• Journal of Pathology and Translational Medicine
• /
• v.52 no.6
• /
• pp.369-377
• /
• 2018

Background: Chemokine receptor CXC chemokine receptor type 4 (CXCR4) and its ligand CXC motif chemokine 12 (CXCL12; stromal cell-derived factor-1) are implicated in tumor growth, metastasis, and tumor cell-microenvironment interaction. A number of studies have reported that increased CXCR4 expression is associated with worse prognosis in triple-negative breast cancer (TNBC), but its prognostic significance has not been studied in TNBC patients treated with adjuvant chemotherapy. Methods: Two hundred eighty-three TNBC patients who received adjuvant chemotherapy were retrospectively analyzed. Tissue microarray was constructed from formalin-fixed, paraffin-embedded tumor tissue and immunohistochemistry for CXCR4 and CXCL12 was performed. Expression of each marker was compared with clinicopathologic characteristics and outcome. Results: High cytoplasmic CXCR4 expression was associated with younger age (p=.008), higher histologic grade (p=.007) and lower pathologic stage (p=.045), while high CXCL12 expression was related to larger tumor size (p=.045), positive lymph node metastasis (p=.005), and higher pathologic stage (p=.017). The patients with high cytoplasmic CXCR4 experienced lower distant recurrence (p=.006) and better recurrence-free survival (RFS) (log-rank p=.020) after adjuvant chemotherapy. Cytoplasmic CXCR4 expression remained an independent factor of distant recurrence (p=.019) and RFS (p=.038) after multivariate analysis. Conclusions: High cytoplasmic CXCR4 expression was associated with lower distant recurrence and better RFS in TNBC patients treated with adjuvant chemotherapy. This is the first study to correlate high CXCR4 expression to better TNBC prognosis, and the underlying mechanism needs to be elucidated in further studies.

• Korean Journal of Head & Neck Oncology
• /
• v.23 no.1
• /
• pp.50-53
• /
• 2007

Adrenal metastasis from papillary thyroid carcinoma is extremely rare. We present herein a patient with adrenal metastases from recurrent papillary carcinoma of the thyroid. A 54 year-old woman had received a total thyroidectomy and postoperative radioactive iodine therapy for locally advanced papillary thyroid carcinoma. One year after initial surgery, distant metastases to multiple organs including right cervical lymph nodes, left upper lung, left 2nd and 3rd ribs, 2nd thoracic vertebra and left adrenal gland were found by 18-FDG-PET-CT whole body scan. She underwent right modified neck dissection, partial resection of left 2nd and 3rd ribs, posterior arch of 2nd thoracic vertebra, left upper lobectomy of lung, and left adrenalectomy. On histologic examination, metastases to the left adrenal gland and cervical lymph nodes were papillary thyroid carcinomas, while other metastatic sites turned out to be anaplastic thyroid carcinomas. Despite aggressive surgery and postoperative adjuvant therapy, her general clinical conditions were getting worse day by day due to regrowing of the anaplastic thyroid carcinomas. To our knowledge, this is the first case reported in Korea.

• Korean Journal of Head & Neck Oncology
• /
• v.1 no.1
• /
• pp.21-34
• /
• 1985

The authors reviewed 114 cases of malignant major and minor salivary gland tumors at Presbyterian Medical Center seen from February, 1963 to December, 1983. The results were obtained as follows; 1) Overall male and female sex ratio was 2:1. The peak age of patients with major and minor salivary gland tumor were both 5 th decade. 2) The ratio of benign and malignant tumor was 83:114. The incidence of malignancy in each group was 52% in parotid (50 patients), 75% in minor salivary gland (45 patients), 49% in submaxillary gland(18 patients) and 25% in sublingual gland (1 patient). 3) The incidence according to the anatomic primary site for minor salivary cancers was 10 cases in the nasal cavity, each 8 in the palate and the maxillary antrum, 7 in the tongue, 5 in the gum, 3 in the larynx and 2 in the buccal mucosa. 4) Adenoid cystic carcinoma was the most common cancer of minor salivary gland and malignant mixed tumor was the most common in major salivary glands, each comprising 34 cases (76%) of minor and 19 cases (28%) of major salivary gland tumors. 5) The incidence of cervical lymph node metastasis was 50% in the submaxillary gland cancers, 44% in the parotid gland cancers and 21% in malignant tumors of minor salivary glands. The highest incidence of lymph node metastasis according to histopathological classification was formed in high grade of mucoepidermoid (67%). 6) Nerve invasion was common in mucoepidermoid carcinoma. According to anatomic site, nerve invasion occurred most often in adenoid cystic carcinoma of the submaxillary gland (44%). 7) The lung was the commonest site for distant metastasis comprising 12 cases among 26 cases in which distant spread occurred. 8) The recurrence rate was 50% for major salivary gland cancer and 52% in cancer of the minor salivary gland. In accordance with pathological classification, adenocarcinoma most frequently recurred after excision. This being seen in 88% of patients undergoing definitive therapy. 9) The determinate 5 year survival rate was 78% in major salivary gland tumors, but 69% in minor salivary gland tumors.

