Publications by authors named "Tony W H Shek"

35 Publications

Case report on metastatic pelvic bone tumor treated with frozen autograft by liquid nitrogen.

Int J Surg Case Rep 2021 May 27;82:105910. Epub 2021 Apr 27.

Department of Orthopaedics and Traumatology, Queen Mary Hospital, The University of Hong Kong Pokfulam, Hong Kong.

Introduction And Importance: Frozen autograft recycling has been used for biological reconstruction of bone defects following tumor excision, more commonly in extremities. We report on the histological outcome of a pelvic recycled frozen autograft.

Case Presentation: We investigated the pelvic frozen autograft removed in 2 years and 8 months after surgery because of soft tissue recurrence in pelvic floor. The autograft bone showed no evidence of revitalization and was non-viable with patchy inflammation, and no residual tumor. There was only fibrous union but the autograft bone remained mechanically stable.

Clinical Discussion: We confirmed the clearance of tumor cells with the treatment with liquid nitrogen. The union at the host-graft junction might be affected by the previous radiotherapy, the presence of infection, the small contact area limited by the anatomy, and the inadequate compression across the osteotomy interface with the fixation.

Conclusion: Frozen autograft treated by liquid nitrogen can be used safely for biological reconstructions after pelvic tumor excision.
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http://dx.doi.org/10.1016/j.ijscr.2021.105910DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8113746PMC
May 2021

Effect of Thyroid Remnant Volume on the Risk of Hypothyroidism After Hemithyroidectomy: A Prospective Study.

Ann Surg Oncol 2017 Jun 5;24(6):1525-1532. Epub 2017 Jan 5.

Department of Anatomical Pathology, The University of Hong Kong, Hong Kong, China.

Background: Hypothyroidism is a common sequel after a hemithyroidectomy. Although various risk factors leading to hypothyroidism have been reported, the effect of the contralateral lobe's volume has been understudied. This study aimed to examine the association between the preoperative contralateral lobe's volume and the risk of postoperative hypothyroidism.

Methods: During a 2-year period, 150 eligible patients undergoing a hemithyroidectomy were evaluated. The volume of the contralateral nonexcised lobe was estimated preoperatively by independent assessors on ultrasonography using the following formula: width (in cm) × depth (in cm) × length (in cm) × (π/6), adjusted for the body surface area (BSA). Postoperative hypothyroidism was defined as serum thyroid-stimulating hormone (TSH) exceeding 4.78 mIU/L. Any significant characteristics in the univariate analysis were entered into the multivariate analysis to determine independent factors.

Results: After a mean follow-up period of 53.5 ± 9.4 months, 44 patients (29.3 %) experienced postoperative hypothyroidism, and 10 of these patients required thyroxine replacement. Hypothyroidism was associated with a higher preoperative TSH level (p < 0.001), a smaller BSA-adjusted volume (p < 0.001), fewer ipsilateral nodules (p = 0.037), and the presence of thyroiditis (p = 0.050). After adjustment for thyroiditis, preoperative TSH (p < 0.001), number of ipsilateral nodules (p = 0.048), and BSA-adjusted volume (p < 0.001) were independent factors for hypothyroidism. Patients with a BSA-adjusted volume smaller than 3.2 ml had a threefold greater hypothyroidism risk than those with a BSA-adjusted volume of 3.2 ml or more (p < 0.001).

Conclusions: A significant inverse association between the preoperative contralateral lobe's volume and hypothyroidism risk was observed after hemithyroidectomy. Together with a higher preoperative TSH level and fewer ipsilateral nodules, a smaller BSA-adjusted volume measured by preoperative ultrasonography independently predicted hypothyroidism.
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http://dx.doi.org/10.1245/s10434-016-5743-9DOI Listing
June 2017

The total number of tissue blocks per centimetre of tumor significantly correlated with the risk of distant metastasis in patients with minimally invasive follicular thyroid carcinoma.

Endocrine 2017 Feb 7;55(2):496-502. Epub 2016 Dec 7.

Department of Clinical Oncology, The University of Hong Kong, Hong Kong, SAR, China.

Background: Given that careful histological examination plays a pivotal role in follicular thyroid carcinoma categorization, we hypothesize that the number of blocks taken at initial specimen review may be associated with survival outcomes of patients initially diagnosed with minimally invasive follicular thyroid carcinoma.

Methods: A total of 162 patients with confirmed minimally invasive follicular thyroid carcinoma were analyzed. The number of tissue blocks taken from each patient was recorded and the number of blocks per each centimeter of tumor was calculated. A multivariate analysis was conducted to identify independent factors for distant metastasis-free survival.

