MARJOLIN'S ULCER IN SCALP: CASE REPORT AND LITERATURE REVIEW

Marjolin's ulcer is a rare skin cancer that originates in areas of chronic wounds and scar tissues. It has more aggressive nature than other primary skin cancers. The exact mechanism of tumor development has not yet been identified. It could be seen on the skin of whole body surface. The most common histopathologic type of this malignancy is squamous cell carcinoma. It could develop in early and late period of time after trauma. Although surgery is still the main treatment, radiotherapy and chemotherapy could be other options in appropriate circumstances. In the present case report we described a patient who had lost her scalp in a work accident 25 years ago and developed skin cancer on scar tissue in late period, with a literature review

Lokal ileri evre serviks kanseri tanısı ile radyokemoterapi uygulanan olgularda erken sonuçlar

Radiotherapy is the standart treatment of locally advanced cervical cancer. Recent results of the prospective randomized trials showed an overall survival and local control advantage for cisplatin based therapy given concurrently with radiation therapy. Thirty-nine patients who received concurrent chemoradiation between October 1999 and December 2000 were evaluated for treatment response, local control and toxicity. Thirty-nine patients with stage IB-IVA cervical carcinoma received weekly cisplatin 40 mg/m2 concurrent with radiotherapy. Median cisplatin administration was 5 weeks. Thirty-two patients received both external and intracavitary radiotherapy and seven patients received only external radiotherapy because of insufficient tumor response for intracavitary apllication. Total external radiotherapy dose was 64.8 Gy with 1.8 Gy daily fractions in patients who received only external radiotherapy. Midline shielding was performed at 50.4 Gy in patients who were going to receive brachytherapy and the total external radiotherapy dose was 54-59.4 Gy. Brachytherapy was performed with Rotterdam applicator via microSelectron HDR machine. A total dose of 8.5-18 Gy was applied to point A. Median age was 55. Distribution by stages according to FIGO staging system were as follows: stage IB 5.1 %, IIA 28.2%, IIB 43.6%, IIIA 7.7%, IIIB 12.8% and IVA 2.6%. Histologically 33 (84.6%) were epidermoid carcinoma, 1 was adenocarcinoma, 2 were indiffrentiated carcinoma, 1 was malignant epithelial tumor. In two patients histological subtype could not be specified. The median duration of follow-up was 20 months. Four patients (10.3%) had local recurrence and three developed distant metastases being two lung and one bone metastases. Thirty patients (76.9%) had complete response, 8 had (20.5%) partial response and one had (2.6%) stable disease. During or after radiochemotherapy 46.2% of the patients developed toxicity due to chemotherapy. Early and late radiation morbidity rates were 66.7% and 71.8% respectively. No grade III-IV toxicity was observed. Concurrent chemoradiation for locally advanced cervical cancer is the treatment of choice in suitable patients providing high response rates with acceptable toxicity.Radyoterapi, lokal ileri evre serviks kanserlerinde standart tedavi yöntemidir. Ancak son yıllarda yapılan prospektif randomize çalışmaların sonuçları radyoterapi ile eşzamanlı kemoterapi uygulamasının yalnız radyoterapiye oranla lokal kontrol ve sağkalım avantajı sağladığını göstermiştir. Bu amaçla Ekim 1999-Aralık 2000 tarihleri arasında serviks kanseri tanısıyla kliniğimizde radyokemoterapi uygulanan 39 olgu erken dönem tedavi yanıtı, lokal kontrol ve yan etkiler açısından değerlendirilmiştir. Evre IB-IVA serviks kanseri tanılı 39 olguya pelvik radyoterapiyle eş zamanlı, haftalık 40 mg/m2 cisplatin uygulanmıştır. Cisplatin uygulaması medyan 5 hafta yapılmış, 32 olguya eksternal ve intrakaviter radyoterapi uygulanırken 7 olguda tümör yanıtının intrakaviter tedavi için uygun olmaması nedeniyle yalnız eksternal radyoterapi uygulanmıştır. Eksternal radyoterapi günlük 1.8 Gy'lik fraksiyonlarla yalnız eksternal radyoterapi uygulanan olgularda toplam 64.8 Gy, eksternal radyoterapi ve brakiterapi uygulanan olgularda ise 50.4 Gy'de orta hat koruması yapılarak toplam 54-59.4 Gy dozlarda uygulanmıştır. Brakiterapi uygulamaları Rotterdam aplikatör seti ile A noktasına toplam 8.5-18 Gy olacak şekilde mikroSelectron-HDR IR-192 cihazı ile gerçekleştirilmiştir. Medyan yaşı 55 olan olguların evrelere göre dağılımı FIGO evreleme sistemine göre %5.1 evre IB, %28.2 evre IIA, %43.6 evre IIB, %7.7 evre IIIA, %12.8 evre IIIB ve %2.6 evre IVA oranında şeklindedir. Histopatolojik değerlendirmede 33 olguda (%84.6) epidermoid karsinom, 1 olguda (%2.6) adenokarsinom, 2 olguda (%5.1) indiferan tümör, 1 olguda (%2.6) malign epitelial tümör saptanmış, 2 olguda (%5.1) ise biopsi sonucu yalnız malign tanısı konulabilmiş, histopatolojik tip belirlenememiştir. Medyan 20 ay takip edilen olguların 4'ünde (%10.3) lokal yineleme, 3 olguda (%7.7) biri kemik, ikisi akciğere olmak üzere uzak metastaz gelişmiştir. Klinik yanıt değeriendirmesinde 30 olguda (%76.9) tam, 8 olguda (%20.5) kısmi yanıt, 1 olguda (%2.6) stabil yanıt saptanmıştır. Radyokemoterapi sırası ve sonrasında kemoterapiye bağlı toksisite oranı %46.2, radyoterapiye bağlı erken toksisite oranı %66.7, geç toksisite oranı %71.8 olup olguların ileri evre serviks kanserlerinde eşzamanlı radyokemoterapi uygulamaları yüksek yanıt oranları ve kabul edilebilir toksisitesi nedeniyle uygun olgularda tercih edilen tedavi yöntemidir

