Kosin Medical Journal

Case reports

Medication-related osteonecrosis of the jaw in a breast cancer patient receiving denosumab for bone metastases: a case report: Min-Kyeong Kim; Kosin Med J. 2025;40(4):322-326. Published online December 26, 2025; DOI: https://doi.org/10.7180/kmj.25.133

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Abstract PDF PubReader ePub: The use of bone-modifying agents in cancer patients to prevent skeletal-related complications associated with bone metastases has been linked to an increased risk of medication-related osteonecrosis of the jaw (MRONJ). In oncologic settings, bone-modifying agents are typically administered at higher doses and shorter intervals than those used for osteoporosis, thereby further elevating MRONJ risk. We report a case of MRONJ in a breast cancer patient receiving denosumab for metastatic bone disease, which was successfully managed with conservative treatment.

Gastric cancer with lymphoid stroma mimicking a subepithelial lesion after a 10-year disease-free interval: a case report: Bang Ju Kim, Sung Eun Kim, Seun Ja Park, Moo In Park, Won Moon, Jae Hyun Kim, Kyoungwon Jung, Myung Hun Lee, Jung Wook Lee, Kyung Won Seo, Hee-Kyung Chang; Kosin Med J. 2025;40(3):233-238. Published online September 23, 2025; DOI: https://doi.org/10.7180/kmj.25.123

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Abstract PDF PubReader ePub: A 74-year-old male patient presented to our hospital for treatment of gastric cancer in 2021. He had previously visited our institution in 2011 for assessment of a gastric subepithelial lesion (SEL), which was discovered incidentally during a health screening esophagogastroduodenoscopy (EGD). Endoscopic ultrasonography and abdominal computed tomography were conducted for evaluation of the gastric SEL, revealing an approximately 1 cm lesion arising from the muscularis propria. The lesion was initially thought to represent a mesenchymal tumor such as leiomyoma or gastrointestinal stromal tumor. Owing to its small size and absence of symptoms, no immediate intervention was undertaken, and the patient underwent regular surveillance only. Follow-up was maintained until 2018 and no notable changes in the gastric SEL were detected. The patient then voluntarily discontinued further follow-up. In 2021, a routine health screening EGD identified changes in the gastric SEL, and histopathological analysis confirmed adenocarcinoma. The patient subsequently underwent radical total gastrectomy utilizing the Roux-en-Y technique, with the final pathological diagnosis being stage I (pT2N0M0) gastric cancer with lymphoid stroma (GCLS). As of April 2025, there has been no evidence of cancer recurrence. This case illustrates a lesion initially diagnosed as SEL that later was identified as GCLS after a 10-year interval. Therefore, during EGD, clinicians should consider the potential for SEL-like gastric cancer if an SEL is observed. This report highlights the importance of close monitoring and a thorough diagnostic evaluation.

Complete response in borderline resectable pancreatic cancer after modified FOLFIRINOX chemotherapy followed by surgical resection: a case report: Seong Hyun Koh, Jung Wook Lee; Kosin Med J. 2025;40(2):136-141. Published online June 18, 2025; DOI: https://doi.org/10.7180/kmj.24.158

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Abstract PDF PubReader ePub: Borderline resectable pancreatic cancer (BRPC) constitutes a challenging subset of cases that fall between clearly resectable and unresectable disease. Pancreatic cancer has a poor prognosis, with a 5-year survival rate of 4.2%. In patients who underwent surgical resection, the 5-year survival rate rose from 1.5% to 17.4%, whereas in those who did not undergo resection, it remained unchanged. Here, we present the case of a patient with BRPC who had no residual tumor during surgery after receiving neoadjuvant FOLFIRINOX chemotherapy. A 57-year-old male patient was hospitalized for abdominal pain and was referred to our hospital for recurrent pancreatitis due to persistent alcohol consumption. Tumor marker testing showed a carbohydrate antigen 19-9 level <2.00 U/mL and a carcinoembryonic antigen level of 4.32 ng/mL. Computed tomography and magnetic resonance cholangiopancreatography revealed signs suggestive of pancreatic cancer, including diffuse gallbladder wall thickening and pancreatic duct dilatation. Endoscopic ultrasound-guided fine needle aspiration biopsy was performed to obtain a tissue sample, and pathological examination confirmed pancreatic ductal adenocarcinoma. Positron emission tomography-computed tomography found no abnormal F-18 fluorodeoxyglucose uptake that would suggest metastasis. Pylorus-preserving pancreaticoduodenectomy was performed, and no visible tumor cells were detected in the resected pancreas after chemotherapy. The patient was followed up for >2 months after surgery without recurrence. The absence of a residual tumor during surgery after upfront chemotherapy in patients with pancreatic cancer is extremely rare and is reported here along with a review of the literature.