Results: After a mean follow-up of 197.88 ± 155.39 months, 7 (4.3%) patients developed distant metastasis during follow-up (group II). Relative to those who remained disease-free (group I), group II were significantly older at initial operation (p = 0.022), had larger tumors (p = 0.002) and fewer number of blocks taken/cm of tumor (p = 0.001). However, after adjusting for age at initial operation and tumor size, total number of tissue blocks taken/cm of tumor was the only independent determinant for distant metastasis-free survival (p = 0.049). The 10-year distant metastasis-free survival was significantly better in those who had ≥ 4 blocks/cm of tumor (n = 82) than those with ≤ 3 block/cm of tumor (n = 80) (100 vs. 84.7%, p = 0.005, by log rank).

Conclusions: Although our study was not able to identify the precise cause for the association between the total number of tissue blocks taken/cm of tumor and distant metastasis-free survival, our data support a more liberal approach in taking tissue blocks on thyroid nodules especially those showing well-differentiated follicular cell differentiation.
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http://dx.doi.org/10.1007/s12020-016-1188-yDOI Listing
February 2017

Significance of Size of Persistent/Recurrent Central Nodal Disease on Surgical Morbidity and Response to Therapy in Reoperative Neck Dissection for Papillary Thyroid Carcinoma.

Thyroid 2017 01 14;27(1):67-73. Epub 2016 Nov 14.

4 Department of Clinical Oncology, The University of Hong Kong , Hong Kong SAR, China .

Background: To balance the risk of disease progression, morbidity, and efficacy of reoperative central neck dissection (RCND) in papillary thyroid carcinoma, the latest clinical guidelines recommend early surgery over surveillance when the largest diseased node is >8 mm in its smallest dimension. However, the evidence remains scarce. To determine an appropriate size for first-time RCND, the relationship between size of largest diseased central node, morbidity, and response-to-therapy following RCND was examined.

Methods: A total of 130 patients who underwent RCND following initial surgery for persistent/recurrent nodal disease were reviewed. Patients with largest diseased central node measured preoperatively by ultrasonography were included. Eligible patients were categorized into three groups: largest central node <10 mm (group I), 10-15 mm (group II), and >15 mm (group III). Surgical morbidity and response to therapy at one year after RCND were compared between groups. To evaluate biochemical response, patients with structural incompleteness were excluded.

Results: Group III not only had significantly more high-risk tumors (by American Thyroid Association risk stratification) at initial therapy (64.5% vs. 44.4%, respectively; p = 0.038), but this group also a higher risk of extranodal extension (35.5% vs. 16.0%; p = 0.055), recurrent laryngeal nerve involvement (19.4% vs. 0.0%; p < 0.001), incomplete surgical resection (48.4% vs. 7.4%; p < 0.001), new-onset vocal cord paresis (16.7% vs. 2.5%; p = 0.017), overall surgical morbidity (22.6% vs. 7.4%; p = 0.021), and biochemical incompleteness (80.6% vs. 67.9%; p = 0.004) than groups I and II combined did. However, overall morbidity did not differ between groups I and II (5.7% vs. 8.7%; p = 0.694). After adjusting for American Thyroid Association risk stratification, only the size of the largest diseased central node ≥15 mm (odds ratio = 7.256 [confidence interval 1.302-40.434], p = 0.001) was an independent risk factor for biochemical incompleteness following RCND.

Conclusions: Patients with larger diseased central node(s) had a significantly higher risk of local invasion, surgical morbidity, and biochemical incompleteness. Relative to nodal size <10 mm, size >15 mm in the largest disease central node was an independent risk factor for incomplete biochemical response, while nodal size 10-15 mm was not. These findings imply that the recommended threshold of 8 mm might be too stringent and could be raised to 15 mm without increasing the surgical morbidity from RCND.
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http://dx.doi.org/10.1089/thy.2016.0337DOI Listing
January 2017

The significance of unrecognized histological high-risk features on response to therapy in papillary thyroid carcinoma measuring 1-4 cm: implications for completion thyroidectomy following lobectomy.

Clin Endocrinol (Oxf) 2017 Feb 1;86(2):236-242. Epub 2016 Sep 1.

Department of Clinical Oncology, The University of Hong Kong, Hong Kong SAR, China.

Background: Although lobectomy is an alternative to total thyroidectomy (TT) for 1-4 cm papillary thyroid carcinoma (PTC) without high-risk features (HRFs) such as aggressive histology, vascular invasion, lymphovascular invasion (LVI), microscopic extrathyroidal extension, positive margin, nodal metastasis >5 mm and multifocality, these HRFs are not recognized until after surgery. Therefore, the chance of completion TT being required following lobectomy might be high. We evaluated the frequency of unrecognized HRFs and how they affected the response to therapy following TT and radioiodine (RAI).

