Round cell sarcoma of the kidney on a patient treated for acute promyelocytic leukemia: A case report and literature review

@#This is a report of a patient who was diagnosed with acute promyelocytic leukemia (APL) last 2007 and was given a standard chemotherapeutic regimen of anthracycline, all-trans-retinoic acid and methotrexate. The patient completed treatment and recovered. Twelve years after chemotherapy, the patient was diagnosed to have renal tumor. The patient presented with intermittent episodes of non-bothersome flank pain. He was managed as a case of renal newgrowth, left, stage II (cT2bN0M0), which was eventually found to have intermediate grade, round cell sarcoma not further classified of the kidney. Immunohistochemical studies and literature review point to a newly classified subtype of sarcoma or a primitive neuroectodermal tumor, both of which are rarely found presenting in the kidneys.

Histomorphological Spectrum of Splenectomy Specimens in a Tertiary Teaching Hospital:A Seven Year Study

Background: Spleen is the largest organ of the mononuclear phagocytic system and is involved in all systemic inflammations, generalized hematopoietic disorders, and many metabolic disturbances. Splenectomy is frequently indicated where diagnosis is already established and the purpose of surgery being largely therapeutic in nature. Objectives: The study aims to highlight the histomorphological patterns in the surgically resected splenectomy specimens received in our centre and to correlate with the clinical indications. Materials and Methods: This was a seven year study of all splenectomy specimens received at histopathology section of Department of Pathology in a tertiary care hospital. All the histopathology slides were reviewed by the authors and the microscopic findings were studied and correlated with clinical data. Results: Twenty two (22) spleen samples were received during the study period with a M:F=1: 1.2 . The age range was 2 years to 60 years. The highest number of splenectomy cases was in the age group of 11-20 years followed by 0-10 years age group. The majority of the cases of splenectomy were indicated for thalassemia (14 cases, i.e. 63.64% of all cases), followed by traumatic rupture and secondary malignancy with 2 cases each (9.09% cases each), one case each for splenic infarct, myelofibrosis, ITP and splenic tuberculosis. Conclusion: Thalassemia was proved to be the commonest indication of splenectomy, followed by traumatic rupture and secondary malignancy in the spleen. Larger studies are needed for better understanding of this important organ and unnecessary splenectomies may thus be avoided

Adjuvant Radiotherapy Outcome of Stage I Testicular Seminoma: A Single Institution Study

PURPOSE: To analyze treatment outcome and side effects of adjuvant radiotherapy using radiotherapy fields and doses which have evolved over the last two decades in a single institution. MATERIALS AND METHODS: Forty-one patients received radiotherapy after orchiectomy from 1996 to 2007. At our institution, the treatment field for stage I seminoma has changed from dog-leg (DL) field prior to 2003 to paraaortic (PA) field after 2003. Fifteen patients were treated with the classic fractionation scheme of 25.5 Gy at 1.5 Gy per fraction. Other patients had been treated with modified schedules of 25.05 Gy at 1.67 Gy per fraction (n=15) and 25.2 Gy at 1.8 Gy per fraction (n=11). RESULTS: With a median follow-up of 112 months, the 5-year and 10-year survival rates were 100% and 96%, respectively, and 5-year and 10-year relapse-free survival rates were both 97.1%. No in-field recurrence occurred. Contralateral seminoma occurred in one patient 5 years after treatment. No grade III-IV acute toxicity occurred. An increased rate of grade 1-2 acute hematologic toxicity was found in patients with longer overall treatment times due to 1.5 Gy per fraction. The rate of grade 2 acute gastrointestinal toxicity was significantly higher with DL field than with PA field and also higher in the 1.8-Gy group than in the 1.5-Gy and 1.67-Gy groups. CONCLUSION: Patients with stage I seminoma were safely treated with PA-only radiotherapy with no pelvic failure. Optimal fractionation schedule needs to be explored further in order to minimize treatment-related toxicity.

