Purpose: Notable effectiveness of trastuzumab deruxtecan in patients with human epidermal growth factor receptor 2 (HER2)–low advanced breast cancer (BC) has focused pathologists’ attention. We studied the incidence and clinicopathologic characteristics of HER2-low BC, and the effects of immunohistochemistry (IHC) associated factors on HER2 IHC results. Materials and Methods: The Breast Pathology Study Group of the Korean Society of Pathologists conducted a nationwide study using real-world data on HER2 status generated between January 2022 and December 2022. Information on HER2 IHC protocols at each participating institution was also collected. Results: Total 11,416 patients from 25 institutions included in this study. Of these patients, 40.7% (range, 6.0% to 76.3%) were classified as HER2-zero, 41.7% (range, 10.5% to 69.1%) as HER2-low, and 17.5% (range, 6.7% to 34.0%) as HER2-positive. HER2-low tumors were associated with positive estrogen receptor and progesterone receptor statuses (p < 0.001 and p < 0.001, respectively). Antigen retrieval times (≥ 36 minutes vs. < 36 minutes) and antibody incubation times (≥ 12 minutes vs. < 12 minutes) affected on the frequency of HER2 IHC 1+ BC at institutions using the PATHWAY HER2 (4B5) IHC assay and BenchMark XT or Ultra staining instruments. Furthermore, discordant results between core needle biopsy and subsequent resection specimen HER2 statuses were observed in 24.1% (787/3,259) of the patients. Conclusion The overall incidence of HER2-low BC in South Korea concurs with those reported in previously published studies. Significant inter-institutional differences in HER2 IHC protocols were observed, and it may have impact on HER2-low status. Thus, we recommend standardizing HER2 IHC conditions to ensure precise patient selection for targeted therapy.

Purpose: Several previous studies and case reports have reported ethanol-induced symptoms in patients receiving anticancer drugs containing ethanol. Most docetaxel formulations contain ethanol as a solvent. However, there are insufficient data on ethanol-induced symptoms when docetaxel-containing ethanol is administered. The primary purpose of this study was to investigate the frequency and pattern of ethanol-induced symptoms during and after docetaxel administration. The secondary purpose was to explore the risk factors for ethanol-induced symptoms. Materials and Methods: This was a prospective, multicenter, observational study. The participants filled out ethanol-induced symptom questionnaire on the day of chemotherapy and the following day. Results: Data from 451 patients were analyzed. The overall occurrence rate of ethanol-induced symptoms was 44.3% (200/451 patients). The occurrence rate of facial flushing was highest at 19.7% (89/451 patients), followed by nausea in 18.2% (82/451 patients), and dizziness in 17.5% (79/451 patients). Although infrequent, unsteady walking and impaired balance occurred in 4.2% and 3.3% of patients, respectively. Female sex, presence of underlying disease, younger age, docetaxel dose, and docetaxel-containing ethanol amount were significantly associated with the occurrence of ethanol-induced symptoms. Conclusion The occurrence of ethanol-induced symptoms was not low in patients receiving docetaxel-containing ethanol. Physicians need to pay more attention to the occurrence of ethanol-induced symptoms and prescribe ethanol-free or low-ethanol-containing formulations to high-risk patients.

Purpose: To investigate ocular surface diseases and changes in the quality of life of patients using glaucoma medications. Methods: Participants were divided into the normal (31 individuals, 62 eyes) and glaucoma medication (30 patients, 60 eyes) groups. Changes in tear break-up time, lipid layer thickness (LLT), corneal and conjunctival staining scores, ocular surface disease index (OSDI), and Visual Function Questionnaire 25 (VFQ-25) score were assessed for 1 year. Results: The change in mean LLT was lower in glaucomatous eyes than in control eyes (p = 0.019) after 1 year. The results of OSDI deteriorated (p’ = 0.008), but conjunctival staining and Schirmer test results showed improvement in glaucomatous eyes compared to those in control eyes (p’ =0.035 and 0.009, respectively). The average LLT decreased at 6 and 12 months, but there was no change at 24 months. In pairwise analysis, the decrease in LLT over the first 6 months was statistically significant (p < 0.001) and remained unchanged until 24 months. Among the VFQ items, scores for near activity and social function deteriorated over 1 year in the medication group (p’ = 0.033 and 0.015, respectively). However, there was no difference in the total VFQ score. Conclusions Significant reduction in LLT and deterioration of OSDI were observed in the medication group compared to the control group. However, this deterioration was observed only in the first 6 months. There was no significant difference in the VFQ total score. Nonetheless, there were significant differences in near activity and social function between the control and medication groups. Therefore, the results of this study showed that although glaucoma medication worsened eye dryness, the change was limited and did not worsen the quality of life. Glaucoma medication should be used with the consideration that they can limit near activity and social functioning.

