A Neonate Diagnosed with Megalencephaly-Capillary Malformation-Polymicrogyria Syndrome with PIK3CA Mutation

Megalencephaly-capillary malformation-polymicrogyria syndrome (MCAP) is a rare genetic disorder characterized by megalencephaly, polymicrogyria, body overgrowth, and cutaneous capillary malformations. It has been reported recently that MCAP is related to a somatic mosaic mutation in the phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit alpha (PIK3CA) gene. We report a case of hemimegalencephaly with polymicrogyria and cutaneous capillary malformations diagnosed by genetic evaluation of MCAP in the neonatal period. The PIK3CA mutation [c.1635G>T (p. Glu545Asp)] was determined by Sanger sequencing. The patient was treated with a ventriculoperitoneal shunt for progressive hydrocephalus. Because of the dynamic, progressive clinical manifestations and tumor-prone traits of MCAP, early diagnosis is important. Moreover, since the phosphoinositide 3-kinase (PI3K)-specific inhibitor, a targeted therapy for the PI3K/AKT/mTOR signaling pathway is emerging as a new therapy, early genetic diagnosis is becoming increasingly important.

Impact of Body Mass Index on Survival Depending on Sex in 14,688 Patients with Gastric Cancer in a Tertiary Hospital in South Korea

Background/Aims@#The incidence and prognosis of gastric cancer (GC) shows sex difference.This study aimed to evaluate the effect of body mass index (BMI) on GC survival depending on sex. @*Methods@#The sex, age, location, histology, TNM stages, BMI, and survival were analyzed in GC patients from May 2003 to February 2020 at the Seoul National University Bundang Hospital. @*Results@#Among 14,688 patients, there were twice as many males (66.6%) as females (33.4%).However, under age 40 years, females (8.6%) were more prevalent than males (3.1%). Cardia GC in males showed a U-shaped distribution for underweight (9.6%), normal (6.4%), overweight (6.1%), obesity (5.6%), and severe obesity (9.3%) but not in females (p=0.003). Females showed decreased proportion of diffuse-type GC regarding BMI (underweight [59.9%], normal [56.8%], overweight [49.5%], obesity [44.8%], and severe obesity [41.7%]), but males did not (p<0.001). Both sexes had the worst prognosis in the underweight group (p<0.001), and the higher BMI, the better prognosis in males, but not females. Sex differences in prognosis according to BMI tended to be more prominent in males than in females in subgroup analysis of TNM stages I, II, and III and the operative treatment group. @*Conclusions@#GC-specific survival was affected by BMI in a sex-dependent manner. These differences may be related to genetic, and environmental, hormonal factors; body composition; and muscle mass (Trial registration number: NCT04973631).

Improving the Performance of Radiologists Using Artificial Intelligence-Based Detection Support Software for Mammography: A Multi-Reader Study

Objective@#To evaluate whether artificial intelligence (AI) for detecting breast cancer on mammography can improve the performance and time efficiency of radiologists reading mammograms. @*Materials and Methods@#A commercial deep learning-based software for mammography was validated using external data collected from 200 patients, 100 each with and without breast cancer (40 with benign lesions and 60 without lesions) from one hospital. Ten readers, including five breast specialist radiologists (BSRs) and five general radiologists (GRs), assessed all mammography images using a seven-point scale to rate the likelihood of malignancy in two sessions, with and without the aid of the AI-based software, and the reading time was automatically recorded using a web-based reporting system. Two reading sessions were conducted with a two-month washout period in between. Differences in the area under the receiver operating characteristic curve (AUROC), sensitivity, specificity, and reading time between reading with and without AI were analyzed, accounting for data clustering by readers when indicated. @*Results@#The AUROC of the AI alone, BSR (average across five readers), and GR (average across five readers) groups was 0.915 (95% confidence interval, 0.876–0.954), 0.813 (0.756–0.870), and 0.684 (0.616–0.752), respectively. With AI assistance, the AUROC significantly increased to 0.884 (0.840–0.928) and 0.833 (0.779–0.887) in the BSR and GR groups, respectively (p = 0.007 and p < 0.001, respectively). Sensitivity was improved by AI assistance in both groups (74.6% vs. 88.6% in BSR, p < 0.001; 52.1% vs. 79.4% in GR, p < 0.001), but the specificity did not differ significantly (66.6% vs. 66.4% in BSR, p = 0.238; 70.8% vs. 70.0% in GR, p = 0.689). The average reading time pooled across readers was significantly decreased by AI assistance for BSRs (82.73 vs. 73.04 seconds, p < 0.001) but increased in GRs (35.44 vs. 42.52 seconds, p < 0.001). @*Conclusion@#AI-based software improved the performance of radiologists regardless of their experience and affected the reading time.

