Yun Hwa Jung

Clinical Features of Male Breast Cancer: Experiences from Seven Institutions Over 20 Years.

Purpose Breast cancer treatment has progressed significantly over the past 20 years. However, knowledge regarding male breast cancer (MBC) is sparse because of its rarity. This study is an investigation of the clinicopathologic features, treatments, and clinical outcomes of MBC. Materials and Methods Clinical records of 59 MBC patients diagnosed during 1995-2014 from seven institutions in Korea were reviewed retrospectively. Results Over a 20-year period, MBC patients accounted for 0.98% among total breast cancer patients, and increased every 5 years. The median age of MBC patientswas 66 years (range, 24 to 87 years). Forty-three patients (73%) complained of a palpable breast mass initially. The median symptom duration was 5 months (range, 1 to 36 months). Mastectomy was performed in 96% of the patients. The most frequent histology was infiltrating ductal carcinoma (75%). Ninety-one percent of tumors (38/43) were estrogen receptor–positive, and 28% (11/40) showed epidermal growth factor receptor 2 (HER-2) overexpression. After curative surgery, 42% of patients (19/45) received adjuvant chemotherapy; 77% (27/35) received hormone therapy. Five out of ten patients with HER-2 overexpressing tumors did not receive adjuvant anti–HER-2 therapy, while two out of four patients with HER-2 overexpressing tumors received palliative trastuzumab for recurrent and metastatic disease. Letrozole was used for one patient in the palliative setting. The median overall survival durations were 7.2 years (range, 0.6 to 17.0 years) in patients with localized disease and 2.9 years (range, 0.6 to 4.3 years) in those with recurrent or metastatic disease. Conclusion Anti–HER-2 and hormonal therapy, except tamoxifen, have been underutilized in Korean MBC patients compared to female breast cancer patients. With the development of precision medicine, active treatment with targeted agents should be applied. Further investigation of the unique pathobiology of MBC is clinically warranted.

Tumor Lysis Syndrome in a Patient with Metastatic Colon Cancer after Treatment with 5-Fluorouracil/Leucovorin and Oxaliplatin: Case Report and Literature Review

Development of tumor lysis syndrome (TLS) may occur after chemotherapy or spontaneously in bulky or rapidly growing tumors. This syndrome is frequent but preventable in patients with hematologic malignancies. TLS following therapy has been reported infrequently in various types of solid tumors. TLS associated with oxaliplatin containing chemotherapy in a solid tumor has never been reported. A 59-year-old man received 5-fluorouracil, leucovorin, and oxaliplatin (FOLFOX) chemotherapy for metastatic colon cancer. Development of TLS occurred three days after administration of chemotherapy. Two days later, his abnormal laboratory findings were recovered with appropriate management. To the best of our knowledge, the current case is the first report on development of acute TLS following oxaliplatin containing chemotherapy in a patient with colon cancer. We also review the literature on tumor lysis syndrome in patients with colorectal cancer.

Transformation into large-cell neuroendocrine carcinoma associated with acquired resistance to erlotinib in nonsmall cell lung cancer.

To the Editor, The epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) erlotinib is active in patients with metastatic lung adenocarcinoma carrying mutations in the EGFR gene. Although erlotinib has been found to improve markedly progression-free survival and quality of life, most patients who show an initial response eventually develop disease progression. Possible mechanisms of acquired or secondary resistance to erlotinib include second mutations in the EGFR gene such as T790M, activation of an alternative pathway including Met or HER2 amplification, histological transformation to small cell lung cancer (SCLC) and epithelial to mesenchymal transition [1]. However, acquired resistance due to histological transformation into a large cell neuroendocrine carcinoma (LCNEC) is uncommon. Herein we describe a patient who developed a LCNEC at the time of acquired resistance to erlotinib during treatment for primary lung adenocarcinoma. A 33-year-old male was admitted to the Department of Neurosurgery because of headache and diplopia. Brain magnetic resonance imaging (MRI) revealed multiple metastatic masses in the left frontal and right temporal lobes and the left cerebellum of the brain. The largest mass in the left frontal lobe measured 3.4 cm and caused midline shifting of the brain (Fig. 1). Figure 1 Magnetic resonance imaging of multiple metastatic masses in the brain. (A) T2-weighted image of the left frontal lobe mass. (B) T2-weighted image of the right temporal lobe. A left frontal craniotomy was performed to remove the mass in the left frontal lobe. The specimen was positive for cytokeratin-7 (CK-7), thyroid transcription factor-1 (TTF-1), leukocyte common antigen, CK-20, and vimentin, indicating a well-differentiated adenocarcinoma (Fig. 2). The patient was subsequently referred to the Department of Medical Oncology. Figure 2 (A) Adenocarcinoma from brain tissue after craniotomy at the time of initial diagnosis (H&E, ×400). (B) Large-cell neuroendocrine carcinoma (LCNEC) from rebiopsied sample (H&E, ×400)

Complete Remission of Brain Metastases in Non-Small Cell Lung Cancer Patients Harboring an EGFR Mutation Treated with Tyrosine Kinase Inhibitor without Radiotherapy: A Report of 3 Cases

Brain parenchymal metastasis from a solid tumor is a serious clinical condition associated with a poor outcome because systemic chemotherapy is usually ineffective for treating brain metastases (BM) due to the blood-brain barrier. Therefore, radiotherapy such as whole brain radiotherapy (WBRT) and stereotactic radiosurgery have taken on a central role in the management of BM. However, WBRT can delay subsequent systemic treatment or cause neurologic complications such as a decline in cognitive function. Therefore, suspending WBRT is worth considering if there is an effective alternative. Although there have been no large prospective studies, many reports are available about the favorable effect of tyrosine kinase inhibitors (TKIs) for treating BM in patients with non-small cell lung cancer (NSCLC). Here, we report 3 NSCLC cases that showed a complete response in BM after TKI treatment without WBRT. Based on these remarkable response rates of BM to a TKI, the potential toxicity of WBRT can be avoided, particularly in patients with small metastatic nodules and an epidermal growth factor receptor activating mutation.

