Siu-Cheung Chan

A retrospective review of the prognostic value of ALDH-1, Bmi-1 and Nanog stem cell markers in esophageal squamous cell carcinoma.

Stem cell markers are upregulated in various cancers and have potential as prognostic indicators. The objective of this study was to determine the expression of three stem cell markers, aldehyde dehydrogenase 1 (ALDH-1), B cell-specific Moloney murine leukemia virus integration site 1 (Bmi-1), and Nanog, in esophageal squamous cell carcinoma (ESCC) tissues. Immunohistochemistry was used to measure the expression of ALDH-1, Bmi-1, and Nanog in ESCC tissues from 41 patients who received pre-operative chemoradiation. We evaluated the relationship between expression of these markers, and clinicopathological features, tumor regression grade (TRG), and 5-year overall survival (OS). There were no significant associations of ALDH-1 or Bmi-1 expression with age, gender, clinical stage, and treatments (p>0.05). However, patients with Nanog-positive tumors were significantly older than those whose tumors were Nanog-negative (p = 0.033). TRG after treatment was significantly associated with expression of ALDH-1 (p = 0.001), Bmi-1 (p = 0.004), and Nanog (p<0.001). Although OS was significantly better in patients with low TRGs (p = 0.001), there were no significant correlations between ALDH-1, Bmi-1, or Nanog with OS. Expression of ALDH-1, Bmi-1, and Nanog correlated with TRG, but not OS. Further large studies are necessary to fully elucidate the prognostic value of these stem cell markers for ESCC patients.

Ileal angiomyolipoma as an unusual cause of small-intestinal intussusception

Angiomyolipomas are benign mesenchymal tumors, but those that arise from the small intestine are exceedingly rare. We report on a 48-year-old woman who had an ileal angiomyolipoma, who presented clinically with vague abdominal pain and bloody stool. Small-bowel intussusception was shown on an abdominal computed tomography (CT) scan. We discuss the clinical manifestations and clinicopathological and immunohistochemical findings of this benign tumor which appeared in this rare location.

Combined hepatocellular-cholangiocarcinoma: a case report

Combined hepatocellular‐cholangiocarcinoma (HCC‐CC) is a rare primary liver tumour. We report a carrier of both HBV and HCV presenting with intermittent abdominal pain, fever, chillness and elevated á‐fetoprotein (AFP) of 1197 ng/ml. Computed tomography showed an irregular hypodense mass in the left lateral segment of the liver with vague contrast enhancement and multiple regional lymphadenopathy. Hepatic angiogram showed that the mass was hypovascular and the left portal vein was occluded with a tapered end. Percutaneous ultrasound‐guided core needle biopsy of the liver yielded HCC‐CC. We suggest that HCC‐CC should be considered in hypovascular liver tumours with striking elevation of serum AFP and multiple regional lymphadenopathy.

Modified Radiology-Guided Percutaneous Gastrostomy (MRPG) for Patients with Complete Obstruction of the Upper Digestive Tract and Who are without Endoscopic or Nasogastric Access

Objective We wanted to report on our experience with modified radiology-guided percutaneous gastrostomy (MRPG) without endoscopic or nasogastric access for treating patients with complete obstruction of the upper digestive tract. Materials and Methods Fourteen oncology patients (13 had hypopharyngeal cancer and 1 had upper esophageal cancer) with complete obstruction of the upper digestive tract were recruited. Conventional percutaneous endoscopic gastrostomy (PEG) and radiologic (fluoroscopy-guided) percutaneous gastrostomy (RPG) were not feasible in all the patients. An MRPG technique (with a combination of ultrasound, an air enema and fluoroscopic guidance) was performed in these patients. Results We achieved successfully percutaneous gastrostomy using the modified technique in all patients without any major or minor complications after the procedure. Conclusion A modified radiology-guided percutaneous gastrostomy technique can be safely performed in patients who failed to receive conventional PEG or RPG due to the absence of nasogastric access in the completely obstructed upper digestive tract.

Solitary hepatic lymphangioma – a case report

Hepatic lymphangioma is an extremely rare benign neoplasm that is usually associated with lymphangiomas of other viscera. We report a patient with huge, solitary hepatic lymphangioma involving only the liver. The clinical features and computed tomography findings of this case are described.

Carbon dioxide insufflation during colonoscopy can significantly decrease post‐interventional abdominal discomfort in deeply sedated patients: A prospective, randomized, double‐blinded, controlled trial

CO2 has been reported to be absorbed from the bowel more rapidly than air, resulting in a discomfort reduction after colonoscopy. Its role in deeply sedated patients is limited. This study was designed to investigate the efficacy and safety of CO2 insufflation during colonoscopy in patients deeply sedated with propofol.