Vimentin Deficiency Prevents High-Fat Diet-Induced Obesity and Insulin Resistance in Mice

BackgroundObesity and type 2 diabetes mellitus are world-wide health problems, and lack of understanding of their linking mechanism is one reason for limited treatment options. We determined if genetic deletion of vimentin, a type 3 intermediate filament, affects obesity and type 2 diabetes mellitus.MethodsWe fed vimentin-null (Vim−/−) mice and wild-type mice a high-fat diet (HFD) for 10 weeks and measured weight change, adiposity, blood lipids, and glucose. We performed intraperitoneal glucose tolerance tests and measured CD36, a major fatty acid translocase, and glucose transporter type 4 (GLUT4) in adipocytes from both groups of mice.ResultsVim−/− mice fed an HFD showed less weight gain, less adiposity, improved glucose tolerance, and lower serum level of fasting glucose. However, serum triglyceride and non-esterified fatty acid levels were higher in Vim−/− mice than in wild-type mice. Vimentin-null adipocytes showed 41.1% less CD36 on plasma membranes, 27% less uptake of fatty acids, and 50.3% less GLUT4, suggesting defects in intracellular trafficking of these molecules.ConclusionWe concluded that vimentin deficiency prevents obesity and insulin resistance in mice fed an HFD and suggest vimentin as a central mediator linking obesity and type 2 diabetes mellitus.

Postpartum Galactocele in Augmented Breast after Using Breast Pump Mimicking Breast Implant-Associated Anaplastic Large Cell Lymphoma: A Case Report

Post-partum galactocele is a common benign disease among breastfeeding women, whereas retromammary and peri-implant galactocele are relatively rare conditions. Herein, a 34-yearold, 1 month-postpartum female, who had augmentation mammoplasty and a 1-month history of breast pump use, presented with left breast enlargement for 2 weeks. An initial left breast US revealed hyperechoic peri-implant fluid collection. Additional US-guided fine needle aspiration was done using a 21G-needle, draining the milk component in the process, and cytologic results revealed numerous crystals, suggestive of galactocele. Various diseases, especially breast implant-associated anaplastic large cell lymphoma, can cause peri-implant fluid collection in an augmented breast. Thus, correlating imaging features with clinical information and cytologic analysis plays an important role in appropriate management.

Mucinous Breast Carcinoma Presenting as a Coarse and Densely Calcified Mass on Mammography: A Case Report

We report herein a 46-year-old woman who presented with mucinous breast carcinoma that appeared as a coarse and densely calcified mass on mammography. The lesion was a 4.6-cmsized palpable, hyperechoic, calcified mass with posterior shadowing on ultrasonography. This finding is a unique feature of mucinous breast carcinoma and is also observed in unusual breast cancer variants such as metaplastic breast cancer with chondroid differentiation, extraosseous osteosarcoma, and breast chondrosarcoma. The lesion showed a slow-growing pattern throughout the 4-year observation period. Mammography performed 4 years ago revealed faint, grouped microcalcifications; the lesion increased in size over 2 years, presenting as a well-circumscribed, calcified mass, mimicking dystrophic calcification. As several unusual variants of breast cancer, including mucinous carcinoma, may present as coarse and densely calcified masses on mammography, immediate biopsy should be considered when they are observed.

A Qualitative Study of Students' Perception on Premedical Curriculum / 이화의대지

OBJECTIVES: A Womans University College of Medicine faces curriculum reform in 2020. To determine what reforms are needed in the premedical curriculum, a needs assessment was conducted.METHODS: This study utilizes qualitative study method. A focus group interview was conducted with four students who completed premedical courses from November to December 2018. Interviews were conducted in two groups by grade level, and each interview was recorded. After transcribing the recorded contents, four researchers analyzed the data using conventional content analysis.RESULTS: Students chose A Womans University College of Medicine considering their future careers as female medical professionals and other considerations such as scholarships. The students expected diverse experiences, exchanges with students in different departments, and fusion of medicine with other fields during their premedical years. Overall, these expectations were met during the course, but individual needs for customized education, such as liberal arts, were unmet. In general, students' attitudes toward premedical courses were very motivated and they actively used resources provided by the university.CONCLUSION: Qualitative research can provide a better understanding of quantitative data, such as a student survey performed to prepare for curriculum reform. Based on this understanding, the curriculum will be reformed to reflect the educational needs of students, to motivate students and to provide satisfactory education.

