PURPOSE: Primary low-grade thyroid-like papillary adenocarcinomas are extremely rare neoplasms that generally originate in the nasopharynx. Here, we describe a novel case of a 15-year-old Chinese girl who was diagnosed with low-grade thyroid-like papillary adenocarcinoma, including a brief review of the literature to reveal the clinicopathological features of low-grade thyroid-like nasopharyngeal papillary adenocarcinoma. MATERIALS AND METHODS: Immunohistochemistry was used to evaluate the expression of pan-cytokeratin (CKpan), cytokeratin (CK) 7, thyroid transcription factor 1 (TTF-1), vimentin, epithelial membrane antigen (EMA), thyroglobulin, CD15, S100, P40, CK20, CDX-2, glial fibrillary acidic protein (GFAP), and Ki-67. Additionally, in situ hybridization investigation was utilized to identify the presence of small Epstein-Barr virus (EBV)–encoded RNA. RESULTS: Histopathological analysis revealed florid proliferation of papillary structures lined by columnar epithelial cells with fibrovascular cores. Immunohistochemically, the neoplastic cells were positive for CKpan, CK7, TTF-1, vimentin, and EMA, but negative for thyroglobulin, CD15, S100, P40, CK20, CDX-2, and GFAP. The Ki-67–labeling index reached 5% in the most concentrated spot. In situ hybridization for EBV was negative. CONCLUSION: Due to the distinct rarity of low-grade thyroid-like papillary adenocarcinomaswith a favorable clinical outcome, a nationwide effort to raise public awareness of this neoplasm is required.
Adenocarcinoma, Papillary* ; Adolescent ; Asian Continental Ancestry Group ; Epithelial Cells ; Female ; Glial Fibrillary Acidic Protein ; Herpesvirus 4, Human ; Humans ; Immunohistochemistry ; In Situ Hybridization ; Keratins ; Mucin-1 ; Nasopharynx ; RNA ; Thyroglobulin ; Thyroid Gland ; Transcription Factors ; Vimentin

PURPOSE: The recent discovery and characterization of an oncogenic ROS1 gene rearrangement has raised significant interest because small molecule inhibitors are effective in these tumors. The aim of this study was to determine frequency and clinicopathological features associated with ROS1 rearrangement in patients with cholangiocarcinoma (CCA). MATERIALS AND METHODS: A total of 261 patients who underwent surgery for CCA between October 1997 and August 2013 were identified from an international, multi-institutional database. ROS1 rearrangement was evaluated by break-apart fluorescence in situ hybridization using tissue microarrays of these patients. RESULTS: Of 261 CCA evaluated, three cases (1.1%) showed ROS1 rearrangement by fluorescence in situ hybridization (FISH), all of which were derived from intrahepatic origin. ROS1 protein expression was observed in 38 samples (19.1%). Significantly larger tumor size was observed in ROS1 immunohistochemistry (IHC)–negative patients compared with ROS1 IHC–positive patients. ROS1 FISH–positive patients had a single tumor with a median size of 4 cm and well-to-moderate differentiation. Overall, there was no difference in terms of baseline characteristics, overall survival, and recurrence-free survival between ROS1-positive and -negative patients. CONCLUSION: ROS1 rearrangement was detected in 1.1% of CCA patients. Although rare, conduct of clinical trials using ROS1 inhibitors in these genetically unique patients is warranted.
Cholangiocarcinoma* ; Fluorescence ; Gene Rearrangement ; Humans ; Immunohistochemistry ; In Situ Hybridization ; In Situ Hybridization, Fluorescence ; Incidence*

