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??Analysis of clinical and pathological features of asymptomatic cystic neoplasms of pancreas DAI Meng-hua*, XU Tao, ZHANG Tai-ping et al. *Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences , Beijing 100730, China
Corresponding author: ZHAO Yu-pei, E-mail: zhao8028@263.net
Abstract Objective To analyze and study clinical and pathological features of incidental cystic neoplasms of pancreas. Methods The clinical data of 126 cases of pancreatic resection performed for cystic neoplasms between January 1984 and June 2008 at Peking Union Medical College Hospital were evaluated retrospectively. Results Among 126 cases of cystic neoplasms of pancreas, 60 cases were asymptomatic including 56 cases of benign and 4 cases of malignant. The benign cases included 28 cases of serous cystic neoplasms, 25 cases of mucinous cystic neoplasms and 3 cases of intraductal papillary mucinous neoplasms. The malignant cases inclued 3 cases of mucinous cystic adenocarcinoma and 1 case of invasive intraductal papillary mucinous neoplasm. Univariate and multivariate analysis showed that gender, tumor size and radiological features(solid component and main duct dilation) were significant different between benign and malignant cystic neoplasm of pancreas. Gender was a predictor of malignant pathology, with male cases having a higher incidence of malignancy (3/11, 27.3%) compared with female cases (1/44, 2.27%; P=0.001). The presence of radiographic features (solid component and main pancreatic duct dilation) was associated with malignancy of cystic neoplasms. Tumor size less than 3cm in diameter was more common in benign, asymptomatic cystic neoplasms of pancreas. Conclusion Among asymptomatic cystic neoplasms of pancreas, the incidence of malignant cases is lower. The study suggests that if tumor size in asymptomatic cases is less than 3cm in diameter without malignant radiographic features (solid component and main pancreatic duct dilation) observation and regular folllow-up can be selected.     

Osteomyelitis: A Descriptive Study

Background

To analyze the incidence and clinical-microbiological characteristics of osteomyelitis (OM) in a tertiary Spanish hospital.

Methods

All cases diagnosed with OM between January 2007 and December 2010 were retrospectively reviewed. The variables examined include epidemiological characteristics, risk factors, affected bone, radiographic changes, histology, microbiological culture results, antibiotic treatment, and the need for surgery.

Results

Sixty-three cases of OM were diagnosed. Twenty-six patients (41.3%) had acute OM whereas 37 patients (58.7%) were classified as chronic OM. OM may result from haematogenous or contiguous microbial seeding. In this group, 49 patients (77.8%) presented with OM secondary to a contiguous source of infection and 14 patients had hematogenous OM (22.2%). Staphylococcus aureus was the most commonly found microorganism.

Conclusions

OM mainly affected patients with risk factors related to the presence of vascular diseases. Antibiotic treatment must be guided by susceptibility patterns of individual microorganisms, although it must be performed together with surgery in most of the cases.     

Risk of Malignancy in Resected Cystic Tumors of the Pancreas ≤3 cm in Size: Is it Safe to Observe Asymptomatic Patients? A Multi-institutional Report

