• Journal of Chest Surgery
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• 제52권2호
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• pp.119-123
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• 2019

Spontaneous regression of lung cancer is a very rare and poorly understood phenomenon. A 64-year-old man presented to Dong-A University Hospital with a shrunken nodule in the right lower lobe. Although the nodule showed a high likelihood of malignancy on needle aspiration biopsy, the patient refused surgery. The nodule spontaneously regressed completely in the next 17 months. However, the subcarinal lymph node was found to be enlarged 16 months after complete regression was observed. We pathologically confirmed metastasis of squamous cell carcinoma and performed neoadjuvant chemotherapy, surgery, and adjuvant chemoradiation. Regardless of tumor size reduction, it is preferable to perform surgery aggressively in cases of operable lung cancer.

• Journal of Chest Surgery
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• 제23권3호
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• pp.537-541
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• 1990

Early esophageal carcinoma is defined as a lesion wherein invasion is confined to the mucosa and submucosa without metastasis to lymph node or other organs. Postoperative 5-year survival rate for early esophageal carcinoma is much superior than advanced carcinoma. Unfortunately, because of the anatomic characteristic of esophagus and absence of specific early symptoms, detection is frequently belated, and advanced disease is present at the time of the initial diagnosis. We experienced 2 cases of early esophageal carcinoma. They complained no specific symptoms. The diagnosis was made by barium esophagogram, esophagofiberscopy with dye staining and endoscopic biopsy. We performed esophagectomy with esophagogastrostomy. All had good postoperative course without any complication. We concluded that the combined use of double contrast radiography, esopagofiberscopy aided by intraluminal staining with Toluidine blue or Lugol`s solution, and endoscopic biopsy is very important in the diagnosis of early esophageal carcinoma in high risk patient group.

• Nuclear Medicine and Molecular Imaging
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• 제41권4호
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• pp.309-316
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• 2007

감시 림프절 생검은 유방암 수술에서 림프절 전이 상태를 알기 위한 표준 시술이다. 환자는 방사성 콜로이드를 주사 받은 후 수술을 받게 된다. 이 과정에서 검사를 하는 핵의학과, 수술장, 유방암 검체를 다루는 병리과의 관계자는 미량이나마 환자와 검체에 의해서 방사선 피폭을 받을 수 있다. 이 연구의 목적은 감시 림프절 생검 과정, 특히 병리처리 과정에서 받는 방사선피폭을 정량하여 그 안전성을 확인하고 병리 시설과 폐기물에 대해서도 방사선 관련 안전성을 확인하는 것이다. 대상 및 방법 : 감시림프절 생검은 방사성 콜로이드를 이용하여 일반적인 임상적 방법으로 시행되었다. 병리기사, 핵의학 기사 및 핵의학 의사의 피폭량을 열형광선량계를 이용하여 1달간 측정하였다. 또한 작업과정중의 잔존 방사능량, 흡수선량, 작업시간, 작업거리, 조직폐기물 및 병리검사실의 공간선량을 측정하였다. 결과 전신 및 손의 피폭량은 병리기사에서 각각 0.21 및 0.85 uSv/study이었고 핵의학과 의사 및 핵의학과 기사의 전신피폭량은 각각 0.2 및 2.3 uSv/study 이었다. 일반인 기준(1000 uSv/year)으로 병리기사는 년간 약 1100건 감시림프절 관련 검체 처리를 할 수 있었다. 각 과정의 잔존방사성 및 피폭거리, 시간으로 측정한 피폭량은 수술의사는 전신/손의 피폭량이 건당 2.47/22.4 uSv 이었고 수술장간호사는 건당 0.22/0 uSv 이었다. 병리실의 공간선량률은 0.02-0.03 mR/hr로 방사성 관리구역의 설정 기준에 도달하지 않았다. 폐기되는 검체 조직의 방사능은 거의 측정되지 않아 100 Bq/g에 훨씬 미치지 않았다. 결론: 방사성동위원소를 이용한 감시림프절 검사에 관계된 병리처리과정은 방사선안전측면에서 일반적으로 안전하며 별도의 안전관리나 시설 없이 이루어 질 수 있다.

