Re-irradiation with stereotactic radiotherapy for recurrent high-grade glial tumors.

Background: Despite the radical treatments applied, recurrence is encountered in the majority of high-grade gliomas (HGG). There is no standard treatment when recurrence is detected, but stereotactic radiotherapy (SRT) is a preferable alternative. The aim of this retrospective study is to evaluate the efficacy of SRT for recurrent HGG, and to investigate the factors that affect survival. Materials and methods: From 2013 to 2021, a total of 59 patients with 64 lesions were re-irradiated in a single center with the CyberKnife Robotic Radiosurgery System. The primary endpoints of the study were overall survival (OS), progression free survival (PFS) and local control rates (LCR). Results: The median time to first recurrence was 13 (4-85) months. SRT was performed as a median prescription dose of 30 Gy (range 15-30), with a median of 5 fractions (1-5). The median follow-up time was 4 months (range 1-57). The median OS was 8 (95% CI: 4.66-11.33) months. Age, grade 3, tumor size were associated with better survival. The median PFS was 5 [95% confidence interval (CI): 3.39-6.60] months. Age, grade 3 and time to recurrence > 9 months were associated with improved PFS. Grade 3 gliomas (p = 0.027), size of tumor < 2 cm (p = 0.008) remained independent prognostic factors for OS in multivariate analysis. Conclusion: SRT is a viable treatment modality with significant survival contribution. Since it may have a favorable prognostic effect on survival in patients with tumor size < 2 cm, we recommend early diagnosis of recurrence and a decision to re-irradiate a smaller tumor during follow-up.

Predictive significance of inflammatory indexes in metastatic nonsmall cell lung cancer patients treated with platinum-doublet chemotherapy.

Introduction: Lung cancer is the leading cause of cancer-related deaths, worldwide. Despite immune checkpoint inhibitors and targeted therapy have revolutionized the treatment of metastatic nonsmall cell lung cancer (NSCLC), a significant proportion of patients are still treated with platinum-based chemotherapy. It is widely noticed that systemic inflammation plays an important role in the development and progression of many solid tumors. In this study, we aimed to analyze the predictive role of the systemic immune-inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), and prognostic nutritional index (PNI) in patients with advanced NSCLC treated with first-line platinum-doublet chemotherapy. Methods: We retrospectively collected data of patients treated with first-line therapy for metastatic NSCLC. All patients were treated with first-line platinum-doublet chemotherapy. The patients were grouped based on the median values of SII, PNI, and NLR. The Mann-Whitney U test was used for comparisons between groups. Results: The chemotherapy response rate (RR) was 75% in all patients. RR is statistically significantly lower in high SII, low PNI, and high NLR groups. Conclusions: High inflammatory indexes in metastatic NSCLC patients who were treated with platinum-doublet chemotherapy are related to low chemotherapy RR.

Two different immune related adverse events occured at pancreas after nivolumab in an advanced RCC patient.

INTRODUCTION: The foremost side effects of anti-PD-1 therapy are immune related and pancreatitis associated with nivolumab treatment has been rarely reported. CASE REPORT: The patient was treating with subcutaneous insulin because of nivolumab induced diabetes mellitus. A patient was diagnosed metastatic renal cell carcinoma and treated with nivolumab. Diabetes mellitus and pancreatitis, which are immune-related adverse events were observed in the patient. MANAGEMENT & OUTCOME: After the diagnosis of nivolumab induced immune pancreatitis methylprednisolone 2 mg/kg per day intravenously started. After steroid treatment, the patient's complaints regressed, amylase and lipase levels began to decline. DISCUSSION: This case report highlights the possibility of different immune-related adverse events that can affect pancreas in all patients which were treated with ICIs.

Clinical significance of standardized uptake values in thyroid incidentaloma discovered by F-18 fluorodeoxyglucose positron emission tomography/computed tomography.

AIM OF STUDY: While using F-18 fluorodeoxyglucose (FDG) positron emission tomography computed tomography (PET/CT) for other than thyroid disease, an increased frequency of incidentally discovered areas of focally or diffuse increased uptake within the thyroid gland can be seen. We aimed to find the focal thyroid FDG uptake and compare the maximum standardized uptake value (SUVmax) results with cytology and histology results. MATERIALS AND METHODS: We examined PET scan reports for all patients undergoing FDG PET/CT investigation over a 10-year period in a single center. Twelve thousand seven hundred and ninety-six patients underwent FDG PET/CT scanning in one PET/CT unit. Within this group, 526 patients had diffuse, focal, or multifocal FDG uptake. About 305 of 526 patients (57.9%) showed diffuse FDG uptake and 221 (42%) showed focal uptake on thyroid gland. RESULTS: The malignant group thyroid nodule sizes were between 8 and 39 mm (21.1 mm average, standard deviation [SD] ±7.3) on ultrasonography (USG) examination. These nodules have SUVmax values between 2.3 and 31.2 (average 8.8 SD ± 5.7). Benign group thyroid nodule sizes were between 5 and 46 mm (average 18.3 mm, SD ± 5.8) on USG examination. There were no significant correlations between SUVmax of the incidental focal thyroid lesions seen on FDG PET/CT and fine needle aspiration biopsy results. CONCLUSION: There is a relatively high possibility of a malignant lesion in thyroid incidentaloma. FDG uptake of these lesions is not a useful tool in absolute discrimination between malignancy and benign lesion. The presence of primary or secondary malign lesion is diagnosed in 34.1% of the patients who are found to have incidental focal FDG uptake within thyroid gland in PET/CT scans, but we suggest that the thyroid incidentalomas detected on FDG PET/CT should be further examined with USG and scintigraphy.

