Carcinoma de células pequeñas en la unión gastroesofágica / Gastroesophageal junction small cell carcinoma

Resumen Los tumores de células pequeñas extrapulmonares pueden aparecer en múltiples órganos y forman una rara afección clínico-patológica de tumores neuroendocrinos, con gran proliferación epitelial y con comportamiento biológico agresivo. El tubo gastrointestinal es la fuente más común de tumores de células pequeñas extrapulmonares. Nuestro caso clínico describe un paciente con carcinoma de células pequeñas en la unión gastroesofágica, que fue diagnosticado en el contexto de sangrado de tubo digestivo alto. Se excluyó un tumor pulmonar primario; el paciente recibió quimioterapia, quimiorradioterapia y radioterapia cerebral profiláctica, con buena evolución clínica. Nuestro caso se trata de una rara afección clínica, lo que evidencia la importancia de diagnosticar enferemedades poco frecuentes. Existe poca evidencia en la bibliografía de cómo deben tratarse estos pacientes.

Abstract Extrapulmonary small cell carcinomas (EPSCC) can arise in multiple organ sites and form a rare clinicopathological entity of high proliferative epithelial neuroendocrine tumors with aggressive biological behavior. Gastrointestinal is the most common source of EPSCC. We report a case of gastroesophageal junction small cell carcinoma, which was diagnosed in the context of upper gastrointestinal bleeding. A primary small cell lung carcinoma was excluded. Chemotherapy, neoadjuvant chemoradiotherapy and prophylactic cranial radiotherapy were given, with good clinical outcome. Our case of a very rare condition highlights the importance of recognizing atypical pathologic diagnoses. More research needs to be conducted with EPSCC patients in order to better characterize disease pathogenesis, and an optimal disease management.

Phenytoin Induced Erythema Multiforme after Cranial Radiation Therapy

The prophylactic use of phenytoin during and after brain surgery and cranial irradiation is a common measure in brain tumor therapy. Phenytoin has been associated with variety of adverse skin reactions including urticaria, erythroderma, erythema multiforme (EM), Stevens-Johnson syndrome, and toxic epidermal necrolysis. EM associated with phenytoin and cranial radiation therapy (EMPACT) is a rare specific entity among patients with brain tumors receiving radiation therapy while on prophylactic anti-convulsive therapy. Herein we report a 41-year-old female patient with left temporal glial tumor who underwent surgery and then received whole brain radiation therapy and chemotherapy. After 24 days of continous prophylactic phenytoin therapy the patient developed minor skin reactions and 2 days later the patient returned with generalized erythamatous and itchy maculopapuler rash involving neck, chest, face, trunk, extremities. There was significant periorbital and perioral edema. Painful mucosal lesions consisting of oral and platal erosions also occurred and prevented oral intake significantly. Phenytoin was discontinued gradually. Systemic admistration of corticosteroids combined with topical usage of steroids for oral lesions resulted in complete resolution of eruptions in 3 weeks. All cutaneous lesions in patients with phenytoin usage with the radiotherapy must be evoluated with suspicion for EM.

Measuring Cranial Soft Tissue Thickness with MRI or Force-Compensated Tracked Ultrasound.

Aims: A new approach to patient tracking in cranial stereotactic radiosurgery relies on contact-free localisation of the cranial bone. It requires accurate information about the soft tissue thickness on the patient's forehead, which in this work is measured using two independent modalities: magnetic resonance imaging (MRI) and force-compensated tracked ultrasound. Methodology: High resolution MRI scans and ultrasound data of the forehead were recorded and the soft tissue thickness was extracted. The datasets were registered using the iterative closest point algorithm with high accuracy (RMS error < 0.5 mm after artefacts from data acquisition were removed). Tissue deformation was analysed using a robotic setup with force control where the ultrasound transducer was pressed against the skin. Results: The force compensation setup showed that a tissue compression factor of 0.75 can be assumed for typically applied forces of 7-10N. This factor was confirmed by comparing histograms of soft tissue thickness. Comparing soft tissue thickness as measured by MRI and ultrasound showed a mean error of 0.14mm and a standard deviation of 0.87mm. Conclusion: We could show that, using MRI as a ground truth, data from 2D ultrasound can be compensated for pressure and can also be used to generate realistic values of soft tissue thickness.

Treatment Outcome of Brain Metastasis after the Cranial Radiotherapy Followed by Fractionated Stereotactic Radiotherapy and Its Prognostic Factors / Journal of the Korean Cancer Association, 대한암학회지

To evaluate the effectiveness of whole brain radiotherapy followed by stereotactic radiotherapy for newly diagnosed brain metastasis. MATERIALS AND METHODS: Thirty-three metastatic brain tumors received radiotherapy to the whole brain and stereotactic radiotherapy in 25 patients. Lung carcinomas were the most common (17/25) primary tumor. The radiation dose was 30 to 40 Gy for the whole brain, with a 12 to 40 Gy boost to the metastatic foci. Survival and local control rates were determined, and the prognostic factors for survival were evaluated. RESULTS: The overall median survival was 15 months and the actuarial survivals at 1- and 2-year were 67% and 31%, respectively. The local tumor control rate was 79%, with a median follow-up period of 9 months (2~36 months). The prognostic factors associated with survival were age, tumor size and the existence of active extracranial metastasis, with the performance status showing marginal significance. No acute or chronic complications were observed in the patients. CONCLUSION: From our data, cranial radiotherapy followed by stereotactic radiotherapy was useful in the local control of metastatic tumors, and in the survival of patients with tumor factors, such as small size or the absence of extracranial tumor activity, and host factors, such as young age or good performance status.