Lojana Tuntiyatorn

Concurrent radiotherapy with temozolomide followed by adjuvant temozolomide and cis-retinoic acid in children with diffuse intrinsic pontine glioma

The prognosis of children with diffuse intrinsic pontine glioma (DIPG) is very poor. Radiotherapy remains the standard treatment for these patients, but the median survival time is only 9 months. Currently, the use of concurrent radiotherapy with temozolomide (TMZ) has become the standard care for adult patients with malignant gliomas. We therefore investigated this approach in 12 children diagnosed with DIPG. The treatment protocol consisted of concurrent radiotherapy at a dose of 55.8-59.4 Gy at the tumor site with TMZ (75 mg/m(2)/day) for 6 weeks followed by TMZ (200 mg/m(2)/day) for 5 days with cis-retinoic acid (100 mg/m(2)/day) for 21 days with a 28-day cycle after concurrent radiotherapy. Ten of the 12 patients had a clinical response after the completion of concurrent radiotherapy. Seven patients had a partial response, four had stable disease, and one had progressive disease. At the time of the report, 9 of the 12 patients had died of tumor progression, one patient was alive with tumor progression, and two patients were alive with continuous partial response and clinical improvement. The median time to progression was 10.2 +/- 3.0 months (95% confidence interval [CI], 4.2-16.1 months). One-year progression-free survival was 41.7% +/- 14.2%. The median survival time was 13.5 +/- 3.6 months (95% CI, 6.4-20.5 months). One-year overall survival was 58% +/- 14.2%. The patients who had a partial response after completion of concurrent radiotherapy had a longer survival time (p = 0.036) than did the other patients (those with stable or progressive disease). We conclude that the regimen of concurrent radiotherapy and TMZ should be considered for further investigation in a larger series of patients.

Acute Marchiafava-Bignami disease with callosal, cortical, and white matter involvement

Marchiafava-Bignami disease (MBD) is a rare complication of chronic alcoholism whose main pathology is symmetrical demyelination and necrosis of the corpus callous. The lesion may be found in hemispheric white matter, but the cortical involvement is extremely rare. We reported herein two cases of MBD with magnetic resonance (MR) findings, additional MR spectroscopy, and MR perfusion which revealed acute demyelination at the corpus callosum and symmetrical signal abnormality at cortical gray matter and hemispheric white matter.

Nasopharyngeal carcinoma segmentation using a region growing technique

PurposeThis paper proposes a new image segmentation technique for identifying nasopharyngeal tumor regions in CT images. The technique is modified from the seeded region growing (SRG) approach that is simple but sensitive to image intensity of the initial seed.MethodsCT images of patients with nasopharyngeal carcinoma (NPC) were collected from Ramathibodi hospital, Thailand. Tumor regions in the images were separately drawn by three experienced radiologists. The images are used as standard ground truth for performance evaluation. From the ground truth images, common sites of nasopharyngeal tumor regions are different from head to neck. Before the segmentation, each CT image is localized: above supraorbital foramen (Group I), below oropharynx (Group III), or between these parts (Group II). Representatives of the CT images in each part are separately generated based on the Self-Organizing Map (SOM) technique. The representative images contain invariant features of similar NPC images. For a given CT slice, a possible tumor region can be approximately determined from the best matching representative image. Mode intensity within this region is identified and used in the SRG technique.ResultsFrom 6,606 CT images of 31 NPC patients, 578 images contained the tumors. Because NPC images above the supraorbital foremen were insufficient for study (6 images from 1 subject), they were excluded from the analysis. The CT images with inconsistent standard ground truth images, metastasis cases, and bone invasion were also disregarded. Finally, 245 CT images were taken into account. The segmented results showed that the proposed technique was efficient for nasopharyngeal tumor region identification. For two seed generation, average corresponding ratios (CRs) were 0.67 and 0.69 for Group II and Group III, correspondingly. Average PMs were 78.17 and 82.47%, respectively. The results were compared with that of the traditional SRG approach. The segmentation performances of the proposed technique were obviously superior to the other one. This is because possible tumor regions are accurately determined. Mode intensity, which is used in place of the seed pixel intensity, is less sensitive to the initial seed location. Searching nearby tumor pixels is more efficient than the traditional technique.ConclusionA modified SRG technique based on the SOM approach is presented in this paper. Initially, a possible tumor region in a CT image of interest is approximately localized. Mode intensity within this region is determined and used in place of the seed pixel intensity. The tumor region is then searched and subsequently grown. The experimental results showed that the proposed technique is efficient and superior to the traditional SRG approach.

