Cerebellar and multiple spinal hemangioblastomas and intraventricular meningioma managed with subtotal resection and external beam radiotherapy; report of a case with literature review.

Hemangioblastomas are cystic, highly vascular benign neoplasms that constitute 1.5-2.5% of all intracranial tumors and 7-10% of primary posterior fossa tumors. They occur sporadically (80%) or in association with von Hippel-Lindau (VHL) disease (20%). This disease consists of multiple intracranial, retinal and spinal hemangioblastomas, pheochromocytoma, retinal angiomas, pancreatic cysts, renal cell carcinomas and adrenal tumors. Our patient was a 21-year-old male who presented with cerebellar and multiple spinal hemangioblastomas, and intraventricular meningioma. There was a positive family history (mother and brother) of VHL disease. Intracranial and spinal lesions were treated with external beam radiotherapy following subtotal excision of the cerebellar lesion. Three-year follow-up revealed radiologically stable lesions. Microsurgical resection remains the treatment of choice for the vast majority of symptomatic and sporadic cystic hemangioblastomas. However, since hemangioblastoma is a highly vascular tumor and local invasion of critical structures is frequent and multifocality is often a characteristic of the hemangioblastomas that are associated with VHL disease, subtotal excision is frequent and adjuvant therapies such as external beam radiotherapy or stereotactic radiosurgery represent a reasonable treatment in such cases.

Oxidative stress in patients undergoing high-dose chemotherapy plus peripheral blood stem cell transplantation.

Chemotherapy and radiation therapy are associated with increased formation of reactive oxygen species and depletion of critical plasma and tissue antioxidants. In patients undergoing high-dose chemotherapy, the plasma antioxidant concentration has been shown to decrease. However, these studies in which the oxidative stress status were investigated have a small number of patients and they are heterogeneous. In this study, the changes in certain trace elements together with oxidative stress parameters were investigated in 36 patients who had undergone autologous stem cell transplantation because of solid and hematological malignancies. Blood samples of the patients were examined before the high-dose chemotherapy (baseline), before stem cell transplantation (day -1), and after stem cell transplantation on day 1, 3, and 6. Erythrocyte zinc, silver, and iron levels were measured by atomic absorption spectrophotometry; malondialdehyde (MDA), superoxide dismutase (SOD), and glutathione peroxidase (GSH-Px) levels were measured by UV-vis spectrophotometry. After high-dose chemotherapy, significant increases in the levels of MDA, GSH-Px, and SOD were observed. On the other hand, Cu levels remained the same while the levels of erythrocyte Zn and Fe were increased. Significant correlation was observed among MDA, GSH-Px, and SOD (p<0.05). High-dose chemotherapy gives rise to an increase in the oxidative stress and the reactive oxygen species. Standard parenteral nutrition protocols were found to be insufficient to lower this stress.

DNA ploidy and nuclear morphometry in adult intracranial ependymomas.

The identification of prognostic parameters in ependymomas remains an important but controversial issue in particular to the significance of histopathological features. Intracranial location is a rare presentation for adult ependymomas. DNA ploidy status and nuclear morphometric features of ependymomas are not well-established. We retrospectively studied the clinicopathologic features of 12 adult intracranial ependymomas and performed image cytometric DNA analysis with nuclear morphometry. The overall survival rate was 75%. Two cases were anaplastic ependymomas. Statistically, histology failed to demonstrate a correlation with clinical outcome or overall survival. DNA ploidy (p = 0.033), DNA index (p = 0.016) and 5c exceeding rate (p = 0.017) were statistically correlated with clinical outcome, but not correlated with overall survival. Nuclear morphometric features measured using 3 different data selection methods were not correlated with clinical outcome or overall survival. It is difficult to identify prognostic factors in a series of cases with limited number. The problem is complicated by the fact that the common criteria used for recognizing malignancy in gliomas are not completely reliable in ependymomas. Nuclear morphometric findings support the general impression that ependymomas are morphologically highly variable tumors. In spite of the small sample size of our series and other factors influencing survival such as the extent of resection and malignant histology, aneuploidy can be suggested as a promising factor, which may reflect potential aggressiveness of the tumor in adult intracranial ependymomas.

Analyses of 98 seminoma cases: a review article.

98 Patients with seminoma were treated at Clinic of Radiation Oncology of Gülhane Military Medicine Academy between the years 1974-1995. All cases were undergone orchiectomy. The median age of the patients whom were staged respectively 76%, 17%, 7% according to AJCC system, stage I, stage II and stage III was 28 (20-58). While 87 patients were undergone only radiotherapy, 11 patients with advanced stage had taken chemotherapy with radiotherapy. In 52 months of median follow up duration, 5 year disease free survival rates were 98.6%, 93.3%, 25% and 94.5% for stage I, stage II, stage III and all stages respectively. As a result, we can propose that the seminoma is a disease with good results in oncology. In our view detailed staging and new treatment approaches in advanced disease will achieve better results in the future.

Fifteen cases of male breast carcinoma treated between 1980 and 1995.

Male breast carcinoma is a rare malignity. In Turkey, as in other countries, there are insufficient studies on male breast cancer. In the Radiation Oncology Department, Gülhane Military Medical Academy, we treated 15 cases of male breast cancer versus 1393 female breast cancer. Two of the cases had stage I, nine had stage II, and the remaining four had stage III disease. Median age was 52. All patients had definitive external beam radiation therapy with daily 200 cGy fractionation, following surgery. Median follow-up was 227 months. Five year survival rate was found to be 60% for all stages. Our evaluations of the pathologic findings, management, and treatment outcome were compared with literature.