Efficiency and clinical results of bleomycin injection in the treatment of lymphatic malformations

Background

Lymphatic malformations (LMs) are rare congenital anomalies. The traditional treatment is surgical excision, but intralesional sclerosing agent injection is also preferred as the first-choice treatment because of postoperative frequent recurrences, poor cosmetic results, and high complication rate. We aimed to evaluate the efficacy of sclerosing agent injection used in the treatment of LMs in children.

Materials and Methods

We retrospectively analyzed the children who were treated for LM between January 2011 and January 2022. The lesion sizes of the patients who were injected with sclerosant (Bleomycin) under sedation anesthesia, measured by ultrasound before and after the treatment, were recorded, and the difference between them was statistically evaluated.

Results

Fifteen patients were retrospectively analyzed. The mean age was 45.2 ± 14.1 months. Of these, ten (66.6%) were male and five (33.3%) were female (F/M = 1/2). The mean age of male patients was 55 ± 20.1 months; the mean age of female patients was 25.8 ± 11. Seven patients had a single dose, two had twice, and six had three and more. The mean measurable size of macrocystic lesions before treatment was 55.2 ± 28.4 mm; after treatment, it was 23.8 ± 18.2 mm. Although no measurable shrinkage was detected in microcystic lesions, it was observed that the lesion shrank to allow surgical resection. With the statistical analysis, it was seen that there was a statistically significant difference between the dimensions before and after the treatment (P < 0.05) and the sclerosant injection had a great effect on the treatment (R: 0.89).

Conclusion

Intralesional injection of bleomycin is less effective for microcystic or mixed-type LMs, but provides an effective reduction for a safe surgical procedure. It is an effective treatment for macrocystic lesions.

Radiation-induced Desmoid Tumor Development in the Radiotherapy Field in a Child With Pineoblastoma: A Case Report

Although treatment-related secondary malignancies are rare, they are important problems after the treatment of childhood malignant diseases. Irradiation-induced sarcomas are the development of sarcoma different from the primary tumor after a latent period of ≥3 years or more in the radiotherapy field. Desmoid tumor is extremely rare as irradiation-induced tumor. A 7.5-year-old girl was referred to our hospital after a subtotal mass excision for a solid lesion with a cystic component located in the pineal gland. Pathologic examination revealed pineoblastoma. After surgery, craniospinal radiotherapy, and chemotherapy consisting of vincristine, cisplatin, and etoposide were performed. Painless swelling in the left parieto-occipital region ~75 months after the end of the treatment developed in the patient. A mass was detected in the intracranial but extra-axial region by radiologic imaging methods. Due to the total removal of the mass and the absence of a tumor in the surgical margins, she was followed up without additional treatment. The pathologic diagnosis was a desmoid tumor. She was followed up disease free for ~7 years after the primary tumor and ~7 months after the secondary tumor. Treatment-related desmoid tumor development after treatment for a central nervous system tumor in a child is extremely rare.

Impact on the survival of neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, and monocyte-lymphocyte ratio on prognosis in children with Hodgkin lymphoma

OBJECTIVES

To evaluate the clinical utility of the recently described absolute neutrophil counts to absolute lymphocyte counts ratio (NLR), absolute platelet counts to absolute lymphocyte counts ratio (PLR), and absolute monocyte counts to absolute lymphocyte counts ratio (MLR) on prognosis in children with Hodgkin lymphoma (HL).

METHODS

We retrospectively evaluated the clinical characteristics, laboratory features (lymphocyte counts, NLR, PLR, and MLR), treatment, and results of 52 children with HL in the Department of Pediatric Hematology and Oncology, Selcuk University, konya, Turkey, from January 2006 until December 2021.

