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Kim, Bun,Lee, Seong Dae,Han, Kyung Su,Kim, Byung Chang,Youk, Eui-Gon,Nam, Myung Jin,Lee, Doo Han,Sohn, Dae Kyung Ovid Technologies (Wolters Kluwer) - Lippincott Wi 2017 Diseases of the colon and rectum Vol.60 No.4
<P>CONCLUSIONS: Oral sulfate solution is effective at colonoscopy cleansing and has acceptable tolerability when it is compared with polyethylene glycol with ascorbic acid. The taste and flavor of oral sulfate solution still need to be improved to enhance tolerability.</P>
Kim, Mi-Jung,Lee, Eun-Jung,Suh, Jung-Pil,Chun, Sung-Min,Jang, Se-Jin,Kim, Do Sun,Lee, Doo Han,Lee, Suk Hee,Youk, Eui Gon American Society for Clinical Pathology 2013 American journal of clinical pathology Vol.140 No.6
<P><B>Objectives:</B></P><P>To investigate the clinicopathologic and endoscopic features of precursor lesions associated with traditional serrated adenomas (TSAs).</P><P><B>Methods:</B></P><P>Mutation studies for BRAF, KRAS, PIK3CA, and EGFR and immunohistochemical staining for Ki-67 were performed on 107 TSAs from 104 patients.</P><P><B>Results:</B></P><P>Nondysplastic hyperplastic polyp (HP) or sessile serrated adenoma/polyp (SSA/P) precursor lesions were found in 56 (52.3%) TSAs, among which 32 (57.1%) cases showed a flat-elevated lesion with a type II pit pattern during endoscopy. TSAs with an SSA/P precursor lesion were usually found in the proximal colon, while TSAs with an HP or with no precursor lesion were mainly located in the distal colon and rectum (<I>P</I> < .001). TSAs with a precursor lesion showed a lower frequency of conventional epithelial dysplasia and KRAS mutation as well as a higher frequency of BRAF mutation compared with those with no precursor lesion (<I>P</I> = .002, <I>P</I> < .001, and <I>P</I> < .001, respectively).</P><P><B>Conclusions:</B></P><P>A significant proportion of HP or SSA/P precursor lesions accompanied by TSAs can be detected by endoscopy based on both their flat-elevated growth and type II pit patterns. The heterogeneity of TSAs in terms of clinicopathologic and molecular features correlated with the status or type of precursor lesions.</P>
Rectal Neuroendocrine and L-cell Tumors: Diagnostic Dilemma and Therapeutic Strategy
Lee, Suk Hee,Kim, Byung Chang,Chang, Hee Jin,Sohn, Dae Kyung,Han, Kyung Su,Hong, Chang Won,Lee, Eun-Jung,Lee, Jae-Bum,Lee, Doo-Seok,Lee, In Taek,Youk, Eui-Gon Lippincott Williams Wilkins, Inc. 2013 The American journal of surgical pathology Vol.37 No.7
Rectal neuroendocrine tumors (NETs) are currently divided into L-cell and non–L-cell types. In the World Health Organization 2010 classification, L-cell tumors are defined as borderline, whereas non–L-cell tumors are considered to represent malignancies. To establish differential diagnostic criteria and therapeutic strategy, we investigated the pathologic features of rectal NETs associated with lymph node metastasis and the clinicopathologic significance of the L-cell phenotype. We analyzed 284 patients with rectal NETs. Factors, including T stage, mitosis, histologic pattern, lymphatic invasion, tumor border, and lymph node metastasis, were retrospectively evaluated. We also evaluated tumor immunoreactivity for L-cell markers, including glucagon-like peptide 1, pancreatic peptide, and peptide YY, in 240 cases. L-cell immunoreactivity was detected in 189 of 240 NETs (79%). Of the factors evaluated, only age and the frequency of lymphatic invasion were significantly different between patients with L-cell and non–L-cell tumors. Of the 284 patients, 18 (6.3%) had lymph node metastases. Lymphatic invasion and T stage were independent risk factors for lymph node metastasis. Subgroup analysis based on tumor size showed lymph node metastasis in 0%, 4%, 24%, and 100% of patients with NETs with a size of <5, 5 to 9, 10 to 14, and ≥15 mm, respectively. Depth of tumor invasion, lymphatic invasion, and mitosis were correlated with tumor size (P<0.0001). In conclusion, L-cell phenotype alone does not guarantee favorable biological characteristics. The clinical management of rectal NETs should depend on tumor size. Careful pathologic examination of lymphatic invasion is necessary.
