• Korean Journal of Bronchoesophagology
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• v.7 no.1
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• pp.29-33
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• 2001

Background and Objectives： Adenoid cystic carcinoma (ACC) is an aggressive, often indolent tumor, with a high incidence of distant metastasis (DM). Relatively little has been written about the factor that influence distant spread and subsequent survival because it is uncommon and has protracted clinical course. We attempted to reemphasize the biologic behavior of ACC by investigating the relationship between the clinical features and prognosis. Materials and Methods : We have retrospectively studied 24 determinate patiens who received definitive treatment in our hospital between 1984 and 1995 for ACC in all salivary sites. Inclusion criteria were no prior treatment elsewhere other than excisional biopsy and eligibility for follow-up of at least 5 years. Variables assessed for their impact on distant metastasis included age, gender, size, node status, stage, histologic pattern, locoregional treatment failure. Results : Treatment failure occurred in a total of 16 of 24 determinate Patients (64%), 12 of whom had DM (50%). This was usually associated with locoregional recurrence (8 patients), but DM was the only indication of failure in 4 whose primary tumor was controlled. Of the 12 patients with known DM, the lung was recored as the only involved site in 7 Patients, lung was involved in addition to other sites in 1, bone and liver metastasis occurred in 2 respectively. Disease-free intervals varied from 3 month to 14 years (median 3 years). The only significant factors influencing survival were the size of the primary tumor, locoregional recurrence. Conclusion : The high incidence of DM with locoregional failure confirms the importance of aggressive initial surgery. combined with irradiation, for high-stage tumors or involved surgical margins. Large tumor size and locoregional recurrence, rather than microscopic appearance, were predictive of DM.

• Journal of the korean academy of Pediatric Dentistry
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• v.25 no.1
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• pp.127-133
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• 1998

An impacted tooth is defined pathologically as a tooth that remains under the mucosa of inside bone without eruption of the crown after a specific period of eruption. Clinically, the term includes those teeth, even before eruption period, that are not expected to erupt due to shape, position and alignment of tooth and lack of space. Canine is prone to impaction more than other teeth because it has the longest time to develop and a complex route from the place of formation to the site of eruption. The impaction incidence of maxillary canine is repoted 0.92$\sim$3.3% (Ferguson, 1990). In 1995 Orton reported that the incidence was 0.92$\sim$2.2% and palatal impaction was more frequent than labial impaction(85%:15%). In 1969 Johnston presented it was more common to woman than to man(3:1). The etiology includes systemic disease such as endocrine disorder, cleidocranial dysostosis, irradiation, Crouzon syndrome, ricketts, facial hemihypertrophy and hereditary and local problems such as ectopic position of the tooth, distance of tooth from its place of eruption, malformation of the tooth, presence of supernumerary teeth, trauma of tooth germ, infection of tooth germ, displacement of tooth germ or tooth by a neoplasm, ankylosis, overretention of deciduous predecessor, lack of space for the tooth in the dental arch and mucosal barrier due to gingival fibrosis. The maxillary canine is especially important as it has the longest root, provides guidance for lateral movement of the mandible and masticatory function and assumes an important role esthetically as it is located at mouth angle. If left untreated, it may cause migration and external, internal resorption of adjacent teeth, loss of arch length, formation of dentigerous cyst or tumors, infection and referred pain as well as malposition of the tooth. Therefore, periodic examination of the development and eruption of the maxillary canine is especially important in a growing child. This case study presents the results of treatment of palatally impacted maxillary canine utilizing surgical exposure and orthodontic tooth movement on patients visiting SNUDH dept. of pediatric dentistry.

