RESUMO
Highly active antiretroviral therapy (HAART) is an important part of the treatment of Kaposi's sarcoma (KS) in HIV-infected patients. We describe two cases of KS, which worsened on HAART.
Assuntos
Terapia Antirretroviral de Alta Atividade/métodos , Doxorrubicina/administração & dosagem , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , HIV , Sarcoma de Kaposi/tratamento farmacológico , Sarcoma de Kaposi/virologia , Adulto , Antibióticos Antineoplásicos/administração & dosagem , Esquema de Medicação , Feminino , Humanos , Masculino , Sarcoma de Kaposi/radioterapiaRESUMO
Peripheral blood mononuclear cells from two well-defined groups of patients with the Sézary syndrome have been studied employing indirect immunofluorescent and indirect immunogold techniques in light and electron microscopy, using monoclonal antibodies against T-cell subpopulations. Four patients had chronic actinic dermatitis (CAD) of the actinic reticuloid variant, with erythroderma. Eight patients had cutaneous T-cell lymphoma. All patients showed the clinical features of the Sézary syndrome, including erythroderma, palmoplantar hyperkeratosis, and peripheral lymphadenopathy, and in all patients significant numbers (0.5-30.5 X 10(9) cells/liter) of circulating mononuclear cells were observed with Sézary cell morphology on light-microscopic examination of blood films. Major differences were observed in the circulating T-cell subpopulations in the two groups. In the erythrodermic CAD patients, there was a moderately elevated T-cell count (1.6 +/- 0.6 X 10(9) cells/liter; normal, 1.0 +/- 0.3 X 10(9) cells/liter) of which the majority of the cells was suppressor T cells (OKT8+) giving a very low helper:suppressor T-cell ratio of 0.1:1-0.36:1 (normal, 1.7:1-3.5:1). In cutaneous T-cell lymphoma, there was also an elevation of the T-cell count (9.5 +/- 12.9 X 10(9) cells/liter), but in these patients the predominant cell was the helper T cell (OKT4+) with a high helper:suppressor T-cell ratio of 3.7:1-98:1.
Assuntos
Linfoma/imunologia , Transtornos de Fotossensibilidade/imunologia , Síndrome de Sézary/imunologia , Neoplasias Cutâneas/imunologia , Anticorpos Monoclonais/imunologia , Doença Crônica , Diagnóstico Diferencial , Imunofluorescência , Humanos , Linfoma/complicações , Linfoma/patologia , Transtornos de Fotossensibilidade/complicações , Transtornos de Fotossensibilidade/patologia , Síndrome de Sézary/etiologia , Síndrome de Sézary/patologia , Neoplasias Cutâneas/complicações , Neoplasias Cutâneas/patologia , Linfócitos T/classificaçãoRESUMO
During irradiation of volumes that incorporate the olfactory system, a proportion of patients have complained of a pungent smell. A retrospective study was carried out to determine the prevalence of this side-effect. A questionnaire was sent to 40 patients whose treatment volumes included the olfactory region and also to a control group treated away from this region. The irradiated tumor volumes included the frontal lobe, whole brain, nasopharynx, pituitary fossa, and maxillary antrum. Of the 25 patients who replied, 60% experienced odorous symptoms during irradiation. They described the odor as unpleasant and consistent with ozone. Stimulation of olfactory receptors is considered to be caused by the radiochemical formation of ozone and free radicals in the mucus overlying the olfactory mucosa.
Assuntos
Neoplasias de Cabeça e Pescoço/radioterapia , Mucosa Nasal/efeitos da radiação , Olfato/efeitos da radiação , Adenoma/radioterapia , Craniofaringioma/radioterapia , Humanos , Neoplasias Nasofaríngeas/radioterapia , Condutos Olfatórios/efeitos da radiação , Neoplasias Hipofisárias/radioterapia , Estudos Retrospectivos , Células Receptoras Sensoriais/efeitos da radiação , Inquéritos e QuestionáriosRESUMO
We report a series of five HIV positive patients with histologically proven non-Hodgkin's lymphoma. The paper illustrates the difficulties experienced in both the clinical diagnosis and its histological confirmation. In this series we have confirmed the predominance of aggressive histological variants and the high frequency of extra-nodal involvement. The prognosis despite treatment was poor; only one patient entered complete remission and the mean survival was only 4.3 months.
