Min Koo Lee

The Effects of Preoperative 18F-FDG PET/CT in Breast Cancer Patients in Comparison to the Conventional Imaging Study

Purpose There have been recent studies of the 18F-fluorodeoxyglucose positron emission tomography and computed tomography (18F-FDG PET/CT) in the staging, detection, and follow-up of the breast cancer occurrence and recurrence. There was controversy concerning the use of 18F-FDG PET/CT for staging primary breast cancer. In this study, we investigated the potential effects of 18F-FDG PET/CT in the initial assessment of patients with primary breast cancer. Methods From January 2008 to December 2009, 154 consecutive biopsy-proven invasive breast cancer patients were enrolled in this study. Patients underwent conventional imaging studies including mammography, breast ultrasonography (USG), and magnetic resonance imaging for local assessment, and plain chest X-ray, liver USG, and bone scan to rule out distant metastasis. All 154 patients underwent 18F-FDG PET/CT in the initial assessment. Results 18F-FDG PET/CT did not detect primary breast lesions in 16 patients with a sensitivity of 89.6% and detected only 5 multiple lesions (12.5%) out of 40 cases. Histologically confirmed axillary lymph node (LN) metastases were in 51 patients, and the sensitivity and specificity of 18F-FDG PET/CT to detect metastatic axilla were 37.3% and 95.8%, respectively; whereas the corresponding estimates of USG were 41.2% and 93.7%, respectively. Eleven extra-axillary LN metastases were found in eight patients, and seven lesions were detected by 18F-FDG PET/CT only. The sensitivity and specificity of 18F-FDG PET/CT in detecting distant metastasis were 100% and 96.4%, respectively; whereas the sensitivity and specificity of the conventional imaging were 61.5% and 99.2%, respectively. Conclusion 18F-FDG PET/CT cannot be recommended as a primary diagnostic procedure in breast cancer, but it has the potential to be used as an additional imaging tool for the detection of axillary metastasis, distant metastasis, and extra-axillary LN metastasis. 18F-FDG PET/CT cannot solely replace the conventional diagnostic procedure in primary breast cancer. The best approach may be the combination of different imaging modalities.

Hepatic perivascular epithelioid cell tumor (PEComa): a case report with a review of literatures

Hepatic perivascular epithelioid cell tumors (PEComas) are very rare. We report a primary hepatic PEComa with a review of the literature. A 56-year-old women presented with a nodular mass detected during the management of chronic renal failure and chronic hepatitis C. Diagnostic imaging studies suggested a nodular hepatocellular carcinoma in segment 5 of the liver. The patient underwent partial hepatectomy. A brown-colored expansile mass measuring 3.2×3.0 cm was relatively demarcated from the surrounding liver parenchyma. The tumor was mainly composed of epithelioid cells that were arranged in a trabecular growth pattern. Adipose tissue and thick-walled blood vessels were minimally identified. A small amount of extramedullary hematopoiesis was observed in the sinusoidal spaces between tumor cells. Tumor cells were diffusely immunoreactive for human melanoma black 45 (HMB45) and Melan A, focally immunoreactive for smooth muscle actin, but not for hepatocyte specific antigen (HSA).

The Importance of a Multidisciplinary Approach to High Voltage Electrical Injuries

A 36-year-old female participated in paragliding during a visit to Jeju island. Due to a rogue wind gust, her and pilot crashed into a high voltage (22000 V) electrical wire. Her ankle was hung from the electrical wire. The pilot was in cardiac arrest upon arrival of emergency personnel at the scene. Her initial vital signs were 128/81mmHg-121/min-20/min-37.8°C, and her EKG was nonspecific. She complained of severe pain in her left-side extremities. We found a severe burn (grade III-IV) on her left upper and lower extremities (Fig. 1.). We inserted a right subclavian central catheter and an additional internal jugular hemo-catheter for vigorous hydration and preparation of hemodialysis. Traumatologists performed an escharotomy on her upper and lower extremities and called for an orthopedic surgeon. The traumatologist and orthopedic doctor elected to perform an emergency operation (fasciotomy of the left upper limb and above-knee amputation of the left lower limb). Her initial urine myoglobulin level was 1923 mcg/L. After resuscitation, she was sent to the operation room. One orthopedic doctor and two traumatologists performed an above-knee amputation and fasciotomy, simultaneously (Fig. 2.). For pain control and facilitation of further operational procedures, we kept the patient ventilated and under continuous infusion of sedatives and analgesics. After the first operation, we consulted a nephrologist and applied renal replacement therapy to her. We debrided and irrigated the necrotic tissue. Finally, she was transferred to the burn center for advanced burn management. Treatment Progression in Trauma eISSN: 2508-8033 pISSN: 2508-5298