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1.
Rev. bras. ginecol. obstet ; 43(4): 323-328, Apr. 2021. tab, graf
Article in English | LILACS | ID: biblio-1280047

ABSTRACT

Abstract Complete hydatidiform mole (CHM) is a rare type of pregnancy, in which 15 to 20% of the cases may develop into gestational trophoblastic neoplasia (GTN). The diagnostic of GTN must be done as early as possible through weekly surveillance of serum hCG after uterine evacuation.We report the case of 23-year-old primigravida, with CHM but without surveillance of hCG after uterine evacuation. Two months later, the patient presented to the emergency with vaginal bleeding and was referred to the Centro de Doenças Trofoblásticas do Hospital São Paulo. She was diagnosed with high risk GTN stage/score III:7 as per The International Federation of Gynecology and Obstetrics/World Health Organization (FIGO/WHO). The sonographic examination revealed enlarged uterus with a heterogeneous mass constituted of multiple large vessels invading and causing disarrangement of the myometrium. The patient evolved with progressive worsening of vaginal bleeding after chemotherapy with etoposide, methotrexate, actinomycin D, cyclophosphamide and vincristine (EMA-CO) regimen. She underwent blood transfusion and embolization of uterine arteries due to severe vaginal hemorrhage episodes, with complete control of bleeding. The hCG reached a negative value after the third cycle, and there was a complete regression of the anomalous vascularization of the uterus as well as full recovery of the uterine anatomy. The treatment in a reference center was essential for the appropriate management, especially regarding the uterine arteries embolization trough percutaneous femoral


Resumo Mola hidatiforme completa (MHC) é um tipo raro de gravidez, na qual 15 a 20% dos casos podem desenvolver neoplasia trofoblástica gestacional (NTG). O diagnóstico de NTG deve ser feito o mais cedo possível, pelo monitoramento semanal do hCG sérico após esvaziamento uterino. Relatamos o caso de uma paciente primigesta, de 23 anos de idade, com MHC, sem vigilância de hCG após esvaziamento uterino. Dois meses depois, a paciente compareceu na emergência com sangramento vaginal, sendo encaminhada ao Centro de Doenças Trofoblásticas do Hospital São Paulo, onde foi diagnosticada com NTG de alto risco, estádio e score de risco III:7 de acordo com a The International Federation of Gynecology and Obstetrics/Organização Mundial de Saúde (FIGO/OMS). O exame ultrassonográfico revelou útero aumentado com uma massa heterogênea constituída pormúltiplos vasos volumosos invadindo e desestruturando o miométrio. A paciente evoluiu com piora progressiva do sangramento vaginal após quimioterapia com o regime etoposide, methotrexate, actinomycin D, cyclophosphamide and vincristine (EMA-CO). Ela foi submetida a transfusão de sangue e embolização das artérias uterinas devido aos episódios graves de hemorragia vaginal, com completo controle do sangramento. O hCG atingiu valor negativo após o terceiro ciclo, havendo regressão completa da vascularização uterina anômala, assim como recuperação da anatomia uterina. O tratamento em um centro de referência permitiu o manejo adequado, principalmente no que se refere à embolização das artérias uterinas através da punção percutânea da artéria femoral, que foi crucial para evitar a histerectomia, permitindo a cura da NTG e a manutenção da vida reprodutiva.


Subject(s)
Humans , Female , Pregnancy , Young Adult , Arteriovenous Malformations/complications , Uterine Hemorrhage/therapy , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Gestational Trophoblastic Disease/complications , Gestational Trophoblastic Disease/drug therapy , Embolization, Therapeutic , Uterine Hemorrhage/etiology , Uterine Hemorrhage/diagnostic imaging , Vincristine/therapeutic use , Methotrexate/therapeutic use , Ultrasonography, Prenatal , Pregnancy, High-Risk , Cyclophosphamide/therapeutic use , Dactinomycin/therapeutic use , Gestational Trophoblastic Disease/diagnostic imaging , Etoposide/therapeutic use , Uterine Artery
2.
Brasília; s.n; 4 ago. 2020.
Non-conventional in Portuguese | PIE, LILACS, BRISA, PIE | ID: biblio-1117744

ABSTRACT

O Informe Diário de Evidências é uma produção do Ministério da Saúde que tem como objetivo acompanhar diariamente as publicações científicas sobre tratamento farmacológico e vacinas para a COVID-19. Dessa forma, são realizadas buscas estruturadas em bases de dados biomédicas, referentes ao dia anterior desse informe. Não são incluídos estudos pré-clínicos (in vitro, in vivo, in silico). A frequência dos estudos é demonstrada de acordo com a sua classificação metodológica (revisões sistemáticas, ensaios clínicos randomizados, coortes, entre outros). Para cada estudo é apresentado um resumo com avaliação da qualidade metodológica. Essa avaliação tem por finalidade identificar o grau de certeza/confiança ou o risco de viés de cada estudo. Para tal, são utilizadas ferramentas já validadas e consagradas na literatura científica, na área de saúde baseada em evidências. Cabe ressaltar que o documento tem caráter informativo e não representa uma recomendação oficial do Ministério da Saúde sobre a temática. Foram encontrados 16 artigos e 13 protocolos.


