Bone Metastasis in Gastric Cancer Patients

Ahn, Jae-Bong,Ha, Tae-Kyung,Kwon, Sung-Joon The Korean Gastric Cancer Association 2011 Journal of gastric cancer Vol.11 No.1

Purpose: Bone metastasis from stomach cancer occurs only rarely and it is known to have a very poor prognosis. This study examined the clinical characteristics and prognosis of patients who were diagnosed with stomach cancer and bone metastasis. Materials and Methods: The subjects were 19 patients who were diagnosed with stomach cancer at Hanyang University Medical Center from June 1992 to August 2010 and they also had bone metastasis. The survival rate according to many clinicopathologic factors was retrospectively analyzed. Results: 11 patients out of 18 patients (61%) who received an operation were in stage IV and the most common bone metastasis location was the spine. Bone scintigraphy was mostly used for diagnosing bone metastasis and PET-CT and magnetic resonance imaging were used singly or together. The serum alkaline phosphatase at the time of diagnosis had increased in 12 cases and there were clinical symptoms (bone pain) in 16 cases. Treatment was given to 14 cases and it was mostly radiotherapy. There were 2 cases of discovering bone metastasis at the time of diagnosing stomach cancer. The interval after operation to the time of diagnosing bone metastasis for the 18 cases that received a stomach cancer operation was on average $14.9{\pm}17.3$ months and the period until death after the diagnosis of bone metastasis was on average $3.8{\pm}2.6$ months. As a result of univariate survival rate analysis, the group that was treated for bone metastasis had a significantly better survival period when the bone metastasis was singular rather than multiple, as compared to the non-treatment group, yet both factors were not independent prognosis factors on multivariate survival analysis. Conclusions: An examination to confirm the status of bone metastasis when conducting a radio-tracer test after the initial diagnosis and also after an operation is needed for stomach cancer patients, and bone scintigraphy is the most helpfully modality. Making the diagnosis at the early stage and suitable treatments are expected to enhance the survival rate and improve the quality of life even for the patients with bone metastasis.

