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6 "Hyunjoo Lee"
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Original Articles
Prognostic Significance of Heat Shock Protein 70 Expression in Early Gastric Carcinoma
Youngran Kang, Woon Yong Jung, Hyunjoo Lee, Wonkyung Jung, Eunjung Lee, Bong Kyung Shin, Aeree Kim, Han Kyeom Kim, Baek-hui Kim
Korean J Pathol. 2013;47(3):219-226.   Published online June 25, 2013
DOI: https://doi.org/10.4132/KoreanJPathol.2013.47.3.219
  • 7,871 View
  • 36 Download
  • 8 Crossref
AbstractAbstract PDF
Background

Overexpression of heat shock protein 70 (HSP70) has been observed in many types of cancer including gastric adenocarcinomas, although the exact role of HSP70 in carcinogenesis remains unclear.

Methods

The study analyzed a total of 458 radical gastrectomy specimens which were immunohistochemically stained with HSP70, p53, and Ki-67 antibodies.

Results

The study determined that the expression of HSP70 was significantly increased in early gastric cancer (EGC) compared to advanced gastric cancer (p<0.001). The HSP70 expression was correlated with well-differentiated tumor type, intestinal type of Lauren classification and the lower pT and pN stage. Negative expression of Ki-67 and p53 expression was associated with poor prognosis. The study did not find any correlation between HSP70 and p53 expression. The study determined that HSP70 expression in the EGC subgroup was associated with a poor prognosis (p=0.009), as well as negative Ki-67 expression (p=0.006), but was not associated with p53. Based on multivariate analysis, HSP70 expression (p=0.024), negative expression of Ki-67, invasion depth and lymph node metastasis were determined to be independent prognostic markers.

Conclusions

HSP70 is expressed in the early stages of gastric adenocarcinoma. In EGC, HSP70 is a poor independent prognostic marker and is correlated with a low proliferation index.

Citations

Citations to this article as recorded by  
  • The Prognostic Importance of Ki-67 in Gastrointestinal Carcinomas: A Meta-analysis and Multi-omics Approach
    Mahdieh Razmi, Fatemeh Tajik, Farideh Hashemi, Ayna Yazdanpanah, Fatemeh Hashemi-Niasari, Adeleh Divsalar
    Journal of Gastrointestinal Cancer.2024; 55(2): 599.     CrossRef
  • Clinicopathological significance of HSP70 expression in gastric cancer: a systematic review and meta-analysis
    Xiaolu Wang, Li Xie, Lijing Zhu
    BMC Gastroenterology.2021;[Epub]     CrossRef
  • Beta-sheet-specific interactions with heat shock proteins define a mechanism of delayed tumor cell death in response to HAMLET
    Aftab Nadeem, James C.S. Ho, Tuan Hiep Tran, Sanchari Paul, Victoria Granqvist, Nadege Despretz, Catharina Svanborg
    Journal of Molecular Biology.2019; 431(14): 2612.     CrossRef
  • Evolving paradigms on the interplay of mitochondrial Hsp70 chaperone system in cell survival and senescence
    Shubhi Srivastava, Vinaya Vishwanathan, Abhijit Birje, Devanjan Sinha, Patrick D’Silva
    Critical Reviews in Biochemistry and Molecular Biology.2019; 54(6): 517.     CrossRef
  • Clinicopathologic significance and prognostic value of Ki-67 expression in patients with gastric cancer: a meta-analysis
    Guanying Luo, Yunzhao Hu, Zhiqiao Zhang, Peng Wang, Zhaowen Luo, Jinxin Lin, Canchang Cheng, You Yang
    Oncotarget.2017; 8(30): 50273.     CrossRef
  • Extracellular HSP70-peptide complexes promote the proliferation of hepatocellular carcinoma cells via TLR2/4/JNK1/2MAPK pathway
    Yi Zhe, Yan Li, Dan Liu, Dong-Ming Su, Jin-Gang Liu, Hang-Yu Li
    Tumor Biology.2016; 37(10): 13951.     CrossRef
  • The cytomegalovirus protein UL138 induces apoptosis of gastric cancer cells by binding to heat shock protein 70
    Wenjing Chen, Kezhi Lin, Liang Zhang, Gangqiang Guo, Xiangwei Sun, Jing Chen, Lulu Ye, Sisi Ye, Chenchen Mao, Jianfeng Xu, Lifang Zhang, Lubin Jiang, Xian Shen, Xiangyang Xue
    Oncotarget.2016; 7(5): 5630.     CrossRef
  • Targeting the hsp70 gene delays mammary tumor initiation and inhibits tumor cell metastasis
    J Gong, D Weng, T Eguchi, A Murshid, M Y Sherman, B Song, S K Calderwood
    Oncogene.2015; 34(43): 5460.     CrossRef
Expression of SIRT1 and DBC1 in Gastric Adenocarcinoma
Youngran Kang, Woon Yong Jung, Hyunjoo Lee, Eunjung Lee, Aeree Kim, Baek-hui Kim
Korean J Pathol. 2012;46(6):523-531.   Published online December 26, 2012
DOI: https://doi.org/10.4132/KoreanJPathol.2012.46.6.523
  • 8,367 View
  • 48 Download
  • 29 Crossref
AbstractAbstract PDF
Background