• Tuberculosis and Respiratory Diseases
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• 제75권3호
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• pp.116-119
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• 2013

Sarcoidosis, a systemic granulomatous disease of unknown etiology. The presentation of sarcoidal granuloma in neck nodes without typical manifestations of systemic sarcoidosis is difficult to diagnose. We describe the case of a 37-year-old woman with an increasing mass on the right side of neck. The excisional biopsy from the neck mass showed noncaseating epithelioid cell granuloma of the lymph nodes. No evidence of mycobacterial or fungal infection was noted. Thoracic evaluations did not show enlargement of mediastinal lymph nodes or parenchymal abnormalities. Immunohistochemistry showed abundant expression of tumor necrosis factor-${\alpha}$ in the granuloma. However, transforming growth factor-${\beta}$ was not expressed, although interleukin-$1{\beta}$ was focally expressed. These immunohistochemical findings supported characterization of the granuloma and the diagnosis of sarcoidosis. Sarcoidosis can present with cervical lymph node enlargement without mediastinal or lung abnormality. Immunohistochemistry may support the diagnosis of sarcoidosis and characterization of granuloma.

• 대한후두음성언어의학회지
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• 제30권1호
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• pp.61-64
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• 2019

Sarcoidosis is a multisystem granulomatous disease of unknown etiology. Vocal fold paralysis secondary to sarcoidosis is extremely rare but it can develop as a result of compressive lymphadenopathy, granulomatous infiltration, and neural involvement. We report the case of a 56-year-old woman who presented with unilateral vocal fold paralysis and enlarged supraclavicular lymph nodes. Computed tomography of the neck revealed multiple, enlarged, and matted lymph nodes at the cervical level of IV. An ultrasound-guided core needle biopsy of the lymph node was performed, and a histopathological diagnosis of sarcoidosis was made by validating the presence of noncaseating granuloma. After implementation of steroid therapy, the patient exhibited immediate recovery from vocal fold paralysis. Although an extremely rare disease, sarcoidosis should be included in the differential diagnosis of vocal fold paralysis. Accurate diagnosis and prompt steroid treatment may reduce the morbidity of patients with vocal fold paralysis secondary to sarcoidosis.

• Tuberculosis and Respiratory Diseases
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• 제71권6호
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• pp.408-416
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• 2011

Background: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a technique developed to allow mediastinal staging of lung cancer and also to evaluate intrathoracic lymphadenopathy. In a tuberculosis-endemic area, tuberculosis should be considered as an etiology of mediastinal lymphadenopathy. The aim of this study was to investigate the utility of the routine culture for tuberculosis from specimens of EBUS-TBNA. Methods: We prospectively performed routine culture for tuberculosis from aspiration or core biopsy specimens got from 86 patients who had undergone EBUS-TBNA due to mediastinal lymphadenopathy between March 2010 and March 2011. Results: A total of 135 lymph node aspiration and 118 core biopsy specimens were included in this analysis. We confirmed the malignancy in 62 (72.9%), tuberculosis in 7 (8.1%), sarcoidosis in 7 (8.1%), asperogillosis in 2 (2.3%) and pneumoconiosis in 2 (2.3%) patients. One lung cancer patient had pulmonary tuberculosis coincidentally and 5 patients had unknown lymphadenopathy. The number of positive culture for Mycobacterium tuberculsosis by EBUS-TBNA is 2 (1.5%) from 135 lymph node aspiration specimens and 2 (1.7%) from 118 core biopsy specimens. Out of eight patients confirmed with tuberculosis, only one patient had positive mycobacterial culture of aspiration specimen from EBUS-TBNA without histopathologic diagnosis. Conclusion: These results propose that routine culture for tuberculosis from EBUS-TBNA may not provide additional information for the diagnosis of coincident tuberculous lymphadenitis. However, if there is any possibility of tuberculous lymphadenopathy or pulmonary tuberculosis, it should be considered to perform EBUS-TBNA in patients who have negative sputum AFB smears or no sputum production.

• Journal of Gastric Cancer
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• 제17권1호
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• pp.93-97
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• 2017

An 84-year-old man was diagnosed with two synchronous adenocarcinomas, a Borrmann type IV advanced gastric adenocarcinoma in his antrum and a well-differentiated Borrmann type I carcinoma on the anterior wall of the higher body of his stomach. Pre-operatively, computed tomography of the abdomen revealed the presence of advanced gastric cancer with peri-gastric and para-aortic lymph node (LN) metastasis. He planned for palliative total gastrectomy owing to the risk of obstruction by the antral lesion. We performed a frozen biopsy of a para-aortic LN during surgery and found that the origin of the para-aortic LN metastasis was from undiagnosed prostate cancer. Thus, we performed radical total gastrectomy and D2 LN dissection. Post-operatively, his total prostate-specific antigen levels were high (227 ng/mL) and he was discharged 8 days after surgery without any complications.

