Young-Tae Joo

Galectin-1 expression in cancer-associated stromal cells correlates tumor invasiveness and tumor progression in breast cancer.

Understanding the molecular background of breast cancer biology is critical in developing new biomarkers for earlier diagnosis and more optimized treatment. We performed a proteomic analysis of human breast carcinoma tissues to investigate the tumor‐specific protein expression in breast carcinoma. Using 2‐dimensional electorphoresis (2‐DE) and matrix‐assisted laser desorption/ionization‐time of flight‐mass spectrometry (MALDI‐TOF‐MS), we were able to identify a list of proteins which are upregulated in cancerous tissue. There was significant increase of galectin‐1 expression in all cancerous tissues compared to noncancerous tissues, and its increased expression was further confirmed by western blot immunostaining. Subsequent immunohistochemical staining against galectin‐1 in 105 breast cancer specimens showed significant correlation between galectin‐1 expression in cancer‐associated stromal cells and tumor invasiveness, T stage, TNM stage, and axillary lymph node metastasis. Galectin‐1 expressionin cancer cells showed no correlation to above‐mentioned pathologic variables. Hormonal receptor status and galectin‐1 expression showed no correlation. This study demonstrates the upregulation of galectin‐1 in breast carcinoma tissues and the clinical significance of galectin‐1 in breast cancer patients. Our data supports the recently highlighted roles of galectin‐1 in cancer‐associated stroma and in tumor immune privilege.

Role Of Ultrasonography in Predicting Malignancy in Patients with Thyroid Nodules

The use of ultrasonography (USG) has become an essential part of endocrine surgical practice. We evaluated the value of USG in predicting malignancy of thyroid nodules. The accuracy of USG in 857 patients who underwent fine-needle aspiration (FNA) with or without surgery was analyzed in a prospective setting. The diagnostic accuracy of USG was compared to that of FNA and of combined models in 153 operated patients. The malignancy-predicting value of USG in follicular neoplasms and its relation to nodule size were also investigated. Sensitivity, specificity, and overall accuracy (OA) of USG were 84.9%, 95.5%, and 93.7%, respectively. In operated patients, USG had accuracy comparable to that of FNA and combined models (sensitivity 93.3%, specificity 90.6%, OA 92.0%) regardless of nodule size but showed a significant rate of indeterminate results (29.4%). For follicular neoplasms, the sensitivity, specificity, and OA of USG were 100%, 95.4%, and 96.1%, respectively, with indeterminate results for three malignant nodules (42.8%). This acceptable malignancy-predicting value of USG in thyroid nodules supports the potential role of USG for predicting malignancy in selected patients with thyroid nodules. However, the high rate of indeterminate results precludes it from being a standard independent diagnostic method for the present time.

Gastric lymphatic basin dissection for sentinel node biopsy using hybrid natural orifice transluminal endoscopic surgery (NOTES)

Abstract The aim of the present study was to describe a method of gastric lymphatic basin dissection for sentinel node biopsy using natural orifice transluminal endoscopic surgery with laparoscopic assistance (hybrid NOTES) in a porcine model. Lymph node dissection was performed in three healthy female domestic farm pigs (each around 40 kg) between October, 2007, and December, 2007. The pigs were administered a general anesthetic and laparoscopy-guided transvaginal colpotomy was performed. A two-channel endoscope was then inserted through the incision into the peritoneal cavity via the transvaginal route. An endoscope was inserted simultaneously into the mouth and indocyanine green solution was injected into the submucosal layer of the gastric wall at four sites. Dyed omentum and lymphatics were dissected using a laparoscopic dissector and the grasping forceps of a transvaginal endoscope. Lymphatics and omentum (mean 13.3 cm, range 8–20 cm) were removed transvaginally. The mean number of detected and resected sentinel nodes was 2.6 (range 1–4, diameter 2∼12 mm). Sentinel lymphatic basin dissection was performed successfully and without intraoperative complications in all three cases. Hybrid NOTES is technically feasible, and this procedure may represent an alternative to laparoscopic sentinel lymph node dissection of the stomach.

Myositis Ossificans of the Abdominal Rectus Muscle: Report of a Case

We herein report a rare case of myositis ossificans originating from the abdominal rectus muscle, found in a 38-year-old woman who presented with a left upper abdominal mass. The mass was initially suspected to be a malignant neoplasm because no history of either operation or trauma existed for this patient. Moreover, the location of the mass was unusual and the enhancement patterns of the dynamic magnetic resonance images were similar to that of a malignant tumor. Based on the radiologic findings, a surgical exploration was performed. A well-circumscribed mass, which measured 3.2 × 2 cm, was found in the rectus muscle. Microscopic findings showed a typical zonal pattern with a fibroblastic central zone and a zone of ossification at the periphery. Although abdominal myositis ossificans is extremely rare, it is one of the causes of abdominal mass lesions and can be mistaken for a malignant tumor. Therefore, a thorough knowledge of the evolution of myositis ossificans is necessary and in cases with malignant suggestion on magnetic resonance imaging, like that seen in our case, we suggest that a surgical excision may be necessary for both the diagnosis and treatment.