RESULTS

The patients included 27 (51.9%) females and 25 (48.1%) males. The age of the patients ranged between 3-17.5 years old (median: 9 years). There were 22 patients in stage II, 24 in stage III, and 6 in stage IV. The most prevalent histopathological subgroup was the nodular sclerosing type (53.8%). The 5-year overall survival rate was 93.7%. The overall survival rate differed based on lymphocyte counts (p<0.0001), NLR (p=0.018), and PLR (p=0.009). However, none of the prognostic factors in the univariate analysis were not prognostic risk factors (p>0.05) in the multivariate analysis.

CONCLUSION

Lymphocyte counts, NLR, and PLR may be useful markers for determining the outcomes in children with HL.

Correlation of myeloid-derived suppressor cells with C-reactive protein, ferritin and lactate dehydrogenase levels in patients with severe COVID-19

The novel coronavirus disease 2019 (COVID‐19) remains a global health emergency, and understanding the interactions between the virus and host immune responses is crucial to preventing its lethal effects. The expansion of myeloid‐derived suppressor cells (MDSCs) in COVID‐19, thereby suppressing immune responses, has been described as responsible for the severity of the disease, but the correlation between MDSC subsets and COVID‐19 severity remains elusive. Therefore, we classified patients according to clinical and laboratory findings—aiming to investigate the relationship between MDSC subsets and laboratory findings such as high C‐reactive protein, ferritin and lactate dehydrogenase levels, which indicate the severity of the disease. Forty‐one patients with COVID‐19 (26 mild and 15 severe; mean age of 49.7 ± 15 years) and 26 healthy controls were included in this study. MDSCs were grouped into two major subsets—polymorphonuclear MDSCs (PMN‐MDSCs) and monocytic MDSCs—by flow cytometric immunophenotyping, and PMN‐MDSCs were defined as mature and immature, according to CD16 expressions, for the first time in COVID‐19. Total MDSCs, PMN‐MDSCs, mature PMN‐MDSCs and monocytic MDSCs were significantly higher in patients with COVID‐19 compared with the healthy controls (P < .05). Only PMN‐MDSCs and their immature PMN‐MDSC subsets were higher in the severe subgroup than in the mild subgroup. In addition, a significant correlation was found between C‐reactive protein, ferritin and lactate dehydrogenase levels and MDSCs in patients with COVID‐19. These findings suggest that MDSCs play a role in the pathogenesis of COVID‐19, while PMN‐MDSCs, especially immature PMN‐MDSCs, are associated with the severity of the disease.

Clinical Features, Treatment and Outcome of Childhood Glial Tumors

AIM

This study aimed to evaluate the clinical features, treatment approaches, and outcomes of glial tumors in children.

MATERIAL AND METHODS

Files (2006 to 2020) of children diagnosed with glial tumors and followed-up were reviewed retrospectively. Information regarding demographic and clinical characteristics, treatment approaches, and outcomes were retrieved from the patients\' files.

RESULTS

Of the total of 180 pediatric patients diagnosed with brain tumors, 73 (40.6%) had glial tumors. The children with astrocytoma were in the age range of 2-18 years (median age: 8.7 years), while the ages of children with ependymoma ranged from three months to 10 years (median age: 3 years). This difference was statistically significant (p 0.0001). The male to female ratio was 1.6. The most common symptoms or signs were headaches (n = 34, 46.6%), abnormal gait or coordination (n = 22, 30.2%), vomiting (n = 21, 28.8%), and cranial nerve palsies (n = 20, 27.4%). The pathological diagnoses were astrocytomas (n = 53, 72.6%), oligodendroglial tumors (n = 2, 2.7%), ependymoma (n = 15, 20.7%), and other glial tumors (n = 3, 4.1%). The most common tumor location was supratentorial (n = 42, 57.5%), while midline glioma was detected in seven patients. The 5-year overall survival (OS) rate of all glial tumors, astrocytoma, and ependymoma was 42%, 40%, and 55%, respectively. The 5-year OS rate of the tumor Grade I, II, III, and IV was 77.2%, 45%, 32%, and 0%, respectively (p 0.0001). The 5-year OS rate of supratentorial, infratentorial, and spinal tumors was 25.6%, 63.6%, and 50%, respectively (p = 0.021). In Cox regression analysis, it was found that the tumor resection and grade had an effect on the tumor prognosis.

