Cancer Research and Treatment

The Postoperative Adjuvant Chemotherapy of Gastric Cancer with 5 - Fluorouracil , Adriamycin and Mitomycin - C ( FAM ): Young Suk Park, Heung Moon Chang, Keun Chil Park, Dae Seog Heo, Yung Jue Bang, Jae Gahb Park, Kuhn Uk Lee, Kuk Jin Choe, Soo Tae Kim, Noe Kyeong Kim; J Korean Cancer Assoc. 1994;26(6):853-860.

Abstract PDF: The postoperative adjuvant chemotherapy with FAM combination chemotherapy has been administered to 167 patients with stage IB, II, IIIA or IIIB gastric adenocarcinoma after cura- tive gastric resection between March l984 and December 1986. Chemotherapy was started within 4 weeks of surgery in most patiente. Treatment consisted of 5-FU 600 mg/m(2) (day 1, 8, 29 and 36), adriamycin 30 mg/m(2) (day l and 29), mitomycin-C 10 mg /m(2) (day 1) of an 8-week cycle. The cycle was repeated 3 times. Appropriate dose adjustment was made for hematologic and other toxicities. Twelve patients were ineligible for the study and excluded from the analysis. After median follow-up of 79 months, 65 of 155 treated patients recurred (41.9%). The sites of recurrent cancer were as follows: loco-regional, 35%, peritoneal, 23%, distant metastases, 23%, multiple sites, 19%. The 5-year disease-free survival rate was 57.1% and the 5-year overall survival rate was 60.6%. Treatment was well tolerated by the majority of patients and the common side effects were nausea and vomiting (51%). Sex, N stage and the number of involved lymph nodes affect- ed disease-free and overall survival. In conclusion, the postoperative adjuvant chemotherapy with FAM combination chemotherapy was safe and well tolerated. Although the results of FAM chemotherapy were more effec- tive than those of FM chemotherapy as historical control, we concluded that adjuvant chemo- therapy as given in this trial is not indicated as routine trestment in operable gastric cancer. So new trials of adjuvant chemotherapy for gastric cancer must be prospectively randomired and include a no-treatment control arm.

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5 - Fluorouracil and Cisplatin ( FP ) Chemotherapy for Advanced Gastric Cancer: Hong Don Joo, Young Sam Cho, Woon Sik Park, Yun Hyoung Joung, Young Woo Son, Chang Wan Han, Chang Wan Han, Hong Bock Lee, Jeong Rye Kim, Jong Hoon Byun; J Korean Cancer Assoc. 1994;26(6):860-868.

Abstract PDF: Backgro#nnd: Evaluation has been undertaken in recent years to define the rale of 5- fluorouracil and cisplatin(FP) combination chemotherapy in the management of patients with locally advanced, metastatic and recurrent gastric cancer. We performed a retrospective analy- sis to assess the efficacy of FP chemotherapy on advanced gastric cancer. Method: Fifty-one patients with advanced gastric cancer were treated with FP chemothera- py. The regimen consisted of infusion of 1g/m of 5- fluorouracil for 5 consecutive days and in- fusion of 60mg/m of cisplatin on the first day. The treatment was repeated every 3 weeks until the progression of disease or development of unacceptable toxicities. Resnlte: Among 31 evaluble patients, 1 patient achieved complete remission(3.2%) and 16 patients, partial remission(51.6%). The median survival of overall patients was 203 days. The me- dian survival of responders was 413 days and that of nonresponders, 125.5 days(p=0.0091). No prognostic factors for response were identified. Perfomance status (p=0.0022) and the main site of measurable disease(p=0.0392) were statistically significant prognostic factors for survi- vaL Major toxicities were neutropenia(33.0%), anemia(59.2%), nausea and vomiting (69.2%). Coneluslon: FP chemotherapy had a modest antitumor effect in terms of median survival and was well tolerated.

