Il Ki Hong

Bone involvement in secondary syphilis: a case report and systematic review of the literature.

Abstract Bone involvement is an unusual manifestation of secondary syphilis, but little information is available in the English-language literature. We carried out a systematic review of the English-language literature from 1964 to 2013, describing cases of secondary syphilis with bone involvement. We also describe a case of secondary syphilis with multiple osteolytic lesions, mimicking metastatic cancer or myeloma, which was included in an analysis of 37 eligible cases of secondary syphilis with bone involvement. Of these 37 patients, 28 (76%) patients were male, and the median age was 32 years (range, 12–64 years). Eleven (30%) patients had human immunodeficiency virus (HIV) infection with a median CD4 lymphocyte count of 343 cells/mm3 (range, 130–689 cells/mm3). The diagnosis of early syphilis was suspected based on mucocutaneous findings in 28 (76%) cases. In the remaining 9 (24%) cases, high titers of nontreponemal serologic tests were the only evidence of early syphilis. The median venereal disease research laboratory (VDRL) titer was 1:64 (range, 1:8–1:320), and median rapid plasma reagin (RPR) titer was 1:64 (range, 1:16–1:512). The bones most often affected were long bones of the limbs (n = 22) and skull (n = 21). The bone lesions were multifocal in 27 (73%) cases and osteolytic in 19 (51%) cases. The treatment of syphilitic bone lesions was medical only in most patients, and prognosis was favorable with high-dose penicillin therapy. Clinical features and outcome between HIV-uninfected and HIV-infected patients were not different. Knowledge of this rare entity may lead to early diagnosis and appropriate management.

Prognostic Significance of 18F-FDG Uptake in Hepatocellular Carcinoma Treated with Transarterial Chemoembolization or Concurrent Chemoradiotherapy: A Multicenter Retrospective Cohort Study

This study aimed to assess the prognostic value of 18F-FDG uptake in hepatocellular carcinoma (HCC) patients who had transarterial chemoembolization (TACE) or concurrent intraarterial chemotherapy with external-beam radiotherapy (CCRT) and to compare the prognosis between patients treated with TACE and those with CCRT according to 18F-FDG uptake. Methods: Two hundred fourteen intermediate–to–advanced-stage HCC patients without extrahepatic metastasis who underwent staging 18F-FDG PET/CT before TACE (153 patients) or CCRT (61 patients) were recruited from 7 hospitals. Progression-free survival (PFS) and overall survival (OS) were compared using an optimal cutoff value for tumor-to-normal liver uptake ratio (TLR). Further, PFS and OS were compared according to treatment modalities (TACE vs. CCRT) using the same TLR cutoff value. Results: On multivariate analysis, age and TLR were independent prognostic factors for PFS (P < 0.050). For OS, Child–Pugh classification and TLR were independent prognostic factors (P < 0.050). When the TLR was greater than 2.0, patients treated with CCRT showed significantly better PFS and OS than those treated with TACE after adjusting for tumor size and number (P = 0.014, for all). In contrast, there was no significant difference in PFS and OS between patients treated with TACE or CCRT when the TLR was 2.0 or less. Conclusion: 18F-FDG uptake was an independent prognostic factor for PFS and OS in HCC patients treated with TACE or CCRT. Especially, in HCCs with high 18F-FDG uptake, patients treated with CCRT showed better survival than those treated with TACE. 18F-FDG PET/CT may help determine the treatment modality for intermediate–to–advanced-stage HCCs.

Diagnostic usefulness of 3'-deoxy-3'-[18F]fluorothymidine positron emission tomography in recurrent brain tumor.

Objective We evaluated the diagnostic usefulness of 3′-deoxy-3′-[18F]fluorothymidine (FLT) compared with 2-[18F]fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (PET) in recurrent brain tumors. Methods Twenty patients with suspected recurrence after surgical removal of primary tumors were studied. The uptake was assessed visually and quantified by standardized uptake value (SUV) and SUV ratio of tumor to white matter, tumor to gray matter, and tumor to normal tissue. Final diagnoses were made by histopathology or clinical and radiological follow-up. Results Of 20 lesions, 15 were recurrences. 3′-Deoxy-3′-[18F]fluorothymidine PET showed high diagnostic sensitivity (15/15 [100%]) and moderate specificity (3/5 [60.0%]). 2-[18F]fluoro-2-deoxy-D-glucose PET showed moderate diagnostic sensitivity (11/15 [73.3%]) and specificity (4/5 [80%]). All of 4 recurrent tumors without FDG uptake showed FLT uptake. Tumor-to-normal tissue ratios (3.99 ± 1.72) of recurrent tumors on FLT PET were significantly higher than tumor-to-white matter ratios (1.96 ± 0.93) and tumor-to-gray matter ratios (1.32 ± 0.33) on FDG PET (P < 0.001), although SUVs (0.62 ± 0.32) of recurrent tumors on FLT PET were lower than those (2.44 ± 1.02) on FDG PET (P < 0.001). Conclusion 3′-Deoxy-3′-[18F]fluorothymidine PET has a high sensitivity but a lower specificity, which has a limited role in the diagnosis of recurrent brain tumors as a complimentary tool of magnetic resonance imaging.

