Association between Body Weight Perception and Metabolic Syndrome in Korean Adults: The Korea National Health and Nutrition Examination Survey 2015–2016

Background@#Obesity has become a concern globally. The incidence of metabolic syndrome has increased rapidly in Korea over the past decades.Previous studies have reported obesity as a major cause of metabolic syndrome. Body mass index (BMI) and body weight perception have beenwidely used as indirect predictors of the risk of metabolic syndrome. Therefore, we aimed to evaluate subjective body weight perception and therisk of metabolic syndrome in adults over 20 years of age and confirm the gap between body weight perception and the objective measure of BMI. @*Methods@#This study was conducted aming 9,842 Korean adults over 20 years of age using data from the VI-3 (2015) and VII-1 (2016) Korea NationalHealth and Nutrition Survey. The BMI criteria were set according to the WHO Asia Pacific Standard criteria. Perceived body weight status wasmeasured according to the question, “How would you describe your body shape?”. The patients were grouped as “obese,” “slightly obese,” “rightweight,” and “under weight” according to the original responses (“very obese,” “slightly obese,” “normal,” “slightly thin,” and “very thin”). Data analysiswas performed using chi-square test, analysis of variance, and logistic regression. @*Results@#Among the participants, the risk of metabolic syndrome was progressively higher with the body weight perception as obese. Additionally, therisk of metabolic syndrome was higher in those with a higher BMI than in those with subjective body weight perception. @*Conclusion@#In this Korean population, increased risk of metabolic syndrome showed higher associated with higher BMI than with body weightperception.

Urinary transglutaminase 2 as a potent biomarker to predict interstitial fibrosis and tubular atrophy of kidney allograft during early posttransplant period in deceased donor kidney transplantation

PURPOSE: Transglutaminase type 2 (TG2) is an extracellular matrix crosslinking enzyme with a pivotal role in kidney fibrosis. We tested whether quantification of urinary TG2 may represent a noninvasive method to estimate the severity of kidney allograft fibrosis. METHODS: We prospectively collected urine specimens from 18 deceased donor kidney transplant recipients at 1-day, 7-day, 1-month, 3-month, and 6-month posttransplant. In addition, kidney allograft tissue specimens at 0-day and 6-month posttransplant were sampled to analyze the correlation of urinary TG2 and kidney allograft fibrosis. RESULTS: Thirteen recipients had increased interstitial fibrosis and tubular atrophy (IFTA) scores at the 6-month protocol biopsy (IFTA group). The mean level of urinary TG2 in the IFTA group was higher compared to that of 5 other recipients without IFTA (no IFTA group). Conversely, the mean level of urinary syndecan-4 in the IFTA group was lower than levels in patients without IFTA. In the IFTA group, double immunofluorescent staining revealed that TG2 intensity was significantly upregulated and colocalizations of TG2/heparin sulfate proteoglycan and nuclear syndecan-4 were prominent, usually around tubular structures. CONCLUSION: Urinary TG2 in early posttransplant periods is a potent biomarker for kidney allograft inflammation or fibrosis.

Successful Localization Using ⁶⁸Ga-DOTATOC PET/CT of a Phosphaturic Mesenchymal Tumor Causing Osteomalacia in a Patient with Concurrent Follicular Lymphoma / 대한핵의학회잡지

Diagnosing tumor-induced osteomalacia is often challenging because conventional imaging modalities may fail to locate the responsible tumor. This report describes the ability of ⁶⁸Ga-DOTATOC PET/CT to successfully distinguish between the responsible phosphaturic mesenchymal tumor and concurrent lymphoma lesions. A 52-year-old man with bone pain for several years was diagnosed with a vitamin D-resistant hypophosphatemic osteomalacia. Whole body ¹⁸F-FDG PET/CT revealed multiple enlarged hypermetabolic lymph nodes in his bilateral cervical, axillary, mediastinal, abdominal, pelvic, and inguinal regions. Core needle biopsy of the right cervical lymph node confirmed the diagnosis of follicular lymphoma. However, lymphoma was not considered the cause of osteomalacia. ⁶⁸Ga-DOTATOC PET/CT before chemotherapy showed a small nodule with intensely increased uptake in the right inguinal region, which was distinguished from the other enlarged lymph nodes. The nodule was surgically removed and histopathologically consistent with phosphaturic mesenchymal tumor. After surgery, the patient's serum phosphorus and alkaline phosphatase levels normalized without nutritional supplement.

