• Journal of Gastric Cancer
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• v.14 no.3
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• pp.215-219
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• 2014

Distant metastasis from papillary thyroid carcinoma (PTC), particularly from papillary thyroid microcarcinoma, is rare. We present a case of perigastric lymph node metastasis from PTC in a patient with early gastric cancer and breast cancer. During post-surgical follow-up for breast cancer, a 56-year-old woman was diagnosed incidentally with early gastric cancer and synchronous left thyroid cancer. Therefore, laparoscopic distal gastrectomy with lymph node dissection and left thyroidectomy were performed. On the basis of the pathologic findings of the surgical specimens, the patient was diagnosed to have papillary thyroid microcarcinoma with perigastric lymph node metastasis and early gastric cancer with mucosal invasion. Finally, on the basis of immunohistochemical staining with galectin-3, the diagnosis of perigastric lymph node metastasis from PTC was made. When a patient has multiple primary malignancies with lymph node metastasis, careful pathologic examination of the surgical specimen is necessary; immunohistochemical staining may be helpful in determining the primary origin of lymph node metastasis.

• Tuberculosis and Respiratory Diseases
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• v.40 no.1
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• pp.72-78
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• 1993

Background: In malignancies, detection of metastatic foci is of value in making therapeutic plans for treatment of disease and prevention of life-threatening complications. Common sites for metastasis of bronchogenic cancer include lymph nodes, liver, brain, adrenals and bone. Skull, vertebrae, ribs and long bones are common sites for bone metastasis. But in epidermoid carcinoma, the incidence of bone metastasis is relatively low and especially to the distal phalangeal bone is rare. Methods: We experienced a case of epidermoid carcinoma with the first distant metastasis to the fifth distal phalangeal bone, right toe. Results: The initial stage in the diagnosis of epidermoid carcinoma was T4N3MO. During the third round of anticancer chemotherapy, we recognized the distant metastasis to the fifth distal phalangeal bone for the first time. Localized abnormal findings were noted by bone X-ray and scanning. By a histopathologic examination of the amputated toe, we confirmed the metastasis of epidrmoid bronchogenic carcinoma. Conclusion: If localized abnormal finding is discovered at an unusual site for metastasis, we recommend physicians to consider the possibility of metastasis even though it is very low.

• Radiation Oncology Journal
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• v.32 no.3
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• pp.125-131
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• 2014

Purpose: We reviewed treatment outcomes and prognostic factors for patients with salivary ductal carcinoma (SDC) treated with surgery and postoperative radiotherapy from 2005 to 2012. Materials and Methods: A total of 16 patients were identified and 15 eligible patients were included in analysis. Median age was 61 years (range, 40 to 71 years) and 12 patients (80%) were men. Twelve patients (80%) had a tumor in the parotid gland, 9 (60%) had T3 or T4 disease, and 9 (60%) had positive nodal disease. All patients underwent surgery and postoperative radiotherapy. Postoperative radiotherapy was delivered using 3-dimensional conformal radiotherapy or intensity-modulated radiotherapy. Locoregional failure-free survival (LRFFS), distant failure-free survival (DFFS), progression-free survival (PFS), and overall survival (OS) were calculated using the Kaplan-Meier method. Differences in survival based on risk factors were tested using a log-rank test. Results: Median total radiotherapy dose was 60 Gy (range, 52.5 to 63.6 Gy). Four patients received concurrent weekly chemotherapy with cisplatin. Among 10 patients who underwent surgery with neck dissection, 7 received modified radical neck dissection. With a median follow-up time of 38 months (range, 24 to 105 months), 4-year rates were 86% for LRFFS, 51% for DFFS, 46% for PFS, and 93% for OS. Local failure was observed in 2 patients (13%), and distant failure was observed in 7 (47%). The lung was the most common involved site of distant metastasis. Conclusion: Surgery and postoperative radiotherapy in SDC patients resulted in good local control, but high distant metastasis remained a major challenge.

• Nuclear Medicine and Molecular Imaging
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• v.42 no.sup1
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• pp.76-90
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• 2008

$^{18}F-FDG$ PET in combination with conventional imaging modalities could help avoid unnecessary biopsy for the primary mass, and it also has a high diagnostic accuracy in patients with dense breasts. In the assessment of metastasis, $^{18}F-FDG$ PET was useful to select patients who required sentinel lymph node biopsy and to detect extra-axillary lymph node metastasis and distant metastasis. To increase the sensitivity for osteoblastic bone metastasis, bone scintigraphy should be added. In the detection of recurrence, $^{18}F-FDG$ PET showed a higher diagnostic accuracy than tumor marker or computed tomography, and therefore it can be used in routine breast cancer follow-up. $^{18}F-FDG$ PET has been reported that it correctly predicted the response of neoadjuvant chemotherapy on as early as 8th day of treatment. Therefore, it is useful for the early detect of therapeutic response in advanced breast cancer.