A Polymorphism (rs1801018, Thr7Thr) of BCL2 is Associated with Papillary Thyroid Cancer in Korean Population

Objectives Among the apoptosis signals, B-cell CLL/lymphoma 2 (BCL2) is a well-known regulator of apoptosis with anti-apoptotic properties. We investigated here whether single nucleotide polymorphisms (SNPs) of the BCL2 were associated with host susceptibility of papillary thyroid cancer (PTC) occurrence and clinicopathologic parameters. Methods Ninety-two PTC patients and 222 control subjects were recruited. One promoter SNP (rs2279115, -938A/C) and one synonymous SNP (rs1801018, Thr7Thr) in the BCL2 gene were selected and genotyped using direct sequencing. Multiple logistic regression models were performed to evaluate odds ratios, 95% confidence intervals, and P-values. Results rs1801018 of the BCL2 gene was not associated with the development of PTC. In the clinicopathologic features, rs1801018 SNP was associated with the number and location. The G allele frequency of rs1801018 in PTC patients with multifocality (13.3%) was about four-fold higher than that in PTC patients with unifocality (3.4%). The G allele frequency of rs1801018 in PTC patients with both lobes (15.4%) was increased by about five-fold, compared to PTC patients with one lobe (3.2%). Conclusion The results suggest that synonymous SNP rs1801018 and the G allele of the BCL2 gene may be associated with the multifocality and bilaterality of PTC in Korean population.

Association between interleukin 17/interleukin 17 receptor gene polymorphisms and papillary thyroid cancer in Korean population.

BACKGROUND Although numerous recent studies have implicated a role for interleukin 17(IL17) in tumor development, the mechanisms of IL17 involvement are still uncharacterized. The aims of this study were to determine whether single nucleotide polymorphisms (SNPs) in IL17 and IL17R contribute to the development of papillary thyroid cancer (PTC) and to assess the relationship between IL17 and IL17R SNPs and the clinicopathologic characteristics of PTC. MATERIALS AND METHODS Eight SNPs located within the IL17A, IL17RA, and IL17RB genes were genotyped using direct sequencing in 94 patients with PTC and 260 patients without PTC (controls). Genetic data were analyzed using commercially available software. Statistical analyses were then performed to examine the relationships between these SNPs and the clinicopathologic characteristics of PTC. RESULTS Genotyping analysis demonstrated that the IL17RA SNP rs4819554 (codominant model 1, odds ratio (OR)=0.39, P=0.001) and the IL17RB SNP rs1025689 (dominant model, OR=0.59, P=0.043) were significantly associated with lack of PTC. Interestingly, the IL17A SNP rs2275913 (codominant model 2, OR=0.19, P=0.034) was significantly associated with lack of multifocality. Furthermore, the IL17RA SNP rs4819554 (dominant model, OR=0.25, P=0.010) was significantly associated with lack of cancer bilaterality. CONCLUSION In this study of SNPs in the IL17 and IL17R genes in patients with PTC, we demonstrated that IL17RA polymorphisms can influence both the development and the bilaterality of PTC.

18F-FDG PET/CT Can Predict Survival of Advanced Hepatocellular Carcinoma Patients: A Multicenter Retrospective Cohort Study

Barcelona Clinic Liver Cancer (BCLC) stage C hepatocellular carcinoma (HCC) consists of a heterogeneous group of patients with a wide range of survival times, requiring further prognostic stratification to facilitate treatment allocation. We evaluated the prognostic value of 18F-FDG uptake on PET/CT at the time of presentation in patients with BCLC stage C HCC. Methods: A total of 291 patients with BCLC stage C HCC who underwent 18F-FDG PET/CT between 2009 and 2010 for staging were retrospectively enrolled from 7 university hospitals. The patients were further divided into 2 groups according to the extent of disease, as intrahepatic or extrahepatic. Tumor-to-liver SUV ratio (TLR) of the primary tumor was measured on 18F-FDG PET/CT. Prognostic values of TLR and other clinical variables were analyzed to predict overall survival (OS) in univariate and multivariate analyses. Differences in the OS stratified by TLR were examined by the Kaplan–Meier method. Results: Higher TLR was associated with extrahepatic disease (P = 0.018). On multivariate analysis, Child–Pugh classification and TLR were independent prognostic factors in the intrahepatic disease group (all P < 0.05), whereas TLR was the only independent prognostic factor in the extrahepatic disease group (P < 0.05). Patients with high TLR showed a significantly worse OS than those with low TLR (P < 0.05) in both groups. Conclusion: In patients with BCLC stage C HCC, 18F-FDG uptake in the primary tumor was significantly higher in patients with extrahepatic disease than in those with intrahepatic disease. In addition, 18F-FDG uptake on pretreatment PET/CT had an incremental prognostic value for OS in both intrahepatic and extrahepatic disease groups.

