Cancer Research and Treatment

Immunohistochemical Expression of bcl-2 and p53 in Breast Carcinomas: Young Euy Park, Jin Ja Park, Kyung Chan Choi, Hyung Shik Shin, Young Euy Park; J Korean Cancer Assoc. 1996;28(5):787-796.

Abstract PDF: The immunohistochemical expression of bcl-2 and p53 protein was evaluated in formali-fixed, paraffin embedded surgical specimens from 107 patients with breast carcinoma. bcl-2 protein was found to be expressed in 66 specimens(62.9%). Bcl-2 expression was correlated with good prognostic factors such as well differentiation, low grade nuclear atypism, few mitoses or absence of lymph node metastasis. p53 protein expression was detected in 60 cases(56.6%). An inverse correlation was observed between of bcl-2 and p53(R=0.l9863, p< 0.05). These findings suggest that overexpression(mutation) of p53 and/or bcl-2 protein may be early events in tumorigenesis and that p53 alterations in particular are essential for maintenance of a malignant phenotype in tumour development.

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Identification of Estrogen Receptor Gene in Breast Cancer: Young Jin Suh, In Chul Kim, Sang Seol Jung; J Korean Cancer Assoc. 1996;28(5):796-806.

Abstract PDF: Background
The initiation and progression of breast carcinoma are profoundly influenced by hormonal factors. Breast tumors that express the estrogen receptor (ER) are slower growing, associated with better long-term disease-free survival, and amenable to endocrine therapy with agents such as the antiestrogen. But only 60% of the ER-positive breast cancer patients respond to endocrine manipulation. In addition, many ER-positive cancers that initially respond to endocrine therapy ultimately progress to a more aggressive hormone-independent phenotype. Loss of estrogen receptor expression is an important means of hormone resistance, but the mechanisms involved are poorly understood. Materials & Method: We examined the ER by dextran-coated charcoal assay and the ER cDNA by reverse transcription-palymerase chain reaction in 19 primary breast cancers to determine if alterations of the gene are associated with the ER-negative status. Results: From this study, we could see the expression of the ER gene in all of the ER- positive specimens, but ER-negative group showed inconsistent results. Four out of 9 ER- negative specimens expressed ER gene. Three of these four were progesterone receptor-positive. Conclusion: This results suggest that ER expression may be determined at the transcription level and that genomic analysis of the ER may be more accurate than conventional ER assays in clinical setting.

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Characteristics of Epstein - Barr Virus Expressed in the Nasopharyngeal Carcinomas of Korean Patients: Jae Myun Lee, Tae Yoon Lee, Jeon Han Park, Se Jong Kim, Hyunee Yim, Charn Il Park, Ho Gune Kim; J Korean Cancer Assoc. 1996;28(5):806-813.

Abstract PDF: Epstein-Barr virus (EBV) is frequently associated with nasopharyngeal lymphoepithe-liomas and certain types of lymphoma, and rare lymphoepithelioma-like carcinomas occuring in various of organs such as stomach, parotid gland, thymus and lung. We have investigated the possibility that EBV may be present not only in the rare type of nasopharyngeal carcinoma, but also in the typical nasopharyngeal carcinoma (NPC) of squamous cell type. Polymerase chain reaction (PCR) for the W fragment of EBV was performed for the detection of EBV DNA, and in situ hybridization was performed for the detection of latent EBV infection in formalin-fixed paraffin embedded surgical specimens with EBER probe. PCR for the variable number of tandem repeat (VNTR) region of the latent membrane protein-1 gene was also performed for the differentiation of the infected EBV subtype in the different tumors. Positive reactions of the EBV was shown in 18 (86 %) of 21 cases of NPC. These reactions were detected by all of the above cases only in the carcinoma tissue specimens. The frequency of EBV gene expression at the NPC was related to the histologic differentiation of the tumors: All of the 9 cases of the lymphoepitheliomas and 3 cases of poorly differentiated squamous cell carcinomas were positive for EBV, 5 out of 7 squamous cell carcinomas of moderate differentiation were positive for EBV, and 2 cases of the well differentiated squamous cell carcinomas were negative for EBV. The EBV found in the NPC has three different number of VNTR in the latent membrane protein gene-1. These results suggest that variable subtypes of EBVs are associated with the NPC and the association of RBV with NPC is late event in the nasopharyngeal carcinoma progression as evidenced by negative association in the preneoplastic lesion and frequent association in the more poor differentiated tumors.

