Phosphorus-32 therapy for cystic craniopharyngiomas

Background and purpose

To examine control rates for predominantly cystic craniopharyngiomas treated with intracavitary phosphorus-32 (P-32).

Material and methods

22 patients with predominantly cystic craniopharyngiomas were treated at Indiana University between October 1997 and December 2006. Nineteen patients with follow-up of at least 6 months were evaluated. The median patient age was 11 years, median cyst volume was 9 ml, a median dose of 300 Gy was prescribed to the cyst wall, and median follow-up was 62 months.

Results

Overall cyst control rate after the initial P-32 treatment was 67%. Complete tumor control after P-32 was 42%. Kaplan-Meier 1-, 3-, and 5-year initial freedom-from-progression rates were 68%, 49%, and 31%, respectively. Following salvage therapy, the Kaplan-Meier 1-, 3-, and 5-year ultimate freedom-from-progression rates were 95%, 95%, and 86%, respectively. All patients were alive at the last follow-up. Visual function was stable or improved in 81% when compared prior to P-32 therapy. Pituitary function remained stable in 74% of patients following P-32 therapy.

Conclusions

Intracystic P-32 can be an effective and tolerable treatment for controlling cystic components of craniopharyngiomas as a primary treatment or after prior therapies, but frequently allows for progression of solid tumor components. Disease progression in the form of solid tumor progression, re-accumulation of cystic fluid, or development of new cysts may require further radiotherapy or surgical intervention for optimal long-term disease control.     

Intracavitary brachytherapy using stereotactically applied phosphorus-32 colloid for treatment of cystic craniopharyngiomas in 53 patients

This paper summarizes outcomes of a single-center study of intracavitary brachytherapy (IBT) with stereotactically applied phosphorus-32 ((32)P) colloid for treatment of cystic craniopharyngiomas. We assessed its efficacy and safety, on the basis of clinical and radiological outcomes in one of the largest reported patient series. Between 1992 and 2011, 53 patients were treated with IBT, 14 without previous treatment and 39 who had previously been treated for recurrent cysts. Intervention was performed by applying 200?Gy to the internal cyst wall (median volume 6.1?ml). Median clinical and radiological follow-up were 60.2 and 53.0?months, respectively. Actuarial tumor cyst control was 86.0?±?5.3?% at 12, 24, and 60?months. Actuarial out-of-field control (development of new cysts or progression of solid tumor parts) was 90.9?±?4.3, 84.0?±?5.6, and 54.5?±?8.8?% after 12, 24, and 60?months, respectively. Corresponding actuarial overall progression-free survival was 79.4?±?6.1, 72.4?±?6.8, and 45.6?±?8.7?% at 12, 24, and 60?months, respectively. Visual function improved for 12 patients (23.5?%), remained unchanged for 34 patients (66.7?%), and worsened for five patients (9.8?%), correlating with tumor progression in each case. Endocrinological deterioration occurred for ten patients (19.6?%); for nine patients this was a result of tumor progression or after tumor resection and for one it was attributed to irradiation. Within six months of IBT seven patients (13.7?%) experienced transient neurological deficits and two patients (3.9?%) deteriorated permanently (hemiparesis and third nerve palsy). Stereotactically applied (32)P is highly efficacious for control of cystic components of craniopharyngiomas and is associated with a low risk of permanent morbidity. The procedure does not, however affect the development of new cysts or the progression of solid tumor parts.     

CT引导立体定向32P内放疗治疗囊性颅咽管瘤

目的探讨囊性颅咽管瘤的最佳治疗方法。方法对30例囊性颅咽管瘤患者行CT立体定向Ommaya管置入术结合^32P内放疗治疗。其中男性19例,女性11例,平均32岁。CT或MRI显示均为单个囊性病变。结果全部病例临床症状持续改善,无手术死亡及严重并发症。随访16～56个月,26例囊腔明显缩小,4例囊腔缩小。无手术死亡及严重并发症。结论Ommaya管置入结合^32P内放疗治疗颅咽管瘤安全有效,本方法应作为治疗囊性颅咽管瘤的首选方法。     

Continuous low-dose-rate radiation of radionuclide phosphorus-32 for hemangiomas

The study goal was to clarify the therapeutic effect and the absorbed dose of radionuclide phosphorus-32 for skin hemangiomas and the consequent risk of side effects in these patients. Phosphorus-32 is an β emitter and is used for skin hemangioma treatment. In comparison with the few Gy per minute of the linear accelerators, the dose rate of phosphorus-32 for hemangiomas is much <1 Gy/hour; so, the latter is called low-dose-rate radiation. To achieve the therapeutic dose, continuous hours or days of radiation is necessary. For strawberry hemangiomas, the phosphorus-32 applicator was tightly placed on the lesion site for several hours until reaching therapeutic dose. The absorbed dose was estimated by radiochromic films. The absorbed dose of phosphorus-32 irradiation declined exponentially with a depth from 0 to 2.5 mm. Of the 316 patients with strawberry hemangiomas, the lesion disappeared completely within 3 months after one-time treatment in 259 cases (82%). For cavernous hemangiomas, 370KBq phosphorus-32 colloid was injected into the hemangioma each square centimeter, and the absorbed radiation was estimated by theoretical calculation. Forty-two of the 58 patients with cavernous hemangiomas (72%) had lesions that completely disappeared within 3 months after receiving one to six treatments. Thus, the phosphorus-32 for strawberry hemangiomas and the chromium phosphate-32 colloid for cavernous hemangiomas were clearly efficacious.     

