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Triple-negative breast cancer (TNBC) is defined by a lack of expression of estrogen, progesterone, and HER2 receptors, and genetically most of them fall into the basal subgroup of breast cancer. The important issue of TNBC is poorer clinical outcome and absence of effective targeted therapy. In this study, we sought to identify DNA copy number alterations and expression of relevant genes characteristic of TNBC to discover potential therapeutic targets. Frozen tissues from 114 breast cancers were analyzed using high-resolution array comparative genomic hybridization. The classification into subtype was determined by estrogen and progesterone receptor expression, and by the presence or absence of gain on the ERBB2 containing clone. The ACE algorithm was used for calling gain and loss of clones. Twenty-eight cases (25%) were classified as TNBC. Recurrent gains (> or =25%) unique to TNBC were 9p24-p21, 10p15-p13, 12p13, 13q31-q34, 18q12, 18q21-q23, and 21q22. Two published gene expression array data sets comparing basal subtype versus other subtype breast cancers were used for searching candidate genes. Of the genes upregulated in the basal subtype, 45 of 686 genes in one data set and 59 of 1,428 in the second data set were found to be located in the gained regions. Of these candidate genes, gain of NFIB (9p24.1) was specific for TNBC in a validation set by real-time PCR. In conclusion, we have identified recurrently gained regions characteristic of TNBC, and found that NFIB copy number and expression is increased in TNBC across the data sets. This article contains Supplementary Material available at http://www.interscience.wiley.com/jpages/1045-2257/suppmat.

BackgroundA considerable proportion of estrogen receptor (ER)-positive breast cancer recurs despite tamoxifen treatment, which is a serious problem commonly encountered in clinical practice. We tried to find novel prognostic markers in this subtype of breast cancer.MethodsWe performed array comparative genomic hybridization (CGH) with 1,440 human bacterial artificial chromosome (BAC) clones to assess copy number changes in 28 fresh-frozen ER-positive breast cancer tissues. All of the patients included had received at least 1 year of tamoxifen treatment. Nine patients had distant recurrence within 5 years (Recurrence group) of diagnosis and 19 patients were alive without disease at least 5 years after diagnosis (Non-recurrence group).ResultsPotential prognostic variables were comparable between the two groups. In an unsupervised clustering analysis, samples from each group were well separated. The most common regions of gain in all samples were 1q32.1, 17q23.3, 8q24.11, 17q12-q21.1, and 8p11.21, and the most common regions of loss were 6q14.1-q16.3, 11q21-q24.3, and 13q13.2-q14.3, as called by CGH-Explorer software. The average frequency of copy number changes was similar between the two groups. The most significant chromosomal alterations found more often in the Recurrence group using two different statistical methods were loss of 11p15.5-p15.4, 1p36.33, 11q13.1, and 11p11.2 (adjustedpvalues p= 0.052).ConclusionOur array CGH analysis with BAC clones could detect various genomic alterations in ER-positive breast cancers, and Recurrence group samples showed a significantly different pattern of DNA copy number changes than did Non-recurrence group samples.

Purpose The implementation of the Korean diagnosis-related groups (DRG) payment system has been recently introduced in selected several diseases including appendectomy in Korea. Here, we report the early outcomes with regard to clinical aspects and medical costs of the Korean DRG system for appendectomies in Seoul Metropolitan Government - Seoul National University Boramae Medical Center throughout comparing before and after introduction of DRG system. Methods The DRG system was applied since January 2013 at our institute. After the DRG system, we strategically designed and applied our algorithm for the treatment of probable appendicitis. We reviewed the patients who were treated with a procedure of appendectomy for probable appendicitis between July 2012 and June 2013, divided two groups based on before and after the application of DRG system, and compared clinical outcomes and medical costs. Results Total 416 patients were included (204 patients vs. 212 patients in the group before vs. after DRG). Shorter hospital stays (2.98 ± 1.77 days vs. 3.82 ± 1.84 days, P < 0.001) were found in the group after DRG. Otherwise, there were no significant differences in the perioperative outcomes and medical costs including costs for first hospitalization and operation, costs for follow-up after discharge, frequency of visits of out-patient's clinic or Emergency Department or rehospitalization. Conclusion In the Korean DRG system for appendectomy, there were no significant differences in perioperative outcomes and medical costs, except shorter hospital stay. Further studies should be continued to evaluate the current Korean DRG system for appendectomy and further modifications and supplementations are needed in the future.

