PURPOSE: To reassess the usefulness of criteria for lymph node size in predicting metastatic lymph node ofgastric adenocarcinoma and to determine appropriate size criteria. MATERIALS AND METHODS: We reviewed the pathology of 1669 lymph nodes from 105 gastric adenocarcinoma patients and measured their long and short axis diameters. To determine the degree of lymph node shrinkage during fixation for pathologic examination, we measured the size of 105 lymph nodes both in the fresh state and on pathology slides after fixation and obtained their correlation equation ; this was used to determine the fresh-state size of the 1669 nodes. We analysed the distribution of metastatic and nonmetastatic lymph nodes according to their long and short axis and plotted a sensitivity-specificity curve to determine the appropriate size criteria for metastatic lymph nodes. RESULTS: There were 535 metastatic lymph nodes and their mean diameter was 8.2+/-4.9mm on the long axis and 5.7+/-3.8mm on the short axis. The mean diameter of nonmetastatic lymph nodes was 4.9+/-2.8mm, 3.0+/-1.7mm on the long and short axis, respectively. There difference in size between metastatic and nonmetastatic lymph nodes was not statistically significant. The (P>0.05) distribution curve of metastatic and nonmetastatic lymph nodesoverlapped over wide range of lymph node size. We determined appropriate size criteria at the point where sensitivity and specificity curves crossed, but the form of the curves was such that this was difficult. CONCLUSION: Appropriate size criteria on lymph node metastasis were 6.2mm for #1-6 lymph node group and 8.1mm for #7-12 lymph node group on long axis diameter and 4.0mm, 5.3mm on short axis diameter. But, even with this size criteria the expected accuracy was low(67-70%). This results showed limitation of size criteria to diagnose metastatic lymph node.
Adenocarcinoma ; Axis, Cervical Vertebra ; Humans ; Lymph Nodes* ; Neoplasm Metastasis* ; Pathology ; Sensitivity and Specificity

STUDY DESIGN: Retrospective clinical study. PURPOSE: We report our experience of eight patients treated with C1-C3 lateral mass rod-screw stabilization and fusion in the treatment of Hangman's fracture and other axis pathologies. OVERVIEW OF LITERATURE: Different surgical approaches, both anterior and posterior, have been described for treating Hangman's fracture and other pathologies where surgery is indicated. METHODS: All patients who underwent surgical treatment for Hangman's fracture and axial pathology where C1-C3 lateral mass screw-rod stabilization and fusion done, following reduction of the fracture or removal of the pathology were included in this series. The recorded patient management data was retrospectively studied. RESULTS: There were 8 cases in total. All were male, with an average age of 40.75 years. Hangman's fracture occurred in 6 cases (75%), one with metastatic squamous cell carcinoma and the remaining with plasmocytoma. Among the Hangman's fractures 4 (66.66%) had no neuro-deficit. Reduction and bilateral C1-C3 lateral mass screw and rod fixation with posterior fusion by bone graft was performed in all cases. In 2 cases, a C2 body tumor was removed transorally. All patients with neuro-deficit fully recovered, except one who expired in the early post-operative period. Rest of all patients were leading a normal life till last follow up. CONCLUSIONS: Although the number of cases was very small with a relatively short follow up period, C1 and C3 lateral mass screw-rod fixation followed by fusion showed promise as an effective and biomechanically sound way for the treatment of properly selected Hangman's fracture cases, and may also be suitable in other axial pathologies.
Axis, Cervical Vertebra ; Carcinoma, Squamous Cell ; Follow-Up Studies ; Humans ; Male ; Pathology* ; Plasmacytoma ; Retrospective Studies ; Transplants

Arteriovenous fistulas of the extracranial vertebral artery are rare. The authors report a case of a spontaneous arteriovenous fistula of the extracranial vertebral artery presenting as an osteolytic lesion at the body of the axis. The patient presented with headache and posterior neck pain. The fistula was obliterated by an endovascular trapping.
Adult ; Arteriovenous Fistula/*pathology/surgery ; Axis/*pathology ; Case Report ; Follow-Up Studies ; Human ; Male ; Osteolysis/pathology ; Support, Non-U.S. Gov't ; Vertebral Artery/*pathology/surgery