Association of the Oncostatin M Receptor Gene Polymorphisms with Papillary Thyroid Cancer in the Korean Population

Objectives To investigate the association between papillary thyroid cancer (PTC) and single nucleotide polymorphisms (SNPs) of oncostatin M receptor (OSMR) in the Korean population. Methods Retrospective case-control study was done. Eighty-five patients with PTC and 287 controls were studied. One missense SNP (rs2278329, Asp553Asn) and one promoter SNP (rs2292016, -100 G/T) of the OSMR gene were genotyped by direct sequencing. Genetic data were analyzed using the SNPStats, Helixtree, and SNPAnalyzer Pro. PTC patients were dichotomized and compared with respect to the clinicopathologic characteristics. Results There was no association between genotypes and allele frequencies of OSMR SNPs (rs2278329 and rs2292016) and PTC susceptibility. SNP rs2278329 was significantly associated with tumor size (dominant model; P=0.028; odds ratio [OR], 2.71; 95% confidence interval [CI], 1.12 to 6.57). The A allele was higher in sizes large than 1 cm (32.5% vs. 16.7%; P=0.018; OR, 2.41; 95% CI, 1.17 to 4.98). Regarding the number of tumors, we found no significant association with genotype, however, the A allele was higher in patients with multifocaltiy (33.3% vs. 19.1%; P=0.040; OR, 2.12; 95% CI, 1.03 to 4.34). Conclusion The results suggest that OSMR polymorphism rs2278329 is associated with clinicopathologic characteristics of the tumor growth and multifocality development.

A rare case of cerebral vasculitis in Henoch-Schönlein purpura with emphasis on the diagnostic value of magnetic resonance angiography (MRA) and single-photon emission computed tomography (SPECT) given normal magnetic resonance imaging (MRI).

Henoch-Schönlein purpura (HSP) is a small-vessel vasculitis that is the most common cause of non-thrombocytopenic purpura in children. The classic manifestations are palpable purpura, arthralgia, abdominal pain, and glomerulonephritis. Although the nervous system is less commonly involved, neurological symptoms and signs occur in a significant proportion of HSP cases. Several cases of cerebral vasculitis in HSP have been reported. To identify the presence and extent of cerebral vasculitis, MRI and magnetic resonance angiography (MRA) have been used as crucial diagnostic tools. In this article, we report a case of cerebral vasculitis in an HSP patient using a new modality, Tc-hexamethylpropyleneamine oxime (HMPAO) singlephoton emission computed tomography (SPECT) with acetazolamide, in addition to MRI and MRA.

Scintigraphic findings of growth arrest lines after bisphosphonate administration in a steroid-induced osteoporosis patient: a case study.

Bisphosphonates inhibit bone resorption, and are used to treat patients who have low bone mineral density. This treatment results in the development of growth arrest lines, which typically appear parallel sclerotic lines to the growth plate on radiographs. We describe the case of a 14-year-old boy with steroid-induced osteoporosis, who was treated by pamidronate. This patient exhibited linearly increased bilateral uptake in the shafts of his femora, tibiae, radii, and ulnae that were parallel to the growth plates. A simple radiograph corresponding bone scan demonstrated linear sclerotic lines at the same sites.

Dilated Virchow-Robin Space and Dopamine Transporter Imaging in the Striatum of Patients with Parkinsonism.

OBJECTIVE The radiological and clinical significance of a dilated Virchow-Robin space (dVRS) in the striatum (STR) remains unclear. We investigated the role of dVRS in STR on parkinsonism and dopamine transporter positron emission tomography (DaT-PET) findings. METHODS Patients with parkinsonism who underwent both brain magnetic resonance imaging and DaT-PET were included. Clinical status was evaluated by Hoehn and Yahr (HY) stage, Korean-Mini Mental Status Examination (K-MMSE), Montreal Cognitive Assessment Korea (MoCA-K), and Frontal Assessment Battery (FAB). dVRS was assessed by semi-quantitative and quantitative scales in each of the three segments of STR (caudate nuclei, anterior and posterior putamen) and was expressed as a dVRS score. DaT-PET was qualitatively assessed as either normal or abnormal in each segment. The relationship between dVRS and DaT-PET abnormality (ab-DaT-PET) was designated in each segment as either concordant or discordant. A concordant segment was defined by the presence of dVRS with ab-DaT-PET [Concordance rate (CR)=number of concordant segments/number of concordant and discordant segments]. RESULTS Eleven patients were included. There was no significant correlation between the presence of dVRS and ab-DaT-PET. The mean CR was 0.39. CR was not significantly correlated with any clinical or neuroimaging scales. The dVRS score was significantly correlated with K-MMSE, MoCA-K, and FAB (r=-0.675, -0.847, and -0.868, respectively) but not with HY stage. CONCLUSION dVRS in STR played no significant role on dopaminergic innervation revealed by DaT-PET and made little contribution to clinical parkinsonism; however, it was correlated with cognitive impairment.