PURPOSE: MicroRNAs (miRNAs) regulate various cellular functions, including development, cell proliferation, apoptosis, and tumorigenesis. Different signatures associated with various tissue types, diagnosis, progression, prognosis, staging, and treatment response have been identified by miRNA expression profiling of human tumors. miRNAs function as oncogenes or as tumor suppressors. The relationship between gastric cancer and miRNA garnered attention due to the high incidence of gastric cancer in Asian countries. miR-222/221 expression increases in gastric tumor tissues. The oncogenic effect of miR-222/221 was previously determined in functional studies and xenograft models. In this study, transgenic mice over-expressing miR-222/221 were generated to confirm the effect of miR-222/221 on gastric carcinogenesis. MATERIALS AND METHODS: At 6 weeks of age, 65 transgenic mice and 53 wild-type mice were given drinking water containing N-nitroso-N-methylurea (MNU) for 5 alternating weeks to induce gastric cancer. The mice were euthanized at 36 weeks of age and histologic analysis was performed. RESULTS: Hyperplasia was observed in 3.77% of the wild-type mice and in 18.46% of the transgenic mice (p=0.020). Adenoma was observed in 20.75% of the wild-type mice and 26.15% of the transgenic mice (p=0.522). Carcinoma was observed in 32.08% of the wild-type mice and 41.54% of the transgenic mice (p=0.341). The frequency of hyperplasia, adenoma, and carcinoma was higher in transgenic mice, but the difference was statistically significant only in hyperplasia. CONCLUSION: These results suggest that hyperplasia, a gastric pre-cancerous lesion, is associated with miR-222/221 expression but miR-222/221 expression does not affect tumorigenesis itself.
Adenoma ; Animals ; Apoptosis ; Asian Continental Ancestry Group ; Carcinogenesis* ; Cell Proliferation ; Diagnosis ; Drinking Water ; Heterografts ; Humans ; Hyperplasia ; Incidence ; Mice ; Mice, Transgenic* ; MicroRNAs ; Oncogenes ; Prognosis ; Stomach Neoplasms

PURPOSE: Histological specimens are not required for diagnosis of liver and bile duct (LBD) cancer, resulting in a high percentage of unknown histologies. We compared estimates of hepatocellular carcinoma (HCC) and cholangiocarcinoma (CCA) incidences by imputing these unknown histologies. MATERIALS AND METHODS: A retrospective study was conducted using data from the Songkhla Cancer Registry, southern Thailand, from 1989 to 2013. Multivariate imputation by chained equations (mice) was used in re-classification of the unknown histologies. Age-standardized rates (ASR) of HCC and CCA by sex were calculated and the trends were compared. RESULTS: Of 2,387 LBD cases, 61% had unknown histology. After imputation, the ASR of HCC in males during 1989 to 2007 increased from 4 to 10 per 100,000 and then decreased after 2007. The ASR of CCA increased from 2 to 5.5 per 100,000, and the ASR of HCC in females decreased from 1.5 in 2009 to 1.3 in 2013 and that of CCA increased from less than 1 to 1.9 per 100,000 by 2013. Results of complete case analysis showed somewhat similar, although less dramatic, trends. CONCLUSION: In Songkhla, the incidence of CCA appears to be stable after increasing for 20 years whereas the incidence of HCC is now declining. The decline in incidence of HCC among males since 2007 is probably due to implementation of the hepatitis B virus vaccine in the 1990s. The rise in incidence of CCA is a concern and highlights the need for case control studies to elucidate the risk factors.
Bile Ducts ; Carcinoma, Hepatocellular* ; Case-Control Studies ; Cholangiocarcinoma* ; Diagnosis ; Female ; Hepatitis B virus ; Humans ; Incidence* ; Liver ; Male ; Methods* ; Retrospective Studies ; Risk Factors ; Statistics as Topic ; Thailand*

PURPOSE: Metformin is associated with an anticancer effect. However, the effects of metformin in rectal cancer are controversial. This study investigated the impact of metformin on the survival of patients with diabetes mellitus and nonmetastatic rectal cancer who underwent curative surgery. MATERIALS AND METHODS: The database was provided by the Korea Center Cancer Registry and National Health Insurance Service of the Republic of Korea. A cohort of patients with newly diagnosed rectal cancer between 2005 and 2011 was identified. Drug exposure was defined as receiving the oral hypoglycemic agent for at least 90 days over the period from 6 months before the initial diagnosis of rectal cancer to the last follow-up. RESULTS: A total of 4,503 patients were prescribed oral hypoglycemic agents and classified as the diabetic group, of which 3,694 patients received metformin for at least 90 days. Unadjusted analyses showed a significantly higher overall survival (hazard ratio, 0.596; 95% confidence interval, 0.506 to 0.702) and rectal cancer-specific survival (hazard ratio, 0.621; 95% confidence interval, 0.507 to 0.760) in the metformin group than in the nonmetformin group. The adjusted overall survival (hazard ratio, 0.631; 95% confidence interval, 0.527 to 0.755) and cancer-specific survival (hazard ratio, 0.598; 95% confidence interval, 0.479 to 0.746) in the group with a medication possession ratio of 80% or greater was significantly higher than in the group with a medication possession ratio of less than 80%. CONCLUSION: Metformin use is associated with overall and cancer-specific survival in diabetic patients with a nonmetastatic rectal cancer treated with a curative resection.
Cohort Studies ; Colorectal Surgery ; Diabetes Mellitus ; Diagnosis ; Follow-Up Studies ; Humans ; Hypoglycemic Agents ; Korea ; Metformin* ; National Health Programs ; Rectal Neoplasms* ; Republic of Korea