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Clinicopathologic Analysis of Stage 4 Gastric Cancer: Song Cheol Kim, Han Kwang Yang, Kuhn Uk Lee, Kuk Jin Choe, Jin Pok Kim; J Korean Cancer Assoc. 1994;26(6):868-878.

Abstract PDF: A statistical analysis of 741 cases of stage IV gastric cancer patients diagnosed between 1987 and 1991 at Seoul National University Hospital was done to evaluate the clinicopathological features and to find a proper management of stage IV gastric cancer. Peritoneal metastais (PM) was present in 227 patients (31%), liver metastasis (LM) in 198 patients (29%), direct invasion to adjacent organ (DI) in 148 patients (20%), and synchronous peritoneal and liver metast sis in 62 patients (8%). Patients with peritoneal metastasis were younger, and have Borrmann type IV and signet rinacell type lesion more frequently. Patients with liver metastasis were loder, and have Borrman type I and II and moderately-differentiated, highly-located lesion more frequently. Two-year survival rate for patients with direct invasion (DI) group was 20.4%, 17.7% for patients with liver metastasis (LM), 6.9% for patients with pritoneal meatstasis (PM), and 4.2% for patients with synchronous liver and peritoneal metastasis. In the group of patients with direct invasion (DI), patients who received gastric resection have better survival time than the patients who recieved bypass procedure (450 days vs 202 days in median survival, P<0.05), althrough resected group shows less invasive than bypass group. There was significant survival gain in resected group when comparision was done in T4NZMO homogenized group. But there was no significant survival gain by resection in liver or peritoneal metastasis (P > 0.05). Two year survival rate of the patients who recieved gastrectomy was 34.0% in immunochemotherapy group (n=23), 23.4% in chemotheraPy group (n=33), and 13.5% in operation ony group (n=22)(P<0.05), where prognostic parameters of these aroups were relatively comparable. We conclude that in stage IV gastric cancer there were different clinicopathologic features according to the metastatic patterns and gastric resection has significant survival gain than bypass procedure in direct invasion group, although not in liver or peritoneal metastasis. This retrospective analysis suggested the possibility that postoperative immunochemotherapy or chemotherapy may have some role in treatment of stage IV gastric cancer.

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Prognostic Significance of p53 Protein Expression in Colorectal Cancer: Kang Choon Lee, Dong Wook Choi, Nan Mo Moon, Yong Kyu Kim, Nam Sun Paik, Jong Inn Lee, Dae Yong Hwang, Ja June Jang; J Korean Cancer Assoc. 1994;26(6):878-885.

Abstract PDF: Molecular carcinogenesis model in colorectal cancer was proposed by Vogelstein in 19B9, that is, the accumulation of a series of genetic alterations results in malignant transformation from normal epithelium. Among them, p 53 gene mutation is known to take place in late stage, and is detected in more than 70% of colorectal cancers. Also, it was suggested that genetic alteration of p53 gene was related to worse prognosis in colorectal cancer patients. On the other hand, it is controversial still now whether p53 oncoprotein expression have relation with poor prognosis in colorectal cancers or not. So, we studied the p53 protein expression in l39 case of colorectal cancer patients who underwent curative surgical resection in Korean Cancer Center Hospital from Jan. 1984 to Dec. 1988 with immunohistochemical technique using Pab 1801, which is monoclonal antibody to p53 protein. We also analyzed the relevance between p53 protein expression and the conventional prognostic parameters. The positive rate of p53 protein expression was 43.9%. We didn't find any relevance between positive p53 protein expression and the conventional prognostic parameters except significantly lower expression rate in mucinous carcinoma(p=0.02). And, we could not detect any prognostic significance of p53 protein expression in resectable colorectal cancer patients. In conclusion, nuclear p53 protein expression by immunohistochemistry is considered to have no prognostic impact in resectable colorectal cancer patients. and we suggest that further study shou1d be going on including multiple genetic alteraions, and cytoplasmic p53 protein expression to detect the factors influencing on prognosis.