Recent international consensus guidelines propose that cystic pancreatic tumors less than 3 cm in size in asymptomatic patients with no radiographic features concerning for malignancy are safe to observe; however, there is little published data to support this recommendation. The purpose of this study was to determine the prevalence of malignancy in this group of patients using pancreatic resection databases from five high-volume pancreatic centers to assess the appropriateness of these guidelines. All pancreatic resections performed for cystic neoplasms ≤3 cm in size were evaluated over the time period of 1998–2006. One hundred sixty-six cases were identified, and the clinical, radiographic, and pathological data were reviewed. The correlation with age, gender, and symptoms (abdominal pain, nausea and vomiting, jaundice, presence of pancreatitis, unexplained weight loss, and anorexia), radiographic features suggestive of malignancy by either computed tomography, magnetic resonance imaging, or endoscopic ultrasound (presence of solid component, lymphadenopathy, or dilated main pancreatic duct or common bile duct), and the presence of malignancy was assessed using univariate and multivariate analysis. Among the 166 pancreatic resections for cystic pancreatic tumors ≤3 cm, 135 cases were benign [38 serous cystadenomas, 35 mucinous cystic neoplasms, 60 intraductal papillary mucinous neoplasms (IPMN), 1 cystic papillary tumor, and 1 cystic islet cell tumor], whereas 31 cases were malignant (14 mucinous cystic adenocarcinomas and 13 invasive carcinomas and 4 in situ carcinomas arising in the setting of IPMN). A greater incidence of cystic neoplasms was seen in female patients (99/166, 60%). Gender was a predictor of malignant pathology, with male patients having a higher incidence of malignancy (19/67, 28%) compared to female patients (12/99, 12%; p < 0.02). Older age was associated with malignancy (mean age 67 years in patients with malignant disease vs 62 years in patients with benign lesions (p < 0.05). A majority of the patients with malignancy were symptomatic (28/31, 90%). Symptoms that correlated with malignancy included jaundice (p < 0.001), weight loss (p < 0.003), and anorexia (p < 0.05). Radiographic features that correlated with malignancy were presence of a solid component (p < 0.0001), main pancreatic duct dilation (p = 0.002), common bile duct dilation (p < 0.001), and lymphadenopathy (p < 0.002). Twenty-seven of 31(87%) patients with malignant lesions had at least one radiographic feature concerning for malignancy. Forty-five patients (27%) were identified as having asymptomatic cystic neoplasms. All but three (6.6%) of the patients in this group had benign disease. Of the patients that had no symptoms and no radiographic features, 1 out of 30 (3.3%) had malignancy (carcinoma in situ arising in a side branch IPMN). Malignancy in cystic neoplasms ≤3 cm in size was associated with older age, male gender, presence of symptoms (jaundice, weight loss, and anorexia), and presence of concerning radiographic features (solid component, main pancreatic duct dilation, common bile duct dilation, and lymphadenopathy). Among asymptomatic patients that displayed no discernable radiographic features suggestive of malignancy who underwent resection, the incidence of occult malignancy was 3.3%. This study suggests that a group of patients with small cystic pancreatic neoplasms who have low risk of malignancy can be identified, and selective resection of these lesions may be appropriate.     

Two distinctive subungual pathologies: subungual exostosis and subungual osteochondroma

BACKGROUND: The purpose of this study was to present features that differentiate subungual exostosis from subungual osteochondroma. METHODS: We treated 11 patients for subungual masses. All were confirmed by radiographic and histologic evaluations to be subungual exostosis or subungual osteochondroma. The study patients comprised eight female and three male patients with a mean age at presentation of 18.7 years (range 1.5 to 70.9). In the five patients with subungual exostosis, three (60%) had a toe lesion, and two (40%) had a finger lesion. In the six patients with subungual osteochondroma, four (67%) had a toe lesion, and two (33%) had finger lesions. We analyzed the clinical features, including trauma history, the existence of infection before surgery, tumor recurrence, and postoperative nail deformity. RESULTS: In all patients, the lesions presented as an exophytic tumor of the nail apparatus, beneath the nail plate, which varied in size from 0.6 x 0.4 cm to 1.2 x 0.9 cm. Excision of these masses produced useful toes or fingers without pain, a tender scar, or nail deformity. Although nails were deformed preoperatively, they grew back without ridges or cracks within 3 to 5 months postoperatively. There were no recurrences based on clinical and radiographic evaluations, and both tumor types showed characteristic radiographic and histologic differences. CONCLUSIONS: Subungual exostosis and subungual osteochondroma are benign but have distinct osseous pathologies. We concluded that subungual exostosis is clinically, developmentally, radiographically, and histologically distinct from subungual osteochondroma.     

