Ascariasis is an intestinal disease caused by Ascaris lumbricoides. Most patients with ascariasis are asymptomatic; however, the presence of many larvae in the bowel can cause gastrointestinal complications, such as intestinal obstruction, obstructive jaundice, cholangitis, cholecystitis, and pancreatitis. Herein, we report a case of ascariasis presenting as hematoma and active bleeding in the sigmoid mesocolon of a 74-year-old man on computed tomography (CT). Sigmoid colon perforation was also detected on follow-up CT. Laparoscopic low anterior resection was performed; there was a large hematoma in the sigmoid mesocolon. Roundworms were microscopically identified in the mesenteric adipose tissue. The clinical and CT findings of this unusual presentation of ascariasis revealed serial complications during parasite migration from the intestinal lumen to the peritoneal cavity.

Ascariasis is an intestinal disease caused by Ascaris lumbricoides. Most patients with ascariasis are asymptomatic; however, the presence of many larvae in the bowel can cause gastrointestinal complications, such as intestinal obstruction, obstructive jaundice, cholangitis, cholecystitis, and pancreatitis. Herein, we report a case of ascariasis presenting as hematoma and active bleeding in the sigmoid mesocolon of a 74-year-old man on computed tomography (CT). Sigmoid colon perforation was also detected on follow-up CT. Laparoscopic low anterior resection was performed; there was a large hematoma in the sigmoid mesocolon. Roundworms were microscopically identified in the mesenteric adipose tissue. The clinical and CT findings of this unusual presentation of ascariasis revealed serial complications during parasite migration from the intestinal lumen to the peritoneal cavity.

Despite advances in the characterization of anaplastic large cell lymphoma (ALCL), little data is available on Asian patients. We report here upon single Korean institution's experience regarding the clinical characteristics and outcomes of ALCL. We performed a retrospective study of 32 adults with ALCL. Most of the patients received anthracycline-based chemotherapy. Ann Arbor stage III-IV, B symptoms, high-intermediate/ high International Prognostic Index (IPI), and extranodal disease at diagnosis were present in 56%, 44%, 41%, and 63%, respectively. Compared with Western studies, the male/female ratio (4.3) was markedly higher and skin (9%) and bone involvement (9%) were less frequent. The staining results for anaplastic lymphoma kinase were positive in 6 (33%) of 18 cases available. The complete response (CR) rate was 62% (95% CI, 44-80%). With a median follow-up of 51.0 months, 5 yr overall survival was 40+/-11%. The 3 yr relapse-free survival for the 18 patients who achieved CR was 74+/-12%. Age, performance status, lactate dehydrogenase, extranodal disease sites number, and IPI were correlated with treatment response and survival. Our data suggest that Korean ALCL patients appear to have a higher male/female ratio, less frequent skin/bone involvement, and lower CR rate compared with those of Western studies.
Treatment Outcome ; Survival Analysis ; Retrospective Studies ; Prognosis ; Neoplasm Staging ; Neoplasm Recurrence, Local ; Middle Aged ; Male ; Lymphoma, Large-Cell, Ki-1/*drug therapy/immunology/*pathology ; Korea ; Humans ; Female ; Antigens, CD30/analysis ; Aged, 80 and over ; Aged ; Adult ; Adolescent

BACKGROUND: Waldenstrom macroglobulinemia (WM) is a lymphoproliferative disorder characterized by monoclonal IgM. Its rarity makes it difficult to know the clinical manifestations and outcomes of patients with WM. METHODS: The clinical records of 13 patients diagnosed with WM between 1983 and 2003 were reviewed, and 12 patients were eligible. RESULTS: The median age was 57 years (range, 40 to 85), and the male to female ratio was 2. B symptoms and hyperviscosity requiring plasmapheresis existed in 5 and 4 patients, respectively, at the time of diagnosis. Hepatomegaly and splenomegaly were detected in 5 and 3 patients, respectively. Sites of extranodal involvement were bone (3) and lung (1) in 3 patients. The peripheral neuropathy was complicated in 3 patients. (Ed note: check this sentence.) Cryoglobulin was checked in 6 patients and it was detected in 3 of them. The median concentration of serum IgM was 4.2 g/dL (0.7~6.2). The median albumin, hemoglobin, WBC, and platelet levels were 2.8 g/dL, 8 g/dL, 5, 400/micro L, and 138, 000/micro L, respectively. One patient had transitional cell carcinoma concomitantly, and one patient developed small cell lung cancer. Of the 11 patients receiving chemotherapy (7-chlorambucil, 2-melphalan, 1-cyclophosphamide, 1-CHOP), 4 patients showed the objective responses including 2 complete remissions, but they all ultimately relapsed. The response rate of second-line therapy was 14% (1/7). After a median follow-up of 20 months, 3 patients were still alive with disease. The median overall and progression-free survival were 24 months (95% confidence interval (CI) : 5-43) and 24 months (95% CI: 8-40), respectively. CONCLUSION: The initial high levels of serum IgM and severe anemia reflect a lack of suspicion of WM at the early stage. Careful suspicion and proper diagnostic approaches will allow more patients to show an improved outcome.
Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Immunoglobulin M/blood ; Korea ; Male ; Middle Aged ; Retrospective Studies ; Waldenstrom Macroglobulinemia/blood/*diagnosis