What is the role of florine-18 fluorodeoxyglucose/positron emission tomography/computed tomography imaging in well-differentiated thyroid cancers with negative iodine-131 scan high thyroglobulin and normal anti-thyroglobulin levels.

PURPOSE: This retrospective study aims to assess the cut-off value of thyroglobulin (Tg) levels in nux or metastatic well-differentiated thyroid cancers (DTCs) with normal anti-Tg levels using with fluorodeoxyglucose/positron emission tomography/computed tomography (FDG PET/CT). MATERIALS AND METHODS: We reviewed FDG PET/CT images of 104 patients with well DTC (28 men, 76 women) whose: Iodine-131 (131 I) whole-body scanning was negative but had elevated Tg with normal anti-Tg levels. RESULTS: The overall sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of florine-18-FDG PET/CT findings were found to be 95.92%, 87.27%, 87.04%, 96.00%, and 91.35%, respectively. The best Tg cut-off value was found to be 10.4 ng/ml. In the Tg level <10.4 ng/ml group, the sensitivity, specificity, PPV, NPV, and accuracy of FDG PET/CT were found to be 94.1%, 91.30%, 88.8%, 95.4%, and 92.5%, respectively. In the other group, which Tg level ≥10.4 ng/ml, sensitivity, specificity, PPV, NPV, and accuracy of FDG PET/CT exams were found to be 96.8%, 84.3%, 86.1%, 96.4%, and 90.6%, respectively. CONCLUSION: FDG PET/CT imaging is a valuable imaging method in the evaluation of patients with elevated serum Tg levels and normal anti-Tg levels. Furthermore, it has potential utility in the dedifferentiation of active foci that are present, and in assessing optimal decision making during follow-up.

Bone Mineral Density in Adolescent Girls with Hypogonadotropic and Hypergonadotropic Hypogonadism.

OBJECTIVE: Deficiency of sex steroids has a negative impact on bone mineral content. In studies conducted on postmenopausal women and animal studies, elevated follicle-stimulating hormone (FSH) levels were found to be correlated with a decrease in bone mineralization and osteoporosis. The aim of the present study was to evaluate bone mineral density (BMD) in adolescent girls with hypogonadotropic and hypergonadotropic hypogonadism and also to investigate the correlation between FSH level and BMD. METHODS: The study group included 33 adolescent girls with hypogonadism (14 with hypogonadotropic hypogonadism and 19 with hypergonadotropic hypogonadism). FSH, luteinizing hormone, estradiol levels, and BMD (using dual energy x-ray absorptiometry) were measured. RESULTS: There were no statistically significant differences between the chronological age and bone age of the two patient groups, namely, with hypogonadotropic and hypergonadotropic hypogonadism. There was also no significant difference between BMD z-score values obtained from measurements from the spine and the femur neck of patients in the two groups (p-values were 0.841 and 0.281, respectively). In the hypergonadotropic group, a moderately negative correlation was detected between FSH level and BMD z-score measured from the femur neck (ρ=-0.69, p=0.001), whilst no correlation was observed between FSH levels and height adjusted BMD-z scores measured from the spine (ρ=0.17, p=0.493). FSH level was not found to be an independent variable affecting BMD z-score. CONCLUSION: BMD z-scores were detected to be similar in adolescent girls with hypogonadotropic and hypergonadotropic hypogonadism, and FSH levels were not found to have a clinically relevant impact on BMD.

Prepubertal unilateral gynecomastia: report of 2 cases.

Prepubertal unilateral gynecomastia is an extremely rare condition. At present, its etiology and management strategy are not well known. Two unrelated prepubertal boys of ages 8 and 9 who presented with complaints of unilateral enlargement of breast tissue are reported. Physical examination, biochemical, hormonal and oncologic work-up findings were normal. Both patients were treated with peripheral liposuction successfully. Histopathological and immunohistochemical examinations showed benign fibroglandular gynecomastia and intensive (3+) estrogen receptor expression in 100% of periductal epithelial cells. Although an extremely rare and generally benign condition, patients with prepubertal unilateral gynecomastia should have a full endocrine and oncologic work-up.

Familial isolated growth hormone deficiency due to a novel homozygous missense mutation in the growth hormone releasing hormone receptor gene: clinical presentation with hypoglycemia.