Gastric cancer is the second leading cause of cancer-related deaths worldwide. In advanced and metastatic gastric cancer, the conventional chemotherapy with limited efficacy shows an overall survival period of about 10 months. Patient specific and effective treatments known as personalized cancer therapy is of significant importance. Advances in high-throughput technologies such as microarray and next generation sequencing for genes, protein expression profiles and oncogenic signaling pathways have reinforced the discovery of treatment targets and personalized treatments. However, there are numerous challenges from cancer target discoveries to practical clinical benefits. Although there is a flood of biomarkers and target agents, only a minority of patients are tested and treated accordingly. Numerous molecular target agents have been under investigation for gastric cancer. Currently, targets for gastric cancer include the epidermal growth factor receptor family, mesenchymal-epithelial transition factor axis, and the phosphatidylinositol 3-kinase-AKT-mammalian target of rapamycin pathways. Deeper insights of molecular characteristics for gastric cancer has enabled the molecular classification of gastric cancer, the diagnosis of gastric cancer, the prediction of prognosis, the recognition of gastric cancer driver genes, and the discovery of potential therapeutic targets. Not only have we deeper insights for the molecular diversity of gastric cancer, but we have also prospected both affirmative potentials and hurdles to molecular diagnostics. New paradigm of transdisciplinary team science, which is composed of innovative explorations and clinical investigations of oncologists, geneticists, pathologists, biologists, and bio-informaticians, is mandatory to recognize personalized target therapy.
Axis, Cervical Vertebra ; Biomarkers ; Gene Expression ; Humans ; Pathology, Molecular ; Phosphatidylinositols ; Prognosis ; Receptor, Epidermal Growth Factor ; Sequence Analysis ; Sirolimus ; Stomach Neoplasms

BACKGROUND: In order to improve MRI volumetry of hippocampus, we obtained the Longitudinal Regional Volume Curve (LRVC) of hippocampi and compared the sensitivity of LRVC with those of conventional hippocampal volume-tries (total and regional) in temporal lobe epilepsy (TLE). METHODS: Thirty-eight normal subjects and 24 TLE patients were included in this study. The pathology of all patients showed hippocampal sclerosis. The volume of the hippocampus was measured by a manual tracing in 3 mm-thickness coronal MRI slices perpendicular to the long axis of the hippocampus and a three-dimensional reconstruction. Total volume and regional volumes (anterior, middle, and posterior 1/3) of the right and left hippocampi were measured. Then, the focal hippocampal volume of each of the coronal slices (3 mm) was plotted in a X-Y graph to obtain LRVC. The presence and pattern of HA were determined in LRVC. RESULTS: The mean volume of right hippocampus (2512+/-629 mm3) was bigger than that of the left one (2262.6+/-563.2 mm3) in normal subjects. The normal range of right-left total volume difference was 3.6~495.2 mm3. The sensitivities of conventional volumetry, regional volumetry, and LRVC were 66.7%, 75%, and 83.3%, respectively. Eleven patients showed diffuse HA (11/20, 55.0%) and nine had focal HA (9/20, 45.0%). In focal HA, the middle and posterior HA were more frequent (6/9, 66.7%) than anterior HA. CONCLUSIONS: LRVC improved the sensitivity of MRI volumetry in detecting hippocampal sclerosis and could reveal the pattern (diffuse or focal) of HA. (J Korean Neurol Assoc 19(2):125~131, 2001)
Axis, Cervical Vertebra ; Epilepsy, Temporal Lobe* ; Hippocampus ; Humans ; Magnetic Resonance Imaging* ; Pathology ; Reference Values ; Sclerosis* ; Temporal Lobe*

BACKGROUND: In order to improve MRI volumetry of hippocampus, we obtained the Longitudinal Regional Volume Curve (LRVC) of hippocampi and compared the sensitivity of LRVC with those of conventional hippocampal volume-tries (total and regional) in temporal lobe epilepsy (TLE). METHODS: Thirty-eight normal subjects and 24 TLE patients were included in this study. The pathology of all patients showed hippocampal sclerosis. The volume of the hippocampus was measured by a manual tracing in 3 mm-thickness coronal MRI slices perpendicular to the long axis of the hippocampus and a three-dimensional reconstruction. Total volume and regional volumes (anterior, middle, and posterior 1/3) of the right and left hippocampi were measured. Then, the focal hippocampal volume of each of the coronal slices (3 mm) was plotted in a X-Y graph to obtain LRVC. The presence and pattern of HA were determined in LRVC. RESULTS: The mean volume of right hippocampus (2512+/-629 mm3) was bigger than that of the left one (2262.6+/-563.2 mm3) in normal subjects. The normal range of right-left total volume difference was 3.6~495.2 mm3. The sensitivities of conventional volumetry, regional volumetry, and LRVC were 66.7%, 75%, and 83.3%, respectively. Eleven patients showed diffuse HA (11/20, 55.0%) and nine had focal HA (9/20, 45.0%). In focal HA, the middle and posterior HA were more frequent (6/9, 66.7%) than anterior HA. CONCLUSIONS: LRVC improved the sensitivity of MRI volumetry in detecting hippocampal sclerosis and could reveal the pattern (diffuse or focal) of HA. (J Korean Neurol Assoc 19(2):125~131, 2001)
Axis, Cervical Vertebra ; Epilepsy, Temporal Lobe* ; Hippocampus ; Humans ; Magnetic Resonance Imaging* ; Pathology ; Reference Values ; Sclerosis* ; Temporal Lobe*