Subject(s)
Humans , Coronavirus Infections/drug therapy , Betacoronavirus/drug effects , Pneumonia, Viral/drug therapy , Technology Assessment, Biomedical , Tetracyclines/therapeutic use , Vitamin D/therapeutic use , Chloroquine/therapeutic use , Adrenal Cortex Hormones/therapeutic use , Azithromycin/therapeutic use , Antirheumatic Agents/therapeutic use , Ritonavir/therapeutic use , Etoposide/therapeutic use , Lopinavir/therapeutic use , Hydroxychloroquine/therapeutic use
3.
Rev. colomb. cancerol ; 24(2): 88-91, abr.-jun. 2020. graf
Article in Spanish | LILACS | ID: biblio-1144325

ABSTRACT

Resumen El carcinoma de célula pequeña (CPCP) o microcítico de pulmón es un subtipo de cáncer de pulmón que típicamente se ha asociado al tabaquismo y que se caracteriza por su agresividad y mal pronóstico a corto plazo. Como entidad, puede metastatizar en cualquier órgano, siendo las metástasis pancreáticas raras y la mayoría de las veces asintomáticas. Por ello, la presencia de una pancreatitis neoplásica, como en el caso presentado, es excepcional, y aún más cuando presenta refractariedad al tratamiento médico convencional y responde al tratamiento citotóxico sistémico. Por todo ello, se expone esta experiencia clínica y se debate la presencia de esta rara entidad y su manejo.


Abstract Small-cell lung carcinoma is a subtype of neoplasm that has been typically associated with smoking; it is characterized by its aggressiveness and poor prognosis in the short term. As an entity, it can metastasize in any organ, but pancreatic metastases are rare and most of the time asymptomatic. Therefore, the presence of neoplastic pancreatitis as in our case is exceptional; even more when it presents refractoriness to conventional medical treatment, responding instead to systemic cytotoxic treatment. Therefore, we expose our clinical experience and discuss the presence of this rare entity and its management.


Subject(s)
Humans , Male , Middle Aged , Pancreatic Neoplasms/secondary , Pancreatitis/etiology , Small Cell Lung Carcinoma/pathology , Lung Neoplasms/pathology , Pancreatic Neoplasms/drug therapy , Pancreatic Neoplasms/diagnostic imaging , Tobacco Use Disorder/complications , Acute Disease , Cisplatin/therapeutic use , Etoposide/therapeutic use , Small Cell Lung Carcinoma/drug therapy , Small Cell Lung Carcinoma/diagnostic imaging , Lung Neoplasms/drug therapy , Lung Neoplasms/diagnostic imaging , Antineoplastic Agents/therapeutic use
4.
Rev. méd. Chile ; 147(2): 247-250, Feb. 2019.
Article in Spanish | LILACS | ID: biblio-1004339

ABSTRACT

Patients transplanted from solid organs have an increased risk of cancer, especially lymphomas. Lymphomas correspond to 4 to 5% of malignant neoplasms in the general population and in solid organ transplant patients it reaches an incidence of 21%. The incidence of non-Hodgkin lymphomas is 10 times higher than in the non-transplanted population. We report the case of a 68-year-old man with a kidney transplant who 6 years after transplantation, developed a non-Hodgkin diffuse large cells B lymphoma with lymph node and pulmonary involvement, with markers of very poor prognosis (triple MYC expressor, BCL2 and BCL6). and its evolution with chemotherapy with DA R EPOCH.