Successful Localization Using ⁶⁸Ga-DOTATOC PET/CT of a Phosphaturic Mesenchymal Tumor Causing Osteomalacia in a Patient with Concurrent Follicular Lymphoma / 대한핵의학회잡지

Diagnosing tumor-induced osteomalacia is often challenging because conventional imaging modalities may fail to locate the responsible tumor. This report describes the ability of ⁶⁸Ga-DOTATOC PET/CT to successfully distinguish between the responsible phosphaturic mesenchymal tumor and concurrent lymphoma lesions. A 52-year-old man with bone pain for several years was diagnosed with a vitamin D-resistant hypophosphatemic osteomalacia. Whole body ¹⁸F-FDG PET/CT revealed multiple enlarged hypermetabolic lymph nodes in his bilateral cervical, axillary, mediastinal, abdominal, pelvic, and inguinal regions. Core needle biopsy of the right cervical lymph node confirmed the diagnosis of follicular lymphoma. However, lymphoma was not considered the cause of osteomalacia. ⁶⁸Ga-DOTATOC PET/CT before chemotherapy showed a small nodule with intensely increased uptake in the right inguinal region, which was distinguished from the other enlarged lymph nodes. The nodule was surgically removed and histopathologically consistent with phosphaturic mesenchymal tumor. After surgery, the patient's serum phosphorus and alkaline phosphatase levels normalized without nutritional supplement.

Predictors of Avascular Necrosis after Kidney Transplantation / 대한이식학회지

BACKGROUND: Risk factors for bone avascular necrosis (AVN), a common late complication after kidney transplantation (KT), are not well known. METHODS: Patients that underwent living-donor KT at Asan Medical Center between January 2009 and July 2016 were included in this retrospective study to determine the incidence and risk factors for AVN after KT. RESULTS: Among 1,570 patients that underwent living-donor KT, 33 (2.1%) developed AVN during a mean follow-up of 49.8±25.0months. Additionally, AVN was diagnosed at a mean of 13.9±6.6 months after KT. The mean cumulative corticosteroid dose during the last follow-up in patients without AVN (9,108±3,400 mg) was higher than that that in patients with AVN (4,483±1,114 mg) until AVN development (P < 0.01). More patients among those with AVN (n=4, 12.1%) underwent steroid pulse treatment because of biopsy-proven rejections during the first 6 months after KT than patients without AVN (n=68, 4.4%; P=0.04). Female (hazard ratio [HR], 2.29; P=0.04) and steroid pulse treatment during the first 6 months (HR, 2.31; P=0.02) were significant AVN risk factors as revealed by the Cox proportional multivariate analysis. However, no significant differences in rejection-free graft survival rates were observed between the two groups (P=0.67). CONCLUSIONS: Steroid pulse treatment within 6 months of KT and being female were independent risk factors for AVN development.

Impact of a preoperative evaluation on the outcomes of an arteriovenous fistula

PURPOSE: The aim of this study was to determine the possible predictors of primary arteriovenous fistula (AVF) failure and examine the impact of a preoperative evaluation on AVF outcomes. METHODS: A total of 539 patients who underwent assessment for a suitable site for AVF creation by physical examination alone or additional duplex ultrasound were included in this study. Demographics, patient characteristics, and AVF outcomes were analyzed retrospectively. RESULTS: AVF creation was proposed in 469 patients (87.0%) according to physical examination alone (351 patients) or additional duplex ultrasound (118 patients); a prosthetic arteriovenous graft was initially placed in the remaining 70 patients (13.0%). Although the primary failure rate was significantly higher in patients assessed by duplex ultrasound (P = 0.001), ultrasound information changed the clinical plan, increasing AVF use for dialysis, in 92 of the 188 patients (48.9%) with an insufficient physical examination. Female sex and diabetes mellitus were risk factors significantly associated with primary AVF failure. Because of different inclusion criteria and a lack of adjustment for baseline differences, Kaplan-Meier survival analysis showed better AVF outcomes in patients assessed by physical examination alone; an insufficient physical examination was the only risk factor significantly associated with AVF outcomes. CONCLUSION: Routine use of duplex ultrasound is not necessary in chronic kidney disease patients with a satisfactory physical examination. Given that female gender and diabetes mellitus are significantly associated with primary AVF failure, duplex ultrasound could be of particular benefit in these subtypes of patients without a sufficient physical examination.