结节性硬化症多器官病变的临床特点及影像学诊断价(附3例报告)

目的：探讨结节性硬化症累及多器官病变的临床特点及影像学诊断价值。方法：回顾性分析3例结节性硬化症伴大脑、肾脏、皮肤、肝脏，脾脏、骨骼等多部位病灶的症状，体征及其影像学表现。结果：1例有典型的结节性硬化“三联征”表现，3例均有典型的面部皮疹，1例有癫痫发作史。3例颅脑CT均发现典型的大脑钙化结节灶，3例均伴双肾多发性错构瘤，2例CT及B超检查发现肝脏多发错构瘤，1例有脾脏占位性病变，2例行X线平片，CT及同位素骨扫描显示腰骶椎，髂骨及颅骨存在骨密度增高灶，肝、脾及骨骼病变均无明显症状，结论：结节性硬化症是一种可累及大脑，肾脏，皮肤，肝、脾，骨骼等多系统器官的综合征，颅脑CT显示脑室管膜下钙化灶，对诊断具有特异性，影像学检查可以发现多发性无症状病灶。     

Lymphoma presenting as a soft tissue mass. A soft tissue sarcoma simulator

Lymphoma presenting as a soft tissue mass is rare and thus may be confused with the more common soft tissue sarcoma. No previous analysis of the clinical and radiologic features of lymphomas presenting as soft tissue masses is available because most of the cases reviewed are from the pathology literature. Four patients with diagnoses of extranodal lymphomas of the soft tissues were reviewed retrospectively with respect to their clinical features, primary tumor characteristics, stage, radiographic characteristics, treatment, and followup. Mean age was 72.5 years (range, 52-85 years). The soft tissue mass occurred in the thigh (three cases) and shoulder (one case). The median size of the soft tissue mass was 6.7 cm (range, 2-15 cm) in the largest dimension, as measured on magnetic resonance imaging. These patients each had evidence of lymphadenopathy at the time of diagnosis. Lactate dehydrogenase was increased significantly in two cases and increased slightly in two other cases. One case was Stage II(E) at presentation, one was Stage III(E), and two were Stage IV. All were B cell immunophenotype. All patients died between 2 and 24 months after diagnosis, despite the use of Cytoxan, vincristine, adriamycin, and prednisone chemotherapy in each case. Clinical and radiographic features that favor extranodal soft tissue lymphoma over sarcoma include pain and tenderness, lymphadenopathy (particularly when confluent radiologically), ipsilateral extremity swelling, and elevated lactate dehydrogenase.     

Radiographic features of staphylococcal pneumonia in adults and children.

BACKGROUND: Clinical and laboratory features do not accurately correlate with the cause of community acquired pneumonia. A study was performed to examine whether the radiographic features of staphylococcal pneumonia are sufficiently distinct to aid early diagnosis. METHODS: The chest radiographs of 34 patients (including eight children) with proven staphylococcal pneumonia were reviewed by two experienced observers using methods described previously. Features on presentation and follow up were noted. RESULTS: The most striking features were the presence of multilobar consolidation on presentation, cavitation, pneumatocoeles and spontaneous pneumothorax, together with a tendency to radiographic deterioration after admission in both adults and children. Some of these features are much less common with other causes of community acquired pneumonia. However, most of the cases did not have these classic features. CONCLUSIONS: The presence of certain radiographic features, including multilobar shadowing, cavitation, pneumatocoeles, and spontaneous pneumothorax, are seen with staphylococcal pneumonia in adults and children, but their absence does not exclude the diagnosis.     

Clinical and radiographic characteristics of patients with osteoarthritis of knees

The study of 60 outpatients with clinical diagnosis of the osteoarthritis (OA) of the knees is performed. Measured parameters were: general demographic data, clinical data and standard radiographic x-ray of knees in standing position, graduated by Kellgren and Lawrence clasificiation from 0-4. The aim of this study was to establish clinical and radiographic features of OA of knees and to compare those characteristiscs in the two subgroups of patients according to radiographic stages: a group of an early disease (stages 0 or 1) and a group of late disease (stages from 2 to 4). The mean age was 60 years with range from 39 to 85 years. 85% of patients were female. Distribution of patients according to Kellgren and Lawrence radiographic stages was as follows: 13 patients (21,7%) in grade 0, 17 (28,3%) in grade 1, 10 (16,7%) in grade 2, 11 (18,3%) in grade 3, and nine patients (15%) in grade 4. Crepitus on movement was registered in aproximatelly 80% of all patients, with no difference between early and late disease. Instability of the knee was present in eleven patients (18%), with more than a half of them (56%) in a radiographic grade 4 of OA of knees. There were no difference between functional parameters comparing original group of patients and two sub-groupes. Crepitus on movement was not related to any specific radiographic stage of disease, but instability of knee was frequently registered in late disease.     

