Prognostic factors for brain metastases from non-small cell lung cancer with EGFR mutation: influence of stable extracranial disease and erlotinib therapy.

The aim of this study was to explore prognostic factors for non-small cell lung cancer (NSCLC) patients with brain metastases (BM) on the basis of EGFR mutation status. Among 779 consecutive NSCLC patients who underwent EGFR mutation screening, all 197 patients with BM were divided according to the EGFR mutation status. The prognostic factors, including patient characteristics at the time of BM diagnosis, treatment history, and radiologic features, were analyzed. Of 197 patients with BM, 108 had wild-type EGFR and 89 had EGFR mutation. The patients with EGFR mutation presented longer overall survival after BM diagnosis (OS) than those with wild-type EGFR, regardless of whether BM was synchronous or metachronous. For the patients with EGFR mutation, favorable prognostic factors in multivariate analysis were age<65 (p=0.037), good performance status (PS) (p<0.0001), cranial radiotherapy (p=0.020), previous chemotherapy≤1 regimen (p=0.009), stable extracranial disease at BM diagnosis (p=0.022), and erlotinib therapy after BM diagnosis (p=0.0015). On the other hand, favorable prognostic factors for the patients with wild-type EGFR were only good PS (p=0.0037) and cranial radiotherapy (p=0.0005). Among patients treated with erlotinib after BM diagnosis, the patients with exon 19 deletion showed longer OS than those with exon 21 point mutation (p=0.019). The prognostic factors for NSCLC patients with BM were different according to the EGFR mutation status. Particularly in NSCLC patients with EGFR mutation and stable extracranial disease, regular cranial evaluation for detecting asymptomatic BM would lead to good prognosis. In addition, erlotinib therapy would be preferable in NSCLC patients with BM and EGFR mutation, especially those with exon 19 deletion.

CT assessment of breast cancer for pathological involvement of four or more axillary nodes.

BACKGROUND: To predict the likelihood of ≥4 pathologically positive axillary nodes in breast cancer patients by computed tomography (CT) before neoadjuvant chemotherapy (NAC). METHODS: Inclusion criteria for the 97 patients reviewed were lymph nodes (LNs) pathologically proved positive with standard level I-II axillary dissection, contrast-enhanced CT was performed before surgery, contralateral breast cancer was not present, and NAC was not given before surgery. The size, number, and level of both ipsilateral and contralateral axillary LNs were studied by contrast-enhanced high-resolution CT for pathologically positive LNs in breast cancer patients. RESULTS: Level III LN was only detected in ipsilateral axilla of patients with ≥4 pathologically involved nodes. The number of ipsilateral level I-II LNs is the only factor significantly related to the pathological involvement of ≥4 axillary nodes. Increasing numbers of contralateral level I-II LNs are significantly related to increasing numbers of ipsilateral level I-II LNs. For the criterion of maximal LN size ≥5 mm, if contralateral level I-II LNs were negative and the cutoff points for ipsilateral level I-II LNs were 0-2 and ≥3, the sensitivity and specificity for ≥4 pathologically involved nodes would be 84.6 and 73.3%. If contralateral I-II LNs were positive, the negative predictive value was 80.0%. CONCLUSION: Level III LN detection in ipsilateral axilla and the number of level I-II LNs in bilateral axilla will be helpful to predict ≥4 pathologically positive axillary nodes.

Transarterial ethanol ablation for sporadic and non-hemorrhaging angiomyolipoma in the kidney.

PURPOSE: We evaluated the efficacy and side effects of transarterial ethanol ablation in sporadic and non-hemorrhaging angiomyolipomas (AMLs) in the kidney. MATERIAL AND METHODS: A total of 10 patients with solitary and sporadic AMLs underwent selective transarterial absolute ethanol ablation for prophylaxis against hemorrhage. We confirmed the ratio areas of tumor vessel on angiogram, those of infraction on post-ablation computed tomography (CT) and those of tumor reduction in a 3-, 6- and 12-month follow-up CT. RESULTS: Once or twice a single infusion of 1 or 2 ml absolute ethanol achieved in a total occlusion of 22 feeding arteries which consisted of 7 proximal interlobar arteries, 12 distal interlobar arteries and 3 renal capsular arteries. Nontarget occlusion did not occur by ethanol reflux in any cases but occurred causing spasms provoked by repeated inflation and deflation of the balloon in one case. Total occlusion of tumor vessels was observed in 7 patients and 92-95% occlusion in 3. Ethanol ablation produced 1.8-22.5% (mean 8.4+/-6.8%) areas of infarctions but the outcome was not serious in all cases. Mean percentage areas of tumor reduction were 29.4+/-10.6% in a 3-month follow-up, 45.7+/-11.9% in a 6-month and 59.3+/-11.5% in a 12-month follow-up. CONCLUSIONS: Absolute ethanol ablation for sporadic and non-hemorrhaging AML is safe and effective in reducing majority of tumor area in a 1-year follow-up.