CONCLUSION

Treatment results are not satisfactory in high-grade astrocytomas. There is a need for new treatment approaches that would take cognizance of molecular features and adopt multidisciplinary approaches.

Pseudoangiomatous Stromal Hyperplasia of Breast in an Adolescent: A Case Report and Review of the Literature

BACKGROUND

Pseudoangiomatous stromal hyperplasia (PASH) is a rare benign breast lesion that is is extremely rare in children and adolescents.

CASE

A 13-year-old girl was admitted to our clinic with a giant mass in the left breast for 3 months. Physical examination findings of the patient were normal except for the mass in the breast. The mass was removed totally, and its pathological diagnosis was pseudoangiomatous stromal hyperplasia. The patient has been followed up for 6 months without disease.

The Correlation between the Level of Doxorubicin-Induced Cardiac Damage and Serum Soluble Fas in an Experimental Rat Model

Aim: This study was planned to research the relationship between doxorubicin cardiomyopathy and the soluble Fas (sFas) level. Materials and Methods: Two groups of rats were included in the study. The control group was given physiological saline, while the study group was given doxorubicin. The rats, whose blood samples were taken weekly, were sacrificed and their myocardial tissues were removed. The tissues were examined in terms of morphological changes and surface Fas expression, while the blood samples were examined in terms of sFas level. Results: In the study group, the sFas levels at 2nd–9th weeks were higher than those found at 1st week before administrating the drug, and the increase at 2nd–7th weeks was meaningful. In addition, sFas levels were gradually increased each week during 1st–5th weeks when compared to the values of a previous week, and the increase during the first 4 weeks was meaningful. After the 5th week, the values gradually decreased each week. The mean values of the study group at 1st–8th weeks were higher than those of the control group, and the increases at 2nd–8th weeks were meaningful. The severe forms of interfibrillar hemorrhage, vascular dilatation, myocardial necrosis, inflammatory infiltration, and splitting of muscle fibers occurred with 15, 15, 17.5, 20, and 22.5 mg/kg dose of medicine, respectively. Conclusions: As the tissue injury increased, the increasing cell-surface Fas expression and sFas plasma level at the acute phase of doxorubicin-related cardiotoxicity decreased. The sFas level determined at acute phase may be helpful in predicting the existing injuries and possible late-term problems.

An aggressive parameningeal rhabdomyosarcoma with multiple spinal cord metastases: a case report and review of the literature

PURPOSE

Spinal cord metastasis from rhabdomyosarcoma (RMS) is extremely rare, with three cases reported to date. Herein, we report an aggressive case of RMS of the infratemporal fossa who which developed spinal cord metastases during treatment.

CASE PRESENTATION

A 6-year-old girl presented with an enlarging painless mass around her right ear for 3 months. An enhanced magnetic resonance imaging (MRI) revealed a 5 × x4 × x4.5 5 cm mass on her right infratemporal fossa. A tru-cut biopsy was performed, and histopathologic examination revealed the diagnosis of rhabdomyosarcoma. At the time of the diagnosis, cerebrospinal fluid cytology was negative for malignant cells. The patient underwent induction chemotherapy. There was minimal response to chemotherapy, and the patient underwent curative radiotherapy. However, by 12th fraction of RT, the patient developed a progressive weakness on her lower extremity. Spinal MRI revealed multiple gross masses in different parts of the spinal cord. The local radiotherapy was changed toas craniospinal radiotherapy. However, two 2 weeks after the completion of the RT, the patient developed sepsis and expired because of septic shock.

CONCLUSION

Parameningeal RMS is a peculiar subgroup of RMS, which needs an aggressive approach. Despite aggressive approach, meningeal spread is the most important cause of the treatment failure. We should keept in mind that during the treatment, there can be meningeal spread towards to either the brain or spinal cord; therefore, we should follow -up the patients closely from this aspect.