유방암의 뇌 전이 : 임상 및 방사선학적 소견

안진경,오기근,오기근,정태섭 대한영상의학회 2001 대한영상의학회지 Vol.45 No.1

목적: 유방암의 뇌 전이에 대한 임상적 특징 및 방사선학적 소견에 대하여 알아보고자 하였다 대상과 방법 1983년부터 1999년까지 본원에서 유방암으로 치료를 받은 환자 1399명중 유방암의 뇌 전이로 진단을 받았던 환자는 61명이었다 전체 1379명의 유방암 환자의 병기는 stage IIA(n=508), stage I(n=366). stage IIB(n=247). stage IIIA(n=189), stage IIIB(n=45) , stage 0(n = 33) stage IV(n = 11)이었으며 이중 뇌 전이를 보였던 61명의 환자의 병기는 stage IIB(12.5%). stage IIA(3.9%), stage IIIA(3.1%), stage IIIB(2.2%). stage I(0.8%)이었다. 전체 유방암 환자의 연령별 분포는 40-49세(n=610). 50-59세(n=301) 30-39세 (n = 291) , 60-69세 (n = 124) 20-29세 (n =41) , 70-79세 (n= 28) , 80-89세 (n=4)였으며 이중 뇌 전이 환자의 연령별 분포는 20-29세 (14.6%) , 30-39세 (79%) . 50-59세 (4.6%) .40-49세(2.6%), 60-69세(1 6%)였다. 61명의 뇌 전이 환자 중 영상 분석이 가능하였던 환자는 35명 이었으며 이들을 대상으로 뇌 전이로 인한 증상, 유방암의 첫번째 원격 전이 장기, 유방암 진단후 뇌 전이가지의 기간, 뇌 전이 이후 사망가지의 기간, 뇌 이외의 장기로 선행 전이가 있은 후에 뇌 전이가 된 환자와 다른 장기로의 전이 없이 뇌로 첫번째 전이가 있었던 환자에서의 생존기간의 타이를 알아보았다. 영상 소견은 CT(29예) 및 MRl(8예)를 분석하였다 결과: 임상적으로 나타난 뇌 전이의 주증상은 두통과 구토였다. 유방암 진단 후 다른 장기로의 전이는 뇌 전이 이전에 타장기로 선행 전이가 있었던 예(n=22)와 타장기로 선행 전이 없이 처음부터 뇌로 전이가 된 예(n=13)로 분류하였다. 유방암 진단 후 뇌 전이가지의 기간은 1-2년 (8/35), 2-3년(8/35)이 가장 많았고, 26명이 뇌 전이가 진단된 후 1년 이내에 사망하였다. 생존기간은 뇌 전이 이전에 타장기로 선행 전이가 있었던 환자가 타장기 전이 없이 처음부터 뇌로 원격 전이가 된 환자보다 좀 더 긴 소견을 보였다. 뇌 전이의 영상 소견상 전이 위치는 상천막 전이 (n=23) , 하천막 전이 (n=2)와 양쪽 모두로의 전이(n=10)가 있었고, 다발성 전이는 24예였으며 단일 전이는 11예였다. Purpose: To analyse the clinical and radiologic findings of brain metastasis of breast cancer. Materiars and Methods: Sixty-one of 1399 patients in whom breast cancer was diagnosed between 1983 and 1999 were affected by brain metastasis. Among these 1399, the stage of the breast cancer, in descending order of frequency, was IIA (n=508),I(n=366), IIB (n=247), IIIA (n= 189), IIIB (n=45),0 (n=33) and IV(n= 11) The stage of the 61 brain metastases, similarly ordered, was IIB (12.5%), IIA (3.9%), IIIA (3.1%), IIIB (2.2%) and I (0.8%) In all confirmed breast cancers, the age distribution, in descending order of frequency, was 40-49years (n= 610), 50-59 (n= 301), 30-39 In=2911, 60-69 (n= 124), 20-29 (n=41), 70-79 (n=28), and 80-89 (n=4). The age distribution of brain metastasis was 20-29 (14.6%), 30-39 (7.9%),50-59 (4.6%),40-49 I(2.6%) and 60-69 (l.6%). Imaging findings were available for 35 of the 61 patients affected by brain metastasis, and symptoms from brain among the 35, analysis of the symptoms of this metastasis, the site of the first distant metastasis to an extracranial or cranial organ, the interval from the diagnosis of breast cancer to brain metastasis, the interval from brain metastasis to death, and the difference in survival time between patients with iiitial and succeeding brain metastasis was undertaken. Brain CT findings were analysed in 29 cases and MRI findings in eight. Results: The most common symptoms were headache and vomiting. Among the 35 brain metastasis patients for whom imaging findings were available, other systemic metastasis occurred in 22. Initial brain metastasis occurred in the remaining 13, and in seven of these there was also coincident organ metastasis, while six showed only brain metastasis. The most frequent intervals from the diagnosis of breast cancer to brain metastasis were 1-2 years(8/35) and 2-3years(8/35). Twenty-six of 35 patients died within one year of brain metastasis. Patients in whom this occurred later survived for longer than those in whom it occurred initially.

