intended for 229 patients who suffered from leukemia andmyelodysplastic syndrome overt leukemia. MDS overt leukemiacases are 45 cases in that and all patients were followed up untildeath or until December 2012. And we studied about age, gender,cytogenetic abnormality, therapy, clinical outcome, and prognosis.Results: All cases are 45 cases, gender are male 28 cases and female17 cases, median age is 74 years (ranged 54–90 years). Cytogeneticexamination performed 40 cases. 29 cases revealed abnormality(72.5%), 11 cases indicated normal. About therapy, 9 cases receivedconventional chemotherapy as first remission induction therapy(daunorbicine 3 days + Cytarabine arabinocide 7 days; DC3-7 therapy,Idarubicine 2 days + Cytarabine arabinocide 7 days;IC2-7 therapy,Cytarabine arabinocide 14 days + Acracinon 4 days + Granulocytestimulate factor 14 days; CAG therapy, Cytarabine arabinocide7 days; Ara-C monotherapy). 19 cases received transfusion only,15 cases received palliative chemotherapy (hydroxycarbamide 500–2000 mg/day) predonisoron (20–50 mg/day), low dose cytarabinearabinocide(continuos div25–50 mg/body 3–7 days), 2 cases did notreceive any therapy except pain control or improving dehydration. Aboutclinical outcome in conventional chemotherapy, patients who achievedat complete remission were 5 cases (55.6%), progression free survivalwas 6 months (ranged 3–18 months), median survival time was14 months (ranged 7–21 months), in transfusion, median survival timewas 6 month (ranged 1–14 months), in palliative chemotherapy,median survival timewas 7 months (ranged 1–16 months).Discussionand conclusion: TheMDS are a group of clonal hematopoietic stem celldisease characterized by cytopenia or cytopenias, dysplasia in one ormore of cell lines. MDS occur principally in older adults with a medianage of 70 years. As another characteristic, clonal cytogenetic abnormal-ities are observed frequently, about 50% or more of MDS cases.Cytogenetic and molecular studies have a major role in the evaluationof patients withMDS in regard to prognosis, determination of clonality,and the recognition of cytogenetic, morphologic, and clinical correlates.About strategy of therapy formyelodysplastic syndrome, it is difficult tocure using conventional chemotherapy, by the present, only bonemarrow transplantation has possibility to cure. But because of there aremany elderly people, there are few cases that could receive bonemarrow transplantation. Many cases selected palliative therapy, in ourstudy, 40 cases received palliative therapy, but there is no difference onthe overall median survival time. This study suggested that therapychoice was case by case and does not hesitate selecting palliativetherapy.

doi:10.1016/j.ejim.2013.08.381

ID: 501CD24 and S100A4 expression in resectable pancreatic cancers withearlier disease recurrence and poor survivalSang Hyub Leea, Haeryoung Kimb, Ho-seong Hanc, Dong-Won Ahnd

aInternal Medicine and Liver Research Institute, Seoul National UniversityCollege of Medicine, Seoul National University Hospital, Seoul, South KoreabPathology, Seoul National University College of Medicine, Seoul NationalUniversity Bundang Hospital, Seongnam, South KoreacSurgery, Seoul National University College of Medicine, Seoul NationalUniversity Bundang Hospital, Seongnam, South KoreadInternal Medicine, Seoul National University Boramae Medical Center,Seoul, South Korea

Background: To study the expression status of markers associatedwith epithelial–mesenchymal transition (EMT) and metastasis inpancreatic ductal adenocarcinomas (PDAC) and to explore theprognostic value of these markers. Methods: Immunohistochemical

stains for CD24, CD44, E-cadherin, N-cadherin, Snail, S100A4, Vimentin,urokinase-type plasminogen activator receptor (uPAR), Ezrin andmatrix metalloproteinase-2 (MMP2) were performed on 67 resectedPDACs. Results: Proteins associated with EMT and metastasis weremore frequently expressed in PDACs with poor differentiation, highertumor stage, lymphatic and perineural invasion. CD24 expressionwas associated with frequent expression of EMT markers [CD44(p= 0.002), S100A4 (p b 0.001), Vimentin (p= 0.022), uPAR (p=0.002) and Ezrin (p= 0.010)]. CD24 and S100A4 expression in PDACwere significant prognostic factors for early tumor recurrence(HR= 5.185 and 2.490, p = 0.048 and 0.009, respectively) and poorsurvival (HR= 11.977 and 3.202, p = 0.006 and 0.004, respectively). Inaddition, the interaction between CD24 and S100A4 expression statuswas a significant prognostic factor for poor survival (HR = 18.518,p = 0.003). Conclusions: The expression of markers of EMT andmetastasis in PDACs was significantly associated with pathologicfeatures of aggressiveness. CD24 and S100A4 expression were signif-icant predictors of poor survival; thus, immunohistochemistry for thesemarkers in resected specimensmay help to identify PDAC patients witha poor prognosis.

doi:10.1016/j.ejim.2013.08.382

ID: 567Superior vena cava syndrome as first presentation of anundifferentiated carcinoma with unknown originJ. Mortágua, N. Ferreira, S. Gomes, A. Fernandes, C. Miranda, L. Revés,I. Serra, A. Leite, P. Freitas

Intensive Care Unit, Hospital Prof. Dr. Fernando da Fonseca,Amadora, Portugal

Introduction: The superior vena cava syndrome (SVCS) results fromblood flow obstruction of superior vena cava by invasion, extrinsiccompression and/or thrombosis. Clinical case: A 55 year old man, withhypertension, heavy smoker and alcohol user (100 g/d) presents at theemergency room with non-productive cough and dyspnea. On admis-sion it is noted plethora, facial edema and jugular engorgement, upperlimbs with edema and chest wall collateral circulation. Blood testsshowed normocytic and normochromic anemia (10.2 g/dL), leukocyto-sis (33,000/μL), thrombocytosis (593,000/μL) and elevation of CRP(20.9 mg/dL). Blood gases reveled hypoxemia (44.8 mmHg). The chestX-ray exhibits widening of the superior mediastinum; chest CT showedbulkymediastinalmass (90 × 80 × 90 mm),which involves the vascularpedicle and leads to extrinsic compressionwithmarked reduction of thediameter of the trachea and a solitary infra-hilar nodule (24 × 26mm).Bronchoscopy described 90% trachea occupancy by irregular tumormass with wall destruction. A tracheal prosthesis was placed. Thehistological diagnosis was a poorly differentiated carcinoma, with areasof differentiation paving stone (with positive staining for CD10, CK5/6,CAM 5.2, p63, hepatocyt, AE1/3). Beta-HCG, alpha-fetal protein andcarcinoma-embryonic antigen were negative. Transferred to theintensive care unit (ICU) due to invasive ventilation need. After reviewby the oncology and cardiothoracic surgery, and considering the stage(T3bNxMx), aggressiveness and severity in the formof presentation,weopted for palliative and comfortmeasures. He died in ICU, due to diseaseprogression. Conclusions: The combination of clinical data and imagingin this case were crucial for diagnosis. Intrathoracic malignancy isresponsible for nearly 60% SVCS cases. SVCS is a form of presentation ofa previously undiagnosed tumor in up to 60% of these cases.

doi:10.1016/j.ejim.2013.08.383

Abstractse148