PURPOSE: Intrahepatic recurrent HCC has been classified according to location, the time to recurrence and the pattern of presentation. The purpose of this study is to classify intrahepatic recurrent HCCs into subgroups that have relatively similar recurrent patterns and to identify the risk factors for each recurrent type. METHODS: A total of 353 patients were retrospectively studied. Intrahepatic recurrent HCC was classified into nodular recurrence (<4 nodules; type I), multinodular-diffuse recurrence (> or =4 nodules; type II) and infiltrative recurrence (type III). The cut-off time between early and late recurrence was chosen to be 12 months following hepatectomy. RESULTS: Among the 134 patients with only intrahepatic recurrence, 94 were type I, 27 were type II and 13 were type III. The median survival time following the recurrence of types I, II and III were 55, 16 and 8 months, respectively. As determined by multivariate analysis, perioperative transfusion and indocyanine green retention at 15 minutes (ICG R 15 >10%) were the independent risk factors for type I; an ICG R 15>10%, microvessel invasion and intrahepatic metastasis were the independent risk factors for type II; an ICG R 15>10% and microscopic portal vein invasion were the independent risk factors for type III. Multivariate analysis revealed that the prognosis of patients with IHR was associated with the recurrent types, the time to recurrence and the serum albumin level at the initial presentation. Following multivariate analysis, an ICG R 15>10% and intrahepatic metastasis were the independent risk factors for early type I recurrence; perioperative transfusion and a higher grade of hepatitis activity were the independent risk factors for late type I recurrence. CONCLUSIONS: The recurrent types and the time to recurrence may help us to predict the cellular origin of intrahepatic recurrent HCC and the prognosis of the patients who suffer with intrahepatic recurrent HCC.
Carcinoma, Hepatocellular ; Hepatitis ; Humans ; Indocyanine Green ; Microvessels ; Multivariate Analysis ; Neoplasm Metastasis ; Portal Vein ; Prognosis ; Recurrence ; Retention (Psychology) ; Retrospective Studies ; Risk Factors ; Serum Albumin

Squamous cell carcinoma of the extrahepatic bile duct is very rare. Only limited information is available concerning its pathogenesis and prognosis, although it is reported to be associated with choledocolithiasis, recurrent pyogenic cholangitis, clonorchiasis, choledochal cyst formation, and primary sclerosing cholangitis. Therefore, we present a case of squamous cell carcinoma of the distal common bile duct. A 64-year-old male patient presented with abdominal pain and obstructive jaundice. Computed tomography and endoscopic retrograde cholangiography showed thickening of the wall and a segmental stricture of the distal common bile duct, and the biopsy confirmed poorly differentiated carcinoma with marked squamous differentiation. The patient underwent a pylorus-preserving pancreaticoduodencetomy. Histological examination revealed that the tumor invaded the pancreas and metastasized to regional lymph nodes (pT3N1M0). The patient developed multiple liver metastases 30 days later and died of rapidly progressive metastatic disease to the liver 5 months following resection. Squamous cell carcinoma of the distal bile duct with lymph node metastasis had a very poor prognosis, even though curative resection was performed.
Abdominal Pain ; Bile Ducts ; Bile Ducts, Extrahepatic ; Biopsy ; Carcinoma, Squamous Cell ; Cholangiography ; Cholangitis ; Cholangitis, Sclerosing ; Choledochal Cyst ; Clonorchiasis ; Common Bile Duct ; Constriction, Pathologic ; Humans ; Jaundice, Obstructive ; Liver ; Lymph Nodes ; Male ; Middle Aged ; Neoplasm Metastasis ; Pancreas ; Prognosis

