Aeree Kim

Primary Large Cell Neuroendocrine Carcinoma of the Breast: Radiologic and Pathologic Findings

Some breast neoplasms are classified as primary neuroendocrine carcinomas because they are positive for neuroendocrine markers. Although neuroendocrine carcinomas can originate from various organs of the body, primary neuroendocrine carcinomas of the breast are extremely rare. The diagnosis of primary neuroendocrine carcinoma of the breast can only be made if nonmammary sites are confidently excluded or if an in situ component can be found. Here we report a primary large-cell neuroendocrine carcinoma (LCNL) involving the left breast. Breast ultrasonography revealed a lobulated, heterogeneous, low-echoic mass in the left breast, and the lesion ap-peared as a well-defined, highly-enhancing mass on a chest computed tomography scan. Ultrasound-guided core needle biopsy was performed on the mass, and primary LCNC was confirmed by histopathologic examination.

Peutz-Jeghers syndrome with multiple genital tract tumors and breast cancer: A case report with a review of literatures

We report here on the multiple genital tract neoplasms in a 41-yr-old Korean woman with Peutz-Jeghers Syndrome (PJS). The patient presented with lower abdominal pain. Her previous medical history was PJS and breast cancer. Pelvic ultrasound showed a multilocular cyst at the right adnexal region, diagnosed as bilateral ovarian mucinous borderline tumors. An ovarian sex cord tumor with annular tubules was incidentally diagnosed together with a minimal deviation adenocarcinoma of the uterine cervix and mucinous metaplasia of both the Fallopian tubal mucosa and the endometrium. Although the cases of multiple genital tract tumors with PJS has rarely been reported, the present case appears to be the first in Korea in which the PJS syndrome was complicated by multiple genital tract tumors and infiltrating carcinoma of the breast. The clinical significance of the multiple genital tract tumors and breast cancer associated with PJS is reviewed.

Fast-Growing Pseudoangiomatous Stromal Hyperplasia of the Breast: Report of a Case

Pseudoangiomatous stromal hyperplasia (PASH) is a rare type of benign mesenchymal proliferative disease of the breast. Histologically, it is composed of a proliferation of spindle cells with inter-anastomosing vascular-like arrangement in the interlobular or interductal stroma. Clinically, pseudoangiomatous stromal hyperplasia is usually found in premenopausal women as a discrete, painless mass, which is firm and movable. We report a case of pseudoangiomatous stromal hyperplasia of the breast, which mimicked a malignant mass in that it grew rapidly and ultrasonography showed a lobulating contoured heterogeneous echotexture.

Comparison of serum levels and the placental expression of resistin between patients with preeclampsia and normal pregnant women.

Objective. The aim of this study was to evaluate serum resistin levels in women with preeclampsia compared to those in normal pregnant women and normal non-pregnant women, and to examine placental resistin expression. Methods. Serum resistin levels were measured by enzyme-linked immunosorbent assay and placental resistin expression was determined by immunohistochemistry. Results. Serum resistin levels were significantly elevated in women with preeclampsia compared to normal pregnant women and non-pregnant women. There was no significant difference in placental resistin expression. Conclusion. The placenta may not be the origin of the resistin that contributes to increased serum levels in women with preeclampsia.

nm23-H1 Protein Expression and Gene Mutation in 150 Patients with Non-Hodgkin' s Lymphomas

The metastasis-suppressing role of the nm23 gene in the metastatic spread of malignant tumor is still debated. We examined the nm23-H1 protein expression and gene mutation in non-Hodgkins lymphomas to compare with the clinicopathologic parameters. The expression of nm23-H1 protein was immunohistochemically examined in 150 cases of non-Hodgkins lymphomas; 85 diffuse large B cell lymphomas (DLBCL), 18 marginal zone B cell lymphomas (MZL), 3 mantle cell lymphomas, 25 peripheral T cell lymphomas, not otherwise specified (TCLNOS), and 19 NK/T cell lymphomas (NK/T). Eighty-one cases (58 DLBCL, 6 MZL, 4 TCLNOS, and 13 NK/T) were studied for nm23-H1 gene mutation in exon 1 to 5. The high expression of nm23-H1 protein was associated with the high IPI score (p=0.019) and the low survival rate of the patients (p=0.0039). The gene mutation of nm23-H1 was detected in 10.3% of DLBCL and 30.7% of NK/T; but none in MZL and TCLNOS. The mutation was found in exon 1 in 5 cases, exon 2 in two cases, exon 4 in one case and both exon 1 and 2 in two cases. Our results suggest that the expression of nm23-H1 protein can be used as a poor prognostic marker in non-Hodgkins lymphomas, and the mutational change of gene may operate in the lymphomagenesis.