• Asian Pacific Journal of Cancer Prevention
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• 제14권9호
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• pp.5375-5378
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• 2013

Background: This study was undertaken to evaluate the surgical outcomes of patients with stage IA2 cervical cancer treated with radical hysterectomy. Data for 58 patients who underwent modified radical hysterectomy or radical hysterectomy with pelvic lymphadenectomy between January 2003 and December 2012 at Chiang Mai University Hospital were retrospectively reviewed. The analysis included clinico-pathological risk factors (nodal metastasis, parametrial involvement), adjuvant treatment, 5-year disease-free survival and 5-year overall survival. All pathologic slides were reviewed by a gynecologic pathologist. Follow-up methods included at least cervical cytology and colposcopy with directed biopsy if indicated. Univariate analysis was performed to identify factors associated with median survival. At the median follow up time of 73 months, the 5-year disease-free survival and the 5-year overall survival were 97.4% and 97.4%, respectively. Two (3.4%) patients had pelvic lymph node metastases. In a univariate analysis, there was no statistically significant association between survival and prognostic factors such as age, histological cell type, lymph-vascular space invasion, vaginal margin status and lymph node status. Surgical and survival outcomes of women with stage IA2 cervical cancer are excellent. No parametrial involvement was detected in our study. Patients with stage IA2 cervical cancer may be treated with simple or less radical hysterectomy with pelvic lymphadenectomy.

• Journal of Gastric Cancer
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• 제18권4호
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• pp.409-416
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• 2018

A 55-year-old man visited our hospital for a detailed examination of a gastric submucosal tumor that was first detected 10 years prior. The tumor continued to grow and had developed a depressed area in its center. A histopathological examination of biopsy specimens revealed gastric adenocarcinoma of the fundic gland type (GA-FG). It was diagnosed as T2 based on the invasion depth as determined by white-light endoscopy and endoscopic ultrasonography. A total gastrectomy with lymphadenectomy was performed and a GA-FG in the mucosa and submucosa was confirmed histopathologically. However, there was a gradual transition to an infiltrative tubular adenocarcinoma with poorly differentiated components in the muscular and subserosal layers. Metastasis was identified in a dissected lymph node (LN). This is the first report of a GA-FG progressing to an aggressive cancer with LN metastasis. These findings modify our understanding of the pathophysiology of GA-FG.

• Asian Pacific Journal of Cancer Prevention
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• 제17권3호
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• pp.1149-1155
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• 2016

Background: Examination of sentinel lymph node (SLN) biopsies provides accurate nodal staging for breast cancer and plays a key role in patient management. Procurement of SLNs and the methods used to process specimens are equally important. Increasing the level of detail in histopathological examination of SLNs increases detection of metastatic tumours but will also increase the burden of busy laboratories and thus may not be carried out routinely. Recommendation of a reasonable standard in SLN examination is required to ensure high sensitivity of results while maintaining a manageable practice workload. Materials and Methods: Twenty-four patients with clinically node-negative breast cancer were recruited. Combined radiotracer and blue dye methods were used for identification of SLNs. The nodes were thinly sliced and embedded. Serial sectioning and immunohistochemical (IHC) staining against AE1/AE3 were performed if initial H&E sections of the blocks were negative. Results: SLNs were successfully identified in all patients. Ten cases had nodal metastases with 7 detected in SLNs and 3 detected only in axillary nodes (false negative rate, FNR=30%). Some 5 out of 7 metastatic lesions in the SLNs (71.4%) were detected in initial sections of the thinly sliced tissue. Serial sectioning detected the remaining two cases with either micrometastases or isolated tumour cells (ITC). Conclusions: Thin slicing of tissue to 3-5mm thickness and serial sectioning improved the detection of micro and macro-metastases but the additional burden of serial sectioning gave low yield of micrometastases or ITC and may not be cost effective. IHC validation did not further increase sensitivity of detection. Therefore its use should only be limited to confirmation of suspicious lesions. False negative cases where SLNs were not involved could be due to skipped metastases to non-sentinel nodes or poor technique during procurement, resulting in missed detection of actual SLNs.