Metastatic spread is the major cause of death from breast cancer. We previously showed that H-Ras, but not N-Ras, induces invasive/migratory phenotypes of MCF10A human breast epithelial cells, while both H-Ras and N-Ras induce proliferation/transformation. Here, we identified flotillin-1 as an H-Ras-induced lipid raft protein through comparative proteome profiling of lipid raft proteins. Flotillin-1 interacts with H-Ras in lipid raft at a higher affinity than with N-Ras. Small interfering RNA(siRNA)-mediated flotillin-1 knockdown significantly reduced H-Ras activation and H-Ras-mediated motility/invasion in MCF10A cells engineered to express active H-Ras as well as in Hs578T breast carcinoma and T24 bladder carcinoma cells that express endogenous active mutant of H-Ras. These results suggest a positive signal amplification loop between flotillin-1 and H-Ras for the invasive signaling program. Flotillin-1 was crucial for the activation of the Ras-GRF1 exchange factor and its interaction with H-Ras in lipid rafts. Using a xenograft tumor model, we show that knockdown of flotillin-1 reduces the tumor growth in vivo. Importantly, tissue microarrays of 289 breast cancer patients revealed that flotillin-1 expression in the plasma membrane positively correlates with HER2/neu expression(p Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 4165. doi:1538-7445.AM2012-4165

Metastatic spread is the major cause of death from breast cancer. We previously showed that H-Ras, but not N-Ras, induces invasive/migratory phenotypes of MCF10A human breast epithelial cells, while both H-Ras and N-Ras induce proliferation/transformation. Here, we identified flotillin-1 as an H-Ras-induced lipid raft protein through comparative proteome profiling of lipid raft proteins. Flotillin-1 interacts with H-Ras in lipid raft at a higher affinity than with N-Ras, elucidating a molecular nature of the crucial link between lipid rafts and the function of H-Ras. Small interfering RNA (siRNA)-mediated flotillin-1 knockdown significantly reduced H-Ras activation and H-Ras-mediated motility/invasion in MCF10A cells engineered to express H-Ras and in highly invasive human breast carcinoma Hs578T cells that express endogenous H-Ras. These results suggest a positive signal amplification loop between flotillin-1 and H-Ras for the invasive signaling program in breast epithelial cells. Importantly, tissue microarrays of 289 patients with invasive breast cancer revealed that flotillin-1 expression positively correlates with lymph node metastases (p=0.027), HER2/neu oncogene expression (p Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 1062. doi:10.1158/1538-7445.AM2011-1062

Disk arm scheduling algorithms have been studied for many years to increase disk I/O performance. Most of the disks by the early 1980’s are characterized as a linear seek time and their seek time is responsible for the most time of disk access. So, the existing disk scheduling algorithms have focused on the reduction of the average seek distance. Seek time has improved greatly and today’s disks usually have nonlinear seek time characteristics, whereas the rotation speed has been steady at the 3600 RPM. So, it is of value to reduce average rotational latency. In this paper we propose two disk scheduling algorithms, i.e. Shortest Rotational Latency First(SRLF) and Shortest Access Tie Fist(SATF) for reduced rotational latency. SRLF services first a request with the shortest expected rotational latency and SATF services first a request with the shortest expected access time. We analyze the expected access time of the request serviced first by each of SSTF and SRLF under the uniform cylinder access. We evaluated the response time of SSTF, SRLF, and SATF through the simulations under the uniform and localized cylinder access. The results of the analysis and simulations show that the algorithms proposed in this paper are more efficient than SSTF which is known for the fastest response time.