A new risk-scoring model for predicting 30-day mortality after repair of abdominal aortic aneurysms in the era of endovascular procedures

PURPOSE: To propose a new, multivariable risk-scoring model for predicting 30-day mortality in individuals underwent repair of abdominal aortic aneurysms (AAA). METHODS: Four hundred eighty-five consecutive patients who underwent AAA repair from January 2000 to December 2010 were included in the study. Univariate and multivariate analyses were performed to evaluate the risk factors, and a risk-scoring model was developed. RESULTS: Multivariate analysis identified three independent preoperative risk factors associated with mortality, and a risk-scoring model was created by assigning an equal value to each factor. The independent predictors were location of the AAA, rupture of AAA, and preoperative pulmonary dysfunction. The multivariable regression model demonstrated moderate discrimination (c statistic, 0.811) and calibration (Hosmer-Lemeshow test, P = 0.793). The observed mortality rate did not differ significantly from that predicted by our risk-scoring model. CONCLUSION: Our risk-scoring model has excellent ability to predict 30-day mortality after AAA repair, and awaits validation in further studies.

Clinical outcome of early relaparotomy after elective open repair of abdominal aortic aneurysms

PURPOSE: The aim of this study was to retrospectively evaluate the association of need for early relaparotomy with clinical outcomes after elective open repair of abdominal aortic aneurysms (AAAs). METHODS: A total of 292 consecutive patients who underwent elective open AAA repair at Asan Medical Center from January 2001 to December 2010 were included in this study, and we compared the demographics, clinical characteristics, related risk factors, and clinical outcomes of early relaparotomy versus nonrelaparotomy patients. RESULTS: The incidence of early relaparotomy during a single hospital stay was 4.1% (n = 12), and the most common causes were bowel ischemia (n = 5, 41.7%) and postoperative bleeding (n = 3, 25.0%). Among the demographics and clinical characteristics significantly associated with relaparotomy were: age (P = 0.025), chronic obstructive pulmonary disease (COPD) (P = 0.010), number of RBC units transfused during the AAA repair (P = 0.022) and in the following week (P = 0.005), and length of intensive care (P < 0.001) and overall hospital stay (P < 0.001). On multivariate analysis, presence of COPD (P = 0.009) and number of RBC units transfused during the AAA repair (P = 0.006) were statistically significantly associated with relaparotomy. Furthermore, early relaparotomy was associated with perioperative (within 30 days) (P = 0.048) and overall in-hospital mortality (P = 0.001). CONCLUSION: Early relaparotomy has an adverse effect on clinical outcomes: increased mortality and hospital length of stay. Presence of COPD and need for RBC transfusion are associated with early relaparotomy.

Renal autotransplantation in open surgical repair of suprarenal abdominal aortic aneurysm

Although the standard treatment of abdominal aortic aneurysm has shifted from open surgery to endovascular repair, open surgery has remained the standard of care for complex aneurysms involving the visceral arteries and in patients unsuitable for endovascular aneurysm repair. Postoperative renal insufficiency may occur after open surgical repair of suprarenal abdominal aortic aneurysm. Methods of minimizing renal ischemic injury include aortic cross-clamping and renal reconstruction techniques. This report describes the use of renal autotransplantation for renal reconstruction during open surgical repair of a suprarenal abdominal aortic aneurysm. This technique was successful, suggesting its feasibility for open suprarenal abdominal aortic aneurysm repair, minimizing renal ischemic injury and optimizing postoperative renal function.