Sirtuin 1 (SIRT1) and deleted in breast cancer 1 (DBC1) are known as tumor suppressor or promoter genes. This may be due to their diverse functions and interaction with other proteins. Gastric adenocarcinoma is one of the most common malignancies, but little is known about its carcinogenesis. Therefore, we investigated the association of immunohistochemical expression of SIRT1, DBC1, p53, and β-catenin and their variable clinicopathological characteristics.

Methods

We obtained samples from 452 patients who underwent gastrectomy. Tissue microarray blocks were constructed and immonohistochemical staining was performed.

Results

Expression of DBC1 and SIRT1 was associated with lower histologic grade, intestinal type of Lauren classification, and lower pT (p<0.001) and pN stage (DBC1, p=0.002; SIRT1, p<0.001). Association between absence of lymphatic invasion, and SIRT1 (p=0.001) and DBC1 (p=0.004) was observed. Cytoplasmic β-catenin expression was associated with lower histologic grade, pT, pN, tumor-node-metastasis (TNM) stage, DBC1 (p<0.001), and SIRT1 (p=0.001). Expression of SIRT1 and DBC1 was not associated with p53 (p=0.063 and p=0.060). DBC1 was an independent good prognostic factor in multivariate analysis (p=0.012).

Conclusions

SIRC1 and DBC1 can be considered to be good prognostic factors in gastric adenocarcinoma.

