OBJECTIVE: The aim of this study was to report on the long-term results of transabdominal ultrasound guided conformal brachytherapy in patients with cervical cancer with respect to patterns of failures, treatment related toxicities and survival. METHODS: Three hundred and nine patients with cervical cancer who presented to Institute between January 1999 and December 2008 were staged with magnetic resonance imaging and positron emission tomography and treated with external beam radiotherapy and high dose rate conformal image guided brachytherapy with curative intent. Follow-up data relating to sites of failure and toxicity was recorded prospectively. RESULTS: Two hundred and ninety-two patients were available for analyses. The median (interquantile range) follow-up time was 4.1 years (range, 2.4 to 6.1 years). Five-year failure free survival and overall survival (OS) were 66% and 65%, respectively. Primary, pelvic, para-aortic, and distant failure were observed in 12.5%, 16.4%, 22%, and 23% of patients, respectively. In multivariate analysis, tumor volume and nodal disease related to survival, whereas local disease control and point A dose did not. CONCLUSION: Ultrasound guided conformal brachytherapy of cervix cancer has led to optimal local control and OS. The Melbourne protocol compares favorably to the more technically elaborate and expensive GEC-ESTRO recommendations. The Melbourne protocol's technical simplicity with real-time imaging and treatment planning makes this a method of choice for treating patients with cervical cancer.
Adenocarcinoma/pathology/radiography/secondary/ultrasonography ; Adult ; Aged ; Brachytherapy/adverse effects/*methods ; Carcinoma, Squamous Cell/pathology/radiography/secondary/ultrasonography ; Female ; Follow-Up Studies ; Humans ; Kaplan-Meier Estimate ; Lymphatic Metastasis ; Middle Aged ; Neoplasm Staging ; Prognosis ; Prospective Studies ; Radiation Dosage ; Radiotherapy, Conformal/adverse effects/*methods ; Treatment Failure ; Ultrasonography, Interventional/*methods ; Uterine Cervical Neoplasms/pathology/*radiography/ultrasonography

Synchronous primary lung cancers are relatively rare. The accurate diagnosis remains challenging, despite of the routine use of bronchoscopy and computed tomography (CT) of the chest. Herein we report a case of synchronous triple primary cancers of the right lung in a 72-year-old male patient in whom each tumor presented distinct CT imaging findings.
Adenocarcinoma/*diagnosis/pathology/radiography ; Adenocarcinoma, Mucinous/*diagnosis/pathology/radiography ; Aged ; Bronchoscopy ; Carcinoma, Squamous Cell/*diagnosis/pathology/radiography ; Diagnosis, Differential ; Humans ; Lung Neoplasms/*diagnosis/pathology/radiography ; Male ; Neoplasm Staging ; Neoplasms, Multiple Primary ; Positron-Emission Tomography ; Tomography, X-Ray Computed

OBJECTIVE: To describe computed tomography (CT) features of metastatic gallbladder (GB) tumors (MGTs) from various primary tumors and to determine whether there are differential imaging features of MGTs according to different primary tumors. MATERIALS AND METHODS: Twenty-one patients who had pathologically confirmed MGTs and underwent CT were retrospectively enrolled. Clinical findings including presenting symptoms, type of surgery, and interval between primary and metastatic tumors were recorded. Histologic features of primary tumor and MGTs including depth of invasion were also reviewed. Imaging findings were analyzed for the location and morphology of MGTs, pattern and degree of enhancement, depth of invasion, presence of intact overlying mucosa, and concordance between imaging features of primary and metastatic tumors. Significant differences between the histologies of MGTs and imaging features were determined. RESULTS: The most common primary tumor metastasized to the GB was gastric cancer (n = 8), followed by renal cell carcinoma (n = 4) and hepatocellular carcinoma (n = 3). All MGTs (n = 21) manifested as infiltrative wall thickenings (n = 15) or as polypoid lesions (n = 6) on CT, similar to the features of primary GB cancers. There were significant differences in the morphology of MGTs, enhancement pattern, enhancement degree, and depth of invasion according to the histology of primary tumors (p < 0.05). Metastatic adenocarcinomas of the GB manifested as infiltrative and persistently enhancing wall thickenings, while non-adenocarcinomatous metastases usually manifested as polypoid lesions with early wash-in and wash-out. CONCLUSION: Although CT findings of MGTs are similar to those of primary GB cancer, they are significantly different between the various histologies of primary tumors.
Adenocarcinoma/pathology/radiography/secondary ; Adult ; Aged ; Carcinoma, Hepatocellular/pathology/radiography/secondary ; Carcinoma, Renal Cell/pathology/radiography/secondary ; Carcinoma, Squamous Cell/pathology/radiography/secondary ; Diagnosis, Differential ; Female ; Gallbladder Neoplasms/pathology/*radiography/*secondary ; Humans ; Kidney Neoplasms/pathology ; Liver Neoplasms/pathology ; Male ; Melanoma/pathology/radiography/secondary ; Middle Aged ; Neoplasm Invasiveness/radiography ; Retrospective Studies ; Stomach Neoplasms/pathology ; *Tomography, X-Ray Computed

