Journal Detail Information

1

Cite

Share

Detection of Micrometastases in the Sentinel Lymph Node from Patients with Early Gastric Cancer.

Myung Sun JUNG ; Wook KIM ; Won Woo KIM ; Jeong Soo KIM ; Hyung Min JIN ; Cho Hyun PARK ; Hae Myung JEON ; Seung Man PARK ; Keun Woo LIM ; Seung Nam KIM

Journal of the Korean Surgical Society.2002;63(6):473-479.

PURPOSE: If the SLN (sentinel lymph node) is an accurate predictor of the lymph node status it should eliminate unnecessary lymph node dissection, resulting in a lower morbidity and mortality in patients with an early gastric cancer. The aim of this study was to investigate the feasibility of SLN biopsy for its location, accuracy and ability to sensitize the tumor cell detection, using reverse transcriptase-polymerase chain reactions (RT-PCR) for the cytokeratin 19 and CD44 variants. METHODS: SLN biopsies were performed in patients with early gastric cancer (n=33). After a gastrectomy to the apposite site, isosulfan blue dye (0.5-1.0 ml) was injected submucosal medially, laterally, superiorly and inferiorly, adjacent to the tumor site. Lymphatic channels were immediately apparent. Sentinel nodes were separately submitted, and evaluated with RT-PCR, using the cytokeratin 19 and CD44 variants. Following the removal of the sentinel node, the adjacent regional nodes were also removed. Both SLN and non-SLN were examined with H&E stain and RT- PCR. RESULTS: Sentinel nodes could be identified in 26 of 33 patients (79%). The average number of sentinel nodes detected was 1.4 and were chiefly perigastric nodes. Of these 26 patients, 6 had micrometastasis in their sentinel nodes by RT-PCR detection using the cytokeratin 19 and CD44 variants. The specificity of the SLN status in the diagnosis of the lymph node status was 95% (20/21). One patient (4%) had skip metastasis. CONCLUSION: A SLN biopsy, using indocyanine green, can be performed with a high success rate. A focused examination of the sentinel nodes detected by indocyanine green with RT-PCR will resolve the underestimation of micrometastasis in regional lymph nodes, and improve the accuracy of the pathological staging. If the sentinel node concept is clinically feasible for early gastric cancer, we would perform not only accurate staging, but also effective surgical treatment, with minimally invasive techniques.
Biopsy ; Diagnosis ; Gastrectomy ; Humans ; Indocyanine Green ; Keratin-19 ; Lymph Node Excision ; Lymph Nodes* ; Mortality ; Neoplasm Metastasis ; Neoplasm Micrometastasis* ; Polymerase Chain Reaction ; Sensitivity and Specificity ; Stomach Neoplasms*

2

Cite

Share

Lymphadenectomy for Stomach Cancer in T2 Stage.

Wan Soo KIM ; Seong Heum PARK ; Jong Heung KIM

Journal of the Korean Surgical Society.2002;63(6):468-472.

PURPOSE: Lymph node metastasis is an important prognostic variable in gastric cancer and most locoregional treatment failures are believed to be caused by insufficient nodal clearance. The aim of this study was to determine the clinicopathological features influencing lymph node metastasis, and an appropriate extent of lymphadenectomy, in T2 stage gastric cancer. METHODS: A retrospective review of eighty one patients with T2 gastric cancer, treated between 1987 and 1996, was performed, and included survival and statistical analysis to determine prognosticators and variables influencing lymph node metastasis. RESULTS: Lymph node metastasis was found in 36 patients (44.4%, 28 N1, 7 N2 and 1 N3), including 3 that had skipped to the second node group. The rate of lymph node metastasis was significantly higher in the subgroup with lymphatic invasion than in those without invasion (80.0% vs. 36.4%, P=0.002). There were no other clinical parameters for the detection of metastasis in regional lymph nodes. Operative curability was the only significant prognosticator in T2 stage gastric cancer (Relative risk; 7.9337, P=0.0049). CONCLUSION: There were no clinical parameters for the detection of metastasis in regional lymph nodes in T2 stage cancer, but assessment of the operative curability was very important for predicting the prognosis. For these reasons, radical lymphadenectomy, including at least the second node group, is the standard surgical procedure for gastric cancer in the T2 stage.
Humans ; Lymph Node Excision* ; Lymph Nodes ; Neoplasm Metastasis ; Prognosis ; Retrospective Studies ; Stomach Neoplasms* ; Stomach* ; Treatment Failure

3

Cite

Share

The Clinical Significance of Fas and Fas Ligand Expression in Thyroid Neoplasms.