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Management of Hypopharyngeal Carcinoma: Hong Gyun Wu, Hyung Joon Yoo, Charn Il Park, Kwang Hyun Kim, Young Kap Cho; J Korean Cancer Assoc. 1996;28(5):813-819.

Abstract PDF: Fifty-nine patients with squamous cell carcinoma of the hyphopharynx were treated at Seoul National University Hospital between October 1979 and December 1992. Of these, l8 patients received radiotherapy alone, 17 patients received planned surgery with neck dissection, followed by post-operative radiotherapy, and 24 patients received radiotherapy following 2 or 3 cycles of FP chemotherapy. A median follwo-up period was 41 months, ranged from 25 months to 129 months. The majority of the patients(94.9%, 56/59) was diagnosed with stage III(19%) or IV(75.9%). The overall survival at 5 years for all patients was 29%,with a median survival of 29 months. The 5-year survival rate was 15% on radiotherapy alone, 35% on surgery and postoperative radiotherapy, and 33% on 2 cyles of FP regimens followed by radiotherapy(p=0.001). However, the survival rates between surgery plus postoperative radiotherapy and chemotherapy following radiotherapy was not statistically significant, but voice preservation and swallowing function is superior with chemotherapy following radiotherapy. Although there was no randomized studies of surgery and postoperative radiotherapy versus chemothrapy following radiotherapy, nonsurgical management of advanced hypopharyngeal cancer employing chemothrapy and radiotherapy is preferred to radical surgery for patients with squamous cell carcinoma of the hypopharynx.

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Micrometastases of Axillary Lymph Nodes from Stage 2 a Breast Cancer : Immunohistochemical Detection and Prognostic Significance: Koo Jeong Kang, Hyung Tae Kim, Ki Yong Chung, You Sah Kim, Sang Han Lee, In Soo Suh; J Korean Cancer Assoc. 1996;28(5):819-829.

Abstract PDF: This study was performed to identify the cancer cells in lymph nodes taken from women stage IIa breast cancer using routine hematoxyline-eosin(HE) stains. Six hundred and thirty-four lymph nodes were taken from 42 cases of breast cancer. Among these, 31 cases were negative for lymph nodes metastasis and 1l were positive for lymph node metastasis. All 634 lymph nodes were immunostained. Eight of 11 patients(72.7%) who had positive lymph nodes had at least one or more nodes stained by anti-epithelial membrane antibody and 7 of ll patients(63.6%) who had positive nodes had at least one or more nodes stained by anti-cytokeratin(PAN-CK) anti-body. Of the 31 cases of negative lymph nodes, 2 cases of occult micrometastases were detected by immunohistochemical stains. One of the 2 cases was stained by only one monoclonal antibody In the follow up study(a mean of 59.9 months), there were no important prognostic factors for 5 year survival rates according to the following 3 categories: age( < 40 years vs. >=40 years), tumor size(< 2.0cm vs. >=2.0cm), and immunohistochemical stain. The presence of metastatic axillary lymph node was the most important prognostic factor for 5 year disease free survival(p=0.05). The immunohistochemical stain of the axillary lymph nodes was not significant for 5 year overall and disease free survival. One of the 2 patients who had negative axillary nodes by HE stain but positive nodes by immunohistochemical stains had a recurrence within 4 years and 11 months after mastectomy. Immunohistochemical stain for axillary lymph nodes of patients without lymph node metastases is a useful tool for detecting occult micrometastases, however, it is not helpful as a prognostic factor.

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Comparison of Risk Factor in Breast Cancer Patients by Menopausal Status: Woo Suk Kim, Koo Jeong Kang, You Sah Kim; J Korean Cancer Assoc. 1996;28(5):829-835.