Bone Metastasis in Gastric Cancer Patients

Jae Bong Ahn,하태경,권성준 대한위암학회 2011 Journal of gastric cancer Vol.11 No.1

Purpose: Bone metastasis from stomach cancer occurs only rarely and it is known to have a very poor prognosis. This study examined the clinical characteristics and prognosis of patients who were diagnosed with stomach cancer and bone metastasis. Materials and Methods: The subjects were 19 patients who were diagnosed with stomach cancer at Hanyang University Medical Center from June 1992 to August 2010 and they also had bone metastasis. The survival rate according to many clinicopathologic factors was retrospectively analyzed. Results: 11 patients out of 18 patients (61%) who received an operation were in stage IV and the most common bone metastasis location was the spine. Bone scintigraphy was mostly used for diagnosing bone metastasis and PET-CT and magnetic resonance imaging were used singly or together. The serum alkaline phosphatase at the time of diagnosis had increased in 12 cases and there were clinical symptoms (bone pain) in 16 cases. Treatment was given to 14 cases and it was mostly radiotherapy. There were 2 cases of discovering bone metastasis at the time of diagnosing stomach cancer. The interval after operation to the time of diagnosing bone metastasis for the 18 cases that received a stomach cancer operation was on average 14.9±17.3 months and the period until death after the diagnosis of bone metastasis was on average 3.8±2.6 months. As a result of univariate survival rate analysis, the group that was treated for bone metastasis had a significantly better survival period when the bone metastasis was singular rather than multiple, as compared to the non-treatment group, yet both factors were not independent prognosis factors on multivariate survival analysis. Conclusions: An examination to confirm the status of bone metastasis when conducting a radio-tracer test after the initial diagnosis and also after an operation is needed for stomach cancer patients, and bone scintigraphy is the most helpfully modality. Making the diagnosis at the early stage and suitable treatments are expected to enhance the survival rate and improve the quality of life even for the patients with bone metastasis

폐암의 피부전이의 유병률 조사와 임상 및 병리조직학적 연구

최지호(Jee Ho Choi),성경제(Kyung Jeh Sung),문기찬(Kee Chan Moon),고재경(Jai Kyoung Koh),장성은(Sung Eun Chang),최정철(Jung Chul Chol) 대한피부과학회 2001 대한피부과학회지 Vol.39 No.6

N/A Background: Cutaneous metastasis from lung cancer is rarely seen in dermatologic clinics although the lung is the most common source of cutaneous metastasis in men. There is much variation of the prevalence of lung cancer and its cutaneous metastasis among different countries and with time. Objective : Our purpose was to study prevalence, relative frequency of pathological subtypes and clinical features of cutaneous metastasis from lung cancer in Korea. Methods : We utilized a computer system in order to analyze the incidence of cutaneous metastasis from lung cancer during the 10-year period from 1990 to 1999 in Asan Medical Center. Clinical records, clinical photographs, and biopsy slides of the biopsy-proven cases were reviewed. Results: 1. Of the 4635 patients with lung cancer, 2954(63.7%) had metastatic diseases and 83(1.8%) had skin metastasis. Of the 2954 metastatic diseases, skin metastasis was only 2.8%. Of the total 83 patients, male to female sex ratio was 3.9:l. 2. Of the 33 proven cases by dermatologists, 8(24%) contributed to detect bidden primary lung cancer. While 23(69.7%) cases had other internal metastasis, detection of skin metastasis preceded other metastasis in 30.4%. 3. Most frequently the chest was involved, followed by the scalp. 4. Of the pathologically-proven 55 cases, 23 cases showed adenocarcinomas, 20 cases squamous cell carcinomas, 8 cases small cell carcinomas, 3 cases large cell carcinomas, and 1 case undifferentiated carcinoma. Conclusion : Although skin metastasis from lung cancer is less common than other organs, diagnosis of skin metastasis is important since it can manifest as a presenting sign of internal malignancy and an early indicator of metastasis. (Korean J Dermatol 2001;39(6) 660~665)

A clinicopathological analysis of metastasis in Korean acral melanomas

( Ryu Geon Wook ),( Jee-bum Lee ),( Seung-chul-lee ),( Young Ho Won ),( Sook Jung Yun ) 대한피부과학회 2019 대한피부과학회 학술발표대회집 Vol.71 No.2