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Correlation of PLC-γ1 Expression and DNA Ploidy Pattern in Hepatocellular Carcinomas: Sung Sook Kim, Soo Yeon Cho, Kyung Hee Kim, Jung Ran Kim, Young Han Lee, Pann Ghill Suh, Man Ha Huh, Young Hoon Park; J Korean Cancer Assoc. 1994;26(6):885-892.

Abstract PDF: Phospholipase C isozymes (PLCs) play a role in ligand-mediated signal transduction for cellu- lar activity such as proliferation and differentation. However, their biological significance of in carcinogenesis or tumor progression is not fully estabilished, although PLC-rl is known to be related to the cell growth or the oncogene. We examined the relative content of PLC-rl in human hepatocellular carcinoma (HCC) and the adjacent non tumorous liver tissue, by immunoperoxidase staining of paraffin embedded sections. Among 32 cases, 25 demonstrated s significant decrease of PLC-rl content in comparison to the adjacent nontumorous tissue. Seven cases revealed no remarkable change in PLC-rl expression. There was no HCC expressing higher level of PLC-rl. We also performed image cytometric studies to evaluate the relationship between the DNA ploidy pattern and the PLC-yl content. Interestingly, the tumors showing a decreased PLC-rl expression, were mostly diploid and tetraploid (except 3 cases) in contrast to those tumors showing no change in PLC-rl content which were exclusively aneuploid. The results suggest that PLC-rl expression is closely related to DNA ploidy of the tumor, and that there may be two different mechanisms of hepatocarcinogenesis: one is related to PLC-rl associated signal trasduction system, and the other is independent of PLC-rl.

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A Clinical Review of Pancreaticoduodenectomy: Jun Hee Park, Young Heon Kim, In Ho Kim, Won Jyun Cho, Tae Jin Lim; J Korean Cancer Assoc. 1994;26(6):892-901.

Abstract PDF: We evaluated 53 patients who underwent Whipple operation at surgical department, Dong San Medical Center, Keimyung University during 5 years from Jan. 1989 to Dec, 1993. The results were as follows: The most prevalent age group was 50(20 cases) and male to female ratio was 2:l. Among 53 cases, 16 were ampulla of Vater cancers, followed by distal CBD cancer (12 cases), pancreatic head cancer(l 1 cases), duodenal cancer (7 cases), and others (7 cases). Fre- quent symptoms and physical findings were jaundice(66%), RUQ abdominal pain(64%), weight loss(50%), general weakness, fever, chill and indigestion. Abnormal laboratory findings were shown in bilirubin (36 cases), alkaline phosphatase (35 cases), CA 19-9 (21 cases), and CEA(12 cases), ERCP was superior than any other radiologic diagnostic tools such as C-T, U-S, PTC and UGI. Frequent postoperative complications were wound infection(8 cases), intraabdominal abscess (5 cases), anastomotic site leakage(4 cases), pleural e#ffusion, pneumonia (4 cases) and others. There was one case of postoperative mortality due to respiratory failure caused by massive transfusion for control of postoperative bleeding. Histologically pathologic invasion from distal CBD to pancreas occured in 9 cases, from ampulla of Vater to distal CBD in 5 cases, from pancreatic head to distal CBD in 3 cases. Survival was much higher in ampulla of Vater cancer (1 year survival 100%, 3 year survival 88%) than that of any other cancers of pancreaticoduodenal region.

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The Expression of c-erbB-2 Oncoprotein and Epidermal Growth Factor Receptor ( EGFR ) in Breast Cancer Patients in Korea: Won Park, Nam Sun Paik, Yong Kyu Kim, Nan Mo Moon, Jong Inn Lee, Dong Wook Choi, Dae Yong Hwang, Ja June Jang; J Korean Cancer Assoc. 1994;26(6):901-912.

