Subdural hematoma during therapy of gastro-intestinal stromal tumor [GIST] with Imatinib mesylate

Imatinib mesylate is a widely used tyrosine-kinase inhibitor [TKI] in chronic myeloid leukemia [CML] treatment. Imatinib has contributed to complete and prolong cytogenetic responses so that it is now the standard treatment of CML. Recently, Imatinib mesylate has shown a significantly prolonged progression-free survival and overall survival in metastatic and locally advanced c-Kit positive gastro-intestinal stromal tumors [GISTs] and more recently a prolonged disease-free survival in operated high risk GIST. Imatinib is a welltolerated treatment with few side effects mainly gastro-intestinal symptoms [nausea, vomiting and diarrhea], headaches, rash and periorbital edema. Hemorrhage incidents are rare in patients treated with Imatinib. They are more frequently seen in CML patients. Hemorrhage incidents in CML include in many cases upper gastro-intestinal [GI] tract bleeding and central nervous system bleeding in rare ones. In GIST patients treated with Imatinib, hemorrhage incidents are exclusively made of upper GI tract bleeding consecutive to tumor perforation or necrosis. In our observation, we present the case of a subdural hematoma occurring in a patient treated with adjuvant Imatinib for a high risk localized gastric GIST. No other case of subdural hematoma in GIST treated with Imatinib has been reported in literature

Pure primary small cell carcinoma of the bladder- a propos of 5 cases

Pure primary small cell carcinoma [PSCC] of the bladder is a rare tumor, and patients commonly present with metastatic disease. No prospective studies evaluating the most efficient treatment have been published. We reviewed our experience with treating these tumors to evaluate their histopathological characteristics and clinical outcome. This study presents our experience in 5 patients with PSCC of the bladder during a 7-year period. The patients' tumor characteristics, therapy, follow-up and revival status were documented. All patients were male with a mean age of 67 years. The main clinical presentation was macroscopic hematuria. All tumors were invasive at the time of diagnosis. Systemic chemotherapy was given in 4 patients, and one patient was treated by radical cystectomy. The overall median survival was 17 months. PSCC of the bladder should be considered a systemic disease, because most patients present with metastases. Prospective studies are needed to determine the optimal treatment