• Annals of Hepato-Biliary-Pancreatic Surgery
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• v.28 no.2
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• pp.125-133
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• 2024

Undifferentiated carcinoma with osteoclast-like giant cells (UC-OGCs) of the pancreas is a rare neoplasm that accounts for less than 1% of all pancreatic malignancies. The aim of this study was to review the literature regarding UC-OGC, and to highlight its biological behavior, clinicopathologic characteristics, prognosis, and therapeutic options. A systematic review of the literature in PubMed/Medline and Scopus databases was performed (last search October 31st, 2023) for articles concerning pancreatic UC-OGC in the adult population. Fifty-seven studies met the inclusion criteria, involving 69 patients with a male-to-female ratio of 1.1:1 and a mean age of 62.96. Main symptoms included abdominal pain (33.3%), jaundice (14.5%), weight loss (8.7%), while fourteen patients (20.3%) were asymptomatic. Surgical resection was performed in 88.4% of cases. Survival rates at one, three, and five years were 58%, 44.7%, and 37.3% respectively. Sex, age, size (cut-off of 4 cm), location, and adjuvant treatment did not significantly affect patient survival. UC-OGC of the pancreas is a rare subtype of undifferentiated pancreatic carcinoma with a better prognosis than conventional pancreatic ductal adenocarcinoma or undifferentiated carcinoma without giant cells. The establishment of a dedicated patient registry is imperative to further delineate the optimal treatment for this uncommon clinical entity.

• Clinical Endoscopy
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• v.57 no.3
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• pp.350-363
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• 2024

Background/Aims: To overcome the technical limitations of classic endoscopic resection for gastric gastrointestinal stromal tumors (GISTs), various methods have been developed. In this study, we examined the role and feasibility of clip-and-cut procedures (clip-and-cut endoscopic full-thickness resection [cc-EFTR]) for gastric GISTs. Methods: Medical records of 83 patients diagnosed with GISTs after endoscopic resection between 2005 and 2021 were retrospectively reviewed. Moreover, clinical characteristics and outcomes were analyzed. Results: Endoscopic submucosal dissection (ESD) and cc-EFTR were performed in 51 and 32 patients, respectively. The GISTs were detected in the upper third of the stomach for ESD (52.9%) and cc-EFTR (90.6%). Within the cc-EFTR group, a majority of GISTs were located in the deep muscularis propria or serosal layer, accounting for 96.9%, as opposed to those in the ESD group (45.1%). The R0 resection rates were 51.0% and 84.4% in the ESD and cc-EFTR groups, respectively. Seven (8.4%) patients required surgical treatment (six patients underwent ESD and one underwent cc-EFTR,) due to residual tumor (n=5) and post-procedure adverse events (n=2). Patients undergoing R0 or R1 resection did not experience recurrence during a median 14-month follow-up period, except for one patient in the ESD group. Conclusions: cc-EFTR displayed a high R0 resection rate; therefore, it is a safe and effective therapeutic option for small gastric GISTs.

• Journal of Cerebrovascular and Endovascular Neurosurgery
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• v.25 no.1
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• pp.36-49
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• 2023

Objective: Arteriovenous malformations (AVMs) are benign congenital lesions. The estimated prevalence is 10-18 per 100,000 individuals, with an incidence rate of 1.1-1.4 per 100,000 person-year; only 12% of AVMs present symptoms during life. It is important to study different characteristics associated with AVMs because these patients require multidisciplinary treatment. Methods: A descriptive, observational, longitudinal, and retrospective study was carried out from January 15, 2016 to October 19, 2021. Convenience sampling was used on patients diagnosed with arteriovenous malformation. Sociodemographic data was obtained, such as: sex, age, site, predominant symptoms, clinical debut, type of malformation, data associated with post therapy evolution, type of embolizing agent used, associated complications, Rankin scale, and death. Results: Data from 535 procedures was collected, we calculated an incidence of 4.4 cases per million inhabitants. Ninety procedures in 56 patients that used endovascular therapy were obtained with a female-male ratio of 0.75 and an age distribution of 35±14 (SD). A 36.3±11.5 (SD) mm diameter was registered. There was a 33% success rate for endovascular surgery. Conclusions: The multidisciplinary treatment of AVMs is made up of three pillar techniques: microsurgical resection, embolization, and radio-neurosurgery. It is extremely important to make an appropriate decision, with an emphasis on achieving better functional outcomes for the patient. Although neurological endovascular therapy was initially used as an adjuvant treatment for neurosurgery and radio-neurosurgery, it has been used more and more frequently as the first line of treatment.