BACKGROUND: This study was to evaluate the therapeutic efficacy of consolidation therapy based on intermediate dose Ara-C in patients with newly diagnosed acute myelogenous leukemia (AML) in Seoul National University Hospital. And also, this study was to assess the toxicities of the treatment. METHODS: We have reviewed retrospectively our experience of patients with newly diagnosed non-M3 AML between January 1993 and July 1997. They were treated with induction chemotherapy with Ara-C 200mg/m2/d over 24 h for 7 days and daunorubicin 45mg/m2/d daily for 3 days. The patients achieving complete remission (CR) are to receive the 3 courses of consolidation chemotherapy based on intermediate dose of Ara-C 1,000mg/m2 given over 2h every 12 h for a total of eight to ten doses. Patients having HLA-matched sibling donors with informed consent could receive allogeneic bone marrow transplantation (BMT). RESULTS: One hundred and fifteen patients were reviewed. The median age was 41 years (range, 16-69) and median follow-up was 75 months. The CR rate was 72.2%. The median disease-free survival (DFS) of patients receiving consolidation therapy and allogeneic BMT was 21 months and 26.5 months, respectively. The overall survival (OS) was 13 months for patients not-receiving consolidation therapy, 21 months for consolidation therapy, and 31 months for allogeneic BMT, respectively. The rate of treatment-related mortality of consolidation therapy was 14% and cause of all deaths was infection. But in allogeneic BMT, that mortality rate was 42%; 2 infections, 2 veno-occlusive diseases and 1 cyclophosphamide-induced cardiomyopathy. CONCLUSION: Patients receiving consolidation therapy with intermediate dose Ara-C had longer DFS and OS. But their DFS and OS was not superior to that of patients receiving allogeneic BMT. In addition, that result was inferior to that of patients receiving high dose Ara-C based consolidation therapy, compared with other previous studies. However, this study was retrospective and so further prospective study will be required for comparing different doses of Ara-C consolidation therapy versus BMT.
Adult* ; Bone Marrow Transplantation ; Cardiomyopathies ; Consolidation Chemotherapy ; Cytarabine* ; Daunorubicin ; Disease-Free Survival ; Follow-Up Studies* ; Humans ; Induction Chemotherapy ; Informed Consent ; Leukemia, Myeloid, Acute* ; Mortality ; Retrospective Studies ; Seoul ; Siblings ; Tissue Donors

PURPOSE: To establish the feasibility of high dose ifosfamide, carboplatin, and etoposide (ICE) chemotherapy followed by autologous stem cell transplantation (ASCT) in patients with high-risk or metastatic breast cancer. MATERIALS AND METHODS: High-risk breast cancer is defined as 10 or more involved axillary lymph nodes (n=3) or stage III (n=2). Patients with metastatic cancer have relapsed diseases after curative resection (n=10) or initially metastatic lesion (n=1). Colony stimulating factor with either cyclophosphamide or combination chemotherapy was administered to mobilize the stem cells. High dose chemotherapy consisted of ifosfamide 16 g/m2, carboplatin 1.8 g/m2, and etoposide 0.75 g/m2 (dose I) and later modified to ifosfamide 12 g/m2, carboplatin 1.35 g/m2, and etoposide 1.2 g/m2 (dose II). RESULTS: The median duration of grunulocyte nadir (<500/ microliter) was 11 (10~17) days and platelet transfusion dependency (<20,000/ microliter) was 11 (7~53) days in 14 patients who achieved engraftment. One out of 5 patients with high-risk breast cancer relapsed after high dose therapy. Two patients remain disease-free at 18th and 40th months. Two among the 4 patients treated with dose I died due to treatment-related complications. The responses of metastatic diseases to ICE chemotherapy were 1 continuing CR, 1 CR, 1 PR, 4 SD and 3 PD in 10 evaluable patients. CONCLUSION: High dose ICE chemotherapy, especially dose II and ASCT were feasible in high-risk or metastatic breast cancer.
Breast Neoplasms* ; Breast* ; Carboplatin* ; Colony-Stimulating Factors ; Cyclophosphamide ; Drug Therapy* ; Drug Therapy, Combination ; Etoposide* ; Humans ; Ice ; Ifosfamide* ; Lymph Nodes ; Platelet Transfusion ; Stem Cell Transplantation* ; Stem Cells*