Subject(s)
Humans , Male , Aged , Lymphoma, Non-Hodgkin , Lymphoma, Large B-Cell, Diffuse/genetics , Vincristine/therapeutic use , Lymphoma, Non-Hodgkin/etiology , Lymphoma, Non-Hodgkin/drug therapy , Prednisone/therapeutic use , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Doxorubicin/therapeutic use , Biomarkers, Tumor/genetics , Genes, myc/genetics , Lymphoma, Large B-Cell, Diffuse/etiology , Lymphoma, Large B-Cell, Diffuse/drug therapy , Kidney Transplantation/adverse effects , Proto-Oncogene Proteins c-bcl-2/genetics , Cyclophosphamide/therapeutic use , Proto-Oncogene Proteins c-bcl-6/genetics , Etoposide/therapeutic use
5.
Autops. Case Rep ; 8(2): e2018025, Apr.-May 2018. ilus
Article in English | LILACS | ID: biblio-905609

ABSTRACT

Large-cell neuroendocrine tumors (NETs) are poorly differentiated malignancies of rare incidence and aggressive nature. NETs mostly arise in the lung followed by the gastrointestinal tract, although they are potentially ubiquitous throughout the body. Primary unknown NET has a worse prognosis and shorter survival comparing with other NETs, with limited available data in the literature concerning this subgroup. The authors report the case of large-cell NET with supraclavicular lymph node presentation. Total excisional biopsy revealed an enlarged adenopathy 18 × 15 × 10 mm, which was extensively infiltrated by a solid malignant neoplasm composed of large cells with granular chromatin, nuclear pseudo-inclusions, high mitotic index, and focal necrosis, with a Ki 67 index 25-30% and positive immunohistochemical study for the expression of cytokeratin 8/18, chromogranin, synaptophysin, and thyroid transcriptional factor-1 (TTF-1). There was no evidence of primary location apart from two infracentimetric lung lesions that could not be accessed for biopsy and were negative at both somatostatin receptor scintigraphy and positron emission tomography. The NET relapsed with three mediastinal masses, so the patient was started on chemotherapy with carboplatin and etoposide with initial total response. Early progression showed no response to further chemotherapy regimens (temozolomide, oral etoposide); therefore, the patient was treated with local radiotherapy. This patient has an atypical long survival (54 months) compared to the literature data. In fact, there are few long-term survivors of large-cell NET and they are all related to complete surgical resection.


Subject(s)
Humans , Female , Aged , Carcinoma, Neuroendocrine , Neoplasms, Unknown Primary , Carboplatin/therapeutic use , Carcinoma, Large Cell , Etoposide/therapeutic use , Neuroendocrine Tumors
6.
Einstein (Säo Paulo) ; 14(3): 420-422, July-Sept. 2016. graf
Article in English | LILACS | ID: lil-796978

ABSTRACT

ABSTRACT A 69-year-old male patient, smoker, was diagnosed with small cell lung cancer metastatic to lung, liver and central nervous system. He received chemotherapy with carboplatin AUC 5 on day 1 and etoposide 100mg/m2 on days 1, 2 and 3. During the first cycle, the patient presented with febrile neutropenia and abdominal distension. Chest, abdomen and pelvis computed tomography scan was performed and detected gas dissecting the wall of sigmoid colon extending to the mesosigmoid. Patient had no abdominal pain, nausea, vomiting, and on physical examination he had no peritoneal irritation, tachycardia or hemodynamic instability compatible with perforation or acute abdomen. Therefore, the radiological finding was interpreted as pneumatosis intestinalis caused by chemotherapy with etoposide. Pneumatosis resolved after continuous oxygen therapy. The second cycle was administered after a complete resolution of the clinical condition and etoposide dose was reduced by 30%. The patient experienced a remarkable evolution.


RESUMO Paciente do gênero masculino, 69 anos, fumante, diagnosticado com câncer de pulmão de pequenas células, metastático para pulmão, fígado e sistema nervoso central. Foi administrada quimioterapia com carboplatina AUC 5 no dia 1 e etoposídeo 100mg/m2 nos dias 1, 2 e 3. Durante o primeiro ciclo, o paciente apresentou neutropenia febril e distensão abdominal. Tomografias de tórax, abdome e pelve detectaram gás dissecando a parede do cólon sigmoide, com extensão para o mesossigmoide. O paciente não apresentava dor abdominal, náusea, vômito e não tinha sinais de irritação peritoneal, taquicardia ou instabilidade hemodinâmica compatíveis com perfuração ou abdome agudo. O achado radiológico foi interpretado como pneumatose intestinal causada por etoposídeo. A resolução do quadro ocorreu após suplementação de oxigênio. O segundo ciclo foi administrado após resolução completa do quadro, com redução da dose do quimioterápico em 30%. O paciente evoluiu de forma bastante satisfatória.