• The Journal of Korean Society for Radiation Therapy
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• v.33
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• pp.71-78
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• 2021

Purpose: To evaluate the inter-fractional position and respiratory reproducibility of lung and liver tumors using pressure conserving type(P-type) abdominal compressor in volumetric modulated arc therapy(VMAT). Materials and methods: Six lung cancer patients and three liver cancer patients who underwent VMAT using a P-type abdominal compressor were included in this study. Cone-beam computed tomography(CBCT) images were acquired before each treatment and compared with planning CT images to evaluate the inter-fractional position reproducibility. The position variation was defined as the difference of position shift values between target matching and bone matching. 4-dimensional cone-beam computed tomography(4D CBCT) images were acquired weekly before treatment and compared with planning 4DCT images to evaluate the inter-fractional respiratory reproducibility. The respiratory variation was calculated by the magnitude of excursions by breathing. Results: The mean ± standard deviation(SD) of overall position variation values, 3D vector in the three translational directions were 1.1 ± 1.4 mm and 4.5 ± 2.8 mm for the lung and liver, respectively. The mean ± SD of respiratory variation values were 0.7 ± 3.4 mm (p = 0.195) in the lung and 3.6 ± 2.6 mm (p < 0.05) in the liver. Conclusion: The use of P-type compressor in lung and liver VMAT was effective for stable control of inter-fractional position and respiratory variation by reproduction of abdominal compression. Appropriate PTV margin must be considered in treatment planning, and image guidance before each treatment are required in order to obtain more stable reproducibility

• The Journal of the Korean bone and joint tumor society
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• v.7 no.1
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• pp.20-27
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• 2001

Purpose : The giant cell tumor of tendon sheath is the second most common tumor of the hand, but recurred frequently although excision was performed. Authors analyzed and would report clinical findings and postoperative results of it. Materials and Methods : Between January 1991 and December 1998, 38 patients, 41 cases which the authors had performed excisional biopsy to the mass in the hand and diagnosed with the giant cell tumor of tendon sheath, was analyzed with age, sex, chief complaint, symptom duration, involved finger, involved tendon, frequently developed site in fingers, size, multiplicity, radiologic findings and recurrence. The mean duration of follow-up was 13.1 months (5~40 months). Results : Of 38 patients, twenty-nine were female. It is frequent in the fourth decade and mean age was 40.1 years old. The neurological compression symptom was found in 5 cases. The mean duration of symptom was 23.4 months. Flexor tendon was involved in 24 cases. The distal interphalangeal joint area in digit was involved most frequently in 20 cases. Index finger was the most common involved finger (14 cases), and long finger was the second most common (9 cases). All tumors were unilateral. The majority of patients had solitary lesion but one case had multiple lesion. In the radiologic findings, erosion or pressure indentation of bone was seen in 3 cases. All patients were operated by marginal excision. Recurrence rate was 5.1%. Conclusion : The risk factors in giant cell tumor of tendon sheath were female, forth decade, index finger, flexor tendon, and distal interphalangeal joint area. The recurrence was increased in marginal excision of recurred cases, in cases with multiple developed lesions or in multilobular lesion, so wide surgical excision is necessary to prevent recurrence.

• Radiation Oncology Journal
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• v.18 no.4
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• pp.257-264
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• 2000