Abstract PDF: Some of the risk factors for breast cancer were compared by menopausal status on 427 patients with proven breast cancer. Statistical analysis was performed with t-test or Chi-Square test and five-year survival rate was obtained by Kaplan-Meier survival method. The results were as follows. 1) In premenopausal patients, the mean age was 40 years old and the peak incidence was in the 5th decades. In postmenopausal patients, the mean age was 55 and the peak incedence was in the 6th decades. 2) Breast feeding was used in 170 premenopausal patients (79.8%) and in 109 postmenopausal patients (94.9%) and the difference was statistically significant (p=0.0001). 3) The mean body weight of premenopausal patients was 59.5Kg and that op postmenopausal patients was 56.4 Kg and there was no statistically significant difference. 4) The mean ages at menarch were 15.7 and 16.4 years old for pre and postmenopausal patients respectively, and the difference was statistically significant. 5) In premenopausal patients the first full term delivery occurred most frequently between the ages of 24 and 29 years and in postmenopausal patients this occurred most frequently before the age of 23. There were 16 nulliparous women in premenopausal patients and l9 in postmenopausal patients. 6) Infiltrating ductal carcinoma was the most common histologic type in both pre and postmeaopausal patients. The histologic types were similar in both group of patients except mucinous carcinoma which was more common in premenopausal patients 7) The five-year survival rates of pre and postmenopausal patients were 86.7% and 81.0 %, respectively, and there was no statistically significant difference (p=0.315).

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5-Fluorouracil and Cisplatin ( FP ) Combination Chemotherapy in Advanced Esophageal Cancer: In Sook Woo, Kyung Hae Jung, Young Iee Park, Jung Ae Rhee, Dae Seog Heo, Yung Jue Bang, Noe Kyeong Kim; J Korean Cancer Assoc. 1996;28(5):835-842.

Abstract PDF: Esophageal Carcinoma is widely disseminated in many patients at the time of diagnosis. Therefore systemic chemotherapy has assumed an important role in the treatment of this disease. We conducted a phase II trial of 5-fluorouracil and cisplatin in 39 patients with advanced esophageal cancer. The regimen consisted of 5-fluorouracil, 1,000 mg/§³/day in 12 hour continuous infusion on day 1 to 5 and cisplatin, 60 mg/§³/day iv on day 1 every three weeks. Response rates were calculated only from 37 patients with measurable disease. The response rate was 39%(complete response 2%, partial response 37%) with a median duration of 4 months (range 2~10 months). Median time of survival for all patients was 9 months(range 1~4 months). The toxicities were moderate. This study demonstrates that combination of 5-fluoriuracil and cisplatin is an efficient and tolerable chemotherapy regimen in patients with advanced esophageal cancer.

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Clinical Parameters and prognosis Correlated to the Histopathologic Type in Gastric Cancer - Retrospective evaluation of 2099 cases -: Sang Ho Lee, Seung Do Lee, Kyung Hyun Choi, In Sun Jun, Man Ha Huh; J Korean Cancer Assoc. 1996;28(5):842-852.

Abstract PDF: Between 1980 and 1992, 3176 patients with adenocarcinoma of stomach underwent surgical treatment at the detartment of Surgery, Kosin University. The prognostic significance of histologic classification in patients with gastric cancer has been controversial. The purpose of this study was to evaluate clinical parameters according to the WHO and Lauren's classification and the implication of both classifications as a prognostic factor in gastric cancer. The clinical characteristic according to the histopathologic classification were evaluated in 2099 patients with gastric cancer who underwent gastrectomy. The authors also investigated whether the WHO and Lauren's classification represent a prognostic parameter by log-rank test and survival rate was examined with Kaplan-Meier method. The 2099 patients were classified as papillary type(23/2099 1.10%), tubular well differentiated(491/ 2099 l9.5%), tubular moderately differentiated(506/2099 24.2%), poorly differentiated(800/2099 38.2%), mucinous(l00/2099 4.8%), signet ring cell(230/2099 11%), and others(31/2099 0.3%), according to WHO, and as intestinal(1040/2099 49.6%), diffuse(835/2099 39.8%), and mixed(224/ 2099 10.6%) according to Lauren. The 5-years survival rate of gastric cancer patients in each stages were 100%, 100%, 50%, 7.6% in papillay adeno carcinoma, 89%, 80%, 49%, 4,8% in tubular well differentiated, 89%, 65%, 45%, 4.7% in tubular moderately differentiated, 86%, 62%, 36%, 4.2% in signet ring cell, 100%, 85%, 64%, 10% in mucinous carcinoma by the WHO's classification and 89%, 17%, 47%, 6% in intestinal type, 89%, 64%, 33%, 6% in diffuse type by the Lauren's classification. Based on the data presented in this study, we conclude the combination of WHO and Laurens classification may provide a good prognostic prediction in gastric cancer.

