• Clinical Endoscopy
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• v.56 no.1
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• pp.75-82
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• 2023

Background/Aims: The etiology of superficial non-ampullary duodenal epithelial tumors (SNADETs) remains unclear. Recent studies have reported conflicting associations between duodenal tumor development and Helicobacter pylori infection or endoscopic gastric mucosal atrophy. As such, the present study aimed to clarify the relationship between SNADETs and H. pylori infection and/or endoscopic gastric mucosal atrophy. Methods: This retrospective case-control study reviewed data from 177 consecutive patients with SNADETs who underwent endoscopic or surgical resection at seven institutions in Japan over a three-year period. The prevalence of endoscopic gastric mucosal atrophy and the status of H. pylori infection were compared in 531 sex- and age-matched controls selected from screening endoscopies at two of the seven participating institutions. Results: For H. pylori infection, 85 of 177 (48.0%) patients exhibited SNADETs and 112 of 531 (21.1%) control patients were non-infected (p<0.001). Non-atrophic mucosa (C0 to C1) was observed in 96 of 177 (54.2%) patients with SNADETs and 112 of 531 (21.1%) control patients (p<0.001). Conditional logistic regression analysis revealed that non-atrophic gastric mucosa was an independent risk factor for SNADETs (odds ratio, 5.10; 95% confidence interval, 2.44-8.40; p<0.001). Conclusions: Non-atrophic gastric mucosa, regardless of H. pylori infection status, was a factor independently associated with SNADETs.

• Archives of Plastic Surgery
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• v.37 no.5
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• pp.699-701
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• 2010

Purpose: Mondor's disease is a rare benign condition which involves thrombophlebitis of the superficial veins of the breast and anterior chest wall after breast surgery, breast tissue biopsy, inflammatory reaction, breast cancer, trauma. The affected veins include the lateral thoracic, axillary veins, thoracoepigastric veins and superior epigastric veins. Methods: A 49-year-old woman presented to the outpatient department with complaints of the sudden appearance of a subcutaneous cord just under the skin at left lower lateral abdominal wall 1 month later of bilateral mastectomy due to both severe breast paraffinoma. The cord was initially red and tender and subsequently became a painless, tough, fibrous band that was accompanied by tension and skin retraction. Results: On ultrasonographic findings, palpable threadlike structures at both lateral superficial abdominal wall after bilateral mastectomy were noted. Superficial short elongated hypoechoic tubular structures were noted just under the skin at palpable lower lateral abdominal wall. It was compatible to Mondor's disease of thoracoepigastric vein. Conclusion: The increase in breast surgery will give rise to the increase in the frequency of Mondor's disease clinically. Mondor's disease can be diagnosed with clinical symptoms and image findings and the disease has proved to be benign and self-limited.

• Journal of Digestive Cancer Research
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• v.8 no.1
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• pp.1-50
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• 2020

Although surgery was the standard treatment for early gastrointestinal cancers, endoscopic resection is now a standard treatment for early gastrointestinal cancers without regional lymph node metastasis. High-definition white light endoscopy, chromoendoscopy, and image-enhanced endoscopy such as narrow band imaging are performed to assess the edge and depth of early gastrointestinal cancers for delineation of resection boundaries and prediction of the possibility of lymph node metastasis before the decision of endoscopic resection. Endoscopic mucosal resection and/or endoscopic submucosal dissection can be performed to remove early gastrointestinal cancers completely by en bloc fashion. Histopathological evaluation should be carefully made to investigate the presence of risk factors for lymph node metastasis such as depth of cancer invasion and lymphovascular invasion. Additional treatment such as radical surgery with regional lymphadenectomy should be considered if the endoscopically resected specimen shows risk factors for lymph node metastasis. This is the first Korean clinical practice guideline for endoscopic resection of early gastrointestinal cancer. This guideline was developed by using mainly de novo methods and encompasses endoscopic management of superficial esophageal squamous cell carcinoma, early gastric cancer, and early colorectal cancer. This guideline will be revised as new data on early gastrointestinal cancer are collected.