Radiographic case definitions and prevalence of osteoarthrosis of the hip: a survey of 4 151 subjects in the Osteoarthritis Substudy of the Copenhagen City Heart Study

BACKGROUND: The diagnosis of osteoarthrosis (OA) is founded on radiographic evidence of joint degeneration and characteristic subjective symptoms. Due to the lack of consensus radiographic case definitions, the prevalence and incidence of OA reported in the literature varies. The aims of the current study were to establish an accurate and workable radiographic definition of OA in hip joints and to examine the association of OA (thus defined) with self-reported pain. METHODS: Radiographic features of hip OA were classified in pelvic radiographs of 3 807 subjects (1448 males and 2 359 females) according to the OA classifications of Kellgren and Lawrence (1957) and Croft (1990), and according to minimum joint space width (JSW) of 2.0 mm regardless of other radiographic features of OA. The relationships between these radiographic discriminators and self-reported hip pain were investigated. RESULTS: Formation of cysts, osteophytes and subchondral sclerosis was significantly more frequent in men. Average minimum JSW was narrower in women than in men (p < 0.001). In both sexes, minimum JSW decreased after the fourth decade of life, but progressively more so in women. Women reported hip pain more frequently than men (p < 0.001). When the cut-off JSW value of 2.0 mm was applied regardless of other radiographic features of OA, prevalences of hip OA ranged from 4.4% to 5.3% in subjects > or = 60 years of age. The radiographic discriminator with the strongest association with self-reported hip pain in men and women > or = 60 years of age was minimum JSW < or = 2.0 mm; OR = 3.3 (95% CI 1.9-5.7) for men, and OR = 3.2 (95% CI 1.9-5.2) for women. INTERPRETATION: We found that minimum JSW < or = 2.0 mm was the radiographic criterion having the closest association with self-reported hip pain. Using composite OA scores emphasizing the relatively inconsequential formation of cysts, osteophytes and subchondral sclerosis runs the risk of over-inflating the prevalence of hip OA in men and of underestimating hip OA prevalence in women.     

Nephron-sparing surgery for renal angiomyolipoma

INTRODUCTION: Renal angiomyolipoma (RAML) is a benign tumor composed of varying amounts of mature adipose tissue, smooth muscle and thick-walled blood vessels. RAML tend to grow over time requiring active intervention due to serious associated complications, such as hemorrhage and pain. Although RAML is an ideal tumor for organ preservation, data concerning efficacy of nephron-sparing surgery (NSS) are sparse. The aim of the study was to evaluate the efficacy of NSS in RAML with regard to renal function, tumor recurrence and surgical feasibility. PATIENTS AND METHODS: Charts of patients with pathologically confirmed RAML were reviewed and data recorded: tumor size, associated symptoms, intraoperative blood loss, serum creatinine, follow-up data with regard to tumor recurrence and long-term renal function. A total of 28 patients were identified with RAML who underwent NSS because of tumor size > 4 cm, pain and/or to rule out malignancy due to radiographic features of uncertain interpretation. RESULTS: The median follow-up of all patients is 58 (3-114) months; median age was 55.6 (34-78) years, 24 patients were women, 4 patients were men. None of the patients developed a local recurrence. Median size of enucleated tumors was 5.5 (2.5-15) cm; indication for NSS was symptomatic tumor with hemorrhage in 4 patients (16%), prophylaxis of hemorrhage in 5 patients (20%) and radiographic features suspicious for malignancy in 16 patients (64%). In those cases, unenhanced and enhanced CT scans exhibit a hyperdense and a hypodense lesion as compared to the adjacent normal renal cortex, respectively. There were no intraoperative complications, median blood loss was 320 (50-1200) ml, none of the patients required blood transfusions. Post-operative course was uneventful in 26 patients (96%), 2 patients (7.1%) developed a urinary fistula managed by an endoluminal stent. Pre-operative serum creatinine was 0.9 (0.7-1.3) mg/dl, post-operative creatinine was 1.23 (0.7-1.5) mg/dl and serum creatinine at last follow-up was 0.95 (0.7-1.2) mg/dl. CONCLUSIONS: NSS can be performed with a high success rate in RAML when surgical management is indicated. Long-term follow-up reveals no local tumor recurrences and stable renal function even in patients with a solitary kidney.     

