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Biomedical subjects

Jae Y Ro

Publications and source records attributed to Jae Y Ro.

At least 19 recordsLinked to original sources

Novel mutations of epidermal growth factor receptor in localized prostate cancer.

We recently demonstrated that EGFR protein overexpression is more common in African American (AA) prostate cancer patients compared to Caucasian patients. We further examine EGFR dysregulation by determining EGFR mutation status in the tyrosine kinase (TK) domain in prostate cancer patients of different ethnicity. Normal and tumor DNA from 89 radical prostatectomy cases were studied for mutations in the EGFR TK domain using genomic DNA sequencing. We identified 4 novel missense mutations in exons 19, 20 and 21 of EGFR TK domain: 3 in Koreans and 1 in Caucasian but none in AA. We also identified 5 distinct synonymous DNA sequence changes, which did not alter the encoded amino acid, in exons 20 and 21 in 31/89 (35%) patients. Interestingly, these synonymous sequence changes were not observed in normal DNA in 7(23%) patients, indicating the presence of de novo somatic mutation to a new synonymous sequence. Our data reveal that EGFR missense mutation in the TK domain occurs in localized prostate cancer. Our data also demonstrate the presence of somatic mutation to a new synonymous sequence in a subset of patients. Larger population-based studies are required to define the association between EGFR mutations and the ethnic background of patients.

Aged↗

Clinicopathologic significance of the basal-like subtype of breast cancer: a comparison with hormone receptor and Her2/neu-overexpressing phenotypes.

DNA microarray profiling studies have led to the classification of invasive breast carcinoma into luminal/estrogen receptor-positive, normal breast-like, Her2/neu-overexpressing, and basal-like types. Among these groups, the basal-like subtype is associated with the poorest clinical outcome in Western countries. To date, the clinicopathologic characteristics of the basal-like carcinomas, compared with other subtypes, have not been described in the Korean population. In this study, we used tissue microarray to examine the expression of basal cytokeratins (CK) (CK5 and CK14) and luminal CK (CK8/18), epidermal growth factor receptor, c-kit, hormone receptors (HRs), p53, and Her2/neu in 776 consecutive patients diagnosed with invasive breast carcinoma from January 1993 to December 1998 and categorized these cases into 5 subgroups (basal-like, HR-expressing, Her2/neu-overexpressing, HR and Her2/neu-expressing, and null subtypes negative for all markers), based on the immunohistochemical data. We identified cases of 114 (14.7%) basal-like, 345 (44.5%) HR-expressing, 133 (17.1%) Her2/neu-overexpressing, 61 (7.8%) HR and Her2/neu-expressing, and 123 (15.9%) null subtypes. Histologically, most basal-like breast cancers were invasive ductal carcinoma, not otherwise specified (98 cases, 86.0%), with high nuclear and/or histologic grades, and most metaplastic carcinomas (6 [75.0%] of 8 cases) were the basal-like subtype. Both basal-like and Her2/neu-overexpressing subtypes were associated with larger tumor sizes (mean, 3.6 and 3.3 cm, respectively) than the HR-expressing group (mean, 2.8 cm) (P = .001 and P = .036, respectively). Nodal stage of Her2/neu-overexpressing subtype was higher than that of basal-like subtype; however, overall stage was not different between the 2 groups (P = .010 and .123, respectively). Distant metastasis was most frequently observed in the Her2/neu-overexpressing subtype (33.8%), which was prognostically the worst subgroup of breast cancers. In contrast to previous findings from Western countries, our analyses reveal that the Her2/neu status is the most important prognostic factor of breast cancers.

Adult↗

Invasive colorectal micropapillary carcinoma: an aggressive variant of adenocarcinoma.

