In Soon Kim

Deformation twins in pure titanium processed by equal channel angular pressing

Abstract The structure of {1 0 1 1} deformation twins in commercially pure titanium processed by equal channel angular pressing was examined by high resolution electron microscopy in an attempt to explain the accommodation of shear strain imposed by the pressing. The results indicate that various twinning dislocations were activated to produce twins that accommodated the imposed shear strain.

Telomerase activity and its clinicopathological significance in gastric cancer

In order to assess the role of telomerase in development of malignant gastric cancer, we measured the telomerase activity in gastric cancer tissues and normal tissues obtained from 95 patients by employing recently developed sensitive PCR (polymerase chain reaction)-based telomerase assay (telomeric repeat amplification protocol, TRAP). We also investigated how telomerase activity related to other clinicopathological findings including DNA ploidy and K-RAS gene point mutation. The telomerase activity was present in 85 of the 95 gastric cancer tissues, whereas we detected no telomerase activity in any normal tissue. The incidence of telomerase activity in gastric cancer tissues was not correlated to age, sex, tumour stage, histological grade, DNA ploidy or K-RAS mutation. Disease-free or overall survival of patients having tumours with detectable telomerase activity was not significantly different from that of those without telomerase activity. These findings suggest that telomerase may play a key role in the establishment and progression of the gastric cancer and further studies will be needed to elucidate the biological role of telomerase in gastric cancer.

Burkitt's Lymphoma Presenting as Ileocaecal Intussusception in Systemic Lupus Erythematosus

Abstract: Patients with systemic lupus erythematosus (SLE) are reported to have an increased risk of malignancy, especially lymphoproliferative disorders. We decribe the occurrence of ileocaecal intussusception secondary to Burkitt’s lymphoma in a patient with SLE. A 23-year-old woman, who had been diagnosed with SLE 2 years ago, developed intermittent abdominal pain with a palpable mass. Computed tomography and a double-contrast barium enema showed a lobulated mass with intussusception at the ileocaecal junction. Right hemicolectomy and splenectomy was performed after histopathological examinations on colonoscopic biopsy revealed Burkitt’s lymphoma. Fourteen months after chemotherapy, there is no evidence of recurrence of the Burkitt’s lymphoma. When a patient with SLE has abdominal complaints, besides serositis, lupus enteritis such as peptic ulcer disease, mesenteric vasculitis with or without complications and pancreatitis, we have to consider intussusception secondary to gastrointestinal lymphoma as one of the differential diagnoses. Therefore, we should thoroughly investigate patients with SLE presenting with abdominal pain and not simply consider it a feature of lupus enteritis until other causes have been ruled out.

A case of primary plasmacytoma of lymph nodes.

Extramedullary plasmacytoma may originate in any organ, either as a primary tumor or as a facet of systemic multiple myeloma. These solid lesions most commonly affect the upper respiratory tract, gastrointestinal and urogenital tract, skin, and lung. Primary plasmacytoma of the lymph node is a rare hematologic neoplasm, which usually manifests as an enlargement of the cervical lymph nodes with no evidence of any other plasma cell dyscrasia. A 56-year-old man was admitted, due to the presence of multiple palpable masses in the right cervical and submandibular areas. Surgical resection revealed plasmacytoma of the lymph nodes. According to our full work-up, no evidence of the systemic involvement of plasma cell dyscrasia was discovered and thus, the diagnosis of primary plasmacytoma of the lymph node was made. Radiotherapy was administered, and the remnant mass was reduced substantially, to 1×2 cm in size. The patient was scheduled to be monitored by a PET CT scan, as well as by a neck CT scan.

A Case of Avascular Necrosis of the Femoral Head as Initial Presentation of Chronic Myelogenous Leukemia

Chronic myelogenous leukemia (CML) is a malignant clonal disorder of hemopoietic stem cells characterized by abnormal proliferation and accumulation of immature granulocyte. Leukostasis is one of the complications of CML and is characterized by partial or total occlusion of microcirculation by aggregation of leukemic cells and thrombi leading to respiratory, ophthalmic or neurologic symptoms. We experienced a rare case of avascular necrosis of the femoral head as the initial presentation of chronic myelogenous leukemia. A 24-year-old male patient was admitted to our hospital with pain in the right hip joint. The patient was diagnosed to be suffering from chronic myelogenous leukemia by packed marrow with granulocytic and megakaryocytic hyperplasia and the presence of Philadelphia chromosome. The right hip joint pain was attributed to avascular necrosis of the femoral head. And the avascular necrosis could be considered as the complication of chronic myelogenous leukemia due to microcirculatory obstruction of the femoral head. The avascular necrosis of the right femoral head was treated with bipolar hemiarthoplasty.