• Radiation Oncology Journal
• /
• v.12 no.3
• /
• pp.369-376
• /
• 1994

This is a retrospective analysis of 64 patients who was treated with postoperative radiation therapy after radical hysterectomy and bilateral pelvic lymphadenectomy (53 patients) or total abdominal hysterectomy(11 patients) for uterine cervix cancer between May 1980 and September 1991 at the Department of Radiation Oncology, Kyung Hee University Hospital. Most patients were FIGO IB (31 Patients) and IIA (25 patients), and median period of follow-up was 5.1 years. Of these patients,24 received adjuvant whole pelvis irradiation of 6000 cGy and 40 received 5000-5500 cGy whole pelvis irradiation and/or intracavitary radiation (7 Patients). The actuarial overall and relapse free 5 year survival rate were $71.0\%$, $68.3\%$ respectively. The survival rates by stage were $79.1\%$ in stage I, and $61.2\%$ in stage II. Treatment failure was noted in 18 of 64 patients ($28.1\%$), Iocoregional failure in 8 ($12.5\%$), distant metastasis in 8 ($12.5\%$), paraaortic node metastasis in 1 and one patient and concurrent locoregional and distant metastasis. The univariate analysis of prognostic factors affecting to overall survival rate represented lymph node status, the number and site of metastatic lymph node, parametrial invasion, the thichness of cervical wall invasion, and size of cancer mass. Histology, vessel invasion, endometrial extension, hemoglobin level. resection margin status, age, radiation dose were not significant prognostic factors. Complication relating to operation and postoperative radiation were variable according to radiation therapy method: 6000 cGy RT group 8/24($33.3\%$), 5000-5500 cGy+ICR 3/7 ($42.9\%$), 5000-5500 cGy external RT only group 3/33 ($9.1\%$). In conclusion, the results suggest that postoperative radiotherapy is necessary in high risk patients for locoregional control and improving survival rate, and higher dose does not improve results but only increases complication.

• Journal of Chest Surgery
• /
• v.53 no.6
• /
• pp.361-367
• /
• 2020

Background: Malignant primary cardiac tumors are extremely rare, but have a poor prognosis. This study evaluated the surgical outcomes of patients with this disease. Methods: Forty patients who underwent surgery for malignant primary cardiac tumors between January 1998 and December 2018 were enrolled. Participants were divided into 3 groups based on resection margins (R0, 14 patients; R1, 11 patients; and R2, 11 patients) and their surgical outcomes were compared. Heart transplantation was performed in 4 patients with unresectable tumors. Results: Early mortality was reported in 2 cases (5%) due to postoperative bleeding and cerebral hemorrhage secondary to brain metastasis. The 1- and 2-year survival rates were 67.5% and 42.5%, respectively. The median survival time of the patients was 20.3 months (range, 9.2-37.6 months). The median survival time was 48.7, 20.3, and 4.8 months in patients with R0, R1, and R2 resections, respectively (p=0.023). Tumor recurrence occurred in 21 patients (61.7%), including 4 cases of local recurrence and 17 cases of distant metastasis. In patients who underwent heart transplantation, the median survival time was 29.5 months, with 3 cases of distant metastasis. Conclusion: Although surgery for malignant primary cardiac tumors has a poor prognosis, complete resection of the tumor may improve surgical outcomes.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
• /
• v.26 no.4
• /
• pp.427-434
• /
• 2000

The authors analyzed retrospectively the 36 patients with malignant salivary gland tumors who were treated at Department of Oral and Maxillofacial Surgery, Pusan National University Hospital from February, 1989 to September, 1997. The results obtained were as follows: 1. There were 14 males(38.9%) and 22 females(61.1%). The peak age of patients with major salivary gland tumors was the 6th decade, but with minor salivary gland was the 5th decade. 2. Of all salivary gland tumors, 5 cases arose in the parotid glands, 2 cases in the submanibular glands, 1 case in the sublingual gland and 28 cases in the minor salivary glands. 3. The incidence according to the anatomic primary site for minor salivary glands was 15 cases in the palate, 5 in the floor of mouth and 2 cases each arising in the tongue, lip, retromolar area and buccal mucosa. 4. Of all salivary gland tumors, adenoid cystic carcinoma was 5 cases in the major salivary glands and 8 in the minor salivary glands. mucoepidermoid carcinoma was 2 cases in the major salivary glands and 14 in the minor salivary glands and others were 2 cases of adenocarcinoma, 4 malignant mixed tumors and 1 undifferentiated carcinoma. 5. The incidence of cervical lymph node metastasis was 100%(2/2) in the submandibular glands, 80%(4/5) in the floor of mouth, 50%(1/2) in the tongue and 20%(1/5) in the parotid glands. The highest incidence of lymph node metastasis according to histopathological classfication was found in the high grade of mucoepidermoid carcinoma and tubular type of adenoid cystic carcinoma. 6. Nerve invasion was common in the adenoid cystic carcinoma. 7. The lung was the commonest site for distant metastasis comprising 7 cases among 7 cases in which distant spread occurred.