Background: The prognosis of acral melanomas depends on metastasis. Objectives: The purpose of current study was to investigate the prognostic factors for metastasis of acral melanomas. Methods: We retrospectively reviewed all patients with melanoma located on acral sites from 1996-2016. Only patients who had followed-up for at least 3 years were included. We divided total 189 acral melanoma patients into groups of no metastasis, first lymph node metastasis, and first distant metastasis. Demographic and clinicopathological characteristics were obtained. Results: The median age was 63 years and 51.3% of patients were male. The number of patients who were diagnosed as melanoma in situ was 46 (24.3%), and that of invasive melanoma without metastasis was 29 (15.3%). Among 114 patients with invasive acral melanomas with metastasis, the first metastasis to regional lymph nodes was predominant (99, 86.8%), whereas the first metastasis to distant organs was detected in only 15 patients (13.2%). Acral melanomas deeper than T3 stages, ulceration, and higher mitotic rate more than 7 per square mm are associated with metastasis with statistical significance. However, there was no statistically significant difference in age, sex, site, height, and duration to the first metastasis among patient groups. Conclusion: Breslow thickness, ulceration and mitotic rate are significant prognostic factors for prediction of metastasis in acral melanomas.

조기위암의 림프절전이에 관한 연구

박선미(Sun Mi Park),김해련(Hae Ryun Kim),민영일(Young Il Min),박건춘(Gun Chun Park),유은실(Eun Sil Yu) 대한소화기학회 1994 대한소화기학회지 Vol.26 No.1

N/A Early gastric cancer(EGC) is defined as gastric cancer confined to mucosa or submucosa re- gardless of lymph node metastasis. But lymph node metastasis affects the prognosis of pa- tients with EGC. And nowadays with increasing interest in endoscopic non-operative treat- ment such as laser therapy or strip biopsy, it is necessary to predict nodal metastasis in pa- tients with EGC. A total of 249 cases of EGC were reviewed post operatively according to their size of lesion, macroscopic classification, depth of invasion and cellular differentiation to identify the fac- tors for nodal metastasis in EGC which act as limitation of radical endoscopic treatment. Out of 805 curative resections for gastric adenocarcinoma frorn July 1989 to Jan 1993 in our institute, there were 249 cases of EGC(30.1%). Sex ratio of EGC was 1.8: 1 and ratio of EGC limited to mucosa to that of submucosal involvement was equal (1: 1). Proportion of EGC ac- cording to macroscopic classification was 20.3% of elevated type ( I, I + lIa, Iia, Iia+ Ilb, Iia + Iic), 5.9% of flat type (II b) and 73.8% of depressed bype (Iic, Lic+ Itl, III, III+ LI b, Iic+ Lia, II b + Iic). Out of 249 cases of EGC, there were 36 cases of lymph node metastasis (14.5%). The frequency of nodal rnetastasis of EGC limited to mucosa and submucosa was 5.9% (7/119) and 21.2k(25/118) respectively. The size of mucosal cancer was less than 2cm in 4cases of de- pressed type out of 7 cases of nodal metastasis while with cases of submucosal involvement, the size of lesion could not effect the frequency of nodal metastasis. The frequency of nodal metastasis in EGC limited to mucosa according to macroscopic classification was 11.1% of ele- vated type, 0% of flat type, 5.3% of depressed type and frequency of nodal metastasis in submucosal involvement was 23.3%, 0% and Z2.5% respectively. There was no significant dif- ference in frequency of nodal metastasis according to cellular differentiation. Though the frequency of nodal metastasis is much lower in EGC limited to mucosa than in cases of submucosal involvement, nodal metastasis is found in mucosal cancer especially in cases with small depressed type. Therfore it is suggested that radical endoscopic treatment be not always safe even in less than 1cm sized EGC limited to mucosa, and this type of treat- ment should be selectively considered in cases with small flat or elevated type of mucosal cancer.(Korean J Gastroenterol 1994;26: 56-62)