Micropapillary carcinoma (MC) has been well described in other organs, including breast, urinary bladder, lung, ovary, and salivary gland, but has not been described in the large intestine. We compared the clinicopathologic and immunohistochemical findings of MC with those of conventional adenocarcinoma in the large intestine. Fifty-five cases of adenocarcinoma with an MC component were identified among 585 consecutive cases of colorectal cancer at the Asan Medical Center between January 2003 and June 2004 and were compared with 119 cases of conventional adenocarcinoma of colorectum without an MC component. Arrayed tissue blocks were constructed and immunostained for cytokeratin 7 and 20 and CDX2. We also compared the results of MLH-1, MSH-2, p53, and carcinoembryonic antigen immunostainings between the 2 groups. The grade of both MC and conventional adenocarcinoma was mostly moderately differentiated. The proportion of MC ranged from 5% to 80%. The presence but not extent of MC in the primary tumors was associated with more frequent lymphovascular invasion and lymph node (LN) metastases, a greater mean number of positive LNs, and a higher tumor stage with more frequent distant metastases, compared with conventional adenocarcinoma (P < .05). Cytokeratin 7 staining was occasionally observed in both MC (9.1%, 5/55 cases) and conventional adenocarcinoma (13.4%, 16/119 cases). Although MLH-1 and CDX2 expression tended to be lower in conventional adenocarcinoma, none of the immunohistochemical results was significantly different between 2 groups. Recognition of MC component is important as MC appeared to be an aggressive variant of colonic adenocarcinoma and presented at a higher stage, with frequent lymphovascular invasion, LN metastasis, and distant metastasis, compared with conventional adenocarcinoma. The proportion of MC component did not impact the prognosis, and the immunoprofiles of MC were not significantly different from those of conventional adenocarcinoma.

Adenocarcinoma↗

Prostate cancer in Korean men exhibits poor differentiation and is adversely related to prognosis after radical prostatectomy.

OBJECTIVES: To investigate the clinical and pathologic characteristics of prostate cancer in Korean men to determine how ethnic differences affect clinical outcome. METHODS: The clinical and pathologic data of 604 Korean men who underwent radical prostatectomy from 1994 to 2003 were reviewed. Biochemical failure was defined as a prostate-specific antigen (PSA) level of 0.2 ng/mL or greater on two consecutive occasions after having achieved an undetectable PSA level. Patient distribution with respect to the clinical and pathologic parameters and biochemical failure rates were compared with those of contemporary Western series. RESULTS: The mean preoperative PSA level was 9.9 ng/mL (range 0.4 to 38.8) and the median biopsy Gleason score was 7. The Gleason score was 7 in 186 patients (30.8%) and greater than 7 in 169 (28.0%). Gleason scores stratified with respect to clinical stage and PSA range revealed the proportion of patients with high Gleason scores (7 or greater) to be more than 50% of each subgroup throughout the clinical stages and PSA ranges. At a median follow-up of 57.9 months (range 22 to 131), biochemical failure occurred in 24.2% of all patients and in 14.3% of those with an initial serum PSA level of 10.0 ng/mL or lower. On multivariate Cox regression analysis, the Gleason score showed the strongest statistical significance for biochemical failure (P = 0.001, hazard ratio 1.376, 95% confidence interval 1.056 to 1.792) for patients with a serum PSA level of 10.0 ng/mL or lower. CONCLUSIONS: A significant proportion of prostate cancers arising in Korean men exhibit poor differentiation, regardless of the initial serum PSA level or clinical stage at presentation, and adversely affect prognosis, causing a greater rate of PSA failure.

Adult↗

Diagnostic and pathogenetic significance of increased stromal apoptosis and incomplete vasculogenesis in complete hydatidiform moles in very early pregnancy periods.

Hydropic swelling, trophoblastic proliferation, and stromal avascularity of chorionic villi are the key features of advanced cases of complete hydatidiform moles (CHMs). Recently, however, the use of high-resolution ultrasonography has enabled earlier detection of CHMs, and these show previously unrecognized histologic features such as numerous immature vascular networks, nonhydropic hypercellular stroma, and frequent karyorrhexis in the villous stroma. To determine whether stromal vasculogenesis is affected in CHMs of very early pregnancy period (VECM), we compared the number of mature and immature blood vessels and their precursors in the villous stroma and counted the rates of stromal apoptosis and proliferation, as defined by immunopositivity for cleaved caspase-3 and Ki-67, in 63 cases of VECM, 11 cases of partial hydatidiform mole (VEPM), and 10 samples of normal placental tissue (NP) before the 13th gestational week. Using antibody to CD31, we found that the number of mature blood vessels with distinct lumen was significantly reduced in both VECM and VEPM compared with NP (P<0.001), but the number of CD31-positive primitive stromal cells or immature vascular networks without lumen did not differ significantly among the three groups. Stromal apoptotic rate was significantly higher in VECM than in VEPM or NP (P<0.001), which was very useful in differential diagnosis. Our results suggest that complete vasculogenic differentiation is significantly retarded in VECM due to increased apoptosis in the precursor components of blood vessels. It may result in a lack of vascular drainage and cause progressive accumulation of vesicular fluid in the later gestational period.