Citations

Citations to this article as recorded by  
  • Mechanistic insights into the dual role of CCAR2/DBC1 in cancer
    Hwa Jin Kim, Sue Jin Moon, Jeong Hoon Kim
    Experimental & Molecular Medicine.2023; 55(8): 1691.     CrossRef
  • Sirtuins (SIRTs) As a Novel Target in Gastric Cancer
    Agata Poniewierska-Baran, Paulina Warias, Katarzyna Zgutka
    International Journal of Molecular Sciences.2022; 23(23): 15119.     CrossRef
  • Histone Deacetylase Functions in Gastric Cancer: Therapeutic Target?
    Amandine Badie, Christian Gaiddon, Georg Mellitzer
    Cancers.2022; 14(21): 5472.     CrossRef
  • Advances on the role of the deleted in breast cancer (DBC1) in cancer and autoimmune diseases
    Qiannan Fang, Joseph A Bellanti, Song Guo Zheng
    Journal of Leukocyte Biology.2021; 109(2): 449.     CrossRef
  • miR-1301-3p Promotes Cell Proliferation and Facilitates Cell Cycle Progression via Targeting SIRT1 in Gastric Cancer
    Dakui Luo, Hao Fan, Xiang Ma, Chao Yang, Yu He, Yugang Ge, Mingkun Jiang, Zekuan Xu, Li Yang
    Frontiers in Oncology.2021;[Epub]     CrossRef
  • CCAR1 and CCAR2 as gene chameleons with antagonistic duality: Preclinical, human translational, and mechanistic basis
    Gavin S. Johnson, Praveen Rajendran, Roderick H. Dashwood
    Cancer Science.2020; 111(10): 3416.     CrossRef
  • Role of Histone Acetylation in Gastric Cancer: Implications of Dietetic Compounds and Clinical Perspectives
    Danielle Q Calcagno, Fernanda Wisnieski, Elizangela R da Silva Mota, Stefanie B Maia de Sousa, Jéssica M Costa da Silva, Mariana F Leal, Carolina O Gigek, Leonardo C Santos, Lucas T Rasmussen, Paulo P Assumpção, Rommel R Burbano, Marília AC Smith
    Epigenomics.2019; 11(3): 349.     CrossRef
  • Survival and Clinicopathological Significance of SIRT1 Expression in Cancers: A Meta-Analysis
    Min Sun, Mengyu Du, Wenhua Zhang, Sisi Xiong, Xingrui Gong, Peijie Lei, Jin Zha, Hongrui Zhu, Heng Li, Dong Huang, Xinsheng Gu
    Frontiers in Endocrinology.2019;[Epub]     CrossRef
  • Cell cycle and apoptosis regulator 2 at the interface between DNA damage response and cell physiology
    Martina Magni, Giacomo Buscemi, Laura Zannini
    Mutation Research/Reviews in Mutation Research.2018; 776: 1.     CrossRef
  • NANOGP8 expression regulates gastric cancer cell progression by transactivating DBC1 in gastric cancer MKN‑45 cells
    Li Li, Ru Feng, Sujuan Fei, Jiang Cao, Qinqin Zhu, Guozhong Ji, Jianwei Zhou
    Oncology Letters.2018;[Epub]     CrossRef
  • Overexpression of DBC1, correlated with poor prognosis, is a potential therapeutic target for hepatocellular carcinoma
    Changcan Li, Jianhua Liao, Shaohan Wu, Junwei Fan, Zhihai Peng, Zhaowen Wang
    Biochemical and Biophysical Research Communications.2017; 494(3-4): 511.     CrossRef
  • Association of sirtuins with clinicopathological parameters and overall survival in gastric cancer
    Xiaobing Shen, Pengfei Li, Yuchao Xu, Xiaowei Chen, Haixiang Sun, Ying Zhao, Mengqi Liu, Wenwen Zhang
    Oncotarget.2017; 8(43): 74359.     CrossRef
  • Co-ordinated overexpression of SIRT1 and STAT3 is associated with poor survival outcome in gastric cancer patients
    Shu Zhang, Shuling Huang, Chao Deng, Yu Cao, Jun Yang, Guangxia Chen, Bin Zhang, Chaoqin Duan, Jiong Shi, Bo Kong, Helmut Friess, Nanyi Zhao, Chen Huang, Xiaoli Huang, Lei Wang, Xiaoping Zou
    Oncotarget.2017; 8(12): 18848.     CrossRef
  • The prognostic role of Sirt1 expression in solid malignancies: a meta-analysis
    Changwen Wang, Wen Yang, Fang Dong, Yawen Guo, Jie Tan, Shengnan Ruan, Tao Huang
    Oncotarget.2017; 8(39): 66343.     CrossRef
  • SIRT1 induces tumor invasion by targeting epithelial mesenchymal transition-related pathway and is a prognostic marker in triple negative breast cancer
    Min-Sun Jin, Chang Lim Hyun, In Ae Park, Ji Young Kim, Yul Ri Chung, Seock-Ah Im, Kyung-Hun Lee, Hyeong-Gon Moon, Han Suk Ryu
    Tumor Biology.2016; 37(4): 4743.     CrossRef
  • Prognostic and clinical value of Sirt1 expression in gastric cancer: A systematic meta-analysis
    Bin Jiang, Jin-huang Chen, Wen-zheng Yuan, Jin-tong Ji, Zheng-yi Liu, Liang Wu, Qiang Tang, Xiao-gang Shu
    Journal of Huazhong University of Science and Technology [Medical Sciences].2016; 36(2): 278.     CrossRef
  • Significance of silent mating type information regulation 2 homolog 1 and claudin 4 expression in gastric carcinoma and precursor lesions
    Nashwa M. Emara, Ranih Z. Amer, Khaled M. Elsadek Attia, Heba M. Rashad, Adel Z. Elseady, Abd El-Latif M. Elbalshy
    Egyptian Journal of Pathology.2016; 36(2): 158.     CrossRef