Palliative 5‐fluorouracil and cisplatin chemotherapy in recurrent metastatic sebaceous carcinoma: Case report and literature review

Sebaceous carcinoma is a rare malignant tumor of the skin. Although this tumor is not completely understood due to its rarity and the paucity of published reports, it is known to be an aggressive tumor with a high incidence in Asia. Sebaceous carcinomas occur preferentially in the periocular region and require attention not to miss the associated Muir–Torre syndrome. In the case of localized disease, a wide local excision with clear margin followed by adjuvant radiation therapy is usually considered the standard treatment strategy but there is no agreed treatment strategy or standard chemotherapeutic regimen for recurrent metastatic sebaceous carcinoma. We report here two cases of recurrent metastatic sebaceous carcinoma patients who responded to 5‐fluorouracil and cisplatin combination chemotherapy, and review the literature. We suggest that 5‐fluorouracil‐cisplatin can be considered a feasible and effective treatment modality for recurrent sebaceous carcinoma.

A case of metastatic gastric neuroendocrine tumor: therapeutic considerations.

Despite remarkable progression in the treatment and classification system of neuroendocrine tumor (NET), some questions have remained unanswered. The lack of an established treatment strategy for gastric NET is one of the problems. Because of its paucity, gastric NET is not discussed in independent, large-scaled prospective studies and tends to be excluded from clinical trials. Moreover, a separate classification system and some distinguished clinical features render the treatment of gastric NET more complicated. Here, we present a case of a female gastric NET patient with G2 proliferation index and multiple liver metastases. Based on the histologic grade and a high serum gastrin level, we initially treated her with somatostatin analogue. However, the patient did not respond. After that, cytotoxic chemotherapy with the etoposide plus cisplatin regimen only showed response in the short-term period. However, combination therapy with octreotide and interferon brought about significant regression of the tumor. Herein, we present our case together with a literature review of the treatment of metastatic gastric NET.

Metronomic chemotherapy with capecitabine for metastatic colorectal cancer in very elderly patients

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A case of Wegener's granulomatosis mimicking recurrent hemophagocytic lymphohistiocytosis

Korean J Intern Med. 2014;29:393-397. http://dx.doi.org/10.3904/kjim.2014.29.3.393 In the article cited above, Fig. 3 was input incorrectly. The correct figure is as following: We apologize for any inconvenience that is may have caused.

18F-fluoro-2-deoxy-D-glucose positron emission tomography findings of neurolymphomatosis

which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. A 53-year-old man with a history of diabetes presented with weakness in both legs accompanied by numbness and pain. Eight months previously, he had a pelvic mass that caused pain during defecation and was diagnosed as having diffuse large B cell lymphoma. He received 6 cycles of R-CHOP chemotherapy and field radiation therapy (dose, 44 Gy). No hypermetabolic lesions were detected by positron emission tomography (PET)-computed tomography scanning. Two months later, he presented with the above neurological manifestations, including right facial palsy. Brain and spine magnetic resonance imaging did not find any evidence of lymphoma involvement. A cerebrospinal fluid (CSF) cytological study was also negative. A nerve conduction study showed delayed peak latencies and reduced amplitudes of sensory nerve action potentials in both the sural nerves. Reduced amplitude of combined motor action potential and conduction velocities were identified in both the deep peroneal nerves. The patient had a history of diabetes and hepatitis C, but because of sensorimotor nerve involvement, polyneuropathy associated with underlying systemic disease or chemotherapy toxicity was not diagnosed. Sequential 18 F-fluoro-2-deoxy-D-glucose (FDG) PET images showed increased 18 F-FDG uptake (SUVmax, 4.11) along the bilateral lumbosacral plexus (arrow). A second CSF study revealed malignant lymphoma cells (A, B).

JAK2 V617F-positive polycythemia vera accompanied by renal artery stenosis

TO THE EDITOR: Polycythemia vera (PV) is a chronic myeloproliferative disorder with panmyelosis that is unrelated to a secondary cause. Although the discovery of JAK2 V617F mutation in the pathogenetic mechanism of PV has made the diagnosis clearer and easier, until recently, diagnosis of PV involved excluding secondary causes of erythrocytosis in clinical practice. Among the secondary causes, smoking history, elevated erythropoietin (EPO) level, and hypoxemia measured by arterial blood gas analysis are well known and recognized as minor criteria for the diagnosis of PV. With the upfront evaluation of JAK2 mutation status in patients with erythropoiesis, clinicians are apt to be neglectful about the evaluation of these secondary causes. However, based on our case, evaluation of other causes is clinically significant.