직장암의 수술 전 항암화학방사선치료 후 병리학 및 임상적 효과 분석
송진호(Jin-Ho Song),장홍석(Hong-Seok Jang),김연실(Yeon-Sil Kim),정수미(Su-Mi Chung),손석현(Seok-Hyun Son),강진형(Jin-Hyeong Kang),육의곤(Eui-Gon Youk),이두석(Doo-Seok Lee),이숙희(Suk-Hi Lee),윤세철(Sei-Chul Yoon) 대한방사선종양학회 2011 Radiation Oncology Journal Vol.29 No.1
목 적: 수술 전 항함화학방사선치료는 국소 진행된 직장암에서 표준치료로 알려져 있다. 이 연구는 동시 항암화학 방사선치료를 받은 국소 진행된 직장암 환자의 생존율 및 병기하향률에 영향을 미치는 인자들을 분석하였다. 대상 및 방법: 2004년 3월부터 2008년 8월까지 수술 전 항암화학방사선치료를 받은 국소 진행된 직장암 환자 33명을 대상으로 하였다. 모든 환자는 전 골반 방사선조사를 시행하였으며, 28명(84.8%)은 동시적 소조사야 추가 방사선치료, 5명(15.2%)은 조사영역축소 방사선치료를 실시하였다. 총 방사선량은 50.4 Gy이었으며, 5-fluorouracil를 동시 투여하였다. 추적관찰 기간은 중앙값 24.2개월(9.8∼64.7개월)이었다. 결 과: 33명 중 31명(93.9%)에서 수술이 시행되었으며, 24명(72.7%)은 항문괄약근보존술, 7명(21.2%)은 복회음부 절제술이 시행되었다. 3년 생존율과 무병생존율은 각각 78.8%, 63.4% 이었다. 무병생존율에 영향을 미치는 인자로 수술 후 병리학적 소견이 중요하였다. 병리학적 N 병기(p=0.001), 절제면 침윤 여부(p=0.029) 및 분화도 (p=0.030)가 통계학적으로 의미 있게 영향을 미치는 인자였다. 종양 크기(p=0.081), 림프혈관과 신경주위 침윤여부 (p=0.073) 모두 영향을 미치는 인자로서의 경향성을 보였다. 한편, 수술 전 임상 소견으로는 임상적 T 병기만이 유의한 결과를 보였다(p=0.018). 병리학적 완전관해율은 9.1%였으며, T병기하향률은 30.3%, N 병기하향률은 72.7%로 나타났다. 단변량 분석에서 항암화학방사선치료 후 수술까지의 기간 및 임상적 T 병기가 의미 있는 병기하향의 예측인자로 분석되었다(p=0.029, 0.027). 치료 전 carcinoembryonic antigen 수치는 예측인자의 경향성을 보였다 (p=0.068). 결 론: 국소 진행된 직장암 환자의 생존율은 임상적 병기보다 수술 후 병리학적 소견에 더 의존되었다. 그러므로 수술 전 항암화학방사선치료로 병기하향을 얻는 것이 의미가 있으며, 수술까지의 기간, 임상적 T 병기가 이러한 병기하향을 예측하는 인자였음을 알 수 있었다. Purpose: To evaluate the pathological and clinical effects of preoperative chemoradiation (CCRT) in cases of locally advanced rectal cancer and to determine the predictive factors for tumor downstaging. Materials and Methods: From March 2004 to August 2008, 33 patients with locally advanced rectal cancer were treated with preoperative CCRT. Twenty-eight patients (84.8%) were treated using a concomitant boost technique while five (15.2%) patients were treated using a cone down boost technique. All patients received 50.4 Gy of irradiation and concurrent chemotherapy with 5-fluorouracil. The median follow-up duration was 24.2 months (range, 9.8 to 64.7 months). Results: Thirty-one (93.9%) patients underwent surgery. Twenty-four patients (72.7%) underwent anal sphincter-preserving surgery. The 3-year disease free survival (DFS) and overall survival rates were 63.4% and 78.8%, respectively. Post-operative factors were more important for DFS. Pathologic N stage, margin status, and pathologic differentiation were significant prognostic factors (p=0.001, 0.029, 0.030). Tumor size and lymphovascular invasion were also associated with marginal significance (p=0.081, 0.073). However, only pre-treatment T stage was a significant pre-operative factor (p=0.018). The complete pathological response rate was 9.1%. T-downstaging was observed in ten (30.3%) patients, whereas N-downstaging was found in 24 (72.7%) patients. Pre-treatment T stage and the interval between CCRT and operation were the predictive factors for downstaging in a univariate analysis (p=0.029, 0.027). Pre-treatment carcinoembryogenic antigen was also associated with marginal significance (p=0.068). Conclusion: The survival of rectal cancer patients can be better determined based on post-operative findings. Therefore, pre-operative CCRT for downstaging of the tumor seems to be important. Pre-treatment T stage and the interval between CCRT and operation can be used to predict downstaging.