Abstract PDF: Samples of breast carcinoma were collected from 1l7 patients who underwent mastectomy in Korea Cancer Center Hospital from Jan. 1982 to Dec. 1984. We studied expression of the c-erbB- 2 oncoprotein and EGFR with the immunohistochemical technique. We also analyzed to clarify the relationship between expression of the c-erbB-2 oncoprotein and/or EGFR and tumor size, node metastasis, stage, histo1ogic grade, TIL, and EIC, and to evaluate the prognostic significance of c-erbB-2 oncoprotein and EGFR in breast cancer. EGFR expression rate was 37.6%(44/ ll7) and EGFR status had positive correlation with histologic grade(p<0.05), But, we did not find any other relationship with other clinicopathological prognostic factors. c-erbB-2 expression rate was 64.1%(71/1 l7). There was no relevance between c-erdB-2 expression and other prognostic factors. Higher histologic grade was poorer survival rate. EGFR positive patients had poorer prognosis than negative patients in stage I and II breast cancer(p<0.05).

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Expression of Multidrug Resistance P-Glycoprotein in Breast Carcinoma: Sung Sik Kang, Se Heon Cho, Sang Soon Kim, Jin Sook Jung, Sook Hee Hong; J Korean Cancer Assoc. 1994;26(6):912-926.

Abstract PDF: In 38 women with breast carcinoma who had locally advanced cancer without distant metastasis, the expression of P-glycoprotein was evaluated, using JSB-1 monoclonal antibody by ABC-immunoperoxidase method, P-glycoprotein was detected in 35 of 38 tumor samples(91.4%). Result were expressed in a semiguantitative manner, taking into account the number of posi- tive tumor cells(N index) and the specific staining index(I index). The frequencies of higher expression(N+I+2 or I+3) were detected in 0% of grade I, 33% of grade II and 90.9% of grade III in infiltrating duct carcinoma. Recurred cases were 4 out of 38(10.5%), of which 3 cases showed high histologic grade and more advanced stage with strong P-glycoprotein expression (N+I+3). Strong P-glycoprotein-positive staining in a majority of tumor cells(N-/I+3) was significantly correlated with histoiogic group with poor prognosis hi#gh histologic grade and recurrence. Thus, the pretreatment evaluation of P-glycoprotein expression may be of prognostic value in patients with locally advanced breast cancer. The possiblity that Mdrl enhances the invasiveness of cancer was suggested.

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Correlation of Tumor Grade and other prognostic factors in Invasive Breast Carcinoma: Young Bae Kim, Tae Sook Hwang, Joon Mee Kim, Young Chae Chu, Kyung Ja Cho, Ja June Jang; J Korean Cancer Assoc. 1994;26(6):926-936.

Abstract PDF: The prognostic factors in breast cancer are tumor stage, type, grade, hormonal receptor, tumor proliferative fraction, oncogene, altered growth factor receptor and angiogenesis. Since the first systematic study on grading system of breast cancer was published by Greenhough in 1925, a number of grading systems including Bloom-Richardson's histologic method and Blacks nuclear method have been reported and used. These grading systems have been considered as a classic and important prognostic factor for long time. In spite of this fact, there is a growing tendency that pathologists and clinicians disagree with grading system due to different results for prognosis and lack of reproducibility. Although these earlier analyses indicated that Bloom-Richardsons grade is prognostically more significant than Blacks grade, subsequent analysis indicate the converse. To investigate and evaluate usefulness of Bloom-Richardson grade and Black's grade, we examined the correlation of two grading systems and other estabiished prognostic factors, (i.e, tumor size, status of estrogen receptor, c-erbB-2 oncoprotein, Ki-67 labelling index, axillary nodal metastasis and microvessel count), in 62 cases of infiltrative ductal carcinoma of the breast. 1) Bloom-Richardson's histologic grade had significant correlation in nuclear grade, status of estrogen receptor, and Ki 67 labelling index. Tumor size and c-erbB-2 oncoprotein were also correlated with histologic grade, but it was statistically insignificant. 2) Blacks nuclear grade had also significant correlation in histologic grade, status of estro- gen receptor, c-erbB-2 oncoprotein and Ki 67 labelling index. Tumor size and axillary node metastasis were correlated, but they were statistically insignificant. 3) Metastasis and angiogenesis were not correlated with tumor grade. We could not compare histologic grade with nuclear grade fundamentally, because we failed to pursue patient's survival rate. However tumor grade in breast carcinoma served as a mandatory factor to get insights for status of other established prognostic factors or further prediction of patient's prognosis.