Primary pulmonary plasmacytoma presenting as multiple lung nodules.

To the Editor, Extramedullary plasmacytoma is a plasma cell tumor arising outside the bone marrow and usually occurs as a solitary tumor in the upper respiratory tract, such as the pharynx, paranasal sinuses, nasal cavity, or oral cavity [1]. Other cases develop in the lymph nodes, skin, gastrointestinal tract, genitourinary tract, and other regions. Primary pulmonary plasmacytomas are very rare and usually present as solitary lung nodules or masses [2]. Unusual cases manifest as diffuse pulmonary infiltration [3,4]. We describe here a unique case of primary pulmonary plasmacytoma, which presented as multiple lung nodules during regular screening in a patient with systemic lupus erythematosus. A 26-year-old woman was admitted and referred to the pulmonary service for an evaluation of multiple lung lesions on simple chest radiographs. The patient was diagnosed with systemic lupus erythematosus 11 years ago and had been treated with methotrexate, hydroxycholoroquine, and deflazacort. At the time of the systemic lupus erythematosus diagnosis, she was treated successfully for pulmonary tuberculosis with antituberculosis medication, and follow-up chest radiographs showed no active lung lesions. A chest radiograph, taken 3 months before admission as a screening for chest abnormalities, showed infiltrative lesions in both lower lung fields and focal consolidation in the right lower lobe but no specific change in her condition. Chest radiographs just before admission showed a slight aggravation of multiple patchy opacities. On admission, she presented slight sputum without other respiratory symptoms such as dyspnea or chest pain, and a review of systems was unremarkable. Vital signs were normal and there were no abnormal findings in the chest. A chest computed tomography (CT) scan revealed ill-defined nodular opacity and consolidation in both lungs (Fig. 1). Nodular lesions were scattered in both lung parenchymas and some were accompanied by ground glass opacities. A CT-guided needle aspiration biopsy specimen was non-diagnostic and, therefore, a subsequent surgical wedge resection via a thoracotomy was performed. The biopsy samples showed two relatively poorly demarcated round grayish white colored masses measuring 1.2 and 3 cm in diameter, respectively. A microscopic examination demonstrated diffuse infiltration of plasma cells (Fig. 2A), which were positive for lambda chain immunohistochemical staining (Fig. 2B). Serum protein and albumin levels were 8.2 g/dL and 3.4 g/dL, respectively. An electrophoretic analysis of serum proteins showed decreased albumin and an increased gamma globulin region without the M component. Serum immunoelectrophoresis detected no abnormal findings. Urine protein electrophoresis and immunoelectrophoresis were normal. An examination of serum immunoglobulins showed the following: IgG, 2,280 mg/dL; IgM, 1,540 mg/dL; IgA, 312 mg/dL; and IgD, 11 mg/dL. A peripheral blood white cell count was 3,800/mm3, and hemoglobin was 9.5 g/dL. A morphological analysis of the peripheral blood smear showed a slight microcytic and hypochromic pattern. A bone marrow examination revealed a normocellular pattern with about 50% cellularity and no increase in the plasma cell proportion. No hypercalcemia or increase in serum creatinine was noted. Chemotherapy with melphalan and prednisolone was initiated, because multiple plasmacytoma nodules were scattered in both lungs. Chest radiographs and CT scans taken after 4 months of pharmacological treatment showed near complete resolution of previously observed ill-defined nodular lesions and ground glass opacities. Figure 1 Chest computed tomography (CT) scan on admission showing ill defined nodular opacities and consolidations in both lungs. Figure 2 Histology of lung nodule showing diffuse infiltration of plasma cells (A, HE B, immunohistochemical stain for lambda chain, × 200). Primary plasmacotyma in the lung is a very rare form of extramedullary plasmacytoma. Clinical manifestations and courses are not well defined because of the small number of reported cases. A review article of 19 cases reported that about half of cases are asymptomatic, whereas the others developed cough, dyspnea, chest pain, and fever, mostly due to the mass effect [2]. The age of incidence was relatively old, and most cases developed in subjects > 40 years old. A slight male preference of incidence was noted with a ratio of 1.4:1. Contrary to previous cases, our patient was female and 24 years old at the time of diagnosis. The diagnosis of primary pulmonary plasmacotyma is based on the histological confirmation of plasma cell infiltration in lung lesions. Additionally, it requires normal bone marrow, normal skeletal survey, no related organ or tissue impairment, and no M protein in serum and/or urine. Thus, the current case fulfilled the diagnostic criteria. Typical lung lesions in previous primary pulmonary plasmacotyma cases were solitary lung nodules or masses, and they occurred in the hilar or parenchymal areas with slight preference to the lower lobes [2]. These tumors were round or ovoid shape, with sizes of 1.5-6 cm. They appeared as homogeneous nodules or masses with smooth and well delineated margins. The most common form of primary pulmonary plasmacotyma is a solitary tumor but different radiographic presentations have been reported. Horiuchi et al. [3] reported a case in a 45-year-old Japanese woman with bilateral reticulonodular infiltration in the lower lobes accompanied by fever, dyspnea, and hypoxemia. In a case report by Lazarevic et al. [4], bilateral reticulonodular opacities in both lungs were noted in an elderly male, who developed malaise, weight loss, and dry cough without fever or dyspnea. In addition to diffuse lung infiltrates in both cases, two separate plasmacytoma masses involving bilateral lungs were reported [5]. In the current case, primary pulmonary plasmacotyma presented as multiple lung nodular opacities in both lungs, which were detected by routine follow-up chest radiographs. These lesions increased in size over time without causing definite symptoms except for slight sputum. The present case is the first report of primary pulmonary plasmacotyma presenting as multiple lung nodules in both lungs. These findings suggest primary pulmonary plasmacotyma should be considered in the differential diagnosis of multiple lung nodules. While most cases of solitary pulmonary plasmacytoma are treated with surgical resection and/or irradiation [2], the previous two cases of diffuse pulmonary infiltration underwent combination chemotherapy including melphalan and prednisolone [3,4]. The clinical responses were relatively good, although the long-term response to chemotherapy remains to be evaluated. Similar to cases of diffuse lung infiltration, the patient in this study was also treated with melphalan and prednisolone, and near complete radiological resolution was observed after six cycles of treatment.