PURPOSE: To compare the clinical utility of two series of dual-phase helical CT scans of the pancreas for tumor detectability and for the evaluation of vascular invasion. MATERIALS AND METHODS:Two series of dual-phase helical CT scans of the pancreas were performed in 49 pa-tients with pancreatic adenocarcinoma proven by pathology (n=21) and by clinical findings (n=28). The first series, in 24 patients, was obtained with a 45-sec (pancreatic phase) and an 80-sec delay (hepatic phase), and for the second series, in 25 patients, the corresponding delay times were 35 and 75 secs. A total of 120 ml non-ionic contrast media was injected of a speed of 3 ml/sec. Tumor conspicuity for each phase was assessed by measuring the attenuation number of the pancreatic mass and of normal pancreas. Enhancement of the celiac axis (CA), superior mesenteric artery (SMA), and superior mesenteric and portal veins was assessed by measuring the attenuation number of each phase. RESULTS: A comparison of the first and second series revealed no statistically significant tumor conspicuity. Enhancement of the celiac axis and superior mesenteric artery was better on scans obtained at 35-sec/75-sec delay (CA 254 HU +/-41, 224 HU +/-43; SMA 259 HU +/-55, 212 HU +/-44; p < .05), as was enhancement of the superior mesenteric and portal veins, but no statistical significance was observed. CONCLUSION: Dual-phase helical CT scans of the pancreas obtained at 35-sec/75-sec and 45-sec/80-sec delay for the pancreatic phase and hepatic phase, respectively, are equal in terms of the detectability of pancreatic ade-nocarcinoma,but for the evaluation of vascular invasion, dual-phase scanning with delays of 35 and 75 sees may be more appropriate.
Adenocarcinoma ; Axis, Cervical Vertebra ; Contrast Media ; Humans ; Mesenteric Artery, Superior ; Pancreas ; Pancreatic Neoplasms* ; Pathology ; Portal Vein ; Tomography, Spiral Computed*

OBJECTIVETo investigate an approach of posterior cervical spinal canal decompression and re-establishing the insertion of extensor, aim at the ossification of the posterior longitudinal ligament (OPLL) involved in C(2).

METHODSFrom 2002 to 2006, 10 patients with OPLL involved in C(2) underwent open-door laminoplasty, with the posterior cervical ligamentous complex and the insertion of extensor reconstructed on C(2), were reviewed retrospectively. The range of decompression was from C(2) to C(7). The sagittal diameter of C(2) vertebral canal, alignment of the cervical spine (C(2)-C(7) angle), and JOA score before and after operation were contrasted respectively.

RESULTSAll patients were followed up, average 14 months. Before the operation, the average sagittal diameter of C(2) vertebral canal was 5.6 mm (4 - 8.8 mm), JOA score was 9.6 scores (6 - 12 scores), C(2)-C(7) angle was 6.5 degrees (-2 degrees - 12 degrees ). After the operation, the average sagittal diameter of C(2) vertebral canal was 13.4 mm (10 - 18.2 mm, P < 0.01), JOA score was 10.9 scores (8 - 14 scores) and the C(2)-C(7) angle was 7.4 degrees (3 degrees - 14 degrees ) in earlier. Finally, the JOA score was 13.2 scores (10 - 17 scores, P < 0.05), and the C(2)-C(7) angle was 7.0 degrees (2 degrees - 15 degrees , P > 0.05) at last.

