BACKGROUND: Serum vitamin B₁₂ has been suggested as one of the cancer diagnostic markers and predictors for survival in cancer patients. In this study, we investigated the relationship between vitamin B₁₂ and tumor progression. METHODS: Solid tumor patients who had serum vitamin B₁₂ levels and radiologic test follow-up were included in the study. A total of 55 patients were included. Receiver operating characteristic analysis was performed to determine the cut-off value of vitamin B₁₂ for tumor progression. Kaplan-Meier method and Cox proportional hazard model for time to progression (TTP) were performed. Subgroup analysis was performed on patients with or without liver lesion (hepatocellular carcinoma and liver metastasis). RESULTS: The cut-off value of vitamin B₁₂ for tumor progression prediction was 691.4 pg/mL, the sensitivity was 57.1% and the specificity was 59.3%. Patients with vitamin B₁₂≥691.4 pg/mL had shorter median TTP (2.1 months vs. 3.4 months, P=0.011). In subgroup analysis of patients without liver lesion, median TTP was significantly shorter in patients with vitamin B₁₂≥691.4 pg/mL (1.6 months vs. 6.3 months, P=0.021), while there was no significant difference in TTP among the patients with liver lesion. Higher vitamin B₁₂ level (≥691.4 pg/mL) was an independent prognostic factor for tumor progression (adjusted hazard ratio 2.4, 95% confidence interval 1.2–4.8, P=0.019). CONCLUSIONS: Serum vitamin B₁₂ level can be used as a predictor of tumor progression in patients with solid tumors especially in patients without liver lesion. Additional large scale prospective studies are required to confirm this.
Biomarkers ; Disease Progression ; Follow-Up Studies ; Humans ; Liver ; Methods ; Proportional Hazards Models ; Prospective Studies ; ROC Curve ; Sensitivity and Specificity ; Vitamins*

Synovial tissue proliferation and inflammation are regarded as possible causes of rheumatoid arthritis. Activation of tyrosine kinase by numerous cytokines and BCR-ABL translocation contribute to synovial tissue inflammation and the development of rheumatoid arthritis, respectively. Imatinib is a tyrosine kinase-blocking agent that is widely used for treating chronic myeloid leukemia. We found several interesting case reports of patients with refractory rheumatoid arthritis who entered remission after initiating imatinib therapy. However, only one case report on treating rheumatoid arthritis with imatinib was found in Korea. Here, we describe the case of a 50-year-old man who showed clinical remission of rheumatoid arthritis and chronic myeloid leukemia after receiving 3 months of imatinib therapy.
Arthritis, Rheumatoid ; Benzamides ; Cytokines ; Humans ; Inflammation ; Korea ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive ; Mesylates ; Middle Aged ; Piperazines ; Protein-Tyrosine Kinases ; Pyrimidines ; Tyrosine ; Imatinib Mesylate

OBJECTIVE: We wanted to evaluate the MR findings for differentiating between necrotizing fasciitis (NF) and pyomyositis (PM). MATERIALS AND METHODS: The MR images of 19 patients with surgically confirmed NF (n = 11) and pathologically confirmed PM (n = 8) were retrospectively reviewed with regard to the presence or absence of any MRI finding criteria that could differentiate between them. RESULTS: The patients with NF had a significantly greater prevalence of the following MR findings (p < 0.05): a peripheral band-like hyperintense signal in muscles on fat-suppressed T2-weighted images (73% of the patients with NF vs. 0% of the patients with PM), peripheral band-like contrast enhancement (CE) of muscles (82% vs. 0%, respectively) and thin smooth enhancement of the deep fascia (82% vs. 13%, respectively). The patients with PM had a significantly greater prevalence of the following MRI findings (p < 0.05): a diffuse hyperintense signal in muscles on fat-suppressed T2-weighted images (27% of the patients with NF vs. 100% in the patients with PM), diffuse CE of muscles (18% vs. 100%, respectively), thick irregular enhancement of the deep fascia (0% vs. 75%, respectively) and intramuscular abscess (0% vs. 88%, respectively). For all patients with NF and PM, the superficial fascia and muscle showed hyperintense signals on T2-weighted images and CE was seen on fat-suppressed CE T1-weighted images. The subcutaneous tissue and deep fascia showed hyperintense signals on T2-weighted images and CE was seen in all the patients with NF and in seven (88%) of the eight patients with PM, respectively. CONCLUSION: MR imaging is helpful for differentiating between NF and PM.
Abscess/pathology ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Diagnosis, Differential ; Fascia/pathology ; Fasciitis, Necrotizing/*pathology ; Female ; Humans ; Image Processing, Computer-Assisted ; *Magnetic Resonance Imaging ; Male ; Middle Aged ; Muscle, Skeletal/pathology ; Pyomyositis/*pathology ; Retrospective Studies ; Young Adult