Metastatic spread is the major cause of death from breast cancer. The objective of our study is to unveil signal transduction pathways specific to breast epithelial cell invasion and migration apart from cell proliferation/transformation. We previously showed that the active H-Ras, but not N-Ras, induces invasive/migratory phenotypes of MCF10A human breast epithelial cells via activation of Rac1/p38 signaling leading to MMP-2 up-regulation, while both H-Ras and N-Ras induce cell proliferation and transformation. In the present study, we hypothesized that the Ras isoform-specific signaling pathway is initiated by differential involvement of lipid raft proteins. To address this, we characterized proteome profiles of lipid raft proteins from three cell lines: normal MCF10A; N-Ras-transformed, non-invasive MCF10A; and H-Ras-transformed, invasive MCF10A cells. Among twenty-four lipid raft proteins that were up-regulated in an H-Ras-specific manner, we tested whether flotillin-1 plays a causative role for H-Ras-mediated MCF10A cell invasion/migration. Here, we show that flotillin-1 interacts with H-Ras and H-Ras signaling increases flotillin-1 expression, suggesting a signaling amplification loop between flotillin-1 and H-Ras. Importantly, siRNA-mediated flotillin-1 knockdown significantly reduced H-Ras-mediated motility/invasion accompanied with down-regulation of Rac1/p38 and MMP-2. We also show that flotillin-1 co-localizes with H-Ras in the plasma membrane, while the interaction between flotillin-1 and N-Ras was negligible. Taken together, this study identified flotillin-1 as an H-Ras-interacting lipid raft protein critical for activation of H-Ras-specific signaling resulting invasive phenotype in breast epithelial cells. Consistently, flotillin-1 mRNA was significantly higher in malignant breast cancer tissues, supporting our hypothesis that flotillin-1 may contribute to breast carcinoma invasion. Note: This abstract was not presented at the AACR 101st Annual Meeting 2010 because the presenter was unable to attend. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 5197.

Dermatofibrosarcoma protuberans is a rare tumor that occurs in the dermis or subcutaneous tissue of the trunk or extremities in relatively young adults. There are few reports of Dermatofibrosarcoma protuberans associated with pregnancy. We experienced a 28-year-old pregnant female patient with an abdominal wall mass, which grew rapidly during pregnancy. Excisional biopsy was performed and the pathologic diagnosis was fibrosarcoma transformed from Dermatofibrosarcoma protuberans. Dermatofibrosarcoma protuberans showed a positive CD34 immunostaining while fibrosarcoma showed a negative CD34. There was no recurrence or metastasis with the follow up period of 2 years. We report here a rare case of Dermatofibrosarcoma protuberans aggravated during pregnancy with a review of the literature.

Whereas extramammary Paget’s disease commonly occurs in the apocrine gland rich skin areas, ectopic extramammary Paget’s disease develops in the skin areas that are devoid of apocrine glands. We experienced the case of a 34 yearold female patient who had a skin lesion in the upper outer quadrant of the right breast for 5 years and that lesion was diagnosed as Paget’s disease according to the punch biopsy. There was no other underlying malignancy, and so wide excision was performed. The final pathologic diagnosis was Paget’s disease confined to the epidermis and the size of the tumor was 3.0×1.1 cm. Positive staining for cytokeratin 7, epithelial membrane antigen and negative staining for S100 protein and HMB-45 was observed on the immunohistochemical tests. We report here on an extremely unusual case of ectopic extramammary Paget’s disease of the breast skin, and we include a review of the relevant literature.

Purpose: This comparative study analyzed the relationship between the preoperative diagnostic tumor size and the postoperative pathologic tumor size for breast cancer patients and benign breast tumor patients. Methods: We analyzed the clinicopathological information of 191 breast cancer patients and 187 benign breast tumor patients by conducting a retrospective chart review. The preoperative diagnostic tumor sizes were measured using physical examination, mammography and sonography in the benign breast tumor patients and they were additionally measured by computerized tomography and magnetic resonance imaging in the breast cancer patients. Body mass index (BMI) was defined as the ratio of the body weight in kilograms to the square of height in meters. Results: The tumor sizes measured by mammography (r=0.66) and physical examination (r=0.87) were highly correlated to the pathologic tumor size in the breast cancer patients and benign the breast tumor patients, respectively. Physical examination and magnetic resonance imaging had a tendency to overestimate the tumor size and sonography underestimated the pathologic tumor size in the breast cancer patients. The correlation coefficient for the physical examination was increased when the patient age was less than 50 years and the BMI was less than 25. Multiple regression analysis revealed that assessing the tumor size according to physical examination, mammography and sonography were effective for determining estimation of pathologic tumor size in the benign breast tumor patients, but assessing the tumor size by physical examination and sonography was not effective for determining the tumor size in breast cancer patients. Conclusion: Mammography and physical examination can be useful to estimate the pathologic tumor size in breast cancer patients and benign breast tumor patients, respectively. Physical examination can be useful to estimate the size when a breast tumor is palpable, the age of a patient is less than 50, and the BMI is less than 25.