Intra-abdominal angiosarcoma developing in a capsule of a foreign body: report of a case with associated hemorrhagic diathesis

BackgroundsAngiosarcoma occurs very rarely in the gastrointestinal tract and can present great diagnostic difficulty, especially when it is associated with intraabdominal abscess or granulation tissue.Case presentationWe report a case where the angiosarcoma was diagnosed after the occurrence of disseminated angiosarcoma and concurrent hemoperitoneum. The tumor developed in the fibrous capsule of a foreign body, which was possibly related to the previous appendectomy twenty years ago, and became a widely disseminated malignant neoplasm in the abdomen. After the operation, the patients course was dominated by a fatal consumptive coagulapathy. Pathologic examination of the multiple intra-abdominal lesions showed the histological and immunohistological characteristics of the angiosarcoma.ConclusionEven though angiosarcoma in the gastrointestinal tract is extremely rare, when dealing with intraabdominal abscess or the gastrointestinal bleeding in patients who have undergone surgery or radiation therapy in the past, the possibility of angiosarcoma should be considered. To make the definite diagnosis of angiosarcoma and to avoid the misdiagnosis of foreign body granuloma, thorough histological examination and immunohistochemical staining may be prerequisite.

Laparoscopy-assisted distal gastrectomy with intracorporeal Billroth I stapled anastomosis using a hand access device for patients with gastric cancer

BackgroundBillroth I gastroduodenostomy is an anastomotic procedure used widely after gastric resection for distal gastric cancer. As laparoscopy-assisted distal gastrectomy (LADG) gains increasing popularity, various techniques of laparoscopic gastroduodenal anastomosis are being introduced.MethodsTo investigate the feasibility and benefit of their novel surgical technique of intracorporeal Billroth I stapled anastomosis using a hand access device (IBISA-HAD), the authors performed LADG using IBISA-HAD for 23 patients with distal gastric cancer and LADG using minilaparotomy Billroth I stapled anastomosis (MLBISA) for 10 patients.ResultsThe time required for the anastomosis procedure of IBISA-HAD was 45.5 ± 12.0 min, and the operative time, perioperative transfusion, and hospital stay were not significantly different between IBISA-HAD and MLBISA. The IBISA-HAD procedure provided a markedly enhanced vision of the stapling process, leading to less wound retraction and extension than MLBISA.ConclusionThe IBISA-HAD technique can provide a markedly enhanced view of the stapling procedure with the help of a current state-of-art laparoscopy system. The authors believe that this novel technique can guide an accurate laparoscopic anastomosis for the surgeon dealing with obese patients who have distal gastric cancer.

Appendicitis caused by a foreign body of dental origin : Diagnosis with ultrasonography

Appendicitis caused by a foreign body is quite rare; however, ingested foreign bodies that enter into the appendix may not be able to reenter the colon and may cause appendicitis or perforation. An accurate and prompt diagnosis is essential for minimizing morbidity. We report a case of a 39-year-old patient in whom ultrasonography was the key diagnostic tool in detecting appendicitis caused by a foreign body of dental origin.

The value of intraoperative imprint cytology in the assessment of lymph node status in gastric cancer surgery

BackgroundThe intraoperative assessment of lymph node status is important when performing limited surgery in gastric cancer patients. Currently available techniques for this assessment are frozen section, imprint cytology, and other molecular methods; most current studies use the frozen-section method. In the present study, we focused on the accuracy and feasibility of imprint cytology as a tool to assess lymph node status intraoperatively in gastric cancer surgery.MethodsBetween April 2001 and March 2003, we performed imprint cytology of the sentinel nodes in 260 consecutive patients. After review by an experienced cytopathologist, the sensitivity, specificity, and overall accuracy of the method were determined.ResultsThe time required for the intraoperative imprint cytology was 8 min, and the sensitivity, specificity, and overall accuracy were 52.2%, 88.8%, and 73.8%, respectively.ConclusionImprint cytology could be a useful technique for the assessment of lymph node status intraoperatively if the sensitivity and specificity can be improved to an acceptable level.

Clinical Factors Affecting the Length of Minilaparotomy Incision in Laparoscopy-Assisted Distal Gastrectomy

This study investigated the factors affecting the length of the minilaparotomy incision (LOMI) in laparoscopy-assisted distal gastrectomy with Billroth I reconstruction. By using abdominal computed tomography scans, we measured the thickness of the rectus muscle (TRM), the thickness of the abdominal wall (TAW), and the distance from the gastroduodenal artery to the skin (GDAS) in 80 patients with early gastric cancer who had undergone surgery. There were positive correlations between the LOMI and body mass index (BMI), TRM, and TAW, and the LOMI increased significantly in patients with BMI > or =25 kg/m2, TAW > or =2.1 cm, and TRM > or =1.0 cm. These observations suggest that patients with two or more of the following clinical factors, BMI > or =25 kg/m2, TAW > or =2.1 cm, and TRM > or =1.0 cm, may require surgical procedures other than laparoscopy-assisted Billroth I, such as total laparoscopic intracorporeal Billroth I, Billroth II, or uncut Roux-en-Y reconstruction.