Tae Hyoung KIM ; Youn Ki MIN ; Seong Jin CHO ; Kil Soo SON ; Jeong Won BAE ; Jong Seok KIM ; Bum Hwan KOO

Journal of the Korean Surgical Society.2002;63(6):462-467.

PURPOSE: Recent studies indicate that Fas and Fas Ligand (Fas-L) are implicated in autoimmune endocrine diseases and tumors of the thyroid. In this study we tried to elucidate the expression stati of Fas and Fas-L in some kinds of thyroid neoplasms, and their relationships with 4 prognostic factors in papillary thyroid cancer (i.e., size, lymph node metastasis, capsule invasion, age). METHODS: 66 cases of thyroid neoplasm including 45 cases of papillary cancer (PTC), 3 of a follicular cancer (FTC), 1 of a poorly differentiated cancer (PDC), 1 of a undifferentiated cancer (UC), 7 of follicular adenoma (FA), and 9 of nodular hyperplasia (NH) were examined, and estimated as negative, weak positive and strong positive about the Fas and Fas-L expression by the immunohistochemical staining intensities. We then collected and compared the differrences between benign and malignant tumors. The expressions of Fas and Fas-L in papillary thyroid cancers were evaluated relating to the differences in the prognostic factors (i.e., the size, lymph node status, capsule invasion, and age of the patients). RESULTS: Malignant thyroid tumors revealed stronger staining intensity than benign neoplasms. In papillary thyroid cancers, Fas-L staining intensities were significantly stronger in the cases with perithyroidal lymph node metastasis, or in those of 45 years old or over than in those with no lymph node metastasis, or younger than 45 years. CONCLUSION: Both Fas and Fas-L are implicated in thyroid tumorigenesis and revealed stronger staining intensities in malignant than benign tumors, and the Fas-L staining intensities may have some prognostic implications at least in papillary thyroid cancers.
Adenoma ; Carcinogenesis ; Endocrine System Diseases ; Fas Ligand Protein* ; Humans ; Hyperplasia ; Lymph Nodes ; Middle Aged ; Neoplasm Metastasis ; Thyroid Gland* ; Thyroid Neoplasms*

4

Cite

Share

Interval Breast Cancers: Comparisons with Screen Detected Cancers.

Jun Young KIM ; Back Hyun CHO ; Min Hee HUR ; Sung Soo KANG ; Jee Hyun LEE ; Sung Kong LEE ; Byung Jae CHO ; Kyung Sang LEE ; Hae Kyung LEE

Journal of the Korean Surgical Society.2002;63(6):458-461.

PURPOSE: Although the screening with a mammography has been shown to reduce breast cancer mortality, it has limitations relating to its sensitivity and efficacy. Interval cancers are those that become symptomatic, and are detected between screening examinations. The success of a screening program in reducing the rate of mortality due to breast cancer relies on keeping the number of interval cancers at a minimum. This study was performed to review the mammographic features of interval cancers, and to compare their clinicopathological factors with those cancers detected by screening. METHODS: Of the 881 women who had operations for breast cancer performed between 1995 and 1999, we retrospectively analyzed the medical records and mammograms of 57 who received at least a mammogram before the diagnosis of their breast cancer. These patients were divided into an interval cancer group, who had symptoms, and a screen detected cancer group, who had not. The factors compared included the clinical, radiographic, histopathological, and immunohistochemical features. RESULTS: Interval cancers were more likely to have masses, than microcalcifications, in their mammographic features, and were more likely to be invasive and at a higher stage according to their histopathological features. The false negative rate was 48% for the screen detected cancers, and 35% for the interval cancers (P=0.414). HRT users had the higher false negative rate of 51.6% than the 26.9% for the nonuser (P=0.103). CONCLUSION: The interval cancers were found to be different from the screen detected cancers in terms of their radiological and pathological features. The standardization of screen interval, and additional magnification mammography, or ultrasonography may contribute to reduce false negative rates of mammography.
Breast Neoplasms ; Breast* ; Diagnosis ; Female ; Humans ; Mammography ; Mass Screening ; Medical Records ; Morinda ; Mortality ; Retrospective Studies ; Ultrasonography

5

Cite

Share

Body Mass Index as a Risk and Prognostic Factor of Breast Cancer.

Seung Sang KO ; Seung Ki KIM ; Seung Il KIM ; Byeong Woo PARK ; Kyong Sik LEE

Journal of the Korean Surgical Society.2002;63(6):449-457.