Extensive lipomatosis of the small bowel and mesentery: CT and MRI findings.

We report a patient with extensive lipomatosis involving both the ileum and mesentery. Axial computed tomographic images showed that diffuse and multiple intramural masses of fat densities compressed the ileum interior and abundant mesenteric fat compressed the retroperitoneum. Coronal magnetic resonance images showed thumbprinting of fluid containing ileum caused by fat-intensity masses.

Right double inferior vena cava: Report of 5 cases and literature review.

OBJECTIVE: To describe the computed tomography appearance, embryology, and clinical implications of right double inferior vena cava (IVC). METHODS: Computed tomography imaging findings were retrospectively reviewed in our 5 patients and in 2 cases reported in the literature with right double IVC. The relationship of the 2 postrenal IVCs, their diameter, level of confluence of the 2 IVCs, course of the left common iliac vein, draining site of the right gonadal vein, and the presence of retrocaval ureter were evaluated. RESULTS: In all cases, the relationship of 2 IVCs was ventral-dorsal, and the left common iliac vein passed ventral to the aortic bifurcation or the right common iliac artery. The relationship of the diameters and level of confluence of the 2 IVCs were variable. The right gonadal vein drained into the ventral vessel in 4 cases and into the IVC between the renal venous confluence and the confluence of the 2 vessels in 1 case. In all cases, the retrocaval ureter was not identified. CONCLUSIONS: Characteristic computed tomography findings of right double IVC were a ventral-dorsal relationship between the 2 vessels and the unusual course of the left common iliac vein. Embryologically, the ventral vessel originates from the right subcardinal vein, whereas the dorsal vessel originates from the right supracardinal vein. Although this anomaly is extremely rare, radiologists should recognize it.

Substrate specificity of aminopeptidase from the mid-gut gland of the scallop (Patinopecten yessoensis).

An action for various peptides and a kinetic study for amino acid p-nitroanilides (pNAs) and 4-methylcoumaryl-7-amides (MCAs) were performed with purified aminopeptidase from the mid-gut of the scallop. The enzyme preferred dipeptides having Ala, Met, and Phe in the amino-terminal or the penultimate position from the amino-termini. The catalytic efficiencies, k(cat)/K(m) values for Ala-pNA and MCA were the highest in the tested substrates, and those for pNA and MCA substrates having Met or Phe were the next highest. The enzyme was found to be a new alanine-specific aminopeptidase.

Purification and properties of an aminopeptidase from the mid-gut gland of scallop (Patinopecten yessoensis).

An aminopeptidase was isolated from the mid-gut gland of Patinopecten yessoensis. The enzyme was purified from an acetone-dried preparation by extracting, ammonium sulfate precipitation, Hi-Load Q column chromatography, isoelectric focusing, and POROS HP2 and HQ column chromatography. The molecular weight of the enzyme was estimated to be 61 kDa by SDS-polyacrylamide gel electrophoresis and 59 kDa by gel permeation chromatography. The isoelectric point of the enzyme was 5.2 and the optimum pH was 7.0 toward leucine p-nitroanilide (Leu-pNA). The enzyme was inhibited by o-phenanthroline. The activity of the enzyme treated with o-phenanthroline was completely recovered by adding excess Zn(2+). Relative hydrolysis rates of amino acid-pNAs and amino acid-4-methylcoumaryl-7-amides (amino acid-MCAs) indicated that the enzyme preferred substrates having Ala or Met as an amino acid residue. The enzyme had a K(m) of 32.2 microM and k(cat) of 29.5 s(-1) with Ala-pNA and a K(m) of 11.1 microM and k(cat) of 9.49 s(-1) with Ala-MCA. The enzyme sequentially liberated amino acids from the amino-termini of Ala-Phe-Tyr-Glu.