Radiation-induced angiosarcoma: case report / Angiossarcoma induzido por radiação: relato de caso

ABSTRACT Angiosarcoma of the breast accounts for less than 1% of breast tumors. This tumor may be primary or secondary to previous radiation therapy and it is also named "radiogenic angiosarcoma of the breast", which is still a rare entity with a poor prognosis. So far, there are only 307 cases reported about these tumors in the literature. We present a case of a 73-year-old woman with a prior history of breast-conserving treatment of right breast cancer, exhibiting mild pinkish skin changes in the ipsilateral breast. Her mammography was consistent with benign alterations (BI-RADS 2). On incisional biopsy specimens, hematoxylin-eosin showed atypical vascular lesion and suggested immunohistochemisty for diagnostic elucidation. Resection of the lesions was performed and histology showed radiogenic angiosarcoma. The patient underwent simple mastectomy. Immunohistochemistry was positive for antigens related to CD31 and CD34, and C-MYC oncogene amplification, confirming the diagnosis of angiosarcoma induced by breast irradiation. A delayed diagnosis is an important concern. Initial skin changes in radiogenic angiosarcoma are subtle, therefore, these alterations may be confused with other benign skin conditions such as telangiectasia. We highlight this case clinical aspects with the intention of alerting to the possibility of angiosarcoma of the breast in patients with a previous history of adjuvant radiation therapy for breast cancer treatment. Sixteen months after the surgery the patient remains asymptomatic.

RESUMO Os angiossarcomas de mama representam menos de 1% dos tumores da mama e podem ser primários ou secundários à radioterapia prévia. Tais tumores são chamados de "angiossarcomas radiogênicos da mama" e representam uma entidade mais rara ainda e de prognóstico ruim. Atualmente, na literatura, são encontrados apenas 307 casos desses tumores. Relatamos o caso de uma mulher de 73 anos, com história prévia de tratamento conservador de câncer de mama direita, apresentando alteração rósea discreta em pele da mama homolateral. A mamografia demostrou resultado compatível com alterações benignas (BI-RADS 2). No material de biópsia incisional, a hematoxilina-eosina demonstrou lesão vascular atípica e sugeriu imuno-histoquímica para elucidação diagnóstica. A paciente foi submetida à ressecção de lesões, e a histologia demonstrou angiossarcoma radiogênico. Em seguida, mastectomia simples foi realizada. A imuno-histoquímica demonstrou positividade para os antígenos relacionados a CD31 e CD34, e a amplificação do oncogene C-MYC confirmou o diagnóstico de angiossarcoma induzido por radiação mamária. O atraso no diagnóstico constitui questão importante. Considerando que as alterações iniciais da pele do angiossarcoma radiogênico são sutis e podem ser confundidas com outras condições benignas da pele, como telangiectasias, neste relato destacamos os aspectos clínicos, no intuito de alertar sobre a possibilidade de angiossarcoma de mama em pacientes com história prévia de radioterapia adjuvante para tratamento de câncer de mama. A paciente permaneceu assintomática 16 meses após a cirurgia.

Radiation-Induced Uterine Carcinosarcoma after Concurrent Chemoradiotherapy for Cervical Squamous Cell Carcinoma

Abstract Objective To describe a case of radiation-induced uterine carcinosarcoma 6 years after a cervical squamous cell carcinoma treatment, which imposed some diagnostic and management challenges. Case Report A 57-year-old woman with a history of pelvic chemoradiotherapy ~ 6.5 years before the event described in this study, following an International Federation of Gynecology and Obstetrics (FIGO) stage IIB cervical cancer, presented with a cervical mass, involving the uterine cavity, the cervical canal and the upper two thirds of the vagina. The biopsy showed a poorly differentiated carcinoma, and a positron emission tomography (PET) scan excluded distant metastasis, although it was unable to define the origin of the tumor as either a new primary malignancy of the endometrium/cervix or as a cervical recurrence. Surgical staging procedure was performed, and the diagnosis was endometrial carcinosarcoma, FIGO stage IIB. The patient was not able to complete the adjuvant therapy, and the progression of the disease was remarkable. Conclusion The present case highlights one of the less common but more serious consequences of radiotherapy for cervical cancer, which has an increasing incidence in younger women, raising concerns about the long-termconsequences of its management.

