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Se Hoon KANG ; Sung Won KIM ; Hee Joon KANG ; Yeo Kyu YOUN ; Seung Keun OH ; Kuk Jin CHOE ; Dong Young NOH

Journal of the Korean Surgical Society.2001;60(4):380-385.

PURPOSE: Women pregnant or lactating at the time of breast cancer diagnosis exhibit a significantly more advanced stage disease at the time of diagnosis than non-pregnant women. The goal of this study was to identify pregnancy-associated breast cancer, and to compare the clinicopathologic characteristics and disease-free survival rates with those of non-pregnancy associated breast cancer. METHODS: The medical records of women pregnant or within 1 year postpartum at the time of breast cancer diagnosis and those of non-pregnant women with breast cancer between 1981 and 1999, were analyzed. Fourteen women with pregnancy-associated breast cancer (group I) were compared to 155 non-pregnant women with breast cancer (group II) of comparable ages, and to 1201 women with breast cancer age of 36 or older (group III). RESULTS: No significant differences were found in regards to dominant histologic types, hormone receptor statuses or histologic grade among those three groups. The delay in diagnosis of group I averaged 5.2 months longer than that of group II (P<0.001). Group I was found to have larger (> or =5 cm) tumors, and a greater portion had advanced staged (stage> or =III) cancer than group II (P<0.025). Stage by stage, there was no significant statistical difference in disease-free survival rates between group I and group II. The younger patients (group I, group II) had lower disease-free survival rates than older patients (group III) (P<0.05). CONCLUSION: No specific pathologic characteristics were found in pregnancy associated breast cancer. The delay in diagnosis and young age at diagnosis may be the primary reasons for the relatively advanced stages seen in breast cancer associated with pregnancy.
Breast Neoplasms* ; Breast* ; Diagnosis ; Disease-Free Survival ; Female ; Humans ; Medical Records ; Postpartum Period ; Pregnancy ; Prognosis

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Incidence of Axillary Lymph Node Metastases in T1 Breast Cancer.

Hee Won HAM

Journal of the Korean Surgical Society.2001;60(4):375-379.

PURPOSE: Tumor size is the strongest predictor of axillary node metastases. Some authors have reported that axillary dissection in T1a breast cancer is not required because the rate of incidence is less than 5%. However I have doubts concerning the omission of axillary dissection in small breast cancers. Therefore, I investigated the incidence of axillary node metastases in T1 breast cancer according to size for the purpose of using this data as a reference for determining whether or not to dissect axillary lymph nodes. METHODS: Data of patients registered at the Strang Cancer Prevention Center affiliated with the New York Hospital-Cornell Medical Center, from January 1988 to December 1998 were reviewed. After review of charts and pathologic reports for tumor size, age at operation and lymph node status, 592 patients were proven to have primary breast tumor 2 cm in size or smaller. The size of the tumor was determined as the largest diameter of the invasive lesion when possible. RESULTS: Lymph node metastases were seen in 7 of 68 cases in the 0.1~0.5 cm T1a (10.3%), 29 of 182 in 0.6~1.0 cm T1b (15.9%), 50 of 206 in 1.1~1.5 cm (24.3%) and 55 of 136 in 1.6~2.0 cm tumor size range (40.4%). CONCLUSION: Although positive node occurrence was lower in small size tumors, significant number of patients with T1a invasive tumors have a positive node. Therefore, a small size of tumor alone is not an indicator for the omission of axillary dissection.
Breast Neoplasms* ; Breast* ; Humans ; Incidence* ; Lymph Nodes* ; Neoplasm Metastasis*

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Relationship between Cathepsin D Expression and Other Prognostic Factors in Primary Breast Cancer.

Woo Jin CHUNG ; Dong Eun PARK ; Kwang Man LEE ; Kwon Mook CHAE ; Ki Jung YOON

Journal of the Korean Surgical Society.2001;60(4):368-374.