PURPOSE: In order to study the effect of body mass index (BMI) on the risk and the prognosis of breast cancers, we analyzed the BMI and clinico-pathological data of the breast cancer patients. We compared the BMIs of breast cancer patients to those of normal women and investigated the association of the BMI with the clinico-pathological data. Then the overall and disease-free survial probabilities were analyzed according to the BMI groups. METHODS: 1,201 breast cancer patients were available for the analysis of BMI and the BMI of the normal control women was adopted from the report of the National Health, Nutrition Survey of 1998. We classified the BMI groups by he World Health Organization classification as follows; BMI under 18.5 as under-weight group, 18.5-24.9 as the normal weight group, 25-30 as the overweight group, and over 30 as the obesity group. BMI was compared between the patient group and the control group by age, while the correlation between BMI and the clinico-pathological characteristics and the recurrence and survival rates for each BMI group were comparatively analyzed. The statistical analysis were performed using x2 test, one-way ANOVA, independent T-test, and one sample T test, and the survival probabilities were generated by Kaplan-Meier methods. RESULTS: The means of BMI increased by aging in both the patients and the control group. The means of BMI of the 30s and 50s were significantly lower in breast cancer patients than those of normal women (P=0.001, 0.002). However, those of 60s and 70s were higher in breast cancer patients with marginal significance (P=0.159). In the pre- menopausal patient group, BMI was associated with the tumor size (P=0.012) and the tumor stage (P=0.018). In the post-menopausal patients, on the other hand, BMI had positive relationship with well-differentiation of the tumor (P=0.025), and also showed a marginal association with estrogen receptor positivity (P=0.074). BMI did not influence on the outcome of premenopausal breast cancer patients but lower BMI (underweight group) showed poorer outcome in postmenopausal patients in terms of overall survival (P= 0.278), locoregional relapse-free survival (P=0.581), and distant relapse-free survival (P=0.040). CONCLUSIONS: As a breast cancer risk factor, BMI seems to have a different association by the age. Higher BMI for the 60s and 70s but lower BMI for the younger age group seems to be a risk factor for the breast cancer development. In terms of the relationship with the clinico-pathological characteristics, BMI has different association by the menopausal status. BMI did not influence on the outcome of premenopausal breast cancer patients but lower BMI (underweight group) showed significantly poorer outcome in postmenopausal patients.
Aging ; Body Mass Index* ; Breast Neoplasms* ; Breast* ; Classification ; Estrogens ; Female ; Hand ; Humans ; Nutrition Surveys ; Obesity ; Overweight ; Prognosis ; Recurrence ; Risk Factors ; Survival Rate ; World Health Organization

6

Cite

Share

Frozen Section Diagnosis of Breast Lesions.

Hyung Jin KIM ; Woo Chan PARK ; Gyeongsin PARK ; Sang Seol JUNG

Journal of the Korean Surgical Society.2002;63(6):445-448.

PURPOSE: Frozen sections of breast specimens can be used to determine malignancy in a suspected lesion of the breast during operation. However, this procedure always has a potential risk of reporting a false positive or negative. This study was performed to evaluate the accuracy of the frozen section diagnosis of breast lesions. METHODS: A retrospective study to comparing the results of frozen and paraffin, section diagnosis was undertaken. RESULTS: 178 frozen breast section diagnoses were made between January 1995 and December 1996 at Kangnam St. Mary hospital. There were no false positive reports (0%) but 3 false negative reports (1.7%). The causes of a false negative were sampling error in 2 cases and interpretation error in the other. The sensitivity and specificity of the frozen section diagnosis were 94.5 and 99.2%, respectively. CONCLUSION: Despite the high sensitivity and specificity of the breast specimen frozen section diagnosis, care should be taken when making a decision on the frozen section diagnosis due to the possibility of false negative results.
Breast Neoplasms ; Breast* ; Diagnosis* ; Frozen Sections* ; Paraffin ; Retrospective Studies ; Selection Bias ; Sensitivity and Specificity

7

Cite

Share

An Accessory Double Cystic Duct with a Single Gall Bladder.

Joongjae YOO ; Donghoon SHIN

Journal of the Korean Surgical Society.2008;74(4):319-321.