CONCLUSIONSThe open-door laminoplasty, with an approach of the posterior cervical ligamentous complex and the insertion of extensor reconstructed, is an appropriate method for treating OPLL involved in C(2). This process keeps the cervical curve in a better way, and decompresses the spinal canal effectively.

Aged ; Axis, Cervical Vertebra ; pathology ; Cervical Vertebrae ; surgery ; Decompression, Surgical ; methods ; Female ; Follow-Up Studies ; Humans ; Laminectomy ; methods ; Male ; Middle Aged ; Ossification of Posterior Longitudinal Ligament ; pathology ; surgery

Central diabetes insipidus(CDI) may result from any abnormalities in the supraoptic-neuropituitary axis. Since 1984, we have studied 7 suprasellar mass lesions presenting with CDI. There were 3 suprasellar germinomas including 1 pituitary stalk(infundibular) microgerminoma, 1 suprasellar lymphoma, 1 craniopharyngioma, 2 suprasellar mass lesions whose pathologies were not confirmed. In two case of germinoma, one at infundibulum and another at suprasellar region, the diagnosis was made on the basis of radiological and endocrinological findings and rapid disappearance of the mass after irradiation. The symptoms of CDI had improved within 2 months after the irradiation in all 3 cases of germinoma. Another 4 cases had been on DDAVP during follow-up periods more than one year. Primary tumorous lesions presenting with CDI always demonstrate pituitary stalk enlargement, suprasellar mass, or both. Among parasellar lesions presenting with CDI, germinoma and lymphoma are very sensitive to radiotherapy and have no need of surgery which and result in pituitary stalk damage and permanent CDI. And lesions of infectious and systemic disease also have no need of surgery. To avoid unnecessary surgery or biopsy, preoperative differential diagnosis of these lesions by CT scan findings and other systemic evaluations is important. In addition, elevation of serum prolactin level appeared to be related to infundibular lesions as a few authors suggested previously but not to aid differential diagnosis.
Axis, Cervical Vertebra ; Biopsy ; Craniopharyngioma ; Deamino Arginine Vasopressin ; Diagnosis ; Diagnosis, Differential ; Follow-Up Studies ; Germinoma ; Lymphoma ; Pathology ; Pituitary Gland ; Prolactin ; Radiotherapy ; Tomography, X-Ray Computed ; Unnecessary Procedures

PURPOSE: We investigated prospectively whether the interpretation considering the patterns of FDG uptake and the findings of unenhanced CT for attenuation correction can improve the diagnostic accuracy for assessing malignant lymph node (LN) and N stage in non-small cell lung cancer (NSCLC) using CT-corrected FDG-PET (PET/CT). MATERIALS AND METHODS: Subjects were 91 NSCLC patients (M/F: 62/29, age: 60+/-9 yr) who underwent PET/CT before LN dissection. We evaluated the maximum SUV ( (max) SUV), patterns of FDG uptake, short axis diameter, and calcification of LN showing abnormally increased FDG uptake. Then we investigated criteria improving the diagnostic accuracy and correlated results with postoperative pathology. In step 1, LN was classified as benign or malignant based on (max) SUV only. In step 2, LN was regarded as benign if it had lower (max) SUV than the cut-off value of step 1 or it had calcification irrespective of its (max) SUV. In step 3, LN regarded as malignant in step 2 was classified as benign if they had indiscrete margin of FDG uptake. RESULTS: Among 432 LN groups surgically resected (28 malignant, 404 benign), 71 showed abnormally increased FDG uptake. We determined the cut-off as (max) SUV = 3.5 using ROC curve analysis. The sensitivity, specificity, and accuracy for assessing malignant LN were 64.3%, 86.9%, 85.4% in step 1, 64.3%, 95.0%, 93.1% in step 2, and 57.1%, 98.0%, 95.4% in step3, respectively. The accuracy for assessing N stage was 64.8% in step 1, 80.2% in step 2, and 85.7% in step 3. CONCLUSION: Interpreting PET/CT, consideration of calcification and shape of the FDG uptake margin along with (max) SUV can improve the diagnostic accuracy for assessing malignant involvement and N stage of hilar and mediastinal LNs in NSCLC.
Axis, Cervical Vertebra ; Carcinoma, Non-Small-Cell Lung* ; Humans ; Lung ; Lymph Nodes ; Pathology ; Positron-Emission Tomography and Computed Tomography ; Prospective Studies ; ROC Curve ; Sensitivity and Specificity