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Chen F, Yang SF, Chen CH, Lieu AS, Cheng ST, Huang MY, Lee HH. Secondary basal cell carcinoma of scalp after radiotherapy: A case report. Medicine (Baltimore) 2018; 97:e12170. [PMID: 30200117 PMCID: PMC6133595 DOI: 10.1097/md.0000000000012170] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 08/09/2018] [Indexed: 01/30/2023] Open
Abstract
RATIONALE Radiotherapy (RT) is widely used for both malignant and benign tumors in order to reduce the risk of recurrence, to promote tumor control, and to improve survival. However, there have been studies reported that RT is also a risk factor of secondary cancer. Very few cases of secondary malignancy after RT to high grade brain cancer have been reported due to short survival of this disease, and most RT-induced malignancies presented with sarcomatous histology. Here we present a patient with basal cell carcinoma (BCC) 14 years after RT to his brain. PATIENT CONCERNS A 28-year-old man without any underlying disease had suffered from left side weakness and clonic-tonic seizures for 12 days. DIAGNOSES His brain images showed a tumor in the right frontal lobe. The pathologic report confirmed anaplastic astrocytoma (WHO Grade III). INTERVENTIONS After craniotomy and tumor biopsy, RT was delivered. Fourteen years later, a gray-colored skin papule was noted in the previously irradiated area. The scalp biopsy revealed BCC. The scalp BCC was adequately resected. He then suffered from brain tumor recurrence and received further craniotomy for three times combined with chemotherapy with temozolomide. OUTCOMES After treatment, follow-up brain images showed that the disease was under control. There was no neurological sequela. For scalp BCC, no skin tumor recurrence has been noted to date after the resection 14 years after initial RT. He has survived for more than 26 years since his initial diagnosis of anaplastic astrocytoma, and more than 12 years from the diagnosis of scalp BCC. LESSONS Notwithstanding the risk of radiation-induced skin cancer, RT contributed to this patient's survival. The possible late adverse events should be informed to the patients.
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MESH Headings
- Adult
- Astrocytoma/diagnostic imaging
- Astrocytoma/therapy
- Brain Neoplasms/diagnostic imaging
- Brain Neoplasms/therapy
- Carcinoma, Basal Cell/diagnosis
- Carcinoma, Basal Cell/etiology
- Carcinoma, Basal Cell/pathology
- Carcinoma, Basal Cell/surgery
- Diagnosis, Differential
- Humans
- Male
- Neoplasm Recurrence, Local/diagnostic imaging
- Neoplasm Recurrence, Local/therapy
- Neoplasms, Radiation-Induced/pathology
- Neoplasms, Radiation-Induced/surgery
- Neoplasms, Second Primary/diagnosis
- Neoplasms, Second Primary/etiology
- Neoplasms, Second Primary/pathology
- Neoplasms, Second Primary/surgery
- Scalp
- Skin Neoplasms/diagnosis
- Skin Neoplasms/etiology
- Skin Neoplasms/pathology
- Skin Neoplasms/surgery
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Affiliation(s)
| | - Sheau-Fang Yang
- Department of Pathology, Kaohsiung Medical University Hospital
- Faculty of Medicine
| | - Chien-Hung Chen
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University
| | | | - Shih-Tsung Cheng
- Faculty of Medicine
- Department of Dermatology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Ming-Yii Huang
- Department of Radiation Oncology
- Faculty of Medicine
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University
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2
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Mull JL, Madden LM, Bayliss SJ. Myelodysplastic Syndrome Occurring in a Patient with Gorlin Syndrome. Pediatr Dermatol 2016; 33:e256-7. [PMID: 27241746 DOI: 10.1111/pde.12880] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
We report a case of myelodysplastic syndrome (MDS) occurring in an African American boy with Gorlin syndrome with a novel PTCH1 mutation. Before developing MDS, the patient had been treated with chemotherapy and radiation for a medulloblastoma. He received a bone marrow transplant for the MDS and eventually died of treatment complications. Secondary hematologic malignancies are a known complication of certain chemotherapeutics, although whether a patient with Gorlin syndrome has a greater propensity for the development of such malignancies is unclear.