Pilomatrixoma in childhood

CONTEXT

Pilomatrixoma is a benign tumor of the skin. Malignant transformation can be seen rarely in the small percentage.

AIM

The aim of the following study is to attract attention to this tumor in the differential diagnosis because if it is not kept in mind it leads to both unnecessary interventions and treatments for the patient.

PATIENTS AND METHODS

From January 2006 to December 2012, 8 patients with pilomatrixoma were evaluated retrospectively.

RESULTS

A total of 8 pediatric pilomatrixoma patients' charts were reviewed retrospectively. None of the patients had familial feature. Of 8 patients 4 (50%) were male and 4 (50%) were female. The patients' age ranged from 2-18 years with a median age 11.5 years. All of the patients were admitted with the complaint of swelling at the lesion site. Two patients have multiple lesions, one of them has two and other has three lesions. A total of 11 lesion were detected in our 8 patients that 5 of them were located upper extremities (46%), 3 of them cervical region (27%), 2 of them on occipital region (18%) and 1 of them in the sacral region (9%). All lesions were excised completely. Until now, no patient had evidence of recurrence or malignant disease.

CONCLUSION

As a result pilomatrixoma is a benign tumor, with atypical forms and unfortunately, no tumor-specific diagnostic feature except of a careful histopathological examination is available.

Coexistence of glomangioma and yolk sac tumour in a child: a case report

Glomus tumours (GTs) primarily arise from glomus bodies that are located in the dermis layer of skin. However, they can be encountered ectopically in most parts of the body. As a result of researches done in a 17-month-old male patient who prssented to us with complaint of an increasingly growing swelling, he was diagnosed with a yolk sac tumour. Chemotherapy was started and then, he was operated. GT was found inside the tumoural mass. Our patient, who is the first case according to our knowledge, where the concurrence of yolk sac and glomus tumours was reported, has been discussed in the light of literature.

Neurological complication of non Hodgkin lymphoma in childhood: experience from a single center in Turkey

PURPOSE

Lymphomas are the third most common childhood malignant disease after leukemia and central nervous system (CNS) tumors. Early diagnosis of these complications will reduce mortality and morbidity. In this study we aimed to review the neurological complications of childhood non Hodgkin Lymphoma (NHL).

PATIENTS AND METHODS

Forty four children with NHL between 2006 and 2012 were investigated retrospectively and 14 cases with neurological complications were identified.

RESULTS

The most common symptom was alteration of the consciousness (10 patients, 71.4 %) followed by convulsion (5 patients, 35.7 %), and hallucination (4 patients, 28.5 %); headache, eye pain, neurogenic bladder, speech disability and facial paralysis, and hemiplegia, were less common and each of them was seen in 1 (7.1 %) of the patients. The neurological complications were mostly seen in children with precursor T lymphoblastic lymphoma followed by anaplastic large cell lymphoma. The complications were secondary to medications (Eight patients) infection (two patients); CNS relapse (two patients); or CNS involvement of the primary disease (two patients). Chemotherapy-related neurologic complications were secondary to intrathecal methotrexate, L-asparaginase, vincristine, and ifosfamide

CONCLUSION

Advanced disease and PTLL subtype can be suggested as predictors of neurological complication. The survival rates of neurological complications are fairly good unless it is secondary to involvement of the primary disease. In patients with drug-induced neurological complications, the treatment can be safely re-administered after controlling the neurological complications. Therefore, clinicians managing children with NHL must be informative about neurological complications.

Intracranial metastasis of neuroblastoma: in two different areas at the same time

INTRODUCTION

Neuroblastoma (NB) is the most common extracranial solid malignancy in children. The major cause of death from this cancer is metastasis of tumors, and metastasis can be seen in different areas of the body. Metastasis of NB occurs by hematogenous and lymphatic routes. Generally, brain metastases have been reported in only one area of the brain parenchyma.

