Jyh-Seng Wang

Intra-articular gouty tophi of the knee: CT and MR imaging in 12 patients

Abstract Objective. To define the imaging characteristics of intra-articular tophi of the knee. Design and patients. Twelve patients with intra-articular tophi in the knee were studied with routine MR imaging, gadolinium (Gd)-enhanced MR imaging, and CT over a 4-year period. There were 11 men and one woman, 25–82 years of age (mean age 48 years). Four patients did not have a documented history of gout at the time of the MR examination. The diagnosis of intra-articular tophi was provided by arthroscopy and histological examination (5 patients), by microscopic study of joint fluid (5 patients), or by characteristic clinical, laboratory and imaging findings (2 patients). Results. In 15 MR examinations the tophi were located purely intra-articularly in 10 knees. In the remaining five MR studies, periarticular soft tissues or bone, or both, were involved. All the intra-articular tophi manifested low to intermediate signal intensity on both T1- and T2-weighted images. All five Gd-enhanced MR examinations demonstrated a heterogeneous peripheral enhancement. All 10 CT scans showed varying degrees of stippled calcifications within the tophi. The nature of the calcifications was confirmed on histological examination in three patients. Conclusion. Presenting clinical manifestations of gout may relate to intra-articular tophaceous deposits. Such deposits present as masses on MR images with low to intermediate signal intensity on both T1- and T2-weighted images and a characteristic enhancement pattern following intravenous Gd administration. These features relate primarily to internal calcifications, which are most evident on CT images. MR evaluation (including Gd administration) supplemented, in some cases, with CT scanning allows accurate diagnosis of intra-articular tophaceous deposits.

Association of vitamin D receptor FokI polymorphism with prostate cancer risk, clinicopathological features and recurrence of prostate specific antigen after radical prostatectomy

To investigate the effect of vitamin D receptor (VDR) FokI polymorphism on susceptibility to prostate cancer and the outcome of the disease in a Taiwanese population, we genotyped a total of 416 prostate cancer patients, 502 age‐matched male controls and 189 non age‐matched symptomatic benign prostatic hyperplasia. Although we did not find a significant association between VDR FokI genotypes and overall prostate cancer risk, we found that in men aged less than or equal to the median age of 73 years with VDR FokI F allele specifically had an increased risk of prostate cancer with a marginal significant trend (OR, 2.08; 95% CI, 1.00–4.34, p for trend = 0.056). The FF genotype was also highly associated with more aggressive prostate cancer (Gleason score 8–10) (OR, 2.47; 95% CI, 1.20–5.08) than did the Ff and ff genotypes. After adjusting other covariates, we found that in patients who had localized prostate cancer for which a radical prostatectomy was performed (n = 131), the VDR FokI FF genotype was associated with worse prostate‐specific antigen (PSA) recurrence‐free survival (hazard ratio = 3.25, 95% CI = 1.32–8.00, p = 0.010). Our findings suggest that the VDR FF genotype may increase the risk of early‐onset prostate cancer and is associated with more aggressive disease. Furthermore, the VDR polymorphism could be used as a prognostic marker for localized prostate cancer after radical prostatectomy.

Prognostic Significance of p53 and X-ray Repair Cross-complementing Group 1 Polymorphisms on Prostate-Specific Antigen Recurrence in Prostate Cancer Post–Radical Prostatectomy

Purpose: The tumor suppressor p53 and DNA repair gene X-ray repair cross-complementing group 1 (XRCC1) are thought to play important roles on prostate cancer susceptibility and tumor development. We investigated the potential prognostic roles of p53 (codon 72) and XRCC1 (codons 194, 280, and 399) polymorphisms in clinical localized prostate cancer after radical prostatectomy. Experimental Design: A total of 126 clinical localized prostate cancer patients undergoing curative radical prostatectomy at the Kaohsiung Medical University Hospital and Kaohsiung Veterans General Hospital were included in this study. The p53 codon 72 and XRCC1 codons 194, 280 and 399 polymorphisms were determined by the PCR-RFLP method. Their prognostic significance on prostate-specific antigen (PSA) recurrence were assessed using the Kaplan-Meier analysis and Cox regression model. Results: The p53 codon 72 Arg/Arg genotype was associated with increased PSA recurrence risk compared with the Arg/Pro and Pro/Pro genotypes, although the difference did not reach significance (30.3% versus 20.4%, P = 0.247). Of these three XRCC1 polymorphisms, the codon 399 Arg/Gln + Gln/Gn genotypes were significantly associated with higher risk of PSA recurrence after radical prostatectomy compared with the Arg/Arg genotype (34.0% versus 15.1%, P = 0.013) and poorer PSA-free survival (log-rank test, P = 0.0056). After considering for other covariates in a Cox proportional hazard model, the XRCC1 Arg/Gln and Gln/Gln genotypes (hazard ratio, 4.73; 95% confidence interval, 1.61-13.92; P = 0.005) and high Gleason score (Gleason score, 8-10; hazard ratio, 5.58; 95% confidence interval, 1.58-19.71; P = 0.008) were still independent predictors of poor PSA-free survival after radical prostatectomy. The similar significant results were not found in XRCC1 codons 194 and 280. Conclusions: Our results suggest that the XRCC1 codon 399 polymorphism may be a prognostic factor for PSA recurrence after radical prostatectomy.