Renal cell carcinoma (RCC) may metastasize to almost any organ, but metastasis to the small bowel is rare. Small bowel metastasis from RCC can induce obstruction or bleeding, and perforation can also be induced in rare case. Yet RCC metastasis to the small bowel is unlikely to be a direct cause of intussusceptions. A few cases of intussusceptions caused by small intestinal metastasis of RCC have been reported, but multiple small intestinal intussusceptions are extremely rare. We report here on a 47-year-old male patient who presented to the emergency room with acute abdominal pain. He had undergone radical nephrectomy 2 years previously due to left RCC. The abdominal CT scan revealed enhanced masses with the "target" sign that suggested enteric intussusceptions in the jejunum. Eight pedunculated masses within the small intestinal lumen led to intussusceptions at 30 and 150 cm distal to Treitz ligament. Three segmental resections of the small intestine and functional end to end anastomosis were done. The patient recovered uneventfully from this operation. To the best of our knowledge, this is the 1st report of metastases from RCC that presented as synchronous intraluminal polypoid tumors, and these tumors served as the lead points for two intussusceptions in the jejunum.
Abdominal Pain ; Carcinoma, Renal Cell ; Emergencies ; Hemorrhage ; Humans ; Intestine, Small ; Intussusception ; Jejunum ; Ligaments ; Male ; Middle Aged ; Neoplasm Metastasis ; Nephrectomy

Breast cancer metastases to the stomach are infrequent, with an estimated incidence rate of approximately 0.3%. Gastric metastases usually are derived from lobular rather than from ductal breast cancer. The most frequent type of a breast cancer metastasis as seen on endoscopy to the stomach is linitis plastica; features of a metastatic lesion that resemble early gastric cancer (EGC) are extremely rare. In this report, we present a case of a breast cancer metastasis to the stomach from an infiltrating ductal carcinoma (IDC) of the breast in a 48-year-old woman. The patient had undergone a left modified radical mastectomy with axillary dissection nine years prior. A gastric endoscopy performed for evaluation of nausea and anorexia showed the presence of a slightly elevated mucosal lesion in the cardia, suggestive of a type IIa EGC. A histological examination revealed nests of a carcinoma in the subepithelial lymphatics, and immunohistochemical staining for estrogen receptor was positive. This is an extremely rare case with features of type IIa EGC, but the lesion was finally identified as a cancer metastasis to the cardia of the stomach from an IDC of the breast.
Anorexia ; Breast ; Breast Neoplasms ; Carcinoma, Ductal ; Cardia ; Endoscopy ; Estrogens ; Female ; Humans ; Incidence ; Mastectomy, Modified Radical ; Middle Aged ; Nausea ; Neoplasm Metastasis ; Stomach ; Stomach Neoplasms