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Cininicopathological Study of Esophageal Invading Carcinoma of the Upper Third Part of the Stomach: Sung Hoon Noh, Chang Hak Yoo, Yong Il Kim, Coong Bai Kim, Jin Sik Min, Kyung Shik Lee; J Korean Cancer Assoc. 1996;28(5):852-860.

Abstract PDF: To evaluate clinicopathological characteristics and prognostic factors of esophageal invading cancer of the upper third of the stomach, we analyzed retrospectively 198 patients who underwent total gastrectomy for adenocarcinoma arising from the upper third of the stomach during 1987 to 1993 at Deparment of Surgery, Yonsei University, College of Medicine and divided into two groups as esophageal invading group(n=39) and non-invading group(n=159). Esophageal invading group had larger tumor size and higher rates of serosal invasion, lymph node metastasis, liver and peritoneal metastasis than non-invading group. Therefore more advanced stage and palliative resection were observed in esophageal invading group. The 5-year survival rate of esophageal invading group(37.6%) was significantly lower than that of non-invading group(60.8%). The significant prognostic factors of esophageal invading group using Cox's proportional hazard method were lymph node metastasis and curability of gastric resection. In conclusion, esophageal invading gastric cancer had more aggressive behavior than that of non-invading group and frozen section of proximal resection margin during operation should be performed for curative resection. For some of patients with far advanced upper third gastric cancer, neoadjuvant chemotherapy, early postoperative intraperitoneal chemotherapy(EPIC) or intraperitoneal hyperthermic chemotherapy(IPHC) may provide better qualiity of life and survival benefit.

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What is the Proper Management for Stage 4 Gastric Cancer ?: Chang Hak Yoo, Sung Hoon Noh, Yong Il Kim, Jin Sik Min, Kyung Shik Lee; J Korean Cancer Assoc. 1996;28(5):860-868.

Abstract PDF: Among 2118 patients with gastric cancer who had undergone gastric resection in the Department of Sursery, Yonsei University College of Medicine over the 7 years period from January 1987 to December 1993, there were 214(10.l%) with stage IV gastric cancer, designated as a lesion with factors such as direct invasion of adjacent organs(T factor), tertiary or quaternary nodal involvement(N factor), peritoneal metastasis(P factor) or hepatic metastasis(H factor). The overall 5-year survival rate in patients with stage IV gastric cancer after gastric resection was 11.3%. The 5-year survival rate in patients without distant metastasis(n=122) was 17.5%, being significantly higher than the 4.4% in cases with distant metastasis(n=92). Patients with tertiary nodal involvement or directly invaded organs alone survived at a rate of 23.8% and 10.2% in the 5-year follow-up, respectively. Signifi cant difference in 5-year survival rates were also noted in curability(curative resection:22.3 %, palliative resection: 5.1%) and type of operation(subtotal: 15.6%, total: 6.0%). But the mean survival time was less than 10months in patients with more than 2 factors in combination. In conclusion, there appear to be 2 subgroups in whom the rates of survival differ in stage IV gastric cancer according to distant metastasis. Therefore radical procedures such as extended lymphadenectomy and combined resection of invaded organ should be performed in M0 cases. On the other hand, in Ml cases, consideration and adaptation of new therapeutic approach except gastric resection will improve the survival and quality of life.

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Response to Informed Consent in Gastric Cancer Patients: Jae Bok Lee, Young Jae Mok, Yun Sik Hong, Ho Sang Ryu, Sae Min Kim; J Korean Cancer Assoc. 1996;28(5):868-876.