Subject(s)
Humans , Male , Aged , Pneumatosis Cystoides Intestinalis/chemically induced , Carcinoma, Non-Small-Cell Lung/drug therapy , Etoposide/adverse effects , Lung Neoplasms/drug therapy , Antineoplastic Agents, Phytogenic/adverse effects , Oxygen Inhalation Therapy , Pneumatosis Cystoides Intestinalis/therapy , Carcinoma, Non-Small-Cell Lung/secondary , Etoposide/therapeutic use , Lung Neoplasms/secondary , Antineoplastic Agents, Phytogenic/therapeutic use
7.
Rev. cuba. farm ; 50(1)ene.-mar. 2016. tab
Article in Spanish | LILACS, CUMED | ID: biblio-844865

ABSTRACT

Objetivo: caracterizar a los pacientes oncológicos que presenten episodios de neutropenia febril postquimioterapia ingresados en el Instituto de Oncología y Radiobiología en el periodo de enero a mayo del 2015. Métodos: se realizó un estudio descriptivo de corte transversal a una muestra de 36 pacientes. Se revisaron las historias clínicas donde se tomaron las variables analizadas. Resultados: predominaron los pacientes del sexo femenino (61,1 por ciento). Dentro de las enfermedades oncológicas predominaron los pacientes con Linfomas no Hodgkin (25,0 por ciento) y los medicamentos citostáticos vinculados a la neutropenia fueron el carboplatino, paclitaxel, ifosfamida y etopósido. La recuperación hematológica se logró en la mayoría de los casos antes de las 72 horas y el mayor número de pacientes (72,2 por ciento) fueron clasificados como una neutropenia de bajo riesgo, según los criterios de la Multinational Association for Supportive Care. Conclusiones: en la muestra estudiada la neutropenia febril presenta un incremento proporcional con la edad y las enfermedades de origen hematopoyéticos, cuyos esquemas quimioterápicos consisten en altas dosis de agentes citostáticos(AU)


Objective: to characterize the oncological patients who present with post chemotherapy febrile neutropenia and were admitted to the Institute of Oncology and Radiobiology in the period of January to May, 2015. Methods: a descriptive cross-sectional study of a sample of 36 patients. Their medical histories were checked from which the analyzed variables were taken. Results: females predominated in the study (61,1 percent). Among the oncological diseases, non-Hodgkin lymphomas (25,0 percent) prevailed whereas the cytostatic drugs found related to neutropenia were carboplatin, paclitaxel, ifosfamide and etoposide. The hematological recovery was reached in most cases before 72 hours and a lot of patients (72, 2 percent) were classified as low risk neutropenia according to the Multinational Association for Supportive Care criteria. Conclusions: in the study sample, the febrile neutropenia increases with the age and with hematopoietic diseases whereas chemotherapy schemes are based on high dose cytostatic agents(AU)


Subject(s)
Humans , Carboplatin/therapeutic use , Paclitaxel/therapeutic use , Etoposide/therapeutic use , Cytostatic Agents/adverse effects , Chemotherapy-Induced Febrile Neutropenia , Ifosfamide/therapeutic use , Epidemiology, Descriptive , Cross-Sectional Studies , Cuba
8.
Rev. méd. Chile ; 143(9): 1172-1178, set. 2015. tab
Article in Spanish | LILACS | ID: lil-762688

ABSTRACT

Hemophagocytic syndrome is a severe condition of excessive immune activation that has a high mortality in the absence of treatment. The syndrome is classified as primary if associated with congenital or hereditary problems, or secondary/acquired if associated with infectious, autoimmune or oncology diseases. We report four adult cases of the syndrome, one with viral, two with autoimmune and one with idiopathic causes who were successfully treated with HLH 94-04 chemotherapy protocol. Our experience shows that a high index of suspicion, early diagnosis and an opportune therapy are essential in the treatment of this disease.


Subject(s)
Adult , Female , Humans , Male , Young Adult , Cyclosporine/therapeutic use , Dexamethasone/therapeutic use , Etoposide/therapeutic use , Immunosuppressive Agents/therapeutic use , Lymphohistiocytosis, Hemophagocytic/drug therapy , Methotrexate/therapeutic use , Drug Therapy, Combination/methods , Early Diagnosis , Ferritins/blood , Lymphohistiocytosis, Hemophagocytic/diagnosis , Lymphohistiocytosis, Hemophagocytic/physiopathology
9.
Damascus University Journal for Health Sciences. 2012; 28 (1): 21-30
in Arabic | IMEMR | ID: emr-132788