Clinical Prognostic Factors and Treatment Outcome of Aggressive Non-Hodgkin's Lymphoma in Elderly Patients

PURPOSE The aim of this study was to determine the prognostic factors and treatment outcome of for elderly patients (age>or=60 at time of diagnosis) with aggressive non-Hodgkins lymphoma (NHL). MATERIALS AND METHODS We analyzed 52 patients diagnosed with aggressive NHL between January 1990 and May 2000. RESULTS The patients median age was 69 years (range: 60~92). Thirty-two (61.5%) patients were male. Patients included those with diffuse large B cell (53.8%), peripheral T cell (23.1%), AILD-like T-cell (3.8%), angiocentric (3.8%), mantle cell (3.8%), Burkitts lymphoma (3.8%), and others (7.9%). International prognostic index (IPI) parameters were as follows: elevated LDH (60.8%), ECOG performance status>or=2 (32.7%), advanced stage (III/IV, 62.7%), and extranodal site>or=2 (11.5%). Twenty-six (50.0%) patients demonstrated a high and high-intermediate IPI. The median follow-up for surviving patients was 26.6 months. The overall median survival was 22.7 months and the 2-year survival rate was 46.9%. Among the 49 patientstreated with chemotherapy, 28 (57.1%) patients achieved complete remission (CR). Univariate analysis identified 8 prognostic factors for overall survival: age<70 (P=0.04), low/low-intermediate IPI (P=0.02), good performance (P= 0.04), normal WBC (P=0.008), normal Hb (P=0.02), normal LDH (P=0.04), CR on first line therapy (P<0.001), and absence of B symptom (P=0.001). In the multivariate analysis, the independent prognostic factors for improved overall survival were age <70 (P=0.03), low/low-intermediate IPI (P=0.03), normal WBC (P=0.006), and CR on first line therapy (P<0.001). CONCLUSION In our experience, even elderly patients (>or=60 years) with aggressive NHL can be successfully treated with conventional chemotherapy and the important prognostic factors for survival are age, IPI, initial WBC, and CR on first line treatment.

