Actinomycosis of the Appendix: A Case Report

Actinomycosis is an uncommon disease caused by actinomycoses, which is a normal flora in the human mucosal membrane. It is difficult to diagnose pre- and intra-operatively and requires long-term use of antibiotics even after surgery. Especially, abdominal actinomycosis is frequently misdiagnosed as a tumor, diverticulitis, chronic inflammatory disease, or other infectious disease preoperatively. Thus, we report the case of a 21-yr-old male patient who was thought to have acute appendicitis and who underwent a cecal wedge resection, including the appendix, with the assistance of laparoscopy for appendiceal actinomycosis.

Colon Cancer Secondary to Hematologic Disease

PURPOSE: The incidence of secondary malignancies in hematologic patients is known to be higher than it is in other patients. However, the characteristics of secondary malignancy and surveillance have not yet been established for colorectal cancer in leukemic patients. METHODS: From 1995 to 2007, 6,030 patients who were diagnosed with acute myeloid leukemia (AML), acute lymphoid leukemia (ALL), chronic myeloid leukemia (CML), chronic lymphoid leukemia (CLL), and multiple myeloma (MM) were enrolled in this study. Among them, 9 patients were diagnosed with colorectal cancer at St. Mary's Hospital and were analyzed retrospectively. RESULTS: Three of the 2,570 patients with AML, 1 of the 1,158 patients with CML, 2 of the 83 patients with CLL, 2 of the 422 patients with MM, and none of the 1,797 patients with ALL were found to have colorectal cancer. There were no operative mortalities, but 2 patients refused to have surgery. The ratio of observed to expected subsequent colorectal cancer in CLL was higher than it was in the other groups, indicating that the relative risk of colorectal cancer is higher in patients with CLL. CONCLUSION: Compared to the Surveillance, Epidemiology and End-Result (SEER) program at the National Cancer Institute (NCI) in the United State, we have the same high relatively risk in CLL patients. Careful attention should be paid to the possibility of colorectal cancer in CLL patients.

Efficacy of Minilaparotomy for Early Gastric Cancer

PURPOSE: Laparoscopic gastrectomy has oncologic unreliability, technical problems, and is expensive. To overcome these drawbacks, we performed operations through a small laparotomy without using a laparoscopic procedure. METHODS: From March to August, 2003, we successfully performed distal gastrectomy with minilaparotomy for 21 patients diagnosed with early gastric cancer in our hospital. An additional 24 patients with advanced gastric cancer underwent conventional laparotomy for distal gastrectomy. We performed distal gastrectomy with lymph node dissection, moving the abdominal window to the surgical site. We compared BMI, operating time, bleeding volume, and postoperative pain, and followed minilaparotomy patients for an average of 48 months. RESULTS: There were no postoperative complications in minilaparotomy patients. The minilaparotomy group had a shorter hospital stay lower analgesic use than conventional laparotomy, but there were no differences in BMI, bleeding volume, or the number of harvested lymph nodes. Minilaparotomy alleviated the severity of postoperative pain, and there were no recurrences during follow-up. CONCLUSION: Minilaparotomy for early gastric cancer improved postoperative outcome without oncologic inadequacy compared with conventional laparotomy. Therefore, distal gastrectomy via a minilaparotomy may become a minimally invasive therapeutic strategy for early gastric cancer.

Modified FOLFOX-6 Chemotherapy for Recurrent or Inoperable Gastric Cancer Patients

PURPOSE: We wanted to evaluate the efficacy and toxicity of modified FOLFOX-6 chemotherapy for treating recurrent or inoperable gastric cancer patients. MATERIALS AND METHODS: From April 2006 to August 2007, 35 patients with recurrent gastric cancer after curative resection and 43 patients with inoperable gastric cancer underwent chemotherapy, and the results were retrospectively investigated. RESULTS: 78 patients were assessable for response and toxicity, and they underwent an average of 7.1 cycles of chemotherapy. The response was evaluated according to the RECIST criteria. 11 partial responses (14.1%), 35 cases of stable disease (44.9%), and 32 cases of progressive disease (41%) were observed. The median time to progression was 6 months, and the average overall survival was 13 months. CTCAE grade 1 or 2 anemia (52.6%) was the most prevalent toxicity. Other common toxicities included thrombocytopenia (17.9%) and peripheral neuropathy (30.8%). There were 13 changes in the chemotherapy regimen to S1-cisplatin due to disease progression, but only an average of 1.76 cycles of S1-cisplatin were delivered due to severe toxicities and poor compliance. CONCLUSION: Acceptable efficacy and toxicity were seen as 59% of the patients showed non-progression, and no grade 3 or 4 toxicities were observed. In conclusion, the modified FOLFOX-6 chemotherapy is considered to be the proper 1st-line choice as a palliative treatment for recurrent or inoperable gastric cancer patients.