We report a rare case of a double cystic duct in a 55-year-old woman. The patient complained of upper abdominal pain and jaundice. The patient was diagnosed with distal common bile duct (CBD) cancer by endoscopic retrograde cholangiopancreatography (ERCP). ERCP was unable to reveal the presence of a double cystic duct. However, magnetic resonance imaging (MRI) and a percutaneous transhepatic biliary drainage (PTBD) were performed as images for obstructive jaundice before surgery showed two ducts that looked like cystic ducts-one duct branched from the common bile duct and the other duct branched from the right hepatic duct. A pancreatoduodenectomy was performed to remove the distal CBD cancer and the presence of a double cystic duct was confirmed with the naked eye. This case suggests that the imaging studies, such as preoperative ERCP and MRI or intraoperative cholangiography are required to avoid complications during hepatobiliary surgery.
Abdominal Pain ; Cholangiography ; Cholangiopancreatography, Endoscopic Retrograde ; Common Bile Duct ; Cystic Duct ; Drainage ; Eye ; Female ; Hepatic Duct, Common ; Humans ; Jaundice ; Jaundice, Obstructive ; Magnetic Resonance Imaging ; Middle Aged ; Pancreaticoduodenectomy ; Urinary Bladder

8

Cite

Share

Congenital Absence of the Horizontal Segment of the Left Portal Vein.

Bon Yong KOO ; Hee Chul YU ; Guang Yu JIN ; Hong Pil HWANG ; Young Kon KIM ; Hyo Sung KWAK ; Baik Hwan CHO

Journal of the Korean Surgical Society.2008;74(4):316-318.

As living-donor liver transplant techniques develop, variations in the portal vein are seen in approximately 20% of the population. However, congenital absence of the horizontal segment of the left portal vein is very rare and has not been reported in Korea. We present a case with a congenital absence of the horizontal segment of the left portal vein that was detected during an evaluation for a living donor liver transplantation, with a review of the relevant literature.
Humans ; Korea ; Liver ; Liver Transplantation ; Living Donors ; Portal Vein ; Transplants

9

Cite

Share

Mesenteric Fibromatosis Presenting as a Submucosal Tumor of the Jejunum.

Changyoung YOO ; Chan Kwon JUNG ; Kyo Young SONG ; Eun Sun JUNG ; Kyo Young LEE

Journal of the Korean Surgical Society.2008;74(4):312-315.

Mesenteric fibromatoses occur as sporadic lesions or as parts of familial adenomatous polyposis, are clonal lesions prone to locally aggressive behavior, but lack metastatic capacity. Fibromatoses harbor somatic beta-catenin or adenomatous polyposis coli (APC) mutations, leading to intranuclear accumulation of b-catenin. We report a case of mesenteric fibromatosis presenting as a 5.4x4.8 cm submucosal tumor of the jejunum in a 42-year-old woman. Histologically, the tumor consisted of proliferation of bland, elongated-spindle fibroblasts with collagen deposition and a characteristic prominent vasculature. Immunohistochemically, the tumor cells showed nuclear staining for beta-catenin. Mesenteric fibromatosis should be included in the differential diagnosis of submucosal spindle cell tumors of the gastrointestinal tract, and nuclear immunoreactivity for beta-catenin may help distinguish these tumors form histological mimics.
Adenomatous Polyposis Coli ; Adult ; beta Catenin ; Collagen ; Diagnosis, Differential ; Female ; Fibroblasts ; Fibroma ; Gastrointestinal Tract ; Humans ; Immunohistochemistry ; Intestine, Small ; Jejunum

10

Cite

Share

Synchronous Double Primary Cancer of the Stomach and Duodenum.

Jong Riul LEE ; Beong Seong KO ; Hyang Mi SHIN

Journal of the Korean Surgical Society.2008;74(4):307-311.

The concern about multiple primary cancers has been raised in recent years, but their cause has yet to be elucidated clearly. It has been speculated that many factors may contribute, such as family history, genetic factors, chemotherapy, and radiotherapy.(1) The incidence of multiple primary cancers is estimated to be 13%. However, synchronous multiple primary cancers of the stomach and duodenum are uncommon due to the rarity of duodenal cancer. Duodenal cancer poses diagnostic difficulties because of its rarity, non- specific signs and symptoms, and the fact that duodenum is usually ignored during upper gastrointestinal endoscopy. This 71-year-old female patient was diagnosed with double primary cancer of the stomach and duodenum, which was found by abdominal computed tomography preoperatively, and she underwent a Whipple procedure. The histological diagnosis revealed poorly-differentiated adenocarcinoma in the stomach and moderately-differentiated adenocarcinoma in the duodenum. Here we report a case of synchronous double primary cancer of the stomach and duodenum with a review of the literature.
Adenocarcinoma ; Aged ; Duodenal Neoplasms ; Duodenum ; Endoscopy, Gastrointestinal ; Female ; Humans ; Incidence ; Stomach ; Stomach Neoplasms

DISPLAY OPTIONS

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share