[Primary Meningeal Lymphoma Diagnosed Using Cytology and Flow Cytometry-A Case Report].

A 72-year-old male was referred with a 2-week history of diplopia. Following magnetic resonance imaging, an area of abnormal signal intensity was observed along the lateral ventricle, without any unusual findings at other sites. Cerebrospinal fluid cytology revealed abnormal lymphocytes with atypia, which were positive for CD20 and light-chain restriction, as detected by surface marker analysis, leading to a diagnosis of primary meningeal B-cell lymphoma. The patient underwent chemoradiotherapy and achieved a remission. While meningeal lymphoma is a rare occurrence, pathological tissue biopsy is considered the gold-standard diagnostic method. However, obtaining a biopsy sample from the tumor site can be challenging. In this case report, cytology and flow cytometry played a vital role in the diagnosis of meningeal lymphoma.

An isolated der(1;21)(q10;q10) translocation in a patient with myelodysplastic syndrome: a case report.

Whole-arm translocations are relatively rare among hematological malignancies. There are a few reports on myeloid malignancies harboring der(1;21)(q10;q10). A 65-year-old male was referred to our hospital due to squamous cell carcinoma of the lung. Pembrolizumab monotherapy resulted in progression, and so chemotherapy involving nab-paclitaxel and carboplatin was administered thereafter. The patient developed cytopenia, and his bone marrow exhibited dysplasia. Chromosomal analysis revealed a whole-arm translocation, der(1;21)(q10;q10). Thus, the patient was diagnosed with myelodysplastic syndrome. The der(1;21)(q10;q10) translocation is a rare variant of the der(1;7)(q10;p10) translocation, which is an adverse prognostic factor for myeloid neoplasms. Clarifying the clinical features of myeloid neoplasms in patients with der(1;21)(q10;q10) would facilitate the elucidation of their tumorigenic mechanisms.

Fluorodeoxyglucose Uptake on Positron Emission Tomography Is a Useful Predictor of Long-Term Pain Control After Palliative Radiation Therapy in Patients With Painful Bone Metastases: Results of a Single-Institute Prospective Study.

PURPOSE: To determine whether fluorodeoxyglucose positron emission tomography (FDG-PET) before and after palliative radiation therapy (RT) can predict long-term pain control in patients with painful bone metastases. METHODS AND MATERIALS: Thirty-one patients with bone metastases who received RT were prospectively included. Forty painful metastatic treatment fields were evaluated. All patients had undergone pre-RT and post-RT PET/CT scanning. We evaluated the relationships between the pre-RT, post-RT, and changes in maximum standardized uptake value (SUVmax) and the pain response, and between SUVmax and pain relapse of the bone metastases in the treatment field. In addition, we compared the SUVmax according to the length of time from the completion of RT to pain relapse of the bone metastases. RESULTS: Regarding the pain response at 4 weeks after the completion of RT, there were 36 lesions of 27 patients in the responder group and 4 lesions of 4 patients in the nonresponder group. Changes in the SUVmax differed significantly between the responder and nonresponder groups in both the early and delayed phases (P=.0292 and P=.0139, respectively), but no relationship was observed between the pre-RT and post-RT SUVmax relative to the pain response. The responder group was evaluated for the rate of relapse. Thirty-five lesions of 26 patients in the responder group were evaluated, because 1 patient died of acute renal failure at 2 months after RT. Twelve lesions (34%) showed pain relapse, and 23 lesions (66%) did not. There were significant differences between the relapse and nonrelapse patients in terms of the pre-RT (early/delayed phases: P<.0001/P<.0001), post-RT (P=.0199/P=.0261), and changes in SUVmax (P=.0004/P=.004). CONCLUSIONS: FDG-PET may help predict the outcome of pain control in the treatment field after palliative RT for painful bone metastases.

Radiation-induced microbleeds after cranial irradiation: evaluation by phase-sensitive magnetic resonance imaging with 3.0 tesla.

BACKGROUND: Although there are many reports regarding radiation-induced microbleeds, its frequency, relation to dose and latency after radiation are not fully elucidated. The purpose of this study was to evaluate the frequency, latency, patient factors and dose relation of radiation-induced microbleeds after cranial irradiation using phase-sensitive magnetic resonance imaging (PSI) at 3.0 T. METHODS: Retrospective evaluation of 34 patients (age range, 13-78 years; mean, 49 years; follow-up period, 3-169 months; mean 29 months) who had undergone cranial irradiation using magnetic resonance (MR) imaging including PSI was performed. Twenty-three patients received high-dose irradiation (44-60 Gy), and 11 patients received 24-30 Gy whole brain irradiation. When microbleeds were detected on MR imaging in these high-dose irradiation patients, dose distribution maps were reproduced by reviewing the clinical records. Then the irradiated areas were divided into 6 radiation-dose classes: regions > 55 Gy, 45-55 Gy, 35-45 Gy, 25-35 Gy, 15-25 Gy and 5-15 Gy. The frequency of microbleeds in each radiation-dose class was analyzed. RESULTS: Microbleeds were detected in 7 (21%) of 34 patients on T2-weighted imaging, whereas they were detected in 16 (47%) of the 34 patients on PSIs. The frequency of microbleeds was higher than previously reported. The latency of radiation-induced microbleeds after radiation was 3 months to 9 years (mean, 33 months). In high-dose irradiation patients, the frequency of microbleeds significantly was associated with radiation dose. There were no foci that were observed in regions that had received < 25 Gy. CONCLUSION: Radiation-induced microbleeds occurred more frequently in the present study than has been previously reported. PSI can be used to detect these vascular changes earlier than other conventional MR imaging techniques.