Colon Cancer Secondary to Hematologic Disease

PURPOSE: The incidence of secondary malignancies in hematologic patients is known to be higher than it is in other patients. However, the characteristics of secondary malignancy and surveillance have not yet been established for colorectal cancer in leukemic patients. METHODS: From 1995 to 2007, 6,030 patients who were diagnosed with acute myeloid leukemia (AML), acute lymphoid leukemia (ALL), chronic myeloid leukemia (CML), chronic lymphoid leukemia (CLL), and multiple myeloma (MM) were enrolled in this study. Among them, 9 patients were diagnosed with colorectal cancer at St. Mary's Hospital and were analyzed retrospectively. RESULTS: Three of the 2,570 patients with AML, 1 of the 1,158 patients with CML, 2 of the 83 patients with CLL, 2 of the 422 patients with MM, and none of the 1,797 patients with ALL were found to have colorectal cancer. There were no operative mortalities, but 2 patients refused to have surgery. The ratio of observed to expected subsequent colorectal cancer in CLL was higher than it was in the other groups, indicating that the relative risk of colorectal cancer is higher in patients with CLL. CONCLUSION: Compared to the Surveillance, Epidemiology and End-Result (SEER) program at the National Cancer Institute (NCI) in the United State, we have the same high relatively risk in CLL patients. Careful attention should be paid to the possibility of colorectal cancer in CLL patients.

Secondary Squamous Cell Carcinoma of the Oral Cavity in Young Adults after Hematopoietic Stem Cell Transplantation for Leukemia / Oral Science International

Two cases of secondary oral squamous cell carcinoma (SCC), which developed in recipients of hematopoietic stem cell transplantation (HSCT) for leukemia, are reported. The first patient underwent allogeneic HSCT for chronic myelogenous leukemia at 32 years of age. He suffered from chronic graft-versus-host-disease (GVHD) of the oral mucosa after HSCT, and has subsequently received immunosuppressive therapy. He experienced metachronous multiple SCCs in the maxillary gingiva and the dorsum of the tongue at 36 years and 40 years of age, respectively. The second patient received autologous HSCT for acute myelogenous leukemia at 22 years of age, and she did not experience GVHD after transplantation. SCC developed in the lateral border of the tongue at 27 years of age. PCR analysis detected both HPV16 and HPV18 in the tongue tumor of the first patient, and only HPV18 in that of the second patient, suggesting that the infection of high-risk HPVs was possibly involved in the development of post-HSCT oral cancers in these patients. Since risk factors for post-HSCT oral SCC are not yet well recognized, long-term close follow-up is necessary for the early detection of secondary oral cancers in all transplant recipients.

Acute Myeloid Leukemia after Chemotherapy for Osteosarcoma: A Case Report / 대한소아혈액종양학회지

There have been advances for the treatment of childhood cancers since the recent several decades, which caused increased incidence of secondary malignancy in the populations of the long term survivors from the primary cancers. The authors report a case of acute myeloid leukemia as a secondary malignancy in a 19-year-old female after successful chemotherapy for osteosarcoma, with a brief review of related literatures.

A Case of Adenocarcinoma of the Lung In Patient with Chronic Lymphpcoytic Leukemia / 대한암학회지

In Korea chronic lymphocytic leukemia(CLL) is a rare diesase with evidence immunologic incompetence. The immunodeficiency of patients with CLL could place them at increased risk of new cancers. The incidence of secondary malignancy, including lung cancer has increased in patients with CLL and this should be also considered in the differential diagnosis of a new pulmonary infiltrate appearing in patients with known CLL. A-73-year old male patient with CLL was admitted to our hospital because of dyspnea. Chest X-ray showed multiple scattered small nodules in both lung fields and alveolar consolidation mass at right lower lung. Histopathological examination of the bronchoscopic biopsy specimen demonstrated that he had a moderatly differentiated adenacarcinoma of lung. Since we experienced a case of metachronous adenocarcinoma of lung in patient with known CLL, we report this with a review of literatures.