PURPOSE: Cathepsin D, a lysosomal protease has been proposed to play a role in the local invasion and metastatic dissemination in primary breast cancer. Although there are many conflicting results, the overexpression of cathepsin D has been considered to be related with a poorer prognosis of breast cancer. This study was designed to verify whether cathepsin D expression is related to other prognostic factors in breast cancer. METHODS: Cathepsin D was assessed by immunohistochemistry using murine monoclonal anti-cathepsin D antibody (ZyMED) in 79 paraffin-embedded primary breast cancer specimens. Cathepsin D expression was compared to other prognostic parameters such as tumor size, axillary lymph node metastasis, tumor histologic grades, hormone receptors (ER & PR), p53, c-erb B2, Ki-67, MVD (microvessel density), and Pgp (P-glycoprotein). RESULTS: A high-expression of cathepsin D was found in 35 of 79 patients (44.3%) with primary breast cancer. Cathepsin D expression was not related to tumor size, axillary lymph node metastasis, tumor histologic grades, hormone receptors, p53, Ki-67, or CD31. However, a significant relationship was found between cathepsin D expression and c-erb B2 (p=0.007), and between cathepsin D expression and Pgp (p=0.003). CONCLUSION: These results suggest that cathepsin D expression may be an indicator of a poor prognosis in breast cancer. However, further studies are required to verify the exact role of cathepsin D in the prognosis of breast cancer.
Breast Neoplasms* ; Breast* ; Cathepsin D* ; Cathepsins* ; Humans ; Immunohistochemistry ; Lymph Nodes ; Neoplasm Metastasis ; Prognosis

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Assessment of MIB1 (Ki-67) Labeling Index and Correlation with Other Well Established Prognostic Factors in Breast Cancer.

Chang Dae KO ; Hee Joon KANG ; Sung Won KIM ; Yeo Kyu YOUN ; Seung Keun OH ; Kuk Jin CHOE ; Dong Young NOH

Journal of the Korean Surgical Society.2001;60(4):361-367.

PURPOSE: The MIB1 labeling index is new method utilizing a monoclonal antibody against Ki-67 antigen and useful for evaluating the proliferation rate in breast cancer due to its ease of use and reliability. We compared the MIB1 labeling index to other, well established prognostic factors and assessed the prognostic value of MIB1 in 564 breast cancers. METHODS: The MIB1 (Ki-67 equivalent monoclonal antibody) proliferation rate, MIB1 labeling index, was determined in formalin-fixed, paraffin-embedded tissue specimens of 564 primary breast cancer patients who underwent surgery between March 1998 and February 2000 at Seoul National University Hospital. The clinicopathologic characteristics of the primary tumor such as age, tumor size, histologic type, nuclear grade, histologic grade, hormone receptor status and various tumor markers (p53, c-erbB-2, bcl-2) were compared with the value of the MIB1 labeling Index. RESULTS: The mean value of MIB1 labeling index was 6.9. MIB1 labeling index was correlated to younger age (p= 0.011), histologic types, low nuclear grade (p=0.0001), high histologic grade (p=0.0001), p53 positive (IDC) (p=0.0001), c-erbB-2 positive (DCIS) (p=0.01), comedo type (DCIS) (p= 0.001) and inversely correlated to hormone receptor positivity (p=0.0001), bcl-2 positive (IDC) (p=0.001). No correlation was found in tumor size, lymph node status and c-erbB-2 positive (IDC). CONCLUSION: The MIB1 labeling index correlated well with well-established poor prognostic factors. The MIB1 labeling index may be an important prognostic determinant in breast cancer.
Biomarkers, Tumor ; Breast Neoplasms* ; Breast* ; Humans ; Ki-67 Antigen ; Lymph Nodes ; Seoul

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Congenital Diaphragmatic Hernia in Rats Using Nitrofen: An Animal Model.

Whan Bong LEE ; Jai Kyoo LEE ; Pyong Chan LEE ; Byung Jun SO ; Kwon Mook CHAE

Journal of the Korean Surgical Society.2001;60(4):355-360.