CASE REPORT

A 4-year-old male patient was treated in our clinic due to the NB that settled in the intra-abdominal region, but the patient presented with headache and nausea approximately 5 months after completion of the treatment. Whereupon, cranial imaging was performed and two masses were detected in the bilateral frontal lobe, and then the patient underwent surgery. Metastatic NB diagnosis was confirmed histopathologically. The patient's chemotherapy treatment is still ongoing.

CONCLUSION

We report the case of a male patient with two separate metastatic masses in the brain parenchyma, which occurred in two different areas at the same time.

Giant mature adrenal cystic teratoma in an infant

CONFLICT OF INTEREST: NONE DECLARED

The activity of valproic Acid in the treatment of refractory hyperleukocytosis in a child with acute lymphoblastic leukemia

Hyperleukocytosis may be associated with an early morbidity and mortality due to leukostasis. Cytoreductive therapies-such as steroids, hydroxiurea, exchange transfusion, and leukapheresis-have been used for the prevention of leukostasis. Herein, the valproic acid used for the treatment of the hyperleukocytosis did not respond to known therapies in a child; lymphoblastic lymphoma developed bone marrow relapse under the treatment is discussed.

Growth-differentiation factor-15 and tissue doppler ımaging in detection of asymptomatic anthracycline cardiomyopathy in childhood cancer survivors

OBJECTIVES

Anthracyclines have led to an increased risk of cardiac morbidity and mortality. Late cardiac complications in cancer survivors may develop from subclinical myocardial damage. Tissue Doppler imaging (TDI) also has potential as a clinically useful technique for the assessment of myocardial function. Biochemical markers may be used to detect cardiac damage growth-differentiation factor-15 (GDF-15) and are emerging as a biomarker of cardiac dysfunction. The aim of this study is to assess the value of the plasma levels of GDF-15 and TDI in detecting late myocardial dysfunction in childhood cancer survivors (CCS) who were treated with anthracyclines.

DESIGN AND METHODS

Thirty-eight CCS who had completed chemotherapy treatment with anthracyclines were included in this study. Control group consisted of 32 age- and gender-matched healthy volunteers. All children underwent a detailed echocardiography, which contained an M-mode, pulse Doppler and tissue Doppler imaging. However, GDF-15 and cardiac troponin-I (cTnI) were measured.

RESULTS

Although, systolic function of the left ventricular was similar in all groups, there were significant differences between parameters of diastolic function of the heart. The mitral valve E wave, E/A ratio, left ventricular E'm wave, and E'm/A'm ratio were different in the patients than in the controls (p = 0.049, p = 0.037, p < 0.0001, p = 0.001, respectively). The tricuspid valve E/A ratio, right ventricular E't wave, and E't/A't ratio in the patients were also different from those of the controls (p = 0.031, p < 0.0001, p < 0.0001, respectively). Mean plasma GDF-15 was significantly higher in patients than healthy controls (p = 0.027). There were no significant differences in cTnI between both groups.

CONCLUSIONS

Growth-differentiation factor-15 level may be used as a biomarker of anthracycline-induced cardiovascular disease severity in the CCS.