Review article

Exploring the influence of olfactory receptors in metabolic diseases and cancers: beyond sensory functions: In-sun Yu, Jeong Sook Ye, Jaewon Shim; Kosin Med J. 2025;40(1):15-20. Published online February 17, 2025; DOI: https://doi.org/10.7180/kmj.24.142

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Olfactory receptors (ORs), which are primarily responsible for olfactory sensation in the nasal epithelium, constitute the largest family of genes in the human genome. The majority of ORs are orphan receptors with unknown ligands; however, recent studies have revealed their expression in non-olfactory tissues, implying that ORs may be involved in various physiological processes beyond olfaction. This review highlights recent findings on the roles of ORs in cancers, including prostate, breast, and lung cancer, as well as their involvement in other diseases, such as atherosclerosis, Alzheimer's disease, and viral infections. Additionally, we explore emerging knowledge about the role of ORs in metabolic regulation, focusing on their effect on triglyceride metabolism, glucagon-like peptide-1 secretion, and lipid accumulation. Advancements in technology, such as structural analysis, have accelerated research on OR ligands and their functions, potentially positioning ORs as novel therapeutic targets for various diseases. This review highlights the need for further research into the non-olfactory roles of ORs and their potential as targets for future therapeutic interventions.

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Decoding the Molecular Mechanisms of Menthol Isomer Perception Based on Computational Simulations
Mengxue Wang, Fengge Wen, Lili Zhang, Baoguo Sun, Jianping Xie, Shihao Sun, Yuyu Zhang
Foods.2025; 14(14): 2494. CrossRef

Original article

Efficacy of intravesical gemcitabine instillation compared with intravesical Bacillus Calmette-Guérin instillation for non-muscle invasive bladder cancer: Dong Ha Kim, Taek Sang Kim, Su Hwan Kang, Seong Bin Kim; Kosin Med J. 2024;39(4):254-258. Published online December 11, 2024; DOI: https://doi.org/10.7180/kmj.24.143

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Abstract PDF PubReader ePub: Background
Intravesical Bacillus Calmette-Guérin (BCG) instillation is the most effective treatment for reducing intravesical recurrence in non-muscle invasive bladder cancer (NMIBC). However, due to the recent global shortage of BCG, there is an increasing need for alternative treatments. This study aimed to retrospectively compare the outcomes of patients treated with intravesical gemcitabine instillation and BCG instillation as initial treatment options for NMIBC.
Methods
Seventy-eight patients with NMIBC who underwent transurethral resection of bladder tumors between January 2022 and September 2023 were reviewed. Of these, 42 patients received intravesical gemcitabine instillation, and 36 patients received BCG instillation. Recurrence-free survival (RFS) was analyzed, along with tumor multiplicity, grade, T stage, size, and bladder storage time after instillation, which could influence RFS.
Results
The mean follow-up period was 18.7 months for the gemcitabine group and 20.6 months for the BCG group. Recurrence occurred in 46.15% of patients (52.38% in the gemcitabine group and 38.92% in the BCG group). Tumor characteristics, including multiplicity, grade, stage, and size, were not significantly different between the two groups. The mean RFS was 15.92 months in the gemcitabine group and 19.84 months in the BCG group, with no statistically significant difference (p=0.397). However, gemcitabine instillation caused more severe bladder irritation, with shorter bladder storage time.
Conclusions
Intravesical gemcitabine and BCG instillation yielded comparable RFS outcomes. However, gemcitabine led to more severe bladder irritation, highlighting the need for further studies to optimize its application.