PURPOSE: Since 1971, Nitrofen (2,4-dichloro-4`-nitrodiphenyl ether) herbicide has been known to induce variable congenital abnormalities in rats. However, until now there has been no animal model of congenital diaphragmatic hernia (CDH) using this herbicide in Korea. Therefore, CDH in rats using Nitrofen was tried for searching on pathogenesis or using therapeutic modalities of CDH. METHODS: 20 Sprague-Dawley rats ingested Nitrofen as indicated on the 9.5th day of gestation, and after sacrificing on the 21th day of gestation. 243 offspring were harvested for the examination of diaphragmatic herniations. Dissections were made along sites of herniations to confirm the diaphragmatic herniation's site and size, lung/body weight ratio comparison as well as to accomplish microscopic radial saccular counting and evaluation of alveolar septal wall maturations and a comparision was made between the groups. RESULTS: CDH appeared in 149 of 243 offspring. CDH only appeared in the posterior portion of the diaphragm regardless of size or the side of appearance. Left sided CDH was the most common single diaphragmatic anomaly, represented in 112 offspring. Right sided CDH was next, found in 31 offspring, and bilateral CDH was seen in 6 offspring. Left sided CDH was almost always associated with visceral herniations and with pulmonary hypoplasia on the affected side, which was proved in the decreased Lung/Body weight ratio and in decreased radial saccular counts and in increased alveolar septal wall thickness in the affected lungs of CDH. In94 offspring without CDH following exposure to Nitrofen, moderate pulmonary hypo plasia was microscopically observed. CONCLUSION: Initial Rat modeling of congenital diaphragmatic hernia using Nitrofen showed results of herniation and pulmonary hypoplasia of the affected lungs acceptable for further experimental studies on CDH and accompaning pulmonary abnormalities.
Animals ; Animals* ; Congenital Abnormalities ; Diaphragm ; Hernia, Diaphragmatic* ; Korea ; Lung ; Models, Animal* ; Pregnancy ; Rats* ; Rats, Sprague-Dawley

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Splenic Metastasis of Lung Cancer.

Tae Jin SONG ; Hoon Bae JEON ; Jin Seog YUN ; Sang Young CHOI

Journal of the Korean Surgical Society.1998;55(5):775-778.

Splenic metastasis from solid cancer is a rare clinical event. Especially splenic metastasis from the lung is very rare. Most spleen metastases are found at autopsy and are part of a widely spread disease. Solitary splenic metastasis in the abscence of other metastases is extremely rare. The authors report the case of a 54-year-old man in whom the only discover distant metastasis from lung cancer was a splenic mass. The splenic lesion was detected after the resection of the primary lung lesion. The time from diagnosis to the development of splenic metastasis was 25 months. The rarity of a solitary spleen metastasis from lung cancer and the treatment modalities are discussed. When solitary spleen metastasis is suspected in a clinical setting, aggressive treatment is indicated, a splenectomy followed by combined modality treatment to prevent the spread and aggravation of the disease.
Autopsy ; Diagnosis ; Humans ; Lung Neoplasms* ; Lung* ; Middle Aged ; Neoplasm Metastasis* ; Spleen ; Splenectomy

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A Case of Bilateral Adrenal Cortical Adenomas Causing Cushing's Syndrome and Primary Aldosteronism.

Seung Eun CHOI ; Young Cheol KIM ; Dong Young NOH ; Yeo Kyu YOUN ; Seung Keun OH

Journal of the Korean Surgical Society.1998;55(5):769-774.

A 38-year old female was admitted to our hospital for further evaluation of an incidentally found cardiac murmur. She had been in a hypertensive state for 5 years but had taken antihypertensive drugs intermittently on her own. Her history revealed that she had become amenorrheic for 7 months and had, had headaches for a few months. Physical examination revealed central obesity and a moon face, but no hirsuitism. When she first visited our hospital, her blood pressure was 260/170 mmHg and grade 2 systolic murmur was audible along the left sternal border. Laboratory studies revealed high levels of 24-hour urine-free cortisol and plasma aldosterone, but a very low level of plasma adrenocorticotropic hormone and plasma renin activity. A low-dose and a high-dose dexamethasone suppression tests, adrenal venous sampling, inferior petrosal sinus sampling, and a renin stimulation test were performed. Bilateral adrenal masses were found on computerized tomographic scanning and magnetic resonance imaging but there was no abnormality of the pituitary gland. The uncontrollable blood pressure and the elevated 24-hour urine-free cortisol and plasma aldosterone levels were corrected by a right-total and left-subtotal adrenalectomy. Pathologic findings were bilateral adrenal cortical adenomas of different cell types. These findings indicate that the adrenal cortical adenomas were tumors that functioned differently, causing Cushing's syndrome and primary aldosteronism in the same patient. A review of, the literature published in English showed that this is the first reported case, of bilateral adrenal adenomas functioning differently.
Adenoma ; Adrenalectomy ; Adrenocortical Adenoma* ; Adrenocorticotropic Hormone ; Adult ; Aldosterone ; Antihypertensive Agents ; Blood Pressure ; Cushing Syndrome* ; Dexamethasone ; Female ; Headache ; Heart Murmurs ; Humans ; Hydrocortisone ; Hyperaldosteronism* ; Magnetic Resonance Imaging ; Obesity, Abdominal ; Petrosal Sinus Sampling ; Physical Examination ; Pituitary Gland ; Plasma ; Renin ; Systolic Murmurs

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Surgically Correctable Hyperinsulinemic Hypoglycemia in Adults Insulinoma vs. Nesidioblastosis.