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Expression of nm23-H1 in Breast Cacner and Its Clinical Significance: Se Hwan Han, Dong Young Noh, Jin Suk Hu, Kuk Jin Choe, Sang Yong Song, Je Geun Chi; J Korean Cancer Assoc. 1994;26(6):936-943.

Abstract PDF: The nm23-Hl gene, identified from murine melanoma cell line, is located in the chromosome 17q22. Its meaning as an anti-metastatic marker was potentiated by the fact that the transfection of nm23-Hl gene into a murine melanoma cell line with high metastatic potential resulted in a change to decreased metastatic capability. This study was designed to determine the frequency of nm23 protein expression in human breast carcinoma and to compare its result with other established prognostic parameters. We studied 8S breast carcinoma samples for the expression of anti-nm23/nucleoside diphosphate kinase A using immunohistochemical analysis. All the patients were female and 7 cases(8%) were not stained immunohistochemically. Among the positively stained group, 43 cases(48.9%) were weakly positive and 38 cases(43.2%) were stained strongly. Expression of nm23 decreased significantly as the tumor size increased and in axillary lymph node metastasis group. There was decreasing tendency of nm23 expression as the nuclear grade increased. Estrogen receptor status or menopausal status did not correlate with nm23 expression. The disease free survival rate was superior in the group with strongly positive expression of nm23. In conclusion, the results suggest that expression of nm23 protein may have a role in the suppression of lymph node metastasis in breast carcinoma.

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Prognostic Significancy of the DNA Ploidy in Breast Cancer: Chang Taek Lim, Sung Jun Park; J Korean Cancer Assoc. 1994;26(6):943-950.

Abstract PDF: Flow cytometric DNA ploidy measurements using paraffin embeded tumor specimen were performed in 60 breast cancer patients. Twenty-six patients (43.3%) of the cases were diploid, thirty-four(56.7%) were aneuploid. DNA idex(DI) of histogram showed bimodal distribution and DI value of second peak incidence was 1.7. The DNA ploidy was not correlated with tumor size, lymph node involvement, progesterone receptor status, histologic type and menopausal status, but significantly correlated with estrogen receptor status. Postoperative clinical survey demonstrated a high tendency of recurrence rate and shorter survival time of patients with aneuploid tumors as compared those with diploid tumors. These results suggested that DNA ploidy is considered to be useful prognostic factor in human breast cancer.

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Treatment Results of Radiation Therapy in Laryngeal Cancer: Hong Seok Jang, Sei Chul Yoon, Sei Chul Yoon, Ki Mun Kang, Chul Seung Kay, Min Sik Kim, Byung Do Suh, Hoon Kyo Kim, Kyung Shik Lee, Kyung Sub Shinn; J Korean Cancer Assoc. 1994;26(6):950-959.

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Anti-tumor Effects of extracts of Pulsatilla koreana ( SB-31 ) in vitro: Sam Yong Kim, Song Bae Kim; J Korean Cancer Assoc. 1994;26(6):959-964.

