Serhan Küpeli

Risks and diagnosis of coronary artery disease in Hodgkin lymphoma survivors.

Higher mortality rates are reported because of cardiovascular diseases in individuals living in industrialized areas of the World. In cancer patients, cardiotoxic chemotherapeutic agents and/or mediastinal radiotherapy are additional risk factors for the development of coronary artery disease. An improved survival rate for patients with Hodgkin lymphoma was reported in recent decades. Determining and handling the long-term effects of cancer treatment have become more important nowadays, parallel to the good results reached in survival rates. Mediastinal radiotherapy and cardiotoxic chemotherapeutic agents are routinely used to treat Hodgkin lymphoma but are commonly associated with a variety of cardiovascular complications. Drugs used in cancer treatment and radiotherapy may cause deleterious effects on contractile capacity and conduction system of the heart. Approximately ten years after the completion of all therapies, the cardiovascular disease risk peaks in patients who survived from Hodgkin lymphoma. The value of coronary computed tomography angiography as a diagnostic tool in determining coronary artery disease as early as possible is underlined in this review, in patients who are in remission and carry the risk of coronary artery disease probably because of chemo/radiotherapy used in their treatment. Survivors of Hodgkin lymphoma especially treated with combined chemoradiotherapy at younger ages are candidates for coronary computed tomography angiography.

Leukemoid reaction associated with pediatric nasopharyngeal carcinoma: An unusual presentation.

Nasopharyngeal carcinoma is a tumor originating from the surface epithelial cells of nasopharynx. It is rare in children and adolescents. Most common physical finding is a neck mass. Most children with nasopharyngeal carcinoma present with advanced stage disease. The presentation with hematological abnormalities in patients without systemic metastasis is extremely rare. We reported a 14-year-old boy presenting with a mass at the right side of the pharynx and leukemoid reaction. To our knowledge, this is the first report of leukemoid reaction associated with pediatric nasopharyngeal carcinoma in English literature.

Refugee children with cancer in Turkey

1 Coates AS, Winer EP, Goldhirsch A, et al. Tailoring therapies—improving the management of early breast cancer: St Gallen international expert consensus on the primary therapy of early breast cancer 2015. Ann Oncol 2015; 26: 1533–46. 2 Abdel-Fatah TMA, Agarwal D, Liu D-X, et al. SPAG5 as a prognostic biomarker and chemotherapy sensitivity predictor in breast cancer: a retrospective, integrated genomic, transcriptomic, and protein analysis. Lancet Oncol 2016; published online June 13. http://dx.doi.org/10.1016/ S1470-2045(16)00174-1. 3 Johansson I, Ringner M, Hedenfalk I. The landscape of candidate driver genes diff ers between male and female breast cancer. PLoS One 2013; 8: e78299. 4 Cornen S, Guille A, Adelaide J, et al. Candidate target genes of luminal B breast cancers identifi ed by genome, gene expression and DNA methylation profi ling. PLoS One 2014; 9: e81843. 5 Finetti P, Guille A, Adelaide J, Birnbaum D, Chaff anet M, Bertucci F. ESPL1 is a candidate oncogene of luminal B breast cancers. Breast Cancer Res Treat 2014; 147: 51–59. 6 Paik S, Shak S, Tang G, et al. A multigene assay to predict recurrence of tamoxifen-treated, node-negative breast cancer. N Engl J Med 2004; 351: 2817–26. 7 van de Vijver MJ, He YD, van’t Veer LJ, et al. A gene-expression signature as a predictor of survival in breast cancer. N Engl J Med 2002; 347: 1999–2009. 8 Filipits M, Rudas M, Jakesz R, et al. A new molecular predictor of distant recurrence in ER-positive, HER2-negative breast cancer adds independent information to conventional clinical risk factors. Clin Cancer Res 2011; 17: 6012–20. 9 Parker JS, Mullins M, Cheang MC, et al. Supervised risk predictor of breast cancer based on intrinsic subtypes. J Clin Oncol 2009; 27: 1160–67. 10 Fischer M, Quaas M, Steiner L, Engeland K. The p53-p21-DREAM-CDE/CHR pathway regulates G2/M cell cycle genes. Nucleic Acids Res 2016; 44: 164–74.

