SUV Analysis of PET Scan for Prognostic Factor of Head and Neck Cancer / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Previous studies have shown that uptake of 18Fluoro-2-deoxy-glucose in head and neck cancer, as determined by the standardized uptake value (SUV) on positron emission tomography scan (PET scan), is associated with the biology of tumor. The aims of this study were to confirm the association with the biology of tumor and to establish whether a high SUV had prognostic significance. MATERIALS AND METHOD: Thirty patients with the head and neck cancer diagnosed as squamous cell carcinoma underwent a PET scan before treatment. SUVs were analyzed for possibility correlated with diseasefree survival. RESULTS: In univariate survival analysis, when patients were divided into two groups based on the SUV cut-off value of 8, the group whose SUV was greater than 8 in the pre-treatment PET scan showed significantly worse outcome (p=0.029). Correlation analysis demonstrated that SUV provided prognostic information independent of the tumor size, pathologic differentiation and stage. CONCLUSION: We conclude that high FDG uptake on PET (SUV >8 in pre-treatment PET scan) is an important prognostic indicator for poor outcome. Identified patients are thought to require intensive treatment protocol and more careful follow up.

A Clinical Analysis of Recurrence in Differentiated Thyroid Carcinoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Differentiated thyroid carcinoma (DTC) is a known malignant tumor arising from the follicular epithelium in thyroid gland. Although the prognosis for patients with DTC is generally good, appropriate surgical management can further reduce recurrence and cancer death rates significantly. The therapeutic methods performed are total thyroidectomy plus radioactive iodine (131I) therapy and life-long thyroid-stimulating hormone (TSH) suppression. Histopathologically, DTC contains papillary and follicular adenocarcinoma. In numerous studies, staging systems-AMES, AGES, MACIS, etc-have been created to evaluate prognostic outcome. By applying staging systems, we have treated 394 patients with DTC since 1998. The purpose of our study was to analyze characteristics of recurrent cases and evaluate remission rates of recurrent cases according to diagnostic methods. MATERIALS AND METHOD: From January 1998 to December 2001, we performed 630 thyroidectomies and 487 malignant tumors (421 papillary, 28 follicular, 20 medullary, 12 undifferentiated carcinoma and 6 other malignant tumors). We analyzed 394 DTC cases; excluding other malignancy, 65 cases were recurrent cancer (58 papillary and 7 follicular carcinoma). The medical records of 394 patients with DTC treated at our hospital were reviewed retrospectively. We analyzed impact of primary surgery on recurrence in 65 recurrent patients and compared the remission rates of those patients using physical examination with those using laboratory tests and imaging studies. RESULTS: 347 patients with DTC were treated initially in our hospital and 18 patients showed recurrence. Among them, lobectomy was performed as a primary surgery in 69 patients of whom one (1.4%) had recurrence. Forty-seven patients with DTC treated initially in other hospitals were referred to our hospital. Lobectomy was performed as a primary surgery in 23 patients (54.7%). Recurrence of 32 patients was detected by palpation. Of these patients, the remission rate was 25.0%, whereas patients diagnosed by laboratory tests and imaging systems showed 53.3% remission rate (p=0.056). CONCLUSION: The extent of primary thyroid resection appeared to have significant impact on the recurrence of DTC. In view of this, we should apply staging system strictly in treating DTC-total thyroidectomy and central neck dissection in high-risk groups. In following up patients, we should check the thyroglobulin level and use image tests like computed tomography and positron emission tomography to detect recurrence earlier.

Plain Roentgenographic Findings on Lumbar Disc Herniation

X-ray films of the lumbosacral spine are necessary in the evaluation of all patients who are considered to have lumbar disc disease. Several positive X-ray film findings are of possible significance, and although not in themselves diagnostic, they are compatible with, lumbar disc disease. Among patients treated and diagnosed by surgical operation for lumbar disc nerniation from August, 1978 to February, 1981 at Korea University Hospital, 132 cases with their simple X-rays available for study were selected. Height of intervertebral disc space(Hurxthal method), spurrings, changes in facet joint, size of spinal canal(Johnes & Thomson method), lumbosacral angle(Ferguson method), congenital defect were studied and measured in simple films. Lumbar disc herniation was most frequent at L4-L5 intervertebral space(65.5%). The incidence of positive radiological findings were 85.6%. 1. Intervertebral disc space narrowing was found in 25%, 59.3% and 50% at L3-4, L4-5 and L5-S1 level respectively. 2. Peripheral osteophyte formations in the bodies of lumbar vertebrae were found in 44.7%. 3. Narrowing and/or sclerotic changes of facet joint were observed in 31.06%, subluxation in 14.39% and facet tropism in 5.3%. 4. The overall mean size of spinal canal at L4 vertebral level was 1:4.325 in male, 1:3.898 in female and at L5, 1:3.772 in female. Narrowed spinal canal in this series were found in 25.6%, at L4 and 17.2% at L5. 5. The overall mean lumbosacral angle was 32.4 degree in male and 31.5 degree in female. Spondylolysis was observed in 4.54%, spondylolisthesis in 3.03%, lumbarization in 8.3% and sacralization in 1.51%.

A Case of Large Choroid Plexus Papilloma of 4th Ventricle

Papilloma of the choroids plexus is a rare tumor with an incidence of 0.4% to 3.9% among all intracranial tumors. This tumor, which is typically located in the lateral ventricles of young children, while most of the tumors in adults were located in the 4 th ventricle, is amenable to surgical removal. We report a case of choroid plexus papilloma of the 4 th ventricle in 17 years old boy with complaints of occipital headache, progressing ataxia and decreased visual acuity. The tumor occupying 4 th ventricle and cisterna magna was a hen's egg sized pinkish globular mass with irregular papillary surface. Microscopically there are monotonous pattern of branching fibrous stroma, containing many blood vessels, radiating from a single area and covered with simple columnar epithelial cells.