Incidence and clinical presentation of posttransfusion TT virus infection in prospectively followed transfusion recipients: emphasis on its relevance to hepatitis

BACKGROUND: A novel transfusion‐transmissible human DNA virus, TT virus (TTV), has been discovered recently. An attempt was made to determine the incidence and clinical outcome of TTV infection in recipients of blood transfusion.

Cerebral Pilocytic Astrocytoma with Spontaneous Intracranial Hemorrhage in Adults

Pilocytic astrocytomas are found predominantly in the pediatric population; reports of these tumors are extremely rare in adults. We report 2 cases of adult pilocytic astrocytoma with intracranial hemorrhage. A 32-year-old male presented with neck stiffness and severe headache, and a 34-year-old male was referred for headache and double vision. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed a well-enhanced and circumscribed cystic hemorrhagic tumor with mural nodule over the cerebral hemisphere region. Perfusion-weighted MRI (PWI) was also performed in both patients. The measured relative cerebral blood volume ratios of the mural nodules in these 2 cases were, respectively, 1.34 and 2.81 when compared with normal white matter. After surgical resection, microscopic examination of the lesions showed pilocytic astrocytomas. Since pilocytic astrocytoma and other cystic tumors with mural nodule (such as hemangioblastoma) have similar findings on conventional CT and MRI, PWI is helpful in the differential diagnosis. The literature on hemorrhagic pilocytic astrocytoma is also reviewed.

Influence of Cytokine Gene Polymorphisms on Prostate-Specific Antigen Recurrence in Prostate Cancer after Radical Prostatectomy

Purpose: Evidence is accumulating indicating that chronic inflammation plays an important role in prostate cancer. We investigated the potential prognostic roles of IL-6, IL-8 and IL-10 polymorphisms in clinical localized prostate cancer after radical prostatectomy. Materials and Methods: A total of 116 clinically localized prostate cancer patients undergoing curative radical prostatectomy were included in this study. The IL-6, IL-8 and IL-10 polymorphisms were determined by the TaqMan real-time PCR method. Their prognostic significance on prostate-specific antigen (PSA) recurrence was assessed using Kaplan-Meier analysis and Cox regression model. Results: The IL-6 polymorphism (rs2066992) T/G and G/G genotype cases were associated with a higher percentage of preoperative PSA levels of ≥10 ng/ml; higher risk of positive surgical margin, and higher risk of extraprostatic extension compared to the T/T genotype. The IL-10 polymorphism (rs1800871) A/A genotype was associated with a higher risk of PSA recurrence compared with the A/G + G/G genotypes and significantly poorer PSA-free survival (log-rank test, p = 0.019). After considering other covariates in a Cox proportional hazard model, the IL-10A/A genotype and high Gleason score (8–10) were still independent predictors of poor PSA-free survival. Conclusion: Our results suggest that the IL-10 polymorphism may be a prognostic factor for PSA recurrence after radical prostatectomy.

Primary vaginal extraosseous Ewing sarcoma/primitive neuroectodermal tumor with cranial metastasis.

Extraosseous Ewing sarcoma is now regarded as a member of the Ewing sarcoma/primitive neuroectodermal tumor (PNET) family. It typically involves the soft tissues of the chest wall, pelvis, paravertebral region, abdominal wall, retroperitoneal region and extremities of children, adolescents and young adults, but it seldom occurs in the female genital tract. We report an extremely rare case of retrospective diagnosis of vaginal extraosseous Ewing sarcoma/PNET which metastasized to the right frontoparietal scalp, skull, and dura. Surgical resection, followed by adjuvant radiotherapy and chemotherapy resulted in a favourable clinical outcome. Both the vaginal and head tumors had similar light microscopic features supporting the diagnosis.