Vesicoenteric fistula is a rare complication of bladder squamous cell carcinoma. We report the case of a 70-year-old male who complained of painless, total gross hematuria. Abdominopelvic computed tomography (CT) revealed an approximately 2.7-cm lobulated and contoured enhancing mass in the bladder dome. We performed partial cystectomy of the bladder dome after transurethral resection of the bladder. The biopsy result was bladder squamous cell carcinoma, with infiltrating serosa histopathologically, but the resection margin was free. Postoperatively, follow-up CT was done after 3 months. Follow-up CT revealed an approximately 4.7-cmx4.0-cm lobulated, contoured, and heterogeneous mass in the bladder dome. A vesicoenteric fistula was visible by cystography. Here we report this case of a vesicoenteric fistula due to bladder squamous cell carcinoma.
Aged ; Carcinoma, Squamous Cell/*complications/pathology/radiography ; Fatal Outcome ; Humans ; Intestinal Fistula/*etiology/radiography ; Male ; Sigmoid Diseases/*etiology/radiography ; Tomography, X-Ray Computed ; Urinary Bladder Fistula/*etiology/radiography ; Urinary Bladder Neoplasms/*complications/pathology/radiography

Basaloid squamous cell carcinoma is a rare and aggressive variant of squamous cell carcinoma, which mostly occurs in the upper aerodigestive tracts. Basaloid squamous cell carcinoma also typically arises in the anal canal, but is extremely rare in the lower gastrointestinal tract. A 70-year-old man presented with loose stool and intermittent hematochezia 2 months ago. Colonoscopy showed an ulceroinfiltrative mass on the rectosigmoid colon from 16 cm to 18 cm above the anal verge. Conventional colonoscope could not pass through the lesion but it was possible with pediatric colonoscope. Abdominal CT scan showed 1.6 cm sized wall thickening with circumferential luminal narrowing in the rectosigmoid colon and multiple ill-defined low density masses in both lobes of the liver. Therefore, colon cancer with liver metastasis was suspected. However, basaloid cells were noted on histologic examination, and they were weakly positive for synaptophysin on immunohistochemical study. After palliative lower anterior resection, histologic examination of the resected specimen revealed basaloid differentiation with keratin pearls, and tumor cells were positively stained with high molecular weighted cytokeratin (34BE12) and CK 5/6. Thus, the patient was finally diagnosed with basaloid squamous cell carcinoma of rectosigmoid colon with distant metastases.
Aged ; Carcinoma, Squamous Cell/*diagnosis/pathology/surgery ; Colonoscopy ; Colorectal Neoplasms/*diagnosis/pathology/surgery ; Humans ; Immunohistochemistry ; Keratins/metabolism ; Liver Neoplasms/radiography/secondary ; Lung Neoplasms/radionuclide imaging/secondary ; Male ; Positron-Emission Tomography ; Synaptophysin/metabolism ; Tomography, X-Ray Computed

Adenocarcinoma ; diagnosis ; pathology ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Biopsy, Needle ; methods ; Carcinoma, Squamous Cell ; diagnosis ; pathology ; False Negative Reactions ; Female ; Granuloma ; diagnosis ; pathology ; Humans ; Lung Diseases ; diagnosis ; pathology ; Lung Neoplasms ; diagnosis ; pathology ; Male ; Middle Aged ; Radiography, Interventional ; Tomography, X-Ray Computed ; Tuberculosis, Pulmonary ; diagnosis ; pathology ; Young Adult

BACKGROUND AND OBJECTIVEThe level-Ib lymph node metastasis is rare in nasopharyngeal carcinoma (NPC). When and how this level should be irradiated with precise radiotherapy remains controversial. This study evaluated the prevalence and prognostic significance of level-Ib lymphadenopathy on the prognosis of NPC patients.

METHODSFrom January 1990 and December 1999, 933 newly diagnosed patients with NPC treated at Sun Yat-sen University Cancer Center were randomly selected, examined with computed tomography (CT) imagining for evidence of level-Ib lymphadenopathy before treatment. All patients received radical radiotherapy with or without chemotherapy. The relationship between level-Ib lymphadenopathy and post-treatment outcomes including overall survival (OS), locoregional recurrence-free survival (LRFS), and distant metastasis-free survival (DMFS) were analyzed using Kaplan-Meier methods. The Cox proportional hazards regression model was used to adjust for other prognostic factors.