Apoptosis↗

Thyroid follicular carcinoma-like tumor of kidney: a case report with morphologic, immunohistochemical, and genetic analysis.

We present an unusual renal tumor, which has not been classified under a known subtype of renal cell carcinoma (RCC) and characteristically shows similar histology to thyroid follicular carcinoma. The patient was a 32-year-old asymptomatic woman who was found to have a kidney mass during her annual physical examination. She had no lesions in the thyroid during physical and ultrasound examinations, and there was no abnormal thyroid function test. Neither mediastinal nor ovarian abnormalities were observed. The resected kidney showed a well-defined nodular tumor measuring 11.8x8.0x8.0 cm. The mass was protruding into the pelvic cavity with areas of yellowish geographic necrosis. Histologically, the tumor showed follicular architectures with inspissated colloid-like material in their lumina. No conventional (clear cell) RCC or any other known subtypes of RCC component was observed. Immunohistochemically, the tumor cells showed intensive staining for cytokeratin (CK) cocktail AE1/AE3 and CD10 and were not reactive to thyroid transcription factor-1 and thyroglobulin. The staining of CK35betaH11 and vimentin revealed focal cytoplasmic reaction. The tumor cells were completely negative for CK7, CK19, CK20, CK34betaE12, carcinoembryonic antigen, epithelial membrane antigen, and CD15. Chromosomal gains of 7q36, 8q24, 12, 16, 17p11-q11, 17q24, 19q, 20q13, 21q22.3, and Xp and losses of 1p36, 3, and 9q21-33 were detected by comparative genomic hybridization. These findings are dissimilar to previously classified renal neoplasm. Only a report that included three cases of primary thyroid-like renal tumor has been described in the abstract form. However, there is no fully documented case on this unusual form of RCC, which morphologically resembles that of thyroid follicular carcinoma. Herein, we present a new case of thyroid follicular carcinoma-like tumor of the kidney with a chromosomal study and review of the literature.

Adenocarcinoma, Follicular↗

SMARCB1/INI1 missense mutation in mucinous carcinoma with rhabdoid features.

Malignant rhabdoid tumor (MRT) is a rare and aggressive tumor associated with deletion or mutation of a tumor suppressor gene SMARCB1/INI1, a member of the SWI/SNF chromatin-remodeling complex. Reported herein is a case of pancreatic mucinous carcinoma accompanying rhabdoid features with immunohistochemical and ultrastructural studies as well as analysis of the SMARCB1/INI1 gene. A 65-year-old woman presented with a 2 month history of abdominal and chest pain. A well-defined grayish tan fish-flesh mass (11 x 9 x 7 cm) with focal mucinous area was present in the pancreatic tail. Microscopically, the tumor had a biphasic growth pattern: a mucinous carcinoma component and a poorly differentiated carcinoma component with rhabdoid features showing loosely cohesive cells with abundant eosinophilic cytoplasm, displaced nuclei, and prominent nucleoli. The rhabdoid component coexpressed vimentin and cytokeratin. Sequencing analysis of the DNA extracted from the mucinous and rhabdoid components showed a missense mutation CCC to ACC in codon 116 of the SMARCB1/INI1 gene. Being aware of rhabdoid features would help diagnose this rare and aggressive malignant tumor and may provide an opportunity for further evaluation of SMARCB1/INI1 gene alteration and determination of its prognostic significance.

Adenocarcinoma, Mucinous↗

Promoter hypermethylation of the p16 gene and loss of its protein expression is correlated with tumor progression in extrahepatic bile duct carcinomas.