  • Distinctive role of SIRT1 expression on tumor invasion and metastasis in breast cancer by molecular subtype
    Yul Ri Chung, Hyojin Kim, Soo Young Park, In Ae Park, Ja June Jang, Ji-Young Choe, Yoon Yang Jung, Seock-Ah Im, Hyeong-Gon Moon, Kyung-Hun Lee, Koung Jin Suh, Tae-Yong Kim, Dong-Young Noh, Wonshik Han, Han Suk Ryu
    Human Pathology.2015; 46(7): 1027.     CrossRef
  • SIRT1 is a regulator of autophagy: Implications in gastric cancer progression and treatment
    Guanglin Qiu, Xuqi Li, Xiangming Che, Chao Wei, Shicai He, Jing Lu, Zongliang Jia, Ke Pang, Lin Fan
    FEBS Letters.2015; 589(16): 2034.     CrossRef
  • DBC1 Functions as a Tumor Suppressor by Regulating p53 Stability
    Bo Qin, Katherine Minter-Dykhouse, Jia Yu, Jun Zhang, Tongzheng Liu, Haoxing Zhang, SeungBaek Lee, JungJin Kim, Liewei Wang, Zhenkun Lou
    Cell Reports.2015; 10(8): 1324.     CrossRef
  • DBC1 promotes anoikis resistance of gastric cancer cells by regulating NF-κB activity
    YONGWEI HUAN, DEPING WU, DAYONG ZHOU, BO SUN, GUOXIN LI
    Oncology Reports.2015; 34(2): 843.     CrossRef
  • Resveratrol relieves ischemia‑induced oxidative stress in the hippocampus by activating SIRT1
    Zhuangzhi Meng, Jianguo Li, Honglin Zhao, Haiying Liu, Guowei Zhang, Lingzhan Wang, He Hu, Di Li, Mingjing Liu, Fulong Bi, Xiaoping Wang, Geng Tian, Qiang Liu, Batu Buren
    Experimental and Therapeutic Medicine.2015;[Epub]     CrossRef
  • CCAR2 deficiency augments genotoxic stress-induced apoptosis in the presence of melatonin in non-small cell lung cancer cells
    Wootae Kim, Joo-Won Jeong, Ja-Eun Kim
    Tumor Biology.2014; 35(11): 10919.     CrossRef
  • Radioprotective and Antioxidant Effect of Resveratrol in Hippocampus by Activating Sirt1
    Jianguo Li, Li Feng, Yonghua Xing, Yan Wang, Liqing Du, Chang Xu, Jia Cao, Qin Wang, Saijun Fan, Qiang Liu, Feiyue Fan
    International Journal of Molecular Sciences.2014; 15(4): 5928.     CrossRef
  • SIRT1 expression is associated with a poor prognosis, whereas DBC1 is associated with favorable outcomes in gastric cancer
    Akira Noguchi, Keiji Kikuchi, Huachuan Zheng, Hiroyuki Takahashi, Yohei Miyagi, Ichiro Aoki, Yasuo Takano
    Cancer Medicine.2014; 3(6): 1553.     CrossRef
  • Sirtuins and Cancer: New Insights and Cell Signaling
    Marcos Vinícius Macedo de Oliveira, João Marcus Oliveira Andrade, Alanna Fernandes Paraíso, Sérgio Henrique Sousa Santos
    Cancer Investigation.2013; 31(10): 645.     CrossRef
  • Deleted in breast cancer-1 (DBC-1) in the interface between metabolism, aging and cancer
    Eduardo Nunes Chini, Claudia C. S. Chini, Veronica Nin, Carlos Escande
    Bioscience Reports.2013;[Epub]     CrossRef
  • SIRT1 Expression Is Associated with Good Prognosis in Colorectal Cancer
    Wonkyung Jung, Kwang Dae Hong, Woon Yong Jung, Eunjung Lee, Bong Kyung Shin, Han Kyeom Kim, Aeree Kim, Baek-hui Kim
    Korean Journal of Pathology.2013; 47(4): 332.     CrossRef
  • Clinicopathological significance of SIRT1 and p300/CBP expression in gastroesophageal junction (GEJ) cancer and the correlation with E-cadherin and MLH1
    Li-Hua Zhang, Qin Huang, Xiang-Shan Fan, Hong-Yan Wu, Jun Yang, An-Ning Feng
    Pathology - Research and Practice.2013; 209(10): 611.     CrossRef
Case Report
Malignant Glomus Tumors of the Stomach: A Report of 2 Cases with Multiple Metastases.
Hyunjoo Lee, Yoon Seok Choi, Sang Cheul Oh, Jong Jae Park, Chul Whan Kim, Han Kyeom Kim, Insun Kim
Korean J Pathol. 2009;43(4):358-363.
DOI: https://doi.org/10.4132/KoreanJPathol.2009.43.4.358
  • 3,803 View
  • 88 Download
  • 5 Crossref
AbstractAbstract PDF
Glomus tumors are mesenchymal neoplasms usually developing in the dermis or subcutis of the extremities. The majority of glomus tumors are entirely benign, and malignant glomus tumors are very rare, especially those arising in the visceral organs. Here, we are presenting two cases of malignant glomus tumor, initially diagnosed in the stomach by endoscopic biopsy. Case 1 was found in the stomach, right kidney, brain and humerus of a 65-year-old woman, and Case 2 in the stomach and liver of a 63-year-old man. Histologically, the tumor was composed of solid sheets and nests of round and short-spindle shaped tumor cells with vesicular nucleus and prominent nucleolus. The tumor cells were closely admixed with blood vessels of varying size. Immunohistochemically, the tumor cells showed diffuse and strong positive staining for smooth muscle actin and paranuclear, dot-like staining for synaptophysin, but negative for desmin, c-kit, CD34 and S-100 protein. These two are rare cases of a malignant glomus tumor with widespread metastases.