ABSTRACT

Hodgkin's lymphoma [HL] is a disease of good response on initial radio-chemotherapy, but there is a ratio of 5-35% does not respond, and some relapses after initial chemotherapy [CT] appear to have a poor prognosis, especially if the duration of the first complete remission [CR] was short. So the aim was to improve the survival by use the combination of VIP. Prospective Study of patients with Hodgkin's lymphoma, of age more than 13 years, who had relapses after combination of ABVD, and the resistant cases. Diagnosed in Almouassat hospital, within 1/2004- 1/2oo9. Then the patients were treated with the combination of VIP. Evaluation of relapse and resistant depended on CT-scan, biopsy, and Gallium scanning. 32 patients were in first relapse or resistance. they were divided into 3 groups, group-1: included 15 patients [47%] without bad prognosis, the interval of end treatment- relapse is about 4,5 years, Treated with ABVD. result was complete remission in 12 patients [80%]. Group- 2; included nine relapsed patients with bad prognosis; the interval of end treatment- relapse is about 1 year, treated with combination of VIP and Radiation Therapy if It is necessary. Result was complete remission in 3 patients, partial remission in 3 patients, and resistance in 2 patients. The whole response is 78%. Group- 3; included 6 resistant patients, treated with combination of VIP combination CT followed by radiotherapy [RT], result was complete remission in 4 patients [78%], partial remission in 2 patients. There was a significant difference, especially in group-3. The protocol ABVD is still the treatment of choice in patients with far relapse and without bad prognosis. while The combination of VIP, followed by radiotherapy or no, is useful and efficacy in resistant and relapse Hodgkin's lymphoma.


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Aged , Ifosfamide/therapeutic use , Carboplatin/therapeutic use , Etoposide/therapeutic use , Antineoplastic Combined Chemotherapy Protocols , Drug Therapy, Combination , Recurrence , Prospective Studies
10.
Article in English | WPRIM | ID: wpr-128869

ABSTRACT

Primary CNS lymphoma (PCNSL) is a very uncommon disease in children, and usually treated by chemotherapy, combined with focal or craniospinal radiotherapy (RT). However, adverse effects of RT are a concern. We evaluated the outcomes of childhood PCNSL, treated with systemic and intrathecal chemotherapy, but without RT. For fifteen years, six patients among 175 of non-Hodgkin lymphoma were diagnosed as PCNSL in Seoul National University Children's Hospital and we analyzed their medical records retrospectively. Their male:female ratio was 5:1, and median age was 10.1 yr. The primary sites were the sellar area in three patients, parietal area in one, cerebellum in one, and multiple areas in one. Their pathologic diagnoses were diffuse large B-cell lymphoma in three patients, Burkitt lymphoma in two, and undifferentiated B-cell lymphoma in one. Five were treated with the LMB96 treatment protocol, and one was treated with the CCG-106B protocol. None had RT as a first-line treatment. One patient had a local relapse and received RT and salvage chemotherapy, without success. No patient had treatment-related mortality. Their estimated 5-yr event-free and overall survival rates were both 83.3%. In conclusion, PCNSL is a rare disease in childhood, but successfully treated by chemotherapy without RT.


Subject(s)
Adolescent , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Central Nervous System Neoplasms/diagnosis , Child , Child, Preschool , Cyclophosphamide/therapeutic use , Cytarabine/therapeutic use , Disease-Free Survival , Doxorubicin/therapeutic use , Etoposide/therapeutic use , Female , Humans , Hydrocortisone/therapeutic use , Infant , Leucovorin/therapeutic use , Lymphoma, Non-Hodgkin/diagnosis , Male , Methotrexate/therapeutic use , Prednisone/therapeutic use , Recurrence , Retrospective Studies , Tomography, X-Ray Computed , Treatment Outcome , Vincristine/therapeutic use
11.
Article in English | WPRIM | ID: wpr-128853

ABSTRACT

Primary CNS lymphoma (PCNSL) is a very uncommon disease in children, and usually treated by chemotherapy, combined with focal or craniospinal radiotherapy (RT). However, adverse effects of RT are a concern. We evaluated the outcomes of childhood PCNSL, treated with systemic and intrathecal chemotherapy, but without RT. For fifteen years, six patients among 175 of non-Hodgkin lymphoma were diagnosed as PCNSL in Seoul National University Children's Hospital and we analyzed their medical records retrospectively. Their male:female ratio was 5:1, and median age was 10.1 yr. The primary sites were the sellar area in three patients, parietal area in one, cerebellum in one, and multiple areas in one. Their pathologic diagnoses were diffuse large B-cell lymphoma in three patients, Burkitt lymphoma in two, and undifferentiated B-cell lymphoma in one. Five were treated with the LMB96 treatment protocol, and one was treated with the CCG-106B protocol. None had RT as a first-line treatment. One patient had a local relapse and received RT and salvage chemotherapy, without success. No patient had treatment-related mortality. Their estimated 5-yr event-free and overall survival rates were both 83.3%. In conclusion, PCNSL is a rare disease in childhood, but successfully treated by chemotherapy without RT.