Clinical value of cystatin c determination in children with lymphoma

Cystatin, a proteinase inhibitor, is involved in the intracellular catabolism of proteins. We investigated the change in concentration of serum Cystatin C (CysC) in children with lymphomas and its diagnostic utility. Twenty-eight newly diagnosed patients with lymphoma were included in this study. The male/female ratio was 20/8, with a median age of 8.5 years (range 3-17 years). Thirteen patients had Hodgkin's lymphoma (HL) and 15 had non-Hodgkin's lymphoma (NHL). Cystatin C concentration was determined at the time of diagnosis and during remission. In the entire group, CysC concentrations at diagnosis and during remission were 0.87+/-0.29 mg/L and 0.86+/-0.21 mg/L, respectively (p=0.93). In the NHL group, CysC concentrations at diagnosis and remission were 0.89+/-0.32 mg/L and 0.85+/-0.23 mg/L, respectively (p=0.73). The CysC concentrations in the HL group at diagnosis and remission were 0.88+/-0.36 mg/L and 0.88+/-0.18 mg/L, respectively (p=0.73). No significant difference was observed between CysC concentrations in the HL (0.88+/-0.36 mg/L) and NHL (0.89+/-0.32 mg/L) groups. Cystatin C concentrations in all the patients with localized versus those with advanced disease were 0.91+/-0.41 mg/L and 0.88+/-0.3 mg/L, respectively (p=0.83). Cystatin C concentrations of the patients with localized and advanced HL were 0.95+/-0.45 mg/L and 0.77+/-0.14 mg/L, respectively, (p=0.41). Cystatin C level was higher in patients with localized disease, in those without B symptoms, and, at diagnosis, in those with an unfavorable response (Tab. 2, Ref. 20). Full Text in free PDF www.bmj.sk.

Cardiac functions evaluated with tissue Doppler imaging in childhood cancers treated with anthracyclines

AIM

The aim of this study was to assess the cardiac functions using conventional echocardiography and tissue Doppler imaging in childhood cancers treated with anthracyclines.

METHODS

The study group was selected from the patients admitted to the pediatric oncology department for a treatment protocol that included doxorubicin. Body surface area was calculated and complete 2-dimensional, M-mode, pulse wave Doppler and pulse wave tissue Doppler echocardiographic examinations were performed just before the first treatment and at least 6 months after the last treatment.

RESULTS

This study included 20 patients (12 males and 8 females). Mean cumulative antracycline dose was 189 +/- 102.90 mg/m(2). There were no significant differences between the pre- and post-treatment groups regarding systolic and diastolic blood pressures, heart rates, left ventricular ejection fraction and fractional shortening, right and left ventricular conventional and tissue Doppler diastolic parameters (E and A waves, E/A ratio, E' and A' waves, E'/A' ratio), but there were significant differences between the pre- and post-treatment groups regarding body surface area, right and left ventricular myocardial performance index observed by conventional pulse wave and pulse wave tissue Doppler methods.

CONCLUSION

Tissue Doppler imaging provided additional information on cardiac functions. While systolic and diastolic functions were in normal range, myocardial performance index observed by tissue Doppler method was impaired in children who were treated with anthracyclines.

Malignant glioblastomatous transformation of a low-grade glioma in a child

BACKGROUND

The term of low-grade glioma addresses a favorable clinical outcome with indolent histological features in general consideration; however, recent studies underline the inconsistency, which originates from the accumulation of different histologic subtypes in this terminology. The malignant transformation of a low-grade glioma is unusual but presents a poor prognosis.

CASE HISTORY

We report a case of a 12-year-old boy, who was referred for complaints of recurrent seizures. His physical examination was unremarkable, but it was learned that a peripheral mass lesion located on the left posterior parietal lobe--which had been thought to be a low-grade glioma--had been detected on a magnetic resonance imaging 2 years ago at a different hospital. The patient was then treated with valproate and carbamazepine for the seizures and advised to be followed up without any additional diagnostic and therapeutic studies for his suspected low-grade glioma. A recent magnetic resonance imaging study showed enlargements of the mass and surrounding edema with additional necrosis. Surgical excision of the tumor was performed. After the diagnosis of glioblastoma multiforme, the patient received radiation therapy and chemotherapy with a good clinical recovery without any evidence of residue or recurrence at 12-month follow-up.

CONCLUSION

The first line treatment modality in the management of low-grade glioma--especially in suitable patients--is clearly surgery. The gross total resection guarantees the distinguishing of the histological types of the low-grade gliomas and reflects the biologic behavior of these tumors. Observation without surgery must be reserved for selected inoperable cases.