Citations

Citations to this article as recorded by  
  • Clinicopathologic features of gastric glomus tumor: A report of 15 cases and literature review
    Minying Deng, Rongkui Luo, Jie Huang, Yuanlong Luo, Qi Song, Huaiyu Liang, Chen Xu, Wei Yuan, Yingyong Hou
    Pathology and Oncology Research.2023;[Epub]     CrossRef
  • Glomus Tumor of the Stomach: A Systematic Review and Illustrative Case Report
    Andrea Pansa, Laura Samà, Laura Ruspi, Federico Sicoli, Ferdinando Carlo Maria Cananzi, Vittorio Quagliuolo
    Digestive Diseases.2023; 41(1): 17.     CrossRef
  • Locally Advanced Glomus Tumor of the Stomach With Synchronous Liver Metastases: Case Report and Literature Review
    Fabio Frosio, Carmine Petruzziello, Elia Poiasina, Michele Pisano, Alessandro Lucianetti
    Cureus.2023;[Epub]     CrossRef
  • Gastric Glomus Tumor: A Clinicopathologic and Immunohistochemical Study of 21 Cases
    Jun Lin, Juan Shen, Hao Yue, Qiongqiong Li, Yuqing Cheng, Mengyun Zhou
    BioMed Research International.2020; 2020: 1.     CrossRef
  • Malignant glomus tumor of the gastric antrum with hepatic metastases: a case report and literature review
    Adina A. Bodolan, Rebecca Wilcox, Michelle X. Yang
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Original Article
Pathological Characteristics of 20 Cases of Langerhans Cell Histiocytosis and Specificity of Immunohistochemical Stain of Langerin (CD207).
Youngjoon Ryu, Hyunjoo Lee, Sangho Lee, Hoiseon Jeong, Bongkyung Shin, Aeree Kim, Hankyeom Kim, Insun Kim
Korean J Pathol. 2009;43(2):113-119.
DOI: https://doi.org/10.4132/KoreanJPathol.2009.43.2.113
  • 3,591 View
  • 37 Download
  • 1 Crossref
AbstractAbstract PDF
BACKGROUND
Langerhans cell histiocytosis (LCH) is a well-known neoplastic disorder of Langerhans cells which has characteristic findings, however, LCH has not been adequately studied in Korea.
METHODS
We analyzed the clinicopathologic features of 20 patients with LCH who were diagnosed between 1997 and 2006 at the Korea University Guro and Anam Hospitals.
RESULTS
The M:F ratio was 3:1 and the age ranged from 2-60 years (mean, 23.8 years [4 in 1st decade, 6 in 2nd decade, 2 in 3rd decade, 5 in 4th decade and 3> or =40 years of age). The cases were classified as unifocal unisystemic in 13 patients, multifocal unisystemic in 4 patients, and multifocal multisystemic in 3 patients. The bone was the most commonly involved organ (14), followed by lymph node (5), lung (2), skin (2) and ureter (1). The Langerhans cells were immunohistochemically stained with Langerin, CD1a, S-100 protein, and CD68. Langerin and CD1a were specific for Langerhans cells.
CONCLUSIONS
The distribution of the involved organs in patients with LCH was similar to the distribution in Western countries, but lymph node involvement was more frequent, whereas lung involvement was less common. Langerin is considered to be a specific marker for Langerhans cells.