Abstract PDF: Extracts of P. koreana(SB-3l) has been tried as an antitumor agent by traditional medicine practitioner in Korea for the past 30 years. It is a specially prepared extract af P. koreana whose fractions lose efficacy compared to the original mixture. Lee" observed substantial antitumor effects and minimal toxicity of SB-31 in sarcoma 180 animal tumor model(unpublished data). For the past 5 ears, there has been dramatic though anecdotal therapeutic outcomes with SB-3l in some advanced stage cancer patients. We evaluated the in vitro antitumor effects of SB-31 against 3 kinds of gastric cancer cells, A549, HeLa and Caski, MCF7, HepG2 and Hep3B and normal mononuclear cells. Cytotoxicity ws evaluated with the Tetrazolium-based colori- metric assay(MTT) after incubation of cancer cells with SB-31. Results; in 3 gastric cancer cells, ID of SB-31 were 0.16, 0.34 and 0.53 mg/mL Most effective tumor cell kill was achieved after 96 hrs of incubation with SB-31. The ID values of SB-31 on various cancer cell lines ranged from 0.14 mg/ml to 0.27 mg/mL Keeping SB-31 ampul in room temperature up to 4 days did not affect the efficacy but the activity decreased after more than 4 days in the ambient temperature. It is concluded that SB-31 is an active antitumor agent without significanct toxicity. The mechanism of action of SB-31 and its toxicity and efficacy should be further evaluated.

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Effect of Fatty Acid Administration on Metabolism of Cancer Patients: Se Hwan Han, Yeo Kyu Yong, Jin Pok Kim; J Korean Cancer Assoc. 1994;26(6):964-968.

Abstract PDF: Weight 1oss and inanition are the poor prognoatic sign in cancer patients. Tumor site is a major determinant of energy expenditure in gastrointestinal cancer patient. Patients with carcinoma of the stomach or pancreas present with a significant weight loss. In the advanced gastric cancer patients with pyloric obstruction, energy balance and weight 1oss have a significant implication on their postoperative recovery. The introduction of total parenteral nutrition (TPN) kindled the hope of ameliorating cancer-associated weight loss. However tumor-related inanition is sometimes resistant to parenteral forced feeding. So we studied the effect of fatty acid administration in the advanced gastric cancer patients with pyloric obstruction. The study group with administration of fatty acid is proved to have better recovery in early postoperative periad. Administratian of fatty acid decreased the protein breakdown and raised the serum ferritin level more rapidly. Serum albumin level was more stable in fatty acid administration group than in the group with TPN without fatty acid supplement. From the results of this study, we suggest that the administration of fatty acid with TPN may improve the postoperative recovery of cancer patients and ameliorate the muscle protein breakdown as well as to enhance the immune function.

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A Case of Pedunculated Hepatocellular Carcinoma: Hyun Hae Bae, Joong Ha Hwang, Kyung Ho Kim, Joo Hyung Lee, Soon Kyu Lee, Heon Soo Kim, Choong Ki Lee; J Korean Cancer Assoc. 1994;26(6):968-973.

Abstract PDF: Pedunculated hepatocellular carcinoma is rarely found in worldwide. Pedunculated HCC may be more amenable to curative resection then ordinary HCC due to its unique localization and growth pattern. Therefore, prognosis is better than ordianry HCC. We report a case of pedunculated hepatocellular carcinama in 60 year old cirrhotic male patient with review of literature.

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A Case of Hemorrhagic Brain Matastasis from Hepatocellular Carcinoma Manifesting Bitemporal Hemianopsia: Ho Yeol Choi, Heon Soo Kim, Tae Rim Park, Joong San Suh, Jae Myung Lee, Young Suk Park, Keun Chil Park, Duk Jhe Shun, Ho Chul Kim, Chul Sun Choi, Gu Kang; J Korean Cancer Assoc. 1994;26(6):973-980.

Abstract PDF: Brain metastasis from primary hepatocellular carcinoma(HCC) is very rare. The authors describe a case of hemorrhagic brain metastasis from hepatocellular carcinoma manifesting bitemporal hemianopsia. The patient was a 56-year old male, who had been diagnosed as HCC with metastasis to the lung in February, 1994. Since then he had been given palliative chemo- therapy with cisplatin and adriamycin with very good response. In June, 1994, he had experience sudden decrease of visual acuity and headache. Neruologic examination revealed anisocoria and bitemporal hemianopsia, and brain MRI demonstrated mutiple hemorrhagic metastases to both occipital lobes and high right parietal lobe. The diagnosis was confirmed by the liver biopsy. This is the first case in Korea, to the best of our knowledge, of HCC with hemorrhagic brain metastasis, manifesting bitemporal hemianopsia.