We report here on a case of metachronous second primary non-Hodgkin's lymphoma (NHL) that was diagnosed 6 years after performing subtotal gastrectomy for treating early gastric cancer (EGC). The subtype analysis revealed mantle cell lymphoma (MCL) of the blastic variant with a leukemic presentation, which was composed of mixed small and medium-sized cells. The immunohistochemical staining for cyclin-D1 was positive. The cytogenetic study revealed t(4;6). In Korea, the risk of developing a second primary cancer following gastric cancer was reported to be less than 3.4%, and NHL comprised less than 6.3% of this second primary cancer. Furthermore, MCL represents about 2% of all lymphomas in Korea. To the best of our knowledge, this is the first report of metachronous primary MCL with a leukemic presentation following curative resection of EGC.
Cytogenetics ; Gastrectomy ; Humans ; Korea ; Leukemia ; Lymphoma ; Lymphoma, Mantle-Cell ; Lymphoma, Non-Hodgkin ; Neoplasms, Second Primary ; Stomach Neoplasms

BACKGROUND: There have been bone mass studies for the treatment of osteoporosis, nonetheless, little attention has been paid to the management of osteopenia. This study was to evaluate the effects of estrogen, alendronate and their combination on bone mineral density and bone metabolism in the postmenopausal women with osteopenia. METHODS: A total of 150 healthy regional patients with osteopenia from Busan were enrolled in prospective randomized clinical trial and randomly assigned to receive conjugated equine estrogen (group I), alendronate (group II), or combination of the two (group III). Assessments included BMD of L2-4 spines and femur neck by DEXA and markers of bone turnover including serum osteocalcin, total alkaline phosphatase and urine deoxydyridinoline (Dpd). BMD and markers of bone turnover were re-evaluated at 6 and 12 months after the treatment. RESULTS: BMD of the lumbar spines increased significantly at 12 months after treatment in the three groups (P<0.05). BMD of the femur neck increased at 12 months after treatment in the three groups, but significantly in group III (P<0.05). Serum osteocalcin decreased at 12 months after treatment in the three groups, but only significantly in group III. Urine Dpd decreased at 12 months after treatment in three groups, but significantly in group, II and III (P<0.05). Serum total alkaline phosphatase decreased at 12 months after treatment in only group III (P<0.05). There was more favorable benefit for group III in BMD of the lumbar spines and serum osteocalcin and urine Dpd at 12 months after treatment compared to group, II and III (P<0.05). CONCLUSION: These results indicated a favorable benefit of conjugated equine estrogen, alendronate, or combination of the two in BMD and important markers of bone turnover. The combined treatment with conjugated equine estrogen and alendronate was more effective in postmenopausal women with osteopenia. Long-term studies are required to confirm these results.
Alendronate ; Alkaline Phosphatase ; Bone Density* ; Bone Diseases, Metabolic* ; Busan ; Estrogens ; Female ; Femur Neck ; Humans ; Metabolism* ; Osteocalcin ; Osteoporosis ; Prospective Studies ; Spine

OBJECTIVE: Uterine sarcomas are rare tumors of mesodermal origin and constitute 2-6% of uterine malignancies. They are the most malignant group of uterine tumors and present difficult problems with regard to diagnosis and treatment. The aim of this study is to investigate the clinicopathologic finding and outcome of patients with uterine sarcoma. METHODS: From Jan. 1996 to Dec. 2004, 40 patients with histologically proven uterine sarcomas at Gospel Hospital were evaluated for their clinical profile and survival retrospectively. RESULTS: The age of patients with uterine sarcoma ranged 28 to 71 years, and the mean age was 48.0 years. The common presenting symptoms were abnormal uterine bleeding, abdominal pain and lower abdominal palpable mass. The overall 5-year survival rate of uterine sarcoma was 48.9% and the mean survival time was 73.6 months. The overall 5-year survival rate of 24 patients less than 50 years was significantly better than that of 16 patients more than 50 years, 69.1% vs 24.6% (P=0.0139). When classified according to histologic type, there were 21 cases (52.5%) of leiomyosarcoma (LMS), 8 cases (20.0%) of endometrial stromal sarcoma (ESS), 10 cases (25.0%) of malignant mixed mullerian tumors (MMMT) and 1 case (2.5%) of liposarcoma. The overall 5-year survival rate of MMMT was significantly worse than that of LMS and ESS, 26.7% vs 49.0% and 100.0%, respectively (P=0.0423). Classifying according to the FIGO surgical staging criteria, we found the following distribution; stage I of 26 cases (66.7%), stage II of 4 cases (10.3%), stage III of 5 cases (12.8%) and stage IV of 4 cases (10.3%). The overall 5-year survival rate of stage I and II was significantly better than stage III and IV, 61.8% vs 11.1% (P=0.0011). The overall 5-year survival rate of 14 patients less than 10 mitotic figures per 10 high-power microscopic fields had a tendency to good prognosis than that of 13 patients more than 10 mitotic figures per 10 high-power microscopic fields, 83.9% vs 38.5% (P=0.0568). The overall 5-year survival rate of 6 patients less than 35 U/mL of CA-125 had a tendency to good prognosis than that of 12 patients more than 35 U/mL of CA-125, 83.3% vs 20.8% (P=0.0580). However, menstrual status and treatment modality were not significant prognostic factors. CONCLUSIONS: Uterine sarcoma are aggressive tumors with a poor prognosis. Age, histologic type, and stage were statistically significant prognostic factors for overall survival in uterine sarcomas.
Abdominal Pain ; Diagnosis ; Humans ; Leiomyosarcoma ; Liposarcoma ; Mesoderm ; Prognosis ; Retrospective Studies ; Sarcoma* ; Sarcoma, Endometrial Stromal ; Survival Rate ; Uterine Hemorrhage

