Inseok Park

Analysis of the Potent Prognostic Factors in Luminal-Type Breast Cancer

Purpose Luminal-type breast cancer has a good prognosis compared to other types, such as human epidermal growth factor receptor 2 and triple negative types. Luminal-type breast cancer is classified into luminal A and B, according to the proliferation index. We investigated the clinicopathological factors that affect the prognosis of the luminal-type subgroups. Methods We reviewed the medical records and the pathologic reports of 159 luminal-type breast cancer patients who were treated between February 2005 and November 2007. We divided luminal-type breast cancer into luminal A and B, according to Ki-67 (cutoff value, 14%) and analyzed the clinicopathologic factors, such as age at diagnosis, intensity score of estrogen receptor and progesterone receptor, histologic grade, and Bcl-2. Moreover, we compared the disease-free survival (DFS) of each group. Results In the univariate analysis, age (p=0.004), tumor size (p=0.010), lymph node metastasis (p=0.001), and Bcl-2 (p=0.002) were statistically significant factors in luminal-type breast cancer. In the multivariate analysis, lymph node (p=0.049) and Bcl-2 (p=0.034) were significant relevant factors in luminal-type breast cancer. In the subgroup analysis, the increased Bcl-2 (cutoff value, 33%) was related with a longer DFS in the luminal B group (p=0.004). Conclusion In our study, luminal A breast cancer showed a longer DFS than luminal B breast cancer, further, Bcl-2 may be a potent prognostic factor in luminal-type breast cancer.

Prognostic Significance of a Micropapillary Pattern in Pure Mucinous Carcinoma of the Breast: Comparative Analysis with Micropapillary Carcinoma

Background Mucinous carcinoma of the breast is an indolent tumors with a favorable prognosis; however, micropapillary features tend to lead to aggressive behavior. Thus, mucinous carcinoma and micropapillary carcinoma exhibit contrasting biologic behaviors. Here, we review invasive mucinous carcinoma with a focus on micropapillary features and correlations with clinicopathological factors. Methods A total of 64 patients with invasive breast cancer with mucinous or micropapillary features were enrolled in the study. Of 36 pure mucinous carcinomas, 17 (47.2%) had micropapillary features and were termed mucinous carcinoma with micropapillary features (MUMPC), and 19 (52.8%) had no micropapillary features and were termed mucinous carcinoma without micropapillary features. MUMPC were compared with 15 invasive micropapillary carcinomas (IMPC) and 13 invasive ductal and micropapillary carcinomas (IDMPC). Results The clinicopathological factors of pure mucinous carcinoma and MUMPC were not significantly different. In contrast to IMPC and IDMPC, MUMPC had a low nuclear grade, lower mitotic rate, higher expression of hormone receptors, negative human epidermal growth factor receptor 2 (HER2) status, lower Ki-67 proliferating index, and less frequent lymph node metastasis (p < .05). According to univariate analyses, progesterone receptor, HER2, T-stage, and lymph node metastasis were significant risk factors for overall survival; however, only T-stage remained significant in a multivariate analysis (p < .05). Conclusions In contrast to IMPC and IDMPC, the micropapillary pattern in mucinous carcinoma does not contribute to aggressive behavior. However, further analysis of a larger series of patients is required to clarify the prognostic significance of micropapillary patterns in mucinous carcinoma of the breast.

Risk Factors of a Pulmonary Thromboembolism After Colorectal Surgery

Purpose Previous studies have revealed that predictors and risk factors of pulmonary thromboembolism (PTE) are malignancy, immobilization, diabetes, and obesity in the postoperative patients. However, in patients undergoing colorectal cancer, studies of PTE have not been enough. Thus, we investigated the risk factors of PTE related to colorectal surgery. Methods From January 2009 to October 2014, 312 patients received colorectal surgery without other organ resection. The postoperative patients with PTE were 14 (4.5%), and they were classified by sex, age, and stage as a 1:3 paired match to the control group. A multiple logistic regression was performed to identify which factors were associated with PTE. Results One patient was in stage I, 3 in stage II, 9 in stage III, and 1 in stage IV. In the binary logistic regression analysis, history of diabetes mellitus (odds ratio, 6.498; P = 0.031) and being overweight (odds ratio, 10.018; P = 0.014) were independent risk factors for PTE in patients undergoing colorectal cancer. Conclusion A history of diabetes mellitus and being overweight were independent risk factors of PTE after colorectal cancer.