Operative mortality after nephrectomy for renal cell carcinoma

OBJECTIVE: To study the rate and causes of operative and treatment-related mortality after nephrectomy for renal cell carcinoma (RCC) in Iceland. MATERIAL AND METHODS: This retrospective population-based study included all patients who underwent nephrectomy for RCC in Iceland between 1971 and 2000. Patients who died <30 days after the operation were analyzed and compared to those who survived surgery. Disease stage, tumor size, patient age and preoperative American Society of Anesthesiologists classification were compared between the two groups. Autopsy records were examined to determine the causes of death. RESULTS: During the study period 880 patients were diagnosed with RCC and 575 (65%) of them underwent a nephrectomy, 116 (20%) with palliative intent. Operative mortality (OM) was 2.8% and did not change during the 30-year period. Patients with OM were significantly older than those without (73 vs 64 years, respectively) but disease stage, tumor size, ASA classification and gender were comparable between the groups. OM was comparable for patients operated on with palliative (3.4%) vs. curative (2.6%) intent (ns). Median time of death was 10 days postoperatively but no patient died intraoperatively. Causes of death were peri- and postoperative bleeding in five patients, infection/sepsis in four, arrhythmia in three, acute renal failure in two, pulmonary embolism in one and multiorgan failure in one. CONCLUSIONS: OM after nephrectomy for RCC has remained low during the past three decades in Iceland. It is most often caused by perioperative bleeding and infections. We find that the low OM in patients with metastases gives support to the use of palliative nephrectomy as a treatment option when other forms of treatment have failed.     

Prevalence of cervical spine stenosis. Anatomic study in cadavers

BACKGROUND: The sagittal diameter of the cervical spinal canal is of clinical importance in traumatic, degenerative, and inflammatory conditions. A small canal diameter has been associated with an increased risk of injury; however, there is a lack of reliable normative data on spinal canal diameters in different age groups in the United States population. The purpose of this study was to use direct measurement of skeletal specimens to determine the spectrum of the sagittal diameters of the cervical spinal canal, the frequency of cervical stenosis in the general population, and the prevalence of cervical stenosis for different age groups, races, and sexes. METHODS: Four hundred and sixty-nine adult skeletal specimens of the cervical spine were obtained from the Hamann-Todd Collection in the Cleveland Museum of Natural History. With use of digital calipers, the distance from the posteriormost aspect of the vertebral body to the anteriormost aspect of the spinolaminar structure was measured and recorded for each specimen at every level from C3 to C7. Cervical stenosis was defined as a canal diameter of <12 mm. We analyzed the direct measurements and then assessed those data after correcting for size increases in the current population compared with the Hamann-Todd Collection. Finally, we analyzed the data after both that size correction and adjustment for radiographic magnification. RESULTS: The average anterior-posterior canal diameter (and standard deviation) in all specimens at all levels was 14.1 +/- 1.6 mm. The canal diameters ranged from 9.0 to 20.9 mm, with a median diameter of 14.4 mm. Men had significantly larger cervical spinal canals than women at all of the levels that were evaluated. Specimens from donors who were sixty years of age or more at the time of death had significantly narrower canals than specimens from younger donors. There were no significant differences, with the numbers available, between black and white groups. After correcting for increased body size and adjusting for radiographic magnification, we estimated that cervical stenosis was present in 4.9% of the adult population, 6.8% of the population fifty years of age or older, and 9% of the population seventy years of age or older. CONCLUSIONS: Cervical spine stenosis appears to be very common. The radiographic finding of cervical stenosis should therefore be correlated with the clinical presentation prior to decision-making regarding treatment.     