• Journal of the Korean Society of Radiology
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• v.85 no.4
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• pp.807-812
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• 2024

Breast lymphomas are rare, malignant breast neoplasms with a heterogeneous pattern of clinical symptoms. Burkitt's lymphoma is a rare, highly aggressive, and rapidly growing B-cell non-Hodgkin lymphoma. We report about a 27-year-old woman diagnosed as having secondary breast Burkitt's lymphoma, probably originating from the stomach, with multiple distant metastases. Breast ultrasonography revealed multiple, variable sized, heterogeneous masses with posterior acoustic enhancement and echogenic rims. These imaging findings may sometimes overlap with those of other breast malignancies. However, unlike other breast malignancies, lymphoma can be diagnosed by biopsy and does not require surgical excision. To avoid unnecessary treatment, radiologists and clinicians should be aware of the characteristic imaging features of breast lymphomas.

• Journal of Gastric Cancer
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• v.5 no.2
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• pp.101-105
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• 2005

Purpose: Some gastric cancer patients in whom the cancer has infiltrated up to the muscularis propria (mp) have a good postoperative course similar to that of early gastric cancer (EGC) patients (this does not match the general classification of gastric cancer). Therefore, we performed a retrospective analysis of 125 patients with mp gastric cancer based on the degree of mp invasion. Materials and Methods: The clinicopathologic features of 125 cases of mp gastric cancer were subdivided according to depth of invasion, and were retrospectively reviewed and compared with the surgical features of 222 patients with gastric cancer invading the submucosa (sm). For each tumor, using the section that showed the greatest extent of invasion, we evaluated the degree of tumor invasion into the mp layer at a magnification of $\times$100. The patients were classified into 2 groups: mp1, the tumor was limited to the first of the 3 mp layers, and mp2, the tumor had expanded beyond the first layer. Results: Patients with mp1 (n=50) had a significantly lower incidence of lymph node metastasis, and a smaller tumor size than patients with mp2 (n=75) (P=0.01 and P=0.029, respectively). The 5-year survival rate of mp1 patients was significantly better than that of mp2 patients ($95.3\%\;vs.\;77.6\%$, P=0.0282), but was similar to that ($91.2\%$) of the 222 sm patients. The 5-year survival rate of mp patients without lymph node metastasis (n=55) was significantly better than that of those with lymph node metastasis (n=70)($93.3\%\;vs.\;78.2\%$, P=0.0192). Patients with mp1 had a significantly higher incidence of lymph node metastasis ($42.5\%\;vs\;23\%$, P=0.006) than patients with sm. Conclusion: There were clear differences in clinical features between the mp1 and the mp2 patients. Subdivision of mp gastric cancer according to the depth of invasion may enable a more precise prognosis and a more pertinent treatment plan for mp patients. In particular, as the clinicopathological findings and surgical outcomes for mp1 patients were akin to those of the sm patients, mp1 patients may require treatment analogous to that administered to patients with sm gastric cancer. (J Korean Gastric Cancer Assoc 2005;5:101-105)

• Tuberculosis and Respiratory Diseases
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• v.49 no.1
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• pp.60-71
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• 2000

Backgrounds : Cathepsin D, an aspartic lysosomal proteinase, is believed to be involved in local invasion and metastasis of tumor cells by its proteolytic activity and has been described to be associated with tumor progression and prognosis in some human malignancies including breast cancer. But, its prognostic value for human lung cancer remains to be determined. The purpose of this study is to determine clinicopathological and prognostic significance of cathepsin D expression in non-small cell lung cancer. Method : Using a polyclonal antibody, immunohistochemical analysis of cathepsin D was performed on paraffin embedded sections of tumors obtained surgically from 54 patients with non-small cell lung cancer (37 squamous cell carcinoma, 14 adenocarcinoma, 2 large cell carcinoma, and 1 undifferentiated carcinoma). Results : Eighteen patients (33.3%) showed positive immunoreactivities of cathepsin D in tumor cells. No significant correlation of cathepsin D expression in tumor cells was found in p-stage (surgical-pathologic stage), tumor size, tumor factor, nodal involvement, and differentiation. Of 54 patients, 29 (53.7%) patients showed moderate to massive cathepsin D-positive stromal cells within the tumor tissues, while the rest (46.3%) showed few cathepsin D-positive stromal cells within the tumor tissues. Cathepsin D expression in stromal cells was significantly associated with p-stage in non-small cell lung canær (p=0.031). No significant correlation of the degree of cathepsin D-positive stromal cells was found in tumor size, T -factor, nodal involvement, differentiation Cathepsin D expression status in tumor cells and stromal cells was not significantly associated with prognosis expressed by survival rate. The results of multivariate analyses of variables possibly associated with prognosis showed that nodal involvement was the only independent prognostic factor in all patients. Conclusion : Cathepsin D expression in stromal cells was significantly associated with p-stage in non-small cell lung cancer. However, it was not related to other clinicopathologic features and prognosis, and Cathepsin D expression in tumor was not related to p-stage and prognosis.