A case of erythema multiforme followed by herpes zoster

A 59-year-old man presented with pruritic erythematous to violaceous patches on the whole body that had first appeared 1 week previously. Mucosa was intact and he had no other medical problem including herpes simplex virus (HSV) infection and had not taken any medication for several months. Physical examination revealed typical target lesions, which were symmetrically distributed over the entire body (Fig. 1). Histopathologic findings demonstrated interface dermatitis with dyskeratosis (Fig. 2). With the typical clinical and histopathologic features, erythema multiforme (EM) minor was diagnosed. Painful erythematous grouped vesicles appeared 4 days later on the right T9 and T10 dermatomes (Fig. 3). The serologic test showed positive for varicella-zoster virus (VZV) IgM and IgG which confirm the diagnosis of herpes zoster (HZ). We prescribed intravenous acyclovir in addition to systemic steroid for erythema multiforme, which improved the skin lesion. Erythema multiforme is an acute mucocutaneous syndrome related to infection or medication with diverse mucocutaneous manifestation [1]. Most commonly identified predisposing factor is HSV [2]. HZ is the reactivation of latent VZV in sensory ganglia [3] which is rarely reported to be associated with erythema multiforme [4]. Twelve cases of VZV-associated EM have been reported in the literature. VZV infection preceded EM in ten cases and followed EM in the remaining two cases [1] as present case. The median interval between the onsets of the two distinct lesions was 9.3 days. HSV infection was excluded with negative serology for HSV and clinical features. Although incidental coincidence of EM and HZ could not be excluded, the VZV is thought to be a more plausible causative factor regarding temporal aspects.

Perioperative Serum Carcinoembryonic Antigen Ratio Is a Prognostic Indicator in Patients With Stage II Colorectal Cancer

Purpose The aim of this study was to evaluate whether the perioperative carcinoembryonic antigen (CEA) ratio could be used as a determinant for adjuvant therapy after curative surgery in stage II colorectal cancer. Methods Data for 119 patients with stage II colorectal cancer who underwent radical surgery between 2010 and 2013 were collected. The perioperative CEA ratio was defined as the postoperative/preoperative serum CEA level, and the patients were grouped according to their perioperative CEA ratios: high ratio (≥0.5) and low ratio (<0.5). Overall survival rates were calculated, and their prognostic significances were analyzed. Results The overall survival rates of the high and the low perioperative CEA groups were 68.2% and 86.8%, respectively (P = 0.033). In patients with normal preoperative CEA levels (<5 ng/mL), the high perioperative CEA ratio group showed a worse survival rate than the low perioperative CEA ratio group (71.7% vs. 100.0%, P = 0.007). In patients with high preoperative CEA levels (≥5 ng/mL), the high perioperative CEA ratio group showed a worse survival rate than the low perioperative CEA ratio group (33.3% vs. 75.0%, P = 0.036). In the multivariate analysis, perioperative CEA ratio (P = 0.046), age (P = 0.034), and venous invasion (P = 0.015) were independent prognostic factors for survival. Conclusion The perioperative CEA ratio is a prognostic indicator for stage II colorectal cancer. Patients with normal preoperative serum CEA levels might also be considered for adjuvant therapy if their perioperative CEA ratios are higher than 0.5.

Predictive Factors Affecting the Clinical Course of Patients With Diverticulitis: Who Needs Hospital Management?

Purpose The aim of this study is to determine the predictable factors that affect the clinical course, especially the hospital stay, the operation performed, and to determine factors that will be helpful in deciding whether in-hospital or outpatient treatment is appropriate. Methods We retrospectively collected medical data for patients who had been diagnosed with acute diverticulitis at Inje University Sanggye Paik Hospital between January and December 2016. In total, 117 patients were enrolled in this study. We examined clinical factors, including age, sex, body mass index, pain, body temperature, white blood cell count, C-reactive protein, nil per os (NPO) time, hospital duration, computed tomography (CT) findings, location of diverticulitis, operation performed, and presence of comorbidity (e.g., hypertension and diabetes mellitus). Results In the multivariate analysis, the statistically significant factor related with hospital duration was the presence of perforation on the CT scan (P < 0.001). Longer NPO time was related with pain score (>7) (P = 0.011). Operations were mainly performed in patients with left-sided colonic diverticulitis (P = 0.012). Conclusion We suggest a perforation finding on the CT scan, a severe pain score at least above 7 on a numeric rating pain scale, and a left-sided lesion are absolute indications for in-hospital management.