PURPOSE: To evaluate clinical features and the effect of parathyroid hormone (PTH) on treatment outcomes of patients with pelvic insufficiency fractures. MATERIALS AND METHODS: Fifteen patients diagnosed with pelvic insufficiency fractures were evaluated retrospectively. All patients had osteoporosis with mean lumbar T score of −3.9 (range, −3.1 to −6.4) and the mean age was 76.5 years. In all cases, simple radiography and computed tomography was used for final diagnosis; additional magnetic resonance imaging and technetium bone scans were used to confirm the diagnosis in 2 and 6 patients, respectively. Initial conservative treatment was used in all cases; treatment with PTH was applied in 5 cases. Radiological follow-up was done every 4 weeks up to 6 months and every 3 months thereafter. Symptom improvement was measured using visual analogue scale (VAS) score. RESULTS: Fractures were located: i) sacrum and pubis (9 cases), ii) isolated sacrum (4 cases) and iii) isolated pubis (2 cases). One case showed fracture displacement and pain aggravation at 4 week follow-up which was treated with percutaneous sacro-iliac fixation using cannulated screws. Duration of bone union was significantly shorter in the patients who used PTH (P<0.05). VAS scores were also lower in the group treated with PTH; however, statistical significance was not reached. CONCLUSION: In patients with osteoporosis, a pelvic insufficiency fracture should be considered if pain is experienced in the pelvic area in the absence of major trauma. While nonoperatic has been shown to be sufficient for treatment, our study shows that PTH therapy shortens treatment period and could be a favorable treatment option.
Diagnosis ; Follow-Up Studies ; Fractures, Stress* ; Humans ; Magnetic Resonance Imaging ; Osteoporosis* ; Parathyroid Hormone ; Pubic Bone ; Radiography ; Retrospective Studies ; Sacrum ; Technetium

Actinomycosis is a slowly progressive, chronic infectious disease. It is caused by the genus Actinomyces, which are gram-positive anaerobic bacteria. It presents as a mass-like lesion, composed of bacterial nidus and characteristic granulomatous inflammatory fibrosis. As such, it has frequently been mistaken for a malignancy. Surgical resection is a common procedure in these patients prior to a definite diagnosis. Although actinomycosis can occur in a variety of regions, including oral-cervicofacial, thoracic, and abdominopelvic cavities, the involvement of the pancreas is very rare. We report a case of a 44-year-old male with a symptomatic actinomycosis caused by a mass in the tail of the pancreas. The diagnosis was made using an endoscopic ultrasound-guided fine needle aspiration biopsy without surgical resection. After the treatment with antibiotics, the pancreatic mass was confirmed to be resolved on the follow-up computed tomography.
Actinomyces ; Actinomycosis* ; Adult ; Anti-Bacterial Agents ; Bacteria, Anaerobic ; Biopsy ; Biopsy, Fine-Needle ; Communicable Diseases ; Diagnosis ; Endoscopic Ultrasound-Guided Fine Needle Aspiration ; Endosonography ; Fibrosis ; Follow-Up Studies ; Humans ; Male ; Pancreas ; Pancreatitis, Chronic* ; Tail