CONTEXT: The p16 gene is one of the tumor suppressor genes, and its inactivation results in abnormal regulation of the cell cycle in human neoplasms. Promoter hypermethylation, a mechanism of p16 gene inactivation, has been reported to play an important role in tumorigenesis and to be related to patient prognosis in several carcinomas. OBJECTIVE: To determine the role of the p16 gene in extrahepatic bile duct (EBD) carcinomas. DESIGN: We examined promoter hypermethylation of the p16 gene using a methylation-specific polymerase chain reaction and the expression of the p16 protein using an immunohistochemical staining method in 90 cases of EBD carcinomas. We then compared the data with various clinicopathologic parameters, including survival rate. RESULTS: Promoter hypermethylation was observed in 69 (77%) of the 90 cases. Of 69 hypermethylated cases, 32 (46%) demonstrated loss of p16 expression. Promoter hypermethylation of the p16 gene was more commonly observed in tumors with vascular invasion (22 [92%] of 24 cases) than without vascular invasion (71%, P = .03). Furthermore, p16 promoter hypermethylation with loss of p16 expression was more frequently observed in cases with lymph node metastasis (P = .006) and higher tumor stage group (P = .04). However, there was no significant difference in survival rate according to the status of p16 promoter methylation and/or p16 expression. CONCLUSION: Promoter hypermethylation is an important mechanism in the inactivation of the p16 gene in EBD carcinogenesis. Furthermore, the loss of p16 expression, with or without p16 gene promoter hypermethylation, is closely related to the tumor progression in EBD carcinomas.

Adenocarcinoma↗

Juxtaglomerular cell tumor of kidney with CD34 and CD117 immunoreactivity: report of 5 cases.

CONTEXT: Juxtaglomerular cell tumor is a rare renal neoplasm. Renin immunohistochemistry and electron microscopic documentation of rhomboid crystals are the primary methods of diagnosing this benign tumor. OBJECTIVES: In this retrospective study, we evaluated the morphologic, immunohistochemical, and ultrastructural features of 5 cases of juxtaglomerular cell tumor to determine the effectiveness of CD34 and CD117 immunohistochemistry for the diagnosis of this tumor. DESIGN: We reviewed 5 cases with clinical, histologic, immunohistochemical, and ultrastructural aspects. RESULTS: Three women and 2 men with a mean age of 37.8 years (range, 16-60 years) were included in this study. All patients presented with severe hypertension. All tumors were well circumscribed and ranged from 1.5 cm to 8.5 cm (mean, 4.4 cm). On light microscopic examination, we found solid sheets and nests of tumor cells with oval-to-round nuclei and eosinophilic cytoplasm. Low-power microscopic examination disclosed a hemangiopericytic vascular pattern. Immunohistochemistry results were as follows: vimentin (positive), renin (weakly positive), smooth muscle actin (focal immunoreactivity), and cytokeratin (negative). All 5 tumors were immunoreactive for CD34 and CD117. Electron microscopy revealed rhomboid crystals in the cytoplasm. Postoperatively, 4 patients were normotensive and 1 patient experienced persistent mild hypertension. CONCLUSIONS: Our findings indicate that immunohistochemistry for CD34 and CD117 are effective at diagnosing juxtaglomerular cell tumor. Juxtaglomerular cell tumor should be considered in the diagnosis of any renal tumors with epithelioid cells and negative initial cytokeratin immunohistochemistry.

Adenocarcinoma↗

Mucinous tubular and spindle cell carcinoma of the kidney with neuroendocrine differentiation: report of two cases.

We encountered 2 cases of mucinous tubular and spindle cell carcinoma (MTSCC) during a short time. In a 61-year-old man who had macroscopic hematuria for 1 month, the 14.5 x 14.0 x 12.0-cm resected tumor involved the right middle aspect of the renal parenchyma and compressed the renal pelvis. In an asymptomatic 47-year-old man, a renal tumor was found during an annual physical examination. The 3.5 x 3.0 x 2.0-cm tumor was located at the upper pole of the right kidney. The histologic findings in both cases were similar Tumors consisted of tightly packed, small, elongated tubules separated by pale mucinous stroma. The tumor cells were cuboidal to spindled with eosinophilic cytoplasm and low nuclear grade. Mitoses were few or nonexistent and without abnormal figures. Both tumors were immunoreactive for cytokeratin (CK) cocktail (AE1/AE3), high-molecular-weight CK (34betaE12), low-molecular-weight CK (35betaH11), CK7, epithelial membrane antigen, E-cadherin, and vimentin. The tumor cells also were reactive for neuron-specific enolase, chromogranin, and synaptophysin. The ultrastructure of the tumor cells contained abundant mitochondria, junctional complex, and dense-core neurosecretory granules. We present 2 additional cases of MTSCC showing typical morphologic features with neuroendocrine differentiation.