• The Journal of the Korean bone and joint tumor society
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• v.15 no.1
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• pp.26-33
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• 2009

Purpose: This study was performed to investigate the maspin gene expression from osteosarcoma and to determine whether its expression correlates with clinical course of the cancer. Materials and Methods: Between 2001 and 2006, 39 patients who were diagnosed and treated surgically for osteosarcoma were included in the present study. We estimated the maspin gene expression from osteosarcoma tissue samples using RT-PCR. And we examined the correlations between the maspin expression and clinical data (post-chemotherapeutic response, local relapse or metastases). Results: Maspin was over expressed in 21 cases of 39 osteosarcoma tissues. There were significant correlations between maspin expression and the response to neoadjuvant chemotherapy, distant metastases & metastasis-free survival. In multivariate analysis, maspin low-expression was significant risk factor for distant metastases. Also, there was significant difference in metastasis-free survivals between maspin hi- expression group ($69.0{\pm}10.5%$) and low-expression group ($25.4{\pm}13.0%$). Conclusion: The degree of maspin expression in osteosarcoma was significant risk factor for distant metastases and predictive factor for metastasis-free of overall survivals. Maspin may be a useful biologic marker in evaluating the prognosis in patients with osteosarcoma and could be used as a therapeutic target clinically.

• Biomolecules & Therapeutics
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• v.29 no.5
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• pp.551-561
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• 2021

Thyroid cancer is the most common endocrine malignancy. Patients with well-differentiated thyroid cancers, such as papillary and follicular cancers, have a favorable prognosis. However, poorly differentiated thyroid cancers, such as medullary, squamous and anaplastic advanced thyroid cancers, are very aggressive and insensitive to radioiodine treatment. Thus, novel therapies that attenuate metastasis are urgently needed. We found that both PDGFC and PDGFRA are predominantly expressed in thyroid cancers and that the survival rate is significantly lower in patients with high PDGFRA expression. This finding indicates the important role of PDGF/PDGFR signaling in thyroid cancer development. Next, we established a SW579 squamous thyroid cancer cell line with 95.6% PDGFRA gene insertion and deletions (indels) through CRISPR/Cas9. Protein and invasion analysis showed a dramatic loss in EMT marker expression and metastatic ability. Furthermore, xenograft tumors derived from PDGFRA geneedited SW579 cells exhibited a minor decrease in tumor growth. However, distant lung metastasis was completely abolished upon PDGFRA gene editing, implying that PDGFRA could be an effective target to inhibit distant metastasis in advanced thyroid cancers. To translate this finding to the clinic, we used the most relevant multikinase inhibitor, imatinib, to inhibit PDGFRA signaling. The results showed that imatinib significantly suppressed cell growth, induced cell cycle arrest and cell death in SW579 cells. Our developed noninvasive apoptosis detection sensor (NIADS) indicated that imatinib induced cell apoptosis through caspase-3 activation. In conclusion, we believe that developing a specific and selective targeted therapy for PDGFRA would effectively suppress PDGFRA-mediated cancer aggressiveness in advanced thyroid cancers.

• Journal of Gastric Cancer
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• v.20 no.3
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• pp.233-244
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• 2020

Purpose: For unresectable or initially metastatic gastric cancer, conversion surgery (CVS), after systemic chemotherapy, has received attention as a treatment strategy. This study evaluated the prognostic value of ypTNM stage and the oncologic outcomes in patients receiving CVS. Materials and Methods: A retrospective review of clinicopathologic findings and oncologic outcomes of 116 patients who underwent CVS with curative intent, after combination chemotherapy, between January 2000 and December 2015, has been reported here. Results: Twenty-six patients (22.4%) underwent combined resection of another organ and 12 patients received para-aortic lymphadenectomy (10.3%). Pathologic complete remission (CR) was confirmed in 11 cases (9.5%). The median overall survival (OS) and disease-free survival (DFS) times were 35.0 and 21.3 months, respectively. In multivariate analysis, ypTNM stage was the sole independent prognostic factor for DFS (P=0.042). Tumors invading an adjacent organ or involving distant lymph nodes showed better survival than those with peritoneal seeding or solid organ metastasis (P=0.084). Kaplan-Meier curves showed that the 3-year OS rate of patients with pathologic CR and those with CR of the primary tumor but residual node metastasis was 81.8% and 80.0%, respectively. OS was 65.8% for stage 1 patients, 49.8% for those at stage 2, and 36.3% for those at stage 3. Conclusions: The ypTNM staging is a significant prognostic factor in patients who underwent CVS for localized unresectable or stage IV gastric cancers. Patients with locally advanced but unresectable lesions or with tumors with distant nodal metastasis may be good candidates for CVS.