BACKGROUND: Bone marrow biopsies following the completion of remission-induction chemotherapy for patients of acute myelogenous leukemia (AML) whose blasts on bone marrow smear are counted less than 5%, show abnormal localization of immature precursors (the so-called ALIP defined as clusters or aggregates of small mononuclear elements with a narrow rim of light blue stained agranular cytoplasm) occasionally. The importance of ALIP in bone marrow section after antileukemic therapy is not determined yet. The purpose of this study is to elucidate the significance of ALIP on patients' remission duration and survival. METHODS: The bone marrow slides from adult AML patients who achieved complete remission (CR) after receiving first antileukemic therapy between January 1987 and April 1996 in Seoul National University Hospital were reviewed. Among them, 24 patients showed ALIP findings in their bone marrow biopsy sections and 8 patients' bone marrow were rebiopsied before next chemotherapy.We analyzed them on the histopathologic aspects. The patients who achieved CR after receiving first antileukemic therapy using Ara- C and daunorubicin were analyzed about their remission duration and survival duration according to ALIP positiveness (ALIP+ group : 16 patients, ALIP- group : 39patients. RESULTS: 1) Among eight rebiopsied bone marrow sections, six patients showed disappearance of ALIP findings spontaneously and none showed the increase of blast counts more than 5%.2) No statistically significant difference about patient characteristics between ALIP+ group and ALIP- group was shown except intervals between first antileukemic chemotherapy and biopsy of bone marrow (ALIP+ vs. ALIP-, 28 days vs. 34 days, P=0.001). The actuarial risk of relapse and CR duration were similar in both groups (P=0.44). The median duration of remission for the ALIP+ patients was 7 months and 12 months for ALIP- patients. Also the overall survival was similar in both groups (P=0.37). The median duration ofsurvival was 12 months for ALIP+ patients and 21 months for ALIP- patients. CONCLUSION: We did not find any statistically significant differences between ALIP+ group and ALIP- group for remission duration and overall survival, and observed ALIP findings in earlier bone marrow biopsies afterchemotherapy. We concluded ALIP findingmight be a indirect evidence of bone marrow regeneration, but further studies with cytogenetics or FISH method should be followed.
Adult ; Biopsy ; Bone Marrow ; Cytogenetics ; Daunorubicin ; Drug Therapy* ; Humans ; Leukemia, Myeloid, Acute* ; Recurrence ; Regeneration ; Retrospective Studies* ; Seoul

PURPOSE: For malignant diseases, predictions about tumor behavior and determination of appropriate therapy are based on the primary tumor sites, but 2-9% of cancer patients are diagnosed without identifiable primary tumor sites. Metastatic tumors of unknown primary origin (MUO) are a heterogeneous group of tumors with variable natural histories. The majority of these patients fall outside of treatable subjects and seldom respond to therapy. To define further the natural history of MUO and identify prognostic factors, we undertook a clinical analysis of 141 consecutive patients with a presumed diagnosis of MUO. MATERIALS AND METHODS: One hundred forty-one patients were diagnosed with unknown primary tumor from Jan. 1, 1992 through Aug. 31, 1995. The primary end point for the study was survival, which was calculated from the first day of patient registration diagnosed histologically. The survival curves were estimated using the Kaplan-Meier method and compared using the log-rank test. To identify important prognostic factors, univariate and multivariate analyses were conducted. RESULTS: Most of the 141 patients had histologic or cytologic evidence of adenocarcinoma and had more than one site metastatically involved. The predominant sites of tumor involvement were lymph node, peritoneum, bone, liver, lung, and pleura. Univariate and multivariate analyses identified numerous important prognostic factors with a significant influence on survival, including performance status (P 0.0001), specific organ sites involved (lung P 0.0076 or liver P 0.0310), and chemotherapy group (P- 0.0480). CONCLUSION: This study validated clinical courses and important prognostic factors that had an impact on survival in MUO.
Adenocarcinoma ; Diagnosis ; Drug Therapy ; Humans ; Liver ; Lung ; Lymph Nodes ; Multivariate Analysis ; Natural History ; Neoplasms, Unknown Primary ; Peritoneum ; Pleura