Intraoperative hyperthermic tissue ablation in pulmonary metastases: a case report

AIMS AND BACKGROUND: The surgical removal of lung metastases is controversial: some authors have reported good results in terms of prognosis and disease-free interval in patients affected by multiple metastases. Recently, percutaneous hyperthermic tissue ablation (HTA) has been used under CT guidance in solitary peripheral pulmonary tumors attached or close to the parietal pleura. METHODS AND STUDY DESIGN: We report the first intraoperative HTA of a lung metastasis from colorectal carcinoma, which might pave the way for possible future application of the procedure in patients with multiple pulmonary metastases. A 64-year-old patient affected by a rectal cancer was treated by abdominal perineal amputation followed by two lines of chemotherapy. After two years two lesions appeared in the lower left pulmonary lobe and another in the lower right lobe. The patient was monitored by three-monthly thoracic and abdominal CT. The lesions were stable for one year, but in the last two months one of the suspected metastases in the left lung increased from 1 to 2 cm. This was an indication for surgical removal. A mini posterolateral thoracotomy was performed. Thanks to complete collapse of the lung with manual squeezing of the parenchyma, ultrasonography provided satisfactory visualization of the two lesions. A frozen biopsy of the larger lesion was obtained which confirmed its metastatic nature. Ultrasound-guided HTA of the larger metastasis (2 cm) was performed. Final US demonstrated the change in the metastatic pattern. The two lesions were eventually removed by wedge resection using a TA 90 stapler. Histological examination of the two lesions confirmed the coagulative necrosis of the treated metastasis. No morbidity or pulmonary problems were recorded.     

Adenocarcinoma arising in mature cystic teratoma: a case report

Benign cystic teratoma is recognized as one of the most common tumors in women during the reproductive age and frequently is treated by pelviscopic operation. Malignant transformation of a benign cystic teratoma is a rare event, and adenocarcinoma is extremely rare, and distinguishing this malignant change from benign disease preoperatively is nearly impossible even by the use of radiological imaging or various tumor markers. Therefore, patients should be informed that if a laparoscopic cystectomy is undertaken, a prompt second staging operation should be performed if the definitive pathology reveals an unexpected malignancy. We present a case with thyroid papillary carcinoma of follicular variant arising from mature cystic teratoma removed by laparoscopic salpingo-oophorectomy followed by staging laparotomy. We briefly reviewed literatures with regard to malignant transformation of a benign cystic teratoma.     

Adenoid cystic carcinoma of the nasopharynx: a case report]

Nasopharyngeal adenoid cystic carcinoma is a rare tumor, few cases have been reported in the literature. The aim of this report is to present a new case of an adenoid cystic carcinoma of the nasopharynx. We report the case of a 50 years-old woman presenting with an adenoid cystic carcinoma of the nasopharynx with diffuse pulmonary metastasis. The treatment combined chemotherapy, based on cisplatin and adriamycin drugs, and palliative radiation therapy at the dose of 30 Gy. The patient died 6 months after diagnosis establishment. The best treatment of adenoid cystic carcinoma is complete surgical resection but extended resection can be difficult in some locations as nasopharynx. The adjuvant radiation therapy seems to improve local control.     

Adenoid cystic carcinoma of the breast--a case report

We report a rare case of adenoid cystic carcinoma (ACC) of the breast. The patient was a 60-year-old female with a lump of the left breast which had present for 20 years. Macroscopically, the resected left breast tumor was well defined, 7.5 X 7 X 5 cm in size, oval shaped, yellowish gray-white and solid, parts of the tumor showed cystic appearance. Microscopic study revealed a cribriform pattern and alveolar proliferation of uniform, small cells forming cysts, and duct-like spaces which contained mucous content. Each tumor nest was surrounded by hyaline stroma. Alcian blue-PAS staining showed that the cysts were alcian blue-positive; the ducts were PAS-positive. The tumor was diagnosed as ACC of the breast.     

^32P玻璃微球经肝动脉栓塞内照射治疗中晚期肝癌

目的探讨32P玻璃微球行经肝动脉栓塞内照射的安全性和有效性。方法原发性肝癌26例,经肝动脉选择性插管后,用32P玻璃微球与超液化碘油混合后作栓塞。治疗放射剂量为75～150Gy。结果术后均有肝功能一过性异常,2周后逐渐恢复至术前水平,血象及肾功能无异常改变。术后无严重并发症。微球主要分布于肝内,癌／肝放射比为3.5:1。随访3～19个月23例（88.4％）。病灶有缩小,体积缩小50％以上11例（42．3％）。9例（75．0％）生存期＞1年,中位生存时间为8．1月。结论32P玻璃微球作为一种新型栓塞内放射材料,具有半衰期适中,射程适宜的优势。初步临床应用表明为行肝动脉栓塞内照射安全、有效。     

食管腺样囊性癌一例报告并文献复习

腺样囊性癌(adenoidl cystic carcinoma,ACC)常发生于涎腺、气管、支气管,偶可发生于乳腺、泪腺、子宫颈等部位,食管原发性ACC临床上罕见.     

