Discriminating myelodysplastic syndrome and other myeloid malignancies from non-clonal disorders by multiparametric analysis of automated cell data

Kim, Seon Young,Park, Yumi,Kim, Hyunjin,Kim, Jimyung,Kwon, Gye Cheol,Koo, Sun Hoe Elsevier 2018 Clinica chimica acta Vol.480 No.-

<P><B>Abstract</B></P> <P><B>Background</B></P> <P>We investigated the usefulness of novel complete blood count (CBC) data for discriminating myeloid malignancies from non-clonal CBC abnormalities.</P> <P><B>Methods</B></P> <P>Data were obtained during routine CBC tests of 119 samples from 37 myelodysplastic syndrome (MDS) patients, 92 samples from 45 myeloproliferative neoplasm (MPN) patients, and 15 samples from 11 chronic myelogenous leukemia (CML) patients using a DxH800 (Beckman Coulter). Data obtained from patients with hypocellular bone marrow and from those with other non-clonal diseases with CBC abnormalities were included in the comparisons.</P> <P><B>Results</B></P> <P>For cell population data of neutrophils, the means of median, upper median, lower median, and low angle light scatters were significantly lower in MDS patients than in patients without hematological malignancies. Low hemoglobin density (LHD) did not significantly differ between the MDS and non-clonal cytopenia patients, but it was significantly higher in the MPN and CML patients. We selected 13 parameters and scored the MDS diagnosis using cut-off values obtained from receiver operating characteristic (ROC) curve analysis. Using a score > 9, MDS was distinguished from non-clonal cytopenia with a sensitivity of 92.4% and a specificity of 85.4%.</P> <P><B>Conclusions</B></P> <P>Multiparametric analyses of new automated parameters are useful for discriminating MDS from non-clonal cytopenia.</P> <P><B>Highlights</B></P> <P> <UL> <LI> For neutrohpils, median of light scatters are significantly lower in MDS patients. </LI> <LI> Low hemoglobin density was significantly higher in MPN and CML patients. </LI> <LI> Multiparametric analysis of new automated parameters is useful for screening MDS. </LI> </UL> </P>

Slow mohs micrographic surgery and wide local excision for melanoma treatment in Korean patients

( Jimyung Seo ),( Jee Eun Kim ),( Jihee Kim ),( Dae San Yoo ),( Kyoung Ae Nam ),( Sang Kyum Kim ),( Mi Ryung Roh ),( Kee Yang Chung ) 대한피부과학회 2018 대한피부과학회 학술발표대회집 Vol.70 No.2

Background: It is not always possible to use conventional wide local excision (WLE) for melanoma in areas that have anatomical complexity and lack a local skin Also, considering the prominent radial growth features of acral melanomas common in darker-pigmented individuals, a new strategy for entire margin evaluation is needed. Objectives: We aimed to show the potential benefits of slow Mohs micrographic surgery (MMS) for treatment of melanoma. Methods: This retrospective study evaluated 244 melanoma patients treated using slow MMS (n = 72) or WLE (n = 144) by a single dermatologic surgeon from 2005 to 2015. We performed slow MMS in melanomas that showed features of radial growth phase or had high recurrence risks; conventional melanomas were treated using WLE. Results: The slow MMS group had greater proportions of acral lentiginous and lentigo maligna melanomas and had more patients with melanoma in situ, suggesting the preferential use of Slow MMS in radial growth feature melanomas. Cox regression analysis of the study cohort revealed that melanoma stage and acral location were the significant factors for recurrence and survival. Kaplan-Meier analysis showed that patients treated with slow MMS had significantly higher disease-free proportions, compared with those treated using WLE. Conclusion: Slow MMS may be a useful alternative in treating difficult-to-manage melanomas for WLE, providing better local control with maximum conservation of surrounding skin.

