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PubMed1986

Radiation-induced thyroid and other head and neck tumors: occurrence of multiple tumors and analysis of risk factors.

In 2561 patients who received conventional external radiation treatment before age 15 yr for benign conditions of the head, neck, and upper thoracic area, we found an increase in the number of salivary gland tumors and benign neural tumors of the head and neck area. To determine whether patients who developed these relatively uncommon tumors were more susceptible to the long term effects of radiation, we analyzed how frequently these patients also developed benign and malignant thyroid neoplasms. Compared to the remainder of the irradiated population, the patients with salivary and neural tumors had an increased frequency of thyroid disease (19.4% vs. 11.2% for thyroid cancer and 52.4% vs. 39.9% for all thyroid nodules). Various risk factors were studied to determine whether they were related to the eventual occurrence of thyroid disease. Higher doses, being female, and lower ages at time of treatment were associated with increased risk. However, these factors did not fully explain the differences in the frequency of coexisting tumors, suggesting that additional factors, such as radiation sensitivity, may account for the increased risk.

Age Factors↗
PubMed2002

Multiple neoplasms in an irradiated cohort: pattern of occurrence and relationship to thyroid cancer outcome.

We have examined the pattern of four radiation-related neoplasms in a radiation-exposed cohort of 2795 patients. They had received conventional radiation treatments for benign conditions in the head and neck area when they were children. At the end of follow-up, 350 thyroid cancers, 108 benign and malignant salivary tumors, 87 neural tumors, and 70 cases of hyperparathyroidism had occurred. In 492 individuals (17.6% of the cohort), there were single tumors, and in 60 individuals (2.1%), there were multiple tumors. Because this was an apparent excess of multiple tumors, we tested the hypothesis that the excess arose, at least in part, from variation in radiation susceptibility in the cohort. To analyze this, we developed a method to account for differences in length of follow-up and known risk factors, such as age at radiation exposure, radiation dose, and gender. This analysis showed that the excess concordance of neoplasms could be explained by known risk factors, thereby suggesting that susceptibility factors did not play a role in the development of multiple tumors. Of the 350 thyroid cancers, 50 occurred in subjects with other radiation-related neoplasms. Therefore, we tested an additional hypothesis, that the presence of these other neoplasms was related to the clinical behavior of the thyroid cancer. Using thyroid cancer recurrence as the end point, we did not observe a relationship with the presence of other neoplasms. In summary, we demonstrated an excess of concordance of radiation-related neoplasms that could be explained by known risk factors, and we found that thyroid cancer behavior was not related to the occurrence of multiple tumors.

Child, Preschool↗
PubMed1987

Glioblastoma after radiotherapy for craniopharyngioma: case report.

A 6-year-old girl developed a glioblastoma in the basal ganglia and brain stem 5 years after surgical excision and local irradiation (5460 cGy) for craniopharyngioma. Clinical and histological details are presented, and the literature on radiation-induced gliomas is reviewed.

Basal Ganglia↗
PubMed1993

Neurofibromatosis 2 in the pediatric age group.

Bilateral acoustic neurofibromatosis or neurofibromatosis 2 (NF2) is an autosomal dominant disease predisposing to the formation of multiple tumors in the central and peripheral nervous system. Vestibular schwannomas (VSs) are considered to be the hallmark of the disease, but other tumors and ocular findings occur as well. In patients that do not carry the NF2 mutation, VSs usually occur in the fifth or sixth decade of life. VSs in patients with NF2 are often bilateral and become symptomatic in the third or fourth decade of life. In order to define the early manifestations of NF2, we examined nine children who either had one parent with NF2 or had multiple skin or spinal tumors suggestive of NF2. In addition to neurological, dermatological, and ocular examinations, all patients were studied by gadolinium-enhanced magnetic resonance imaging of the brain and spine. None of the children exhibited symptoms or signs due to VSs. However, VSs were detected during the neuroradiological work-up in six children. Seven children developed symptoms or signs due to skin or spinal tumors. Slit lamp examination detected cataracts in four patients as young as 10 years of age. The diagnosis of NF2 in the pediatric age group requires a high degree of suspicion and should be considered in children with multiple central nervous system or skin tumors without cafe-au-lait spots or Lisch nodules. Because VSs are unlikely to produce the signs seen at the time of admission, careful examination of the skin and eyes is necessary and should be followed by gadolinium-enhanced magnetic resonance imaging of the brain and spine. First-degree relatives need to be examined as well.