Methods: Altogether, 1513 patients were analysed. Only 1-4 cm PTCs without recognizable HRFs were included. For response-to-therapy evaluation, only patients who had TT and post-RAI-stimulated thyroglobulin were analysed. Patients without an excellent response were defined as having 'incomplete response'. A multivariate analysis for incomplete response was performed.

Results: Of the 600 patients eligible for lobectomy, 257 (42·8%) had ≥1 unrecognized histological HRF before surgery. The prevalence of unrecognized HRFs was similar between 1-2 cm and >2-4 cm PTCs (P = 0·393). Of the 330 patients eligible for response-to-therapy evaluation, 260 (78·8%) had an excellent response while 70 (21·2%) had an incomplete response. LVI was the only independent unrecognized HRF for incomplete response (P = 0·021).

Conclusions: The prevalence of unrecognized histological HRFs under the current recommendations is relatively high among 1-4 cm PTCs. Among the unrecognized histological HRFs, LVI was the only one which independently associated with an incomplete response (i.e. posing an increased risk of persistent/recurrent disease after curative surgery). These findings may have implications for patients who undergo lobectomy for 1-4 cm PTCs with no clinically recognizable HRFs under the current recommendations.
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http://dx.doi.org/10.1111/cen.13165DOI Listing
February 2017

Does microscopically involved margin increase disease recurrence after curative surgery in papillary thyroid carcinoma?

J Surg Oncol 2016 May 4;113(6):635-9. Epub 2016 Feb 4.

Department of Clinical Oncology, The University of Hong Kong, Hong Kong SAR, China.

Background: The prognostic significance of microscopically involved margin in papillary thyroid carcinoma (PTC) following curative surgery remains unclear. We aimed to evaluate the impact of an involved margin and its location (anterior vs. posterior) on disease recurrence.

Methods: Of the 638 eligible patients, 538 (85.9%) did not have an involved margin (group I) while 100 (14.1%) did (group II). The latter group was further classified according to its location relative to the surface of the thyroid gland (anterior or posterior). A multivariate analysis was conducted to identify independent factors for recurrence risk.

Results: After a mean of 130.1 ± 93.5 months, 22 patients had disease recurrence. The 10-year disease-free survival (DFS) was significantly worse in group II (95.0% vs. 97.0%, P = 0.011). After adjusting other significant factors, involved margin was not an independent risk factor for disease recurrence (P = 0.358). Compared to a negative margin, an anterior involved margin did not pose increased recurrence risk (HR = 1.21, 95%CI = 0.93-500.00, P = 0.368), whereas a posterior involved margin had almost 23 times higher recurrence risk (HR = 22.95; 95%CI = 4.33-121.70, P < 0.001).

Conclusions: Overall, a microscopically involved margin was not an independent factor for DFS. However, although an anterior involved margin itself did not increase disease recurrence, a posterior involved margin did. J. Surg. Oncol. 2016;113:635-639. © 2016 Wiley Periodicals, Inc.
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http://dx.doi.org/10.1002/jso.24194DOI Listing
May 2016

Impact of microscopic extra-nodal extension (ENE) on locoregional recurrence following curative surgery for papillary thyroid carcinoma.

J Surg Oncol 2016 Apr 21;113(5):526-31. Epub 2016 Jan 21.

Department of Clinical Oncology, The University of Hong Kong, Hong Kong SAR, China.

Background: The presence of microscopic extra-nodal extension (ENE) may increase locoregional recurrence (LRR) in papillary thyroid carcinoma (PTC). We aimed to evaluate the association between microscopic ENE, response to initial therapy and LRR risk following total thyroidectomy, therapeutic neck dissection, and radioactive iodine (RAI) ablation in PTC.

Methods: Of the 369 eligible PTC patients, 264 (71.5%) did not have microscopic ENE (group I) while 105 (28.5%) did (group II). All presented with clinical nodal metastasis (cN1) and underwent therapeutic neck dissection and RAI ablation. Biochemical incompleteness meant post-ablation stimulated thyroglobulin (sTg) >10 ng/ml. Multivariate analyses were conducted to identify independent factors for LRR.

Results: Biochemical incompleteness was significantly more common group II (43.8% vs. 17.4%, P < 0.05). The 10-year locoregional free-survival was significantly worse in group II than I (52.0% vs. 86.2%, P = 0.005). After adjusting for other significant factors, age <45 (P < 0.05), multifocality (P < 0.05), presence of ENE (P = 0.027) were independent risk factors of LRR. The number and size of positive lymph nodes were not independent factors.

