Nalan Yazici

Second malignant neoplasms following the treatment of brain tumors in children.

We investigated retrospectively 992 children with central nervous system tumors who were treated at our center between 1970 and 2004. All of the patients were treated by surgery, chemotherapy, and/or radiotherapy. Six patients developed second malignant neoplasms, and their clinical and histopathologic characteristics are reviewed in this article. The second malignant neoplasms were diagnosed as non-Hodgkin lymphoma, myelodysplastic syndrome, basal cell carcinoma, malignant melanoma, Kaposi sarcoma, and high-grade neuroectodermal tumor. The initial diagnoses were ependymoblastoma in one, medulloblastoma in three, and low-grade astrocytoma in two patients. The median latency time was 3.03 years (range 0.39—22.93 years). The outcome varied according to the histopathologic type of the second tumor. The patients who developed non-Hodgkin lymphoma and myelodysplastic syndrome died of progressive disease. The patients with second skin neoplasms are alive as of the time of this writing. The patient with Kaposi sarcoma developed one of the rare reported second malignant neoplasms following a primary brain tumor in childhood. A wide spectrum of second malignant neoplasms was detected after treatment of primary brain tumors with surgery, radiotherapy, and chemotherapy. Long-term follow-up is therefore necessary for the child who has survived a primary central nervous system tumor. (J Child Neurol2006;21:433—436; DOI 10.2310/7010.2006.00108.

Maxillary ameloblastic carcinoma in a child

We report an extremely rare occurrence of ameloblastic carcinoma located in the maxilla of a pediatric patient. Wide surgical resection was done along with adjuvant radiotherapy because of involved surgical margins. Histopathological diagnosis was established with morphological features of both ameloblastoma and carcinoma. Pediatr Blood Cancer 2008;50:175–176.

Comparison of accelerated and rapid schedules for monovalent hepatitis B and combined hepatitis A/B vaccines in children with cancer.

The aim of this study was to determine the efficacy of immunization against hepatitis A and B infections with “rapid” or “accelerated” schedules in children with cancer receiving chemotherapy. Fifty-one children were recruited to receive either vaccination schedule, in the “rapid vaccination schedule”; hepatitis B (group I) or combined hepatitis A/B vaccines (group III) were administered at months 0, 1, 2, and 12; in the “accelerated vaccination schedule,” hepatitis B (group II) or combined hepatitis A/B (group IV) vaccines were administered on days 0, 7, 21, and 365 intramuscularly. The seroconversion rates at months 1 and 3 were 35.7 and 57.1% in group I and 25 and 18.8% in group II, respectively. Group I developed higher seroconversion rates at month 3. In group III the seroconversion rates for hepatitis B at months 1 and 3 were 54.5 and 60% and in group IV 50 and 70%, respectively. For hepatitis A, the seroconversion rates at months 1 and 3 were 81.8 and 90% in group III and 80 and 88.9% in group IV, respectively. The accelerated vaccination schedule seems to have no advantage in children receiving cancer chemotherapy except for high antibody levels at month 1. In conclusion, the accelerated vaccination schedules are not good choices for cancer patients. The combined hepatitis A/B vaccine is more effective than monovalent vaccine in cancer patients, which probably can be explained by an adjuvant effect of the antigens. The seroconversion of hepatitis A by the combined hepatitis A/B vaccination is very good in cancer patients.

Successful use of intraventricular and intravenous rituximab therapy for refractory primary CNS lymphoma in a child