A 46-year-old woman visited our hospital presenting throat pain and globus sensation. The symptoms occurred seven days after eating raw perch and mullet. An endoscopy under sedation showed a fluke―with an approximate length of 4.8 mm and width of 1.5 mm―on the left aryepiglottic fold, with active motility on the mucosa. It was extracted from the larynx using biopsy forceps and was identified as Clinostomum complanatum. To the best of our knowledge, this is the second reported case of human infection with Clinostomum complanatum diagnosed and treated by an endoscopy in Korea. Endoscopy is a useful tool in the diagnosis and treatment of patients at risk for parasitic infections complaining of throat pain.
Biopsy ; Diagnosis ; Eating ; Endoscopy ; Female ; Foodborne Diseases ; Humans ; Korea ; Larynx ; Middle Aged ; Mucous Membrane ; Parasites ; Perches ; Pharynx ; Sensation ; Smegmamorpha ; Surgical Instruments

BACKGROUND: Income is a major socioeconomic index, and low household income is known to negatively affect health. Nevertheless, there is a lack of research on the health status and health behavior of middle-aged and older women with low-income. This study aims to provide basic information on the health status and health behavior of low-income women, using data representative of South Koreans. METHODS: This cross-sectional study used data from the 6th Korea National Health and Nutrition Examination Survey. Among the total of 8,018 respondents, 2,713 women aged 35 years or older were enrolled in the study. The subjects were classified by income status based on standard household income quartiles. RESULTS: The low-income group showed the lowest education levels and the highest unemployment rate (P<0.001). The percentage of smokers was the highest, while the frequency of exercise was the lowest in this group (P<0.001). The incidence of hyperlipidemia was highest (P=0.028), and they showed the highest body mass index, waist circumference (P<0.001), blood pressure, fasting blood glucose (P=0.018), and triglyceride level (P=0.03), as well as the lowest high density lipoprotein level (P=0.039), and the highest risk of cardiovascular diseases (P=0.002). Additionally, perceived health status was negative and quality of life was lowest among the groups (P<0.001). Although the enrollment rate for free health check-up services was highest (P=0.007), subscription to private health insurance, adult health check-ups, cancer screening rate were all lowest of the groups. CONCLUSIONS: This study confirmed a health gap among middle-aged and elderly women of low income, compared to higher income groups.
Adult ; Aged ; Blood Glucose ; Blood Pressure ; Body Mass Index ; Cardiovascular Diseases ; Cross-Sectional Studies ; Early Detection of Cancer ; Education ; Family Characteristics* ; Fasting ; Female ; Health Behavior* ; Humans ; Hyperlipidemias ; Incidence ; Insurance, Health ; Korea ; Lipoproteins ; Nutrition Surveys* ; Quality of Life ; Surveys and Questionnaires ; Triglycerides ; Unemployment ; Waist Circumference

BACKGROUND: Dense breast reduced the sensitivity of mammography in breast cancer screening and known as an independent risk factor of breast cancer. The relationship between breast density and age, body mass index has studied. However, there are few studies on the relationship between breast density and lifestyle related disease. In this study, we investigated the relationship between mammographic breast density and lifestyle related disease. METHODS: Retrospective cross sectional research was carried out from people who visited a single health screening center in Busan from January 2015 to December 2015. We investigated age, past history of the subjects and measured their height, weight, blood pressure and waist circumference. The biochemical test was carried out using their blood. All patients underwent mammography. The breast density on mammography determined by the basis of American College of Radiology Breast Imaging Reporting and Data System (ACR BI-RADS) breast composition and 996 people was recruited. RESULTS: In the distribution of breast density, 16.3% of women (n=160) had dense breast. Age (under 49), body mass index (BMI) (underweight) were positively correlated with the BI-RADS composition category 3, 4 but the number of lifestyle related disease were negatively correlated (age ρ=0.17, BMI ρ=0.39, the number of lifestyle related disease ρ=-0.21). The odds ratio (OR) of dense breast increased with decreasing lifestyle related disease severity (OR=3.06, 95% confidence interval: 1.13-8.22, P=0.027). CONCLUSIONS: This study showed that the number of lifestyle related disease was negatively correlated with mammographic density. The OR of dense breast increased with decreasing lifestyle related disease severity. Therefore, primary physicians should consider negative correlation between breast density and lifestyle related disease in breast cancer screening.
Blood Pressure ; Body Mass Index ; Breast Neoplasms ; Breast* ; Busan ; Female ; Humans ; Information Systems ; Life Style* ; Mammography* ; Mass Screening ; Odds Ratio ; Retrospective Studies ; Risk Factors ; Waist Circumference