Synchronous Occurrence of a Gastric Adenocarcinoma and a GIST (Gastrointestinal Stromal Tumor): A Case Report

A gastric adenocarcinoma is the second most common cause of cancer deaths worldwide, but there are some geographical differences in its incidence. A gastrointestinal tumor is an uncommon disease with a wide spectrum of aggressive behavior. These two tumors have a distinct pathogenesis, and synchronous occurrence of an adenocarcinoma and a GIST (gastrointestinal stromal tumor) in the stomach is very rare. We report a case of synchronous occurrence of a gastric adenocarcinoma and GIST in a 64-year-old man. We performed the following tests: barium swallowing test, gastroduodenoscopy, and CT scanning. We performed a total gastrectomy, and a 9 cm-sized GIST at the fundus and a small early gastric cancer at the antrum were confirmed pathologically. Some explanations for this rare case exist, but in our opinion, the synchronous occurrence is a rare but probable event that can happen in an endemic area. We describe a case of synchronous occurrence of a gastric adenocarcinoma and GIST in the stomach, with a review of the literature.

Stomach Cancer Secondary to Hematologic Diseases

PURPOSE: Patients with hematologic diseases such as chronic myeloid leukemia (CML) or chronic lymphoid leukemia (CLL) are known to have an increased chance of acquiring a secondary neoplasm. Stomach cancer is one of the most common malignant diseases in Korea, and we investigated whether the incidence of secondary stomach cancer in patients with a hematologic disease increases, in order to determine if a more intensive screening program for detecting secondary gastric cancer was required. We also investigated the safety of performing a gastrectomy in hematologic disease patients. MATERIALS AND METHODS: From 1992 to 2006, the medical records of 8376 patients diagnosed with one of the six common hematologic diseases were reviewed. RESULTS: Nine secondary stomach cancers were found among the 8376 patients during the 15-year observation period. No surgical-related complications occurred, and there was no recurrence of stomach cancer if detected early. CONCLUSION: It seems that a more intensive screening program for detecting secondary gastric cancer in hematologic disease patients is not required, and surgery is not risky in these patients.

Methylation Patterns of Cancer-Associated Genes in Breast Cancer / 한국유방암학회지

PURPOSE: To investigate the methylation status of cancerassociated genes in breast cancer to assess its use in the diagnosis of breast cancer and the relationship with distinctive clinical and pathological features. METHODS: A total of 29 benign tumors and their adjacent normal tissues as well as 67 malignant tumors and adjacent normal samples, from women undergoing surgery for primary invasive breast carcinoma at Uijongbu St. Mary's Hospital, between March 2003 and March 2005, were used. Eleven candidate genes were chosen; P14, P16, DAPK, MGMT, h-MLH, E-cadherin, RASSF1 , Twist, RAR , HIN-1, and Cyclin D. DNA was extracted from fresh tissues, and methylation specific PCR performed. RESULT: The number of methylated genes was increased in the malignant tissues compared to the benign tumors and adjacent normal tissues. 7 genes; P14, P16, MGMT, RASSF1, Twist, RAR beta and Cyclin D, were more frequently methylated in malignant than benign tumors, with the differences in the p14, p16, and RAR beta genes were statistically significant (p<0.05). In benign tumors, the p16 and HIN-1 genes were the most infrequently (6.9%) and frequently methylated (82.8 %), respectively. In malignant tumors, the h-MLH and RASSF1 genes were most infrequently and frequently methylated genes, respectively. The ubgroup showing methylation of the DAPK gene had a higher nuclear grade and greater progesterone receptor negativity. The group in which the RASSF1 gene was methylated, had greater estrogen receptor (ER) and progesterone receptor (PgR) positivities. The Twist gene was frequently methylated in the subgroup showing higher nuclear and histologic grades. The group with HIN- 1 and cyclin D methylation had a tendency to show greater ER positivity. CONCLUSION: The subgroups showing methylated DAPK and Twist should be more intensely treated and followed up more carefully than those with RASSF1 , HIN-1 and Cyclin D methylation. Gene methylation may be linked to various pathological features of breast cancer; however, this will require confirmation from larger studies.