Abstract PDF: The response of gastric cancer patients who have received surgical resection and follow-up OPD treatment to the informed consent was analyzed. The subjects analyzed were the responses to questionnaires given to 80 patients who were receiving follow-up OPD treatment following gastric resections for gastric cancer. The questionnaire consisted of inquiry on the disease, abount the doctors attitude, about the operation, about the postoperative chemoimmunotherapy and about Expertise. (5 titles, 22 items). The preoperative patient information rate of gastric cancer at Korea University Hospital was 62.3%. 55% had knowledge of the cancer prior to surgery while 45% acquired knowledge following surgery. The source of informatian pertaining to the patient's disease was the attending doctor in 62.3%, and 32.1% of the patients first acquired knowledge through family members. Changes following knowledge of cancer included active participation in treatment in 54% of the patients, planning for the future of the family in 31%, and acquirement of a new religion in 10%, showing an overall positive change in 85% of the informed patients. Degree of satisfaction following the operation after the doctors explanation was very satisfactory in 69.4% compared to the 38.9% in the absence of explanatian(p=0.027). Patient questions pertaining to postoperative treatment included inquiries on future treatment plans in 30%, survival period in 10%, and possibility of recurrence in 10%, 50% of the respondents did not comment. The confidence that the patients had in their doctors was compared on the basis of whether there was prior explanation by the attending doctor. 75.8% of the patients who received a doctors explanation were very confident in their doctor, whereas only 27.8% of those who did not receive nay explanation had such confidence(p=0.037). Patient confidence in chemoimmunotherapy also varied, as 28(48.3%) of the 58 patients receiving therapy had prior explanation gieven while 30(51.7%) received were without any explanation. 60.7% of patients who received explanation about the therapy were very confident in the chemoimmunotherapy, while only 43.3% of the non-explained group had such confidence(p=0.044). The result showed that adequate explanation about disease and patient's course by doctor influenced the patient's participation to treatment and sense of well-being. In conclusion, doctors active explanation to patient of gastric cancer is needed and we should develop an adequate method of giving and receiving informed consent.

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Treatment Outcome of the Nonfunctioning Pituitary Adenoma with Radiation Therapy: Hyung Jun Yoo, Il Han Kim; J Korean Cancer Assoc. 1996;28(5):876-881.

Abstract PDF: Purpose
This study was done to analyze survivals, local control, improvement of symptoms, and complications of nonfunctioning pituitary adenoma after radiation therapy. Materials and Methods: Radiation treatment results were analyzed in a retrospective analysis of 103 patients with nonfunctioning pituitary adenoma treated with radiation or combined with surgery from 1979 through 1990 at the Department of Therapeutic Radiology of Seoul National University Hospital. Radiation doses of 4000-5540 cGy were delivered over a periods of 4~7 weeks. Results: The 10-year overall and progression-free survival rates for all patients were 88. 6% and 85.2%. The tumor was controlled in 91 of 103(90.4%) patients for an observed period of 17 to 165 months. Sixty-two of 88(70.5%) patients with impaired visual acuity and 54 of 85(64.3%) patients with visual field defect experienced normalization or improvement. The only prognostic variable identified by univariate analysis to significantly alter progression-free survival was the extent of visual field defect(p=0.04). Conclusion: We concluded that radiotherapy is clearly effective in tumor control and controlling of clinical symptoms and signs resulted from nonfunctioning pituitary adenoma.

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Hodgkin's Disease of the High Cervical Lymph Nodes: Jong Ouck Choi, Yong Whoan Kim, Chan Park, Kwang Yoon Jung, Gun Choi; J Korean Cancer Assoc. 1996;28(5):881-888.

Abstract PDF: Hodgkin's disease is a lymphoreticular malignancy that usually presents as painless lymphadenopathy, frequently in the cervical area. The most frequently palpable lymph nodes of the Hodgkin's disease at presentation are in the lower cervical and supraclavicular areas. Lymphadenopathy of high cervical nodes are commonly diagnosed as reactive lymphadenopathy rather than the Hodgkin's disease which may cause a delay in making a correct diagnosis of Hodgkin's lymphoma. Here we report 3 cases which were admitted with the chief complaint of high cervical mass. They were initially misdiagnosed as nonspecific lymphadenitis and were treated with antibiotics for a few weeks without improvement. Therefore, we performed excisional biopsy of palpable nodes to confirm to diagnose the Hodgkin's disease. The patients were treated with radiotherapy or chemoradiotherapy according to Ann Arbor staging. In our experience, excisional biopsy is preferred in cases of high cervical lymph nodes greater than 3 cm in diameter which are not accurately diagnosed with fine needle aspiration biopsy and are not responsive to antibiotics for a few weeks.

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A Case of Synchronous Triple Primary Cancers in Larynx , Esophageu , and Stomach: Gyo Seon Kwun, Kyung Tae Kim, Yong Cho Kim, Ju Byeung Sung, Young Wo Lee, Eun Jung Jang, Baek Yeol Ryoo, Tae You Kim, Young Hyuck Im, Yoon Koo Kang, Seung sook Lee, Jim Oh Lee, Tae Woong Kang; J Korean Cancer Assoc. 1996;28(5):888-897.