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Affiliation(s)
- Jamie L Mull
- Division of Dermatology, School of Medicine, Washington University, St. Louis, Missouri.,Barnes-Jewish Hospital, St. Louis, Missouri
| | - Lisa M Madden
- Division of Pediatric Hematology-Oncology, School of Medicine, Washington University, St. Louis, Missouri.,St. Louis Children's Hospital, St. Louis, Missouri
| | - Susan J Bayliss
- Division of Dermatology, School of Medicine, Washington University, St. Louis, Missouri.,St. Louis Children's Hospital, St. Louis, Missouri
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3
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Chen DY, Crawford JR. Hodgkin's lymphoma in an adolescent previously treated with surgical resection of third ventricular juvenile pilocytic astrocytoma. BMJ Case Rep 2015; 2015:bcr-2015-209343. [PMID: 26113587 DOI: 10.1136/bcr-2015-209343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We present a case of a 19-year-old man with cervical lymphadenopathy diagnosed with classical Hodgkin's lymphoma 9 years after gross total resection of a third ventricular juvenile pilocytic astrocytoma (JPA). Chemotherapy or radiation therapy was not a part of his initial JPA treatment. Owing to his two primary neoplasms, genetic testing was performed, which revealed heterozygous polymorphisms of unknown significance for CDH1 and p53, and negative BRAF mutation analysis. Our case reports development of classical Hodgkin's lymphoma after JPA in the absence of antecedent radiation and/or chemotherapy, and identifiable genetic predisposition.
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Affiliation(s)
- Dillon Y Chen
- Department of Neurosciences and Pediatrics, University of California San Diego, San Diego, California, USA
| | - John Ross Crawford
- Department of Neurosciences and Pediatrics, University of California San Diego, San Diego, California, USA
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4
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Baehring JM, Marks PW. Treatment-related myelodysplasia in patients with primary brain tumors. Neuro Oncol 2012; 14:529-40. [PMID: 22459128 DOI: 10.1093/neuonc/nos068] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Treatment-related myelodysplastic syndrome (t-MDS) and treatment-related acute myelogenous leukemia (t-AML) represent rare secondary events in patients with primary tumors of the nervous system and predominantly affect those treated with alkylating agents or topoisomerase II inhibitors. Temozolomide has become the standard chemotherapeutic agent for malignant gliomas. The emergence of this alkylating agent with little acute toxicity or cumulative myelosuppression has led to off-label protracted chemotherapy for many patients with malignant and even low-grade infiltrative gliomas, raising concern for increased risk of t-MDS/t-AML in the few long-term survivors. On the basis of an extensive literature search, we provide a discussion of epidemiology, pathogenesis, clinical presentation, diagnosis, and therapy of these disorders. t-MDS/t-AML remain rare complications of chemotherapy in patients with primary brain tumors, and the vast majority of patients die of their primary neoplasm. Prospective randomized studies with long-term follow-up are required to accurately assess the risk of t-MDS/t-AML; however, unless survival in the most common gliomas substantially increases, t-MDS/t-AML incidence will likely remain low in this patient population.
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Affiliation(s)
- Joachim M Baehring
- Department of Neurology and Neurosurgery, Section of Hematology, Yale University School of Medicine, New Haven, Connecticut 06510, USA.