Cerebral venous sinus thrombosis in an adolescent with Ewing sarcoma

BACKGROUND

Although thromboembolic complications are common in adult patients with malignant diseases, cerebral venous sinus thrombosis has been rarely described in cancer afflicted pediatric and adolescent population.

CASE HISTORY

A 16-year-old adolescent girl referred for complaints of pain and swelling on her left leg. On physical examination, a solid tibial mass was discovered. After the diagnosis of Ewing sarcoma with a tru-cut biopsy, chemotherapy protocol consisting of cisplatin, ifosfamide, adriamycine, and vincristine was started. During the first course of the treatment, the patient expressed headache, diplopia, and ptosis. Contrast-enhanced magnetic resonance (MR) images and MR angiography showed superior sagittal and transverse sinus thromboses. After anticoagulant therapy, the thromboses disappeared within 1.5 months. She received her chemotherapy protocol with the anticoagulant prophylaxis. After a follow-up period of 12 months, she is still in a good neurological recovery without any sequel.

CONCLUSION

Children and adolescents with cancer should be monitored closely for thrombotic complications. We discuss this uncommon case to draw attention to the importance of early diagnosis and adequate treatment of intracranial thrombosis in childhood cancer, and we review the relevant literature.

Left ventricular diastolic function evaluated with tissue Doppler imaging in children with familial Mediterranean fever

The aim of this study was to assess the left ventricular diastolic function using conventional echocardiography and tissue Doppler imaging in children with familial Mediterranean fever. This study included 29 (13 males and 16 females) patients and 30 healthy subjects as controls. Body mass index was calculated and arterial blood pressure was monitored. After an overnight fast, venous blood samples were taken and serum amyloid A protein, C-reactive protein, serum-fasting glucose, total cholesterol, triglycerides, high-density lipoprotein cholesterol, very low density lipoprotein cholesterol, and serum low-density lipoprotein cholesterol levels were measured. A complete 2-dimensional, M-mode, pulse wave Doppler, and pulse wave tissue Doppler echocardiographic examination was performed. There were no significant differences between the groups regarding age, body mass index values, systolic and diastolic blood pressures, heart rates, serum-fasting glucose, total cholesterol, triglycerides, high-density lipoprotein cholesterol, very low density lipoprotein cholesterol, and serum low-density lipoprotein cholesterol. Serum levels of inflammatory markers were higher in patients' group (C-reactive protein and serum amyloid A protein levels were 10.84 mg/dl, 22.32 mg/l in patients' group, respectively, and 4.11 mg/dl, 3.65 mg/l, respectively, in the healthy controls.) Peak mitral A wave, E and A wave ratio differed significantly in both groups. There were statistically significant differences regarding parameters observed by tissue Doppler imaging such as E'm, A'm, E'm, and A'm ratio between patients' group and controls. Tissue Doppler imaging provided additional information on left ventricular diastolic function. While systolic functions were in normal range, some of the diastolic function parameters were impaired in patients with familial Mediterranean fever during childhood.

A case of Burkitt lymphoma re-presenting as periportal hepatic and multiple organ infiltration

Burkitt lymphoma (BL) is a high-grade, B-cell-originated pediatric malignancy that is a type of non-Hodgkin lymphoma involving different organs. Mediastinal mass, ascites, peritoneal thickening, and infiltration of the small intestine, kidney, and liver were found in our patient. In this case, we describe the radiologic appearances and possible infiltration patterns of multi-organ BL. Also, we discuss infiltration of the periportal area, such as hypodense lesions in the liver, which is rarely seen in BL.

Pilocytic astrocytoma developing at the site of a previously treated medulloblastoma in a child

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.

Astroblastoma in a child

BACKGROUND

Astroblastoma, an uncommon neuroepithelial tumor, typically presents in young adults as a well-circumscribed cortical or subcortical spherical mass. Astroblastoma may cause a diagnostic problem to anyone unfamiliar with its architectural and histological features.