Abstract PDF: Multiple primary cancers can occur in up to 20% of primary aerodigestive tract cancer patients. The multiplicity of cancer in aerodigestive tract suggests that the exposure to common carcinogen may be the cause of multiplicity(field cancerization). Continuous alcohol drinking and smoking are considered to be the major factors in development of multiple cancers. Also, high frequency of genetic alterations in multiple primary cancer patients implys that the genetic instability such as replication error or mutation of tumor suppressor gene may play a role in the development of multiple primary cancers. We report a case of a 61 year-old man who had triple synchronous cancers in larynx, esophagus, and stomach. He was a heavy smoker of 30-pack-years and a heavy drinker. Pathological examination showed squamous cell carcinoma of larynx and esophagus, and adenocarrinoma of stomach, respectively.

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A Case of Well - Differentiated Thymic Carcinoma with Severe Aplastic Anemia: Jung Ah Kim, Gi Hyeon Seo, Sung Soo Yoon, Won Ki Kang, Hong Ghi Lee, Keun Chil Park, Young Hyeh Ko, Chan Hyung Park; J Korean Cancer Assoc. 1996;28(5):897-903.

Abstract PDF: Thymoma is occasionally associated with hematologic disorders such as pure red cell aplasia, agranulocytosis, and thrombocytopenia and several cases have been associated with pancytopenia. In contrast, thymic carcinoma has rarely been associated with aplastic anemia except one case reported by Thomas et aL. This case report concerns a patient in whom we have observed simultaneous occurrence of a well differentiated thymic carcinoma and a severe marrow aplasia for which we describe our therapeutic approach. Our patient did not benefit from thymectomy. We then tried antilymphocyte globulin and cyclosporine and the patient had a partial response with hematologic improvements.

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Gastric Endocrine Cell Carcinoma in Peutz - Jeghers Syndrome : - A case report -: Jeong Hee Cho; J Korean Cancer Assoc. 1996;28(5):903-910.

Abstract PDF: We report a rare case of Peutz-Jeghers syndrome(PJS) in a 27-year-old woman who developed endocrine cell carcinoma of the stomach, hamartomatous polyps in stomach and jejunum, and sex cord tumor with annular tubules and serous cystadenoma in ovary. Polyps removed from the stomach and jejunum showed features typical of hamartomas. Gastric endocrine cell carcinoma(ECC) revealed undifferentiated medullary type growing in solid islands of large cells and having remarkable cellular atypia and numerous mitoses. ECC cells were argentaffinic and diffusely strong positive for chromogranin and neuron-specific enolase. Synchronous production of several peptides, such as glucagon, ACTH, and somatostatin, was shown in this gastric ECC. The nuclei of the tumor cells were diffusely and strongly positive for anti-p53 anti body, reflecting the presence of p53 mutation. Ultrastructurally, membrane bound dense core neuroendocrine granules were present in the cytoplasm of the tumor cells. This is the first report of a PJS associated with gastric ECC. We also firstly demonstrated that p53 mutation occured in carcinogenesis of gastric ECC as well. This case adds an example of predisposition of PJS to unusual gastric ECC and indicates the importance of alterations of p53 tumor suppressor genes in carcinogenesis of gastric ECC.

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CD34+ Selected Peripheral Blood Stem Cell Transplantation: Hoon Kook, Hyeoung Joon Kim, Jin Soo Hwang, Keun Mo Kim, Keun Mo Kim, Ik Joo Chung, Tai Ju Hwang; J Korean Cancer Assoc. 1996;28(5):910-921.

Abstract PDF: The CD34 antigen is a 115 kDa glycoprotein that marks 1%-4% of human bone marrow cells, including virtually all committed progenitor cells and long-term reconstituting stem cells. The selection of CD34+ cells may be useful in several areas of clinical stem cell transplantation, including purging of tumor cells, T cell depletion, stem cell expansion and gene therapy. Using immunomagnetic beads method (Isolex-50TM), we report hereby the first two Korean experiences of CD34+ selected peripheral blood stem cell (PBSC) transplantations. As a mean of tumor cell purging, CD34+ cells were positively selected from mobilized PBPCs and infused to a 5-year-old girl with a relapsed stage IV neuroblastoma with resultant early short-term trilineage hematopoietic recovery. In the second patient with chronic myelogenous leukemia who showed poor graft function after having underwent an initial partially-matched bone marrow transplant, CD34+ selected allogeneic PBSC transplantation was attempted to reduce the likelihood of inducing graft-versus-host disease. Augmentation of marrow function was noted with infused PBSCs which were depleted of T cells to the degree of log3.65. As CD34+ selected PBSCs are capable of restoring hematopoietic recovery after high dose therapy, further development of selection technique to ensure high purging efficiency without significant loss of stem cells and further identification of best mobilizing and conditioning regimens are required in this new field of clinical transplantation.

