Alpha Tsui

Royal Melbourne Hospital, Melbourne, Victoria, Australia

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Publications (22)52.41 Total impact

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    ABSTRACT: The purpose of this study was to add to the current body of literature which is aimed at establishing the role of postoperative adjuvant radiotherapy (RT) in the treatment of atypical and malignant meningiomas. Meningiomas are the most frequently reported primary intracranial tumours, accounting for more than 35%. The majority of meningiomas are benign, with atypical and malignant tumours accounting for only 6-18%. Utilising a prospective multi-institutional database, we retrospectively reviewed 67 patients with documented World Health Organisation (WHO) Grade II/III meningiomas, diagnosed between 1989 and 2012 and resected at two major Australian hospitals. Nine patients were excluded and the remaining 58 were analysed. The patient demographics, tumour characteristics, surgical details and adjuvant therapy were retrieved. Kaplan-Meier curves were used to compare the survival of patients treated with RT versus surgery alone. The 3year progression free survival (PFS) and overall survival (OS) were 44 and 76% for the entire cohort, respectively. Of the patients who had gross total resections, 42% had 3years PFS and 77% had 3years OS, which was not significantly different from those with subtotal resection. The overall median survival was 11.0years, 12.2 for atypical and 1.6 for malignant meningiomas. The patients with malignant meningiomas were 14 times as likely to receive RT as the patients with atypical meningiomas. The patients who received RT had a 3year PFS of 63% compared to 40% in those who did not receive radiation. The 3year OS was 31% higher for females than males. Histopathological progression was noted in 17% of our cohort. This study reinforces a number of important factors that should be considered when treating patients presenting with WHO Grade II and III meningiomas, including sex, potential for grade progression, and the lack of evidence for adjuvant RT and the timing thereof. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Journal of Clinical Neuroscience 07/2015; DOI:10.1016/j.jocn.2015.03.054 · 1.38 Impact Factor
  • Journal of Clinical Neuroscience 07/2015; 22(7):1183, 1218. · 1.38 Impact Factor
  • Journal of Clinical Neuroscience 04/2015; 22(7). DOI:10.1016/j.jocn.2015.01.027 · 1.38 Impact Factor
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    Journal of Clinical Neuroscience 04/2015; 25(7). DOI:10.1016/j.jocn.2015.03.001 · 1.38 Impact Factor
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    ABSTRACT: The aim of the study was to determine the accuracy of rapid on-site examinations, performed on transbronchial brushings of peripheral pulmonary lesions, in determining final bronchoscopic diagnosis. In addition to determining if rapid on-site examination impacts procedural outcomes. A prospective cohort study of consecutive patients with peripheral pulmonary lesions, which had been located by radial endobronchial ultrasound, was undertaken. Bronchoscopy was terminated if rapid on-site examination demonstrated diagnostic malignant material. Non-diagnostic rapid on-site examination resulted in further bronchoscopic sampling, including transbronchial lung biopsy and/or sampling from different locations. 128 peripheral pulmonary lesions were located by endobronchial ultrasound in 118 patients. The final bronchoscopic diagnoses included nonsmall cell lung cancer (n=76), carcinoid (n=3), and metastatic malignancy (n=3). Procedure times were significantly shorter for procedures when rapid on-site examinations demonstrated malignancy compared to those where rapid on-site examination was non-diagnostic (19±8 min versus 31±11 min, respectively; p<0.0001). In four procedures, initial negative rapid on-site examination results prompted redirection of sampling from alternate bronchial segments, resulting in positive diagnostic tissue being obtained. Positive and negative predictive value of rapid on-site examination for a malignant bronchoscopic diagnosis was 63 (97%) out of 65, and 43 (68%) out of 63, respectively. Rapid on-site examination of brushing specimens has a very high, positive, predictive value for bronchoscopic diagnosis of cancer and shortens the bronchoscopy procedure times. It has the potential to reduce complications, improve cost-effectiveness, and may improve diagnostic performance via live feedback. Copyright ©ERS 2014.
