ABSTRACT
Bone involvement has been described in tumors with melanocytic differentiation such as melanotic neuroectodermal tumor of infancy, and very rarely in cellular blue nevi and neurocristic cutaneous hamartoma. We present an unusual case of facial congenital melanocytic tumor that involved the underlying bones and maxillary sinus and led to unilateral blindness. A newborn with a large red bluish patch with peripheral brown and black macules overlying marked swelling on the left side of his face was presented. The tumor was shown by magnetic resonance imaging, scintigraphy, and histopathology to invade the underlying bones and maxillary sinus and to compress the left eyeball resulting in blindness. Histopathology, immunohistochemistry, morphometric computerized microscopy, molecular genetic mutation analysis, and fluorescent in situ hybridization studies were more congruent with a melanocytic nevus. An 8.5-year follow-up was uneventful, with spontaneous partial shrinkage of the tumor.
Subject(s)
Blindness/etiology , Facial Bones/pathology , Head and Neck Neoplasms/congenital , Head and Neck Neoplasms/pathology , Nevus, Pigmented/congenital , Nevus, Pigmented/pathology , Skin Neoplasms/congenital , Skin Neoplasms/pathology , Age Factors , Biomarkers, Tumor/analysis , Biomarkers, Tumor/genetics , Biopsy , Blindness/diagnosis , Child , Facial Bones/chemistry , Head and Neck Neoplasms/chemistry , Head and Neck Neoplasms/therapy , Humans , Immunohistochemistry , In Situ Hybridization, Fluorescence , Infant , Magnetic Resonance Imaging , Male , Maxillary Sinus/pathology , Multimodal Imaging , Neoplasm Invasiveness , Nevus, Pigmented/chemistry , Nevus, Pigmented/therapy , Positron-Emission Tomography , Predictive Value of Tests , Prognosis , Skin Neoplasms/chemistry , Skin Neoplasms/therapy , Tomography, X-Ray Computed , Tumor BurdenABSTRACT
BACKGROUND: Interim 18F-FDG PET helps predict outcome and tailor treatment in adults with Hodgkin disease (HD). OBJECTIVE: The purpose of this study was to assess predictive values of interim 18F-FDG PET/CT in children with HD and to define the potential added value to interim PET of low-dose CT. MATERIALS AND METHODS: Children were prospectively enrolled August 2002-April 2007. PET/low-dose CT was performed at staging, after 2 cycles, at the end of treatment and during follow-up (mean 45 months). Treatment was unchanged regardless of interim results. PET and low-dose CT were read independently. RESULTS: Of 34 enrolled children (ages 3-17 years), 27 achieved complete response, 4 had progressive disease and 3 had relapse. Interim PET alone had positive and negative predictive values of 67% and 89%, respectively. Interim low-dose CT alone had positive and negative predictive values of 35% and 100%, respectively. Interim PET/CT had positive and negative predictive values of 75% and 96%, respectively. CONCLUSIONS: Early interim PET/CT was a good predictor of outcome. Integrated PET and low-dose CT improved the predictive value in children with HD.
Subject(s)
Fluorodeoxyglucose F18 , Hodgkin Disease/pathology , Hodgkin Disease/therapy , Multimodal Imaging , Positron-Emission Tomography , Tomography, X-Ray Computed , Adolescent , Child , Child, Preschool , Disease Progression , False Negative Reactions , False Positive Reactions , Female , Follow-Up Studies , Humans , Male , Neoplasm Recurrence, Local , Predictive Value of Tests , Prognosis , Prospective Studies , Radiation Dosage , RadiopharmaceuticalsABSTRACT
PURPOSE: This Rare Cancer Network (RCN) study was performed in pediatric nasopharyngeal carcinoma (PNPC) patients to evaluate the optimal dose of radiotherapy and to determine prognostic factors. PATIENTS AND METHODS: The study included 165 patients with the diagnosis of PNPC treated between 1978 and 2003. The median age was 14 years. There were 3 (1.8%) patients with stage I, 1 (0.6%) with IIA, 10 (6.1%) with IIB, 60 (36.4%) with III, 44 (26.7%) with IVA, and 47 (29%) with IVB disease. While 21 (12.7%) patients were treated with radiotherapy (RT) alone, 144 (87.3%) received chemotherapy and RT. The median follow-up time was 48 months. RESULTS: The actuarial 5-year overall survival (OS) was 77.4% (95% CI: 70.06-84.72), whereas the actuarial 5-year disease-free survival (DFS) rate was 68.8% (95% CI: 61.33-76.31). In multivariate analysis, unfavorable factors were age >14 years for LRC (p=0.04); male gender for DMFS (p=0.03); T3/T4 disease for LRFS (p=0.01); and N3 disease for DFS (p=0.002) and OS (p=0.002); EBRT dose of less than 66 Gy for LRFS (p=0.02) and LRRFS (p=0.0028); and patients treated with RT alone for LRFS (p=0.0001), LRRFS (p=0.007) and DFS (p=0.02). CONCLUSION: Our results support the current practice of using combined radiation and chemotherapy for optimal treatment of NPC. However, research should be encouraged in an attempt to reduce the potential for long-term sequelae in pediatric patients given their relatively favorable prognosis and potential for longevity.
Subject(s)
Nasopharyngeal Neoplasms/radiotherapy , Rare Diseases/radiotherapy , Adolescent , Age Factors , Child , Combined Modality Therapy/adverse effects , Combined Modality Therapy/methods , Disease-Free Survival , Dose Fractionation, Radiation , Epidemiologic Methods , Female , Humans , Male , Nasopharyngeal Neoplasms/drug therapy , Nasopharyngeal Neoplasms/mortality , Neoplasm Recurrence, Local , Prognosis , Rare Diseases/drug therapy , Rare Diseases/mortality , Sex Factors , Treatment OutcomeABSTRACT
Acquired resistance towards apoptosis is the hallmark of most if not all types of cancer. We have previously identified and characterized ARTS, a broadly expressed protein localized to mitochondria. ARTS was initially shown to mediate TGF-beta induced apoptosis. Recently, we have found that high levels of ARTS induce apoptosis without additional pro-apoptotic stimuli. Further, ARTS promotes apoptosis in response to a wide variety of pro-apoptotic stimuli. Here, we report that the expression of ARTS is lost in all lymphoblasts of more than 70% of childhood acute lymphoblastic leukemia (ALL) patients. The loss of ARTS is specific, as the related non-apoptotic protein H5, bearing 83% identity to ARTS, is unaffected. During remission, ARTS expression is detected again in almost all patients. Two leukemic cell lines, ALL-1 and HL-60 lacking ARTS, were resistant to apoptotic induction by ara-C. Transfection of ARTS into these cells restored their ability to undergo apoptosis in response to this chemotherapeutic agent. We found that methylation process contributes to the loss of ARTS expression. We conclude that the loss of ARTS may provide a selective advantage for cells to escape apoptosis thereby contributing to their transformation to malignant lymphoblasts. We therefore propose that ARTS can function as a tumor suppressor protein in childhood ALL.