Adenocarcinoma, Mucinous↗

Association of fragile site-associated (FSA) gene expression with epithelial differentiation and tumor development.

A novel gene designated as fragile site-associated (FSA) gene was recently identified by positional cloning from the CHO 1q31 fragile site which plays an important role in regulating amplification of multidrug resistance (mdr1) gene in multidrug-resistant cells. FSA produces a message of approximately 16 kb which encodes an open-reading frame of 5005 amino acids. FSA shares sequence similarity with that in Caenorhabditis elegans lpd-3, a lipid storage gene. Using immunohistochemical staining and RNA in situ hybridization we report here that expression of FSA is associated with developmental programs of spermatogenesis and mammary gland in mice. Real-time RT-PCR results also support the upregulation of FSA expression in mammary gland development. Expression of FSA in many tissues including colon, skin, ovary, prostate, and bladder is mainly in the postmitotic, well-differentiated compartments. Moreover, levels of FSA expression are downregulated in tumors of these tissue origins. These results suggest that FSA also plays important roles in regulating mammalian epithelial growth and differentiation and tumor development.

ATP Binding Cassette Transporter, Subfamily B, Mem↗

Analysis of extrahepatic bile duct carcinomas according to the New American Joint Committee on Cancer staging system focused on tumor classification problems in 222 patients.

BACKGROUND: Although the sixth edition of the American Joint Committee on Cancer (AJCC) staging system for extrahepatic bile duct carcinoma was updated, the system has a problem on T classification due to its ambiguous definition of T1 as "tumor confined to bile duct histologically" and T2 as "tumor invading beyond the bile duct." METHODS: The authors considered the outermost part of the muscle layer or fibrous tissue as within the extrahepatic bile duct and considered the area starting from large clusters of adipose tissue as beyond the extrahepatic bile duct. After designing a precise definition of the extrahepatic bile duct wall, they analyzed the new AJCC staging system in 222 patients with of extrahepatic bile duct carcinomas. Then, other clinicopathologic variables for prognosis were evaluated using univariate and multivariate analyses. RESULTS: The 5-year survival rates for patients with tumors that were classified as T1, T2, T3, and T4 were 53.1%, 29.7%, 24.9%, and 0%, respectively. There was a significant difference in survival between patients with T1 tumors and T2 tumors (P < 0.05), but not between patients with T2 tumors and T3 tumors. Significant prognostic factors included depth of invasion (P < 0.005), lymph node metastasis (P < 0.005), and patient age (P < 0.05). CONCLUSIONS: Based on a proposed histologic definition, depth of invasion was practical for evaluating the prognosis of patients with middle and upper extrahepatic bile duct carcinomas. Therefore, the authors recommended changing the current pT1 and pT2 classifications to more precise pathologic terminology.

Adult↗

Phase II study of a liposome-entrapped cisplatin analog (L-NDDP) administered intrapleurally and pathologic response rates in patients with malignant pleural mesothelioma.