A case of paraneoplastic pemphigus associated with a malignant thymoma

( Jimyung Seo ),( Jae Won Lee ),( Dongyun Shin ),( Soo Chan Kim ),( Do Young Kim ) 대한피부과학회 2015 대한피부과학회 학술발표대회집 Vol.67 No.1

A 56-year-old female visited our dermatology clinic with a two-month history of persistent painful oral mucositis and erythematous to violaceous papules and plaques without blisters over her trunk and limbs. The patient had been treated with multiple drugs including high-dose oral corticosteroid and ciclosproin under the clinical impression of a generalized lichen planus; however the disease remained inadequately controlled for four months. Paraneoplastic pemphigus (PNP) was considered due to therapy-refractory erosive mucosal lesions, weight loss, and recent hemoptysis. Two biopsies of the skin and oral mucosa revealed interface dermatitis with a thick lichenoid inflammatory infiltrate. Direct immunofluorescence on skin lesion revealed intraepidermal, intercellular IgG staining. Circulating antibodies against desmogleins 1 and 3 were negative in ELISA analysis. Serum indirect immunofluorescence using rat bladder as a substrate was positive for intraepithelial binding. Subsequently computed tomography of the thorax revealed an invasive mediastinal mass and the final diagnosis of PNP associated with malignant thymoma was made. PNP is a debilitating chronic blistering mucocutaneous disease associated with an underlying neoplasm and a poor prognosis. When treatment-recalcitrant erosive mucosal lesions persist, even in patients without known malignancy, PNP should be ruled out.

Prognosis of palmar melanoma: A single-center experience

( Jimyung Seo ),( Yeongjoo Oh ),( Kyoung Ae Nam ),( Jihee Kim ),( Jun Young Kim ),( Mi Ryung Roh ),( Kee Yang Chung ) 대한피부과학회 2016 대한피부과학회 학술발표대회집 Vol.68 No.2

Background: Melanoma can develop in acral sites: the fingers and toes, hands, and feet. The sole of the foot is well-known as the most common site for acral melanoma. However, there is a paucity of reported data on melanoma located on the palm. Objectives: To study the authors`` experience with melanoma affecting the palm Methods: In this retrospective case series, all acral melanomas treated at the authors`` institution from March 1, 2005, through March 31, 2015, were retrospectively reviewed. Patient demographics, treatment offered, pathology, and outcomes were collected and analyzed. Results: The study population consisted of 208 patients diagnosed with acral melanoma at Severance Hospital. A total of seven patients with melanoma involving the palm (three male and four female; median age, 54 years; age range, 27.75 years) were identified from our search. Except for one patient having melanoma in situ, the remaining six patients with palmar melanoma presented with either initially advanced or rapidly progressing tumours. Mean duration of follow-up was 23.1 ±9.1 months. Conclusion: Although six patients in our series with invasive melanoma affecting the palm resulted in regional or distant metastasis, further study with larger number of patients is needed to ensure whether the anatomic location of palm is related to poor prognosis of melanoma.

FCT 1-5 Ingenol mebutate in the treatment of melanoma

( Jimyung Seo ),( Young In Lee ),( Kyoung Ae Nam ),( Jihee Kim ),( Jun Young Kim ),( Mi Ryung Roh ),( Kee Yang Chung ) 대한피부과학회 2016 대한피부과학회 학술발표대회집 Vol.68 No.2

Background: Noninvasive, tissue-sparing, topical treatments may be a highly desirable option in the treatment of melanoma. A number of topical drugs are used off-label or are under investigation. Objectives: We report our treatment experience with ingenol mebutate in patients with melanoma, and evaluate the efficacy and safety of this treatment as a monotherapy or neoadjuvant treatment. Methods: This is a retrospective study on patients with melanomas who underwent topical treatment with ingenol mebutate. Results: A total of five patients (five female; median age, 67 years; age range, 44.87 years) were identified from our search. Considering the anatomically challenging locations and the morbidity of surgery, ingenol mebutate was administered as a monotherapy in two patients with melanoma in situ. The remaining three patients were treated with topical ingenol mebutate before surgery. Of the five patients, only one patient, who had melanoma in situ on the vaginal mucosa and underwent slow Mohs micrographic surgery, presented local recurrence during the follow-up period (13.8 ± 2.8 months). Conclusion: Despite limitations arising from the small number of patients analyzed and the retrospective design, the results of this study provide additional insights into the role of ingenol mebutate in the treatment of in situ melanoma or melanoma on an anatomically challenging location. Further studies are needed to establish the prerequisites that can ensure treatment success.