Purpose: A better predictive model for occult invasive disease in ductal carcinoma in situ (DCIS) patients is essential to guide the tailored use of sentinel node biopsies. We hypothesized that recent improvement of contrast-enhanced breast magnetic resonance imaging (MRI) could provide more accurate information on the presence of occult invasion in DCIS patients. Methods: From a prospectively maintained database, we identified 143 DCIS patients diagnosed with needle biopsies in whom MRI images were available. Results: Sixty-five patients (45.5%) were upstaged to invasive carcinoma after curative surgery. Ultrasonographic lesion size, mass-appearance on mammography, type of needle used, and the presence of suspicious microinvasive foci were associated with increased likelihood of upstaging. Among the features of MRI, only mass-appearance was significantly associated with the presence of invasive disease (p=0.002). However, up to 50% of masses in MRI cases had massappearance on mammography as well. Other morphologic and pharmacokinetic features of MRI, such as shape, margin, and patterns of enhancement and washout, did not have a significant association. Conclusion: Among various morphologic and pharmacokinetic parameters of contrast-enhanced MRI, only mass-appearance was associated with occult invasive disease. Our results show the limitations of current contrast-enhanced MRI in predicting invasive disease in patients with preoperative diagnoses of DCIS.

Adenosquamous carcinoma arising in congenital choledochal cyst is very rare and herein we report a case thereof. A 37-year-old woman was referred for further evaluation of pancreas head mass and a hepatic nodule on CT. She had been diagnosed with congenital choledochal cyst at 22-years-old and received Roux-en-Y choledochojejunostomy at that time. Endoscopic ultrasonography-guided biopsy proved the pancreas head mass as a squamous cell carcinoma and liver biopsy also proved the liver mass as a metastatic squamous cell carcinoma. We performed pancreaticoduodenectomy and tumorectomy of metastatic liver nodule. Grossly, the primary lesion was located at intrapancreatic portion of choledochal cyst. Histologically, the primary lesion and hepatic nodule was metastatic adenosquamous carcinoma. So far, there have been only three cases of adenosquamous carcinoma arising in congenital choledochal cyst reported in English-language literature. This is another case and the first case reported in Korea.

Although acute appendicitis is one of the most common surgical diseases, very rare but serious complications can occur including retroperitoneal abscess complicated by acute appendicitis. The early diagnosis of retroperitoneal abscess is often difficult and delayed because its clinical course is often insidious and does not present with typical symptoms of acute appendicitis. We experienced a 65-year-old male patient who was diagnosed with acute appendicitis with retroperitoneal abscess. As the retroperitoneal abscess was not fully removed via emergency operation, postoperative percutaneous drainage was performed but not effective. Retroperitoneal abscess can be cured by 2nd operation with retroperitoneal approach. We report here an unusual case of retroperitoneal abscess complicated by acute appendicitis.

Purpose: We tried to select and validate the candidate gene for the prognostic marker of breast cancer by comparing the analysis of copy number variation (CNV) between normal breast tissues and breast cancer tissues by performing array comparative genomic hybridization (CGH). Methods: Array CGH was performed with using the fresh frozen tissues of 77 breast cancer patients. We selected the clones with more than a 20% frequency of gain or loss, and the clones with gain or loss in more than 2 consecutive clones. We finally selected the clones that were statistically significant on the survival analysis. We searched for the candidate gene that belonged to the candidate clones and we selected the final candidate gene that is assumed to be most related to the carcinogenesis of breast cancer by searching for information of the individual gene. We performed RT-PCR to validate the RNA expression of the final candidate gene with using the breast tissues of another 20 breast cancer patients. Results: Eleven (10 in the gain group and 1 in the loss group) clones were finally selected as candidate clones. The significant CNVs with gain were found in the regions of 1q23.1, 1q41, 1q44, 5p15.33, 8q21.3, 15q26.3, 17q12 and 21q22.3 and the significant CNV with loss was found in 14q32.33. COL18A1 (21q22.3) was selected as the final candidate gene and the RT-PCR results revealed that the expression of COL18A1 was up-regulated in the cancer tissues of 18 of the other 20 (90%) breast cancer patients. Conclusion: We selected COL18A1 (21q22.3) as the candidate gene for the prognostic marker of breast cancer by comparing the analysis of CNVs from the array CGH. The RNA of COL18A1 was over-expressed in breast cancer tissue, as determined by RT-PCR.