대장암의 난소 전이의 특성

윤철희,박재우,문선미,황대용 대한대장항문학회 2008 Annals of Coloproctolgy Vol.24 No.5

Purpose: Treatment of ovarian metastasis from colorectal cancer has been controversial, and only limited data on ovarian metastasis have been reported. We reviewed the clinical features of patients with ovarian metastasis from a colorectal carcinoma. Methods: From 1993 to 2002, 568 women were treated for colorectal cancer. Of those, 17 cases were diagnosed as ovarian metastasis. We reviewed the 17 cases retrospectively. Results: The incidence of ovarian metastasis was 3.0% (17/568). The number of cases involving synchronous ovarian metastasis was 7 (1.2%). Those 7 patients also had another metastasis including ovarian metastasis. Ten cases (1.8%) involved metachronous ovarian metastasis. Of those 10 patients, 8 had ovarian metastasis in combination with other organ metastasis. The median disease-free interval from the diagnosis of the primary colorectal cancer to the diagnosis of ovarian metastasis was 9.8 months, and the median survival after the diagnosis of ovarian metastasis was 17.2 months. The median survival after the diagnosis of ovarian metastasis was 23.4 months in the ovarian- metastasis-only group, compared with 10.1 months in the group with ovarian and other metastasis. The difference in survival between the two groups was statistically significant. Conclusions: The incidence of ovarian metastasis from colorectal cancer was low. When such an event occurred, it was frequently associated with widespread disease and resulted in a poor prognosis. However, patients having only ovarian metastasis had a higher survival rate.

The Predictive Values of Lesion Size, F-18 FDG Avidity and I-131 Avidity for the Clinical Outcome of I-131 Treatment in Patients with Metastatic Differentiated Thyroid Carcinoma Only in the Lung

Choi, Joon Ho,Byun, Byung Hyun,Lim, Ilhan,Moon, Hansol,Park, Jihyun,Chang, Kyoung Jin,Kim, Byung Il,Choi, Chang Woon,Lim, Sang Moo 대한핵의학회 2018 핵의학 분자영상 Vol.52 No.2

Purpose We aimed to evaluate the prognostic values of radiography, F-18 FDG PET, and I-131 whole body scans in patients with lung-only metastasis from differentiated thyroid carcinoma (DTC). Methods Between 1998 and 2013, we included 31 patients (F: 26, M: 5) with lung-only metastasis from DTC who had been treated with I-131 and underwent PET. Lung metastasis was categorized according to the size (macronodular ${\geq}1.0cm$ vs. micronodular <1.0 cm), FDG avidity (avid vs. non-avid), and I-131 avidity (avid vs. non-avid). Progression-free survival (PFS) was evaluated for each patient. Results Among 31 patients, seven (23%) had macronodular lung metastasis, 26 (84%) had FDG avid lung metastasis, and 16 (52%) had I-131 avid lung metastasis. During the median follow-up period of 9.4 y, median PFS was 6.1 y. Based on Kaplan-Meier analysis, macronodular lung metastasis (p = 0.017) and I-131 non-avid lung metastasis (p = 0.059) were significantly associated with worse outcomes, but FDG avid lung metastasis was not (p = 0.135). Patients with FDG non-avid lung metastasis did not experience disease progression during follow-up, while 11 of 26 patients (42%) experienced disease progression. Based on univariate analysis, the hazard ratio for a poor prognosis was 3.78 (p = 0.029) for macronodular lung metastasis and 3.29 (p = 0.079) for I-131 non-avid lung metastasis. Conclusions Macronodular and I-131 non-avid lung metastasis were associated with a poor prognosis in lung-only metastasis from DTC. Although FDG avid lung metastasis may be associated with a poor prognosis, a larger-scale study is needed.