PURPOSE: To determine pathologic response rates to liposome-entrapped cis-bisneodecanoato-trans-R,R-1,2-diaminocyclohexane platinum(II) (L-NDDP) administered intrapleurally in patients with malignant pleural mesothelioma. PATIENTS AND METHODS: Thirty-three patients with malignant pleural mesothelioma and free-flowing pleural effusions received intrapleural L-NDDP once every 3 weeks at a dose of 450 mg/m2. Thoracoscopic evaluation with pleural biopsies was performed before therapy and then after every two cycles. The primary end point was pathologic response as determined by thoracoscopic biopsy. RESULTS: After at least two cycles, post-treatment pleural biopsy analysis was negative in 14 patients for a pathologic response rate of 42% (95% CI, 25% to 61%). Median survival was 11.2 months. There were three treatment-related deaths secondary to peritonitis, cellulitis at the thoracoscopy site, and empyema. Grade 3 nonhematologic toxicities included infection, fever, dyspnea, and anorexia, which occurred in five (15%), one (3%), one (3%), and one (3%) patients, respectively. There were no grade 4 nonhematologic toxicities. Grade 3 or 4 neutropenia, thrombocytopenia, and anemia occurred in five (15%), three (9%), and two (6%) patients, respectively. Two patients with pathologic responses subsequently underwent pleural decortication. Both surgical specimens revealed residual tumor in regions that were not in direct communication with the pleural space. CONCLUSION: Intrapleural L-NDDP therapy in this patient population is feasible with significant but manageable toxicity. Although pathologic responses are highly encouraging, areas of mesothelioma that are not in direct communication with the pleural space will evade drug exposure and limit efficacy in some patients. The optimal role of intrapleural L-NDDP therapy currently remains to be determined.

Adult↗

Neuroendocrine differentiation in extrahepatic bile duct carcinomas and its prognostic significance.

Neuroendocrine differentiation is known to be one of the prognostic factors in many carcinomas. However, the characteristics of neuroendocrine differentiation are not well elucidated in extrahepatic bile duct (EBD) carcinomas. One hundred ninety-four cases of EBD carcinomas were analyzed using immunohistochemistry with synaptophysin and chromogranin. The tumors were graded as degree 0, 1, and 2 when the positive tumor cells were 5% or less, 6% to 25%, and 26% or more, respectively. Immunohistochemical results were compared with clinicopathologic variables and survival rate. Synaptophysin and chromogranin were positive in 54 (27.8%) and 74 (38.1%) cases, respectively. Thirty-four cases (17.5%) were positive for both synaptophysin and chromogranin, 20 (10.3%) and 40 cases (20.6%) were positive only for synaptophysin and for chromogranin, respectively, and 100 cases (51.6%) were negative for both markers. There was a significant survival difference between overall synaptophysin-positive (median, 27 months) and synaptophysin-negative (38 months) groups (P < .05). However, there was no survival difference between chromogranin-positive and chromogranin-negative groups. There was a significant survival difference between the dual-positive expression to synaptophysin and chromogranin group (median, 21 months) and the dual-negative expression group (median, 35 months; P < .05). In summary, synaptophysin expression was an important prognostic factor because synaptophysin-positive cases showed a worse prognosis than synaptophysin-negative cases. The more tumor cells expressed chromogranin, the poorer the survival. Therefore, immunohistochemical studies for neuroendocrine differentiation may be helpful in routine pathological examinations for evaluating the survival and the prognosis of patients with EBD carcinomas.

Adenocarcinoma↗

Prognostic value of lymphovascular invasion in transitional cell carcinoma of upper urinary tract.

OBJECTIVES: To elucidate the prognostic significance of lymphovascular invasion (LVI) in patients with upper tract transitional cell carcinoma. METHODS: Of 86 patients with upper tract transitional cell carcinoma who underwent nephroureterectomy with bladder cuff (95%) or parenchymal-sparing (5%) surgery from 1991 to 2002, and who met our inclusion criteria, the data of 73 were available for pathologic review of LVI. The mean patient age was 59.1 years, and the median follow-up was 42.3 months. Using univariate and multivariate analyses, we determined the influence of multiple prognostic factors, including age, sex, tumor stage (T or N), tumor grade, and LVI, on the 5-year disease-specific and recurrence (local recurrence or distant metastasis)-free survival rates. We generated 5-year disease-specific and recurrence-free survival curves in terms of LVI in patients without lymph node involvement. RESULTS: The overall 5-year disease-specific and recurrence-free survival rate was 88% and 75%, respectively (n = 73). In univariate analysis, T stage, grade, and LVI significantly affected both survival rates. N stage was significant for 5-year recurrence-free survival. In multivariate analysis, LVI was the only significant predictor of recurrence-free survival, and no factor was significant for disease-specific survival. Of 10 patients with positive lymph nodes, 7 had LVI. In patients without lymph node involvement or Stage T4 disease (Ta-T3N0M0, n = 62), the 5-year disease-specific and recurrence-free survival rate was 98% and 94%, respectively, in the absence of LVI and 70% and 60%, respectively, in the presence of LVI (P = 0.0005 and P = 0.0007, respectively). CONCLUSIONS: LVI is an independent prognostic factor for recurrence-free survival in transitional cell carcinoma of the upper urinary tract. Because LVI is strongly associated with a poorer prognosis, systemic adjuvant therapy should be considered in the presence of LVI, even if the lymph nodes are not involved.