• Tuberculosis and Respiratory Diseases
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• v.53 no.3
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• pp.309-318
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• 2002

Background : Usual interstitial pneumonia (UIP) is a fatal progressive fibrotic disorder of the lung with unknown etiology and characterized by a poor response to conventional immunosuppressive therapy. The histologic hallmark of UIP is parchy distribution of subpleural fibrosis and fibroblastic foci(FBF) with interposed normal appearing lung. Because FBF is a collection of actively proliferating myofibroblasts, it can be a marker of activity and prognosis of UIP. However, there were contradictory reports about the correlation between the degree of FBF and survival. Therefore we performed this study to investigate the value of FBF as prognostic marker of UIP. Methods : This was a retrospective study on the 46 patients(M:F=33:13, mean age:$59{\pm}12$ years) with UIP diagnosed by the surgical lung biopsy at the Asan Medical Center, Seoul, Korea between 1990 and 2000 and had follow-up of more than a year. All the biopsy specimens were reevaluated and diagnosed as UIP according to the ATS/ERS classification. Semiquantitative grading of FBF(absent, 0; mild 1; moderate 2; marked 3) by the experienced pathologists who did not know the clinical findings were compared to the clinical data and the follow up course. Results : Thirteen patients(28.2%) died of UIP progression during the study period. The median survival time of all the subjects was 26 months after the biopsy. At the univariate analysis, FVC, $D_Lco$, smoking history and the grade of FBF were significantly related to the survial. The survival was longer in subjects with lesser degrees of FBF, higher DLco, higher FVC and history of smoking. However the multivariate analysis with Cox regression test showed the extent of FBF was the only independent prognostic marker of UIP. Conclusion : These data suggested that the extent of FBF on the surgical lung biopsy can be used as a prognostic marker of UIP.

• Radiation Oncology Journal
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• v.16 no.4
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• pp.389-398
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• 1998

Purpose : To evaluate the role of conventional postoperative adjuvant radiotherapy in the management of supratentorial malignant glioma and to determine favorable prognostic factors affecting survival. Materials and Methods : From Sep. 1985 to Mar. 1997, the number of eligible patients who received postoperative radiotherapy completely was 69. They ranged in age from 7 to 66 years (median, 47). Forty-two (61$\%$) patients were glioblastoma multiforme and the other 27 (39$\%$) were anaplastic astrocytoma. Twenty patients (29$\%$) had Karnofsky score equal or more than 80 preoperatively. Forty-three patients (62$\%$) had symptom duration equal or less than 3 months. Twenty-four patients (35$\%$) had gross total resection and forty patients(58$\%$) had partial resection, the remaining five patients (7$\%$) had biopsy only. Radiotherapy dose ranged from 50.4 Gy to 61.2 Gy (median, 55.8; mode, 59.4) with fraction size of 1 8 Gy-2.0 Gy for 33-83 days(median, 48) except three patients delivered 33, 36, 39 Gr, respectively with fraction size of 3.0 Gy due to poor postoperative performance status. Follow-up rate was 93$\%$ and median follow-up period was 14 months. Results : Overall survival rate at 2 and 3 years and median survival were 38$\%$, 20$\%$, and 16 months for entire patients; 67$\%$, 44$\%$, and 34 months for anaplastic astrocytoma; 18$\%$, 4$\%$, and 14 months for glioblastoma multiforme, respectively (p=0.0001). According to the extent of surgery, 3-year overall survival for gross total resection, partial resection, and biopsy only was 38$\%$, 11$\%$, and 0$\%$, respectively (p=0.02) The 3-year overall survival rates for patients age 40>, 40-59, and 60< were 52$\%$, 8$\%$, and 0$\%$, respectively (p=0.0007). For the variate of performance score 80< vs 80>, the 3-year survival rates were 53$\%$ and 9$\%$, respectively (p=0.008). On multivariate analysis including covariates of three surgical and age subgroups as above, pathology, extent of surgery and age were significant prognostic factors affecting overall survival. On another multivariate analysis with covariates of two surgical (total resection vs others) and two a9e (50> vs 50<) subgroups, then, pathology, extent of surgery and performance status were significant factors instead of age and 3-year cumulative survival rate for the five patients with these three favorable factors was 100$\%$ without serious sequela. Conclusion : We confirmed the role of postoperative conventional radiotherapy in the management of supratentorial malignant glioma by improving survival as compared with historical data of surgery only. Patients with anaplastic astrocytoma, good performance score, gross total resection and/or young age survived longest. Maximum surgical resection with acceptable preservation of neurologic function should be attempted in glioblastoma patients, especially in younger patients. But the survival of most globlastoma patients without favorable factors is still poor, so other active adjuvant treatment modalities should be tried or added rather than conventional radiation treatment alone in this subgroup.