• Journal of Gastric Cancer
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• v.4 no.3
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• pp.180-185
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• 2004

Recently, we experienced two advanced gastric cancer (AGC) patients younger than 17 years of age. The first case was a 15-year, 2-month-old male who had suffered from epigastric soreness for 5 weeks. His grandfather died of gastric cancer at 39 years of age. Under the diagnosis of AGC, he underwent a total gastrectomy with D2 lymph node dissection. There was no evidence of distant metastasis. Pathologic examination revealed a 4.5$\times$4 cm, signet ring cell adenocarcinoma with subserosal invasion and with metastasis in 9 of 42 regional lymph nodes (T2bN2M0). The second case was a 17-year, 11-month-old male who had suffered from epigastric pain for 2 years without familial clustering. Under the diagnosis of AGC, he underwent a distal subtotal gastrectomy with D2 lymph node dissection. There was no evidence of distant metastasis. Pathologic examination revealed a 3$\times$2 cm, signet ring cell adenocarcinoma with subserosal invasion and with metastasis in 9 of 45 regional lymph nodes (T2bN2M0). The two patients have been alive without recurrence for 27 months and 4 months, respectively. Even among teenagers, patients with abdominal complaints should be subjected to a thorough examination of the gastrointestinal tract.

• Korean Journal of Clinical Oncology
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• v.14 no.2
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• pp.69-75
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• 2018

Purpose: We analyzed our 10-year experience in a single-center, public hospital and thereby evaluated the changing trends of clinico-pathologic and surgical characteristics as well as treatment outcomes in patients with gastric cancer. Methods: The current single-center, retrospective study was conducted with patients who had been treated at department of our medical institution during a period ranging from March 1, 2007 to June 16, 2018. The eligible patients were divided into two groups: group I (March 2007-April 2012) and II (May 2012-June 2018). Then, we compared time-dependent changes in clinico-pathologic characteristics between the two groups. Results: The mean age was $63.0{\pm}11.3$ years in group I and $65.8{\pm}10.5$ years in group II, respectively (P=0.017). The American Society of Anesthesiologist (ASA) score was 34.9% for 1 point, 38.3% for 2 points, and 26.9% for 3 points or more in group I, and 31.1% for 1 point, 52.5% for 2 points, and 16.4% for 3 points or more in group II, which was statistically significant (P=0.012). The average follow-up duration was significantly different between the two group ($39.8{\pm}39.7$ vs. $23.4{\pm}20.6$) (P<0.001). The duration of postoperative hospital stay was 1.8 days longer in group II than group I (P=0.047). Tumor depth, node metastasis and distant metastasis were significantly different between the two groups (P<0.001, P=0.009, and P=0.019, respectively). Conclusion: There were significant differences in the age, ASA score, average follow-up duration, postoperative hospital stay, tumor depth, node metastasis and distant metastasis between the two groups.

• Korean Journal of Radiology
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• v.22 no.5
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• pp.714-724
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• 2021

Objective: To evaluate the value of ¹⁸F-fluorodeoxyglucose PET/MRI added to contrast-enhanced CT (CECT) in initial staging, assessment of resectability, and postoperative follow-up of biliary tract cancer. Materials and Methods: This retrospective study included 100 patients (initial workup [n = 65] and postoperative follow-up [n = 35]) who had undergone PET/MRI and CECT for bile duct or gallbladder lesions between January 2013 and March 2020. Two radiologists independently reviewed the CECT imaging set and CECT plus PET/MRI set to determine the likelihood of malignancy, local and overall resectability, and distant metastasis in the initial workup group, and local recurrence and distant metastasis in the follow-up group. Diagnostic performances of the two imaging sets were compared using clinical-surgical-pathologic findings as standards of reference. Results: The diagnostic performance of CECT significantly improved after the addition of PET/MRI for liver metastasis (area under the receiver operating characteristic curve [A_z]: 0.77 vs. 0.91 [p = 0.027] for reviewer 1; 0.76 vs. 0.92 [p = 0.021] for reviewer 2), lymph node metastasis (0.73 vs. 0.92 [p = 0.004]; 0.81 vs. 0.92 [p = 0.023]), and overall resectability (0.79 vs. 0.92 [p = 0.007]; 0.82 vs. 0.94 [p = 0.021]) in the initial workup group. In the follow-up group, the diagnostic performance of CECT plus PET/MRI was significantly higher than that of CECT imaging for local recurrence (0.81 vs. 1.00 [p = 0.029]; 0.82 vs. 0.94 [p = 0.045]). Conclusion: PET/MRI may add value to CECT in patients with biliary tract cancer both in the initial workup for staging and determination of overall resectability and in follow-up for local recurrence.