갑상선 유두암에서 외측 경부 림프절 전이 양상

양준영,이규언,김수진,이정훈,한원식,노동영,윤여규,오승근 대한갑상선-내분비외과학회 2009 The Koreran journal of Endocrine Surgery Vol.9 No.3

Purpose: Papillary thyroid carcinoma (PTC) is the most common thyroid cancer and lymph node (LN) metastasis is common in PTC. Lateral LN metastasis is associated with local recurrence of PTC. The aim of this study is to evaluate the patterns of lateral LN metastasis of PTC. Methods: One-hundred seventy four patients who undergone total thyroidectomy, central LN and ipsilatereal or bilateral LN dissection due to PTC 'from 2007 to 2008 in Seoul National University Hospital were retrospectively reviewed. The average age of the patients was 50.4 years and the male to female ratio was 1:4.12. Sixty-seven patients (38.5%) had central LN metastasis and 47 patients (27.0%) had lateral node metastasis. Results: The factors related with lateral LN metastasis of PTC are male gender, the tumor size, extrathyroidal extension, multifocality and central LN metastasis. The level III LN group was the most frequent site of lateral LN metastasis followed by the jugular, level IV, level II, and level V groups. The jugular LN metastasis is mainly related with the metastasis of the upper lateral neck area, including level II LNs, and the lymphatic pathway to the lower lateral neck area, including level IV, seems to be independent from the jugular LNs. Ten cases had lateral LN metastasis without central LN metastasis (skip metastasis). Conclusion: Lateral LN metastasis of PTC has a certain pattern. The operator must consider this pattern when managing patients with lateral LN metastasis of PTC. (Korean J Endocrine Surg 2009;9:133-139)

Retrocrural Lymph Node Metastasis Disclosed by $^{18}F$-FDG PET/CT: A Predictor of Supra-diaphragmatic Spread in Ovarian Cancer

Im, Hyung-Jun,Kim, Yong-Il,Paeng, Jin-Chul,Chung, June-Key,Kang, Soon-Beom,Lee, Dong-Soo The Korea Society of Nuclear Medicine 2012 핵의학 분자영상 Vol.46 No.1

Purpose : Retrocrural lymph nodes (RCLNs) communicate with retroperitoneal and posterior mediastinal LNs. It is possible that, when RCLNs are involved, supra-diaphragmatic extension will occur in abdomino-pelvic cancers. The authors investigated performance of $^{18}F$-FDG PET/CT to diagnose RCLN metastasis and whether RCLN metastases were associated with supra-diaphragmatic lymphatic metastases of ovarian cancer. Materials and methods : Sixty-seven patients with stage IV ovarian cancer who had undergone $^{18}F$-FDG PET/CT were included in this retrospective study. Diagnostic performance of $^{18}F$-FDG PET/CT for RCLN metastasis was evaluated. Patients were divided into two groups by presence or absence of supra-diaphragmatic LN metastasis. The prevalences of RCLN metastasis between the two groups were compared and the odds ratio was calculated. Results : Sensitivity and specificity of $^{18}F$-FDG PET/CT for RCLN metastasis were 96.3 and 100%, respectively. Of the 67 study subjects, 27 patients had RCLN metastases (40.3%). Fifty patients had supra-diaphragmatic LN metastases. $^{18}F$-FDG PET/CT showed 26 RCLN metastases in patients with supra-diaphragmatic LN metastases (54.5%), and only 1 in patients without supra-diaphragmatic LN metastasis (5.9%), and the difference between two groups was statistically significant (P<0.05). The odds ratio that patients with RCLN metastasis would have supra-diaphragmatic LN metastasis was 17.3 (95% confidence interval=2.1 to 140.9, P=0.008). Conclusion : Performance of $^{18}F$-FDG PET/CT to diagnose RCLN metastasis was excellent. RCLN metastasis revealed by $^{18}F$-FDG PET/CT was strongly associated with supra-diaphragmatic LN spread of ovarian cancer. Thus, RCLN metastasis could be used as a predictor of supra-diaphragmatic lymphatic metastasis of ovarian cancer.