Conclusions: Patients with microscopic ENE were significantly more likely to have biochemical incompleteness after initial therapy. After adjusting for other significant primary and nodal characteristics, microscopic ENE was an independent factor for LRR in patients with cN1. J. Surg. Oncol. 2016;113:526-531. © 2016 Wiley Periodicals, Inc.
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http://dx.doi.org/10.1002/jso.24180DOI Listing
April 2016

Macrophage activation syndrome leading to fatality in subcutaneous panniculitis-like T cell lymphoma.

Ann Hematol 2014 May 31;93(5):873-5. Epub 2013 Aug 31.

Department of Medicine, Queen Mary Hospital, Pokfulam Road, Hong Kong, China.

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http://dx.doi.org/10.1007/s00277-013-1888-9DOI Listing
May 2014

Association of exon 19 and 21 EGFR mutation patterns with treatment outcome after first-line tyrosine kinase inhibitor in metastatic non-small-cell lung cancer.

J Thorac Oncol 2013 Sep;8(9):1148-55

Department of Clinical Oncology, Queen Mary Hospital, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, PR China.

Background: This study investigated whether there were differential survival outcomes to first-line tyrosine kinase inhibitors (TKI) in patients with metastatic non-small-cell lung cancer harboring different subtypes of exon 19 and exon 21 mutations on epidermal growth factor receptor (EGFR).

Methods: Of 452 patients with stage IIIB and IV non-small-cell lung cancer, 192 patients (42.5%) harbored EGFR mutation and 170 (37.5%) received TKI as first-line treatment. EGFR mutation analysis was performed by direct sequencing. Survival and response outcome were compared among different subtypes of exon 19 and exon 21 EGFR mutations in these 170 patients.

Results: Patients harboring exon 19 18-nucleotide deletion (delL747_P753insS) had the shortest median progression-free survival (PFS) (6.5 months), followed by those with 15-nucleotide deletion (delE746_A750) (12.4 months) and mixed insertion/substitution mutations (22.3 months; p = 0.012). However, patients who had exon 19 deletions starting on codon E746 had better median PFS (14.2 months) than those starting on L747 (6.5 months; hazard ratio, 0.445; 95% confidence interval [0.219-0.903]; p = 0.021). Besides, exon 21 L858R derived a longer median PFS than L861R/L861Q (11.4 months versus 2.1 months, respectively; hazard ratio, 0.298; 95% confidence interval [0.090-0.980]; p = 0.034).

Conclusions: Different subtypes of EGFR exon 19 and 21 mutations exhibited differential survival to first-line TKI therapy. Detailed sequence evaluation of exon 19 deletions may provide important prognostic information on survival outcome after TKI.
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http://dx.doi.org/10.1097/JTO.0b013e31829f684aDOI Listing
September 2013

Diabetic mastopathy.

Breast J 2013 Sep-Oct;19(5):533-8. Epub 2013 Jul 29.

Department of Surgery, Queen Mary Hospital, Hong Kong, Hong Kong.

Diabetic mastopathy is an uncommon condition found in patients with long-standing diabetic mellitus (DM). Although benign in nature, it can sometimes not be distinguishable from breast carcinoma, and may lead to unnecessary anxiety or intervention. Clinicopathologic features of 10 patients were reviewed in detail. Only three of the 10 patients had type I DM. All patients had over a 10-year history of DM, and presented with unilateral, solitary, palpable breast mass, ranging in size from 1.5 to 5 cm. Radiologic and pathologic features of each patient were described. None of the patients in our series developed malignancy during the follow-up period. Diabetic mastopathy is a benign condition and not unique to type I DM. Surgeons should be aware of this distinct fibroinflammatory breast condition and its association with long-standing DM.
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http://dx.doi.org/10.1111/tbj.12158DOI Listing
June 2014

Asymptomatic grade-2 central chondrosarcoma of the distal femur with non-aggressive radiological features.

Hong Kong Med J 2013 Feb;19(1):85-7

Department of Orthopaedics and Traumatology, Queen Mary Hospital, Pokfulam, Hong Kong.

This paper discusses the case of a 57-year-old man with an incidental finding of a radiologically non-aggressive chondroid lesion and concomitant osteonecrosis in the left distal femur. The final resected specimen showed a grade-2 chondrosarcoma. This case illustrates that long-term follow-up is necessary for non-aggressive chondroid lesions. If surgical management is considered, resection with an adequate margin is superior to intralesional curettage.
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February 2013

Combined use of 18F-FDG PET/CT, DW-MRI, and DCE-MRI in treatment response for preoperative chemoradiation therapy in locally invasive rectal cancers.

