From May 1978 to Sep. 1990, 106 patients who had been diagnosed as primary lung cancer and operated on at the Department of Thoracic & Cardiovascular Surgery, Han Yang University, were clinically evaluated. 1. The peak incidence of age was 5th decade of life[37.7%] and 6th decade[29.2%]. Male to female ratio was 3.8: l. 2. Most of symptoms were respiratory, which were cough, chest pain, hemoptysis, and asymptomatic cases were 2.9%. 3. Histopathologic classifications were squamous cell carcinoma[53.7%], adenocarcinoma [23.8%], bronchioloalveolar cell carcinoma[6.6%], undifferentiated large cell carcinoma[6.6%], small cell carcinoma[3.8%], adenosquamous carcinoma[3.8%] and others[1.8%]. 4. Methods of operation were pneumonectomy 49.1%[52cases], lobectomy 21%[22cases] bilobectomy[6cases], lobectomy with wedge resection[3cases], exploration 21.9%[23cases], and resectability was 78.3%. 5. Staging classifications were Stage I [22.6%], Stage II [11.3%], Stage IIIa[42.6%], Stage IIIb[21.7%] and Stage lV[1.6%]. Resectability by Stage; Stage I was 100%, II 100%, IIIa 84.4% and IIIb 30.4%. 6. Causes of most of inoperable cases were invasion of mediastinal structures and diffuse chest wall, and others were contralateral lymph node invasion and malignant pleural effusion. 7. Operative mortality was 6.7% which caused by arrhythmia, sepsis, pulmonary edema, and radiation pneumonitis. 8. On the long term follow up of the resectable cases, overall 1 year survival rate was 58.5 %, 2 year 39%, and 5 year 19.5%. Five year survival rate was 40% in Stage I, 25% in Stage II and 11.7% in Stage Illa. As for the method of operation, the higher 5 year survival rate was observed in lobectomies[33.3%] than in pneumonectomies[10.3%].
Objectives: Calcification of the thyroid nodule has been reported to have a close relationship with differentiated thyroid carcinoma, however there are limited studies on the relationship between the calcified thyroid nodule and thyroid malignancy. The authors studied the clinical significance of calcification within the thyroid nodule. Materials and Methods: There were total of 60 patients who underwent surgery for calcified thyroid nodules which were identified from plain neck X-ray, ultrasound and computed tomography during the period January 1991 to June 1996 at the Department of Otorhinolaryngology-Head and Neck Surgery of Korea University Hospital. Six patients were not included because of recurrence and previous thyroid surgery. Histopathologic and radiologic analysis was done on the remaining 54 patients. Results: Results showed that 25 of 54 cases(46%) to be malignant histopathologically. Of the 25 malignant cases, papillary carcinoma was the most common with 22 cases followed by 2 cases of undifferentiated carcinoma and I case of medullary carcinoma. Statistically high incidence of malignancy was observed when the consistency of calcified thyroid nodule was solid, shape of calcification was irregular and inhomogenous, and adhesion of calcified thyroid nodule to the regional structure was present. Conclusion: The probability that a thyroid nodule is malignant has been reported to be 320%. However, about half of the thyroid nodules with calcification found to be malignant on this study, calcification of the thyroid nodule can be used as a guideline for detecting thyroid malignancy.
The thyroid nodules are the most common endocrine disease requiring surgical management. Up to date, various diagnostic techniques and surgical management have been developed. Authors analysed 2285 cases of thyroid nodules who were treated at Department of Surgery, Pusan National University for the duration of 10 years from January 1980 to December 1989 and the results obtained were summerized as follows: 1) Patients were composed of 1727 cases(75.8%) of benign nodule and 558 cases(24.5%) of malignant nodule. Benign nodule was prevalent in forth and fifth decade comparing with malignant nodule was sixth and fifth decade. The sexual distribution revealed female preponderance with 1:10.8 in benign nodule and 1:9.3 in malignant nodule. 2) The histopathologic classfication of benign nodule in decreasing order of frequency were follicular adenoma 1009 cases(54.8%), adenomatous goiter 573 cases(33.3%), simple cyst 65 cases(3.8%), and Hashimoto's thyroiditis 52 cases(3.0%). The malignant disease were papillary adenocarcinoma 460 cases(82.4%), follicular adenocarcinoma 69 cases(12.4%), undifferentiated carcinoma 13 cases (2.0%), and medullary carcinoma 7 cases(1.0%). 3) Fine needle aspiration cytology was performed in 1758 cases and it showed 80.5% of sensitivity, 96.5% of specificity, 19.5% of false negative and 80% of accuracy. 4) The location of nodule was 87.7%, in unilateral, 12.2% in bilateral. 5) On the radioiodine scanning, the incidence of benign nodule with cold nodule was 83.9% and the incidence of benign nodule with hot nodule was 7.5%. The incidence of thyroid carcinoma with cold nodule was 88.3% and the incidence of thyroid carcinoma with hot nodule was 4.6%. 6) Most cases of benign nodules were treated with lobectomy 82.6%, subtotal thyroidectomy 10.1% and subtotal lobectomy 3.0%. Malignant nodules were treated with lobectomy and/or isthmusectomy 37.6%, total thyroidectomy 17.7%, subtotal thyroidectomy 15.4%, and any thyroidectomy and neck dissection 13.5%. 7) Postoperative complications were developed in 3.8% of benign nodules and 13.8% of malignant nodules.