Juxtacortical chondromyxoid fibroma of bone: a unique variant: a case study of 20 patients

BACKGROUND: Chondromyxoid fibroma (CMF) is a rare neoplasm of the appendicular skeleton of young adults. We report 20 cases of a poorly recognized subtype which arises on the surface of long bones and erodes the cortical surface causing a periosteal reaction. This entity should be included in the differential diagnosis of bone surface lesions as it may be mistaken for a more aggressive neoplasm. DESIGN: A retrospective review at the Mayo Clinic identified 259 CMF cases, 13 of which were parosteal. Additionally, 2 cases were diagnosed at the University of Alabama at Birmingham and 5 cases were from one of our authors' files. We reviewed the clinical radiographic and pathologic findings of all 20 cases. RESULTS: Juxtacortical CMF occurred over a large age range (12 to 82 y) with a median age of 40.2 years. A slight male predilection (5:4) was seen. The most common presentation was bone pain. All 20 cases showed solitary, radiolucent surface lesions with sclerotic margins and extension into the overlying soft tissues. Most of the lesions were in the proximal tibial metaphysis. Histologically, the tumors had characteristic features of CMF. Several cases contained distinctive areas of calcification, which is not a feature of conventional CMF. Eleven of 12 cases were cured with simple excision. CONCLUSION: CMF should be included in the differential diagnosis of bone surface lesions. The clinical and radiologic findings must be known. The morphology of this lesion is similar to conventional CMF with the exception of focal exuberant calcification. Conservative therapy is the treatment of choice.     

Osteogenesis imperfecta misdiagnosed as child abuse

The differential diagnosis of child abuse includes osteogenesis imperfecta (OI). Mild phenotypes of OI may be misdiagnosed as child abuse. The purpose of this study was to review the experience of families in which OI was misdiagnosed as child abuse. Sixty-one potential cases of misdiagnosis were identified from a lay support organization. Upon review of the medical records, 33 cases were identified with a confirmed diagnosis of OI (skin biopsy or DNA blood test). Questionnaires were given to families to describe their condition and experiences. There were 19 male and 14 female children. Mean age at presentation was 7.1 months (range: 1-23 months). All patients had fractures and the presenting symptoms included pain (n=14), swelling (n=7), decreased limb movement (n=5), or unusual limb position (n=2). Abnormal radiograph findings consistent with OI were found in 19 of 33 patients (58%), clinical findings of OI were present in 23 of 33 patients (70%), and a family history that could be supportive of OI was present in 18 of 33 families (55%). Children were removed from the family in 70% of cases and older siblings were removed from the family in 62% of cases. The mean age at the time of diagnosis of OI was 10.5 months (range: 3-35 months). The consequences of misdiagnosis of OI as child abuse are devastating to the family. OI should be considered in all cases of suspected child abuse. In children with any clinical, radiographic, or family history features of OI, early involvement of a bone specialist and performance of laboratory testing should be considered to establish a timely and accurate diagnosis.     

Radiographic features of tumefactive giant cavernous angiomas

Summary Background. Giant cavernous angiomas (GCAs) are very rare, and imaging features of GCAs can be very different from those of typical cavernous angiomas (CAs), making them a diagnostic challenge. The purpose of the study was to evaluate the radiographic features of GCAs, with an emphasis on the differentiating features from neoplastic lesions. Methods. The neuroradiological findings of 18 patients who harbored a histologically verified GCA (CA of 4 cm or larger) were reviewed retrospectively. The magnetic resonance imaging (MRI) appearance, enhancement pattern, presence of edema or mass effect, size, and location of each lesion were recorded. When available, pertinent clinical information, including age, sex, and mode of presentation, was obtained. Findings. Seizures, neurologic deficits, hemorrhage, and hydrocephalus were the most common presenting symptoms. The lesions were hyperdense and nonenhancing on computed tomography with frequent calcifications. On MRI, the lesions most commonly had a multicystic appearance, representing blood of various ages, and multiple complete hemosiderin rings. GCAs can present in any location with associating edema and mass effect, giving them a tumefactive appearance. No developmental venous anomaly was observed with any lesion. Conclusions. Most GCAs in our series presented as multicystic lesions with complete hemosiderin rings on MRI, giving a “bubbles of blood” appearance. Although this characteristic feature is helpful in the diagnosis of many cases of GCAs, the correct diagnosis in the remaining cases may not be apparent until histopathological evaluation of the specimen is made. Correspondence: William T. Couldwell, M.D., Ph.D., Department of Neurosurgery, University of Utah School of Medicine, 175 N. Medical Drive East, Salt Lake City, UT 84132, Utah     

Primary intraosseous odontogenic carcinoma arising in an odontogenic cyst or de novo: a clinicopathologic study of six new cases.