Review articles

Oncoplastic breast-conserving surgery: evolution, techniques, and the emerging role of acellular dermal matrix: Jun Ho Choi, Yoonsoo Kim; Kosin Med J. 2024;39(3):153-159. Published online September 26, 2024; DOI: https://doi.org/10.7180/kmj.24.129

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Oncoplastic breast-conserving surgery (OBCS) has revolutionized breast cancer treatment, aiming to achieve optimal oncological outcomes while preserving an aesthetically favorable appearance. This review explores the evolution, techniques, and outcomes of OBCS, with a particular focus on the emerging role of acellular dermal matrix in volume replacement techniques. We conducted a comprehensive literature review using PubMed, Medline, and Cochrane databases, focusing on studies published between 2010 and 2024. OBCS demonstrates comparable oncological safety to traditional breast-conserving surgery, with local recurrence rates ranging from 2.7% to 5.7% at 5 years. Patient satisfaction rates are consistently high, with 85% to 95% reporting good to excellent aesthetic outcomes. Volume replacement techniques using acellular dermal matrix show promising results, with one study reporting that 94% of patients were highly satisfied with cosmetic outcomes. Although the current results are encouraging, future advancements in OBCS may require innovative approaches, including the integration of robotic surgery and artificial intelligence technologies.

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Trends and Perspectives in Oncoplastic Breast Surgery: Findings From a Web-Based Survey With the Korean Breast Cancer Society
Jeeyeon Lee, Byeongju Kang, Ho Yong Park, Sang Yull Kang, Min Kyoon Kim, Hong-Kyu Kim, Sun Young Min, Min-Ki Seong, Tae-Kyung Robyn Yoo, Seokwon Lee, Eun-Shin Lee, Kyung-Hwak Yoon, Eun-Kyu Kim
Journal of Breast Cancer.2025; 28(3): 171. CrossRef

Surgical management of recurrent laryngeal nerve invasion by papillary thyroid carcinoma: Jae Hong Park, Hyoung Shin Lee; Kosin Med J. 2024;39(2):94-98. Published online June 18, 2024; DOI: https://doi.org/10.7180/kmj.24.117

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Preservation of the recurrent laryngeal nerve (RLN) is a priority for surgeons during thyroidectomy in patients with papillary thyroid cancer (PTC). RLN invasion by PTC in a patient presenting with preoperative vocal fold paralysis may require resection of the nerve with the tumor. However, the decision should be made regarding whether to preserve or sacrifice a functioning RLN invaded by PTC. Under certain conditions, preservation of the nerve with incomplete tumor resection could be considered. An RLN that has been resected due to PTC invasion may be managed by various reinnervation techniques to improve vocal outcomes. This article reviews clinical considerations and rationales for surgical decisions related to patients with PTC invasion of the RLN.

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Management of Voice after Thyroidectomy
Hyoung Shin Lee
International Journal of Thyroidology.2025; 18(1): 1. CrossRef
Options to enhance voice quality during and after thyroidectomy
Hyoung Shin Lee
Korean Intraoperative Neuromonitoring Society.2024; 4(2): 141. CrossRef

Gastric cancer and metabolic syndrome: Hyeong Ho Jo; Kosin Med J. 2024;39(1):26-34. Published online March 22, 2024; DOI: https://doi.org/10.7180/kmj.24.108

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Gastric cancer (GC), a prevalent disease in Asian countries, presents a substantial global health challenge. The risk factors for GC include Helicobacter pylori infection, diet, smoking, alcohol, and metabolic syndrome (MetS). This review meticulously examines the intricate connections between MetS and GC, focusing on visceral adipocytes, hormonal factors, obesity, and their impact on survival outcomes. Visceral adipocytes, which secrete inflammatory cytokines and hormones, play a pivotal role in influencing cancer development. Hormonal factors demonstrate nuanced associations with specific GC subtypes, underscoring the complexity of their impact. Large-scale studies exploring obesity-related factors reveal sex-specific nuances and underscore the importance of considering overall weight and body composition. Furthermore, the review explores the impact of eradication therapy for H. pylori infection, which is the most significant factor in the onset of GC, on the components of MetS. Additionally, the influence of MetS on postoperative outcomes and survival in GC patients highlights the interplay between therapeutic interventions and lifestyle factors. This comprehensive exploration sheds light on the multifaceted relationship between MetS and GC, providing valuable insights for future research and preventive strategies.