Previously, we reported that DNA copy number of NFIB is amplified in triple negative breast cancer (TNBC; estrogen(−)/progesterone(−)/HER2(−)). The transcriptional activator NFIB plays wide roles in regulation of gene transcription, cell proliferation, viral DNA replication and development. But the functional role of NFIB in breast cancer cell has not been elucidated. In order to understand the role of upregulated NFIB in breast cancers, we examined mRNA and protein level of NFIB in 20 breast cancer tissues. In ER negative breast cancer subtype, expression of NFIB is up-regulated and correlated with Ki67 expression. And intracellular localization of NFIB is restricted in nucleus. In ER negative cell line, knock-down of NFIB leads to reduced cell proliferation by cell cycle arrest. Cell cycle arrest is accompanied by S phase arrest and alteration of S phase regulating protein expression. Take together, transcription activator of NFIB regulates cancer cell proliferation in ER negative breast cancer and it may act as a therapeutic marker. Citation Information: Mol Cancer Ther 2009;8(12 Suppl):C26.

Obturator hernia is a rare type of pelvic hernia and occurs most commonly in elderly and debilitated women. It is still a challenge for surgeons to diagnose precisely in early stages because of its nonspecific symptoms and consequently delayed diagnosis could lead to high morbidity and mortality. We experienced a 92-year old patient who was diagnosed as obturator hernia which was confirmed by computed tomography scan of the abdomen and pelvis. The operation was delayed due to the refusal of family members but eventually done after 12 days from initial diagnosis. After manual reduction of small bowel impacted into right obturator foramen, segmental resection of impacted small bowel and anastomosis was done. The hernial defect was closed by primary closure with Dexon suture material. After the operation, the patient was discharged without significant complications. We report here successful results of delayed operation for obturator hernia.

Purpose: The POSSUM (Physiological and Operative Severity Score for Enumeration of Mortality and Morbidity) score was developed to predict post-operative mortality and morbidity rates. The aim of this study was to validate the POSSUM physiologic score (POSSUM-P) in emergent operations for peptic ulcer complications. Methods: We retrospectively collected data on patients who underwent emergent operation for peptic ulcer complications at Boramae Hospital between January 2003 and April 2009. The data included patients’ characteristics (underlying disease, medication, duration of symptoms), operative characteristics (operation method, morbidity, and mortality) and the items for the POSSUM-P (basic information (age, sex, etc.), circulatory and respiratory signs, electrocardiogram, blood pressure, hemoglobin, white blood cell count, potassium level, sodium level, urea level and Glasgow coma scale). The POSSUM-P was calculated and compared according to the morbidity and mortality. Results: One hundred and twelve patients were included. As for operation methods, primary repair (48.2%) was most common, followed by truncal vagotomy with pyloroplasty (27.7%). Thirty-seven patients had morbidities including wound infections (20), pneumonias (14), fluid collections (9), and so on. Eight patients died due to sepsis or pulmonary edema. The means of POSSUM-P were significantly different between patients with and without mortality (37.8 vs. 19.2, P＜0.001) and between patients with and without morbidity (26.7 vs. 17.3, P＜0.001). Those were different between patients with and without postoperative pneumonia and wound infection (P=0.002 and P=0.029, respectively). Conclusion: The POSSUM physiologic score could help to predict the mortality or morbidity after emergency operation for complications of peptic ulcer disease, especially postoperative pneumonia or wound infection.