CONTEXT: Mutations in the growth hormone releasing hormone receptor (GHRHR) gene are a relatively rare cause of isolated growth hormone deficiency (IGHD). OBJECTIVE: This study aimed to understand the biochemical basis of hypoglycemia in the index case and the molecular basis of severe short stature in a large consanguineous family with IGHD. PATIENTS AND METHODS: The index case presented with a hypoglycemic convulsion, following which eight members in two related consanguineous Turkish families were identified with IGHD. Homozygosity mapping identified the homozygous regions shared only among the affected individuals. Sanger sequencing of GHRHR, which resided in the shared homozygous region, was performed. In silico analysis of the pathogenic GHRHR variant was performed. RESULTS: The clinical presentation and hormonal analysis confirmed GH deficiency in all affected individuals. Magnetic resonance imaging scan of the pituitary gland showed anterior pituitary hypoplasia in five affected individuals in which the youngest was only 0.4 years old, but with normal pituitary size in three affected individuals. Homozygosity mapping showed two large homozygous regions on chromosome 7 shared only among affected individuals. Sanger sequencing of GHRHR gene present in one of these shared regions identified a novel homozygous missense mutation (p.C64G) segregating with the disease phenotype. In silico analysis predicted the mutation to be deleterious and disease causing. CONCLUSIONS: We describe a large consanguineous Turkish kindred with IGHD due to a novel homozygous missense GHRHR mutation. This is the first description of presentation with hypoglycemia and the earliest reported occurrence of anterior pituitary hypoplasia in patients with GHRHR mutation.

Multiple pituitary hormone deficiency due to gunshot injury in a 6-year-old girl.

Gunshot injuries (GSI) of the cranial area have an extremely high mortality rate. Herein, we present a girl who has been living with a bullet in the posterior sellar region. A 6-year-old girl was admitted with complaints of headache, polyuria and polydypsia, which started after a GSI. At the time of admission the patient's anthropometric, physical and neurological examinations were normal. Urine output was 5.5 L/m2/24h. A water deprivation test suggested central diabetes insipidus, which responded to treatment. Evaluation of other pituitary hormones revealed central hypothyroidism and growth hormone deficiency. Pituitary hormone deficiency must be kept in mind in patients injured by a gunshot to the sellar/parasellar region.

Reversible cardiomyopathy associated with autoimmune polyendocrine syndrome type II.

Recovery of the ventricular function in a patient with cardiomyopathy is very rare. Autoimmune polyendocrine syndrome is also very rare. We herein report a case of reversed cardiomyopathy associated with autoimmune polyendocrine syndrome type II (Schmidt's syndrome) composed of Addison's disease, vitiligo and Hashimoto's thyroiditis. The ventricular function and size were reversed following the administration of suitable hormone replacement therapy for polyendocrine syndrome.

A pediatric renal lymphoma case presenting with central nervous system findings.

UNLABELLED: In pediatric patients renal lymphoma frequently presents in the form of multiple, bilateral mass lesions, infrequently as a single or retroperitoneal mass, and rarely as diffuse infiltrative lesions. In patients with apparent central nervous system involvement close attention to other physical and laboratory findings are essential for preventing a delay in the final diagnosis. Herein we present a pediatric patient with renal lymphoma that presented with central nervous system findings that caused a delay in diagnosis. CONFLICT OF INTEREST: None declared.

How does childhood otitis media change the radiological findings of the temporal bone?

CONCLUSION: Inflammatory changes in the middle ear mucosa since childhood may affect mastoid pneumatization without a change in the position of the sigmoid sinus. Also, despite the fact that recurrences of inflammatory middle ear disease lead to bone destruction, we did not see any relationship between the childhood otitis media and bone destruction. OBJECTIVE: To assess radiological findings in temporal bone in both healthy ears and diseased ears in patients with unilateral chronic otitis media since their childhood. METHODS: Twenty-five patients who had unilateral otological symptoms, such as recurrent otalgia, purulent otorrhea or hearing loss since their childhood were included in the study. Assessment of radiological parameters was performed using a quantitative digital image processing computed tomography program. RESULTS: Mastoid volume values in the chronic otitis media group were significantly smaller when compared with those of a healthy group (p < 0.05). In healthy and diseased mastoid groups, there were no significant differences between groups when we assessed Henle spine-sigmoid sinus (HS-SS) distances. There was a significant correlation (p = 0.001) in both the groups when we compared mastoid volume values with HS-SS distances. There was ossicular discontinuity in two cases and in one patient tegmen tympani was not intact in diseased ears.

Alemtuzumab in Sézary syndrome: efficient but not innocent.

Mycosis fungoides is the most common form of cutaneous T-cell lymphomas. The related Sézary syndrome is a more aggressive form in which the skin is diffusely affected and the peripheral blood is involved. Although easily managed during its early phases, late-stage mycosis fungoides/Sézary syndrome is usually difficult to treat and becomes refractory to chemotherapy. Recently, promising case-based results have been obtained with alemtuzumab, a humanized immunoglobulin G1 monoclonal antibody that binds to CD52 cell surface antigens, in the treatment of advanced stage mycosis fungoides/Sézary syndrome. We report a case of Sézary syndrome treated successfully with alemtuzumab but who died of treatment-related infection.