Background: Although international guidelines recommend palliative care approaches for many serious illnesses, the palliative needs of patients with serious illnesses other than cancer are often unmet, mainly due to insufficient prognosis-related discussion. We investigated physicians' and the general public's respective attitudes toward prognostic disclosure for several serious illnesses. Methods: We conducted a cross-sectional survey of 928 physicians, sourced from 12 hospitals and the Korean Medical Association, and 1,005 members of the general public, sourced from all 17 administrative divisions in Korea. Results: For most illnesses, most physicians (adjusted proportions – end-organ failure, 99.0%; incurable genetic or neurologic disease, 98.5%; acquired immune deficiency syndrome [AIDS], 98.4%; stroke or Parkinson's disease, 96.0%; and dementia, 89.6%) and members of the general public (end-organ failure, 92.0%; incurable genetic or neurologic disease, 92.5%; AIDS, 91.5%; stroke or Parkinson's disease, 92.1%; and dementia, 86.9%) wanted to be informed if they had a terminal prognosis. For physicians and the general public, the primary factor to consider when disclosing terminal status was “the patient's right to know his/her condition” (31.0%). Yet, the general public was less likely to prefer prognostic disclosure than physicians. Particularly, when their family members were patients, more than 10% of the general public did not want patients to be informed of their terminal prognosis. For the general public, the main reason for not disclosing prognosis was “psychological burden such as anxiety and depression” (35.8%), while for the physicians it was “disclosure would have no beneficial effect” (42.4%). Conclusion Most Physicians and the general public agreed that disclosure of a terminal prognosis respects patient autonomy for several serious illnesses. The low response rate of physicians might limit the generalizability of the results.

BACKGROUND: The incidence of early colorectal epithelial neoplasm (ECEN) is increasing, and its pathologic diagnosis is important for patient care. We investigated the incidence of ECEN and the current status of its pathologic diagnosis. METHODS: We collected datasheets from 25 institutes in Korea for the incidence of colorectal adenoma with high grade dysplasia (HGD) and low grade dysplasia in years 2005, 2007, and 2009; and early colorectal carcinoma in the year 2009. We also surveyed the diagnostic terminology of ECEN currently used by the participating pathologists. RESULTS: The average percentage of diagnoses of adenoma HGD was 7.0%, 5.0%, and 3.4% in years 2005, 2007, and 2009, respectively. The range of incidence rates of adenoma HGD across the participating institutes has gradually narrowed over the years 2005 to 2009. The incidence rate of early colorectal carcinoma in the year 2009 was 21.2%. The participants did not share a single criterion or terminology for the diagnosis of adenoma HGD. The majority accepted the diagnostic terms that distinguished noninvasive, mucosal confined, and submucosal invasive carcinoma. CONCLUSIONS: Further research requirements suggested are a diagnostic consensus for the histopathologic diagnosis of ECEN; and standardization of diagnostic terminology critical for determining the disease code.
Academies and Institutes ; Adenoma ; Colorectal Neoplasms ; Consensus ; Incidence ; Korea ; Neoplasms, Glandular and Epithelial ; Pathology, Surgical ; Patient Care

Peutz-Jeghers syndrome (PJS), is a rare autosomal dominant hereditary disorder. Intestinal hamartomatous polyps in association with melanocytic pigmentation of the skin and mucous membranes characterize PJS. Patients with PJS often have complications associated with the polyps, such as intestinal obstruction, intussusception, acute or chronic gastrointestinal bleeding, and the development of various types of cancer. Enteroclysis, small bowel follow-through, and push enteroscopy are generally used to identify the presence and location of small bowel polyps. Wireless capsule endoscopy (CE) has been confirmed as a feasible, safe, and sensitive test for the surveillance of small bowel polyps in patients with PJS and could replace radiographic small bowel surveillance. Here, a case of PJS newly diagnosed by CE is reported. The patient, a 30-year-old man who had developed rectal polyps associated with anal extrusion 7 years previously, had six episodes of hematochezia.
Adult ; Capsule Endoscopy ; Gastrointestinal Hemorrhage ; Hemorrhage ; Humans ; Intestinal Obstruction ; Intussusception ; Mucous Membrane ; Peutz-Jeghers Syndrome ; Pigmentation ; Polyps ; Skin