Clin Nucl Med 2013 May;38(5):e226-9

Department of Diagnostic Radiology, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China.

We investigated if 18F-FDG PET/CT, DW-MRI, and DCE-MRI are able to predict preoperative chemoradiation therapy (CRT) response in patients with T3-4 rectal adenocarcinomas. MRI and PET/CT scans were performed within 1 week, at baseline, early midtreatment (2 weeks of CRT), and posttreatment (6 weeks after completing CRT). Responders (n = 4) and nonresponders (n = 4) were defined according to tumor regression grade by histology. Only SUVmax (P = 0.030) at early midtreatment could significantly differentiate between responders and nonresponders, suggesting that 18F-FDG PET/CT may be effective to predict early treatment response compared with DW-MRI and DCE-MRI in T3-4 rectal cancer.
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http://dx.doi.org/10.1097/RLU.0b013e318266ce52DOI Listing
May 2013

Factors affecting the adequacy of lymph node yield in prophylactic unilateral central neck dissection for papillary thyroid carcinoma.

J Surg Oncol 2012 Dec 20;106(8):966-71. Epub 2012 Jun 20.

Department of Surgery, The University of Hong Kong, Hong Kong SAR, China.

Background: Determinants for adequate lymph node yield (LNY) in prophylactic central neck dissection (pCND) for papillary thyroid carcinoma (PTC) remain unclear. We aimed to determine factors affecting LNY in pCND.

Methods: Of 230 patients, 109 (47.4%) had total thyroidectomy and unilateral pCND. A specimen of ≥ 6 central lymph nodes (CLNs) was considered adequate. Factors such as patient clinicopathologic features, specimen dimensions, and pathologists' experience were compared between those with LNY  <  6 (n = 52) and LNY  ≥  6 (n  =  57). A multivariate analysis was conducted to identify independent factors for LNY ≥  6.

Results: Age, sex, presentation, body mass index, tumor characteristics, TNM stages, MACIS score, and pathologist's experience were not significant determinants for LNY  ≥  6. In the univariate analysis, the length (P  =  0.021), width (P  = 0.047), thickness (P  =  0.024), and pN1a (P  =  0.042) were significant determinants but in the multivariate analysis, the length (OR  =  1.486 (95% CI: 1.053-2.097), P  =  0.024) was the only independent factor for LNY  ≥  6. Postoperative vocal cord palsy, hypoparathyroidism, stimulated thyroglobulin and recurrences were similar between LNY <6 and ≥ 6.

Conclusions: Length (or the longest measured dimension) of the fresh CLN specimen was the only factor assuring LNY ≥ 6. Surgical complications and short-term outcomes appeared similar between LNY <6 or ≥ 6.
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http://dx.doi.org/10.1002/jso.23201DOI Listing
December 2012

A sarcoma of 23 years' duration: symptom duration is not a reliable parameter to exclude malignancy.

Hong Kong Med J 2012 Jun;18(3):250-2

Department of Orthopaedics and Traumatology, Queen Mary Hospital, Pokfulam, Hong Kong.

This report describes a 31-year-old woman with a 23-year history of a right buttock mass that was otherwise asymptomatic, but was proven to be a low-grade fibromyxoid sarcoma (a fully malignant soft tissue tumour with a potential for distant metastasis). This case illustrates that a long-standing tumour does not necessarily imply a benign pathology. A vigilant approach should be taken for any tumours that are of significant size (larger than 5 cm).
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June 2012

Pictorial essay: imaging of peripheral nerve sheath tumours.

Can Assoc Radiol J 2011 Aug 26;62(3):176-82. Epub 2010 May 26.

Department of Diagnostic Radiology, Alexandra Hospital, Singapore, Republic of Singapore.

Peripheral nerve sheath tumours (PNST) may be benign or malignant. Benign PNSTs include neurofibroma and schwannoma. Neurogenic tumours share certain characteristic imaging features, suggested by a fusiform-shaped mass with tapered ends, the "split-fat" sign, atrophy of the muscles supplied by the involved nerve, the "fascicular sign," and the "target sign"; these imaging features are best demonstrated on magnetic resonance imaging. This pictorial essay emphasizes the characteristic signs and distinguishing features of PNSTs on imaging.
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http://dx.doi.org/10.1016/j.carj.2010.04.009DOI Listing
August 2011

Case 139: nasal septum low-grade chondrosarcoma.