Diagnostic efficacy of ultrasonography-guided fine needle aspiration biopsy in evaluating salivary gland malignancy

BACKGROUND Salivary gland masses constitute a diagnostic challenge in daily clinical practice and tissue sampling is required to establish a diagnosis. We aimed to evaluate the efficacy of ultrasonography-guided fine needle aspiration biopsy (UGFNAB) in the diagnosis of salivary gland lesions. METHODS From January 2007 to September 2010, a total of 158 patients who underwent both UGFNAB and surgical excision for salivary gland mass lesions were included in this study. Patients with insufficient sampling or inconclusive cytology diagnosis were excluded from the analysis of diagnostic accuracy of UGFNAB. RESULTS UGFNAB yielded sufficient sampling for analysis in 137 patients, leading to a diagnostic yield of 86.7%. Among these 137 patients, 24 patients were confirmed to have malignant tumors. The sensitivity, specificity and accuracy of UGFNAB for malignancy were 66.7%, 98.2%, and 92.7%, respectively. No UGFNAB-related complications were encountered. CONCLUSIONS UGFNAB of salivary gland masses is a safe technique that offers high specificity and accuracy but moderate diagnostic yield and sensitivity.

Improved sonographic visualization by fluid challenge method of renal lithiasis in the nondilated collecting system experience in seven cases

Ultrasound is an effective means of detecting renal stones in patients with hydronephrosis. The filled urinary bladder in a normal person under hydration frequently results in the sonographic appearance of minimal or moderate hydronephrosis. For optimal visualization of stones and associated acoustic shadows, six patients with radiographically opaque renal stones were evaluated with fluid-loaded renal ultrasonography, which was compared to conventional renal sonogram in basal state. Although ultrasound in basal state can be used for detection of intrarenal lithiasis, fluid-challenged renal sonogram appears more accurate for the determination of contour, location, size, and number of small stones. In one case, this fluid-loaded ultrasound well demonstrated the tramline appearance of an isolated renal artery, which mimics stone before fluid challenge.

Complications of fluoroscopically guided percutaneous gastrostomy with large-bore balloon-retained catheter in patients with head and neck tumors.

BACKGROUND/PURPOSE To review the complications, mortality rate and nutritional status of patients with head and neck cancer after fluoroscopically guided percutaneous gastrostomy (FPG). METHODS We retrospectively recruited 110 patients who had undergone FPG using 14-French balloon-retained catheters. The mortality rate, procedural and catheter-related complications, and Eastern Cooperative Oncology Group performance status were reviewed. Peritonitis, abscess, septicemia and bleeding were defined as major complications. Tube-related problems, including dislodgment, obstruction, leakage, vomiting and infection, were classified as minor complications. RESULTS Patients were stratified according to Eastern Cooperative Oncology Group performance status as follows: grade 0 (n=6); grade 1 (n=22); grade 2 (n=44); grade 3 (n=29); and grade 4 (n=7). The respective complication rates were 21%, 24%, 26%, and 29% for grades 1-4; however, there were no significant intergrade differences. The rates of major and minor complications were 1.9% and 20.0%, respectively. A total of 47 (43.5%) patients succumbed due to cancer deterioration; however, there was no gastrostomy-induced mortality. The catheter-occlusion rate of 3.7% in this cohort was significantly lower than that reported in other pigtail-retained gastrostomy studies. CONCLUSION FPG is a safe method with low mortality and complication rate for constructing long-term enteral access in patients with head and neck cancer and esophageal abnormalities, who have no endoscopic access to the stomach.

Percutaneous computed tomography-guided cryotherapy of thoracic masses in nonsurgical candidates: experience in 19 patients.

BACKGROUND/PURPOSE Percutaneous cryotherapy has become a minimally invasive treatment option for unresectable lung malignancies. We report the experience and outcomes with percutaneous computed tomography (CT)-guided cryotherapy of primary lung malignancies, as well as recurrence and metastases, in patients ineligible for surgery. METHODS The procedure was performed after administration of local anesthesia on 23 tumors in 19 patients (10 male and 9 female patients; mean age, 58.7 years). None of the patients were surgical candidates and underwent CT-guided percutaneous cryotherapy for treatment of the malignant mass in the lung. Visualization of low-attenuation ice ball formation was performed using CT scanning after each cycle of freezing and thawing therapy. Subsequent CT scans were scheduled at 3-month intervals post-procedure to assess tumor control. RESULTS No lethal complication, major bleeding or bronchial damage was observed in any of the 23-cryotherapy sessions performed. Three patients developed pneumothorax and one patient required chest tube insertion. Thirteen tumors (56.5%) regressed, including two complete responses, five tumors (21.7%) were stationary and the remaining five tumors (21.7%) were found to be progressing at the 3-month follow-ups. No recurrence was found in the 11 regressed tumors for 6 months, and there was also no recunence in the two tumors that completely responded up to 12 months later with a satisfactory procedure. CONCLUSION Percutaneous cryotherapy for primary lung cancer, recurrence and metastatic lung tumors is feasible and safe for local control.