This randomized prospective study investigated the effect of fibrin glue use on drainage duration and overall drain output after lumpectomy and axillary dissection in breast cancer patients. A total of 100 patients undergoing breast lumpectomy and axillary dissection were randomized to a fibrin glue group (N=50; glue sprayed onto the axillary dissection site) or a control group (N=50). Outcome measures were drainage duration, overall drain output, and incidence of seroma. Overall, the fibrin glue and control groups were similar in terms of drainage duration, overall drain output, and incidence of seroma. However, subgroup analysis showed that fibrin glue use resulted in a shorter drainage duration (3.5 vs. 4.7 days; p=0.0006) and overall drain output (196 vs. 278 mL; p=0.0255) in patients undergoing level II or III axillary dissection. Fibrin glue use reduced drainage duration and overall drain output in breast cancer patients undergoing a lumpectomy and level II or III axillary dissection.

Abstract #5006 Although every effort has been made to discover single potent biomarkers in oncology, the promising single biomarker often loses its clinical potency in the course of clinical validations. We aimed to construct and verify a biomarker panel with multiple proteins for breast cancer diagnosis. Using Surface-Enhanced Laser Desorption/ Ionization Time-of-Flight mass spectrometry (SELDI-TOF-MS) and microbead array system, epidermal growth factor (EGF), vascular cell adhesion molecule-1 (VCAM-1), CD40L, vitronectin, plasminogen activation inhibitor-1 (PAI-1), vitamin-D binding protein (VDBP), C-reactive protein (CRP), kininogen, apolipoprotein A1 and proapolipoprotein A1 were identified and validated as useful biomarkers for detection of breast cancer. The multiplexing panel (MP) which was constructed by combining algorithm (random forest, support vector machine) with above biomarkers showed that the diagnostic accuracy approached 91% in 216 test samples. A following double blind test verified that the diagnostic accuracy of the MP was 68% with an additional validation set including sera from 49 patients with breast cancer and 51 healthy women (sensitivity=74%; 95% confidence interval (CI)=58.9–85.0%, specificity=62.7%; 95% CI=48.1–75.9%, positive predictive value=65.5%; 95% CI=55.7-75.3%, negative predictive value=71.7%; 95% CI=61.7-80.35%). We suggest that these results support the potential use of the MP as an early detector of breast cancer. In order to validate the role and potency of the MP in routine clinical practice, a large scale clinical validation in a cohort consisting of 500 patients with breast cancer and the same number of healthy women are underway and the results will be released in the near future. Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 5006.

Abstract #1086 Purpose: We sought to determine the significance of Ki-67, one of the tumor cell proliferation indexes, as a useful prognostic factor in early breast cancer. Patients and Methods: 1,080 consecutive patients with stage I or II breast cancer operated between 1998 and 2003 were enrolled. Patients were categorized based on the 2007 St. Gallen consensus and Adjuvant! Online. The expression of Ki-67 in the tumor was assayed using immunohistochemistry (cut-off value: 10%). Results: Univariate analysis revealed that tumor size, lymph node involvement, histologic grade, estrogen receptor, progesterone receptor, bcl-2, and Ki-67 (≥10%) were significant for both overall survival (OS) and distant metastasis-free survival (DFS). Of them, lymph node involvement and high Ki-67 expression were identified as independent prognostic factors for OS at multivariate analysis. The survivals of intermediate- and high-risk groups according to 2007 St Gallen consensus were further separated by Ki-67 expression level (5-yr DFS rate=93.3% vs 86.6% for Ki-67 Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 1086.

Gastrointestinal stromal tumor (GIST) is the most common non-epithelial tumor in the gastrointestinal tract. Although GIST occurs mainly in the gastrointestinal tract, it also occurs, rarely, in non-gastrointestinal tract and in this case, it is often named as extra-gastrointestinal stromal tumor (EGIST). We experienced a 68-year-old male patient who had been diagnosed preoperatively with accidentaloma of the left adrenal gland by computed tomography, and finally diagnosed as primary retroperitoneal malignant GIST, postoperatively. The operation was performed via anterior abdominal approach, and complete surgical resection was done for a 7 cm sized retroperitoneal tumor near the left adrenal gland. Primary retroperitoneal malignant GIST was the final pathologic diagnosis and the size of the tumor was 6.5 cm and the mitotic count was 7 per high-power field. Diffuse strong positive staining for c-kit protein, CD34 and negative staining for desmin were observed in a immunohistochemistry test. We report here the unusual case of primary retroperitoneal malignant GIST mimicking adrenal mass.