Obstructive jaundice associated with hepatocellular carcinoma (HCC) is an uncommon symptom caused by intraductal tumor growth, the migration of tumor necrosis, blood clots within the biliary tract, or compression of the biliary tract by the tumor. Most cases of icteric-type HCC involve a main tumor in the liver parenchyma. Bile duct HCC without a primary hepatic tumor is extremely rare, but because it shows similar clinical manifestations and imaging results to extrahepatic bile duct cancer, it is possible to misdiagnose this condition as a primary bile duct tumor or choldocholithiasis. Recently, we experienced a case of obstructive jaundice associated with an extrahepatic bile duct tumor in a 69-year-old woman. Upon radiologic studies and endoscopic cholangiography, the cause of obstructive jaundice was initially attributed to the bile duct tumor itself. However, subsequent analysis indicated that the condition was, in fact, due to bile duct thrombi associated with extrahepatic bile duct HCC.
Aged ; Bile Ducts ; Bile Ducts, Extrahepatic ; Biliary Tract ; Carcinoma, Hepatocellular ; Cholangiography ; Female ; Humans ; Jaundice ; Jaundice, Obstructive ; Liver ; Necrosis ; Thrombosis

We describe a case of Streptococcus pyogenes pneumonia in a 63-year-old man presenting with rhabdomyolysis and acute renal failure. The patient completely recovered following treatment with mechanical ventilation, continuous venovenous hemodiafiltration, and intravenous antimicrobial agents.
Acute Kidney Injury ; Anti-Infective Agents ; Hemodiafiltration ; Humans ; Middle Aged ; Pneumonia* ; Respiration, Artificial ; Rhabdomyolysis* ; Streptococcus pyogenes* ; Streptococcus*

We describe a case of Streptococcus pyogenes pneumonia in a 63-year-old man presenting with rhabdomyolysis and acute renal failure. The patient completely recovered following treatment with mechanical ventilation, continuous venovenous hemodiafiltration, and intravenous antimicrobial agents.
Acute Kidney Injury ; Anti-Infective Agents ; Hemodiafiltration ; Humans ; Middle Aged ; Pneumonia* ; Respiration, Artificial ; Rhabdomyolysis* ; Streptococcus pyogenes* ; Streptococcus*

PURPOSE: To evaluate the ultrasonographic and mammographic findings of cases of nodular adenosis. MATERIALS and METHODS: We evaluated 22 lesions with a pathologically proven nodular adenosis from five hospitals for three years. We excluded adenosis cases combined with other breast diseases. The findings of ultrasonography and mammography were retrospectively interpreted in consensus by two radiologists that were experienced in breast imaging according to the BI-RADS criteria. RESULTS: The age of the patients was 29-56 years with a mean age of 43.4 years. Ten lesions were biopsied with a 14-gauge core needle, seven lesions were biopsied with an 11-gauge vacuum-assisted mammotome and five lesions were removed by surgical excision. Mammography was performed in 15 patients and distinct abnormalities were seen in seven cases. These abnormalities consisted of an indistinct irregular mass, three circumscribed masses and three focal asymmetries. Calcifications were not seen in all of the masses. Ultrasonography was performed in 22 patients, revealing 13 irregular shaped lesions 8 oval shaped lesions and one round shape lesion. The margin was either circumscribed (n = 7) and not circumscribed (n = 15) in the lesions. The orientation of mass was parallel in 13 lesions and not parallel in 9 lesions. The boundary was an abrupt interface in all of the cases. The echogenecity of the mass was hypoechoic in 15 cases, isoechoic in 4 cases, hyperechoic in 2 cases and complex echogenic in one case. Nineteen of the cases showed no posterior feature and one case showed combined features. The final categories by the BI-RADS criteria were category 3 in three cases and category 4 in 19 cases (C4a 11, C4b 8). CONCLUSION: Nodular adenosis mostly presents as category 4 on ultrasonography. Therefore, a differential diagnosis with malignancy is difficult to determine. However, the findings of lesions highly suggestive of being malignant such as a spiculation or echogenic halo, are rare. On mammography, it is commonly obscured.
Breast ; Breast Diseases ; Consensus ; Diagnosis, Differential ; Humans ; Mammography ; Needles ; Retrospective Studies ; Ultrasonography