    European Respiratory Journal 12/2014; 45(6). DOI:10.1183/09031936.00111314 · 7.64 Impact Factor
  • Shirley P. Ma · Alpha Tsui · Andrew H. Kaye
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    ABSTRACT: Gangliogliomas are rare primary central nervous system tumours that characteristically contain both neuronal and glial neoplastic components. They usually present as solitary, slow growing tumours that are frequently associated with pharmacologically refractory epilepsy. Multicentric variants of the tumour are exceedingly rare. We report a 20-year-old patient with multiple gangliogliomas located in the right frontal, temporal and occipital lobes. He presented with headache, fatigue and occasional nausea and vomiting. MRI revealed three large, distinct tumours with striking cyst formation. Stereotactic craniotomy and excision of the temporal and occipital tumours confirmed ganglioglioma. The coincidence of three distinct gangliogliomas involving the right frontal, temporal and occipital lobes has not been reported to our knowledge.
    Journal of Clinical Neuroscience 10/2014; 22(2). DOI:10.1016/j.jocn.2014.08.003 · 1.38 Impact Factor
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    Journal of Clinical Neuroscience 10/2014; 21(10):1802, 1833. DOI:10.1016/j.jocn.2014.03.031 · 1.38 Impact Factor
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    Journal of Clinical Neuroscience 10/2014; 21(10). DOI:10.1016/j.jocn.2014.06.002 · 1.38 Impact Factor
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    ABSTRACT: Background and purpose: Histologic grading of intracranial astrocytomas is affected by sampling error and substantial inter- and intraobserver variability. We proposed that incorporating MR imaging into grading will predict patient survival more accurately than histopathology alone. Materials and methods: Patients with a new diagnosis of World Health Organization grades II-IV astrocytoma or mixed oligoastrocytoma diagnosed between September 2007 and December 2010 were identified. Two hundred forty-five patients met the inclusion criteria. Preoperative MRIs were independently reviewed by 2 readers blinded to the histologic grade, and an MR imaging grade was given. The MR imaging and histopathologic grades were compared with patient survival. Results: Patients with grade II or III astrocytomas on histology but evidence of necrosis on MR imaging (consistent with a grade IV tumor) had significantly worse survival than patients with the same histology but no evidence of necrosis on MR imaging (P = .002 for grade II histology and P = .029 for grade III). Their survival was not significantly different from that in patients with grade IV tumors on histology (P = .164 and P = .385, respectively); this outcome suggests that all or most are likely to have truly been grade IV tumors. MR imaging evidence of necrosis was less frequent in grade II and III oligoastrocytomas, preventing adequate subgroup analysis. Conclusions: MR imaging can improve grading of intracranial astrocytomas by identifying patients suspected of being undergraded by histology, with high interobserver agreement. This finding has the potential to optimize patient management, for example, by encouraging more aggressive treatment earlier in the patient's course.
    American Journal of Neuroradiology 08/2014; 36(1). DOI:10.3174/ajnr.A4077 · 3.59 Impact Factor
  • Adrian J Praeger · Alpha Tsui · Thomas G Hardy
    Clinical and Experimental Ophthalmology 09/2013; 42(4). DOI:10.1111/ceo.12242 · 2.35 Impact Factor
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    ABSTRACT: We report a 78-year-old man who presented with rapidly progressive cerebellar ataxia, dysarthria and vertigo. MRI of the brain showed no evidence of infiltrative pathology in the posterior fossa. Cerebrospinal fluid analysis revealed an elevated protein and pleocytosis. He was subsequently diagnosed with squamous cell carcinoma of the lung on bronchoscopy. Paraneoplastic cerebellar degeneration (PCD) was diagnosed. To our knowledge, there are only two previously reported patients with PCD associated with squamous cell carcinoma of the lung.
    Journal of Clinical Neuroscience 06/2013; 20(10). DOI:10.1016/j.jocn.2012.11.009 · 1.38 Impact Factor
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    ABSTRACT: Neuroenteric cysts (NC) are rare, benign lesions lined by mucin-secreting cuboidal or columnar epithelium of an intestinal or respiratory type. They are regarded as ectopic endodermal cysts, and tend to be found in the spine rather than an intracranial location. Advances in neuroimaging have led to an increased frequency of diagnosis of NC, especially as an incidental finding, although such cysts may be confused radiologically with other lesions such as epidermoid and arachnoid cysts. We undertook a PubMed search of the literature using the search terms "neuroenteric cyst" and its many pseudonyms, including "endodermal cyst", "enterogenous cyst", "neurenteric cyst", "epithelial cyst", "intestinome", "teratomatous cyst", "gastrocytoma", and also "enterogenic", "foregut", "respiratory", and "bronchogenic cyst". Only reports in English and those containing histopathologically-confirmed NC were considered for this review. In total, 140 patients with intracranial NC were found, including the patient reported in the present review. This review describes the classification, epidemiology, embryology, clinical presentation, radiology, histopathology, and surgical treatment of NC, and includes an illustrative patient.