Radiology 2008 Nov;249(2):714-7

Department of Radiology, Alexandra Hospital, Singapore.

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http://dx.doi.org/10.1148/radiol.2492040409DOI Listing
November 2008

Treatment outcome of rhabdomyosarcoma in Hong Kong Chinese children.

Hong Kong Med J 2008 Apr;14(2):116-23

Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong.

Objectives: To review the treatment outcome of rhabdomyosarcoma in Hong Kong Chinese children.

Design: Retrospective review.

Setting: University teaching hospital, Hong Kong.

Patients: Consecutive cases of rhabdomyosarcoma diagnosed and treated by the Department of Paediatrics and Adolescent Medicine of Queen Mary Hospital between 1989 and 2005. Each patient was staged and treated according to the Intergroup Rhabdomyosarcoma Study guidelines.

Main Outcome Measures: Overall and event-free survival rates, and toxicity data.

Results: Of 19 patients (8 males and 11 females), 14 (74%) were younger than 10 years old. The median age at diagnosis was 6 (range, 0.5-17) years. Primary sites of rhabdomyosarcoma included: the head and neck (n=8; 6 classified as cranial parameningeal), genitourinary (3), extremity (3), pelvis (3), and trunk (2). Thirteen (68%) had embryonal and six (32%) had alveolar histology. Two, 2, 9, and 6 were classified as belonging to Intergroup Rhabdomyosarcoma Study groups 1, 2, 3, and 4, respectively. Respective 5-year overall and event-free survival rates of the entire cohort were 49% (95% confidence interval, 26-73%) and 32% (10-55%), with a median follow-up of 3.4 (range, 0.2-16.7) years. In non-metastatic cases (Intergroup Rhabdomyosarcoma Study groups 1-3), the 5-year overall survival rate was 66% (95% confidence interval, 39-93%) and in metastatic cases (group 4) it was 17% (0-46%). The 5-year overall survival rate for patients aged less than 10 years was 60% (95% confidence interval, 33-87%) compared to 20% (0-55%) in those aged 10 years and over. Significant treatment-related toxicities including myelosuppression, infections, peripheral neuropathy, and second cancers were encountered.

Conclusions: Treatment outcome of rhabdomyosarcoma in this cohort of Chinese children was less favourable than that reported in international studies. Whilst the main reason could have been related to the high proportion of metastatic cases, also non-metastatic cases faired worse. Improved outcomes may be achieved by advances in multidisciplinary (paediatric oncology, pathology, radiotherapy, and surgery) management and supportive care.
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April 2008

Multiple myeloma with testicular involvement.

J Clin Oncol 2008 Mar;26(9):1558-9

Department of Medicine, Queen Mary Hospital, University of Hong Kong, Pokfulam Road, Hong Kong, China.

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http://dx.doi.org/10.1200/JCO.2007.15.1316DOI Listing
March 2008

High incidence of tuberculosis after alemtuzumab treatment in Hong Kong Chinese patients.

Leuk Res 2008 Apr 21;32(4):547-51. Epub 2007 Aug 21.

Department of Medicine, Queen Mary Hospital, Hong Kong, China.

Twenty-seven patients received the anti-CD52 monoclonal antibody alemtuzumab for hematologic malignancies and autoimmune cytopenias in a tuberculosis-endemic area. Seven patients developed mycobacterium tuberculosis (TB) infections (median: 4, 1-24, months from alemtuzumab). The actuarial 1- and 2-year incidence of TB was 31% and 45%. All patients had severe depression of lymphocyte counts subsequent to alemtuzumab treatment, and tuberculosis was extra-pulmonary in three cases. All seven patients had received prior chemotherapy/immunosuppression and tuberculosis had not occurred until alemtuzumab was administered. Patients receiving alemtuzumab in areas endemic for tuberculosis should have careful initial evaluation of TB exposure, so that prophylactic antibiotics might be administered. Tuberculosis reactivation should be considered for unexplained fever and symptoms after alemtuzumab treatment.
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http://dx.doi.org/10.1016/j.leukres.2007.06.010DOI Listing
April 2008

Sustained disease remission after spontaneous HBeAg seroconversion is associated with reduction in fibrosis progression in chronic hepatitis B Chinese patients.

Hepatology 2007 Sep;46(3):690-8

Department of Medicine,University of Hong Kong, Queen Mary Hospital, Hong Kong Special Administrative Region (SAR), China.

