon test. RESULTS: There were statistical differences between 0 and 1 lymph node involved, between 7 and 8, and between 15 and 16. We classified the nodal status into 4 groups according to the number of involved lymph nodes based on the following: group 1 with no lymph node involved, group 2 with 1~7, group 3 with 8~15 and group 4 with more than 15. There was a significant survival difference among the 4 groups with no survival difference between the number of positive lymph nodes in each group. We compare our results with the nodal staging of the UICC TNM classification and found that there were differences between group 2 (1~7 positive lymph nodes) and pN1 of TNM (1~6 positive lymph nodes) and between group 3 (8~15) and pN2 (7~15). CONCLUSION: We were able to classify nodal status into 4 groups according to the number of involved lymph nodes. There was little difference compared with the new nodal staging of the 5th UICC TNM classification, which suggested that the nodal classification of the UICC TNM classification based on the number of metastatic lymph nodes is acceptable. Further analysis of a larger sample size may be necessary.
Classification* ; Humans ; Korea ; Lymph Nodes* ; Retrospective Studies ; Sample Size ; Stomach Neoplasms* ; Survival Rate

Obturator hernia is a rare type of pelvic hernia and occurs most commonly in elderly and debilitated women. It is still a challenge for surgeons to diagnose precisely in early stages because of its nonspecific symptoms and consequently delayed diagnosis could lead to high morbidity and mortality. We experienced a 92-year old patient who was diagnosed as obturator hernia which was confirmed by computed tomography scan of the abdomen and pelvis. The operation was delayed due to the refusal of family members but eventually done after 12 days from initial diagnosis. After manual reduction of small bowel impacted into right obturator foramen, segmental resection of impacted small bowel and anastomosis was done. The hernial defect was closed by primary closure with Dexon suture material. After the operation, the patient was discharged without significant complications. We report here successful results of delayed operation for obturator hernia.
Abdomen ; Aged ; Benzenesulfonates ; Delayed Diagnosis ; Disulfiram ; Female ; Hernia ; Hernia, Obturator ; Humans ; Pelvis ; Sutures

The purpose of this study was to detect where the center of pressure in foot would be located at the end point of loading response and the terminal stance by the dynamic plantar pressure measurement. Seventeen adults who had the usual feet without a pathologic gait were evaulated simultaneously by the motion analysis using VICON 370, and the plantar pressure measurement using EMED-SF. Two devices were set in the 60 Hz frame. The foot was divided into 3 different zones; hindfoot, midfoot, and forefoot. The end point of loading response was located at the 1.92+/-1.46 frame distal to the hindfoot- midfoot borderline. The end point of terminal response was located at the 2.27+/-1.96 frame distal to the maximal pressure points of metatarsal head. Authors could differentiate each period of stance phase; the initial contact, loading response, mid-stance, terminal stance, and preswing, using the analysis of center of pressure by the dynamic plantar pressure measurement.
Adult ; Foot* ; Gait* ; Head ; Humans ; Metatarsal Bones

PURPOSE: Carcinoids are rare neuroendocrine tumors, mainly detected in the gastrointestinal tract. This study was performed to evaluate the incidence and necessity for additional treatment in incidental appendiceal carcinoids from patients presenting with symptoms of acute appendicitis. METHODS: Of the patients; who underwent appendicectomies, with the diagnostic impression of acute appendicitis, from 1994 to 2003, six cases were diagnosed as appendiceal carcinoids. The medical records of these patients were retrospectively reviewed. RESULTS: During the study period, a total of 2477 patients (male: 1336 and female: 1141) underwent appendicectomies due to the diagnostic impressions of acute appendicitis, with 2 male and 4 female cases diagnosed as appendiceal carcinoids by pathological examination. The rate of incidental appendiceal carcinoids in those patients was 0.24% (male: 0.15% and female: 0.35%) An appendiceal carcinoid was detected in one of 396 child patients (0.25%), but in none of 610 patients over the age of 40. Additional bowel resections were necessary in two patients (33%) in whom the carcinoids had infiltrated the serosa or mesoappendix, and were involved in the resection margins In one of these (50%), the carcinoid had metastasized to regional lymph nodes. CONCLUSION: Incidental appendiceal carcinoids are not common events in patients with symptom of acute appendicitis. However, the possibility of a metastatic disease in these incidental carcinoids warrants careful considerations for additional treatment on the basis of a close pathological examination.
Appendicitis* ; Appendix ; Carcinoid Tumor* ; Child ; Female ; Gastrointestinal Tract ; Humans ; Incidence ; Lymph Nodes ; Male ; Medical Records ; Neuroendocrine Tumors ; Retrospective Studies ; Serous Membrane