조적항암, 방사선, 호르몬치료의발전으로유방암수술후생존 Purpose: Nearly half of all breast cancers are treated with breast conserving therapy (BCT). The purpose of this study was to identify the risk factors for ipsilateral breast tumor recurrence (IBTR) after BCT in T1 and T2 breast cancer patients. Methods: The medical records of 294 T1 or T2 breast cancer patients who underwent BCT at Seoul National University Hospital between January 1998 and December 2002 were retrospectively reviewed. Kaplan-Meier curves and Cox proportional regression analysis were used to identify the significant clinicopathologic factors that influence IBTR. Results: Among the 294 patients, 12 patients (4.8%) developed IBTR after a median follow-up of 82 months. Univariate analysis demonstrated that younger age (≤35 year) had significant associations with IBTR (p=0.006). Tumor size, lymph node status, histologic grade, extensive intraductal component, lymphovascular invasion, and close resection margins were not significant factor associated with IBTR. The triple negative breast cancer subtype also did not have significant association with IBTR. Multivariate analysis showed that the younger age at diagnosis was a significant predictor of IBTR with a HR of 3.86 (p=0.036; 95% CI, 1.09-13.60). Conclusion: Younger age at diagnosis (≤35) may be associated with an increased risk of IBTR in patients who underwent BCT.

응을 예상할 수 있는 예측인자로서 이들에 대한 면역조직화학염 Purpose: We aimed to assess the concordance of the immunohistochemical profiles of core biopsy before administrating neoadjuvant chemotherapy with that of the surgical specimens after a definitive operation for breast cancer. Methods: We retrospectively reviewed the estrogen receptor (ER), progesterone receptor (PR), and HER-2 expressions in 130 consecutive patients who received neoadjuvant chemotherapy and were followed by surgery during the period between February 2002 and March 2006. The pathologic complete tumor response rate for this group was 4.6% (6/ 130). Both the preand post-operative immunohistochemical profiles were available in 32 of the 124 patients (25.8%). Immunohistochemical staining was done on the core biopsies before chemotherapy and on the surgical specimens after operation. Results: There were 12 markers from 11 patients that were altered out of the 96 total markers (ER, PR, or HER-2) from 32 patients: 2 ER (2/12, 16.7%), 4 PR (4/12, 33.3%), and 6 HER-2 (6/12, 50.0%). One patient simultaneously had changes in the expressions of PR and HER-2. Conversion of the hormone receptor status occurred in 3 patients (3/32, 9.4%): this was positive to negative in two, and vice versa in one. In addition, there were 6 conversions (6/32, 18.8%) of the HER-2 status from negative to positive. Conclusion: The hormone receptor status changed in 9.4% of the 32 patients and the HER-2 status changed in 18.8% of the 32 patients after neoadjuvant chemotherapy. We have concluded that conducting only a single immunohistochemical study about ER, PR, and HER-2 may not be enough to exactly estimate the tumor marker status in the neoadjuvant setting.

Purpose: Breast cancer in male is uncommon, accounting for approximately 1% of all breast cancer and less than 1.5% of all the malignant neoplasms in males. The information concerned with the treatment of male breast cancer is limited. The objective of this study is to evaluate the histopathologic characteristics and clinical outcome of male breast cancer patients. Methods: We retrospectively analyzed the medical record of 17 male breast cancer patients who had been operated on Seoul National University Hospital between 1996 and 2006. Results: The peak age of incidence was the 6th decade and the mean age of the patients was 56.2 yr. The most common symptom was a palpable mass and the mean duration of symptoms was 13 months. Fifty-three percent of the patients were stage 0 or I. Mastectomy was performed in 15 cases and lumpectomy was performed in 2 cases. Twelve patients received adjuvant hormonal therapy. The median duration of follow up was 28 months. Of the two patients with distant relapse, one patient died due to multiple metastasis and the other patient is still alive. The other patients are still alive without any evidence of metastasis or recurrence. Conclusion: Active diagnosis, appropriate treatments (surgery and adjuvant therapy) and close follow up are necessary for male patients who have a palpable mass in their breast.