Development and Validation of a Education Nurse Specialist-Led Education Satisfaction Scale for Nurses Working at Comprehensive Nursing Care Service Wards / 임상간호연구

Purpose@#The purpose of this study was to develop and validate a education nurse specialist-led educational satisfaction scale for nurses working at comprehensive nursing care service wards. @*Methods@#A methodological study was conducted. A total of 237 nurses working at comprehensive nursing care service wards in a general hospital participated in this study. The scale was developed through literature reviews, in-depth interview, development of preliminary items, verification of content validity, development of secondary items, evaluation of construct validity, and extraction of final items. Analysis included exploratory factor analysis, pearson's analysis, and reliability analysis using cronbach's ⍺. @*Results@#The education nurse specialist-led educational satisfaction scale for nurses working at comprehensive nursing care service ward consisted of 21 items. Two factors (critical thinking disposition and clinical competency) were identified which explained 63.5% of the total variance.Cronbach's ⍺ of each factors were >.95. @*Conclusion@#The results suggested that the education nurse specialist-led educational satisfaction scale for nurses working at comprehensive nursing care service wards demonstrated acceptable validity and reliability. Items of the instrument can assess the level of satisfaction with regards to education led by education nurse specialist among nurses working at comprehensive nursing care service wards.

Development and Validation of a Education Nurse Specialist-Led Education Satisfaction Scale for Nurses Working at Comprehensive Nursing Care Service Wards / 임상간호연구

Purpose@#The purpose of this study was to develop and validate a education nurse specialist-led educational satisfaction scale for nurses working at comprehensive nursing care service wards. @*Methods@#A methodological study was conducted. A total of 237 nurses working at comprehensive nursing care service wards in a general hospital participated in this study. The scale was developed through literature reviews, in-depth interview, development of preliminary items, verification of content validity, development of secondary items, evaluation of construct validity, and extraction of final items. Analysis included exploratory factor analysis, pearson's analysis, and reliability analysis using cronbach's ⍺. @*Results@#The education nurse specialist-led educational satisfaction scale for nurses working at comprehensive nursing care service ward consisted of 21 items. Two factors (critical thinking disposition and clinical competency) were identified which explained 63.5% of the total variance.Cronbach's ⍺ of each factors were >.95. @*Conclusion@#The results suggested that the education nurse specialist-led educational satisfaction scale for nurses working at comprehensive nursing care service wards demonstrated acceptable validity and reliability. Items of the instrument can assess the level of satisfaction with regards to education led by education nurse specialist among nurses working at comprehensive nursing care service wards.

Bilateral Triple Negative Invasive Ductal Breast Carcinoma in a BRCA1 Mutation Carrier with Discrepant Pathologic Response to Neoadjuvant Chemotherapy

Herein, we report a case of synchronous bilateral triple negative invasive ductal breast carcinoma in a patient with discrepant pathologic response to neoadjuvant chemotherapy. Right and left breast cancer stages at the initial diagnosis were T1cN0M0 and T4dN3aM0, respectively. The patient was identified as a BRCA1 mutation carrier and treated with four cycles of adriamycin and cyclophosphamide, followed by four cycles of docetaxel. Bilateral breast cancer stages decreased with the first regimen. However, the bilateral breast cancers showed discrepant responses to chemotherapy with docetaxel. The right breast cancer showed a continuous tumor volume reduction while the left breast cancer showed marked progression. Finally, the tumor size was 0.3 cm and 12 cm in the right and left mastectomy specimens, respectively. As bilateral breast cancers of the same subtype may show discrepant responses to neoadjuvant chemotherapy, close monitoring and follow-up imaging are required to avoid delayed surgery.