Background: Renal cancer is a serious public health problem which may be under reported and registered in our setup, since the Karachi cancer registry documented only 43 cases out of 4,268 incident cancer cases over 3 year duration. Therefore we aimed to determine the clinicopathologic characteristics of adult renal tumors in our setup. Materials and Methods: The study was conducted in histopathology department, Liaquat National Hospital and included total of 68 cases of adult renal tumors over 4 years. Detailed histopathologic characteristics of tumors were analyzed. Results: Mean age of patients was 56.4 (18-84) years. Renal cell carcinoma (RCC) was the most common cell type (78%) cases; followed by transitional/urothelial carcinoma (12.5%), leiomyosarcoma (4.7%), oncocytoma (1.6%), squamous cell carcinoma (1.6%) and high grade pleomorphic undifferentiated sarcoma (1.6%). Among 50 RCC cases; 62% were conventional/clear cell RCC (CCRCC) type followed by papillary RCC(PRCC), 24%; chromophobe RCC(CRCC), 6% and sarcomatoid RCC(SRCC), 8%. Mean tumor size for RCC was 7.2 cm. Most RCCs were intermediate to high grade (60% and 40% respectively). Capsular invasion, renal sinus invasion, adrenal gland involvement and renal vein invasion was seen in 40%, 18%, 2% and 10% of cases respectively. Conclusions: We found that RCC presents at an earlier age in our setup compared to Western populations. Tumor size was significantly larger and most of the tumors were of intermediate to high grade. This reflects late presentation of patients after disease progression which necessitates effective measures to be taken in primary care setup to diagnose this disease at an early stage.
Clinical evaluation of contact sensitization to 2, 4-dinitro-chlorobenzene [DNCB] was performed in 2 groups: group A [30 patients with non-malignant disease] and group B [30 patients with bronchogenic carcinoma]. Initial sensitization was elicited out by applying 2, 000 ug of DNCB to skin surface of the both group A and B. Subsequently a relatively weak challenge dose, 200 ug of DNCB, was applied 14 days later, showing the satisfactory results of sensitization with minimizing non-specific irritative inflammatory skin response. Delayed cutaneous hypersensitivity reactions shown by spontaneous flare phenomena appeared at the challenge site, and they were assessed 48 hours later. The reaction were graded from +1 to +4 according to the degree of flare or vesicular reaction. The results were as follows: 1. 28 cases [93%] of group A, however, only 18 cases [67%] of group B exhibited delayed cutaneous hypersensitivity reaction to DNCB contact sensitization [P<0.02]. 2. Of group A, the delayed cutaneous hypersensitivity reactions above +2 of DNCB score were 25 cases [83%], meanwhile 11 cases [37%] in group B [P<0.001]. 3. Undifferentiated carcinomas showed highest incidence of anergy to DNCB contact sensitization in the all histologic types of group B. 4. In group B, 8 [42%] of 19 cases who react to DNCB were resectable, whereas only 2 [18 %] of 11 cases who failed to react to DNCB were resectable for curative cancer surgery. These study suggests that cellular immune reaction of group B was depressed remarkably comparing with that of group A.
Superior Vena Cava Syndrome: Dacron and Nylon graft between the left innominate vein and the right atrial appendage. Two cases with typical superior vena cave syndrome treated by by-pass graft between the left innominate vein and the right atrial apepndage were presented. One of them was a 58 year old farmer who suffered from marked swelling of the neck and upper half of body, the other was a 50 years old government employee who had acutely progressive symptoms of superior vena cave obstruction. Both of cases revealed that [1] cubitel venous pressure was markedly increased. [2] tumors were noted in the posterior mediastinum by laminography. [3] preoperative cavogram showed the occlusion of superior vena cava and marked collaterals. Dacron and Nylon graft were inserted between the left innominate vein and the right atrial appendage. Postoperatively, the symptoms were relieved markedly, showing edema free face and decreased cubital venous pressure. Postoperative cavogram showed patent graft. Histologically the first case was diagnosed as squamous cell carcinoma and the second as undifferentiated carcinoma, originated probably from bronchus. Total doses of 3150 r X-ray irradiation and 5000 mg of 5-FU were administered in each cases. The first case expired 11 months postoperatively without recurrence of superior vena cave obstruction symptom and the second case is living now without obstruction signs, 4 months after by-pass operation.