RESULTSOf the 933 patients, 55 (5.9%) were found to have level-Ib lymphadenopathy, which was associated with carotid sheath involvement, oropharynx involvement and levels, and lateral cervical lymph node involvement. In the subgroup with carotid sheath involvement, with multivariate analysis accounting for all previously known prognostic factors, level-Ib lymphadenopathy was still associated with a risk of decreased OS (RR, 2.124; P<0.001), DMFS (RR, 2.168; P<0.001), and LRFS (RR, 1.989; P=0.001).

CONCLUSIONLevel-Ib lymphadenopathy in the patients with carotid sheath involvement is an independent prognostic factor.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Carcinoma, Squamous Cell ; diagnostic imaging ; drug therapy ; pathology ; radiotherapy ; Chemotherapy, Adjuvant ; Child ; Cobalt Radioisotopes ; therapeutic use ; Female ; Humans ; Lymph Nodes ; pathology ; Lymphatic Metastasis ; Male ; Middle Aged ; Nasopharyngeal Neoplasms ; diagnostic imaging ; drug therapy ; pathology ; radiotherapy ; Neck ; pathology ; Neoplasm Metastasis ; Neoplasm Recurrence, Local ; Particle Accelerators ; Pharynx ; pathology ; Prognosis ; Proportional Hazards Models ; Radiography ; Radioisotope Teletherapy ; Retrospective Studies ; Survival Rate ; Young Adult

OBJECTIVETo evaluate the accuracy of radiographic examination, endoscopic examination and clinical response evaluation criteria in staging for esophageal carcinoma after preoperative chemoradiation therapy(pre-CRT).

METHODSTwenty-seven patients of locally advanced esophageal squamous cell carcinoma were involved. CT scan for cervical part, chest and abdomen, and endoscopic ultrasound(EUS), electronic fibrobroncoscopic examination were used to assess the tumor for staging before pre-CRT. The tumors were re-assessed using the same methods after the completion of CRT. Response evaluation criteria in solid tumors(RECIST) was used to assess the tumor response. Surgery was carried out 3 to 6 weeks after CRT. The clinical tumor response before surgery was compared with pathological tumor response after surgery. Micrometastasis detection was carried out for paraffin embedded lymph nodes using anti-keratin monoclonal marker AE1 and AE3 by immunohistochemical(IHC) method.

RESULTSThe accuracy of CT scan in staging after pre-CRT was 40.9%(9/22) for primary tumors and 68.2%(15/22)for lymph nodes, with overall accuracy of 40.9%(9/22) for TNM staging. The accuracy of EUS in staging was 38.5%(5/13) for primary tumors and 69.2%(9/13) for lymph nodes, with overall accuracy of 38.5%(5/13)for TNM staging. While CT scan combined with EUS, the accuracy for TNM staging was 46.2%(6/13). Five cases achieved CR, 14 cases achieved PR and 8 cases achieved SD according to RECIST. Among 5 clinical CR cases, 3 cases were confirmed by pathologic examination, 1 case was diagnosed as pT(3)N(1) disease by HE stain. One case with pT(0)N(0) disease by HE stain was detected with lymph node micrometastasis by IHC. Among 5 pathological CR cases, 3 cases were diagnosed as clinical CR, 2 cases were diagnosed as clinical PR before surgery. Among 15 cases of N(0) disease by HE stain, 3 lymph nodes from 2 cases were detected with micrometastasis by IHC.

CONCLUSIONSThe current examinations(barium swallow, CT scan,EUS, endoscopy guided biopsy) and RECIST are not accurate enough to assess the tumor response for esophageal squamous cell carcinoma after pre-CRT. Surgery should be recommended for patients with clinical CR after pre-CRT.

Aged ; Carcinoma, Squamous Cell ; diagnostic imaging ; pathology ; therapy ; Chemotherapy, Adjuvant ; Esophageal Neoplasms ; diagnostic imaging ; pathology ; therapy ; Female ; Humans ; Male ; Middle Aged ; Neoplasm Staging ; Preoperative Care ; Radiography ; Radiotherapy, Adjuvant ; Treatment Outcome