Hyuk Jai JANG ; Song Cheal KIM ; Heon Kyung LEE ; Ki Up LEE ; Young Kee SHONG ; Sung Kwan HONG ; Duck Jong HAN

Journal of the Korean Surgical Society.1998;55(5):757-768.

BACKGROUNDS: Hyperinsulinemic hypoglycemia is caused by insulinoma mostly and by nesidioblastosis. While an insulinoma is the most common functional endocrine tumor of pancreas, nesidioblastosis primarily is a childhood disease and is rarely reported in adults. Nesidioblastosis has been defined as a diffuse islet cell hyperplasia accompanied by a differentiation of the islets arising from the pancreatic ductal epithelium. Preoperative localization and proper surgical treatment are crucial because these disases can induce critical and permanent neurologic sequela from the hypoglycemia. However, nesidioblastosis has to be considered differently from the insulinoma in terms of diagnosis and therapeutic aspects in adults. METHODS: We retrospectively analyzed 13 and 3 patients who had been diagnosed as having an insulinoma and nesidioblastosis and who had undergone operations during the 8-year period from 1990 to 1998 at Asan Medical Center. We compared the 2 diseases with respect to diagnosis and therapy. RESULTS: There were 3 men and 10 women with an insulinoma and their mean age was 45 (17~64 years). There were 2 men and 1 woman with nesidioblastosis and their mean age was 45 (22~58 years). The most common clinical manifestation was loss of consciousness, and all the patients had findings compatible with Whipple's triad. The median duration of symptoms before diagnosis was 28 months (6~120 months) in insulinoma and 1.1 months (7 days~2 months) in nesidioblastosis (p=0.009). Hyperinsulinemic hypoglycemia was confirmed during prolonged fasting and the concomitant insulin level was 3~130 U/ml (median=25) in the insulinoma patients and 37~202 U/ml (median=67) in the nesidioblastosis patients (p=0.03). Insulinoma can be localized in 12 patients (93%) preoperatively. The combination of negative angiography and a lack of difference in the insulin concentration gradientin THPVC (transhepatic portal vein catheterization) suggested preoperatively a nesidioblastosis in only one patient (33.3%). All the patients with nesidioblastosis was confirmed intraoperatively by a frozen biopsy. In terms of treating the insulinoma, an enucleation was performed in 5, and pancreatic resection in 8. In nesidioblastosis, subtotal pancreatectomy was done on 2 and pybrus preserving pancreaticoduodenectomy (70%) on one patient. Following the operation, the symtoms of hypoglycemia and the laboratory values were normal in all the patients. CONCLUSION: We observed 13 cases of insulinoma (81%) and 3 of nesidioblastosis (19%). Preoperative suspicion, proper utilization of diagnostic tools, and prudent intraoperative diagnostic procedures enhanced the diagnostic accuracy for hyperinsulinemic hypoglycemia and led to better treatment strategies.
Adult* ; Angiography ; Biopsy ; Chungcheongnam-do ; Diagnosis ; Epithelium ; Fasting ; Female ; Humans ; Hyperplasia ; Hypoglycemia* ; Insulin ; Insulinoma* ; Islets of Langerhans ; Male ; Nesidioblastosis* ; Pancreas ; Pancreatectomy ; Pancreatic Ducts ; Pancreaticoduodenectomy ; Portal Vein ; Retrospective Studies ; Unconsciousness

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Clinical Analysis of 2504 Cases of a Laparoscopic Cholecystectomy and 2672 Cases of an Open Cholecystectomy.

Young Jin KIM ; Yong Keum PARK ; Kyong Choun CHI ; Jung Hyo LEE ; In Taik CHANG ; Sang Jhoon KIM

Journal of the Korean Surgical Society.1998;55(5):749-756.