CASE HISTORY

We report the case of a 4-year-old boy who was referred for complaints of progressive deficits of balance and difficulty with walking during the previous 3 months. A large fronto-parietal cystic mass with solid mural nodule was discovered. Total removal of the tumor mass was performed, and a diagnosis of high grade (malignant) variant of astroblastoma was made. Postoperatively, the patient received radiation therapy, for a period of 11 weeks, followed by chemotherapy. He is in a good neurological recovery without any evidence of recurrence for 8 months.

PROGNOSIS

The best treatment modality for astroblastoma is surgical resection if possible, whereas adjuvant therapy (radiotherapy and/or chemotherapy) can be considered in high-grade astroblastomas, with a close follow-up for all cases.

Intracranial desmoid tumor with familial adenomatous polyposis coli

Intracranial desmoid tumors are extremely rare. The association of desmoid tumors with familial adenomatous polyposis coli was reported previously, with the tumors involving trunk and extremities. We report a 3.5-year-old girl with intracranial desmoid tumor with familial adenomatous polyposis coli. This condition in a child is rarely reported. Follow-up of the patient after cranial surgery and of the family for this premalignant inherited condition is necessary.

Dysgerminoma in a child with ataxia-telangiectasia

Ataxia-telangiectasia is an autosomal recessive disease characterized by progressive cerebellar ataxia, oculocutaneous telangiectasia, immunodeficiency, high incidence of cancer, and increased sensitivity to ionizing radiation. The authors report a case of dysgerminoma in a child with high alpha-fetoprotein, CA125 and beta-human chorionic gonadotropin, who has been followed-up for ataxia-telangiectasia for 2 years.

Thyroid Medullary Carcinoma in a Teenager With Cowden Syndrome

Cowden syndrome is a multisystemic cancer predisposition disorder, in which the mucocutaneous lesions are the most constant features. We present a case of Cowden syndrome in a teenage boy with hyperkeratotic papules of the facial skin, especially on the eyelids, with episcleritis, proptosis, and papillomatous lesions on the tip of the tongue and lip mucosa. In addition, two nodules in the thyroid gland were detected. On laboratory examination, the carcinoembryonic antigen (CEA) was 34 ng/mL (normal limits: 0-3 ng/mL). Total thyroidectomy was performed. Histopathologic examination of the specimen revealed thyroid medullary carcinoma. After operation, levels of CEA decreased to normal limits.

Kluver-Bucy syndrome in a boy with non-Hodgkin lymphoma

Kluver-Bucy syndrome is a rare neurobehavioral condition characterized by visual agnosia, excessive oral tendency, hypermetamorphosis, placidity, altered sexual behaviors, and changes in dietary habits. The authors report a case of Kluver-Bucy syndrome in a 10-year-old boy with non-Hodgkin lymphoma after intratechal methotrexate administration. He was treated by risperidone without any sequels.

A case of primary ovarian lymphoma in a child with high levels of CA125 and CA19-9

Primary ovarian lymphoma is extremely rare in children. The authors report a case of primary ovarian lymphoma in a child with high levels of CA125 and CA19-9. To their knowledge, this is the first such case to be reported in the literature.

Galactorrhea-associated granulosa cell tumor in a child

Granulosa cell tumor of the ovary is a rare form of ovarian cancer in children. An 11-year-old girl was admitted with complaints of galactorrhea and abdominal mass. Abdomino-pelvic ultrasound and computed tomography revealed an ovarian tumor. Her prolactine and estradiol levels were increased but luteinizing hormone and follicle-stimulating hormone were decreased. An exploratory laparotomy revealed a giant solid mass, which was completely removed and determined as juvenile granulosa cell tumor. The clinical, hormonal, and radiological findings and the therapy of galactorrhea associated with granulosa cell tumor in a child are discussed. To our knowledge, this is first time it has been described in childhood.