Infiltration of intratumoral T cells and regulatory T cells are associated with p53 expression and ER status in early breast cancer: a Korean breast cancer study.

CTRC-AACR San Antonio Breast Cancer Symposium: 2008 AbstractsnnAbstract #5049 nnBackground: Immune responses, such as rich lymphocyte infiltrate, have shown associated with improved clinical outcomes in patients with breast cancer. Recently, number of tumor-infiltrating regulatory T cell has been identified as a poor prognostic marker. There is, however, not enough data evaluating the associations between the clinicopathologic factors and quantity or quality of TILs in Asian breast cancer patients. Material and methods: CD4-, CD8-, and Foxp3-positive tumor-infiltrating lymphocytes (TILs) were detected by immunohistochemistry using the paraffin-embedded samples from the 40 patients with early stage (I-III) breast cancer. Expression status of ER, PR, HER-2, p53, and Ki-67 were also evaluated by immunohistochemistry. Clinical data, such as pathologic stage, patients age, were available for statistical analysis. Results: Statistically significant correlation between ER expression and CD8/CD4 ratio of the TILs (Spearman r=0.447, p=0.024) was observed. Other clinicopathlogical factors, such as PR, tumor size, nodal metastasis, tumor grade, did not show significant correlation with ratio of the TILs. Additionally, tumors with more dense accumulation of p53 protein were associated with recruitment of higher number of Foxp3-positive regulatory T cells (Spearman r=0.52, p=0.0002). Ki-67, a proliferation index of the tumor cells, was also statistically significantly associated with infiltration of regulatory T cells (Spearman r=0.46, p=0.019). Discussion: Our data showed that ER-positive tumors had higher ratio of CD8/CD4 TILs, which is opposite result from the previous studies. In addition, p53 overexpression and high proliferation index of the breast cancer were associated with high regulatory T cell infiltration, but not with total TIL. The role of the p53 overexpression of the tumor cells in determining immune balance and its prognostic implication will be evaluated in the future study.nnCitation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 5049.

Medullary Carcinoma of the Breast After Radiation Therapy for Hodgkin's Disease in a Young Woman: Report of a Case

A 28-year-old woman who had received mantle-field radiation therapy for Hodgkins disease (HD) almost 10 years earlier was referred to our hospital for investigation of a palpable mass in her left breast. Mammography, sonography, and fine-needle aspiration were done and the results showed medullary carcinoma of the breast, an uncommon type of breast cancer in young women. We review the literature on the secondary development of breast cancer after radiation therapy for HD.

An exactly solvable self-avoiding walks model

A self-avoiding walks model is studied in which the walker is, in addition to the usual self-avoiding condition, restricted not to make any turn which will put the walker in a direction rotated more than Phi max from any of the directions previously taken. Here, Phi max( Phi R where Phi R=2 pi - (the smallest exterior angle of the unit cell of the lattice under consideration). The generating function for the square lattice is obtained, and various properties such as the number of N-step walks, the total number of steps to given directions and the mean-square end-to-end distance are evaluated analytically. The model exhibits characteristics reminiscent of one-dimensional self-avoiding walks in all directions, while retaining the anisotropic effect of the direction of the first step.