• Archives of Plastic Surgery
• /
• v.35 no.6
• /
• pp.743-747
• /
• 2008

Purpose: Malignant changes of Marjolin's ulcer arising from chronic burn scar are rare. The majority of them are squamous cell carcinoma and basal cell carcinoma. Malignant fibrous histiocytoma is a deep seated pleomorphic sarcoma, which occurs principally as a mass of the extremities, abdominal cavity, or retroperitoneum in adults. Methods: We report a 58-year-old male patient who was admitted due to $3.5{\times}5cm$ chronic ulceration of anterior chest wall on the center of old burn scar. His scar had been occurred by boiling oil and treated with conservative treatment 45 years ago. Preoperative punch biopsy showed suspicious malignant changes and contrast enhanced chest CT showed well-defined, irregular shape enhancing lesion on anterior chest wall without intrathoracic metastasis. Results: The tumor was widely excised and defect was covered with skin graft without infection, necrosis and any other complication. The pathologic findings are compatible with malignant fibrous histiocytoma(storiform - pleomorphic type). The patient underwent 3 cycles of chemotheraphy. Although distant metastasis to the lung developed 6 months later and the patient died 9 month later, there was no local reoccurrence. Conclusion: Aggressive and early excision is needed because malignant fibrous histiocytoma has characteristics of high malignancy with a propensity for early and distant spread. Furthermore, the patient's education about disease entity and postoperative regular follow-up for local recurrence or metastasis is very important. To prevent malignancy from secondly healing burn scar, early skin graft is recommended for patients with deep second degree burn.

• Radiation Oncology Journal
• /
• v.11 no.2
• /
• pp.411-419
• /
• 1993

A total of 44 patients with extremity soft tissue sarcomas had received conservative surgery and radiation therapy in the Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine between Jan. 1980 and Dec. 1990. Initial surgical treatment consisted of intracapsular excision in 33 patients $(75\%),$ marginal excision in 9 patients, and wide excision in two patients. Total radiation doses were between 40Gy and 65Gy (median 60 Gy). Median follow-up period was 47 months. Overall actuarial 5-year survival rate was $76.9\%$ and 5-year recurrence free survival rate was $39.3\%.$ There was no statistically significant prognostic factors but the 5-year survival rates tended to be decreased in the patients with high grade tumors and treated with narrow surgical extent. Sixteen patients recurred during fellow-up (16/31, $51.6\%).$ The incidence of initial local recurrence was $22.6\%$ (7/31) and distant metastasis was $29\%(9/31).$ Of the 7 who did not have metastasis at diagnosis of local recurrence, 5 were submitted to a salvage treatment. All of them achieved local control and distant metastasis appeared in three of them. In conclusion, conservative surgery and radiation therapy in the patients with extremity soft tissue sarcomas was the effective treatment modality.

• Korean Journal of Head & Neck Oncology
• /
• v.34 no.1
• /
• pp.9-13
• /
• 2018

Background/Objectives: Brain metastasis (BM) is a rare form of distant metastasis with papillary thyroid cancer (PTC). Patients with BM of PTC carry a poor prognosis. The aim of this study was to contribute to the understanding of this disease by analyzing patients with BM of PTC. Materials & Methods: Between March 2003 and December 2013, the patient database was conducted to identify thyroid cancer patients treated. Among the 22,758 thyroid cancer patients, 14 (0.06 %) were identified to have metastasis to the brain during follow-up. The medical records of 14 patients with BM were retrospectively reviewed, focusing on the following: patient characteristics, synchronous or previous distant metastasis, treatments including whole brain radiotherapy (WBRT), stereotactic radiosurgery (SRS) and surgery, and characteristics on radiologic findings, time interval between first diagnosis of primary thyroid cancer and BM and survival after BM. Results: The mean age at initial diagnosis and BM were $50.9{\pm}15.8years$ and $61.3{\pm}12.7years$. The mean duration between initial diagnosis and BM was $10.4{\pm}7.9years$. Patients were treated with varied combinations of surgery, SRS and WBRT except 4 patients who had refused treatment. The median overall survival (OS) time after BM diagnosis was 10 months (range 1 - 19). Patients receiving treatment (WBRT and/or surgery, SRS) had a significant longer median OS of 16.5 months in comparison to 3.5 months for those treated without treatment. (p = 0.005) Conclusion: Patients who received aggressive treatment had a longer OS than those with only supportive care. Treatment such as surgery, SRS and WBRT should be considered in patients with BM.

• Advances in pediatric surgery
• /
• v.11 no.1
• /
• pp.40-45
• /
• 2005

Solid pseudopapillary tumor of pancreas in children is a tumor with low malignant potentiality. and is rarely associated with distant metastasis. A 13-year-old girl was hospitalized because of abdominal pain of one week duration. Abdominal CT revealed not only a $12{\times}6cm$ sized mass at the pancreatic body and tail but also a 1cm sized mass in left lobe of the liver. The patient underwent a near-total pancreatectomy and tumorectomy of the liver. A solid pseudopapillary tumor with liver metastasis was confirmed by pathology. She has undergone 13 courses of chemotherapy and has been well for 13 monthswithout any sign of recurrence.