• Molecular & Cellular Toxicology
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• v.2 no.1
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• pp.1-6
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• 2006

Photodynamic therapy (PDT), a newly established treatment for solid tumors, involves the systemic administration of a tumor localizing photosensitizer that is only activated when exposed to light of appropriate wavelength. Photoactivation of photosensitizer in the presence of oxygen results in the formation of highly cytotoxic molecular species, which precipitates necrosis. PDT has now become a promising means for the treatment of cancer due to its specificity, relatively minimal side effects, and inexpensive. However, the application of PDT has been restricted to the treatment of superficial lesions or the use of interstitial light delivery. A single photon generally activates the photochemical reaction in traditional PDT. However the use of multi photon excitation, where two or more photons simultaneously excite a photosensitizer, allows for the use of wavelengths twice as long. Such wavelengths exhibit better transmittance through tissue and thereby deeper penetration is achieved. This paper will review theoretical principles of multi photon excitation, challenges associated with multi photon PDT and update the current and future role of multi photon PDT in cancer.

• Clinical Endoscopy
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• v.55 no.4
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• pp.520-524
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• 2022

Background/Aims: Intralesional steroid injections have been administered as prophylaxis for stenosis after esophageal endoscopic submucosal dissection. However, this method carries a risk of potential complications such as perforation because a fine needle is used to directly puncture the postoperative ulcer. We devised a new method of steroid intralesional infusion using a spray tube and evaluated its efficacy and safety. Methods: Intralesional steroid infusion using a spray tube was performed on 27 patients who underwent endoscopic submucosal dissection for superficial esophageal cancer with three-quarters or more of the lumen circumference resected. The presence or absence of stenosis, complications, and the number of endoscopic balloon dilations (EBDs) performed were evaluated after treatment. Results: Although stenosis was not observed in 22 of the 27 patients, five patients had stenosis and dysphagia requiring EBD. The stenosis in these five patients was relieved after four EBDs. No complications related to intralesional steroid infusion using the spray tube were observed. Conclusions: Intralesional steroid infusion using a spray tube is a simple and safe technique that is adequately effective in preventing stenosis (clinical trial number, UMIN000037567).

• Journal of the Korean Society of Radiology
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• v.81 no.5
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• pp.1194-1203
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• 2020

Purpose To evaluate the diagnostic utility of the stalk and the inchworm sign on preoperative MRI for detecting superficial bladder cancers, and to compare the diagnostic performance between the stalk and the inchworm sign. Materials and Methods We retrospectively reviewed 240 patients (505 tumors) who had undergone radical cystectomy. The tumors were classified as follows: superficial or invasive tumors indicated by the stalk or inchworm sign on 3.0 Tesla MRI. We evaluated the diagnostic accuracy of the stalk and inchworm signs, by comparing each finding with the postoperative pathologic T stage. We compared diagnostic performance between them statistically. Results The stalk and inchworm signs showed high specificity (93% and 91%, respectively), positive predictive values (89% and 90%, respectively), and acceptable accuracy (70% and 74%, respectively), but low sensitivity (54% and 61%, respectively) and negative predictive values (60% and 63%, respectively). There was no statistically significant difference between the two signs (p > 0.05). Conclusion Superficial bladder cancers could be differentiated from invasive tumors using the stalk or inchworm sign on MRI.

• Korean Journal of Bronchoesophagology
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• v.17 no.1
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• pp.5-8
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• 2011

The proliferation of new technologies has significantly enhanced the diagnostic capabilities of flexible bronchoscopy compared with traditional methods. Narrow band imaging (NBI), an optical technique in which filtered light enhances superficial neoplasms based on their neoangiogenic patterns, was developed to screen for central intraepithelial moderate or severe dysplasia, carcinoma in situ (CIS), and microinvasive neoplasia in patients at risk for lung cancer. Because angiogenesis occurs preferentially in dysplastic and neoplastic lesions, NBI may identify early dysplastic lesions better than white light bronchoscopy (WLB) currently in use. NBI bronchoscopy can be used not only to detect precancerous lesions, but also to screen for cancerous lesions. We prospectively evaluated 101 patients with suspected lung cancer between July 2009 and June 2010. All were previously scheduled for flexible bronchoscopy CT scans. Abnormal NBI was defined by Shibuya's descriptors (tortuous, dotted, or spiral and screw patterns). Biopsies of 132 lesions in 92 patients showed that 78 lesions (59.1%) were malignant and 54 (40.9%) were benign. The diagnostic sensitivity of bronchoscopy in detecting malignancy was 96.2% (75/78). When assorted by lesion pattern, the sensitivity and specificity of NBI bronchoscopy in detecting malignancies were 69.2% (54/78) and 96.3% (52/54), respectively, for the spiral and screw pattern and 14.1% (11/78) and 96.3% (52/54), respectively, for the dotted pattern. Unexpectedly, additional cancerous lesions were detected in five patients (2 dotted and 3 spiral and screw). As a screening tool for malignant lesions, NBI bronchoscopy should assess combinations of all three lesion. The dotted and spiral and screw patterns may be helpful in determining which lesions should be biopsied. NBI bronchoscopy may be useful not only for the diagnosis of early-stage lung cancer but also for more accurate local staging of lung cancer.