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Loh JK, Lieu AS, Chai CY, Howng SL. Malignant transformation of a desmoplastic infantile ganglioglioma. Pediatr Neurol 2011; 45:135-7. [PMID: 21763958 DOI: 10.1016/j.pediatrneurol.2011.04.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2010] [Accepted: 04/04/2011] [Indexed: 10/18/2022]
Abstract
We describe a rare case of desmoplastic infantile ganglioglioma that appears to have transformed into a glioblastoma multiforme tumor in a 5-year-old girl. The patient was initially treated with total removal of the tumor, without subsequent radiation therapy or chemotherapy. She was in good health for 3 years, but manifested a sudden onset of seizures, followed by severe headache, vomiting, and left-sided weakness. Cranial magnetic resonance imaging revealed a large mass with rim enhancement at the previously operated site. The mass was completely removed, and the pathology report revealed glioblastoma multiforme. Postoperative chemotherapy and radiation treatment were administered. She has been followed for 11 years, and is alive without recurrence.
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Affiliation(s)
- Joon-Khim Loh
- Division of Neurosurgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
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6
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Abstract
Overall survival from cancer has greatly improved, although it still remains the second leading cause of mortality in the world. This result was achieved through the use of chemotherapy and radiotherapy, which are severely toxic to normal tissues. In the long-term follow-up of cancer patients, the development of secondary malignant disease is common and it is one of the most severe side effects of cancer treatment. Physicians aim to decrease this toxicity and reduce the development of secondary cancers. In this study, the epidemiology and etiology of second malignant neoplasms are reviewed.
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Affiliation(s)
- Ali Varan
- Department of Pediatric Oncology, Hacettepe University Institute of Oncology, Ankara, Turkey.
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7
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Subcutaneous malignant melanoma of the scalp surgical flap after brain irradiation for anaplastic astrocytoma. J Neurooncol 2011; 106:203-7. [PMID: 21720809 DOI: 10.1007/s11060-011-0646-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Accepted: 06/20/2011] [Indexed: 10/18/2022]
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Rohrer TR, Langer T, Grabenbauer GG, Buchfelder M, Glowatzki M, Dörr HG. Growth hormone therapy and the risk of tumor recurrence after brain tumor treatment in children. J Pediatr Endocrinol Metab 2010; 23:935-42. [PMID: 21175094 DOI: 10.1515/jpem.2010.150] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
To assess the effect of human growth hormone (hGH) therapy and other factors on tumor recurrence after treatment of pediatric brain tumors (BTs), we retrospectively analyzed data from 108 craniopharyngioma, medulloblastoma, and ependymoma patients. Risk factors were identified using multifactorial univariate regression analysis. Recurrences occurred in 41 and second malignant neoplasms in 4 patients. There were significant correlations for completeness of tumor removal and recurrence-free survival (RFS). 13/44 hGH-treated and 28/59 non-hGH-treated children relapsed. This difference was found only for medulloblastomas and accounted for by higher rates of incomplete tumor removal in non-hGH patients. Craniopharyngioma recurrence correlated only with RFS. Malignant BT recurrence correlated with completeness of tumor removal, chemotherapy, and RFS. 4 children developed SMNs, 3/4 after hGH therapy. Our regression model yielded accurate within-sample prediction of recurrence for 90% of the study population. We conclude that hGH therapy after treatment of pediatric BTs does not increase tumor recurrence risk.
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Affiliation(s)
- Tilman R Rohrer
- Department of Pediatrics and Adolescent Medicine, Saarland University Hospital, Homburg/Saar, Germany
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9
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Weinstein JL, Ayyanar K, Watral MA. Secondary neoplasms following treatment for brain tumors. Cancer Treat Res 2009; 150:239-273. [PMID: 19834673 DOI: 10.1007/b109924_16] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- Joanna L Weinstein
- Division of Hematology, Oncology and Stem Cell Transplantation, Children's Memorial Hospital, Chicago, IL, USA.