Subject(s)
Adolescent , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Central Nervous System Neoplasms/diagnosis , Child , Child, Preschool , Cyclophosphamide/therapeutic use , Cytarabine/therapeutic use , Disease-Free Survival , Doxorubicin/therapeutic use , Etoposide/therapeutic use , Female , Humans , Hydrocortisone/therapeutic use , Infant , Leucovorin/therapeutic use , Lymphoma, Non-Hodgkin/diagnosis , Male , Methotrexate/therapeutic use , Prednisone/therapeutic use , Recurrence , Retrospective Studies , Tomography, X-Ray Computed , Treatment Outcome , Vincristine/therapeutic use
12.
Maroc Medical. 2011; 33 (3): 184-189
in French | IMEMR | ID: emr-162263

ABSTRACT

Desmoplastic small round cell tumor is a recently recognized and rare clinicopathologic entity with distinctive morphologic and immuno histochemical features .Moreover, specific cytogenetics abnormalities and molecular characteristics have been described and confirmed its identity. It is often located at the abdominal cavity, but can exceptionally be located at the cerebral level or some soft tissue and the bones of the members. We report a case of Desmoplastic small round cell involving gluteal muscle and iliac bone at a 25-year-old girl. Our patient had been treated by chemotherapy based on ifosfamide, doxorubicine, etoposide and cis platine. The evolution was marked by the tumoral progress and the death of the patient 18 months after the discovery of the disease. The second case is a 27-year old man .He had a retro peritoneal desmoplastic small round cell tumor treated by surgery alone. The evolution was marked by metastasis and the patient died 10 months after diagnosis. The prognosis of these tumors remains unclear in spite of the mulitidisciplinary treatment. Hence the necessity of new lines of therapeutic research


Subject(s)
Humans , Male , Adult , Desmoplastic Small Round Cell Tumor/therapy , Muscle Neoplasms , Ilium , Ifosfamide/therapeutic use , Etoposide/therapeutic use
13.
Indian J Med Sci ; 2010 May; 64(5) 237-240
Article in English | IMSEAR | ID: sea-145512

ABSTRACT

Choriocarcinoma include a spectrum of chorionic neoplasms that may be gestational or non-gestational. By virtue of their high vascularity and affinity of trophoblast for blood vessels, metastases often occur early, and the most common site of such metastases is the lung. Metastatic pleural effusions from choriocarcinoma are infrequent. Pleural seeding usually results from extension of a sub-pleural peripheral nodule. We describe a case of gestational choriocarcinoma whose clinical presentation was medical like hemothorax as in our case rather than gynecologic.


Subject(s)
Adult , Antineoplastic Agents/therapeutic use , Choriocarcinoma/diagnosis , Choriocarcinoma/drug therapy , Choriocarcinoma/diagnostic imaging , Dactinomycin/analogs & derivatives , Dactinomycin/therapeutic use , Etoposide/therapeutic use , Female , Hemothorax/etiology , Hydatidiform Mole/etiology , Humans , Methotrexate/therapeutic use
14.
Yonsei Medical Journal ; : 280-283, 2009.
Article in English | WPRIM | ID: wpr-109392

ABSTRACT

The prognosis for patients with primary central nervous system (CNS) lymphoma (PCNSL) who relapse after the initial response is usually poor. A standard treatment for relapsed PCNSL has not yet been identified because of the heterogeneity of the therapies employed and the lack of large, prospective clinical trials. We describe a 46-year-old relapsed PCNSL patient who was successfully treated with intraventricular applications of rituximab to minimize neurotoxicity, 2 cycles of salvage chemotherapy with etoposide, ifosfamide, and cytarabine (VIA) regimen and high-dose chemotherapy with autologous stem cell rescue. The high-dose chemotherapy consisted of bischloroethylnitrosourea, etoposide, cytarabine, and melphalan (BEAM) regimen. Partial remission was detected after intraventricular rituximab therapy and the patient has been in complete remission without evidence of neurotoxicity for 28 months after high-dose chemotherapy with autologous stem cell rescue. This case indicates a new appropriate treatment guideline in relapsed PCNSL patient after initial intensive chemo-radiotherapy.