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Engraftment Syndrome after Peripheral Blood Stem Cell Auto - transplantation - A report of the case -: Bong Seok Choi, Yeo Hyeon Ahn, You Jeong, Ik Joo Chung, Hyeoung Joon Kim, Hoon Kook, Tai Ju Hwang; J Korean Cancer Assoc. 1996;28(5):921-927.

Abstract PDF: We experienced two cases of engraftment syndrome (ES) in a 17-year-old boy with malignant lymphoma and in a 53-year-old female patient with small cell lung cancer following peripheral blood stem cell auto-transplantation. ES is a reproducible clinical constellation of fever, skin rash, capillary leak and pulmonary infiltrates without infection, characteristically observed during engraftment in patients undergoing autoglogous bone marrow or peripheral stem cell transplantation. The incidence of ES has been reported to be about 60%. The early recognition of ES followed by administration of steroids might obviate the unnecessary use of antibiotics and help improve clinical manifestaions in the critical post-transplant neutropenic period.

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A Case of Ph chromosome - Negative , bcr / abl Rearrangement - Positive Chronic Myelogenous Leukemia Prasenting with Dermopathy and Lymphadenopathy: Young Wo Lee, Gyo Seon Kwun, kyung Tae Kim, Young Cho Kim, Ju Byeung Sung, Eun Jung Jang, Choon Hong Hwnag, Baek Yeol Ryoo, Tae You Kim, Young Hyuck Im, Yoon Koo Kang, Jhin Oh Lee, Tae Woong Kagn; J Korean Cancer Assoc. 1996;28(5):927-936.

Abstract PDF: Chronic myelogenous leukemia(CML) is a clonal stem cell disorder, characterized by markedly increased myelopoiesis and the presence of the Philadelphia(Ph) chromosome. Ph chromosome, the result of a translocation between the abl proto-oncogene on chromosome 9 and the bcr gene on chromosome 22, is found in more than 95% of CML patients. The remaining 5% of patients are classified as Ph chromosome-negative CML and the bcr/abl gene rearrangement is detectable in approximately 50% of these patients. These Ph chromosome-negative, bcr/abl rearrangement-positive patients have clincal course and prognosis very similar to those of Ph chromosome-positive CML patients. We experienced a case of Ph chromosome-negative, bcr/abl rearrangement-positive CML presenting with multiple skin lesions and lymphadenopathy in a 59-years-old man. Bone marrow aspiration and biopsy showed typical features of CML in chronic phase. Skin and lymph node biopsies showed extramedullary leukemic cell infiltration, suggesting aggressive phase of CML. While the chramosome study revealed normal karyotype, RT-PCR analysis revealed bcr/abl fusion transcripts. In spite of chemotherapy, he expired 13 months after diagnosis.

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A Case of Multiple Myeloma Presented Simultaneously with Intracranial Extramedullary Plasmacytoma: Hueng Seuk Ko, Jeong Keun Park, Kyung Seuk Kim, Jin Gu Kim, Sang Tae Woo, Tae Eui Song; J Korean Cancer Assoc. 1996;28(5):936-942.

Abstract PDF: Multiple myeloma is a neoplasm of mature and immature plasma cells. Extraosseous tissues frequently are involved in multiple myeloma. The most common sites of involvement are the spleen, the liver, lymph nodes, and the kidneys, but infiltrates may also be encountered in most other tissues, such as thyroid and adrenal glands, ovaries, testes, lungs, pleura, pericardium, skin, and intestinal tract. Intracranial involvement of multiple myeloma is rare and usually presents in one af three forms, cases with single or multiple cranial nerve palsies caused by myeloma deposits in the bone of the base of the skull, cases simulating intracranial space-occupying lesions, and cases with orbital involvement. Evaluation of the extent of disease is essential for proper management of this patient. The treatment and prognosis differs according to whether the extramedullay plasmacytoma is primary or secondary. We report a case of multiple myeloma presented simultaneously with intracranial extramedullary plasmacytoma of pituitary which erodes the sella with compression of optic chiasma.

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