Rare sarcomas of the skin: a case series

( Jimyung Seo ),( Yeongjoo Oh ),( Jihee Kim ),( Jun Young Kim ),( Zhenlong Zheng ),( Kyoung Ae Nam ),( Kee Yang Chung ) 대한피부과학회 2016 대한피부과학회 학술발표대회집 Vol.68 No.1

All sarcomas of deep soft tissues may also arise in superficial locations and there can be important clinicopathologic differences. Recently, we have experienced some kinds of these rare malignancies occurring in the skin. We report herein the four cases of different sarcomas having a primary cutaneous location: Ewing sarcoma, histiocytic sarcoma, myxofibrosarcoma, and liposarcoma. Extensive metastatic work-up, including a total body computed tomographic and positron emission scan (PET/CT scan), showed the neoplasm to be a primary sarcoma of the skin. All four patients presented with negative sentinel lymph node biopsy specimen and were treated by Mohs micrographic surgery (MMS) using paraffin-embedded sections, i.e. slow Mohs. We hope that our experience will broaden dermatologists’ understanding of these rare sarcomas arising from the skin.

P129 : The efficacy of Mohs micrographic surgery for the treatment of dermatofibrosarcoma protuberans: a report of 50 Asian patients

( Jimyung Seo ),( Hee Su Kim ),( Ji Hee Kim ),( Hong Sun Jang ),( Byung Ho Oh ),( Mi Ryung Roh ),( Kee Yang Chung ) 대한피부과학회 2014 대한피부과학회 학술발표대회집 Vol.66 No.2

Background: Dermatofibrosarcoma protuberans (DFSP) is a rare, invasive dermal mesenchymal tumor known to have high risk of local recurrence. Recently, there have been preliminary reports of DFSP successfully treated by MMS with favorable cure rates. Objectives: To review data of 50 DFSP patients treated by MMS at Severance Hospital and summarize the accumulated experience Methods: The results of 50 DFSP patients treated by MMS from 2000 to 2013 were analyzed retrospectively. Results: There were 23 male and 27 female patients and most were treated by slow-MMS using permanent paraffin-embedded sections. The trunk (60%), followed by the extremities, and head and neck, were the most common sites for DFSP. Two stages of MMS were sufficient to achieve clearance in the majority of cases and all patients treated had clear margins at final stages. Local flaps including complex flaps were the most common reconstruction methods to repair the surgical defects (95%). The average follow-up period was 52.5 months (13 -85 months). Two out of 50 patients developed local recurrence and underwent a second MMS. However, two recurred patients had been treated by wide local excision before being referred to our institution for the MMS. Conclusion: Our results demonstrate that the recurrence rate of DFSP is low (4%) after MMS. Furthermore, there was no recurrence in the cases of primary DFSP lesions during the follow-up period. MMS can be suggested as a safe and effective treatment method with low recurrence rate.

Eccrine adenocarcinoma treated by Mohs micrographic surgery

( Jimyung Seo ),( Minseok Lee ),( Shinwon Hwang ),( Jun Young Kim ),( Jihee Kim ),( Kyoung Ae Nam ),( Kee Yang Chung ) 대한피부과학회 2016 대한피부과학회 학술발표대회집 Vol.68 No.1