Automatic segmentation of nasopharyngeal carcinoma from CT images: Region growing based technique

This paper describes a framework for automatic nasopharyngeal carcinoma segmentation from CT images. The proposed technique is based on the Region Growing Method. It is automatic segmentation in which an initial seed is generated without human intervention. The seed is generated from a probabilistic map representing the chances of it being tumor. This map is created from three probabilistic functions based on location of the tumor, intensities, and non-tumor region respectively. The pixel in which the probability is the highest will be selected as potential seeds. Only one representative of these seeds will be selected as an initial seed. Then the seed will be used for region growing subsequently. The experimental results showed that the potential seeds and initial seed were correctly determined with a percentage accuracy of 81.60% and 95.10%. The seed was grown in preprocessed CT images for identifying the nasopharyngeal carcinoma region. The results showed that, perfect match and corresponding ratio were 71.31% and 53.00% respectively

Automatic Segmentation of Nasopharyngeal Carcinoma from CT Images

This paper presents an automatic segmentation technique for identifying nasopharyngeal carcinoma regions in CT images. The proposed technique is based on the region growing method by which an initial seed is automatically generated. A probabilistic map representing a chance of being the tumor pixel in each CT image will be created and used for initial seed determination. This map is generated from three probabilistic functions established upon location of the tumor considered, intensities of the tumor pixels, and asymmetry of organs respectively. A representative of potential tumor pixels will be selected as an initial seed. The experimental results showed that seeds were correctly determined with the percent accuracy of 84.32%. These seeds were grown in preprocessed CT images for identifying the nasopharyngeal carcinoma regions subsequently. The results showed that, for no metastasis cases, perfect match and corresponding ratio were 85.03% and 52.44% respectively and 29.26% and 28.03% correspondingly for metastasis cases. This resulted from a single seed generated in each CT image. It was unable to identify more than one tumor region.

Antiphospholid antibody syndrome and Hb E/Beta thalassemia disease post-allogeneic stem cell transplantation.

We report a 10‐year‐old male with Hb E/Beta thalassemia disease who developed chronic graft‐versus‐host disease (cGVHD) of antiphospholipid antibody syndrome after successful allogeneic stem cell transplantation (SCT). He exhibited a recurrent ischemic stroke on day 368 post‐SCT while on cyclosporine A, azathioprine, and prednisolone. The immunosuppressive agents were switched to pulse methylprednisolone, tacolimus, mycophenolate mofetil, and enoxaparin, but the patient was more confused. An additional plasma exchange which was aimed at the immediate removal of autoantibody was performed with a good response. The symptoms rapidly disappeared except for the complex partial seizure which persisted until seven years post‐SCT. Pediatr Blood Cancer 2011;57:153–156.

Lacrimal myoepithelial carcinoma ex recurrent pleomorphic adenoma: A clinicopathological report and review of the literature

Myoepithelial carcinoma is an uncommon malignant tumor of the lacrimal gland, composed of neoplastic myoepithelial cells with an infiltrative growth. The present study describes a unique case of progressive proptosis and blindness of the right eye in a 68-year-old woman following total tumor removal for lacrimal pleomorphic adenoma. Clinical study, surgical exploration, and pathology revealed lacrimal myoepithelial carcinoma ex recurrent pleomorphic adenoma, T2N0M0. In addition, 18 cases of lacrimal myoepithelial tumor that have been previously described in the literature are reviewed. The application of clinical, radiological, histopathologic, and immunohistochemical investigations may help to reach the definite diagnosis. Criteria for malignancy of lacrimal myoepithelial tumor should be the same as salivary myoepithelial tumor diagnosis, until long-term outcome data for a larger number of patients with lacrimal myoepithelial carcinoma become available.

Favorable response of intraommaya topotecan for leptomeningeal metastasis of neuroblastoma after intravenous route failure

A 3‐year‐old male, diagnosed with stage 4 neuroblastoma, developed recurrent leptomeningeal metastasis after multi‐modality treatment including multi‐agent chemotherapy, surgery, high dose chemotherapy plus stem cell rescue, cis‐retinoic acid and intravenous (IV) topotecan. He then received intraommaya (IO) topotecan three times weekly (maximum dose; 0.4 mg). A complete response was achieved by a resolution of malignant cells in cerebrospinal fluid and resolution leptomeningeal enhancement by brain MRI. Treatment toxicities included low‐grade fever and minimal headache. The duration of treatment response from IO topotecan was 18 weeks. The survival time from CNS recurrence in this patient was 13 months. We suggest IO topotecan be considered for neoplastic meningitis of tumors with known sensitivity to topotecan. Pediatr Blood Cancer 2008;50:169–172.