Bilateral Triple Negative Invasive Ductal Breast Carcinoma in a BRCA1 Mutation Carrier with Discrepant Pathologic Response to Neoadjuvant Chemotherapy

Herein, we report a case of synchronous bilateral triple negative invasive ductal breast carcinoma in a patient with discrepant pathologic response to neoadjuvant chemotherapy. Right and left breast cancer stages at the initial diagnosis were T1cN0M0 and T4dN3aM0, respectively. The patient was identified as a BRCA1 mutation carrier and treated with four cycles of adriamycin and cyclophosphamide, followed by four cycles of docetaxel. Bilateral breast cancer stages decreased with the first regimen. However, the bilateral breast cancers showed discrepant responses to chemotherapy with docetaxel. The right breast cancer showed a continuous tumor volume reduction while the left breast cancer showed marked progression. Finally, the tumor size was 0.3 cm and 12 cm in the right and left mastectomy specimens, respectively. As bilateral breast cancers of the same subtype may show discrepant responses to neoadjuvant chemotherapy, close monitoring and follow-up imaging are required to avoid delayed surgery.

Mediating Effects of Perceptions Regarding the Importance of Patient Safety Management on the Relationship between Incident Reporting Attitudes and Patient Safety Care Activities for Nurses in Small- and Medium-sized General Hospitals / 중환자간호학회지

PURPOSE: The purpose of this study was to examine the mediating effect of perceptions regarding the importance of patient safety management in the relationship between incident reporting attitudes and patient safety care activities for nurses in small-and medium-sized general hospitals. The objective was to provide a basis for planning tailored training programs aimed at improving patient safety care activities.METHODS: This study was conducted with 187 participants in small- and medium-sized general hospitals in K city in South Korea from March 15 to March 31, 2019. The data collected from participants were analyzed using descriptive statistics, a t-test, ANOVA, Pearson's correlation coefficients, and a multiple regression using IBM SPSS/WIN 21.0 software.RESULTS: Patient safety care activities were found to be correlated with incident reporting attitudes (r=.27, p < .001) and perceptions of the importance of patient safety management (r=.59, p < .001). Further, perceptions of the importance of patient safety management had a complete mediating effect (β=.409, p < .001) on the relationship between incident reporting attitudes and patient safety care activities.CONCLUSION: Based on the findings of this study, tailored training programs regarding patient safety care activities focused on boosting perceptions of the importance of patient safety management are highly recommended to improve nurses' patient safety care activities in small- and medium-sized general hospitals.

Interobserver agreement in breast ultrasound categorization in the Mammography and Ultrasonography Study for Breast Cancer Screening Effectiveness (MUST-BE) trial: results of a preliminary study

PURPOSE: The purpose of this study was to record and evaluate interobserver agreement as quality control for the modified categorization of screening breast ultrasound developed by the Alliance for Breast Cancer Screening in Korea (ABCS-K) for the Mammography and Ultrasonography Study for Breast Cancer Screening Effectiveness (MUST-BE) trial. METHODS: Eight breast radiologists with 4-16 years of experience participated in 2 rounds of quality control testing for the MUST-BE trial. Two investigators randomly selected 125 and 100 cases of breast lesions with different ratios of malignant and benign lesions. Two versions of the modified categorization were tested. The initially modified classification was developed after the first quality control workshop, and the re-modified classification was developed after the second workshop. The re-modified categorization established by ABCS-K added size criteria and the anterior-posterior ratio compared with the initially modified classification. After a brief lecture on the modified categorization system prior to each quality control test, the eight radiologists independently categorized the lesions using the modified categorization. Interobserver agreement was measured using kappa statistics. RESULTS: The overall kappa values for the modified categorizations indicated moderate to substantial degrees of agreement (initially modified categorization and re-modified categorization: κ=0.52 and κ=0.63, respectively). The kappa values for the subcategories of category 4 were 0.37 (95% confidence interval [CI], 0.24 to 0.52) and 0.39 (95% CI, 0.31 to 0.49), respectively. The overall kappa values for both the initially modified categorization and the re-modified categorization indicated a substantial degree of agreement when dichotomizing the interpretation as benign or suspicious. CONCLUSION: The preliminary results demonstrated acceptable interobserver agreement for the modified categorization.

Effect of Different Types of Mammography Equipment on Screening Outcomes: A Report by the Alliance for Breast Cancer Screening in Korea

