Primitive neuroectodermal tumor of the jejunum; a case report and literature review.

OBJECTIVE AND IMPORTANCE: The aim of this paper is to report an unusual presentation of extranodal follicular dendritic cell tumor of neck with spinal metastasis. Follicular dendritic cells are nonlymphoid immune accessory cells present in the germinal centers of lymphoid follicles and play a crucial role in the induction and maintenance of the humoral immune response. Tumors from these cells are rare and treatment modality poorly defined. CLINICAL PRESENTATION: A 37-year-old lady presented with recurrent neck swelling which was initially reported as malignant paraganglioma. The primary disease was treated with surgery and radiotherapy. Eleven years later, the patient presented with metastasis to the spinal cord. Subsequent immunohistochemical analysis of the primary site tumor and the metastatic deposits revealed it to be a follicular dendritic cell tumor. INTERVENTION: The patient was treated with surgery followed by radiotherapy to spine, and one and half year after treatment, the patient is doing well and has regained complete motor functions. CONCLUSION: Metastasis to spinal cord for follicular dendritic cell tumor is very rare, and to the best of our knowledge, no such case has been previously reported in the scientific literature so far. In the present case, good local control was achieved with initial surgery and radiotherapy but resulted in distant failure after 11 years. This underlines the need for adjuvant systemic therapy, and understanding the biology of the tumor may help in formulating targeted therapy in the future for this rare disorder.

Extracranial doses in stereotactic and conventional radiotherapy for pituitary adenomas.

The purpose of this study is to determine the extracranial dose in patients treated for pituitary adenoma with conventional and stereotactic radiotherapy (SRT). Twelve patients receiving treatment with radiation for pituitary adenoma were selected. Six patients underwent SRT, and six patients underwent conventional radiotherapy. Extracranial doses were measured with pre-irradiation annealed lithium fluoride thermoluminscent dosimetry (TLD) chips. The chips were wrapped and placed on the patients' skin, over each eyelid, the thyroid, chest, and scrotum for males and over the suprapubic region for females. Postradiation annealing was done, and the TLDs were read in a TLD reader system. The results were analyzed using the Wilcoxon matched-pairs signed rank test by SPSS, version 6.01. The doses to the thyroid, center, and gonads were significantly higher (74.62 +/- 9.12 mrad, 65.42 +/- 9.35 mrad, and 58.42 +/- 5.36 mrad, respectively) in patients receiving SRT than in conventional radiotherapy portals (69.45 +/- 21.19 mrad, 38.33 +/- 19.44 mrad, and 31.41 +/- 18.25 mrad). But the average doses to the right eye (84.84 +/- 8.80 mrad) and to the left eye (85.68 +/- 5.82 mrad) in the stereotactic group were less when compared with the patients treated with conventional radiotherapy, who received 127.5 +/- 37.90 mrad and 117.29 +/- 34.01 mrad, respectively. In conclusion, SRT is definitely superior to conventional radiotherapy as far as dose to the surrounding normal structures is concerned. The higher extracranial doses in SRT seem to be within the acceptable range; however, the clinical significance of this is still unclear and needs longer followup.