Radiation exposure and thyroid cancer: a review

ABSTRACT The association between radiation exposure and the occurrence of thyroid cancer has been well documented, and the two main risk factors for the development of a thyroid cancer are the radiation dose delivered to the thyroid gland and the age at exposure. The risk increases after exposure to a mean dose of more than 0.05-0.1 Gy (50-100mGy). The risk is more important during childhood and decreases with increased age at exposure, being low in adults. After exposure, the minimum latency period before the appearance of thyroid cancers is 5 to 10 years. Papillary carcinoma (PTC) is the most frequent form of thyroid carcinoma diagnosed after radiation exposure, with a higher prevalence of the solid subtype in young children with a short latency period and of the classical subtype in cases with a longer latency period after exposure. Molecular alterations, including intra-chromosomal rearrangements, are frequently found. Among them, RET/PTC rearrangements are the most frequent. Current research is directed on the mechanism of genetic alterations induced by radiation and on a molecular signature that can identify the origin of thyroid carcinoma after a known or suspected exposure to radiation.

Residential radon and lung cancer: a cohort study in Galicia, Spain / Radón residencial y cáncer de pulmón: un estudio de cohorte en Galicia, España / Radônio residencial e câncer de pulmão: um estudo de coorte na Galícia, Espanha

Case-control studies show an association between residential radon and lung cancer. The aim of this paper is to investigate this association through a cohort study. We designed an ambispective cohort study using the Galician radon map, Spain, with controls drawn from a previous case-control study. Subjects were recruited between 2002 and 2009. The data were cross-checked to ascertain lung cancer incidence and then analysed using a Cox regression model. A total of 2,127 subjects participated; 24 lung cancer cases were identified; 76.6% of subjects were drawn from the radon map. The adjusted hazard ratio was 1.2 (95%CI: 0.5-2.8) for the category of subjects exposed to 50Bq/m3 or more. This risk rose when subjects from the case-control study were analyzed separately. In conclusion, we did not observe any statistically significant association between residential radon exposure and lung cancer; however, it appears that with a sample of greater median age (such as participants from the case-control study), the risk of lung cancer would have been higher.

Los estudios de casos y controles muestran una asociación entre el radón residencial y el cáncer de pulmón. El objetivo del artículo fue investigar esa asociación a través de un estudio de cohorte. Proyectamos un estudio de cohorte ambispectivo, utilizando el mapa de radón de Galicia, España, con los controles obtenidos de un estudio anterior de casos y controles. Los individuos fueron reclutados entre 2002 y 2009. Los datos fueron verificados para confirmar la incidencia de cáncer de pulmón y después analizados con un modelo de regresión de Cox. Participaron un total de 2.127 individuos; se identificaron 24 casos de cáncer de pulmón; un 76,6% de los individuos fueron obtenidos a través del mapa de radón. El hazard ratio ajustado era 1,2 (IC95%: 0,5-2,8) para la categoría de individuos expuestos a 50Bq/m3 o más. El riesgo aumentó cuando los individuos del estudio de casos y controles fueron analizados separadamente. En conclusión, no se observó una asociación estadísticamente significativa entre exposición al radón residencial y cáncer de pulmón; sin embargo, parece que con una muestra con una media de edad más elevada (tales como los participantes del estudio de casos y controles), el riesgo de cáncer de pulmón habría sido más alto.