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Chemotherapy for Metastatic Gastric Cancer
Sung Eun Kim, Moo In Park, Myung Hun Lee
The Korean Journal of Gastroenterology.2025; 85(1): 1. CrossRef
Therapeutic Potential of Anti‐Diabetes Drugs and Anti‐Dyslipidemia Drugs to Mitigate Head and Neck Cancer Risk in Metabolic Syndrome
Sujung Yeom, Dong Hoon Lee, Juhyun Song
CNS Neuroscience & Therapeutics.2025;[Epub] CrossRef

Exploring the nexus between obesity, metabolic syndrome, and colorectal cancer: Jong Yoon Lee; Kosin Med J. 2024;39(1):18-25. Published online March 12, 2024; DOI: https://doi.org/10.7180/kmj.24.107

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The increasing global prevalence of obesity and metabolic syndrome (MetS) is strongly associated with the incidence of colorectal cancer (CRC). Obesity and MetS detrimentally impact the treatment outcomes of CRC and share similar mechanisms that contribute to the development of CRC. Increased insulin resistance in patients with obesity is linked to CRC, and altered levels of sex hormones and adipokines affect cell growth and inflammation. Obesity and MetS also alter the gut microbiome. Bile acids, which are crucial for lipid metabolism, are elevated in patients with obesity. Moreover, specific bile acids are associated with colonic damage, inflammation, and the development of CRC. Obesity and MetS increase the risk of postoperative complications and affect the response to chemotherapy. The promotion of weight loss and the resolution of MetS can reduce the occurrence of CRC and increase treatment efficacy. Therefore, it is imperative to implement appropriate management strategies to address obesity and MetS with the aim of improving the prognosis and reducing the incidence of CRC. Moreover, additional research should be conducted to determine the optimal timing for tailored CRC screening in patients with obesity or MetS. In this review, we explore the impact of obesity and MetS on the development of CRC and examine potential strategies to mitigate CRC risk in individuals with obesity and MetS.

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Explainable AI for colorectal cancer mortality and risk factor prediction in Korea: A nationwide cancer cohort study
Sang Won Park, Na Young Yeo, Tae-Hoon Kim, Myoung Nam Lim, Inhyeok Yim, Oh Beom Kwon, Seung-Joo Nam, Hui-Young Lee, Woo Jin Kim
International Journal of Medical Informatics.2026; 205: 106125. CrossRef
Colorectal Cancer and Obesity
Hyeong Ho Jo
Journal of Digestive Cancer Research.2024; 12(2): 82. CrossRef

Case reports

Interpedicular approach in percutaneous sacroplasty for treating pain due to direct invasion of rectal cancer into the S3 body: a case report: Jinseok Yeo, Saeyoung Kim, Chang Sub Lee; Kosin Med J. 2024;39(2):132-137. Published online February 20, 2024; DOI: https://doi.org/10.7180/kmj.23.153

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Abstract PDF PubReader ePub: Percutaneous sacroplasty is mainly used as an intervention for pain associated with sacral insufficiency fractures or sacral metastatic tumors. However, sacroplasty for managing the pain associated with direct sacral invasion of rectal cancer has been rarely reported. We present a case of a 74-year-old patient who underwent sacroplasty via the interpedicular approach under fluoroscopic guidance to relieve pain resulting from direct tumor invasion into the S3 body. After the procedure, the patient experienced immediate pain relief and did not feel worse pain with ambulation. Aside from peritumoral vascular leakage, no other significant complications occurred immediately post-procedure. Our results suggest that fluoroscopically guided interpedicular sacroplasty is a safe and effective option for relieving the pain associated with direct sacral invasion by rectal cancer.

