Bilateral Synchronous Testicular Germ Cell Tumors in Children: Case Report and Review of the Literature.

Bilateral testicular tumors are very rare in pediatric patients and only a few case reports have been reported. These patients have a high risk of sterility due to bilateral orchiectomy and subsequent gonadotoxic treatments. Therefore, if possible, testis-sparing surgery should be performed in patients with benign masses and testicular tissue preservation may be recommended in order to maintain fertility in later life. We present a 23 months old boy with synchronous bilateral testicular tumor managed with unilateral orchiectomy and testis-sparing surgery and testicular tissue cryopreservation performed to the controlateral side. We also review the literature on bilateral testis tumors in children.

Desmoplastic small round cell tumor of the mandible in a child with unusual plantar metastasis.

SUMMARY: Desmoplastic small round-cell tumor (DSRCT) is a rare and aggressive tumor that usually affects young males. Abdominal or pelvic disease is generally present in patients with DSRCT. Despite multimodality treatment, it still remains highly aggressive and has poor prognosis. We report a 16-year-old male with DSRCT in the mandible, an unusual site of the disease, treated with chemo-radiotherapy but recurred in an unexpected site 5 months after the completion of treatment.

Expression of matrix metalloproteinase-9 (MMP-9) and tissue inhibitor of matrix metalloproteinase (TIMP-1) in tissues with a diagnosis of childhood lymphoma.

Matrix metalloproteinases (MMP) are enzymes involved in the reconfiguration of the microenvironment by means of degrading the extracellular matrix and have more than 20 subgroups containing zinc. Proteins that serve as the inhibitors of these enzymes are called tissue inhibitors of matrix metalloproteinase (TIMP). These enzymes have been shown to be active in a wide range of processes, from wound recovery to fetus development, heart diseases, and spread of malignant diseases. The aim of this study was to investigate whether there is a relationship between the type, stage, and prognosis of childhood lymphoma subjects and matrix metalloproteinase type-9 (MMP-9) and its inhibitor, tissue inhibitor of matrix metalloproteinase type-1 (TIMP-1). Paraffin blocks of childhood patients diagnosed with non-Hodgkin lymphoma (n = 23), Hodgkin lymphoma (n = 14), or reactive lymphadenopathy (n = 12) were retrospectively immunohistochemically stained with MMP-9 and TIMP-1 stains and whether there was a relationship between the degree of staining and the type, tumor stage, and prognosis of the disease was investigated. Moderate and high degrees of MMP-9 staining were detected in 94.6% of the lymphoma patient tissues and a slight TIMP-1 staining was detected in 21.6% of the lymphoma patient tissues. No relationship was observed between the degree of these staining patterns and the type, tumor stage, and prognosis of the disease. This study indicates that the equilibrium between MMP-9 and TIMP-1 is important in lymphomas in addition to all the physiological and pathologic events although MMP-9 and the TIMP-1 staining patterns are not related to the tumor stage, prognosis, and type of the disease. Larger series of patients are needed to determine the prognostic value of MMP-9 and TIMP-1 in childhood lymphoma.

Serum Ca 125 levels in children with acute leukemia and lymphoma.

Ca 125 is a tumor marker for the diagnosis and monitoring of ovarian carcinoma. We investigated serum Ca 125 levels in 44 children with leukemia and 59 children with lymphoma at initial presentation and 4 weeks after chemotherapy. Serum Ca 125 levels were measured chemilumimetrically with a sandwich enzyme-linked immunosorbent assay. The incidence of elevated serum Ca 125 levels was significantly higher in children with leukemia (14 children) and lymphoma (26 children) than in the healthy children (2 children). In the patients with non-Hodgkin's lymphoma (NHL) who had abdominal involvement and/or serous membrane involvement (ascides, pleural, pericardial effusion) at presentation, serum Ca 125 levels were significantly higher than in the patients without abdominal and/or serosal involvement. Serum Ca 125 levels were impressively increased in the patients with Burkitt's lymphoma (BL) in whom abdominal and/or serous membrane involvement were observed more frequently than the other types of lymphoma. The increased serum Ca 125 levels in the patients returned to normal 4 weeks after chemotherapy when they achieved complete remission. In conclusion, serum Ca 125 seems to be a good indicator for serous membrane involvement and it seems to be a promising tumor marker in the assessment of therapeutic response in children with leukemia and NHL.

Hemostatic side effects of high-dose methotrexate in childhood acute lymphoblastic leukemia.

The purpose of this study is to investigate the hemostatic side effects of HDMTX. Between 2001 and 2002, 20 children with acute lymphoblastic leukemia at the Dr. Sami Ulus Children's Hospital, Department of Pediatric Hematology and Oncology, treated according to the St. Jude ALL XIII protocol were eligible to this study. Methotrexate at a dose of 2 g/m(2) was infused over 24 hours. Coagulation screening studies included prothrombin time (PT), APTT, fibrinogen, fibrin degradation product (D-Dimer), factor II, factor V, factor VII, factor VIII, factor IX, factor X, PC, PS, AT-III determinations before HDMTX therapy (PreT), 1 day after (PostT(1D)), and 1 week after (PostT(1W)) the end of the HDMTX infusion. We found that PT and APTT were prolonged, PC, PS, and AT-III levels were decreased with a slight increase in D-Dimer 1 day after the administration of HDMTX and all of them returned to the normal levels by 7 days. In addition we found that FVII, FIX, FX were significantly decreased 1 day after therapy and normalised by 7 days.