Adolescent↗
PubMed1984

Subsequent malignancies in patients irradiated for testicular tumours.

897 patients received radiotherapy in Scotland for tumours of the testis between 1950-1969. 299 patients who died within two years of treatment, and a further 51 patients with inadequate follow-up data, were excluded from a survey of the incidence of second tumours. 547 patients with a mean follow-up of 15.4 years were included in the study. Fifty-one second and six third malignancies were found. The observed incidence is significantly higher than expected (ratio 1.87; p less than 0.001), both in the irradiated sites (ratio 1.94; p less than 0.05) and in unirradiated sites (ratio 1.99; p less than 0.01). These patients have a higher incidence of second testicular tumours (ratio 23.1; p less than 0.001). Analysis of the incidence of new malignancies in successive quinquennia after irradiation shows a significantly higher incidence in two periods. Within five years the greater incidence (p less than 0.05) is due mainly to the occurrence of second testicular tumours. In the period 15-19 years after irradiation the higher incidence (p less than 0.01) is accounted for by tumours arising in the urinary and gastro-intestinal tracts. The increased risk of developing a second cancer is low and there was no observed increase in radiation-related leukaemia.

Adolescent↗
PubMed1981

Collision tumor of the frontal sinus: evidence of prior intrasinus instillation of thorotrast.

Carcinoma of the frontal sinus is relatively rare. We describe a case of two independent carcinomas, squamous cell and adenoid cystic, in the right frontal sinus region of a patient who received sinus irrigation with an unidentified, substance 30 years previously. Radioautography performed on sections of the tumor tissue revealed linear tracks of the type produced by thorium decay, strongly suggesting that the substance was thorotrast. In addition to being the first description of a "collision tumor" of the frontal sinus, the case would represent the first reported instance of frontal sinus carcinoma following intrasinus instillation of thorotrast.

Aged↗
PubMed1994

Papillary squamous neoplasms of the head and neck.

Papillary squamous neoplasms of the upper respiratory tract are rare variants of squamous cell carcinoma and are related temporally to proliferative verrucous leukoplakia. Fifty-two cases of papillary squamous neoplasms were selected from 2366 cases of squamous cell carcinoma. This is the first study to characterize the biological behavior of papillary squamous neoplasms. Papillary squamous neoplasms exhibit two distinct, yet sometimes overlapping, histologic patterns including an exophytic papillary and an inverting verrucous morphologic appearance. A high rate of synchronous or metachronous lesions were found, especially with the inverting-type of papillary squamous neoplasm. Stage T3 and T4 lesions had a high rate of neck metastasis. Early surgical intervention and close long-term follow-up is mandatory.

Adult↗
PubMed1995

Squamous cell carcinoma arising in inverted papilloma.

A retrospective review of all cases of inverted papilloma at the University of Michigan from 1975 to 1992 revealed 51 cases of inverted papilloma. Of these, 14 (27%) had an associated squamous cell carcinoma (SCC). Eight (16%) were metachronous and 6 (11%) were synchronous. At a mean follow-up of 53 months, the disease-free survival of patients with carcinoma limited to the nasal cavity and paranasal sinuses was 57% (4/7) compared to 14% (1/7) of those patients presenting with disease extending beyond the nasal cavity and paranasal sinuses. The data also support the lateral rhinotomy approach with medial maxillectomy and ethmoidectomy as a minimum procedure followed by postoperative radiation therapy. The mean interval between the diagnosis of inverted papilloma and development of SCC was 63 months (range, 6 months to 13 years). Therefore, long-term follow-up with clinical examination and computed tomography (CT) scan is indicated for all patients with inverted papilloma.