Selective adjuvant radiation therapy for distant lymph node metastasis in patients with stage 4B epithelial ovarian cancer: a case series: Eun Taeg Kim, Seung Yeon Oh, Sun Young Ma, Tae Hwa Lee, Won Gyu Kim; Kosin Med J. 2023;38(4):293-299. Published online December 20, 2023; DOI: https://doi.org/10.7180/kmj.23.146

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Abstract PDF PubReader ePub: Although the efficacy of surgery followed by taxane- and platinum-based systemic chemotherapy has been clearly demonstrated in the standard first-line treatment of epithelial ovarian cancer, the role of radiation therapy for distant lymph node metastasis in patients with epithelial ovarian cancer is not well-established due to a lack of reported studies. We identified four patients who underwent selective adjuvant radiation therapy for neck and para-aortic lymph node lesions after primary debulking surgery between 2020 and 2022, followed by platinum-based chemotherapy for stage 4B high-grade serous ovarian cancer. Through a retrospective review of medical records, we analyzed patient clinicopathologic features, treatment course, and imaging findings. The median age was 49.25 years (range, 46–54 years). All patients had the International Federation of Gynecology and Obstetrics stage 4B disease. Following primary debulking surgery, all patients received weekly paclitaxel-carboplatin chemotherapy and maintenance treatment with poly(ADP-ribose) polymerase (PARP) inhibitors. All patients received selective adjuvant radiation therapy for neck and para-aortic lymph node metastasis before PARP inhibitor maintenance. The median follow-up time was 36.75 months (range, 19–45 months). All patients achieved a complete response. None of the patients experienced disease recurrence or died during the follow-up period. The management of distant lymph node metastasis in patients with epithelial ovarian cancer remains a matter of debate. Selective adjuvant radiation therapy in first-line treatment for ovarian cancer appears to be a feasible approach with maintenance therapy for stage 4B epithelial ovarian cancer.

Surgical management of giant adrenal myelolipoma using a modified Makuuchi incision: a case report: Byeong Jin Kang, Seung Hyeon Kim, Kyoungha Jang, Kyung Hwan Kim, Hong Koo Ha; Kosin Med J. 2024;39(1):75-79. Published online December 14, 2023; DOI: https://doi.org/10.7180/kmj.23.132

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Abstract PDF PubReader ePub: Giant adrenal myelolipomas are rare, benign, and hormonally inactive tumors. We present the case of a 53-year-old man with a 19-cm retroperitoneal mass, initially suspected to be a retroperitoneal liposarcoma, angiomyolipoma, or adrenal myelolipoma. After conducting endocrine assessments, which were within normal ranges, we decided to perform surgical excision using a modified Makuuchi incision. The tumor was successfully removed, and the final pathological examination confirmed the diagnosis of adrenal myelolipoma. The patient was discharged with no complications and remained without disease recurrence or distant metastasis as of 1 year postoperatively. In conclusion, giant myelolipomas are rare and cause symptoms owing to their large size. Surgical removal is recommended for large or symptomatic myelolipomas. The modified Makuuchi incision allows efficient and safe tumor removal in open surgery for giant myelolipomas.

Original article

Initial experience with Retzius-sparing robot-assisted radical prostatectomy compared to the conventional method: is it a suitable option for robotic prostatectomy beginners?: Su Hwan Kang; Kosin Med J. 2023;38(4):267-273. Published online November 9, 2023; DOI: https://doi.org/10.7180/kmj.23.143

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Abstract PDF PubReader ePub: Background
Retzius-sparing robot-assisted radical prostatectomy (rsRARP) is a surgical procedure that can minimize the resection of surrounding prostate tissue by enabling access through the anterior surface of the Douglas pouch. We reported our initial experiences with rsRARP compared to conventional robot-assisted radical prostatectomy (RARP).
Methods
Retrospective data were collected from March 2019 to June 2022, including 69 patients who underwent robotic radical prostatectomy for localized prostate cancer. The operations were performed at a single center, and we alternated between the two methods. Perioperative characteristics and oncologic and functional outcomes were analyzed.
Results
In total, 35 patients underwent RARP and 34 patients underwent rsRARP. The preoperative characteristics of the patients were similar. Oncologic and functional parameters were analyzed postoperatively. Except for early recovery of urinary incontinence (immediate, 1 month, 3 months, 6 months: p<0.001, p=0.002, p=0.004, and p=0.014, respectively), there were no significant differences between the two groups. We also analyzed trends in operation time and oncologic and functional outcomes according to the progression of rsRARP cases.
Conclusions
rsRARP has the major advantage of enabling an early recovery from urinary incontinence after surgery, and it is also a good surgical approach that shows oncologically similar results to the conventional approach. It is also highly reproducible and can be recommended to surgeons new to robotic radical prostatectomy.