Adenoid cystic carcinoma of the parotid metastasizing to liver: case report

Background  

Adenoid cystic carcinoma is a rare malignant parotid tumor. Metastasis can occur even a decade or more after initial treatment of the primary.     

多房囊性肾细胞癌1例报告及文献复习

目的:探讨多房性囊性肾细胞癌的临床病理特征及其鉴别诊断。方法:对1例多房性囊性肾细胞癌的临床表现、病理特征及免疫组化表型进行观察分析并文献复习。结果:男55岁,因体检时发现右肾肿瘤伴尿急、尿频和尿痛3天入院,CT示:①右肾上极占位性病变,考虑肾癌;②右肾上腺囊肿;③左肾囊肿。镜下可见囊腔内衬单层或数层异型小的透明细胞,囊壁之间可见透明细胞巢,部分囊腔内有粉染液体,内含大量红细胞。免疫组化CK(++)、EMA(++)CD68(-)。病变符合多房性囊性肾细胞癌。结论:多房囊性肾细胞癌的诊断依赖病理特征及免疫表型,并需与其他肾囊性病变相鉴别。     

Primary adenoid cystic carcinoma of the esophagus: report of a case.

A case of primary adenoid cystic carcinoma of the esophagus is reported. A 51-year-old male patient had a tumor in the lower third of the esophagus which was incidentally found during an examination for cholelithiasis, and resected successfully. The tumor exhibited a polypoid appearance covered by normal esophageal epithelium, localized entirely in the submucosal layer, and morphologically identical to adenoid cystic carcinoma in the salivary glands. The patient is still alive and well three and one-half years after surgery. This seems to be a typical case of adenoid cystic carcinoma of the esophagus arising from the submucosal esophageal gland.     

子宫囊性淋巴管瘤1例并文献复习

目的 探讨子宫囊性淋巴管瘤的临床病理特征,提高临床医师对子宫囊性淋巴管瘤的认识。方法 分析1例子宫囊性淋巴管瘤的临床表现、辅助检查、病理学特点、鉴别诊断及治疗,并进行相关文献复习。结果 患者,女性,45岁,因“间歇性腹部胀痛2年,发现腹部肿块1年余”入院,结合入院相关检查,术前诊断为子宫肌瘤囊性变,行全子宫切除术。病理检查：子宫体前壁可见一囊性肿瘤,囊液呈淡黄色、清亮,囊内壁光滑,囊腔与子宫腔不通;镜下见囊壁内衬一层被覆单层扁平细胞,囊壁平滑肌间见淋巴网状结构,囊腔内见纤维蛋白物及少许淋巴细胞。免疫组化示D2-40阳性、CKpan弱阳性。术后病理诊断为子宫囊性淋巴管瘤。术后未行特殊治疗,随访6个月未见异常征象。结论 子宫囊性淋巴管瘤少见,临床以阴道不规则流血及盆腔包块多见,影像学无特异性表现,血清肿瘤标志物水平不升高,治疗以手术为主,确诊需要根据术后组织病理学及免疫组化检查。     

Multilocular cystic renal adenocarcinoma: A case report and review of the literature

A case of multilocular cystic renal adenocarcinoma is presented. Although the multilocular renal cyst is an uncommon lesion, nine cases of these lesions associated with adenocarcinoma have been reported in the English literature so far. The related reports are reviewed in addition to three cases in the Japanese literature.     

Cholesonographic characteristics of cystic duct metastasis causing acute acalculous cholecystitis: case report

A variety of epithelial malignancies are capable of metastasizing to the bile ducts and gall bladder in a fashion distinct from concurrent spread to the liver. Ultrasonography has proved useful in evaluating obstructive jaundice in this setting and, in the case described, accurately diagnosed acute acalculous cholecystitis caused by a solitary metastasis from carcinoma of the breast to the cystic duct. Exploratory laparotomy confirmed the accuracy of this preoperative diagnosis.     

Adenoid cystic carcinoma of nasal cavity - a case report

A 38 year old male patient presented with pain and swelling on left side of nose with mass in left nostril. The other symptoms were nasal obstruction, epistaxisc from left nostril and epiphora from left eye. CT scan showed a mass arising from lateral wall of nose on left side eroding anterior part of medial wall of maxillary sinus. The tumor was excised with wide margin through a lateral rhinotomy approach under general anaesthesia. In histopathologieal examination it was found to be cribriform type of Adenoid Cystic Carcinoma. This case is reported here for its rarit.