H.-W. Jung

Prevalence and risk factors of chronic sinusitis in Korea: results of a nationwide survey

From July through October 1991, a nationwide survey was conducted on the prevalence and risk factors of chronic sinusitis in Korea, using medical and family histories as well as physical examination. In all, 9,069 subjects were examined from 2,899 households residing in 60 different areas throughout the country. The overall prevalence of sinusitis was 1.01%. Case-control analysis was performed to determine possible risk factors for sinusitis. No significant differences were found in age groups or sexes. A significant geographic difference was seen in prevalence in the different provinces studied. Economic activity, crowding and allergy were significant risk factors. Other factors such as urban or rural residence, birth place, maternal and paternal age at birth, marriage, smoking history, education, social class, prior trauma, height and weight, and nasal septal deformities did not correlate with the occurrence of sinusitis.

Primary central nervous system lymphoma: Variety of clinical manifestations and survival

SummaryA retrospective analysis of 23 non-immune compromised patients with primary central nervous system lymphoma (PCNSL) is reported. The patients consist of 14 males and 9 females and the median age is 50 years. Most patients presented with focal neurological deficits or symptoms of increased intracranial pressure (ICP) due to mass effects around the periventricular area. However, there were four cases of diffuse type, one case of intramedullary tumour, and four cases with rapid disease progression. All the patients underwent histological confirmation by craniotomy (16 cases) or stereotactic biopsy (7 cases). The radiation therapy started after histological diagnosis in all and 6 cases received additional chemotherapy.The median survival after diagnosis of overall patients was 23 months. Six patients are in disease free status at a mean of 35 months follow-up. The uni- and multi-variative risk analysis revealed five favourable factors on survival: (1) age less than 60 years (0.05 < p < 0.1); (2) pre-operative Karnof-sky performance scale (KPS) ≥ 70 (p < 0.05); (3) symptom duration over four weeks (p < 0.05); (4) radiation dosage ≥ 5500 cGy (p < 0.05); (5) absence of malignant cells in cerebrospinal fluid (CSF) (p < 0.05). The most frequent site of recurrence was the local area as shown in seven cases out of 11 recurrent cases. But six patients had diffuse recurrence (4 cases), systemic recurrence (2 cases), and drop metastasis (1 case). Although the recurred PCNSL had rapid progression and a grave prognosis, aggressive treatment prolonged the postrecurrence survival time significantly. Our experience suggests that 1) there are various clinical and radiological presentations and progressions of the disease; 2) treatment method should be decided along with the clinical presentation, progression of disease, and prognostic factors; 3) early diagnosis and early detection of recurrence enable the start of definitive treatment when the medical condition is still satisfactory.

The significance of gemistocytes in astrocytoma

Background. A retrospective clinical analysis of astrocytomas which contained a significant proportion of gemistocytes was carried out in order to evaluate their effect on prognosis, and other factors influencing prognosis. Method. From 253 consecutive cases of astrocytic tumours in adults, 25 were selected who had more than 20% gemistocytes in every high-power field examined. 9 of these had anaplasia, the remainder did not. They were divided into two groups according to the proportion of gemistocytes; group A, contained more than 60% gemistocytes, and group B, had between 20 and 60% gemistocytes. TUNEL and immunohistochemical staining for PCNA, p53, Ki-67, bcl-2 were performed in the 20 available cases. Findings. The median follow-up period was 46 months. There were 14 recurrences, with a median time to recurrence of 15 months. Thirteen repeat operations were performed in nine cases, and two cases showed recurring malignant transformation. The overall median survival time following diagnosis was 73 months and the 5-year survival rate was 52%. There were no significant differences in median survival between groups A and B with different proportions of gemistocytes. On the other hand the median survival of the gemistocytic astrocytomas with anaplasia was 25 months, compared with 158 months for those without anaplasia (p=0.0005). The significant impact of anaplasia on survival persisted in both groups. There were no significant differences in immunohistochemical staining between the two groups, with the exception of staining for Ki-67 (means of the two groups: group A 1.40; group B 2.50). Conclusions. It is suggested that the proportion of gemistocytes does not itself affect prognosis.