CT and MRI are utilized to differentiate between different types of masses and to determine the extent of lesions involving the lacrimal gland and the fossa. Although many diseases that affect the lacrimal gland and fossa are specifically diagnosed by imaging, it is frequently very difficult to differentiate each specific disease on the basis of image characteristics alone due to intrinsic similarities. In lacrimal gland epithelial tumors, benign pleomorphic adenomas are seen most commonly with a well defined benign appearance, and a malignant adenoid cystic carcinoma is seen with a typical invasive malignant appearance. However, a malignant myoepithelial carcinoma is seen with a benign looking appearance. Lymphomatous lesions of the lacrimal gland include a broad spectrum ranging from reactive hyperplasia to malignant lymphoma. These lesions can be very difficult to differentiate both radiologically and pathologically. Generally, lymphomas tend to occur in older patients. The developmental cystic lesions found in the lacrimal fossa such as dermoid and epidermoid cysts can be diagnosed when the cyst involves the superior temporal quadrant of the orbit and manifests as a non-enhancing cystic mass and, in case of a lipoma, it is diagnosed as a total fatty mass. However, masses of granulocytic sarcoma and xanthogranuloma, as well as vascular masses, such as a hemangiopericytoma, are difficult to diagnose correctly on the basis of preoperative imaging findings alone. A careful clinical evaluation and moreover, a pathologic verification, are needed. In this pictorial review, the various imaging spectrums of pathologic masses involving the lacrimal gland and fossa are presented, along with appropriate anatomy and pathology reviews.
Carcinoma, Squamous Cell/radiography ; Conjunctival Neoplasms/radiography ; Cysts/radiography ; Eye Neoplasms/*radiography ; Hemangiopericytoma/radiography ; Humans ; Lacrimal Apparatus/*pathology ; Lacrimal Apparatus Diseases/radiography ; Lipoma/radiography ; Lymphoma/radiography ; Neoplasms, Glandular and Epithelial/radiography ; Neurofibroma/radiography ; Sarcoma, Myeloid/radiography

OBJECTIVEThe aim of this study is to investigate the release of TNF-alpha mRNA in two lung cancer cell lines in vitro and the regulation of TNF-alpha mRNA expression by ionizing radiation.

METHODSTwo lung cancer cell lines (A549 and NCI-H596) were investigated for their TNF-alpha mRNA expression before and after exposure to different irradiation doses (2, 5, 10, 20, 30 and 40 Gy) and at different time intervals (1, 3, 6, 12, 24, 48 and 72 hours after irradiation). The TNF-alpha mRNA expression was quantified by fluorescence-based real-time quantitative RT-PCR. Colony formation assays were performed after irradiation with a dose of 2, 4, 6, and 8 Gy to determine the clonogenic survival.

RESULTSDependent on the dose given, irradiation was found to cause increasing induction of TNF-alpha mRNA expression of NCI-H596 cells, reaching maximal level after 40 Gy irradiation, which was 83 times higher than that of normal controls. On the other hand, dependent on the time after irradiation, TNF-alpha mRNA expression of NCI-H596 and A549 cells was increased, reaching maximal level at 6h for NCI-H596 cells, which was 568 times higher than that of normal control cells. TNF-alpha mRNA expression of A549 cells was increased to maximum at 1 h after irradiation and was 136 times higher than that of control cells. Colony formation efficiency (number of colonies divided by the number of inoculated cells) of unirradiated control A549 and NCI-H596 cells was 0.37-0.45 and 0.12-0.24, respectively. The survival fraction (SF) of A549 cells was 47.3% +/- 9.0% at 2 Gy, 18.0% +/- 3.0% at 4 Gy, 6.0% +/- 2.0% at 6 Gy, 1.4% +/- 0.3% at 8 Gy. The SF of NCI-H596 cells was 55.2% +/- 51.0% at 2 Gy, 15.9% +/- 9.2% at 4 Gy, 3.5% +/- 1.7% at 6 Gy; 0.9% +/- 0.6% at 8 Gy. The curves of TNF-alpha expression of the two tumor cell lines were nearly identical, therefore the radiosensitivity of these cell lines was similar. Statistically there was no significant difference for D(0) and D(q) (P > 0.05).

CONCLUSIONThe two lung cancer cell lines studied express TNF-alpha following irradiation in a time- and irradiation dose-dependent manner. Radiation-induced TNF-alpha production of tumor cells may be of paramount importance not only for tumor behaviour, but also in respect to potential damage to normal tissues and the clinical status of the host.

Adenocarcinoma ; diagnostic imaging ; metabolism ; pathology ; Carcinoma, Squamous Cell ; diagnostic imaging ; metabolism ; pathology ; Cell Line, Tumor ; Humans ; Lung Neoplasms ; diagnostic imaging ; metabolism ; pathology ; RNA, Messenger ; biosynthesis ; genetics ; Radiation Dosage ; Radiography ; Reverse Transcriptase Polymerase Chain Reaction ; Tumor Necrosis Factor-alpha ; biosynthesis ; genetics