Subject(s)
Antibodies, Monoclonal/therapeutic use , Central Nervous System Neoplasms/drug therapy , Cytarabine/therapeutic use , Etoposide/therapeutic use , Female , Humans , Ifosfamide/therapeutic use , Lymphoma, Non-Hodgkin/drug therapy , Middle Aged , Stem Cell Transplantation/methods
15.
Article in English | IMSEAR | ID: sea-92705

ABSTRACT

Hemophagocytic lymphohistiocytosis is a rare condition characterized by highly stimulated but inactive immune response. The disease may be inherited or acquired due to infections, collagen vascular diseases and malignancies. The pathological hallmark of the syndrome is aggressive proliferation of macrophages and histiocytes. Decreased NK cell activity results in increased T cell activation resulting production of large quantities of interferon gamma (IFN gamma), tumor necrosis factor alpha (TNF alpha) and granulocyte macrophage colony stimulating factor (GM-CSF). This causes sustained macrophage activation and tissue infiltration as well as production of interleukin 1 (IL1) and interleukin 6 (IL6).The resulting inflammatory reaction causes extensive damage and associated symptoms. Patients with HLH commonly present with high fever, anemia and splenomegaly. Minimal diagnostic parameters are a complete hemogram, liver function test, serum triglycerides and ferritin, coagulation profile including fibrinogen and bone marrow aspiration. Two highly sensitive diagnostic marker are an increased plasma concentration of the alpha chain of soluble IL2 receptor (CD25) and impaired NK cell activity. Hyperinflammation can be treated with steroid, Cyclosporine prevents T lymphocytes and immunoglobulin infusion helps to control the infection. Etoposide may be life saving specially in case of HLH with Ebstein Barr Viruses infection. The Histiocyte Society in 1994 developed a common treatment protocol (HLH-94). In January 2004 a revised HLH treatment protocol was opened entitled HLH-2004, which is based on HLH-94 with minor modifications. There is a high remission rate on the HLH-94 and HLH-2004 treatment protocols.


Subject(s)
Biomarkers/blood , Etoposide/therapeutic use , Granulocyte-Macrophage Colony-Stimulating Factor/biosynthesis , Humans , Interferon-gamma/biosynthesis , Interleukin-1/biosynthesis , Interleukin-6/biosynthesis , Killer Cells, Natural/immunology , Lymphocyte Activation , Lymphohistiocytosis, Hemophagocytic/diagnosis , Macrophage Activation , Receptors, Interleukin-2/blood , T-Lymphocytes/immunology , Tumor Necrosis Factor-alpha/biosynthesis
17.
Rev. bras. cancerol ; 53(2): 211-215, abr.-jun. 2007. ilus
Article in Portuguese | LILACS | ID: lil-523364

ABSTRACT

O teratoma imaturo de ovário é uma neoplasia maligna derivada de células embrionárias de diferenciação somática. Sua incidência é baixa, e rara em gestantes. Costuma se manifestar em pacientes jovens, sendo, frequentemente, assintomáticos. Relata-se aqui o caso de uma paciente de 21 anos que veio à consulta apresentando ecografia obstétrica de 25 semanas, com presença de massa anexial à esquerda. Uma nova ecografia, realizada dois dias após a primeira avaliação, revelou massa de aspecto heterogêneo, sólido-cístico, septada, com 9,4cm em seu maior diâmetro. Havia presença de líquido livre na cavidade abdominal, ocupada por formações teciduais de distribuição ampla. Duas semanas após a primeira consulta, foi submetida à laparotomia exploradora com salpingo-ooforectomia unilateral e ressecção de implantes peritoneais, obtendo citorredução ótima. O laudo histopatológico revelou teratoma imaturo de ovário grau III, com líquido de ascite negativo para células malignas. Realizados 3 ciclos de quimioterapia adjuvante, segundo protocolo BEP (bleomicina, etoposide e cisplatina), os dois primeiros com a gestação em curso. Com 36 semanas de gestação, iniciou-se a indução de trabalho de parto, com boa evolução. O recém-nascido apresentou um índice de Apgar de 8/8, sem sinais de danos secundários à quimioterapia. No momento, a paciente encontra-se assintomática e livre de doença no décimo quarto mês pós-operatório. Acredita-se que esse trabalho possa acrescentar ao conhecimento atual da doença, visto a raridade do caso e a escassa quantidade de literatura disponível.