    Journal of Clinical Neuroscience 03/2012; 19(3):352-9. DOI:10.1016/j.jocn.2011.10.005 · 1.38 Impact Factor
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    ABSTRACT: Endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA) may diagnose suspected lung cancer. Determination of non-small cell lung cancer (NSCLC) subtype may guide therapy in select patients. Small-volume biopsies may be subject to significant interobserver variability in subtype determination. Three pathologists independently reviewed specimens from 60 patients who underwent EBUS-TBNA for diagnosis/staging of suspected/known NSCLC. Smear, haematoxylin and eosin (H&E) and immunohistochemistry (IHC) specimens were reviewed without reference to other specimen types obtained from the same patient. Final diagnoses, and degree of confidence in the diagnosis, were recorded for each specimen. Almost perfect agreement was seen for distinguishing between small cell lung cancer and NSCLC for all specimen types. Agreement in determination of NSCLC subtype for smear, H&E and IHC specimens was slight (κ=0.095, 95% CI -0.164-0.355), fair (κ=0.278, 95% CI 0.075-0.481) and moderate (κ=0.564, 95% CI 0.338-0.740), respectively. Perfect agreement was seen when all three observers were confident of diagnoses made on IHC specimens. Interobserver agreement in interpretation of EBUS-TBNA specimens is moderate for determination of NSCLC subtype. Agreement is highest following examination of IHC specimens. Clinicians should be aware of the degree of pathologist confidence in the tissue diagnosis prior to commencement of subtype-specific therapy for NSCLC.
    European Respiratory Journal 02/2012; 40(3):699-705. DOI:10.1183/09031936.00109711 · 7.64 Impact Factor
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    ABSTRACT: Olfactory neuroblastomas are malignant, neuroectodermal nasal tumours. We describe a 62-year-old patient with a recurrent olfactory neuroblastoma invading a radiation-induced meningioma. Given the temporal and spatial relationship between the primary lesion and the described recurrence, this was due to metastatic rather than direct contiguous spread, fulfilling all the criteria for true tumour-to-tumour metastasis. To our knowledge, this is the first description of an olfactory neuroblastoma metastasising to a meningioma.
    Journal of Clinical Neuroscience 09/2011; 18(9):1249-51. DOI:10.1016/j.jocn.2011.01.013 · 1.38 Impact Factor
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    ABSTRACT: Sarcoidal reactions occurring in regional lymph nodes of patients with non-small cell lung carcinoma appear to be limited to patients with stage I disease. The prognostic significance of this remains unknown. Such reactions are thought to represent a cell-mediated antitumor response and have been associated with improved outcomes in other solid organ malignancies. We performed a retrospective chart review of all patients undergoing lobectomy with curative intent for non-small cell lung carcinoma. Eligible cases were selected based on pathologic reports, with matched controls then drawn from the same surgical cohort. One hundred fifty-seven patients underwent lobectomy and lymph node dissection. Eight patients with sarcoidal granulomas present in regional lymph nodes were identified as cases and matched to 16 control subjects. All subjects were staged pN0. Disease recurrence was noted in no case subjects but in 7 (44%) of control subjects (P = .044, χ(2) = 4.051). The presence of sarcoidal reactions within regional lymph nodes of patients with non-small cell lung carcinoma predicts a lower rate of disease recurrence after definitive surgical resection. The exact mechanism by which antitumor immunity is achieved remains to be elucidated.
    Human pathology 08/2011; 43(3):333-8. DOI:10.1016/j.humpath.2011.05.006 · 2.77 Impact Factor
  • Journal of Clinical Neuroscience 06/2011; 18(6):815, 875. DOI:10.1016/j.jocn.2010.03.018 · 1.38 Impact Factor
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    ABSTRACT: Protoplasmic astrocytomas are a poorly recognized and uncommon subtype of astrocytoma. While usually categorized with other low-grade gliomas, there is literature to suggest that protoplasmic astrocytomas have differences in biology compared to other gliomas in this group. This paper presents the MR imaging characteristics of a series of eight protoplasmic astrocytomas. We retrospectively reviewed MR images and histopathology of eight consecutive cases of histologically proven protoplasmic astrocytomas. Patients ranged from 17 to 51 years of age with a 5:3 male to female ratio. The tumors were located in the frontal or temporal lobes and tended to be large, well defined, and had a very high signal on T2 (close to cerebrospinal fluid). Generally, a large proportion of the tumor showed substantial signal suppression on T2 fluid-attenuated inversion recovery (FLAIR). Six of the eight lesions also demonstrated a partial or complete rim of reduced apparent diffusion coefficient (ADC) around the T2 FLAIR suppressing portion. The possibility that a primary cerebral neoplasm represents a protoplasmic astrocytoma should be considered in a patient with a large frontal or temporal tumor that has a very high signal on T2 with a large proportion of the tumor showing substantial T2 FLAIR suppression. A further clue is a partial or complete rim of reduced ADC.