Purpose: For early stage non-small-cell lung cancer, surgical resection is the treatment of choice. But when the patients are not able to tolerate it because of medical problem and when refuse surgery, radiation therapy is considered an acceptable alternative. We report on the treatment results and the effect of achieving local control of primary tumors on survival end points, and analyze factors that may influence survival and local control. Materials and Method : We reviewed the medical records of 32 patients with medically inoperable non-small cell lung cancer treated at our institution from June, 1987 through June, 1997. All patients had a pathologic diagnosis of non-small cell lung cancer and were not candidate for surgical resection because of either patients refusal (4), old age (2), lung problem (21), chest wail invasion (3) and heart problems (3). In 8 patients, there were more than 2 problems. The median age of the patients was 68 years (ranging from 60 to 86 years). Histologic cell type included souamous (24), adenocarcinoma (6) and unclassiried squamous cell (2). The clinical stages of the patients were 71 in 5, 72 in 25, 73 in 2 patients. Initial tumor size was 3.0 cm in 11, between 3.0 cm and 5.0 cm in 13 and more than 5.0 cm in 8 patients. Ail patients had taken chest x-rays, chest CT, abdomen USG and bone scan. Radiotherapy was delivered using 6 MV or 10 MV linear accelerators. The doses of primary tumor were the ranging from 54.0 Gy to 68.8 Gy (median; 61.2 Gy). The duration of treatment was from 37 days through 64 days (median; 0.5 days) and there was no treatment interruption except 1 patient due to poor general status. In 12 patients, concomitant boost technique was used. There were no neoadjuvant or adjuvant treatments such as surgery or chemotherapy. The period of follow-up was ranging from 2 months through 93 months (median; 23 months). Survival was measured from the date radiation therapy was initiated. Results : The overall survival rate was 44.6$\%$ at 2 years and 24.5$\%$ at 5 years, with the median survival time of 23 months. of the 25 deaths, 7 patients died of intercurrent illness, and cause-specific survival rate was 61.0$\%$ at 2 years and 33.5$\%$ at 5 years. The disease-free survival rate was 38.9$\%$ at 2 years and 28.3$\%$ at 5 years. The local-relapse-free survival rate was 35.1$\%$, 28.1$\%$, respectively. On univariate analysis, tumor size was significant variable of overall survival (p=0.0015, 95$\%$ C.1.; 1.4814-5.2815), disease-free survival (P=0.0022, 95$\%$ C.1., 1.4707-5.7780) and local-relapse-free survival (p=0.0015, 95$\%$ C.1., 1.2910- 4.1197). 7 stage was significant variable of overall survival (p=0.0395, 95$\%$ C.1.; 1.1084-55.9112) and had borderline significance on disease-free survival (p=0.0649, 95$\%$ C.1.; 0.8888-50.7123) and local-relapse-free survival (p=0.0582, 95$\%$ C,1.; 0.9342-52.7755). On multivariate analysis, tumor size had borderline significance on overall survival (p=0.6919, 955 C.1., 0.9610-5.1277) and local-relapse-free survival ( p=0.0585, 95$\%$ C.1.; 0.9720-4.9657). Tumor size was also significant variable of disease-free survival (p=0.0317, 95% C.1.; 1.1028-8.4968). Conclusion : Radical radiotherapy is an effective treatment for small (71 or f3 cm) tumors and can be offered as alternative to surgery in elderly or infirmed patients. But when the size of tumor is larger than 5 cm, there were few long-term survivors treated with radiotherapy alone. The use of hypefractionated radiotherapy, endobronchial boost, radisensitizer and conformal or IMRT should be consider to improve the local control rate and disease-specific survival rate.

• Korean Journal of Head & Neck Oncology
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• v.5 no.1
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• pp.39-46
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• 1989