The first report of cabergoline-induced immune hemolytic anemia in an adolescent with prolactinoma.

Abstract Prolactinomas are common pituitary tumors that can cause gonadal dysfunction and infertility related to hyperprolactinemia. Dopamine agonists are the first-line treatment in these patients. Cabergoline leads to significant reduction in serum prolactin levels and tumor size in patients with prolactinoma. Dopamine agonists have been associated with adverse effects such as nausea, vomiting and psychosis. We report here a case with cabergoline-induced immune hemolytic anemia. The patient had cabergoline treatment history for prolactinoma and presented with weakness, fatigue, nausea, and paleness. Laboratory findings revealed severe anemia-related immune hemolysis. There were no causes identified to explain hemolytic anemia except cabergoline. Therefore, cabergoline therapy was stopped and subsequently hemolytic anemia resolved and did not occur again. This is the first reported pediatric case with prolactinoma and cabergoline-induced hemolytic anemia. Clinicians should be watchful for this rare side effect induced by cabergoline.

Successful treatment with propranolol in a patient with a segmental hemangioma: a case report.

The treatment of hemangiomas in infancy may be associated with significant morbidity. In addition to morbidity, an objective response cannot be obtained because of the absence of targeted therapeutic options. Herein, we present an infant with a segmental hemangioma and marked glucocorticoid toxicity due to prior steroid therapy that was successfully treated with propranolol. Propranolol was tolerated well and no side effects were observed during the treatment. The only problem to occur was disease recurrence following the withdrawal of propranolol at age 13 months, which was not within the age of spontaneous regression (generally considered as >18 months).

Treatment of Wilms Tumor Using Carboplatin Compared to Therapy Without Carboplatin

Wilms tumor (WT) is the most common pediatric malignant primary renal tumor. One of the main drugs used in treatment is actinomycin‐D. This was not readily available in Turkey at one time. Carboplatin was used in the primary treatment of WT in order to prevent delays in treatment. The aim of this study is to present the results of patients with WT receiving carboplatin or actinomycin‐D therapy.

Evaluation of Late Cerebral Vascular Complications in Cranially Irradiated Pediatric Cancer Patients with Magnetic Resonance Angiography

Background: We aimed to establish the early diagnosis of cerebral vascular complications by using cerebral magnetic resonance angiography (MRA) in patients who were treated with cranial RT in childhood as part of their cancer treatment. Procedure: Patients who had received cranial RT before the age of 18 and had been in remission for at least 1 year were enrolled in the study. A data form including demographic and clinical characteristics and findings of cerebral MRA was filled in for each patient. Results: Cerebral MRA examination was performed between November 2013 and October 2015 in 53 patients who met the inclusion criteria. Abnormalities were found in 7 patients (13.2%). All patients were asymptomatic at the time of examination. There was a significant difference between patients in the abnormality-positive and abnormality-negative groups related to cranial radiation dose (p = 0.013) and age at the time of examination (p = 0.015) in univariate analysis. In multivariate analysis, cranial radiation dose was found to have an impact on developing cerebral vascular abnormalities (p = 0.045). Conclusions: Cerebral MRA is a noninvasive method of follow-up for late cerebral vascular complications in surviving pediatric oncology patients who were treated with cranial RT as part of their cancer treatment.

Prevalence and Related Factors of Euthyroid Sick Syndrome in Children with Untreated Cancer According to Two Different Criteria

Objective: In this study, we evaluated the frequency of euthyroid sick syndrome (ESS) among patients with childhood cancer and its association with the stage of disease, nutritional parameters and cytokines levels. Methods: Eighty newly diagnosed children were included in the study. ESS was assessed in two different ways. According to criteria 1 ESS was present if free triiodothyronine (fT3) was below the lower limit and free thyroxine was within the normal or low limits, thyroid-stimulating hormone (TSH) was in the normal range. According to criteria 2, in addition to the above, it was required that reverse triiodothyronine (rT3) be performed and was higher than normal limits. Results: Three of our pediatric patients had subclinical hypothyroidism and two had subclinical hyperthyroidism. Out of 75 patients, ESS was identified in 14 (17.3%) according to criteria 1 and in eight (10.6%) according to criteria 2. Only fT3 levels were significantly different in the ESS (+) and ESS (-) groups (p<0.05) according to criteria 1. A significantly negative correlation between interleukin (IL)-6 and fT3 was found, according to both sets of criteria. tumor necrosis factor alpha was negatively correlated with fT3 levels only in the criteria 1 group. There were no correlations between IL-1β and fT3, free thyroxine, rT3 and TSH levels. Conclusion: ESS may occur in childhood cancer and thyroid function testing should be performed routinely when cancer is diagnosed.