OBJECTIVE: To investigate the effects of different types of mammography equipment on screening outcomes by comparing the performance of film-screen mammography (FSM), computed radiography mammography (CRM), and digital mammography (DM).MATERIALS AND METHODS: We retrospectively enrolled 128756 sets of mammograms from 10 hospitals participating in the Alliance for Breast Cancer Screening in Korea between 2005 and 2010. We compared the diagnostic accuracy of the types of mammography equipment by analyzing the area under the receiver operating characteristic curve (AUC) with a 95% confidence interval (CI); performance indicators, including recall rate, cancer detection rate (CDR), positive predictive value₁ (PPV₁), sensitivity, specificity, and interval cancer rate (ICR); and the types of breast cancer pathology.RESULTS: The AUCs were 0.898 (95% CI, 0.878–0.919) in DM, 0.860 (0.815–0.905) in FSM, and 0.866 (0.828–0.903) in CRM (p = 0.150). DM showed better performance than FSM and CRM in terms of the recall rate (14.8 vs. 24.8 and 19.8%), CDR (3.4 vs. 2.2 and 2.1 per 1000 examinations), PPV₁ (2.3 vs. 0.9 and 1.1%), and specificity (85.5 vs. 75.3 and 80.3%) (p < 0.001) but not in terms of sensitivity (86.3 vs. 87.4 and 86.3%) and ICR (0.6 vs. 0.4 and 0.4). The proportions of carcinoma in situ (CIS) were 27.5%, 13.6%, and 11.8% for DM, CRM, and FSM, respectively (p = 0.003).CONCLUSION: In comparison to FSM and CRM, DM showed better performance in terms of the recall rate, CDR, PPV₁, and specificity, although the AUCs were similar, and more CISs were detected using DM. The application of DM may help to improve the quality of mammography screenings. However, the overdiagnosis issue of CIS using DM should be evaluated.

Hospitalization Experience of Patients Admitted to Nursing Care Integrated Service Wards in Small and Medium-size General Hospitals / 간호행정학회지

PURPOSE: This study was conducted to identify meaning and essential structure of the hospitalization of patients in nursing care integrated service wards of small and medium-size general hospitals. METHODS: Experiential data were collected through in-depth interviews with 10 patients who had been hospitalized in nursing care integrated service wards of medium general hospitals. The main question was ‘Could you describe your hospitalization experience in nursing care integrated service wards of medium general hospitals?’, and collected data were analyzed using Colaizzi's Phenomenological Research Method. RESULTS: Four categories obtained were ‘Realize the system that is not established yet’, ‘Secure care services which are less of a psychological and financial burden’, ‘Thanks for care providers’, and ‘Confident of the hopeful system to desire to reuse in the future.’ CONCLUSION: Patients in nursing care integrated service wards of small and medium-size general hospitals were satisfied with the reduction of mental and financial burden caused by nursing and were thankful to nursing staff, who put a lot of efforts into nursing. But, at the same time, they were confused and inconvenienced by the services that were not yet completely established. To improve this situation, it is thought that institutional complements including development of a service standardization manual would be helpful.

Influential Factors for Happiness of Adolescents Who Use Community Child Centers

PURPOSE: The purpose of this study is to determine factors affecting happiness of adolescents who attended community child centers. METHODS: We surveyed 154 adolescents attending a community child center in P City with a structured self-report questionnaire from October 3 to October 15, 2016. Data was analyzed by SPSS 18.0 descriptive statistics, t-test, ANOVA, Scheffé test, Pearson's correlation coefficients and stepwise multiple regression. RESULTS: The mean scores of family strength, friend support, teacher support, and happiness were 3.8±0.84, 3.8±0.98, 3.7±0.84 and 3.7±0.63. There were significant differences in happiness according to the subjects' number of close friends and duration of their stay at the community child center. There were a significant positive correlations among family strength, friend support, teacher support, and happiness. The most significant factors affecting happiness included friend support (β=.40) and peaceable family strength (β=.35). These variables explained 44% of the total variance in happiness. CONCLUSION: It is desirable to prepare and support measures to increase friends' support and family strength in order to improve happiness of adolescents attending community child centers. The findings suggest that it is necessary to develop nursing intervention programs to promote friend support and family strength.

Analysis of Participant Factors That Affect the Diagnostic Performance of Screening Mammography: A Report of the Alliance for Breast Cancer Screening in Korea