• Asian Pacific Journal of Cancer Prevention
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• v.17 no.6
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• pp.2787-2793
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• 2016

Background: Urinary bladder cancer is a common malignancy in the West and ranks as the $7^{th}$ most common cancer in our region of Kashmir, India. FGFR3 mutations are frequent in superficial urothelial carcinoma (UC) differing from the RAS gene mutational pattern. The aim of this study was to analyze the frequency and association of FGFR3 and RAS gene mutations in UC cases. Materials and Methods: Paired tumor and adjacent normal tissue specimens of 65 consecutive UC patients were examined. DNA preparations were evaluated for the occurrence of FGFR3 and RAS gene mutations by PCR-SCCP and DNA sequencing. Results: Somatic point mutations of FGFR3 were identified in 32.3% (21 of 65). The pattern and distribution were significantly associated with low grade/stage (p<0.05). The overall mutations in exon 1 and 2 in all the forms of RAS genes aggregated to 21.5% and showed no association with any clinic-pathological parameters. In total, 53.8% (35 of 65) of the tumors studied had mutations in either a RAS or FGFR3 gene, but these were totally mutually exclusive in and none of the samples showed both the mutational events in mutually exclusive RAS and FGFR3. Conclusions: We conclude that RAS and FGFR3 mutations in UC are mutually exclusive and non-overlapping events which reflect activation of oncogenic pathways through different elements.

• Asian Pacific Journal of Cancer Prevention
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• v.16 no.13
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• pp.5349-5357
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• 2015

Background: Breast cancer is the most common cancer and the leading cause of cancer mortality among women of all ethnic and age groups in Malaysia. Delay in seeking help for breast cancer symptoms is preventable and by identifying possible factors for delayed diagnosis, patient prognosis and survival rates could be improved. Objectives: This narrative review aimed to understand and evaluate the level of in-depth breast cancer knowledge in terms of clinical breast examination and breast self-examination, and other important aspects such as side-effects and risk factors in Malaysian females. Since Malaysia is multicultural, this review assessed social perceptions, cultural beliefs and help-seeking behaviour in respect to breast cancer among different ethnic groups, since these may impinge on efforts to 'avoid' the disease. Materials and Methods: A comprehensive literature search of seven databases was performed from December 2015 to January 2015. Screening of relevant published journals was also undertaken to identify available information related to the knowledge, perception and help-seeking behaviour of Malaysian women in relation to breast cancer. Results: A total of 42 articles were appraised and included in this review. Generally, women in Malaysia had good awareness of breast cancer and its screening tools, particularly breast self-examination, but only superficial in-depth knowledge about the disease. Women in rural areas had lower levels of knowledge than those in urban areas. It was also shown that books, magazines, brochures and television were among the most common sources of breast cancer information. Delay in presentation was attributed mainly to a negative social perception of the disease, poverty, cultural and religion practices, and a strong influence of complementary and alternative medicine, rather than a lack of knowledge. Conclusions: This review highlighted the need for an intensive and in-depth breast cancer education campaigns using media and community health programmes, even with the existing good awareness of breast cancer. This is essential in order to avoid misconceptions and to frame the correct mind-set about breast cancer among women in Malaysia. Socio-cultural differences and religious practices should be taken into account by health care professionals when advising on breast cancer. Women need to be aware of the risk factors and symptoms of breast cancer so that early diagnosis can take place and the chances of survival improved.

• Journal of Chest Surgery
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• v.35 no.11
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• pp.773-778
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• 2002

Surgery remains the main stay in the treatment of carcinoma of the esophagus and the results of surgery for esophageal cancer have improved over the past 10 years. The ideal operation for cancer of the esophagus should have good palliation, low morbidity and mortality, and optimize both long-term function and survival. The two main approaches currently used for surgical treatment of esophageal cancer are: transthoracic esophagectomy (TTE) and transhiatal esorhagectomy(THE). The advantages of THE are low morbidity and mortality, short operating time, a short hospital stay and low interference with respiratory physiology The selection criteria for this procedure may differ but there are two situations which could clearly benefit from THE; these are epithelial and superficial submucosal lesions, particularly in cases of multiple lesions, and any resectable tumor at any stage with poor clinical status. I reviewed the selection criteria, surgical procedures, and results of THE in esophageal cancer with the literatures.