PURPOSE: Peripheral T-cell lymphoma (PTCL) derived from mature T cells forms morphologically diverse group of non-Hodgkin's lymphomas and the clinicopathologic features remain to be debated. In order to elucidate the specific characteristics of PTCL, comparison with a group of diffuse B-cell lymphomas (DBCL) was done. MATERIALS AND METHODS: Between Dec. 1989 and Feb. 1993, clinical data of 67 cases of intermediate or high grade NHL identified as T-cell or B-cell origin by immunophenotyping was reviewed. RESULTS: There were 30 cases of PTCL and 37 cases of DBCL. PTCL had more advanced stage and B symptoms at diagnosis. Frequent sites of extranodal involvement were bone marrow, nasal cavity/paranasal sinus, and skin in PTCL and gastrointestinal tract in DBCL. Based on NCI Working Formulation, 40% of PTCL and 14% of DBCL were high grade. Patients with DBCL had a better 3-year overall survival rate (67% vs 47%), however, there was no difference in complete remission rate and disease-free survival rate between two groups with intensive treatment. A subgroup of PTCL patients who had died earlier was found to have more advanced stage and poor performance status. CONCLUSION: Although patients with PTCL had worse survival in advanced stage, the outcome of patients with PTCL who received intensive treatment was comparable to that of DBCL.
B-Lymphocytes* ; Bone Marrow ; Diagnosis ; Disease-Free Survival ; Gastrointestinal Tract ; Humans ; Immunophenotyping ; Lymphoma, B-Cell* ; Lymphoma, Non-Hodgkin ; Lymphoma, T-Cell, Peripheral* ; Skin ; Survival Rate ; T-Lymphocytes

PURPOSE: Soft tissue sarcomas are uncommon primary malignancies. So studies on the effective chemotherapy for soft tissue sarcomas are limited. We started this study to evaluate the effectiveness of VIP (etoposide, ifosfamide, cisplatin) combination chemotherapy for advanced soft tissue sarcomas. MATERIALS AND METHODS: Thirty patients with recurrent or metastatic soft tissue sarcoma were treated with VIP combination chemotherapy between December 1989 and June 1996. Each patient was given etoposide 75 mg/m2, ifosfamide 1000 mg/m2, cisplatin 20 mg/m2 intravenously for five consecutive days every three weeks. Mesna (sodium-2-mercaptoethansulfonate) was given to avoid the urologic toxicity. RESULTS: Twenty-eight of 30 patients were evaluable for response, and among the 28 evaluable patients, there were 9 partial response (32%). Duration of response in 9 responders ranged from 4.1 to 16.2 months (median 8.8 months). Overall survival ranged from 1.7 to 41.5 months (median 11 months) and survival was better for patients with partial response (median survival 14.8 months vs. 9.7 months with stable disease vs. 5.1 months with progressive disease p=0.0006). Nausea and vomiting was noted in more than 90% of cycles, but was markedly severe in only 4%. Leukopenia was noted in 60% of cycles, including 11% of cycles with counts <2,000/mm3. There was no treatment related death, but we had to stop chemotherapy in 2 patients due to leukopenia (1 patient) and neurotoxicity (1 patient). CONCLUSION: Combination of etoposide, ifosfamide, and cisplatin was fairly active for advanced soft tissue sarcoma, with myelosuppresion and peripheral neuropathy being the most serious toxicities.
Cisplatin* ; Drug Therapy* ; Drug Therapy, Combination ; Etoposide* ; Humans ; Ifosfamide* ; Leukopenia ; Mesna ; Nausea ; Peripheral Nervous System Diseases ; Sarcoma* ; Vomiting