Despite the attempts of new and intensive chemotherapy regimens and radiotherapy, response rates and survival of the patients with primary central nervous system lymphomas (PCNSL) has still not been satisfactory [1 – 3]. We would like to share our experience of the efficacy of systemic and intraventricular rituximab treatment in a 14-year-old boy who had recurrent and refractory B cell-PCNSL. After the gross total excision, he was given intensive systemic chemotherapy with French LMB-89 protocol (high-dose cyclophosphamide, high-dose methotrexate/leucovorin, cytarabine, vincristine, prednisone, doxorubicin); but the tumor recurred at the fourth week of treatment. A large recurrent tumor mass measured almost the same preoperative size (6.5 cm), diffuse leptomeningeal involvement with nodular contrast enhancements on cauda equine were noted [Figure 1(a)]. After the second near-total tumor resection [Figure 1(b)], craniospinal radiotherapy (RT) was given (54 Gy to cranium, 5.4 Gy to tumor bed and 30.6 Gy to spinal column). After the first few days of RT, new clinical symptoms, back and cervical pain, urinary retention, and increased paresis on the right arm developed, which did not resolve during RT. He developed hyponatremia and hypothyroidism. A week after the end of RT, a large recurrent mass of 6.6 cm in the operation cavity and a new hipothalamochiasmatic tumor measuring 13 mm were detected. Also, unchal herniation and midline shift were noted [Figure 1(c)]. Because of diffuse CD20 staining on tumor tissue and unresponsiveness to the standard treatment modalities, intraventricular rituximab (chimeric anti-CD20 monoclonal antibody, Mabthera) treatment was given on his second recurrence of disease. After two systemic rituximab infusions (375 mg/m) given weekly (Day 1 and Day 8), intraventricular rituximab injections were administered via Ommaya reservoir on Day 16 (10 mg in 1 ml), Day 17 (25 mg in 2.5 ml), Day 24 (30 mg in 3 ml), and Day 25 (30 mg in 3 ml) as described by Pels et al. and Shulz et al. [4,5]. Premedication with paracetamol of 10 mg/kg was given p.o. The only reversible side effects after systemic rituximab were chills and fever lasting a few hours on Day 1. No side effect was observed after the first intraventricular application of rituximab. But, after the dose of 25 mg on Day 17, reversible and short-lasting fever was observed. After the next dose of 35 mg, he disoriented for a few minutes. Intraventricular rituximab dose was lowered to 30 mg, and no more side effects were observed. No other chemotherapeutic was given systemically or through the intraventricular route during therapy. Dexamethasone, given during RT, ceased gradually before rituximab treatment and no other steroid was given during treatment. Clinical and radiological evaluations were performed just before the intraventricular applications and at the end of the first cycle of treatment (Days 15 and 30). On Day 15, MRI showed partially regressed tumor.

Intracranial Desmoid Tumor with Familial Adenomatous Polyposis Coli

Intracranial desmoid tumors are extremely rare. The association of desmoid tumors with familial adenomatous polyposis coli was reported previously, with the tumors involving trunk and extremities. We report a 3.5-year-old girl with intracranial desmoid tumor with familial adenomatous polyposis coli. This condition in a child is rarely reported. Follow-up of the patient after cranial surgery and of the family for this premalignant inherited condition is necessary.

IMMUNOGENICITY OF HEPATITIS A VACCINE IN CHILDREN WITH CANCER

This study evaluated the immuned response of the hepatitis A vaccine in children with cancer who were receiving chemotherapy. Twenty-eight patients with lymphomas or solid tumors and who had negative serology for hepatitis A were enrolled. The median age was 4.7 years (range 2–16). The patients received 1440 IU hepatitis A vaccine at 0 and 6 months. Seroconversion rates at the first and seventh months were 60% (n = 17/28 patients) and 89% (n = 24/27 patients). No adverse effects were observed. The hepatitis A vaccine was found to be effective and safe in children with cancer.

DISCITIS FOLLOWING LUMBAR PUNCTURE IN NON-HODGKIN LYMPHOMA

Discitis in children is a rare disorder of intervertebral disc and vertebral end plate. Infection or trauma, like lumbar puncture, may be the possible causes. Low-back pain and gait disturbance are the main symptoms. The most appropriate diagnostic procedure is MRI. Treatment is mainly empirical. Here a case with non-Hodgkin lymphoma is discussed. Treatment consisted of strict bed rest and antibiotics. Safe and sterile technique is important in patients with invasive procedures like intrathecal chemotherapy. Although discitis is a self-healing condition, it might cause vertebral osteomyelitis. In this regard, physicians should be aware of this probable complication after lumbar puncture and manage it earlier in children with cancer.