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10
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Fossati P, Ricardi U, Orecchia R. Pediatric medulloblastoma: toxicity of current treatment and potential role of protontherapy. Cancer Treat Rev 2008; 35:79-96. [PMID: 18976866 DOI: 10.1016/j.ctrv.2008.09.002] [Citation(s) in RCA: 106] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2008] [Revised: 08/30/2008] [Accepted: 09/03/2008] [Indexed: 11/25/2022]
Abstract
Post-operative craniospinal irradiation and systemic chemotherapy are both necessary in the treatment of pediatric medulloblastoma. Late toxicity is a major problem in long term survivors and significantly affects their quality of life. We have systematically reviewed the literature to examine data on late toxicity, specifically focusing on: endocrine function, growth and bone development, neurocognitive development, second cancers, ototoxicity, gynecological toxicity and health of the offspring, cardiac toxicity and pulmonary toxicity. In this paper, we describe qualitatively the kind of detected side effects and, whenever possible, try to assess their incidence and the relative role of craniospinal irradiation (as opposed to other treatments and to the disease itself) in producing them. Subsequently we examine the possible approach to reduce unwanted effects from craniospinal irradiation to target and non-target tissues and we consider briefly the role of hyperfractionation, tomotherapy and IMRT. We describe the characteristics of protontherapy and its potential for non-target tissues toxicity reduction reviewing the existing physical and dosimetric studies and the (still very limited) clinical experiences. Finally we propose intensity modulated spot scanning protontherapy with multiportal simultaneous optimization (IMPT) as a possible tool for dose distribution optimization within different areas of CNS and potential reduction of target tissues toxicity.
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Affiliation(s)
- Piero Fossati
- Institute of Radiological Sciences, University of Milan, Milano, Italy.
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Yanagawa Y, Shimazaki H, Shima K, Isoda S, Maehara T. Atrial myxoma occurring 15 years after subtotal resection of cerebellar hemangioblastoma. Neurol Med Chir (Tokyo) 2008; 48:37-9. [PMID: 18219192 DOI: 10.2176/nmc.48.37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 51-year-old female, with a past medical history of resection of cerebellar hemangioblastoma, presented with an atrial tumor detected by sonography after undergoing a series of examinations for fever of unknown origin and subsequent symptoms of heart failure. After removing the atrial tumor, the histological findings demonstrated myxoma. Immunohistopathological study showed that the tumor cells in both the hemangioblastoma and the myxoma had strong cytoplasmic immunoreactivity for vascular endothelial growth factor. Hemangioblastoma associated with myxoma is extremely rare, and was probably a random occurrence in this case.
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Affiliation(s)
- Youichi Yanagawa
- Department of Traumatology and Critical Care Medicine, National Defense Medical College, Tokorozawa, Saitama, Japan.
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Koksal Y, Toy H, Unal E, Baysal T, Esen H, Paksoy Y, Ustun ME. Pilocytic astrocytoma developing at the site of a previously treated medulloblastoma in a child. Childs Nerv Syst 2008; 24:289-92. [PMID: 17657496 DOI: 10.1007/s00381-007-0444-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2007] [Indexed: 10/23/2022]
Abstract
BACKGROUND After the achieved high cure rates, the survivors of medulloblastoma have come to face other complications associated with treatment regimes. One of these complications is secondary malignant neoplasm (SMN), which is rare but generally fatal. CASE HISTORY We report a case of an 8-year-old girl in whom a pilocytic astrocytoma developed at the site of previously excised medulloblastoma 26 months earlier. The patient had then received postoperative radiotherapy and chemotherapy for the treatment of medulloblastoma. Twenty-five months after the cessation of treatment, she had no complaint and physical examination was unremarkable, but a mass in the operation region was detected. Surgical excision of the secondary pilocytic astrocytoma was performed with a good clinical recovery without any evidence of residue or recurrence at 9-month follow-up. CONCLUSION Clinicians must be vigilant for the risk of expected SMNs. Rigorous and prolonged follow-up of patients with central nervous system (CNS) tumors is warrant.
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Affiliation(s)
- Yavuz Koksal
- Department of Pediatrics, Meram Faculty of Medicine, Selcuk University, Meram, Konya 42080, Turkey
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