Kimura's Disease is a chronic inflammatory and proliferative condition producing subcutaneous masses especially in the head and neck area. This report of our experience with 5 patients with this disease is the first in the Korean surgical literature. Kimura's Disease is thought to be part of the larger spectrum of the entity known as angiolymphoid hyperplasia with eosinophilia (ALHE). It is characterized pathologically by hyperplastic lymphoid follicles, eosinophilic infiltration, and vase 비 ar proliferation. It produces masses which are most common in the area of the parotid, submandibular gland and upper neck. These masses occupy the subcutaneous tissues but also extend into salivary tissue and into upper neck nodes. One of our patients had masses in the groin. The tumors are extremely vascular due to the presence of new proliferative vessels and sinusoids. The average age of our 5 patients was 35, but all but one case were younger than 38 years of age. The male: female ratio was 3 : 2, and the average duration of symptoms was 5,2years. All patients had peripheral blood eosinophilia. All had multiple masses, sometimes symmetrical. The management was surgery alone in one case, surgery and steroids in one case, surgery and radiotherapy in two cases, and all three modalities in one case. The relationship of this entity to ALHE and our experience in the management of this disease are presented. A clinicopathological discrepancy alerted us to the existence of Kimura's Disease. A nineteen-year old male presented with subcutaneous masses over both mastoid areas present for 3 years (Case III). When biopsy on each side was reported as 'eosinophilic granuloma' we submitted the slides to an internationally expert pathologist. Symmetrically occurring tumors in the peri-parotid subcutaneous areas did not fit any category of neoplasm or granuloma known to us. The diagnosis, made by Dr. Gist Fan at the Ochsner Clinic, was Kimura's Disease. We found two additional cases in a review of soft tissue eosinophilic granuloma previously reported at Presbyterian Medical Center, and since then have diagnosed two new cases. These five cases constitute the basis for this, the largest series to be reported in Korea. These vascular, tumor-like lesions of the skin, subcutaneous areas and subjacent structures of the head and neck have been a variety of names, such as angiolymphoid hyperplasia with eosinophilia, eosinophilic hyperplastic lymphogranuloma, angioblastic lymphoid hyperplasia with eosinophilia, histioid hemangioma, and epithelioid hemangioma. The history of this disease spectrum dates back to 1937 when Kimm and Szeto (1) reported 7 cases of 'eosinophilic hyperplastic lymphogranuloma' in the Proceedings of the Chinese Medical Journal. In 1948 Kimura and his associates(2) reported additional cases in Japan under the title 'On the unusual granulation combined with hyperplastic changes of lymphatic tissue.' From then until 1966 several hundred cases were reported in China and Japan. The first report from the West was by Wells and Whimster(3) in the British Journal of Dermatology, in 1969. These authors coined the term, angiolymphoid hyperplasia with eosinophilia (ALHE). Since that time a debate has ensued as to whether Kimura's Disease and ALHE are distinct entities, or whether Kimura's is part of the larger spectrum of ALHE, perhaps a later or advanced phase. From the clinical perspective, surgeons should be aware of the diagnosis of Kimura's Disease not only as part of the differential diagnosis of head and neck tumors but also because these lesions are indolent, and generally require conservative surgical removal as part of the management program. CASE I. A 37-year-old female company employee presented in August 1982 with submental swelling of 12 years' duration and with inguinal swelling of 7 years' duration. The submental mass measured 5x5cm. and the inguinal mass was 8x4cm. in size. Peripheral eosinophilia varying from 14% to 40% was found. On August 20, 1982, the submental mass was removed and a superficial groin dissection was done. In May 1983 an intraoral lesion of the palate was removed. The patient is free of disease. CASE II. A 23-year-old unemployed man visited this hospital for the first time in July, 1984, with swelling of the right cheek present for 6 years. The mass was soft and ill-defined but measured 10x20cm. and extended from the submandibular upper neck to the zygomatic arch, and from the mastoid to the cheek, over the parotid gland. Eosinophilia varying from 27% to 29% was noted in the peripheral blood. On March 21, 1986, the lesion was resected. The procedure comprised an extended superficial parotidectomy from the temporalis fascia to the upper neck. Post-operatively radiotherapy 3000 rad tissue dose was administered using the 6 MeV linear accelerator. The patient remains free of disease. CASE III. A 19-year-old student came to the clinic with masses over both mastoid areas, present 3 years. On the right there were two adjacent lesions, one over the mastoid, the other in the upper jugular level of the neck. On the left it was a single mass over the mastoid. Eosinophilia varied from 13 to 32% in the peripheral blood, and 11.6% in the bone marrow. Incisional biopsy revealed 'eosinophilic granuloma' and a trial of predisolone was employed. The mass increased in size so a small dose of radiation (600 rads) was used, with substantial regression,. The lesion on the left was excised and follwed by 1000 rads radiotherapy. Finally recurrent tumor on the right side was removed on November 5, 1985. The patient remains free of disease. CASE N. A 29-year-old local merchant had had swelling of both upper necks since childhood. At the time of his first visit on March 17, 1986, the right submandibular mass measured 5x3.5cm. and the ,right upper neck and parotid tail mass measured 2.5cm. On the left there were masses in the upper neck, the largest of which measured 2.5cm, and of the parotid tail, 2.0cm. in size.(See Fig. 1) Peripheral eosinophilia of 39% was recorded. Left side partial parotidectomy and resection of the upper neck and subdigstric mases was done on May 2, 1986. The mass involving the right parotid tail and upper neck nodes was removed on Angust 7,1986. Postoperatively the patient was placed on prednisolone 30 mg. per day. No definite masses are palpable. CASE V. A 66-year-old housewife informed us, at the time of her first visit in May, 1986, that she had had multiple neck masses since 10 years ago. On the right side there was a 2.5cm. subcutaneous mass of the upper neck, over the upper jugular chain. On the left there was a 9x4.5cm. mass involving the entire parotid, the post-auricular area and the upper neck. A third mass presented in the submental area and measured 3.5cm. (See Fig. 2) Eosinophilia of 51% was noted in the peripheral blood. partial excision of the left upper neck lesion and complete excision of the submental mass were performed on june 6, 1986. post-operatively she was placed on 20 mg. of prednisolone daily, but when the mass re-grew after two months she was referred to Radiation Therapy for a 2500 rad course of treatment. A barely palpable thickening remains.