Role of p21WAF1 and p27KIP1 in Predicting Biochemical Recurrence for Organ-confined Prostate Adenocarcinoma

Background: Both p21WAF1 and p27KIP1 have been reported as prognostic markers predicting biochemical failure for prostate cancers. We examined the expression and prognostic significance of p21WAF1 and p27KIP1 in organ‐confined (pT2) prostate cancer patients. Methods: The medical records of 53 pT2 prostate adenocarcinomas were analyzed retrospectively. Radical prostatectomy specimens were stained using anti‐p21WAF1 and anti‐p27KIP1 antibodies. Biochemical relapse was defined as 2 consecutive elevations in serum prostate specific antigen (PSA) level > 0.2 ng/mL with an interval of more than 3 months. The prognostic significance of p21WAF1 and p27KIP1 expression was assessed. Results: p21WAF1 immunoreactivity was found in 19 patients (35.8%). Twenty‐nine tumors (54.7%) had decreased p27KIP1 expression. Both markers were not associated with Gleason scores (p = 1.00 for both). At a median follow‐up of 49 months, 15 patients (28.3%) experienced biochemical recurrence. Both p21 and p27 had no prognostic significance in log‐rank test (p = 0.98 and p = 0.64, respectively). Conclusion: p21WAF1 and p27KIP1 expression have no role in predicting biochemical relapse for stage pT2 prostate cancers.

E-Cadherin Expression in Prostate Adenocarcinomas in Chinese and Its Pathological Correlates

Introduction: We examined the E-cadherin expression in prostate adenocarcinomas in Chinese to correlate this immunohistochemical marker with histopathological features. Materials and Methods: Primary adenocarcinomas from 122 radical prostatectomy specimens were stained using anti-E-cadherin (HECD-1) antibody. The association of E-cadherin expression with serum prostate-specific antigen (PSA), pathological stage and Gleason score was assessed by Kendall’s tau-b test. Results: Aberrant E-cadherin expression was identified in 79 tumors (64.8%). Abnormal E-cadherin expression did not correlate to serum PSA (p = 0.802), tumor stage (p = 0.684) and Gleason score (p = 0.385). Conclusions: The frequency of aberrant E-cadherin expression was higher in prostate adenocarcinomas of Chinese as compared to that reported in Caucasians. No association with pathological stage, Gleason score and serum PSA was identified.

Expression of Vascular Endothelial Growth Factor in Taiwanese Benign and Malignant Prostate Tissues

Background: The expression of vascular endothelium growth factor (VEGF) has been correlated to the grading and stage of prostate cancers. However, data regarding Taiwanese prostate cancer patients are lacking. The aim of the present study was to examine VEGF expression in our radical prostatectomy specimens. Methods: Fifty‐one radical prostatectomy specimens with prostate cancer (15 stage pT2N0, 25 pT3N0, 11 pT2‐4 N1) were stained using goat anti‐human VEGF polyclonal antibody (AB‐293NA; R&D Systems Inc., Minneapolis, MN, USA). The VEGF expression in malignant and nonmalignant prostate tissues was compared. The correlations of VEGF immunoreactivity with Gleason scores and pathologic stages were examined. Mann–Whitney U test was used for comparison of preoperative prostate‐specific antigen levels between patients with and without VEGF expression. Results: Positive VEGF staining was observed in 80.4% of malignant epithelia, 39.2% of peritumoral stroma, 68.6% of benign hyperplastic glands, and 25.5% of adjacent stroma. There was no difference in VEGF expression between malignant and nonmalignant areas. Advanced disease had significantly higher frequency of stroma but not epithelium VEGF staining as compared to organ‐confined disease (p = 0.002 and p = 0.412, respectively). The Gleason 7 and higher tumors had significantly higher frequency of VEGF staining in stroma but not glandular epithelium (p = 0.041 and p = 0.353, respectively). Tumors with positive epithelium VEGF staining had significantly higher PSA levels (21.3 ± 18.1 vs. 10.8 ± 6.8 ng/mL; p = 0.013). Conclusion: There was no difference in VEGF immunoreactivity between malignant and benign prostatic epithelium in Taiwanese. High Gleason grade tumors and advanced disease had significantly higher frequency of VEGF expression in stroma but not glandular epithelium. Tumors with positive epithelium VEGF staining had significantly higher PSA levels.