Unlabelled: Recently, controversies have arisen about whether hepatitis B e antigen (HBeAg) seroconversion can result in regression of fibrosis, thus improving the clinical outcome of Chinese patients with chronic hepatitis B. In this study, we determined if spontaneous HBeAg seroconversion is associated with regression of fibrosis in Chinese chronic hepatitis B patients. We evaluated the histology of liver samples from 128 HBeAg-positive treatment-naive Chinese patients who had undergone 2 liver biopsies over the years. Regression of fibrosis was defined as a decrease in fibrosis stage of at least 1 point. Sustained disease remission was defined as HBeAg seroconversion and hepatitis B virus (HBV) DNA < 10(4) copies/ml at follow-up liver biopsy. The mean duration (+/- standard error of the mean) between the initial and follow-up liver biopsies was 43.9 +/- 3.4 months. Regression of fibrosis was higher in patients with sustained disease remission (5 of 13 [38.5%] versus 22 of 115 [19.1%], P < 0.00005), patients who were younger (20-29 years old) at initial liver biopsy (17 of 54 [31.5%] versus 10 of 74 [13.5%], P = 0.0004), and patients with genotype B (17 of 43 [39.5%] versus 10 of 85 [11.8%], P = 0.004). On multivariate analysis, sustained disease remission (relative risk [RR] 3.00, 95% confidence interval [95% CI] 1.29-7.01, P = 0.01) and being 20-29 years old at initial liver biopsy (RR 2.94, 95% CI 1.01-8.62, P = 0.04) were independently associated with regression of fibrosis. The rate of fibrosis progression was lower in patients with sustained disease remission than in those who remained HBeAg positive (median 0 fibrosis units/year, range -2.00 to -0.70 fibrosis units/year, versus median 0.51 fibrosis units/year, range 0 to +2.03 fibrosis units/year, P = 0.02).

Conclusion: Spontaneous sustained remission of disease is associated not only with little progression of fibrosis but also with regression of fibrosis.
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http://dx.doi.org/10.1002/hep.21758DOI Listing
September 2007

Non-secretory plasma cell myeloma of the true non-producer type.

Br J Haematol 2007 Sep 4;138(5):561. Epub 2007 Jul 4.

Department of Pathology, Hong Kong Sanatorium & Hospital, Hong Kong.

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http://dx.doi.org/10.1111/j.1365-2141.2007.06691.xDOI Listing
September 2007

Hematologic and genetic characterization of an MYH9-related disorder in a Chinese family.

Haematologica 2006 Jul;91(7):1002-3

We describe a Chinese family with an MYH9-related disorder in which a novel mutation V1516L at exon 31 of the MYH9 gene was identified. To the best of our knowledge, this is the first reported Chinese family with MYH9 mutation and supports the pan-ethnic nature of the disorder.
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July 2006

Epstein-barr virus-related gastric adenocarcinoma: an early secondary cancer post hemopoietic stem cell transplantation.

Gastroenterology 2005 Dec;129(6):2058-63

Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong, China.

Background & Aims: Epstein-Barr virus (EBV) infection has been associated with some cases of gastric cancer.

Methods: We studied a case of early onset gastric adenocarcinoma after nonmyeloablative hematopoietic stem cell transplantation for myeloma in a 56-year-old man.

Results: The development of gastric adenocarcinoma was preceded by severe graft-versus-host disease (GVHD) necessitating strong immunosuppression, which resulted in an intense reactivation of EBV infection. Three sequential gastric biopsy examinations performed at 100, 130, and 150 days after hematopoietic stem cell transplantation showed gastritis, dysplasia, and adenocarcinoma, respectively. There was no evidence of Helicobacter pylori infection. Quantitative polymerase chain reaction for circulating EBV showed a surge of EBV DNA peaking at the time of gastritis, followed by a gradual decrease afterward with adequate control of GVHD and tailing of immunosuppression. In situ hybridization for EBV-encoded early small RNA showed absence of EBV in the gastritis specimen, but the presence of EBV in the dysplastic and carcinoma specimens. Aberrant promoter methylation of E-cadherin was observed only in the carcinoma specimens, showing that infection with EBV preceded E-cadherin methylation.

Conclusions: Mucosal damage caused by GVHD, immunosuppression, and EBV reactivation combined to lead to EBV infection of the gastric cells and initiation of carcinogenesis, suggesting this case to be a genuine EBV-related opportunistic malignancy post-transplantation. An interesting proposition is that this case also might reflect a compacted timeline of events in EBV-related gastric cancers developing in immunocompetent patients.
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http://dx.doi.org/10.1053/j.gastro.2005.10.011DOI Listing
December 2005

Case 84: desmoid tumor of the abdominal wall.

Radiology 2005 Jul;236(1):81-4

Department of Diagnostic Imaging, Kandang Kerbau Women's and Children's Hospital, Singapore.