Does Pregnancy after Renal Transplantation Affect Their Allograft and Pregnancy Outcomes? / 대한이식학회지

BACKGROUND: The number of pregnancies in renal transplant recipients has increased. Many studies have shown that pregnancy increases the risk of graft, fetal, and maternal complications but does not affect the long-term outcome of the graft. We assessed the incidence and effect of pregnancy after renal transplantation and examined graft, fetal, and maternal outcomes. METHODS: Our study included 145 female recipients of child-bearing age (15~45 years) in our center from January 1990 to December 2011. The subjects were divided into two groups: pregnancy (n=17) and control (n=128). The 26 pregnancies in the 17 recipients were categorized as live births (n=10) or no-live births (n=16). These were analyzed for evaluation of pregnancy outcomes, graft function, and long-term graft survival. RESULTS: The pregnancy and control group had similar graft function and graft survival rates 5- and 10-year after renal transplantation. Outcomes of pregnancy were 10 live births, 8 therapeutic abortions, 7 spontaneous abortions, and 1 stillbirth. The mean serum creatinine levels of the pregnant recipients diminished during the first trimester (1.14+/-0.37 mg/dL) and increased slightly during the third trimester (1.18+/-0.37 mg/dL) to levels nearer the baseline (1.23+/-0.37 mg/dL). These ranges were stable. The mean time from transplantation to pregnancy was 20.73+/-3.57 months. Live birth rates were associated with the time from transplantation to pregnancy (71.78+/-37.75 months for live births and 19.38+/-12.71 months for no-live births, P=0.000). There were no significant differences in graft function, graft failure rates, and survival. CONCLUSIONS: Pregnancy does not appear to have an adverse effect on graft function and the long-term outcomes of renal transplantation. Recipients with stable renal function who want to become pregnant can have successful pregnancies.

Kidney Transplantation from the Deceased Donor Who Need Continuous Renal Replace Therapy / 대한이식학회지

BACKGROUND: Brain death donors may require continuous renal replacement therapy (CRRT) in severe acute renal failure (ARF) during management. To maximize donor organ usage we performed renal transplantation from deceased donors requiring CTTR with informed consent. This single-center study reviewed the clinical outcomes of kidney transplant recipients from extreme marginal donors requiring CRRT. METHODS: Medical records of all patients using a graft from extreme marginal donors who underwent CRRT in Asan Medical Center between June 2007 and September 2014 were reviewed retrospectively. RESULTS: Between June 2007 and September 2014, 27 kidneys were transplanted from 19 CRRT donors. Mean donor age was 35.1 years (range; 16~56), male donors were 14 (74%). The causes of brain death included head trauma in 6, hypoxia in 5, stroke in 4, and others in 4. The main causes of CRRT were anuria in 14, electrolyte imbalance or acidosis in 5, and mean duration of donor CRRT was 3.6 days (range; 1~11). Delayed graft function (DGF) developed in 24 (88.9%), but all recovered renal function; they can be free from dialysis 11 days after transplantation. Mean serum creatinine level at 1 month, 1 year, and 5 years was 1.85, 1.26, and 1.31 mg/dL, respectively. CONCLUSIONS: Five-year follow-up data showed that renal transplantation from severe ARF donor has an excellent outcome. Although CRRT donor kidney transplants have a higher rate of DGF, the presence of DGF, unlike other donation after brain death donor kidney transplants, does not portend a worse prognosis.

Spontaneous Superior Mesenteric Artery Branch Pseudoaneurysm / 대한혈관외과학회지

Spontaneous pseudoaneurysm of the superior mesenteric artery (SMA) is rare. However, it may have severe life-threatening complications such as ruptures or thrombosis. Our patient has developed a pseudoaneurysm, which was being misdiagnosed as superior mesenteric vein dissection by the computed tomography angiography. The pseudoaneurysm is revealed from branches of the SMA with no specific causes and is being treated by endovascular embolization after emergency exploratory laparotomy.

The Effect of an Internet-Based Anger Management Program for School-Aged Children to Prevent School Violence

OBJECTIVES: This study aims to investigate the effectiveness of an internet-based anger management program for school-aged children. METHODS: Forty-eight elementary school students took part in an anger management training program; subsequently, participants, their parents, and their teachers answered questionnaires assessing the participants' anger, aggressiveness, and other emotional/behavioral problems, pre- and post-training. RESULTS: At the post-training self-assessment, the participants showed significant reductions in their "anger-out" tendencies and physical aggressiveness. In addition, the effects of the program on "anger-out" tendencies, aggressiveness, anger and peer relational problem were found to be more significant in participants who reported depressive symptoms. Teachers rated the participants' peer-relational problems as having decreased after the training. CONCLUSION: The proposed internet-based anger management program had a significant effect on the school-aged children's abilities to control their anger.