Citations

Citations to this article as recorded by  
  • Treatment Outcome of Langerhans Cell Histocytosis
    So Hak Chung, Jae Do Kim, Hyun Ik Jo
    The Journal of the Korean Bone and Joint Tumor Society.2014; 20(1): 14.     CrossRef
Case Report
Micropapillary Variant of Urothelial Carcinoma of the Urinary Bladder: Report of a Case with Cytologic Diagnosis in Urine Specimen.
Young Seok Lee, Hyunjoo Lee, Jung Woo Choi, Bongkyung Shin, Hankyem Kim, Insun Kim, Aeree Kim
Korean J Cytopathol. 2006;17(1):46-50.
  • 1,703 View
  • 17 Download
AbstractAbstract PDF
A micropapillary variant of urothelial carcinoma (MPC) is a distinct entity with an aggressive clinical course. It has a micropapillary configuration resembling that of ovarian papillary serous carcinoma. Its cytologic features have rarely been reported. We report a case of MPC detected by urine cytology. A woman aged 93 years presented with a chief complaint of macroscopic hematuria. Cytology of her voided urine showed clusters of malignant cells in a micropapillary configuration. Each tumor cell had a vacuolated cytoplasm, a high nuclear:cytoplasmic ratio, and irregular hyperchromatic nuclei. An ureteroscopic examination revealed exophytic sessile papillary masses extending from the left lateral wall to the anterolateral wall of the urinary bladder. A transurethral resection of the tumor was carried out. The tumor was characterized by delicate papillae with a thin, well-developed fibrovascular stromal core and numerous secondary micropapillae lined with small cuboidal cells containing uniform low- to intermediate-grade nuclei and occasional intracytoplasmic mucinous inclusions. These tumor cells infiltrated the muscle layers of the bladder, and lymphatic tumor emboli were frequently seen. Recognizing that the presence of MPC components in urinary cytology is important for distinguishing this lesion from low-grade papillary lesions and high-grade urothelial carcinomas can result in early detection and earlier treatment for an improved treatment outcome.
Original Article
The Clinicopathological Characteristics of Gastrointestinal Neuroendocrine Tumors; An Analysis of 65 Cases.
Hyunjoo Lee, Jungwoo Choi, Jung Suk An, Hyunchul Kim, Bong Kyung Shin, Aeree Kim, Hankyeom Kim, Insun Kim
Korean J Pathol. 2007;41(3):149-157.
  • 1,818 View
  • 25 Download
AbstractAbstract PDF
Background
: This study was designed to investigate gastrointestinal neuroendocrine tumors with an emphasis on their clinicopathological characteristics.
Methods
: Sixty-five cases were reviewed and classified as typical carcinoid (TC), atypical carcinoid (AC), large cell neuroendocrine carcinoma (LCNEC) and small cell carcinoma (SmCC). We performed immunohistochemistry to characterize the expression of the immunoreactivity for synaptophysin, chromogranin, gastrin, somatostatin, thyroid transcription factor-1, p53 and Ki-67.
Results
: Most commonly, the tumors were located in the rectum (54%), followed by the stomach (23%) and colon (9%). Histologically, the tumors were classified as 49 TCs, 4 ACs, 6 LCNECs and 6 SmCCs. Most tumors were stained positive for synaptophysin and/or chromogranin. Four LCNECs and one SmCC were p53-positive. The carcinoids revealed a low level (<5%) of reactivity for Ki-67, while > or =30% of the cells showed reactivity for Ki-67 in the majority of LCNECs and SmCCs. Six patients with metastatic carcinoids were older than those patients without metastasis (64 vs 48 years, respectively, p=0.004). Furthermore, the size of tumors was larger for the patients with metastatic carcinoids than for the patients with nonmetastatic carcinoids (2.3 vs 0.5 cm, respectively, p=0.005).
Conclusion
: Old age, large tumor size and muscle invasion are associated with high grade neuroendocrine tumor and lymph node metastasis for those patients with carcinoids.

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