• The Journal of the Korean bone and joint tumor society
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• v.14 no.2
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• pp.95-105
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• 2008

Purpose: To identify which is the best procedure in recycling autograft according to the resection & reconstruction type and recycling methods, and so when the recycling autograft is used in limb salvage surgery. Materials and Methods: We have treated fifty-eight patients (34 male, 24 female; age range 5 to 74 years, mean age 36.5 years), who had the malignant musculoskeletal tumors, with recycling autograft (47 patients with extracoporeal irradiation, 11 patients with pasteurization) from December 1995 to February 2006. The resection and reconstruction type was 3 cases with fragmentary, 8 intercalary, 23 rAPC (recycling-Autograft-Prosthesis composite), 18 osteoarticular, 5 total joint and 1 soft tissue (achilles tendon). The result was evaluated by the radiologic union at junctional site, the functional score by musculoskeletal tumor society score and complications according to the resection & reconstruction type and recycling methods. Results: The junctional union was obtained at 15.0 months in extracoporeal irradiation and 12.6 months in pasteurization. Also the mean radiologic union was shown at 6.0 months in fragmentary, 12.8 months in intercalary, 10 months in rAPC, 23.3 months in osteoarticular and 15.6 months in total joint. The functional score was 65.5% in fragmentary, 60.8% in intercalary, 62.8% in APC (except pelvis), 66.0% in osteoarticular and 66.6% in total joint. We have experienced 1 infection, 1 prutrusio acetabuli in pasteurization (18.1%) and other 22 complications (3 deep infections, 8 nonunions, 2 fractures, 2 epiphyseal problems, 5 joint instabilities, 2 local recurrence) in extracoporeal irradiation (46.8%). Also we have experienced 3 complications (3 nonunions) in intercalary (37.5%), 9 complications (4 nonunions, 1 deep infection, 1 periprosthetic fracture, 1 epiphyseal problem, 1 local recurrence, 1 protrusio acetabuli) in rAPC (50.0%), 6 complications (2 deep infections, 2 nonunions, 1 epiphyseal problem, 1 pathologic fracture) in osteoarticular (33.3%), 5 complications (5 joint instabilities) in total joint (100%) and 1 complication(1 local recurrence) in soft tissue (100%). Conclusion: In our experience, according to the resection & reconstruction type fragmentary and intercalary may have several advantages such as good radiologic and functional result and low rate of complication. And it seems that rAPC was available in case which have no sufficient residual bone stock. Also the pasteurization may have more advantages than that of the extracorporeal irradiation.

• Clinical and Experimental Pediatrics
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• v.51 no.1
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• pp.73-77
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• 2008

Purpose : p16 gene, mapped to the 9p21 chromosomal region, has emerged as a candidate tumor suppressor gene in human neoplasm. It is an inhibitor of cyclin-dependent kinase and inhibits Rb phosphorylation. In a variety of tumors including childhood acute lymphoblastic leukemia (ALL), deletion and/or mutation of the p16 gene has been found. Despite their high frequency, the prognostic importance of p16 alterations is still controversial in ALL and has been reported to be either unfavorable or similar to that of other patients. We studied the correlation between loss of p16 protein confirmed by immunohistochemical staining and clinical outcomes of patients diagnosed as ALL. Methods : We performed an immunohistochemical staining for p16 protein in 74 cases of bone marrow biopsy slide initially diagnosed as ALL between January 1998 and December 2006. We reviewed the clinical manifestations, laboratory findings, treatment outcomes retrospectively. Results : Of 74 slides, 12 were negative for p16 protein. Seven were males and 5 were females with a median age at diagnosis was 5.8 (1.3-18.8) years. Initial WBC were 17,225 $(500-403,300)/{\mu}L$. By immunologic surface marker analysis, 7 patients were early pre-B CALLA (+) and 5 patients were T-cell ALL. Two patients of intermediate risk group had relapsed and died. Three patients had family history of breast cancer. Four patients died and overall survival rates were $53.5{\pm}18.7%$. Conclusion : Loss of p16 protein is supposed to be an independent risk factor of childhood ALL associated with poor outcomes. In clinical setting, the clinician must take into account p16 status, not only at the genomic but also at the protein level. Further clinical experience on thoroughly investigated cases will help a better understanding between p16 status and clinical outcomes.