Estudos de casos e controles mostram uma associação entre radônio residencial e câncer de pulmão. O artigo teve como objetivo investigar essa associação através de um estudo de coorte. Projetamos um estudo ambispectivo coorte, utilizando o mapa de radônio da Galícia, Espanha, com os controles obtidos de um estudo anterior de casos e controles. Os indivíduos foram recrutados entre 2002 e 2009. Os dados foram verificados para confirmar a incidência de câncer de pulmão e depois analisados com um modelo de regressão de Cox. Participaram um total de 2.127 indivíduos; foram identificados 24 casos de câncer de pulmão; 76,6% dos indivíduos foram obtidos através do mapa de radônio. O hazard ratio ajustado era 1,2 (IC95%: 0,5-2,8) para a categoria de indivíduos expostos a 50Bq/m3 ou mais. O risco aumentou quando os indivíduos do estudo de casos e controles foram analisados separadamente. Em conclusão, não foi observada associação estatisticamente significativa entre exposição ao radônio residencial e câncer de pulmão; entretanto, parece que com uma amostra com mediana de idade mais elevada (tais como os participantes do estudo de casos e controles), o risco de câncer de pulmão teria sido mais alto.

Estimates of Radiation Doses and Cancer Risk from Food Intake in Korea

The aim of this study was to estimate internal radiation doses and lifetime cancer risk from food ingestion. Radiation doses from food intake were calculated using the Korea National Health and Nutrition Examination Survey and the measured radioactivity of 134Cs, 137Cs, and 131I from the Ministry of Food and Drug Safety in Korea. Total number of measured data was 8,496 (3,643 for agricultural products, 644 for livestock products, 43 for milk products, 3,193 for marine products, and 973 for processed food). Cancer risk was calculated by multiplying the estimated committed effective dose and the detriment adjusted nominal risk coefficients recommended by the International Commission on Radiation Protection. The lifetime committed effective doses from the daily diet are ranged 2.957-3.710 mSv. Excess lifetime cancer risks are 14.4-18.1, 0.4-0.5, and 1.8-2.3 per 100,000 for all solid cancers combined, thyroid cancer, and leukemia, respectively.

Riesgos de la radiación en imágenes pediátricas / Radiation risks in pediatric images

The advance of medical imaging technology has led to an increase in the medical radiation exposure, especially derived from computed tomography (CT). Recent studies confirm a small but significant increase of cancer cases induced by CT radiation. Children are markedly more sensitive to radiation than adults and in addition, their life expectancy is longer, so we must use all resources to optimize and reduce the exposure dose using the ALARA concept. CT is an important diagnostic tool in medical practice and its benefits far outweigh the costs of radiation if the indication is properly justified.

El avance tecnológico de las imágenes para evaluación de enfermedades ha llevado a un aumento considerable de la radiación de origen médica, principalmente la proveniente de la tomografía computada (TC). Estudios recientes confirman un pequeño pero significativo incremento de casos de cáncer inducidos por radiación generada por la TC. Siendo los niños reconocidamente más sensibles a la radiación que los adultos y sumado a su mayor expectativa de vida, es que debemos usar todos los recursos para optimizar y reducir la dosis de exposición aplicando el concepto de ALARA. La TC es una herramienta diagnóstica importantísima en la práctica médica, y sus beneficios superan ampliamente los costos de la radiación si su indicación está adecuadamente justificada.

Radiology Residents' Awareness about Ionizing Radiation Doses in Imaging Studies and Their Cancer Risk during Radiological Examinations

OBJECTIVE: Imaging methods that use ionizing radiation have been more frequent in various medical fields with advances in imaging technology. The aim of our study was to make residents be aware of the radiation dose they are subjected to when they conduct radiological imaging methods, and of cancer risk. MATERIALS AND METHODS: A total of 364 residents participated in this descriptive study which was conducted during the period between October, 2008 and January, 2009. The questionnaires were completed under strict control on a one-to-one basis from each department. A chi2-test was used for the evaluation of data obtained. RESULTS: Only 7% of residents correctly answered to the question about the ionizing radiation dose of a posteroanterior (PA) chest X-ray. The question asking about the equivalent number of PA chest X-rays to the ionizing dose of a brain CT was answered correctly by 24% of residents; the same question regarding abdominal CT was answered correctly by 16% of residents, thorax CT by 16%, thyroid scintigraphy by 15%, intravenous pyelography by 9%, and lumbar spine radiography by 2%. The risk of developing a cancer throughout lifetime by a brain and abdominal CT were 33% and 28%, respectively. CONCLUSION: Radiologic residents should have updated knowledge about radiation dose content and attendant cancer risks of various radiological imaging methods during both basic medical training period and following practice period.