Renal hücreli karsinomlarda fuhrman nükleer derece, evre ve sarkomatoid diferansiyasyonun sağkalım ile ilişkisi

Amaç: Renal hücreli karsinom, böbrek tubul epitelinden kaynaklanan malign bir tümördür. Çalışmamızda bu tümörlerin histolojik özellikleri, boyutu, evrelendirme, nükleer derecelendirme ve sarkomatoid diferansiyasyon parametreleri ile sağkalım arasındaki ilişki araştırıldı. Hastalar ve Yöntemler: 2000-2008 yılları arasında renal hücreli karsinom tanısı almış 78 nefrektomi olgusu 2004 Dünya Sağlık Örgütü sınıflamasına göre yeniden değerlendirildi. Beş histolojik alt tipte sınıflandırılan olguların Fuhrman Nükleer Dereceleri, evreleri, sarkomatoid diferansiyasyon varlığı ve sağkalım oranları kaydedildi. Tüm parametrelerin birbirleriyle ilişkileri istatistiksel yöntemlerle değerlendirildi. Bulgular: Çalışmamızda yüksek nükleer derece, ileri evre ve sarkomatoid diferansiyasyon gösteren olgularda sağkalım süreleri kısaydı (p<0,05). Sonuç olarak, renal hücreli karsinomlarda prognostik değeri olan histopatolojik parametreler ile sağkalım arasında literatürle uyumlu olarak anlamlı ilişki saptandı. Sonuç: Renal Hücreli Karsinomların değerlendirilmesinde kullanılan Fuhrman nükleer dereceleme, evre ve sarkomatoid diferansiyasyon sağkalım ile ilişkili önemli parametrelerdir. Fuhrman nükleer derecelemenin mutlaka doğru yapılması ve tumor içinde izlenen en yüksek derecenin raporlanması uygundur. Literatürde çok sayıda çalışma yapılmamış olmakla birlikte tümörde sarkomatoid diferansiyasyon varlığı sağkalım oranlarını anlamlı ölçüde azaltmaktadır. Sarcomatoid diferansiasyonu da içeren histopatolojic parametrelerin doğru değerlendirilmesi ve patoloji raporunda bildirilmesi çok önemlidir.Objective: Renal cell carcinoma derived from tubular epithelium is one of the malignant tumors of the kidney. We have investigated the histological features, pathological stage, nuclear grade and sarcomatoid differentiation of these tumors. Material and Methods: Histological slides from seventy-eight nephrectomy specimens diagnosed as renal cell carcinoma between 2000 and 2008 were reevaluated according to the 2004 World Health Organization classification system of kidney tumors. Reclassified cases were collected in five groups and were scored for Fuhrman nuclear grading, stage, sarcomatoid differentiation and survival rate. Results: In our study, cases with high nuclear grade, advanced stage and sarcomatoid differentiation revealed poor survival rates (p&lt;0.05). In conclusion, the correlation between prognostic histopathological parameters and survival rates was consistent with literature findings. Conclusion: Fuhrman nuclear grading, stage and sarcomatoid differentiation are important parameters and are related factors in survival when investigating renal cell carcinomas. Fuhrman nuclear grading must be evaluated correctly and the highest grade should be reported. Although there aren't enough studies about sarcomatoid differentiation, its presence significantly decreases survival rates. It is very important to state histopathological parameters including sarcomatoid differentiation precisely on the pathology report

Factors affecting local control, distant recurrence and survival in patients with locally advanced bladder cancer treated by definitive radiotherapy or chemoradiotherapy

OBJECTIVE

Palliative radiotherapy for malign melanoma: a case report

Malignant melanoma is a skin cancer with poor prognosis. Historically melanoma has been thought of as a relatively radioresistant tumour. Nowadays, radiation delivered according to hypofractionated schedule is the most used, although there are few data confirm that this schedule improves the therapeutic impact. We report a case, with stage IV malignant melanoma, whose tumoral bleeding was palliated successfully giving 20 Gy external radiotherapy in 5 fractionations

The Relationship of Fuhrman Nuclear Grade, Tumor Stage and Sarcomatoid Differentiation with Survival in Renal Cell Carcinomas

Objective: Renal cell carcinoma derived from tubular epithelium is one of the malignant tumors of the kidney. We have investigated the histological features, pathological stage, nuclear grade and sarcomatoid differentiation of these tumors. Material and Methods: Histological slides from seventy-eight nephrectomy specimens diagnosed as renal cell carcinoma between 2000 and 2008 were reevaluated according to the 2004 World Health Organization classification system of kidney tumors. Reclassified cases were collected in five groups and were scored for Fuhrman nuclear grading, stage, sarcomatoid differentiation and survival rate. Results: In our study, cases with high nuclear grade, advanced stage and sarcomatoid differentiation revealed poor survival rates (p<0.05). In conclusion, the correlation between prognostic histopathological parameters and survival rates was consistent with literature findings. Conclusion: Fuhrman nuclear grading, stage and sarcomatoid differentiation are important parameters and are related factors in survival when investigating renal cell carcinomas. Fuhrman nuclear grading must be evaluated correctly and the highest grade should be reported. Although there aren’t enough studies about sarcomatoid differentiation, its presence significantly decreases survival rates. It is very important to state histopathological parameters including sarcomatoid differentiation precisely on the pathology report

Prevention of radiation-induced liver and kiney toxicity: a role for amifostine

OBJECTIVE