A Case of Primary Intestinal T-Cell Lymphoma Involving Entire Gastrointestinal Tract: Esophagus to Rectum

Primary intestinal T-cell lymphoma is a rare disease entity, which is approximately 10% to 25% of intestinal lymphomas, and most of the lymphomas occur in the small intestine. We report here a case of a 56-year-old woman who has been suffering from chronic diarrhea and weight loss for 6 months. Abdominal CT scan and small bowel series showed diffuse wall thickening of the small bowel. Gastroscopic examination showed diffuse erythematous lesions on the esophagus and small gastric ulcerations on the antrum of the stomach, and colonoscopic examination also showed multiple punched-out ulcerations and erosions on the entire colon, including the sigmoid colon to the terminal ileum. Diffuse infiltration of CD 3 positive lymphoma cells was found on biopsy. The patient was diagnosed as primary intestinal T-cell lymphoma with diffuse involvement of the entire gastrointestinal tracts from the esophagus to the rectum. Although the patient received systemic combination chemotherapy and achieved partial response initially, the lymphoma relapsed repeatedly.

A case of severe chronic active Epstein-Barr virus infection with T-cell lymphoproliferative disorder.

The Epstein-Barr virus (EBV) is an ubiquitous human herpesvirus that mainly infects B-cells. After primary infection, EBV can induce both replicative (productive or lytic) and latent (persistent) infections in lymphocytes. Latent EBV infection is linked to the development of severe chronic active EBV (SCAEBV) infection with T-cell/natural killer cell (T/NK-cell) lymphoproliferative disorder (LPD) [1]. SCAEBV infection with T-cell LPD is characterized by persistent or recurrent infectious mononucleosis (IM)-like symptoms: high titers of anti-EBV antibodies, the presence of EBV genomes in affected tissues, including peripheral blood, chronic illness that cannot be explained by other known diseases, and monoclonal proliferation of EBV-infected T-cells [2]. In here, we report a case of SCAEBV infection in which T-cell LPD was confirmed by lung biopsy with videoassisted thoracic surgery (VATS) in an adult Korean patient with a history of follicular lymphoma (FL). A 57-year-old man was admitted to Korea Cancer Center Hospital with the chief complaint of intermittent fever for four months. He had lost 5 kg weight over a period of 2 months and had a sore throat, night sweating, and intermittent uveitis. Approximately 4 years prior to his admission to our hospital, he was diagnosed with FL (histologic grade 3, Ann Arbor stage IIA) involving both tonsils and both internal jugular chain lymph nodes. A complete response (CR) was achieved after six cycles of therapy with rituximab, cyclophosphamide, vincristine, and prednisolone followed by radiation therapy, and the CR status was maintained by the patient for 3 years. Therefore, we initially suspected FL recurrence or FL transformation to diffuse large B-cell lymphoma (DLBL). Imaging studies revealed the presence of multi-

Combination Chemotherapy of Oxaliplatin and Capecitabine in Patients with Metastatic Colorectal Cancer: a Pilot Study.

PURPOSE To evaluate the efficacy and toxicity of oxaliplatin and capecitabine in patients with metastatic colorectal cancer. MATERIALS AND METHODS Between December 2001 and April 2003, fourteen patients were enrolled in this study. Oxaliplatin, 80 mg/m(2), was administered intravenously on day 1, and capecitabine, 1, 250 mg/m(2) bid po (total daily dose 2, 500 mg/m(2)), was given on days 1~14 of 3 week cycles. RESULTS The median age of the patients was 57 years (range: 41~74), and the most common sites of metastasis were liver, lung or lymph node. Of the 12 evaluable patients, the overall response rate was 41.7%, but with no complete response. The median response duration and median progression free survival of 12 patients were 42 and 24.4 weeks, respectively. The median overall survival was not reached. A median 6 (range: 1~9), and a total 80, cycles were administered to 14 patients. 80 cycles were evaluable for toxicity. The most common hematological toxicities were NCI grades I/II anemia (45%), leucopenia (33.75%) and thrombocytopenia (17.5%). The most common non-hematological toxicities were nausea/ vomiting (28.75/5%) and neurotoxicity (8.75%). Hand and foot syndrome was noted in only 3.75%. There was no life-threatening toxicity. CONCLUSION Oxaliplatin and oral capecitabine combination chemotherapy showed significant activity and favorable toxicity in patients with metastatic colorectal cancer. Further studies, with larger numbers of patients and long-tern follow-up will be needed.