Nörofibromatozis Tip1 Hastalarında Telomeraz Aktivitesi

Cesitli kanser turlerinde yapilan calismalarda kisa telomer uzunlugu ve dusuk telomeraz aktivitesinin bazi kanser tiplerinde koruyucu etkisi oldugundan bahsedilmektedir. Norofibromatozis Tip-1 (NF1) hastalarinin bazi kanser turleri icin yuksek risk altinda oldugu bilinmektedir. Beyin tumorleri, malign periferik sinir kilifi tumorleri, optik gliom, yumusak doku sarkomlari gibi malign tumorler ve norofibromlar ve hamartomlar gibi benign olanlar bunlar arasinda sayilabilir. Ilginc olarak NF1 hastalarinda ortaya cikan kanserlerde prognoz genel olarak ayni tanili NF1 olmayan hastalara gore daha iyi olmakta ve sagkalim daha uzun olmaktadir. Bu derlemede NF1 hastalarindaki telomeraz aktivitesinin gelisebilecek kanserlerle olan iliskisi literatur bilgileri isiginda irdelenmistir. NF1 hastalarinda benign veya malign tumor gelisimi acisindan telomeraz aktivitesi olcumu tumor belirleyici islevi gorebilir.

Brucella abortus Causing Febrile Neutropenia Together with Epididymoorchitis.

To the Editor: Brucellosis, the commonest zoonotic infection worldwide, can affect individuals and immunocompromised patients in countries that are endemic for this infection [1]. In this report, we describe an unusual case of febrile neutropenia together with typhlitis and epididymoorchitis caused due to Brucella abortus. An 8-y-old boy, who had been treated for precursor B-cell lymphoma, presented 5 mo post-treatment completion with pain and purulent secretion from penis. He was diagnosed as relapse and local care for balanitis and chemotherapy protocol was initiated. On the fifth day of treatment, he developed neutropenic fever and meropenemwas started. On the third day of the treatment with meropenem, he had diarrhea, abdominal pain and distension in addition to scrotal pain and swelling (Fig. 1); a diagnosis of typhlitis and bilateral epididymoorchitis was considered. Vancomycin, amikacin, ornidazole and amphotericin-B were added. A few days later his blood culture was reported as Brucella abortus; doxycycline and rifampicin were initiated. Since he belonged to a rural region in the eastern part of Turkey where brucella infections are endemic, this result was meaningful. After 20 d of treatment with these two drugs, he almost completely recovered and was discharged with oral antibiotics for completing therapy to a total duration of 6 wk. Unfortunately, he died of progressive cancer. Brucellosis is characterized by the classic triad of fever, arthralgia/arthritis and hepatosplenomegaly; it is also known to cause anemia, thrombocytopenia, neutropenia or pancytopenia [2, 3]. However, febrile neutropenia caused by Brucella species is rare; Ozçay et al. [4] and Citak et al. [5] have reported febrile neutropenia caused by Brucella melitensis in children. To our knowledge, this is a unique case of neutropenic fever due to Brucella abortus. Since true antimicrobial agent and the time are very important in managing febrile neutropenia and Brucella species grow very slowly in blood cultures, brucellosis should be considered as a possible cause of febrile neutropenia and pancytopenia in immunocompromised hosts in endemic areas to prevent diagnostic delay, mortality and morbidity. Brucella is a rare causative agent of epididymoorchitis; it is more rarely seen in pediatric ages and is mostly unilateral [2] unlike our patient who had bilateral epididymoorchitis. In conclusion, in countries endemic for brucellosis, B. abortus must be kept in mind as an etiological agent for febrile neutropenia and epididymoorchitis. If there is a strong suspicion, Brucella agar or * Tuba Kasap tubaserdar06@hotmail.com