Aneurysm of deep femoral artery rarely occurs as an isolated lesion because of the anatomical position and characteristics of wall tissue. Early surgery is mandatory because the aneurysm has a tendency to become large and to rupture. We report herein a case of an isolated true deep femoral artery aneurysm in a 67-year-old female, who presented with a pulsatile mass in the groin showing rapid enlargement. CT angiography followed by conventional angiography confirmed the diagnosis and revealed no evidence of aneurysm or occlusive disease in the other arteries. Endo-aneurysmectomy with 6 mm PTFE graft interposition was performed. Acute deep vein thrombosis was developed postoperatively but was cured by short-term anticoagulation therapy. At ten-months follow-up, she resumed her normal activity with no ischemic or thrombotic symptoms.
Aged ; Aneurysm* ; Angiography ; Arteries ; Diagnosis ; Female ; Femoral Artery* ; Follow-Up Studies ; Groin ; Humans ; Polytetrafluoroethylene ; Rupture ; Transplants ; Venous Thrombosis

PURPOSE: For the treatment of residual visible tributaries following minimally invasive saphenous vein ablation procedures such as endovenous laser treatment (EVLT) and radiofrequency ablation (RF), a variety of options including observation, sclerotherapy, ultrasonography-guided sclerotherapy, stab phlebectomy (SP) and additional laser therapy have been developed. We performed endovenous laser treatment combined with stab phlebectomy and we evaluated the early results to assess the efficacy and safety of this procedure. METHODS: Between February 2003 and February 2006, one hundred twelve venous insufficiencies of the lower limbs in 106 patients (46 men and 60 women; mean age: 51.7 years) were treated with EVLT combined with SP. According to the CEAP classification, 103 limbs were C2, and nine were C3/C4. 810-nm diode laser energy was delivered percutaneously into the saphenous veins (86 GSVs, 20 SSVs, 6 GSV+SSVs). All patients were followed up on an outpatient basis and duplex ultrasonography (US) was performed 3 months after operation. RESULTS: The mean follow-up period was 2.92 months. All the patients had symptomatic improvement and immediately returned to normal daily activities. The overall complication rate was 36.6% (41 cases), and most of them were minor problems including ecchymosis in 22, paresthesia in 8, induration in 5 and excessive pain in 2. Three cases of cellulitis or thrombophlebitis were present and this resolved with drainage and antibiotics. One case of foot drop developed, but this improved with active physiotherapy within a few months. No postprocedural symptomatic deep vein thrombosis occurred. The recurrence rate of tributaries at 3 months was 13.6%, but these were easily controlled by sclerotherapy if needed. The duplex US-confirmed saphenous vein recanalization rate at 3 months was 5.9%. CONCLUSION: EVLT combined with SP could be a novel minimally invasive modality for treating lower extremity varicose veins with an acceptable complication rate and a low recanalization rate of the saphenous veins. It could lessen the possibility of additional treatments for the residual visible tributaries and so improve the satisfaction index, along with the cosmetic and economic advantages. However, long-term follow up and postoperative duplex US with an additional objective index examination are required to confirm the effectiveness and durability of this operative procedure.
Anti-Bacterial Agents ; Catheter Ablation ; Cellulitis ; Classification ; Drainage ; Ecchymosis ; Extremities ; Female ; Follow-Up Studies ; Foot ; Humans ; Laser Therapy ; Lasers, Semiconductor ; Lower Extremity* ; Male ; Outpatients ; Paresthesia ; Recurrence ; Saphenous Vein ; Sclerotherapy ; Surgical Procedures, Operative ; Thrombophlebitis ; Ultrasonography ; Varicose Veins* ; Venous Insufficiency ; Venous Thrombosis

PURPOSE: We tried to select and validate the candidate gene for the prognostic marker of breast cancer by comparing the analysis of copy number variation (CNV) between normal breast tissues and breast cancer tissues by performing array comparative genomic hybridization (CGH). METHODS: Array CGH was performed with using the fresh frozen tissues of 77 breast cancer patients. We selected the clones with more than a 20% frequency of gain or loss, and the clones with gain or loss in more than 2 consecutive clones. We finally selected the clones that were statistically significant on the survival analysis. We searched for the candidate gene that belonged to the candidate clones and we selected the final candidate gene that is assumed to be most related to the carcinogenesis of breast cancer by searching for information of the individual gene. We performed RT-PCR to validate the RNA expression of the final candidate gene with using the breast tissues of another 20 breast cancer patients. RESULTS: Eleven (10 in the gain group and 1 in the loss group) clones were finally selected as candidate clones. The significant CNVs with gain were found in the regions of 1q23.1, 1q41, 1q44, 5p15.33, 8q21.3, 15q26.3, 17q12 and 21q22.3 and the significant CNV with loss was found in 14q32.33. COL18A1 (21q22.3) was selected as the final candidate gene and the RT-PCR results revealed that the expression of COL18A1 was up-regulated in the cancer tissues of 18 of the other 20 (90%) breast cancer patients. CONCLUSION: We selected COL18A1 (21q22.3) as the candidate gene for the prognostic marker of breast cancer by comparing the analysis of CNVs from the array CGH. The RNA of COL18A1 was over-expressed in breast cancer tissue, as determined by RT-PCR.
Breast ; Breast Neoplasms ; Clone Cells ; Coat Protein Complex I ; Collagen Type XVIII ; Comparative Genomic Hybridization ; DNA ; DNA Copy Number Variations ; Gene Amplification ; Humans ; Microarray Analysis ; RNA