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A Case of Secretory Carcinoma of the Breast: Sei One Shin, Dong Sug Kim, Ki Kwon Kim; J Korean Cancer Assoc. 1994;26(6):980-984.

Abstract PDF: Secretory carcinoma of the breast is a rare tumor which has unique pathological features such as large amount of intracellular and extracellular secretian and granular eosinophilic cytoplasm. Moreover axillary nodal metastasis at initial presentation is a rarer conditian. We report a case of secretory carcinoma of the breast with axillary nodal metastasis which occurred in a 29-year-old woman. The involved breast was radiologically unremarkable but enlargement of ipsilateral axillary lymph node was demonstrated. Cytological examination of nipple discharge and ultrasound guided fine needle aspiration biopsy of axillary nodal lesion were diagnosed as ductal carcinoma and metastatic carcinoma of axillary lymph node from primary breast cancer. Traditionally surgery has been standard treatment and extended simple mastectomy was the most appropriate treatment. In this case axillary nodal metastasis was unusual presentation, and modified radical mastectomy (Patey's operation) with axillary node dissection was performed. Final histopathological examination confirmed secretory carcinoma with invasion of underlying fascia and metastatic axillary lymph nodes, all the three removed nodes. Postop- erative radiotherapy and systemic multiagents chemotherapy were administered. To our knowledge this is the first case of a secretory carcinoma in our institution and we re- port this case with review of literature.

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A Case of Thyroid Cancer Combined with Gastric Cancer: Yun Ho Lee, Seok Hwan Lim, Won Yeop Bae, Seung Jun Kim, In Pyo Jeon, Yeun Keun Lim, Hong Bae Park, Chin Duk Huh, Jang Sin Shon; J Korean Cancer Assoc. 1994;26(6):984-991.

Abstract PDF: Multiple primary malignant neoplasms in an individual are not rare. Recent reports indicate a gradual and steady increase of such occurences. This increase has been attributed to the fact that lifespan of cancer patients is longer than it used to be; the increase also has been attributed to more throught clinical evaluations and increased autopsies. We report a patient who had papillary carcinoma of the thyroid combined with adenocarcinoma of the stomach. The lesions were confirmed by endoscopic and fine needle aspiration biopsies. Our case is multiple primary malignant neoplasm of different organs a#nd is not common. Until present time, most commonly associated tumors with thyroid cancer were breast cancer, cervical cancer, ovarian cancer, pheochromocytoma, and leukemia. In this report, we discuss the multiple primary malignant neoplasm.

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A Case of gastric Adenocarcinoma Associated with Chronic Myelogenous Leukemia: Joong Ha Hwang, Hyun Hae Bae, Kyung Ho Kim, Joo Hyung Lee, Hye Jeong Yoon, Ho Yeong Lee, Choong Ki Lee; J Korean Cancer Assoc. 1994;26(6):991-997.

Abstract PDF: The incidence of multiple primary cancer is increasing recently due to various reasons. A case of gastric cancer was developed during the course of treatment of CML and the interval between CML and subsequently found gastric adenocarcinoma was l6 months. We report a case of gastric adenocarcinoma with CML with review of literature.

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Current Concepts of Diagnosis and Management of Insulinoma: Chang Yong Sohn, You Sah Kim, In Kyu Lee, Seok Kil Zeon; J Korean Cancer Assoc. 1994;26(6):997-1005.