Alterações tireoidianas associadas à radiação externa em crianças e adolescentes / Thyroid disorders associated with external radiation in children and adolescents

O efeito da radiação ionizante sobre a tireoide vem sendo estudado há várias décadas, e os acidentes nucleares têm sido a maior fonte de informação. Existe associação de hipotireoidismo, hipertireoidismo, nódulos e câncer de tireoide com a radiação, mas os limiares de dose, mecanismos de lesão e alguns fatores de risco ainda não estão bem estabelecidos. Crianças são mais suscetíveis à lesão tireoidiana por radiação e necessitam de seguimento prolongado após a exposição. Esse tema adquire maior relevância atualmente, pois um grande número de pessoas tratadas com radioterapia para câncer na infância sobrevive e poderá apresentar sequelas. Exames radiodiagnósticos também representam fonte de exposição à radiação na população pediátrica. Nesta revisão, analisamos as diferentes alterações clínico-patológicas e os mecanismos de lesões tireoidianas provocadas por tratamento radioterápico e tomografia computadorizada em crianças e adolescentes. É importante conhecer esses dados para prevenção, detecção precoce e tratamento da disfunção tireoidiana.

The effects of ionizing radiation on the thyroid have been studied for several decades, and nuclear accidents are the major source of information about the subject. There is an association of hypothyroidism, hyperthyroidism, thyroid nodules and cancer with radiation, but the threshold dose, mechanism of injury, and some risk factors have not been fully established. Children are more susceptible to thyroid injury caused by radiation and require prolonged follow-up after exposure. This issue is especially relevant nowadays, since a large number of people treated with radiation for childhood cancer survive and may have sequelae. Diagnostic radiology tests also represent a source of exposure to radiation in the pediatric population. In this review, we analyze different clinical and pathological changes, and the mechanisms of thyroid lesions caused by radiotherapy and computed tomography in children and adolescents. It is important to understand these data for prevention, early detection, and treatment of thyroid dysfunction.

Efectos de la radiación electromagnética no ionizante sobre lasalud y el caso específico de los efectos en la salud humana de la telefonía celular / Health effects of non-ionizing electromagnetic radiation, and the specific case of the effects of mobile telephony

Los efectos en salud de la radiación electromagnética ionizante son bien conocidos; sin embargo hay menos reconocimiento de los efectos en salud causados por exposición a radiación electromagnética no ionizante. La primera parte del presente trabajo se refiere a los efectos en salud de las radiaciones electromagnéticas no ionizantes, independiente de su origen, puesto que no hay diferencias apreciables entre los efectos producidos por los diversos tipos de radiación electromagnética no ionizante y por lo tanto, son también válidas para aquellas emitidas por la telefonía celular. Se describe una asociación estadísticamente significativa de varias enfermedades a radiación electromagnética de frecuencia baja (ELF) proveniente de tendidos o transformadores de alta tensión, radiación electromagnética ELF del tendido eléctrico domiciliario y de artefactos electrodomésticos, exposición ocupacional a radiación electromagnética principalmente ELF, y radiación electromagnética de radiofrecuencia (RF) proveniente de antenas de transmisión de televisión. A continuación se analizan los efectos ya demostrados de la telefonía celular (los teléfonos y sus antenas repetidoras). Luego se analizan los grados de certeza de un estudio del Estado de California (USA) para relacionar las diversas enfermedades causadas por radiación electromagnética no ionizante. Este estudio confirmó la alta o mediana probabilidad de una relación causa-efecto de la radiación electromagnética con las siguientes enfermedades: leucemia en adultos y niños, cáncer cerebral en adultos y niños, cáncer de mama femenino y masculino, abortos espontáneos, suicidio, enfermedad de Alzheimer, esclerosis lateral amiotrófica y enfermedades cardiovasculares incluyendo infarto del miocardio. Se describen cuales son estas enfermedades de acuerdo al origen de estas radiaciones y se analizan cuales pueden ser los mecanismos biológicos que determinan la génesis de éstas...