PURPOSE: We purpose to determine the correlation of HER-2/neu and paxillin expression in ductal carcinoma in situ (DCIS), invasive ductal carcinoma with ductal carcinoma in situ (IDC with DCIS) and mucinous carcinoma. METHODS: To evaluate the expression of HER-2/neu and paxillin, the immunohistochemical staining was performed for 13 cases of DCIS, 13 cases of IDC with DCIS and 6 cases of mucinous carcinoma. RESULTS: The DCIS and IDC were associated with infiltration of the inflammatory cells, especially in the comedo type and solid type of tumor. In cases with infiltration of the inflammatory cells, HER-2/neu and paxillin were strongly expressed. When comparing the expression level of HER-2/neu from adjacent normal tissue between DCIS and IDC with DCIS, expression of HER-2/neu was similar to that of normal tissue adjacent to DCIS. However, in the adjoining normal ductal epithelial cells, paxillin was highly expressed in cells of all of the tumor types, and especially for IDC with DCIS. HER-2/neu and paxillin were not expressed in mucinous carcinoma cells in all cases. CONCLUSION: HER-2/neu in the DCIS and IDC with infiltration of inflammatory cells shows higher expression than non-inflammatory DCIS and IDC. If normal duct epithelial cells show a high level of HER-2/neu expression, the epithelial cells have a high probability of transformation into anaplastic cells. However, paxillin appears to have no value as a prognostic factor. The difference of expression of HER-2/neu between IDC with DCIS and DCIS suggests a different origin of tumor cells. The growth pattern of mucinous carcinoma cell is different from the that of DCIS or IDC cell, which grow slowly.
Adenocarcinoma, Mucinous ; Carcinoma, Ductal ; Carcinoma, Intraductal, Noninfiltrating ; Epithelial Cells ; Mucins ; Paxillin

Blood Platelets ; Centrifugation ; Intercellular Signaling Peptides and Proteins ; Mandible ; Osteoblasts ; Osteogenesis ; Platelet Count ; Platelet-Rich Plasma ; Transplants

Bone Marrow Cells ; Dexamethasone ; Mandible ; Osteoblasts ; Osteogenesis ; Platelet-Rich Plasma ; Rabbits ; Silver Nitrate

BACKGROUND/AIMS: This study reviewes the clinicopathological features, prognosis, and differences in the expression of p53 and Ki-67 immunochemical staining in squamous cell and adenosquamous carcinoma of the stomach. METHODS: From January 1995 to June 2005, 2,282 cases of gastric carcinoma were resected surgically in our hospital and 191 additional cases were resected by endoscopic mucosal resection. Retrospective pathologic review and immunochemical staining of p53 and Ki-67 were performed. RESULTS: The study consists of eight cases (0.032%) of primary squamous cell carcinoma (one case) and adenosquamous carcinoma (seven cases) without early gastric cancer. Six cases (75.0%) were male and two cases were female. The mean age was 66 year-old. The clinical presentation and physical findings did not differ from those of adenocarcinoma. The mean tumor size was 5.2+/-1.7 cm. Macroscopically, five were Borrmann type 3 (62.5%) and three were type 2. At the initial diagnosis, six (75%) were stage IV based on TNM tumor staging. Six cases (75%) progressed despite the therapy while two cases responded to the treatment. The median survival time was 11.0 months (range 4.3+/-17.7). Overexpression of p53 was seen in five cases (62.5%) and their survival was poor when compared to the p53-negative group (p=0.04). The mean Ki-67 labeling index was 70.0+/-20.8%, and was not associated with p53 staining (p>0.05). CONCLUSIONS: Adenosquamous and squamous cell carcinoma of the stomach are very rare. They tend to be at advanced stages on initial diagnosis, and progress rapidly. They show p53 protein overexpression and high Ki-67 labeling index, which might be related to poor prognosis.
Adult ; Aged ; Carcinoma, Adenosquamous/chemistry/mortality/*pathology ; Carcinoma, Squamous Cell/chemistry/mortality/*pathology ; Female ; Humans ; Immunohistochemistry ; Ki-67 Antigen/*analysis ; Male ; Middle Aged ; Stomach Neoplasms/chemistry/mortality/*pathology ; Survival Rate ; Tumor Suppressor Protein p53/*analysis