Splenic Hemorrhage with Hemoperitoneum Caused by a Snakebite / 대한구급학회지

In Asia, snakebites are estimated to affect 4 million people every year, and of these, 100,000 people are estimated to die. In Korea, snakebites occur frequently from the spring to the fall, but their importance is often overlooked. Fatal complications, including acute respiratory distress and acute kidney injury, can occur, and in some cases, severe hemorrhage results from coagulopathy. There have been only a few cases of snakebite-induced liver or intestinal bleeding, but to our knowledge, spontaneous bleeding from the spleen has not been previously reported. Here, we report the case of a 61-year-old male who visited the emergency room with abrupt abdominal pain due to hemoperitoneum associated with splenic hemorrhage after a snakebite.

Clinicopathologic Characteristics of Gastric Cancer Patients according to the Timing of the Recurrence after Curative Surgery

PURPOSE: There are few studies that have focused on the predictors of recurrence after gastrectomy for gastric carcinoma. This study analyzed the patients who died of recurrent gastric carcinoma and we attempted to clarify the clinicopathologic factors that are associated with the timing of recurrence. MATERIALS AND METHODS: From June 1992 to March 2009, 1,795 patients underwent curative gastric resection at the Department of Surgery, Hanyang University College of Medicine. Among them, 428 patients died and 311 of these patients who died of recurrent gastric carcinoma were enrolled in this study. The clinicopathologic findings were compared between the 72 patients who died within one year after curative gastrectomy (the early recurrence group) and the 92 patients who died 3 years after curative gastrectomy (the late recurrence group). RESULTS: Compared with the late recurrence group, the early recurrence group showed an older age, a more advanced stage, a poorly differentiated type of cancer and a significantly higher tendency to have lymphatic invasion, vascular invasion and perineural invasion.Especially in the gastric cancer patients with a more advanced stage (stage III and IV), the early recurrence group was characterized by a significantly higher preoperative serum carcino embryonic antigen level, perineural invasion and a relatively small number of dissected lymph nodes. CONCLUSIONS: The clinicopathologic characteristics of recurrent gastric cancer are significantly different according to the stage of disease, and even in the same stage. For the early detection of recurrence after curative surgery, it is important to recognize the clinicopathological factors that foretell a high risk of recurrence. It is mandatory to make an individualized surveillance schedule according to the clinicopathologic factors.

Clinicopathologic Characteristics in Node-negative Gastric Cancer Patients According to the Presence of Lymphatic Invasion

PURPOSE: We evaluated the clinicopathological charicterics and prognostic impacts of lymphatic vessel invasion in gastric cancer without lymph node involvement. MATERIALS AND METHODS: Among 1,795 patients who underwent gastric surgery with gastric cancer at the department of surgery, Hanyang university college of medicine from June 1992 to March 2009, we retrospectively evaluated 890 patients with lymph node negative gastric cancer. RESULTS: The lymphatic vessel invasion correlated significantly with tumor stage, age, tumor size, perineural invasion and operation method. The survival rates were only significantly different between the patients with and without lymphatic vessel invasion in patients with stage Ia (P=0.036). Univariate and multivariate analysis demonstrated that blood vessel invasion and preoperative serum CEA level were significant factor influencing the survival rate in lymph node negative gastric cancer patients with lymphatic invasion. CONCLUSIONS: In patients with lymph node negative gastric cancer, the survival rate is significantly lower in those with lymphatic vessel invasion than in those without. Especially, in patients with stage Ia gastric cancer, the survival rates is significantly different between those with and those without lymphatic vessel invasion. Blood vessel invasion and preoperative serum CEA level is an adverse prognostic indicator in patients with stage Ia gastric cancer with lymphatic invasion. Thus we should consider further adjuvant therapies in case of need and need to show more concern to identify gastric cancer patients early at risk for recurrence.