The health effects of ionizing electromagnetic radiation are well known; neverthless there exist less recognition on the health effects of exposure to non-ionizing electromagnetic radiation. The first part of the present report refers to health effects of non-ionizing electromagnetic radiation, independently of its origin, since there are not important differences among effects caused by the different kind of non-ionizing radiations, therefore, they are valid for those emmited by the mobile telephony. A statistically significant association is described among various diseases and extremely low frequency electromagnetic radiation (ELF) from high tension electric conductors or transformers, intradomiciliary electric lines or electrodomestic appliances, occupational exposure to electromagnetic fields, mainly ELF, and radiofrequency (RF) electromagnetic radiation from television transmission. Already demonstrated effects of mobile telephony (cellular telephones and their antenas). The degrees of certainty from a study of the State of California (USA) is analyzed to relate various diseases caused by non-ionizing radiation. This study confirmed high or moderate probability of a cause-effect relationship for adult and child leukemia, brain cancer in adults and children, female and male breast cancer, spontaneous abortions, suicide, Alzheimer disease, amiotrophic lateral sclerosis and cardiovascular diseases including myocardial infarction. Various diseases are related to the different origin of the radiation, and the biological mechanisms involved in disease generation are analyzed. Research performed in the USSR and afterwards in Russia on health effects of mobile telephony are summarized, these investigations originated the regulation in this country and afterwards in West Europe, and influenced the decisions of WHO on its carcinogenicity...

UVB: suscetibilidade no melanoma maligno / UVB: susceptibility in malignant melanoma

FUNDAMENTOS: Está bem definido que a radiação ultravioleta provoca depleção imunológica na pele, permitindo o desenvolvimento de tumores cutâneos malignos. A maioria dos pacientes de cânceres da pele não melanomas são considerados UVB-suscetíveis. OBJETIVOS: Estudar a UVB-suscetibilidade nos pacientes com melanoma maligno e se este é um fator de risco para o desenvolvimento desse câncer. MÉTODOS: Foram selecionados 88 voluntários divididos em dois grupos: grupo-controle saudável (n=61) e grupo de portadores de melanoma (n=27), todos identificados de acordo com os critérios: tipo histológico, nível de invasão, fotótipos de pele, sexo e idade. A suscetibilidade à radiação ultravioleta B (UVB) foi medida pela reação de hipersensibilidade ao contato com o difenciprone nos voluntários sensibilizados em áreas previamente irradiadas. RESULTADOS: A suscetibilidade à radiação UVB foi de 81,5 por cento nos pacientes com melanoma maligno e de 31,2 por cento no grupo-controle. O risco de um indivíduo desenvolver o melanoma maligno foi 9,7 vezes maior do que nos indivíduos UVB-resistentes. CONCLUSÕES: A UVB-suscetibilidade pode ser considerada um fator de risco importante para o desenvolvimento do melanoma maligno.

BACKGROUND: It is well established that UV radiation provokes an immunological depletion in the skin, enabling the development of malignant cutaneous tumors. Most nonmelanoma skin cancer patients are considered to be UVB-susceptible. OBJECTIVE: To study the behavior of UVB- susceptibility in malignant melanoma (MM) patients and whether this is a risk factor to the development of MM. METHODS: Eighty-eight volunteers were selected and divided into two groups: healthy control group (n = 61) and MM group (n = 27), which were identified according to the following clinical criteria: histopathological type, level of invasion, skin phototype, sex and age. Susceptibility to ultraviolet B (UVB) radiation was measured by the onset of a contact hypersensitivity reaction to diphenylcyclopropenone among individuals sensitized in previously irradiated areas. RESULTS: Susceptibility to UVB radiation was 81.5 in the MM group and 31.2 percent in the control group. The risk of an UVB-susceptible individual to develop MM was 9.7 times higher than when UVB resistant. CONCLUSION: UVB susceptibility should be considered an important risk factor to the development of this type of cancer.

Radiation-induced spindle cell sarcoma: A rare case report.