Carcinoma, Transitional Cell↗

Superficial vs deep pancreatic parenchymal invasion in the extrahepatic bile duct carcinomas: a significant prognostic factor.

Pancreatic invasion of the extrahepatic bile duct (EBD) carcinomas is known to have a poor outcome. We hypothesized that EBD carcinoma showing shallow invasion to the pancreas may have a better outcome than the usual deep pancreatic invasion. We divided 87 cases of the distal EBD carcinomas into superficial and deep pancreatic invasion groups according to degrees of the pancreatic invasion. The superficial pancreatic invasion group included cases with tumor abutting the pancreatic lobule or pancreatic parenchymal invasion equal to or less than 1 mm from the uppermost portion of the pancreatic lobule or tumors invading into the fibroadipose tissue between pancreatic lobules without parenchymal invasion. The deep invasion group consisted of tumors with more than 1 mm pancreatic parenchymal invasion. The cases with superficial pancreatic invasion showed significantly better survival rate than those with deep pancreatic invasion (P<0.001). Therefore, we recommend that a specific remark on the pathology report about the presence or absence of parenchymal invasion and the depth of invasion of the pancreas is required for managing patients and determining the prognosis. We also recommend that the current pT3 stage of distal EBD carcinomas be subdivided into superficial (pT3a) and deep pancreatic invasion (pT3b).

Adult↗

Endometrial stromal tumor with limited infiltration and probable extrauterine metastasis: report of a case.

Endometrial stromal nodule (ESN) is a tumor composed of cells closely resembling those of the endometrial stroma with minimal cytologic atypia. The most important criterion for the differential diagnosis from the endometrial stromal sarcoma (ESS) is a well-defined noninfiltrative expansile border. However, the definition of the ESN also includes a tumor with the presence of focal irregularities or fingerlike projections of the margin into the adjacent myometrium, none of which exceeds 2 to 3 mm. In some cases, however, it is difficult to differentiate marginal irregularities of ESN from "true invasion" of ESS. We described a case of extrauterine ESS that was associated with small intramyometrial stromal lesions with limited infiltration. The intramyometrial lesion could be definitionally categorized as ESNs. However, peritumoral fibroblastic band and inflammatory stromal reactions, irregular fingerlike projections, and multiple concurrent extrauterine ESS strongly suggested that these were small primary focus of ESS mimicking ESN. We propose that the patient with endometrial stromal tumor with limited infiltration should be more carefully followed than the usual ESN for possible metastasis and that a hysterectomy with meticulous histological examination of the specimen be performed before a diagnosis of primary extrauterine ESS is made, even in a case showing a grossly or radiologically normal uterus.

Adult↗

The number of metastatic lymph nodes in extrahepatic bile duct carcinoma as a prognostic factor.

The number of lymph nodes with metastases is known to be an important prognostic factor in carcinomas of many organs. The insufficient sampling of lymph nodes has also been associated with worse outcome in several types of carcinoma. However, the prognostic significance of lymph node dissection is not well characterized in extrahepatic bile duct (EBD) carcinomas. For 209 patients with EBD carcinoma, the total number of retrieved lymph nodes and the number of metastatic lymph nodes were evaluated, and other clinicopathologic variables were correlated with patient survival. The number of retrieved lymph nodes was not significantly correlated with survival in this study. The presence of metastasis to lymph nodes significantly decreased survival of patients with EBD carcinoma. The patients with 5 or more metastatic lymph nodes had significantly worse survival than those with 4 or less metastatic lymph nodes. To evaluate the prognosis of the patients with EBD carcinomas more precisely, the number of metastatic lymph nodes as well as the status of metastasis to lymph nodes should be examined and reported. Based on the present data, we propose that nodal classification should be divided into N1 (metastasis in 1 to 4 regional lymph nodes) and N2 (metastasis in 5 or more regional lymph nodes).

Adult↗