Primary eccrine adenocarcinoma is a rare malignant cutaneous adnexal tumor most commonly arising in the head and neck. Eccrine adenocarcinoma does not have diagnostic clinical features, and histologic recognition becomes important to consolidate the diagnosis of this tumor. Due to the small number of reported cases in the literature, optimal treatment modality has yet to be established. Earlier, surgical resection with wide local excision was performed for most of the cases. Mohs micrographic surgery (MMS), which becomes popular for treating infiltrative skin cancers, can be suggested as another treatment option for this rare malignant tumor of the skin. We have experienced five patients (M = 4; F = 1) with primary eccrine adenocarcinoma of the skin. Four patients had facial lesions and one had the tumor on the interdigital finger web space. Mean patient age was 50.4 ± 14.6 years (range, 29-70 years). Whole-body positron emission tomography revealed no other visceral neoplasm. Sentinel lymph node biopsy or lymph node dissection was performed if clinically indicated. All five patients were treated by MMS using frozen sections. Local recurrence occurred in one patient who were referred to our clinic and underwent MMS after initial recurrence. The remaining four patients showed no recurrence and metastases of the tumor during the follow-up period.

Melanoma: wide local excision vs Mohs micrographic surgery

( Jimyung Seo ),( Young In Lee ),( Jihee Kim ),( Jun Young Kim ),( Zhenlong Zheng ),( Kyoung Ae Nam ),( Kee Yang Chung ) 대한피부과학회 2015 대한피부과학회 학술발표대회집 Vol.67 No.2

Background: Wide local excision (WLE) depending on the maximum Breslow thickness of the tumor is the standard of care for primary cutaneous melanoma. Mohs micrographic surgery (MMS) is used increasingly to treat this tumor. Objectives: To study the authors`` experience with these 2 approaches Methods: Primary cutaneous melanomas treated at the authors`` institution from January 1, 1996, through December 31, 2014, were studied retrospectively. Main outcome measures were recurrence and disease-free and overall survival. Results: With respect to locoregional and distant metastases, the MMS group showed comparable result to the WLE group. The WLE group needed larger excision margins than those of the MMS group. One stage of WLE was sufficient to achieve clearance in the majority of cases, however, the mean stages of MMS needed to completely remove the tumor were 2.16 【 0.93 stages. Conclusion: This follow-up study of surgical treatments for cutaneous melanoma shows comparable outcomes for wide excision and MMS. Because this is a nonrandomized retrospective study, no direct comparisons between the 2 treatments can be made. Surgical treatments, either standard excision or MMS, can be successfully made considering tumor location and functional and cosmetic outcomes.

P128 : Mohs micrographic surgery for extramammary Paget`s disease: a study of 60 Asian patients

( Jimyung Seo ),( Hee Su Kim ),( Ji Hee Kim ),( Hong Sun Jang ),( Byung Ho Oh ),( Mi Ryung Roh ),( Kee Yang Chung ) 대한피부과학회 2014 대한피부과학회 학술발표대회집 Vol.66 No.2

Background: Extramammary Paget disease (EMPD) is an uncommon intraepithelial tumor characterized by ill-defined margins and high recurrence rates after wide local excision. Objectives: To evaluate the efficacy of MMS for EMPD and establish surgical treatment guidelines for EMPD in Asian patients. Methods: The results of 60 patients with EMPD treated by MMS from 2000 to 2013 have been analyzed retrospectively. Results: There were 54 male and 60 female patients and most were treated by slow-MMS using permanent paraffin-embedded sections. Among 60 patients, 58 had genital lesions and 2 had axillary lesions. The average follow-up period was 61.5 months (14 -140 months). The recurrence rate of EMPD after MMS was 3.3% (n=2) and the mean time to recurrence was 11 months. Among the recurred patients, one had been previously treated by topical 5% imiquimod and the other had undergone prior wide local excision. Estimated 5-year tumor-free rate using Kaplan-Meier graph was 96.3% in all patients for MMS. None of the primarily occurring cases recurred, indicating 0% (n=50) recurrence rate. However, among patients who underwent MMS after initial recurrence, the recurrence rate was significantly higher at 20% (n=10). Conclusion: Our results demonstrate that the recurrence rate of EMPD is low (3.3%) after MMS. MMS is an effective surgical method with low recurrence rate, and can be suggested as the first-line treatment for non-metastatic primary EMPD patients and also for patients with recurred disease.