Ionizing radiation has been known to induce malignant transformation in human beings. Radiation-induced sarcomas are a late sequel of radiation therapy. Most sarcomas have been reported to occur after exposure to a radiation dose of 55 Gray (Gy) and above, with a dose ranging from 16 to 112 Gys. Spindle cell sarcomas, arising after radiotherapy given to treat the carcinoma of head and neck region is a very uncommon sequel. This is a rare case report of spindle cell sarcoma of left maxilla, in a 24-year-old male, occurring as a late complication of radiotherapy with Cobalt-60 given for the treatment of retinoblastoma of the left eye 21 years back.

The Chernobyl accident 20 years on: an assessment of the health consequences and the international response

Twenty years after the Chernobyl accident the WHO and the International Atomic Energy Authority issued a reassuring statement about the consequences. Our objectives in this study were to evaluate the health impact of the Chernobyl accident, assess the international response to the accident, and consider how to improve responses to future accidents. So far, radiation to the thyroid from radioisotopes of iodine has caused several thousand cases of thyroid cancer but very few deaths; exposed children were most susceptible. The focus on thyroid cancer has diverted attention from possible nonthyroid effects. The international response to the accident was inadequate and uncoordinated, and has been unjustifiably reassuring. Accurate assessment in future health effects is not currently possible in the light of dose uncertainties, current debates over radiation actions, and the lessons from the late consequences of atomic bomb exposure. Because of the uncertainties from and the consequences of the accident, it is essential that investigations of its effects should be broadened and supported for the long term. The United Nations should initiate an independent review of the actions and assignments of the agencies concerned, with recommendations for dealing with future international-scale accidents. These should involve independent scientists and ensure cooperation rather than rivalry.

Vinte anos após o acidente de Chernobyl ocorrido em 1986, a OMS e a Autoridade Internacional sobre Energia Atômica lançaram um relatório sobre as conseqüências desse desastre. Nosso objetivo neste estudo é avaliar o impacto de tal acidente sobre a saúde e a reação internacional sobre o ocorrido, além de considerar se é possível melhorar as respostas em futuros desastres. Observamos que a radiação sobre a tireóide, proveniente de radioisótopos de iodo, causou milhares de casos de câncer, mas poucas mortes; as crianças expostas foram as mais suscetíveis. O foco no câncer de tireóide, porém, distraiu a atenção de especialistas sobre outros possíveis efeitos. A resposta internacional ao acidente foi inadequada, descoordenada e injustificavelmente tranqüilizadora. Acurada avaliação sobre efeitos futuros nem sempre é possível por causa de uma certa dose de incertezas frente ao estágio atual dos debates sobre radiação. É essencial que investigações sobre efeitos e conseqüências do desastre possam ser socializadas e apoiadas por um longo período de tempo. Por causa das inadequadas respostas internacionais ao problema, a ONU deveria iniciar uma revisão independente a respeito das ações e responsabilidades das agências, com recomendações de como agir em futuros desastres. Isso deveria envolver cientistas independentes e não que atuassem em competição.

Malignant astrocytoma following radiotherapy for craniopharyngioma.

Radiation induced gliomas are uncommon. Occurrence of glioma following radiotherapy for craniopharyngiomas is extremely uncommon and only eight case reports have been so far published. We present our experience with one similar case of temporal gliomas occurring twelve years following radiotherapy for a sub totally excised craniopharyngioma. Although the exact mechanism of gliomas formation is unclear, their occurrence following conventional radiotherapy is a distinct possibility and signifies a poor prognosis.

Consideraciones sobre la capa de ozono y su relación con el cáncer de piel / The relationship between the ozone layer and skin cancer

In the recent decades, a sustained increase in the worldwide incidence of skin cancer has been observed and Chile is not the exception. The most important risk factor is the exaggerated and repeated exposure to ultraviolet radiation coming from the sun. The ozone layer restricts the transmission of type B and C ultraviolet light. Since 1980, a sustained depletion of stratospheric ozone levels is occurring, specially in middle latitudes (-30 to ¡60). Along with this depletion, the amount of ultraviolet light that reaches the earth surface is increasing. This article reviews some basic concepts about the ozone layer and the association between its depletion and skin cancer. The general population should be informed about the risks of inadequate and exaggerated exposure to sunlight.