Significance of the Expression of Tumor Markers in Adenoid Cystic Carcinoma and Pleomorphic Adenoma of the Salivary Gland / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Salivary gland tumors are characterized by extreme histological diversity. Even within a single tumor, various histological patterns are observed. The same histological patterns are shared among various tumor types, regardless of the biological behavior, making diagnosis difficult. Although a great number of immunohistochemical studies of major salivary gland tumors have been published, their clinical and diagnostic implications are not fully apparent. We have performed basic immunohistochemical stains of pleomorphic adenoma (PA) and adenoid cystic carcinoma (ACC) to determine the diagnostic value of c-kit, Ki-67, glial fibrillary acidic protein (GFAP) and p53. MATERIALS AND METHOD: Paraffin-embedded tissue specimens from 48 cases, who were diagnosed as PA (n=31) and ACC (n=17) from 1993 to 2002, were immunohistochemically stained for c-kit, Ki-67, GFAP and p53. RESULTS: In the immunohistochemical stains of c-kit, Ki-67 and p53, there were no difference between PA and ACC. However, in the immunohistochemical stain of GFAP, there were difference in PA and ACC. GFAP was expressed in 74% of the PA and was not expressed in all cases of ACC. CONCLUSION: These data suggest that GFAP immunoreactivity could be helped in the occasional differential diagnostic dilemma of pleomorphic adenoma versus adenoid cystic carcinoma in salivary gland.

An Immunohistochemical Study of p53, Cyclin D1 and Cathepsin D Expression in Sinonasal Tumors / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Various host and tumor parameters, particularly the tumor size and lymph node metastasis have been studied in an attempt to evaluate and decide the optimal treatment of the patients with head and neck carcinomas. Moreover, it has been recognized that prognostic parameters can be useful for the evaluation of biological behaviors of malignancy. The p53 is a tumor suppressor gene and cyclin D1 is a cell cycle regulator, essential for G1 phase progression. Cathepsin D is a lysosomal aspartyl endopeptidase which degrades the extracellular matrix and proteoglycan. But there are still controversy in their clinical meanings in sinonasal malignant tumors. The purpose of this study is to assess the roles of p53, cyclin D1 and cathepsin D in sinonasal tumorigenesis. MATERIALS AND METHOD: 27 inverted papilloma (IPs), 5 IPs associated with malignant transformation, and 16 squamous cell carcinoma tissue specimens were investigated by immunohistochemical staining for p53, cyclin D1, and cathepsin D. Clinicopathologic values were compared with the incidence of p53, cyclin D1, cathepsin D expression in sinonasal malignant tumors. RESULTS: p53/cyclin D1 expressions were increased as tumor progressed and these expressions were statistically significant (p< .05). No significant correlations were found among p53, cyclin D1, cathepsin D and other clinicopathologic factors. CONCLUSION: These data suggest that expressions of p53, cyclin D1 and cathepsin D may play an important role in the tumorigenesis and progression of sinonasal malignant tumor sequence. Also, it is suggested that p53/cyclin D1 expressions may be useful variables for the prognostic assessment of sinonasal malignant tumors. However, it is not enough conclude so based on this result alone. Further studies, such as using molecular biological techniques, will be required to determine that p53/cyclin D1 expressions are related to the development or prognosis of sinonasal malignant tumors.

A Study of Apoptosis in Sinonasal Malignant Tumors : Bcl -2 and Fas-L Expression / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Apoptosis may play a key role in determining the growth, aggressiveness, and therapy responsiveness of tumors. Dysregulation of apoptosis can cause the tumorigenesis of sinonasal malignant tumors. The purpose of this study was to assess apoptosis and the expression of its related proteins, bcl-2 and Fas-L, in the sinonasal malgnant tumors. MATERIALS AND METHODS: The study samples were obtained after surgical removal of 22 cases of inverted papilloma (IPs), 4 cases of IPs associated with squamous cell carcinoma (SCC), 14 cases of SCC in sinonasal cavity and 5 cases of normal inferior turbinate mucosa as a control. Apoptosis was evaluated by analysing DNA fragmentation using the TUNEL method. Bcl-2 and Fas-L expressions were assessed by immunohistochemical staining. RESULTS: Apoptotic index (Al) was decreased progressively from IPs, through IP with SCC to reach the lowest level in SCC (p<0.05). Bcl-2/Fas-L expressions were increased as tumor progressed but Fas-L expression was statistically significant only (p<0.05). An inverse relationship between the Fas-L expression and apoptosis was observed as tumor progressed (p<0.05). No significant correlation was found between AI, expressions of bcl-2/Fas-L and other clinicopathologic factors. CONCLUSIONS: These data suggest that bcl-2/Fas-L expressions are related to apoptosis and tumorigenesis of sinonasal malignant tumors. The inverse tendency between Fas-L expression and apoptosis might be an important role in evading surveillance of the immune system of sinonasal malignant tumors.