Radiation-induced damage to microstructure of parotid gland: evaluation using high-resolution magnetic resonance imaging.

PURPOSE: To elucidate the radiation-induced damage to the microstructure of the parotid gland using high-resolution magnetic resonance imaging. METHODS AND MATERIALS: High-resolution magnetic resonance imaging of the parotid gland was performed before radiotherapy (RT) and during the RT period or < or =3 weeks after RT completion for 12 head-and-neck cancer patients using a 1.5-T scanner with a microscopy coil. The maximal cross-sectional area of the gland was evaluated, and changes in the internal architecture of the gland were assessed both visually and quantitatively. RESULTS: Magnetic resonance images were obtained at a median parotid gland dose of 36 Gy (range, 11-64). According to the quantitative analysis, the maximal cross-sectional area of the gland was reduced, the width of the main duct was narrowed, and the intensity ratio of the main duct lumen to background was significantly decreased after RT (p <.0001). According to the visual assessment, the width of the main duct tended to narrow and the contrast of the duct lumen tended to be decreased, but no significant differences were noted. The visibility of the duct branches was unclear in 10 patients (p = .039), and the septum became dense in 11 patients (p = .006) after RT. CONCLUSION: High-resolution magnetic resonance imaging is a noninvasive method of evaluating radiation-induced changes to the internal architecture of the parotid gland. Morphologic changes in the irradiated parotid gland were demonstrated during the RT course even when a relatively small dose was delivered to the gland.

Multi-institutional study of radiation therapy for isolated para-aortic lymph node recurrence in uterine cervical carcinoma: 84 subjects of a population of more than 5,000.

PURPOSE: Most patients who had any recurrent sites of cancer have been considered to be in their last stage of life. However, recent advances of clinical research reveal some patients achieve long-term survival even in recurrence. Furthermore, for patients who had only one recurrent region, radiation therapy could play an important role. As for uterine cervical carcinoma, the most common recurrent site other than the pelvis is the para-aortic lymph nodes. Thus we conducted the current study. PATIENTS AND METHODS: Between 1994 and 2003, more than 5,000 uterine cervical carcinoma patients were treated with curative intended treatments at 13 Japanese hospitals. Of these patients, 84 developed para-aortic lymph node recurrence as the only site of initial tumor progression. These patients were treated with external beam radiation therapy. Radiation therapy protocol was as follows: 1.7-2.0 Gy per fraction, 5 fractions per week, and the mean total dose was 50.8 Gy (25-60 Gy). RESULTS: Three- and 5-year overall survival rates of all patients were 49.5% and 31.3%, respectively. Stratified by symptom sign, 3-year overall survival rate of symptom positive was 27.6% and those of the negative was 56.1% (p = 0.018). Three-year overall survival rates of the total dose > or =51 Gy and that of < or =50 Gy were 58.0% and 42.8%, respectively (p = 0.07). As for morbidity, no patients received Grade 3 or greater late toxicity. CONCLUSIONS: The current study suggested that radiation therapy for isolated para-aortic lymph node recurrence in uterine cervical carcinoma could have a significant impact on survival.

Frequency and characteristics of isolated para-aortic lymph node recurrence in patients with uterine cervical carcinoma in Japan: a multi-institutional study.

OBJECTIVE: In most cases of uterine cervical carcinoma recurrence, the first site of distant metastasis or recurrence is reported to be the para-aortic region. Some reports have demonstrated that, in cases of isolated para-aortic lymph node recurrence treated by radiation therapy, patients survived for a long period, which suggests that isolated para-aortic lymph node recurrence in uterine cervical carcinoma is a regional disease rather than systemic disease. Determining the predictive characteristics of isolated para-aortic lymph node recurrence in patients at the time of the initial treatment for primary uterine cervical carcinoma is important, so we conducted the current multi-institutional study. PATIENTS AND METHODS: Patients (n=3137) with uterine cervical carcinoma of stages Ia to IVa were treated in twelve Japanese hospitals between 1994 and 2003. The current study investigated the frequency and characteristics of patients with isolated para-aortic lymph node recurrence as well as the characteristics of clinical stage, histopathology, serum squamous cell carcinoma antigen level, the treatment method at the initial treatment, the duration between the initial treatment and the recurrence, and the serum squamous cell carcinoma antigen level at the recurrence. RESULTS: Of the 3137 patients with uterine cervical carcinoma in stages Ia-IVa, 67 (2.1%) experienced recurrence in isolated para-aortic lymph nodes. Stratified by clinical stage, none of the 613 patients with stage Ia experienced recurrence in isolated para-aortic lymph nodes. However, recurrence was experienced by 14 (1.4%) of the 966 patients with stage Ib, 7 (3.5%) of the 199 patients with stage IIa, 14 (2.3%) of the 613 patients with stage IIb, 1 (2.1%) of the 48 patients with stage IIIa, 26 (4.6%) of the 538 patients with stage IIIb, and 5 (5%) of the 100 patients with stage IVa. The mean duration time between the initial treatment and isolated para-aortic recurrence was 20 months (range, 2-49 months). The correlations between duration time and the clinico-pathological factors (clinical stage, histopathology, serum squamous cell carcinoma antigen level, and treatment method) at the initial treatment were investigated. No statistically significant factors have been revealed in the current study. CONCLUSIONS: The frequency of isolated para-aortic lymph node recurrence was 2.1% and increased with increasing clinical stage at the initial treatment (stage IVa: 5%) in the current study.