• Journal of Chest Surgery
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• v.30 no.5
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• pp.471-478
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• 1997

Introduction: The use of rabbits as a cardiopulmonary bypass(CPB) animal model is extremely dif%cult mainly due to technical problems. On the other hand, deep hypothermic circulatory arrest(CA) is used to facilitate surgical repair in a variety of cardiac diseases. Although steroids are generally known to be effective in the treatment of cerebral edema, the protective effects of steroids on the brain during CA are not conclusively established. Objectives of this study are twofold: the establishment of CPB technique in rabbits and the evaluation of preventive effect of steroid on the development of brain edema during CA. Material '||'&'||' Methods: Fifteen New Zealan white rabbits(average body weight 3.5kg) were divided into three experimental groups; control CA group(n=5), CA with Trendelenberg position group(n=5), and CA with Trendelenberg position + steroid(methylprednisolone 30 mglkg) administration group(n=5). After anesthetic induction and tracheostomy, a median sternotomy was performed. An aortic cannula(3.3mm) and a venous ncannula(14 Fr) were inserted, respectively in the ascending aorta and the right atrium. The CPB circuit consisted of a roller pump and a bubble oxygenator. Priming volume of the circuit was approximately 450m1 with 120" 150ml of blood. CPB was initiated at a flow rate of 80~85ml/kg/min, Ten min after the start of CPB, CA was established with duration of 40min at $20^{\circ}C$ of rectal temperature. After CA, CPB was restarted with 20min period of rewarming. Ten min after weaning, the animal was sacrif;cod. One-to-2g portions of the following tissues were rapidly d:ssected and water contents were examined and compared among gr ups: brain, cervical spinal cord, kidney, duodenum, lung, heart, liver, spleen, pancreas. stomach. Statistical significances were analyzed by Kruskal-Wallis nonparametric test. Results: CPB with CA was successfully performed in all cases. Flow rate of 60-100 mlfkgfmin was able to be maintained throughout CPB. During CPB, no significant metabolic acidosis was detected and aortic pressure ranged between 35-55 mmHg. After weaning from CPB, all hearts resumed normal beating spontaneously. There were no statistically significant differences in the water contents of tissues including brain among the three experimental groups. Conclusion: These results indicate (1) CPB can be reliably administered in rabbits if proper technique is used, (2) the effect of steroid on the protection of brain edema related to Trendelenburg position during CA is not established within the scope of this experiment.

• Journal of Chest Surgery
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• v.40 no.11
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• pp.733-744
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• 2007

Background: There is a controversy regarding the pathogenesis and management principle of an acute intramural hematoma (IMH) of the aorta, Recent studies have reported intimal defects in many patients diagnosed with IMH, and suggested that intimal defects play important roles in the pathogenesis, progression of the pathology, and prognosis. Material and Method: This study reviewed the preoperative and postoperative computed tomography (CT) scan images of 36 patients who underwent surgical treatment for Stanford type A acute IMH of the aorta. The surgical findings were also reviewed retrospectively from the medical records. Result: In 15 patients (41.7%), the findings suggestive of the intimal defects were found in the preoperative CT. During the operation, 20 patients (72.2%) were found to have small intimal defects in the ascending aorta or the arch, of which 13 patients (50.5%) did not have the CT findings suggestive of intimal defects. In 17 patients, the intimal defects were located in the aortic arch or distal ascending aorta, where a gross examination would have been impossible without total circulatory arrest. In all patients, the intimal defects identified were included in the resected aortic segment, or locally closed. Follow-up CT at 4 months or longer after surgery showed that the IMH in the descending aorta had disappeared or was markedly improved. Conclusion: Most patients undergoing surgical treatment for acute type A IMH had intimal defects. This suggests that a large proportion of IMH might have a similar pathogenic mechanism as classic dissection. Consequently, it is believed that those two entities of acute aortic syndrome should be treat-ed using the same principles.