Aged↗
PubMed1991

Differential gene expression during multistage carcinogenesis.

The use of the mouse skin multistage model of carcinogenesis has aided our understanding of critical target genes in chemical carcinogenesis. The mutagenic activation of the Harvey-ras proto-oncogene has been found to be an early event associated with the initiation of mouse skin tumors by the polycyclic aromatic hydrocarbon 7,12 dimethylbenz[alpha]anthracene and the pure initiator ethyl carbamate (urethane). In contrast to chemical initiation of mouse skin tumors, ionizing radiation-initiated malignant skin tumors have been shown to possess distinct non-ras transforming gene(s). Differential screening of cDNA libraries made from chemically initiated malignant skin tumors has been used to identify a number of cellular gene transcripts that are overexpressed during mouse skin tumor progression. These differentially expressed genes include beta-actin, ubiquitin, a hyperproliferative keratin (K6), a gene whose product is a member of a fatty acid or lipid-binding protein family, and a gene called transin or stromelysin. The overexpression of the stromelysin gene, which encodes a metalloproteinase that degrades proteins in the basement membrane, is hypothesized to play a functional role in malignant tumor cell invasion and metastasis. We believe that the cloning, identification, and characterization of gene sequences that are differentially expressed during tumor progression could lead to the discovery of gene products that either play functional roles in skin tumor progression or in the maintenance of various progressive tumor phenotypes.

3T3 Cells↗
PubMed1993

Synchronous carcinoma and soft-tissue sarcoma. The importance of searching for incidental radiation exposure.

A 68-year-old woman was found to have synchronous soft-tissue sarcoma of the anterior chest wall and adenocarcinoma of the breast. During her initial interview, she denied prior radiation therapy. On further questioning, it was learned that the patient had been treated for tuberculosis, as a young woman, by the induction of a pneumothorax that was monitored by repeated chest fluoroscopies. Biologically important doses of ionizing radiation can be given as an incidental part of a variety of medical treatments. The importance of searching for atypical radiation exposures, particularly in patients with unusual tumor presentations, is stressed.

Adenocarcinoma↗
PubMed1990

Multicentric endobronchial granular cell myoblastoma.

Granular cell myoblastoma (GCM) is a rare benign neoplasm involving the tracheobronchial tree. It is believed to arise from the Schwann cell. Four cases of tracheobronchial GCM, all of which were multicentric, are presented and a conservative therapeutic approach is suggested.

Adult↗
PubMed1993

Duodenal stromal tumor with neural differentiation.

A 49-year-old woman was admitted to our hospital for detailed evaluation of an abdominal mass. Ultrasonography and computed tomography revealed two tumors, one a submucosal lesion of the duodenal second portion and the other a left adrenal tumor. Angiography showed that the tumors were hypervascular. Both tumors were removed surgically and examined histologically using hematoxylin-eosin staining. The duodenal tumor (10 x 6 x 5 cm) was initially diagnosed as a schwannoma, but immunohistochemical studies showed that it was S-100 protein negative and neuron-specific enolase positive. Therefore, this tumor was identified as a stromal tumor with neural differentiation. The left adrenal tumor was a nonfunctioning adenoma.

Adenoma↗
PubMed2003

Synchronous triple lung cancers after treatment for non-Hodgkin's lymphoma: metachronous quadruple cancers.

After chemotherapy and radiotherapy for non-Hodgkin's lymphoma during a one-year period, a 66-year-old man developed synchronous triple lung cancers in both lungs. Of the three resected tumors, one was advanced large cell carcinoma with neuroendocrine morphology, and the other two were early squamous cell carcinoma without lymph node metastasis. Although he received repeated chemotherapy for lung cancer, the patient died of hepatic failure due to multiple liver metastases. Autopsy revealed disseminated metastasis of the large cell carcinoma with neuroendocrine morphology throughout the entire body, but no recurrence of malignant lymphoma or squamous cell carcinoma was found. To our knowledge, this is the first report of triple lung cancers occurring after treatment for malignant lymphoma.

Aged↗