    Neuroradiology 06/2011; 53(6):405-11. DOI:10.1007/s00234-010-0741-2 · 2.49 Impact Factor
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    ABSTRACT: Gliosarcoma is a rare glioblastoma variant, classically arising in the cerebral hemispheres. We report a patient with primary diffuse leptomeningeal gliomatosis (PDLG) with a sphenoid sinus and sellar mass. An 84-year-old woman presented with progressive headache and right-sided visual failure, associated with ipsilateral oculomotor nerve palsy and left temporal field loss. Neuraxial MRI showed a large lesion within the sphenoid sinus and sella resulting in chiasmal compression, and diffuse cranial and spinal leptomeningeal enhancement. Endoscopic transphenoidal biopsy and debulking of the sphenosellar lesion was performed, and gliosarcoma was diagnosed on histopathological examination. The patient was palliated due to poor performance status. To our knowledge, this is the only report of gliosarcoma within the paranasal sinuses and the second report of PDLG where the histological analysis has confirmed gliosarcoma. We believe this adds significant weight to the theory that heterotopic nests of glial tissue, in this instance within the sphenoid or sella, are the putative origin of PDLG.
    Journal of Clinical Neuroscience 02/2011; 18(5):702-4. DOI:10.1016/j.jocn.2010.09.006 · 1.38 Impact Factor
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    ABSTRACT: Pilocytic astrocytoma, the most common glioma of childhood, is considered a clinically benign tumour. Malignant transformation of this tumour is rare and thought to occur almost exclusively in the setting of prior radiotherapy. We describe a patient with mixed pilocytic and gemistocytic astrocytoma which transformed into a glioblastoma multiforme, leading to rapid deterioration and death of the patient, without prior radiotherapy.
    Journal of Clinical Neuroscience 02/2011; 18(5):705-7. DOI:10.1016/j.jocn.2010.09.005 · 1.38 Impact Factor
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    ABSTRACT: Evidence regarding the utility of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in the assessment of isolated mediastinal lymphadenopathy (IMLN) is evolving. Its diagnostic accuracy in the evaluation of suspected lymphoma remains uncertain. We reviewed a prospectively recorded database of consecutive patients with suspected lymphoma who underwent EBUSTBNA to evaluate IMLN. Patients in whom EBUS-TBNA was nondiagnostic subsequently underwent surgical biopsy or a minimum of 6 months radiologic surveillance. Ninety-eight patients underwent EBUS-TBNA for evaluation of IMLN. Clinicoradiologic features suggested sarcoidosis as the likely diagnosis in 43 patients. In the remaining 55 patients, EBUS-TBNA achieved definitive diagnosis in 42 patients (76%; 95% confidence interval [CI] 55-90). Lymphoma was ultimately diagnosed in 21 of 55 patients (38%). EBUS-TBNA demonstrated lymphoma in 16 (76%) patients; however, four patients required further surgical biopsy to completely characterize lymphoma subtypes. Surgical biopsy was required to diagnose specific lymphoma subtypes not readily amenable to diagnosis with low volume specimens. Sensitivity and specificity for definitive diagnosis of lymphoma were 57% (95% CI 37-76) and 100% (95% CI 91-100), respectively. Although the diagnostic accuracy of EBUS-TBNA for lymphoma is lower than that for the lung cancer staging, the procedure is an appropriate investigative technique for the patients with IMLN because of the low incidence of lymphoma in this population, and the significant proportion of such patients (76%) in whom surgical biopsy is obviated.
    Journal of thoracic oncology: official publication of the International Association for the Study of Lung Cancer 06/2010; 5(6):804-9. DOI:10.1097/JTO.0b013e3181d873be · 5.28 Impact Factor