Computed tomographic findings and prognosis in thymic epithelial tumor patients.

OBJECTIVE: To determine which computed tomographic findings are associated with high-risk thymic epithelial tumors and a poor prognosis. METHODS: Computed tomographic findings of thymic epithelial neoplasms were retrospectively evaluated in 75 patients diagnosed with thymic tumor between January 1997 and October 2003. We analyzed the correlation of the computed tomographic findings, histological subtype according to the World Health Organization classification, and the prognosis. RESULTS: There were 34 with type A approximately B1 tumor and 41 with type B2 approximately C tumor. On multiple regression analysis, vascular obliteration and a blunt sternum-anterior mediastinum angle were more frequent with thymic carcinoma than with thymoma. On multivariate analysis, pleural effusion and mediastinal fat infiltration on initial computed tomography had a significant impact on survival. CONCLUSIONS: Vascular obliteration and a blunt sternum-anterior mediastinum angle were predictive of thymic carcinoma. Pleural effusion and mediastinal fat infiltration were predictive of a poor prognosis.

Brain microbleeds and global cognitive function in adults without neurological disorder.

BACKGROUND AND PURPOSE: Increasing attention has been paid to associations between cognitive dysfunction and brain microbleeds (MBs). Because all previous studies have investigated patients with neurological disorders, we examined subjects without neurological disorder in order to clarify pathogenic relationships. METHODS: A total of 518 consecutive adults without neurological disorder who had undergone health-screening tests of the brain were studied prospectively. Gradient-echo T2*-weighted MRI using a 1.5-T system was used to detect MBs. The Mini-Mental State Examination (MMSE) was administered to determine cognitive functions. MMSE scores <27 or >1.5 SDs below the age-related mean were regarded as subnormal. RESULTS: MBs were found in 35 subjects (6.8%). MMSE score <27 was found in 25 subjects (4.8%), with MMSE score >1.5 SDs below the age-related mean in 34 subjects (6.6%). Univariate analysis showed presence and number of MBs, short duration of education, and severe white matter hyperintensities as significantly associated with subnormal scores. In logistic regression analysis, presence of MBs (odds ratio [OR], 5.44; 95% CI, 1.83 to 16.19) and number of MBs (OR, 1.32; 95% CI, 1.04 to 1.68) still displayed significant associations with MMSE score <27. Logistic regression analysis revealed a significant relationship between presence (OR, 3.93; 95% CI, 1.44 to 10.74) and number (OR, 1.26; 95% CI, 1.01 to 1.59) of MBs and MMSE score >1.5 SDs below the age-related mean. Among MMSE subscores, "attention and calculation" was significantly lower in MB-positive subjects (P=0.017). CONCLUSIONS: MBs appear to be primarily associated with global cognitive dysfunction.

Cancer of unknown primary site: review of consecutive cases at the National Cancer Center Hospital of Japan.

BACKGROUND: Cancer of unknown primary (CUP) is not a rare clinical entity, accounting for 3%-5% of all solid malignancies. METHODS: We retrospectively reviewed 86 (38 male/48 female) patients with a diagnosis of CUP (exclusive of female patients with adenocarcinoma involving the axillary lymph nodes alone and patients with squamous cell carcinoma of the cervical lymph nodes) who were referred to the National Cancer Center Hospital between April 1996 and October 2002. RESULTS: The median interval between the first visit to a local community hospital and referral to our hospital was 1 month (range, 1 to 45 months). The histological diagnosis was adenocarcinoma in 61 patients (71%), poorly differentiated carcinoma in 18 patients (21%), and squamous cell carcinoma in 4 patients (5%). Twenty-three female patients had peritoneal carcinomatosis of adenocarcinoma. Seventy-eight patients (91%) received platinum-containing chemotherapy. Sixty-one of the 86 patients (71%) were categorized as a subgroup of CUP without a specific therapy, and 55 of these 61 patients (90%) received platinum-containing regimens. The median survivals of all 86 patients and the 61 patients in the subgroup without a specific therapy in this series were 13 months and 11 months, respectively. CONCLUSION: In this series, the survival of the patients in the CUP subgroup without a specific therapy did not seem worse than that in previous reports. Empirical chemotherapy with platinum-containing regimens may benefit some CUP patients in a subgroup without a specific chemotherapy.

[A case of pulmonary Langerhans' cell histiocytosis with liver involvement].

We report a case of pulmonary Langerhans' cell histiocytosis with liver involvement in an adult. An asymptomatic 51-year-old man who had, until his referral to our hospital, been a smoker was suspected on examination to have multiple metastases to the lungs and liver. Chest CT showed multiple micronodules, located predominantly in the upper and middle lung fields. Many of these nodules were cavitary. Abdominal US showed multiple, well-defined, round and oval nodules of decreased echogenicity within the liver. Hepatic nodules were enhanced rapidly by contrast-enhanced CT. Comparatively large nodules were demonstrated as well-circumscribed hypoattenuating lesions with ring enhancement. Since further work-up did not demonstrate any evidence of malignancy, open lung biopsy was performed. The results of open lung biopsy were consistent with Langerhans' cell histiocytosis. The infiltrates consisted of variable numbers of Langerhans' cells with folded nuclei and eosinophils. Immunohistochemically, the histiocytes were positive for S-100 protein and CD1a, and negative for CD68. The nodules regressed within 5 months after smoking cessation, and the patient became free of disease 10 months after the initial presentation.