OBJECTIVE: To evaluate the effects of combined estrogen and fluocalcic therapy on the bone metabolism in the surgicalyl menopausal women with osteopenia. METHODS: This prospective randomized clinical trial examined the effects of conjugated equine estrogen and fluocalcic in combination and separately, on BMD in 200 women with low bone mass. Treatment included 0.3 mg conjugated equine estrogen (CEE) (Group I), 0.625 mg CEE (Group II), 0.3 mg CEE plus fluocalcic (Group III), and 0.625 mg CEE plus fluocalcic (Group IV) for 12 months. Biochemical markers of bone turnover were also measured every six months. RESULTS: Urinary deoxypyridinoline in Group III and Group IV decreased signifiantly at 12 months of treatment (p<0.005). Serum osteocalcin and total alkaline phosphatase decreased slightly during the treatment in all groups but statistical significance was not foundsignificantly. CONCLUSION: The combined treatment with conjugated equine estrogen and fluocalcic is more effective in surgically menopausal women with osteopenia by decreasing bone biochemical marker.
Alkaline Phosphatase ; Biomarkers ; Bone Diseases, Metabolic* ; Estrogens* ; Female ; Humans ; Metabolism* ; Osteocalcin ; Prospective Studies

A 44-year-old male was admitted because of nausea and fatigue. At admission, renal insufficiency was disclosed (serum BUN 94 mg/dL, Cr 8.4 mg/ dL). Serum protein electrophoresis was normal. Urine electrophoresis showed non-selective proteinuria with M component in gamma globulin fraction. Serum immunoelectrophoresis disclosed a predominance of free lambda chain protein. Bone marrow aspiration showed a heavy infiltration of immature plasma cells. Percutaneous renal biopsy showed 9 of 10 glomeruli were slightly increased in size. Cellularity and area of mesangium were also increased. Immunohistochemical staining of kappa and lambda light chain was negative. Electron microscopy showed sparse electron dense deposits with no deposition of amyloid-like fibrils in mesangial area. In summary, these finding were compatible with those of mesangial proliferative glomerulonephritis with acute renal failure associated with multiple myeloma (lambda light chain type). There was no published report like this case. Although serum creatinine decreased to 2.1 mg/dL following steroid-pulse therapy, renal function came to deteriorate again after a month of discharge. Permanent hemodialysis was applied.
Acute Kidney Injury* ; Adult ; Biopsy ; Bone Marrow ; Creatinine ; Electrophoresis ; Fatigue ; gamma-Globulins ; Glomerulonephritis* ; Humans ; Immunoelectrophoresis ; Male ; Microscopy, Electron ; Multiple Myeloma ; Nausea ; Plasma Cells ; Proteinuria ; Renal Dialysis ; Renal Insufficiency