Ya-Yen Lee

Treatment‐related white matter changes in cancer patients

Forty cancer patients with bilateral diffuse cerebral white matter hypodensities on computerized tomography (CT) scan were reviewed. Brain irradiation and/or chemotherapy were considered responsible for the CT abnormalities in all patients but one, whose changes were presumably due to demyelination related to the aging process. Among these 39 patients, 7 had clinical symptoms of leukoencephalopathy. Two patients had acute transient leukoencephalopathy, and one of them experienced permanent neurologic changes after continuing treatment. Six additional patients had delayed leukoencephalopathy. The interval between whole‐brain irradiation (WBXRT) alone and the CT detection of white matter hypodensities was almost always longer than 1 year. This interval was shortened to less than 1 year in a significant number of patients when WBXRT was followed by various chemotherapeutic protocols. More importantly, there was an increased incidence of clinical leukoencephalopathy. A higher incidence of clinical leukoencephalopathy in patients receiving intracarotid chemotherapy in the treatment of brain tumors and in patients receiving combination chemotherapy for central nervous system relapse of adult leukemia suggests a need for further investigation. Cancer 57:1473–1482, 1986.

Radiologic Findings of Hamartomas of the Tuber Cinereum and Hypothalamus

Five cases, four histologically proved, or hamartoma of the tuber cinereum and hypothalamus in children (age range: 2--12 years) are reported. Three cases had pubertas praecox, and in all of these the hamartoma was located in the basal cistern between the chiasm and pons, and had a collar button shape and size typical of hamartoma of the tuber cinereum. In the third case, which presented with headache, a huge calcified mass in the suprasellar region was initially thought to be craniopharyngioma. The fourth case had a hamartoma within the substance of the hypothalamus and presented with hyponatremia and temporal lobe seizures.

Intracarotid VP-16 in malignant brain tumors

Twenty-eight patients with malignant brain tumors (16 with primary brain tumors and 12 with brain metastases) progressing after cranial irradiation with or without chemotherapy received varying doses of intracarotid VP-16. Courses of therapy were repeated every 4 weeks along with computerized axial tomography scan and neurologic examination. Of 15 evaluable patients with primary malignant brain tumors, 1 responded to therapy and 5 had no immediate tumor progression for 2–10 months. None of 12 evaluable patients with brain metastases responded to intracarotid VP-16 although 5 had no immediate tumor progression from 1–4 months. Side effects of treatment were uncommon. Using this route of administration, intracarotid VP-16 does not appear to increase response rates in patients with primary malignant brain tumors, compared with results reported for intravenous VP-16.

A large lumen microcatheter for oncologic intervention

A newly available Tracker-325 catheter (Target Therapeutics, Fremont, CA, USA), modified from the Tracker-18 catheter, has the same outer diameter but a larger lumen. This catheter was used in 15 patients during a 7-month period for superselective arterial catheterization when conventional catheters could not be placed successfully. Arterial embolization (n = 7), chemoembolization (n = 5), and chemoinfusion (n = 3), were performed. The increased luminal diameter of the Tracker-325 allowed an increased flow rate for diagnostic arteriography, accommodated larger embolic particles, and improved the ability to achieve a superselective position.

Flow-directed catheter for superselective arterial catheterization: An experimental evaluation

A coaxial infusion catheter of 3 Fr Teflon and Gore-Tex was developed to facilitate superselective catheterization of cerebral arteries for the delivery of therapeutic agents. The catheter, technique for use, and preliminary results are described.

Malignant fibrous histiocytoma of the tongue demonstrated by magnetic resonance imaging.

Malignant fibrous histioc ytoma (MFH) has been described fairly recently. but is the most commonly encountered variety of soft tissue sarcoma. Its presentation as a primary tumor of the tongue is extremely rare. with only three previou s reported cases. 1·.\ None of the three cases was studied by magnetic resonance imaging (MRI). We present a case of MFH of the tongue in which MRI was used as one of the modalities for the radio logic evaluation of the size and extent of tumor before surgery. MR images correlated well with the surgical findings.