BACKGROUND: The surgical treatment of gall stone disease consists of a conventional open cholecy stectomy (OC) and a laparoscopic cholecystectomy (LC), both of which are accepted standard methods. METHODS: The goal of this study was to compare the two operations which are used at present in the treatment of gall stone disease. During the period from September 1990 to April 1997, 2504 laparoscopic cholecystectomies and from August 1984 to April 1997, 2672 open cholecystectomies were performed at the Department of Surgery, Yong San Hospital, Chung-Ang University. We did a retrospective study of these cases and addressed the age and the sex distributions, the chief complaints, the previous operation history, associated diseases, radiologic findings, operation time, pathology, postoperative admission period, perioperative changes of bilirubin, AST (aspartate aminotransferase) & ALT (alanine aminotransferase), complications, and reasons for conversion to an open cholecystectomy. RESULTS: 1) The most common age was fifty, and female patients were in the majority. 2) The most common chief complaint was right upper-quadrant pain. 3) If ultrasonography showed wall thickening, an open cholecystectomy was more acceptable. 4) A LC had advantages in operation time and period of hospitalization. 5) The most common pathology of the gallbladder was chronic cholecystitis; others were polyps, metaplasia, and adenocarcinomas. 6) Elevation of the liver function was more prominant in LC cases than in OC cases. 7) The complication rate was 10.9% for LC cases and 12.5% for OC cases, but major complications were higher among LC paitents than among OC patients. 8) The conversion rate was 1.4%, and reasons for conversion were bile duct injury, bleeding, adhesion, and bowel injury. CONCLUSIONS: A LC has many advantages, but its problems are elevation of the liver function after the operation and a high major-complication rate. If ultrasonography shows no empyema or wall thickening, LC is more acceptable and good results are expected.
Adenocarcinoma ; Bile Ducts ; Bilirubin ; Cholecystectomy* ; Cholecystectomy, Laparoscopic* ; Cholecystitis ; Empyema ; Female ; Gallbladder ; Gallstones ; Hemorrhage ; Hospitalization ; Humans ; Liver ; Metaplasia ; Pathology ; Perioperative Period ; Polyps ; Retrospective Studies ; Sex Distribution ; Ultrasonography

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Results of Treatments for Pyogenic Liver Abscesses.

Young Cheol CHOI ; Woo Shik CHUNG ; Tae Soo CHANG

Journal of the Korean Surgical Society.1998;55(5):737-748.

Pyogenic liver abscess has been a life-threatening disease with a uniformly fatal outcome if left untreated. Changes in the etiology, clinical manifestations, methods of diagnosis, treatment and prognosis of pyogenic liver abscess have occurred slowly, but continuously, over the past century. Modern imaging techniques, improved drainage procedures, and appropriate antibiotic therapy have substantially reduced the mortality and the morbidity. A review of 103 patients with pyogenic liver abscess who were treated at Masan Samsung Hospital over a 5-year period from January 1992 to December 1996 was undertaken to characterize recent trends in diagnosis and management. There were 60 males and 43 females whose ages ranged from 11 to 85 years (mean 62.3 years). The peak age was in the 6th decade. Pyogenic liver abscess more often involved the right lobe (65.1%) than the left lobe (26.2%), and a single abscess was encountered more often than multiple abscesses in a 2.2:1 ratio. Upper abdominal pain, fever, and chills were the most common symptoms, and upper abdominal tenderness was the most common physical finding. An elevated serum alkaline phosphatase was seen in 73.8% of all patients and was the most common biochemical abnormality. Biliary tract disease was the most frequent underlying disorder. In the bacteriological study, we obtained positive cultures in 89.3% of the cases:65.0% were Gram-negative organism, 17.5% were Gram-positive organism, and 6.8% were anaerobes. E. coli was the most frequently cultured organism (31.5%). Ultrasonography and/or CT scanning was employed in the diagnosis and the follow up of all patients. Surgical open drainage was performed in 52 cases (50.5%) and percutaneous closed drainage in 51 cases (49.5%). The outcome of surgical open drainage was similar to that of percutaneous closed drainage, except for the mortality rate. Post-treatment complications occurred in 26 cases (25.2%), and the most frequent complication was a pulmonary problem (8.7%). The mortality rate due to pyogenic liver abscess was 7.8%, and the most common cause of death was sepsis.
Abdominal Pain ; Abscess ; Alkaline Phosphatase ; Biliary Tract Diseases ; Cause of Death ; Chills ; Diagnosis ; Drainage ; Fatal Outcome ; Female ; Fever ; Follow-Up Studies ; Humans ; Liver Abscess, Pyogenic* ; Male ; Mortality ; Prognosis ; Sepsis ; Tomography, X-Ray Computed ; Ultrasonography

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