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http://dx.doi.org/10.1148/radiol.2361031038DOI Listing
July 2005

Hemangioendothelioma with an epithelioid phenotype arising in hemangioma of the fibula.

Skeletal Radiol 2005 Nov 15;34(11):750-4. Epub 2005 Apr 15.

Department of Diagnostic Radiology, Changi General Hospital, Singapore.

The classification of certain vascular bone tumors that show an epithelioid cytologic appearance remains confusing, with overlap in features of epithelioid hemangioma, hemangioendothelioma and epithelioid hemangioendothelioma. Radiographs of a 27-year-old woman who presented with ankle pain showed an expanded lytic-sclerotic lesion in the distal left fibula. Magnetic resonance imaging showed an intramedullary lesion with a small lateral intracortical component. The lesion was hypo- to isointense to muscle on T1-weighted images and heterogeneously hyperintense on T2-weighted images. Initial incisional biopsy was inconclusive. Open biopsy showed hemangioendothelioma with epithelioid morphology, and the lesion was completely resected with reconstruction using a peroneal fibular rotation graft. Examination of the resected specimen showed focal hemangioendothelioma with an epithelioid phenotype arising in a hemangioma. This case illustrates the difficulty and pitfalls of making the correct diagnosis on the basis of a small biopsy specimen.
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http://dx.doi.org/10.1007/s00256-005-0912-0DOI Listing
November 2005

Dutcher-Fahey intranuclear inclusions in multiple myeloma.

Br J Haematol 2005 Apr;129(2):164

Department of Pathology, The University of Hong Kong, Queen Mary Hospital, China.

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http://dx.doi.org/10.1111/j.1365-2141.2005.05391.xDOI Listing
April 2005

Squamous cell carcinoma of the tongue complicating chronic oral mucosal graft-versus-host disease after allogeneic hematopoietic stem cell transplantation.

Am J Hematol 2004 Oct;77(2):200-2

University Department of Medicine, Queen Mary Hospital, Hong Kong.

Two patients underwent allogeneic hematopoietic stem cell transplantation (HSCT) for acute myeloid leukemia. Chronic graft-versus-host disease (GVHD) developed, with persistent symptomatic oral lesions. At 2 and 6 years post-HSCT, both patients developed squamous cell carcinoma (SCC) of the tongue in areas previously involved by chronic GVHD. None had any known risk factor for SCC. Histologically, moderate to severe dysplasia was present in noncancerous oral mucosa. Oral SCC is rarely described after HSCT, and a review of the reported cases showed chronic GVHD to be a common risk, suggesting that the chronic inflammation associated with GVHD might be of pathogenetic significance.
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http://dx.doi.org/10.1002/ajh.20160DOI Listing
October 2004

A 28-year old man with a growth at the dorsum of the left foot.

Am J Orthop (Belle Mead NJ) 2004 Feb;33(2):96-9

Singapore Health Services, Singapore.

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February 2004

Melanotic oncocytic metaplasia of the nasopharynx: a report of seven cases and review of the literature.

Virchows Arch 2004 Apr 4;444(4):345-9. Epub 2004 Feb 4.

Department of Pathology, University of Tokushima School of Medicine, 3-18-15 Kuramoto-cho, 770-8503 Tokushima, Japan.

We describe seven cases of melanotic oncocytic metaplasia of the nasopharynx and review five other cases in the literature. It is usually a small, brown to black lesion that occurs around the Eustachian tube opening, where abundant seromucinous glands and lymphoid tissue are present. Multiple or bilateral lesions are sometimes seen. All 12 reported cases are of Asian origin. Melanotic oncocytic metaplasia occurs predominantly in men (male:female=11:1), with a mean age of 68 years. Simple excisional biopsy appears to be curative. Microscopically, melanotic oncocytic metaplasia is a combination of oncocytic metaplasia of the epithelium of the gland and melanin pigmentation in its cytoplasm. Fontana-Masson staining and immunohistochemical staining of S-100 protein revealed numerous melanocytes with conspicuous dendrites in the glands and stroma, which probably transfer melanin to adjacent glands. The exact pathogenesis of melanotic oncocytic metaplasia is unknown, but we postulate that the lesion could be related to the oncocytic metaplasia of the seromucinous glands around the Eustachian tube, which is followed by the local production and/or acquisition of the melanin pigment, under the influence of certain neuropeptides in the vicinity. The recognition of melanotic oncocytic metaplasia is of clinical importance, as it may be misdiagnosed as a malignancy to the unwary.
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http://dx.doi.org/10.1007/s00428-003-0970-4DOI Listing
April 2004