• The Journal of the Korean bone and joint tumor society
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• v.9 no.1
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• pp.52-60
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• 2003

Purpose: To analyse their end results and also to differentiate the single or multiple giant cell tumor(GCT) of tendon sheath in hand. Materials & Methods: Total 21 cases with GCT of tendon sheath in hand were treated surgically and analyzed their end results with clinically, radiologically and pathologically to allowed for average 16 months after surgical excision. Results: The finger flexor tendons, especially on index and ring finger, involving distal interphalangeal joint and mid-phalanges in fourth decades (average age of 47 years old) were frequently involved, and the mass was not exceed than 2 cm in size, fixed on tendon sheath with rubbery hard tenderness but rare bony involvements except 4 cases of bony erosion and cortical perforation. The three cases with multiple GCT of hand was also combined with familial hypercholesterolemia, and are commonly involved the extensor tendons as well as achilles tendons bilaterally, treated with partial excision because of multiplicity. Average 16 months after surgical excision for single GCT cases was followed and showed the recurrence in 3 cases(3/18,16.7%), treated with wide excision. The single and multifocal GCT are similar in pathologic changes but different soft tissue tumors in their pathogenesis, treatment and prognosis. Conclusion: Incomplete excision of GCT of tendon sheath in hand are thought to be the cause of recurrence, especially in cases with incomplete lesional excision, in multilobular and bony involvement etc. So careful wide excision is necessary to prevent the recurrence.

• Progress in Medical Physics
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• v.9 no.3
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• pp.155-162
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• 1998

Ho-l66 was produced by neutron reaction in a reactor at the Korea Atomic Energy Institute (Taejon, Korea). Ho-l66 emits a high energy beta particles with a maximum energy of 1.85 MeV and small proportion of gamma rays (80 keV). Therefore, the radiation absorbed dose estimation could be based on the in-vivo quantification of the activity in tumors from the gamma camera images. Approximately 1 mCi of Ho-l66 in solution was mixed into the flood phantom and planar scintigraphic images were acquired with and without patient interposed between the phantom and scintillation camera. Transmission factor over an area of interest was calculated from the ratio of counts in selected regions of the two images described above. A dual-head gamma camera(Multispect2, Siemens, Hoffman Estates, IL, USA) equipped with medium energy collimators was utilized for imaging(80 keV${\pm}$10%). Fifty-nine year old female patient with hepatoma was enrolled into the therapeutic protocol after the informed consent obtained. Thirty millicuries(110MBq) of Ho-166-CHICO was injected into the right hepatic arterial branch supplying hepatoma. When the injection was completed, anterior and posterior scintigraphic views of the chest and pelvic regions were obtained for 3 successive days. Regions of interest (ROIs) were drawn over the organs in both the anterior and posterior views. The activity in those ROIs was estimated from geometric mean, calibration factor and transmission factors. Absorbed dose was calculated using the Marinelli formula and Medical Internal Radiation Dose (MIRD) schema. Tumor dose of the patient treated with 1110 MBq(30 mCi) Ho-l66 was calculated to be 179.7 Gy. Dose distribution to normal liver, spleen, lung and bone was 9.1, 10.3, 3.9, 5.0 % of the tumor dose respectively. In conclusion, tumor dose and absorbed dose to surrounding structures were calculated by daily external imaging after the Ho-l66 therapy for hepatoma. In order to limit the thresholding dose to each surrounding organ, absorbed dose calculation provides useful information.