Subject(s)
Female , Pregnancy , Adult , Ovarian Neoplasms/surgery , Ovarian Neoplasms/diagnosis , Ovarian Neoplasms/drug therapy , Pregnancy Complications, Neoplastic , Teratoma/surgery , Teratoma/diagnosis , Teratoma/drug therapy , Bleomycin/therapeutic use , Cisplatin/therapeutic use , Etoposide/therapeutic use , Neoplasm Staging , Prognosis , Antineoplastic Combined Chemotherapy Protocols/therapeutic use
18.
Säo Paulo med. j ; 124(6): 343-345, Nov. 7, 2006. ilus
Article in English | LILACS | ID: lil-441175

ABSTRACT

CONTEXT: There are no reports in the literature of massive deep venous thrombosis (DVT) associated with cisplatin, bleomycin and etoposide (BEP) cancer treatment. CASE REPORT: The patient was a 18-year-old adolescent with a nonseminomatous germ cell tumor of the right testicle, with the presence of pulmonary, liver, and massive retroperitoneal metastases. Following radical orchiectomy, the patient started chemotherapy according to the BEP protocol (without routine prophylaxis for DVT). On day 4 of the first cycle, massive DVT was diagnosed, extending from both popliteal veins up to the thoracic segment of the inferior vena cava. Thrombolytic therapy with streptokinase was immediately started. On day 2 of thrombolytic therapy, the patient developed acute renal failure, due to extension of the thrombosis to the renal veins. Streptokinase was continued for six days and the outcome was remarkably favorable.


CONTEXTO: Não há relatos na literatura de trombose venosa profunda (TVP) extensa associada ao protocolo de quimioterapia cisplatina, bleomicina e etoposite (BEP). RELATO DO CASO: O paciente era um adolescente de 18 anos com um tumor germinativo não-seminomatoso no testículo direito, com metástases pulmonares, hepáticas e retroperitoneais. Após orquiectomia radical, o paciente começou a receber quimioterapia de acordo com o protocolo BEP (sem profilaxia rotineira para TVP). No quarto dia do ciclo, TVP massiva foi diagnosticada, estendendo-se das veias poplíteas até o segmento inferior da veia cava torácica. Tratamento trombolítico foi iniciado imediatamente com estreptoquinase. No segundo dia da terapia trombolítica, o paciente desenvolveu insuficiência renal aguda, devido ao acometimento das veias renais pela trombose. Estroptoquinase foi mantida por seis dias e o paciente teve evolução surpreendentemente favorável.


Subject(s)
Humans , Male , Adult , Antineoplastic Agents/adverse effects , Antineoplastic Combined Chemotherapy Protocols/adverse effects , Testicular Neoplasms/drug therapy , Vena Cava, Inferior , Venous Thrombosis/chemically induced , Venous Thrombosis/therapy , Antineoplastic Agents/therapeutic use , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Bleomycin/adverse effects , Bleomycin/therapeutic use , Cisplatin/adverse effects , Cisplatin/therapeutic use , Etoposide/adverse effects , Etoposide/therapeutic use , Fibrinolytic Agents/therapeutic use , Streptokinase/therapeutic use , Ultrasonography, Doppler, Duplex
19.
Indian J Pediatr ; 2006 Mar; 73(3): 241-3
Article in English | IMSEAR | ID: sea-80281

ABSTRACT

We report an 11-year-old child who presented with an abdominal lump and was diagnosed as having an extragonal primary mesenteric seminoma. Patient was treated with 4 cycles of combination chemotherapy cisplatin, etoposide and bleomycin; he is now disease free for 2 years. We discuss and review extragonadal germ cell tumors arising from the mesentery and their management.


Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Bleomycin/therapeutic use , Child , Cisplatin/therapeutic use , Etoposide/therapeutic use , Humans , Male , Mesentery , Peritoneal Neoplasms/diagnosis , Seminoma/diagnosis
20.
Indian J Chest Dis Allied Sci ; 2006 Jan-Mar; 48(1): 49-57
Article in English | IMSEAR | ID: sea-30125

ABSTRACT

Small cell lung cancer comprises approximately 20% of all lung cancers and continues to be a difficult management issue. More than two-thirds of cases present with extensive disease, which has spread beyond the himithorax and regional ipsilateral nodes. While response rates to chemotherapy are relatively high, durable responses are rare, and long-term survival rates are anecdotal. Although many attempts have been made to develop new therapies, a combination of etoposide with either cisplatin or carboplatin remains the most widely used first-line therapy for extensive disease. For those with limited disease, chemotherapy with concomitant radiotherapy (given with the first or second cycles of chemotherapy) is considered the standard of care. Over the last decade, several new drugs and targeted agents have been identified with the aim to improve outcome of this malignancy. In this review we highlight recent developments in the management of this tumour.


Subject(s)
Camptothecin/analogs & derivatives , Carboplatin/therapeutic use , Carcinoma, Small Cell/drug therapy , Cisplatin/therapeutic use , Etoposide/therapeutic use , Humans , Lung Neoplasms/drug therapy , Neoplasm Staging , Radiotherapy
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