Thyroid carcinoma ranks low in incidence and as a cause of death when compared to carcinomas arising in the other site. With adequate surgical treatment, the prognosis of operable thyroid carcinoma is good. However, the extent of surgical resection in treatment of thyroid cancer remains still controversy. The aim of this study was to assess the results of thyroid cancer patients treated surgically and to analyze the prognostic factors affecting survival and to improve the survival rate. We retrospectively analyzed the outcome of a total of 278 thyroid cancer patients treated surgically at Inje University Paik Hospital from 1980 to 1995 and followed for 1 to 16 years. There were man in 47 and woman in 231 patients with age range of 14 to 79 years(mean 42 years). Histopathologic findings were papillary carcinoma in 233, follicular carcinoma in 33, mixed carcinoma in 7, medullary carcinoma in 2, and undifferentiated carcinoma in 3 patients, respectively. Operative procedures were unilateral lobectomy in 111, subtotal thyroidectomy in 100, and total thyroidectomy in 67 patients. Central node dissection was performed in 92, modified neck disseciton in 62, radical neck dissection in 28, and no node dissection in 96 patients. Thyroid hormone was administered for the period of 3 to 5 years to suppress endogenous TSH production. Overall 5-year survival rate according to Kaplan-Meier method was 91.1%. Independently, significant factors affecting the prognosis were age at diagnosis, tumor size, pathologic type, tumor stage, lymph node metastasis, angioinvasion, extrathyroidal extension, and 'risk' group category. but, the prognosis were not influenced by sex and capsular invasion. Patients at low risk or with small size carcinomas had long survival over 5 years with only lobectomy. Lymph node dissection was carried out with a limited type in no jugular metastasis, radical neck dissection was performed only therapeutically in proved jugular node metastasis. Fifteen patients were dead of tumor recurrence after surviving for three months to two and half years, and the cause of death was local recurrence in nine, bone metastasis in four and lung metastasis in two patients. In conclusion, more extensive surgery including total thyroidecotmy and systematic compartment-oriented dissection of the lymph node metastases in patient at high-risk group will results in better survival and lower recurrence rate.
Nanog is a newly identified member of the homeobox family of DNA binding transcription factors that functions to maintain the undifferentiated state of stem cells. However, molecular mechanisms underlying the function of Nanog remain largely unknown. To elucidate the regulatory roles of Nanog involved in maintenance of P19 embryonal carcinoma (EC) stem cells, we transfected three small interfering RNA (siRNA) duplexes targeted against different regions of the Nanog gene into P19 cells. The Nanog siRNA-100 duplexes effectively decreased the expression of Nanog up to 30.7% compared to other two Nanog siRNAs, the Nanog siRNA-400 (67.9 %) and -793 (53.0%). When examined by RT-PCR and real-time PCR, the expression of markers for pluripotency such as Fgf4, Oct3/4, Rex1, Sox1 and Yes was downregulated at 48 h after transfection with Nanog siRNA-100. Furthermore, expression of the ectodermal markers, Fgf5 and Isl1 was reduced by Nanog knockdown. By contrast, the expression of other markers for pluripotency such as Cripto, Sox2 and Zfp57 was not affected by Nanog knockdown at this time. On the other hand, the expression of Lif/Stat3 pathway molecules and of the endoderm markers including Dab2, Gata4, Gata6 and the germ cell nuclear factor was not changed by Nanog knockdown. The results of this study demonstrated that the knockdown of Nanog expression by RNA interference in P19 cells was sufficient to modulate the expression of pluripotent markers involved in the self-renewal of EC stem cells. These results provide the valuable information on potential downstream targets of Nanog and add to our understanding of the function of Nanog in P19 EC stem cells.
Fine needle aspiration cytology(FNAC) has become a popular method for the diagnosis of a wide variety of both superficial and deep-seated lesions. However, there are few reports about the potential of FNAC for the diagnosis of intraoral lesions. We experienced 44 FNACS from intraoral lesions at Asan Medical Center: 22 from the palate, 6 from the tongue, 5 from the parapharyngeal space, 5 from the lip, 2 from the floor of mouth, 1 from the buccal mucosa, and 3 from other intraoral sites. Histological confirmation was obtained in 32 cases and we analyzed 27 cases excluding 5 cases of inadequate aspirates. Diagnosis was specifically made in 19 of 27 cases(70%) including 1 mucoepidermoid carcinoma, 1 undifferentiated carcinoma, 1 chordoma, 9 pleomorphic adenomas, 1 neurofibroma, and 6 benign lesions. There were three false negative cases(sensitivity, 62.5%) and no false positive cases(specificity, 100%): Two cases diagnosed as "cystic lesion" were confirmed to be mucoepidermoid carcinomas and a case diagnosed as pleomorphic adenoma was proved to be adenoid cystic carcinoma. The results of our study suggest that FNAC is a useful technique in the diagnosis of intraoral lesion.
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