The term primary intraosseous odontogenic carcinoma (PIOC) has been primarily used to describe a squamous cell carcinoma within the jaws arising either from a previous odontogenic cyst or de novo. Here, we report 6 new cases of PIOC, affecting 4 female and 2 male patients with a mean age of 56.2 years. Two cases involved the maxilla and 4 cases occurred in the mandible. The typical radiographic presentation was that of a radiolucent lesion with well or ill defined margins. Histopathologically, 4 cases were diagnosed as well differentiated keratinizing PIOC arising from previous odontogenic cysts (2 odontogenic keratocysts and 2 periapical cysts). The remaining 2 cases were poorly differentiated nonkeratinizing PIOC, which appeared to arise de novo. Treatment consisted of surgical removal, with postoperative radiotherapy in 5 cases, and to date neither recurrence nor metastasis have occurred. Knowledge of the clinical, radiographic, and histopathologic features of PIOC allows accurate diagnosis and appropriate treatment of this rare malignancy.     

Bronchioloalveolar carcinoma: clinical, radiographic, and pathological findings. Surgical results

BACKGROUND: Bronchioloalveolar carcinoma (BAC) remains one of the most controversial of lung cancer subtypes. METHODS: From 1980 to 1998, 374 resected patients for NSCLC were followed up in our department. Of the 147 cases histologically defined as adenocarcinoma, 34 were pure BAC. The records of these 34 patients were retrospectively reviewed in order to evaluate patient and tumor characteristics and to identify which variables had a prognostic impact on survival and recurrence rate. RESULTS: Patient age, sex, smoking habits and symptoms were not differentiating characteristics when related to radiographic presentation or to natural history. Mucinous cell-type (23.6% of cases) was more frequent with non-smokers, presence of a single nodule or mass and stage I. Favorable characteristics were: a) the prevalence of stage I and N0 cases (59% and 76.7% of cases, respectively) with a mean survival time of 66 and 77 months, respectively; and b) the radiographic presentation of a solitary pulmonary nodule or mass (76.4% of cases), that, independently of nodal involvement, showed a higher mean survival time (62 months). Independently significant adverse prognostic factors were: stage II-IV, lymph node involvement, and patient age over sixty years. The radiographic presence of multiple or satellite nodules was related to a significantly adverse prognosis (mean survival time: 18 months) by univariate analysis; this was not confirmed by multivariate analysis. CONCLUSIONS: In our experience BAC was the NSCLC subtype more frequently associated with a good outcome after resection; surgery should not to be denied also in patients with multiple nodules, when under sixty years of age and no lymph node involvement.     

Survey of incidence of urological cancer in South Korea: A 15-year summary

BACKGROUND: Although the pattern of cancer incidence in South Korea is not the same as that of western countries, urological cancer will become one of the major cancers in South Korea in the near future. The pattern of cancer in South Korea is becoming steadily similar to that in western countries. It is, therefore, important to understand the epidemiological features of cancer. Surveillance of cancer incidence and mortality trends provides clues to etiology and helps to assess the effects of improved diagnostic, screening and intervention measures. METHODS: The subjects of the study were 13,208 patients living in South Korea, newly diagnosed with urological cancer during the period of 1985-1999. The data were analyzed by age, sex, geography and period of diagnosis (1985-1989; 1990-1994; 1995-1999). RESULTS: Bladder cancer was the most common urological cancer in South Korea (6,867 cases, 52.0%). The incidence of prostate cancer and renal cell carcinoma was similar. Male patients outnumbered female patients by a ratio of 5.4 : 1. In both sexes, the peak incidence of urological cancer in South Korea was noted in the 70+ age group. The geographic distribution of urological cancer across seven residential areas was similar. The incidence rate of all urological cancer (except urethral and penile cancer) had increased remarkably, especially in the last several years. The crude incidence rate of urological cancer among Koreans in South Korea was estimated to be 46.55 per 100,000 males, 8.64 per 100,000 females and 27.67 per 100,000 across both sexes. CONCLUSION: Although this survey is not definitive, these data should be useful in showing general patterns or changes of incidence of urological cancer in South Korea. The elevated incidence of urological cancer noted in our survey also indicates the need for continued promotion of urological cancer screening programs. Moreover, these results may be useful in indicating directions for future research of urological cancer.     