Review article

Application of Raman spectroscopy in breast cancer surgery: Yikeun Kim, Sung Ui Jung, Jinhyuk Choi; Kosin Med J. 2023;38(3):176-183. Published online September 14, 2023; DOI: https://doi.org/10.7180/kmj.23.129

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The incidence of breast cancer is increasing worldwide. As cancer screening has become more widespread, the rate of early breast cancer detection has increased and treatment methods have changed. Partial mastectomy is performed more often than total mastectomy for the surgical treatment of early breast cancer, and sentinel lymph node biopsy plays an important role. A high level of accuracy is necessary for the intraoperative examination of surgical margins and sentinel lymph nodes to identify malignancies. Therefore, several examination techniques, including Raman spectroscopy, that replace or supplement the currently used frozen-section methods are being studied. Raman spectroscopy has the ability to diagnose cancer in normal tissue by providing in real time a chemical fingerprint that can be used to differentiate between cells and tissues. Numerous studies have investigated the utilization of Raman spectroscopy to identify cancer in the margins of resected tissues and sentinel lymph nodes during breast cancer surgery, showing the potential of this technique for clinical applications. This article introduces and reviews the research on Raman spectroscopy for breast cancer surgery.

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Biomedical Applications of Raman Spectroscopy: A Review
Sara Pimenta, José H. Correia
Photochem.2025; 5(4): 29. CrossRef

Original article

Post-percutaneous core needle biopsy sputum cytology: diagnostic value and factors for positive prediction in diagnosing malignancy: Sang Kyu Lee, Hee Kang, Min Jung Jung, Sekyoung Park, Ki Nam Lee; Kosin Med J. 2023;38(3):201-209. Published online August 16, 2023; DOI: https://doi.org/10.7180/kmj.23.127

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Background
This study evaluated the diagnostic yield and positive predictive factors of post-percutaneous core needle biopsy (PCNB) sputum cytology in diagnosing malignancy.
Methods
This retrospective study included patients who underwent PCNB at a single center from January 2014 to March 2022. Patient demographics, lung lesion characteristics on computed tomography, underlying lung disease, post-PCNB complications, histopathologic results of PCNB, post-PCNB sputum specimens, and final diagnoses were reviewed. The diagnostic yields and related factors were analyzed.
Results
Overall, 177 consecutive patients with sputum specimens obtained after PCNB for intrapulmonary lesions were enrolled. Among them, 152 patients had a final diagnosis of malignancy. Diagnostic sputum specimens with atypical or malignant cells were obtained in 12 patients. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of sputum cytology were 7.89%, 100%, 20.90%, 100%, and 15.15%, respectively. Lesion size, air-bronchogram, lesion multiplicity, and the cell type of squamous cell and adenocarcinoma differed significantly between the groups with diagnostic versus non-diagnostic sputum (p<0.05). The lesion size (odds ratio [OR], 1.035; 95% confidence interval [CI], 1.008–1.064; p=0.013), presence of air-bronchogram (OR, 23.485; 95% CI, 2.532–217.316; p=0.005), and squamous cell carcinoma (OR, 7.397; 95% CI, 1.773–30.865; p=0.006) were significantly associated with a diagnostic sputum specimen post-PCNB.
Conclusions
Although post-PCNB sputum cytology had low sensitivity in diagnosing lung cancer, it showed diagnostic results in some peripheral lung cancer patients who have squamous cell types, relatively large tumors, and air-bronchograms in the lesions.

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Automated lung cancer diagnosis from chest X-ray images using convolutional neural networks
Aya Aboelghiet, Samaa M. Shohieb, Amira Rezk, Ahmed Abou Elfetouh, Ahmed Sharaf, Islam Abdelmaksoud
PeerJ Computer Science.2025; 11: e3145. CrossRef

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