Abstract PDF: Insulinoma is a functional endocrine tumor arising from beta cells of the islets of Langerhans of the pancreas. The tumor is usually a benign, single adenoma and of small size (1~2 cm), and is evenly distributed throughout the pancreas. The symptoms and signs are triggered by hypoglycemia. Mechanisms for the production of symptoms are related to the neuroglycopenia causing cerebral dysfunction and the hypoglycemic stimulation of catechola- mine release. Complex symptoms originating from these mechanisms frequently lead to misdiagnosis as a neurologic or psychiatric disorder and delay proper treatment. Once suspicion of an insulinoma is made, the diagnosis is not complicated. Supervised fast until symptoms develop or for 72 hours bring the blood sugar level down below 50 mg/dl with inappropriately high endogenous insulin leveL C-peptide and proinsulin fraction measured at the termination of the fast confirm the diagnosis. Preoperative localization of a small insulinoma by ultrasono#graphy, arteriograh or computed tomography is not always successfuL Selective portal venous sampling for insulin has been found to be the most accurate method of localization. Careful exploration of the entire pancreas is very important at laparotomy and intraoperative ultrasonoaraphy is essential especially in identifying tumors in the head of the pancreas and in defining the relationship of the tumor to the pancreatic duct. We report our experience of three patients with insulinoma d uring the last five year period: one male 23 years old and two females, 38 and 40 years old. Preoperative localization failed in the first patient but in two patients, preoperative percutaneous transhepatic portal venous sampling for insulin helped to 1ocalize the tumor. A relatively well-demarcated mass lesion was found in each patient, and all three patients were treated with successful outcome. The sizes of the tumors were 1.5 x 1.0 x 1.0 cm, 2.7 x 2.2 x 1.4 cm, L.5 x 1.0 x 1.0 cm respectively.

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2 Cases of Primary Uterine Lymphoma: Seok Nam Yoon, Young Yiul Lee, In Soon Kim, Kyung Tai Kim, Byung Hee Ko, Young Hyeh Ko; J Korean Cancer Assoc. 1994;26(6):1005-1013.

Abstract PDF: Primary Uterine lymphoma is a rare presentation of extranoal lymphoma: therefore, informations regarding histologic type, immunophenotype of tumor cell and etiologic factors are limited. Usually uterine cervix was predominant 1ocation in primary uterine lyphoma and most patients reported abnormal vaginal bleeding as a initial presentation in uterine lymphoma. Histologically, approximately 70% of all uterine lymphoma were diffuse large cell type by Working Formulation. Recently We experienced two cases of uterine lymphoma, one from uterine cervix, the other from uterine corpus. A uterine cervix lymphoma was diagnosed by colposcopic punch biopsy. A uterine corpus lymphoma was suggested by MRI findings; diffuse uterine enlargement without contour alteration of endometrium, and confirmed by deep cervical punch biopsy. Two cases were found to have diffuse large cell lymphoma and immunologically one was Bll lineage, the other T-cell lineage. Two case were treated with chemotherapy only. We report these cases with literature review.

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Complete Response to Treatment in a Patient with Patient with Grossly Unresectable Neuroblastoma: Won Hoe Kuh, Dong Yi Kim, Sang Young Chung, Shin Kon Kim; J Korean Cancer Assoc. 1994;26(6):1013-1020.

Abstract PDF: Neuroblastoma occurs as a derivative of neurel crest cells and occasionally can be matured from a malignant neuroblastoma into a benign ganglioneuroma. Neuroblastoma ie responsible for 10 percent of all pediatric neoplasms and seen most often in the newborn period. and the median age at diagnosis is 2 years. It has the highest rate of spontaneoue regression of any pediatric tumor. But this tumor presents with metastaaes in 70% of cases, and despite aggressive multimodal therapy, has not significantly increased the proportion of patients with advanced disease who are cured. Recently, combined treatment, including aggressive chemotherapy, radiation therapy, and surgery, has induced complete regression and prolongation of disease free survival in some patients. This article presents a case of complete regression of neuroblastoma with brief review of the literature.

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Histologically Transformed Non - Hodgkin's Lymphoma in Pregnancy: Seock Ah Im, Ki Nam Shim, Soon Nam Lee, Soo Yeon Cho, Hae Soo Koo, Kyung Ja Lee; J Korean Cancer Assoc. 1994;26(6):1020-1028.

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