Perforated Duodenal Diverticulum after Distal Subtotal Gastrectomy and Billorth II Gastrojejunostomy

A 69-year old man presented with severe epigastric pain for 1 day. He had early gastric cancer at the antrum and underwent a distal subtotal gastrectomy and Billorth II gastrojejunostomy one month later without any post-operative complications. Radiologic examination revealed a large amount of retroperitoneal free air formation. Because of unremitting pain and unstable vital sign, exploratory laparotomy was followed. During the operation, a perforated duodenal diverticulum at the posterior wall of the 2nd portion of the duodenum was identified. He underwent diverticulectomy and primary closure. He was discharged on the 18th post operative day and has been followed up without any evidence of comlpication for several months.

Successful Abdominal Aortic Aneurysm Repair in Ninety-Five Years Old Man

The overall life expectancy of the population is rising and more elderly patients with abdominal aortic aneurysm (AAA) have been reported. The management of AAA is open surgical or endovascular repair because neglected AAA usually yields an eventually fatal course. Older age is commonly considered as a risk factor for AAA repair due to the concomitant age-related diseases such as coronary artery disease. The chronological and physiological age are not always identical, and sometimes a patient's physiological age appears younger than the chronological age. We report here on successful open surgical repair of AAA in a 95 years old man (birth date: April 11, 1911) who looked younger and healthier than his chronological age. The preoperative CT angiography showed an infrarenal saccular AAA 4.2 cm in diameter with fingertip-sized outpouching of the aneurysmal wall, which suggested possible impending rupture. His preoperative work-up was within normal limits. This 95 years old gentleman well tolerated all the surgical procedures with a smooth postoperative course. We propose that the age limitation for AAA repair should be considered individually for each case.

Successful Abdominal Aortic Aneurysm Repair in Ninety-Five Years Old Man

The overall life expectancy of the population is rising and more elderly patients with abdominal aortic aneurysm (AAA) have been reported. The management of AAA is open surgical or endovascular repair because neglected AAA usually yields an eventually fatal course. Older age is commonly considered as a risk factor for AAA repair due to the concomitant age-related diseases such as coronary artery disease. The chronological and physiological age are not always identical, and sometimes a patient's physiological age appears younger than the chronological age. We report here on successful open surgical repair of AAA in a 95 years old man (birth date: April 11, 1911) who looked younger and healthier than his chronological age. The preoperative CT angiography showed an infrarenal saccular AAA 4.2 cm in diameter with fingertip-sized outpouching of the aneurysmal wall, which suggested possible impending rupture. His preoperative work-up was within normal limits. This 95 years old gentleman well tolerated all the surgical procedures with a smooth postoperative course. We propose that the age limitation for AAA repair should be considered individually for each case.

Alterations of HLA Class I and II Antigen Expressions in Borderline, Invasive and Metastatic Ovarian Cancers / 대한암학회지

PURPOSE: The relationship between altered HLA expressions and ovarian carcinogenesis is not fully elucidated. MATERIALS AND METHODS: Histological evaluation comprised 20 serous adenocarcinoma, 5 borderline serous malignancy, 10 mucinous adenocarcinoma, 15 borderline mucinous malignancy. We used monoclonal antibodys to HLA class I beta2-microglobulin, class I B/C and class II heavy chain. RESULTS: There was no statistical difference in HLA expressions between borderline serous malignancy and normal ovarian tissue. In serous adenocarcinoma, beta2-microglobulin, B/C and class II heavy chain expressions were down-regulated. In metastatic cancer, B/C and class II ex pressions were also down-regulated. But the HLA expression of tumor or normal stromal tissue in primary tumor, were not down-regulated compared with the tissues in metastasis. In borderline mucinous malignancy, class II expressions were down-regulated. In mucinous adenocarcinoma, beta2-microglobulin, B/C and class II expressions were down-regulated. In metastatic ovarian cancer, B/C and class II expressions were down-regulated. But, in borderline malignancy, the result failed to reach statistical significance except class II of borderline mucinous malignancy. CONCLUSION: Loss of HLA class I and II molecules in invasive ovarian cancers raises the possibility that this could be a mechanism for tumor cells to have invasiveness.