OBJECTIVE: To analyze participant factors that affect the diagnostic performance of screening mammography. MATERIALS AND METHODS: We enrolled 128756 cases from 10 hospitals between 2005 and 2010. We analyzed recall rate, cancer detection rate (CDR) per 1000 examinations, positive predictive value (PPV), sensitivity, specificity, false positive rate (FPR), and interval cancer rate (ICR) per 1000 negative examinations according to participant factors including age, breast density, and number of visit to the same institution, and adjusted for confounding variables. RESULTS: Increasing age improved recall rates (27.4% in 40's, 17.5% in 50's, 11.1% in 60's, and 8.6% in 70's), CDR (2.7, 3.2, 2.0, and 2.4), PPV (1.0, 1.8, 1.8, and 2.8%), sensitivity (81.3, 88.8, 90.3, and 94.7%), specificity (72.7, 82.7, 89.0, and 91.7%), and FPR (27.3, 17.3, 11.0, and 8.4%) (p < 0.05). Higher breast density impaired recall rates (4.0% in P1, 9.0% in P2, 28.9% in P3, and 27.8% in P4), PPV (3.3, 2.3, 1.2, and 1.3%), specificity (96.1, 91.2, 71.4, and 72.5%), and FPR (3.9, 8.9, 28.6, and 27.6%) (p < 0.001). It also increased CDR (1.3, 2.1, 3.3, and 3.6) and ICR (0.2, 0.3, 0.6, and 1.6) (p < 0.05). Successive visits to the same institution improved recall rates (20.9% for one visit, 10.7% for two visits, 7.7% for more than three visits), PPV (1.6, 2.8, and 2.7%), specificity (79.4, 89.6, and 92.5%), and FPR (20.6, 10.4, and 7.5%) (p < 0.001). CONCLUSION: Young age and dense breasts negatively affected diagnostic performance in mammography screening, whereas successive visits to the same institution had a positive effect. Examinee education for successive visits to the same institution would improve the diagnostic performance.

Evaluation of Digital PCR as a Technique for Monitoring Acute Rejection in Kidney Transplantation

Early detection and proper management of kidney rejection are crucial for the long-term health of a transplant recipient. Recipients are normally monitored by serum creatinine measurement and sometimes with graft biopsies. Donor-derived cell-free deoxyribonucleic acid (cfDNA) in the recipient's plasma and/or urine may be a better indicator of acute rejection. We evaluated digital PCR (dPCR) as a system for monitoring graft status using single nucleotide polymorphism (SNP)-based detection of donor DNA in plasma or urine. We compared the detection abilities of the QX200, RainDrop, and QuantStudio 3D dPCR systems. The QX200 was the most accurate and sensitive. Plasma and/or urine samples were isolated from 34 kidney recipients at multiple time points after transplantation, and analyzed by dPCR using the QX200. We found that donor DNA was almost undetectable in plasma DNA samples, whereas a high percentage of donor DNA was measured in urine DNA samples, indicating that urine is a good source of cfDNA for patient monitoring. We found that at least 24% of the highly polymorphic SNPs used to identify individuals could also identify donor cfDNA in transplant patient samples. Our results further showed that autosomal, sex-specific, and mitochondrial SNPs were suitable markers for identifying donor cfDNA. Finally, we found that donor-derived cfDNA measurement by dPCR was not sufficient to predict a patient's clinical condition. Our results indicate that donor-derived cfDNA is not an accurate predictor of kidney status in kidney transplant patients.

Increased Malignant Microcalcifications after Neoadjuvant Chemotherapy in Advanced Breast Cancer / 한국유방암학회지

In patients with advanced breast cancer, most new calcifications detected on a mammogram after neoadjuvant chemotherapy are benign dystrophic calcifications, but this is not always observed. We present a patient with advanced breast cancer who had paradoxically increased malignant microcalcifications concomitant with primary tumor regression after undergoing neoadjuvant chemotherapy. After the neoadjuvant chemotherapy, the follow-up mammogram revealed that local, fine pleomorphic microcalcifications had markedly increased. Pathologically, these calcifications were ductal carcinoma in situ. We concluded that, in patients with breast cancer undergoing neoadjuvant chemotherapy, newly developed microcalcifications on follow-up mammograms should be carefully evaluated, and any suspicious malignant microcalcifications should be included in surgical excision planning.

Huge Bilateral Breast Hamartoma Accompanied with Pseudoangiomatous Stromal Hyperplasia

A 34-year-old woman presented with sudden breast enlargement that had occurred within 6 months. She also had an accessory breast mass on the left axilla. Clinical impression was phyllodes tumor. Needle biopsy revealed fibroepithelial tumor, a mixture of fibrous stroma and pseudoangiomatous stromal hyperplasia. The final pathologic report was hamartoma associated with focal pseudoangiomatous stromal hyperplasia and macromastia. This is the first reported case of bilateral breast hamartoma with hamartoma in ectopic breast tissue. The masses on the right and left breasts weighed 1,980 g and 1,233 g, respectively, while the mass on the left axilla weighed 36 g.