BACKGROUND/AIMS: Gastritis cystica profunda (GCP) is a rare disease that is characterized by a hyperplastic and cystic dilatation of the pseudopyloric gland with submucosal invasion. GCP is regarded as a benign lesion. However, there is some controversy regarding its malignant potential. This study reviewed the clinical features and association with malignancy. METHODS: From January 2001 to June 2005, 1,010 cases of resected and 1,228 cases of an endoscopic mucosal resection or polypectomy were examined. RESULTS: Thirty-nine cases (1.7%) were confirmed pathologically and were not associated with prior gastric surgery mostly. The mean age was 60.0+/-11.4 years old and there were 29 male patients. The body was most commonly located on the longitudinal axis (57.1%). Eleven cases (28.2%) were not associated any other gastric lesion, the majority of which were the polypoid type (82.0%). However, two cases were found as a hypertrophic mucosal fold, and a submucosal tumor, respectively. Seventeen cases (43.6%) were associated with early gastric cancer. CONCLUSIONS: Despite its rarity, GCP should be considered when an endoscopically polypoid lesion or submucosal tumor (SMT) is found. Because of its association with early gastric cancer or adenoma, more study will be needed to examine the relationship between GCP and gastric carcinogen
Adenoma ; Axis, Cervical Vertebra ; Dilatation ; Gastritis* ; Humans ; Male ; Rare Diseases ; Stomach Neoplasms

Soft-tissue lateral neck radiography is important for diagnosing acute supraglottitis. This study aimed to determine the objective criteria for a diagnosis of acute supraglottitis from soft-tissue lateral neck radiographs in Korean adults. The parameters in 30 adult patients with acute supraglottitis were compared with those of age- and sex-matched normal 30 Korean adults. The mean of epiglottis width (EW) and aryepiglottic fold width (AEW) in the control group were 4.37 +/- 0.93 mm, 2.45 +/- 0.71 mm, respectively and in the patient group they were 15.87 +/- 3.60 mm, 6.4 +/- 2.55 mm, respectively. The sensitivity and specificity of an EW greater than 7mm were 100%, and 100% respectively. The sensitivity and specificity of an AEW greater than 4.5 mm were 83%, and 100% respectively.
Acute Disease ; Adult ; Epiglottitis/*radiography ; Female ; Human ; Larynx/*radiography ; Male ; Middle Age

Subcutaneous emphysema often occurs as a result of surgery, trauma of the aerodigestive tract, and increased alveolar pressure. Generally, spontaneous emphysema is rare, because "spontaneous" is only used to describe emphysema that has no obvious etiology. We reviewed six cases of non-traumatic subcutaneous emphysema occurring in the head and neck. Among them, four cases were associated with pneumomediastinum. Two occurred without obvious etiology, another two were due to heavy lifting events, one due to severe vomiting, and the last one due to severe blowing. Most cases occurred in young males. Clinical symptoms, commonly involved sites, treatments and results of these cases of spontaneous emphysema were analysed.
Emphysema ; Head* ; Humans ; Lifting ; Male ; Mediastinal Emphysema ; Neck* ; Subcutaneous Emphysema* ; Vomiting

BACKGROUND AND OBJECTIVES: An anatomic variant of left anterior descending coronary artery (LAD), termed "dual LAD", consists of early bifurcation of the proximal LAD into one early terminating branch (short LAD) which remains in the anterior interventricular sulcus (AIVS) and doesn't reach the apex, and the second (long LAD), which has a variable course outside the AIVS but returns to the distal sulcus and continues to the apex. Its incidence, angiographic features and clinical significance are investigated. MATERIALS AND METHOD: Consecutive 696 coronary angiograms during October 1997 through August 1998 were analyzed. RESULTS: A dual LAD variant was noted in 45 patients (6%) of the 696 patients. Type I, in which the long LAD descends on the left ventricular side of the AIVS before reentering the AIVS, was noted in 24 patients (53%) and type II, in which the long LAD descends on the right ventricular side of the AIVS before reentering the AIVS, in 21(47%). First septal branch was commonly originated from LAD proper in both type (54% vs 52%), but first diagonal branch from LAD proper (63%) in type I, from short LAD (71%) in type II. Presence of dual LAD was recognized before percutaneous coronary intervention (10) or bypass surgery (2) in 12 (63%) of 19 patients. Regional wall motion abnormalities (RWMA) were localized in distal septum or anterolateral wall in 2 patients with short or long LAD obstruction, respectively. CONCLUSION: Recognition of dual LAD is essential to prevent errors of interpretation of the coronary angiogram, to plan optimal strategy for percutaneous coronary intervention or bypass surgery, especially in case of total occlusion, and to understand localized septal or anterolateral RWMA.
Coronary Vessels* ; Humans ; Incidence* ; Percutaneous Coronary Intervention