Whole-Body [18F]FDG PET in the Management of Metastatic Brain Tumours

SummaryBackground To determine its roles in the diagnosis and the systemic evaluation of metastatic brain tumours, whole-body positron emission tomography (PET) using [18F]FDG was performed in 20 consecutive patients. Methods  All patients were thought to be suffering or needing to be differentiated from metastatic brain tumours. Nine patients had multiple brain lesions; six were older and showed a rim-enhancing lesion with surrounding oedema; seven had homogeneously enhancing periventricular lesion(s) on computed tomography (CT) and/or magnetic resonance (MR) imaging, thought to be central nervous system lymphomas. Two patients had skull mass(es) and two patients had a solid mass suspected to be, respectively, a haemorrhagic metastasis and a metastatic malignant melanoma. All of them received whole-body [18F]FDG PET and conventional systemic work-up for metastasis in order to compare the results of the two methods. Results  Metastatic brain tumours were diagnosed on whole-body [18F]FDG PET in eleven patients who had extracranial and intracranial hypermetabolic lesions. In nine of these, a conventional work-up also detected primary lesions which on whole-body [18F]FDG PET were seen to be hypermetabolic foci. Systemic lymph node metastases were detected by whole-body [18F]FDG PET only in two patients and histological diagnosis was possible by biopsy of lymph nodes rather than of brain lesions. In the remaining nine patients who had only intracranial hypermetabolic foci, histological diagnosis was made by craniotomy or stereotactic biopsy. It was confirmed that seven of nine patients were suffering from a primary brain tumour and two from metastatic carcinoma. None of the nine showed evidence of systemic cancer on conventional work-up. Histological diagnoses of the primary brain tumours were four cases of primary central nervous system lymphoma and one each of multifocal glioblastoma, Ewings sarcoma, and cavernous angioma. Patients felt no discomfort during the whole-body [18F]FDG PET procedure and there were no complications. The false negative rate in [18F]FDG PET and in conventional work-up was 15.4% and 30.7% respectively. There were no false positives on either [18F]FDG PET or conventional work-up. Conclusion  It is suggested that whole-body [18F]FDG PET is a safe, reliable, and convenient method for the diagnosis and systemic evaluation of patients thought to be suffering or needing to be differentiated from a metastatic brain tumour.

Malignant Triton tumour mistaken for pituitary adenoma

A 72-year-old man presented with an intrasellar mass that was found incidentally. Magnetic resonance images (MRI) demonstrated an 8 mm-sized right sided sellar mass with low signal intensity on T1-weighted sequences and peripheral Gadolinium enhancement (Fig. 1a). It had slightly high signal intensity on T2-weighted images and iso-signal intensity on T1-weighted non-enhanced images. The MRI findings were consistent with a typical pituitary adenoma and there were no findings suggesting the possibility of malignancy. On the basis of a diagnosis of a nonfunctioning pituitary adenoma not causing any neurological symptoms, we decided to observe the mass. Nine months later, he developed ptosis of the left eye and diplopia. Neurological examination revealed a left oculomotor nerve palsy without impairment of visual acuity. A sellar MRI demonstrated a well-enhancing large mass extending into the sphenoid sinus, nasal cavity, and cavernous sinus with bony erosion (Fig. 1b). Endocrinological evaluation demonstrated normal results. The preoperative radiological differential diagnoses included unusual invasive pituitary adenoma, pituitary carcinoma, and metastasis. The mass was sub-totally removed by a trans-sphenoidal approach. It was hypervascular and rather firmer than the usual pituitary adenoma. The histopathological features confirmed the diagnosis of MTT (Fig. 1c). In immunohistochemical studies, S-100, myoglobulin and myogenin showed positive results (Fig. 1d). The Ki-67 labeling index of the tumour was 20%. Adjuvant radiotherapy was administered with a total dose of 59.4 Gy. However, the disease progressed 3 months after surgery requiring palliative chemotherapy using etoposide, ifosfamide and cisplatin. Thereafter, the patient remained in a stable condition until 15 months after surgery when the follow-up MRI demonstrated an increase in size of the mass. Although gamma knife radiosurgery was performed for the recurrent tumour, the disease continued to progress and the patient eventually required terminal care in a hospice.