Abstract P4-06-02: Changes in intrinsic subtype of breast cancer during tumor progression in same patient

Introduction: Hormone receptor(ER, PR), Epidermal growth factor receptor 2 (HER2) and Ki67 are important prognostic factors and key variables in classification of intrinsic subtype which is essential for selection of adjuvant therapy in breast cancer management. There have been previous reports that instability of hormonal and HER2 status during tumor progression. Recently breast cancer treatment guidelines recommended using intrinsic subtype for treatment option. Especially intrinsic subtypes were determined by using 4 immunohistochemical (IHC) assays that is ER (estrogen receptor), PR (progesterone receptor), HER2 and Ki67. The purpose of this study was to investigate whether the intrinsic subtype changes as tumor progresses from ductal carcinoma in situ (DCIS) to lymph node metastasisnnMethods : 90 cases of breast cancer were constructed with 2-mm core tissue microarrays (TMA). All cases simultaneously have DCIS, invasive carcinoma (IDC) and lymph node metastasis. IHC and Silver in situ hybridization (SISH) assay was performed on TMA. All of the cases after 2005 had informed consent from the patients for using their medical information and tumor tissues. Evaluation of hormone receptors expression was based on the Allred scoring method. For HER2, membranous staining was evaluated according to the guidelines of the American Society of Clinical Oncology/College of American Pathologists (ASCO/CAP). Using the results of the immunohistochemical analyses, tumors were classified into four subtypes. To define luminal A type is an ER positive and/or PR positive, HER2 negative and Ki67 low. As well as luminal B type is an ER positive and/or PR positive, HER2 positive or Ki67 high. HER2 type is HER2 positive, ER negative and PR negative and Ki67 low or high. Basal like type is classified as exhibited ER, PR, and HER2 negative.nnResults : Of the 90 cases, the lesions with DCIS showed 39 were luminal A, 24 were luminal B, 19 were HER2, and 8 were basal like. The lesions with IDC showed 31 with luminal A, 26 with luminal B, 23 with HER2, and 10 with basal like. Also, 28 were luminal A, 29 were luminal B, 21 were HER2, and 12 were basal like for lymph node metastasis. Overall 25% breast cancer change their intrinsic phenotype during progression.nnConclusions : This study demonstrated that a subset of breast cancers can change their intrinsic subtype during cancer progression. These changes have huge impact on patient prognosis and management because each subtype have own different optimized treatment options according to St Gallen and NCCN guideline.nnCitation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P4-06-02.

Apocrine carcinoma of the breast: clinical presentations, multimodality imaging findings and pathologic correlation.

CTRC-AACR San Antonio Breast Cancer Symposium: 2008 AbstractsnnAbstract #4029 nnBackground : Apocrine carcinoma (AC) of the breast is a rare malignant tumor and is lack of standardized criteria for the diagnosis. Thus clinicopathological features and radiologic findings have not been determined. We retrospectively analyzed the clinical presentation and the multimodality imaging findings of mammography, ultrasography and MRI and correlated with pathologic results. Materials and Methods : We retrospectively examined data on 850 patients who had been surgically treated for primary breast carcinoma between 2003 and 2008. Among them, there were 10 cases with the diagnosis of apocrine carcinoma. Ten patients underwent mammography and ultrasonography and six patients underwent MR imaging. Eight patients underwent pre-operative US-guided core needle biopsy. We analyzed the radiologic findings and pathologic results. Results : The present study showed that the frequency of apocrine carcinoma was 1.2%. Almost all patients were symptomatic and painless lump was the most common complaint. Patient ranged in age from 38 to 62 year (mean, 50.5 years). The mean lesion size was 1.9cm (range, 1.1-3.5cm). Common imaging features were as follows: mass or focal asymmetry without microcalcifications (n=7), mass with microcalcifications (n=3) on mammography; a mass with an round to irregular shape (n=9), indistinct-margin(n=8) on ultrasonography. On six dynamic contrast-enhanced MRI, enhancing masses in 3, mass with spotty nodular enhancement adjacent to the tumor in 3, which showed rapid enhancement and delayed washout pattern in five cases and plateau enhancement pattern in one case. Specifically, 3 patients had unilateral multifocal cancer. Two patients showed ipsilateral axillary lymphadenopathy. Pathologic examination revealed AC (n=3), AC with apocrine carcinoma in situ (n=3), apocrine carcinoma in situ (n=1) and, AC with intraductal component and EIC positivity (n=3). Mass with spotty nodular enhancement on MRI was correlated with intraductal component and EIC positivity. Conclusion : The radiologic findings of apocrine carcinoma of the breast are not specific. Occasionally, apocrine carcinoma shows mass with spotty nodular enhancement adjacent to the tumor on MRI and this finding is correlated with intraductal component and EIC positivity.nnCitation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 4029.