Modulation of spinal deformities in patients with neurofibromatosis type 1

STUDY DESIGN: A consecutive case retrospective chart and radiographic review. OBJECTIVES: To determine the incidence of nine radiographic dystrophic features acquired during the process of modulation, and to analyze the statistical correlation of these acquired dystrophic features with clinical progression of a spinal deformity. SUMMARY OF BACKGROUND DATA: In patients with neurofibromatosis, spinal deformities with seemingly few initial dystrophic features have shown a tendency to acquire dystrophic changes during long-term follow-up periods. Similarly, deformities with dystrophic changes can acquire further dystrophic features. This phenomenon is termed "modulation," a feature unique to spinal deformities in neurofibromatosis. These dystrophic changes may evolve slowly or aggressively, and may spread to other regions as well. METHODS: A review was done of the clinical records, photographs, radiographs, and other imaging studies of 457 patients referred between 1982 and 1995 with the diagnosis of neurofibromatosis Type 1. One hundred twenty-eight patients were diagnosed with a spinal deformity. Ninety-one patients who had a complete set of clinical and radiographic data were included in the study. Location and type of curve as well as the extent of spinal deformity were studied for their effect on the tendency for modulation. Initial spinal radiographs were analyzed for nine radiographic dystrophic features: rib penciling, vertebral rotation, posterior vertebral scalloping, anterior vertebral scalloping, lateral vertebral scalloping, vertebral wedging, spindling of the transverse process, widened interpedicular distance, and enlarged intervertebral foramina. Subsequent radiographs were analyzed critically for evolution, progression, or spread of these features. Correlation of acquisition in these dystrophic features with clinical progression in the spinal deformity, as measured in increments of scoliosis and kyphosis, was analyzed. RESULTS: In 81% of patients with spinal deformity diagnosed before 7 years of age and in 25% of patients with such a diagnosis after 7 years of age, evidence of modulation was observed. Location, side, and extent of the deformity and patient gender did not influence the propensity of the deformity to modulate. Correlation of modulation with clinical progression of the deformity showed rib penciling to be the only singular factor statistically influencing risk of progression. Of the deformities that acquired three or more penciled ribs, 87% showed significant clinical progression. No other radiographic dystrophic feature individually influenced progression. However, when three or more of the dystrophic skeletal features were acquired, the risk of progression reached statistical significance in 85% of patients. CONCLUSIONS: Spinal deformities in patients with neurofibromatosis 1 should be regarded as deformities in evolution. One should resist assigning these evolving deformities to either the dystrophic or nondystrophic end of the spectrum without considering the possibility of modulation across the spectrum. A spinal deformity that develops before 7 years of age should be followed closely for evolving dystrophic features (i.e., modulation). When a curve acquires either three penciled ribs or a combination of three dystrophic features, clinical progression is almost a certainty.     

Fibromyxoma of bone: a case report and review of the literature

In this study, a case of fibromyxoma of the proximal femur in a 59-year old woman is reported. The classification of this rare bone tumour is still a matter of debate and some investigators have suggested that these lesions represent a degenerative form of fibrous dysplasia. Some authors make a further distinction between fibromyxoma and myxoma of bone. In a review of 23 cases of fibromyxoma and five cases of myxoma, no differences in clinical, radiographic and biologic behaviour between fibromyxoma and myxoma were found. Apart from the age at diagnosis, the most important difference between fibromyxoma and myxoma was the degree of myxoid matrix. Therefore, we suggest that extragnathic myxoma is a regressive variant of extragnathic fibromyxoma and should be termed as the same entity. In contrast to monostotic fibrous dysplasia fibromyxoma / myxoma often causes pain and presents as a Lodwick IC lesion with a soft tissue mass. Therefore, fibromyxoma / myxoma should be distinguished from fibrous dysplasia because of its different clinical and radiographic features.