Assuntos
Síndrome da Imunodeficiência Adquirida/complicações , Linfoma não Hodgkin/etiologia , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Terapia Combinada , Inglaterra , Homossexualidade , Humanos , Linfoma não Hodgkin/mortalidade , Linfoma não Hodgkin/terapia , Masculino , PrognósticoRESUMO
Evidence of occult alveolar haemorrhage was sought by Perls's staining of bronchoalveolar lavage fluid to detect haemosiderin laden macrophages in 63 human immunodeficiency virus positive (HIV-1) men who underwent bronchoscopy. Twenty three patients had bronchopulmonary Kaposi's sarcoma; occult alveolar haemorrhage was present in 16 of these (including two in whom no tracheobronchial lesions were evident at bronchoscopy, but in whom the diagnosis was confirmed at necropsy). Forty patients had other diagnoses including Pneumocystis carinii pneumonia and bacterial pneumonia; 18 had occult haemorrhage. Occult alveolar haemorrhage seems to be a non-specific finding in HIV-1 positive men undergoing bronchoscopy.
Assuntos
Infecções por HIV/complicações , Hemorragia/etiologia , Pneumopatias/etiologia , Neoplasias Pulmonares/complicações , Sarcoma de Kaposi/complicações , Adulto , HIV-1 , Humanos , Masculino , Pessoa de Meia-Idade , Alvéolos PulmonaresRESUMO
248 patients with locally radically treated early breast cancer (196 node-positive) were randomized post-operatively between 6 courses of a 'CMF like' chemotherapy and no further treatment. Results (with a minimum of 5 years follow-up on every patient) favour chemotherapy with a significant increase in the median time to recurrence from 31 to 50 months for all patients (P = 0.04) and from 26 to 49 months for node-positive patients (P = 0.023). No significant effect on survival is seen although there is a trend towards longer survival in the treated group. The regimen used was relatively non-toxic when compared to the traditional CMF with 34% of patients experiencing mild nausea and vomiting immediately post-injection and only 11% complaining of more severe nausea and vomiting. Because of this lower toxicity the treatment was found to be amenable to administration in both regional hospitals and specialized centres.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias da Mama/tratamento farmacológico , Adulto , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Ensaios Clínicos como Assunto , Terapia Combinada , Feminino , Humanos , Pessoa de Meia-Idade , Náusea/induzido quimicamente , Recidiva Local de Neoplasia , Contagem de Plaquetas , Distribuição Aleatória , Fatores de Tempo , Vômito/induzido quimicamenteRESUMO
Four different regimes of radiotherapy employed in the treatment of basal cell epitheliomas were compared in order to assess their effect on the visual appearance and mechanical properties of skin. Three groups of mice received exposures identical to those given in the radiotherapy treatments; three months after completion of the radiation the visual and mechanical properties of the skin and its appendages were examined. The skin scarring, coat condition, greying of hair, skin, thickness, load at rupture, extension at rupture, mechanical stress at rupture and stiffness were used as cirteria for comparing the four treatments. The treatment regime which caused the least damage to normal skin was identified.
Assuntos
Pele/efeitos da radiação , Animais , Fenômenos Biomecânicos , Carcinoma Basocelular/radioterapia , Cabelo/efeitos da radiação , Masculino , Camundongos , Camundongos Endogâmicos C3H , Lesões Experimentais por Radiação/fisiopatologia , Dosagem Radioterapêutica , Pele/fisiopatologia , Neoplasias Cutâneas/radioterapia , Raios XRESUMO
A patient with a seminoma, squamous cell carcinomas of the skin and anus, Bowen's disease and lymphopenia is reported. The underlying aetiology is thought to be impaired cell mediated immunity and susceptibility to viral infections.
Assuntos
Carcinoma de Células Escamosas/complicações , Linfopenia/complicações , Seminoma/complicações , Neoplasias Testiculares/complicações , Neoplasias do Ânus/complicações , Neoplasias do Ânus/radioterapia , Doença de Bowen/complicações , Doença de Bowen/cirurgia , Carcinoma de Células Escamosas/radioterapia , Carcinoma de Células Escamosas/cirurgia , Feminino , Humanos , Masculino , Seminoma/radioterapia , Seminoma/cirurgia , Neoplasias Cutâneas/complicações , Neoplasias Cutâneas/cirurgia , Neoplasias Testiculares/radioterapia , Neoplasias Testiculares/cirurgiaRESUMO
A case of Stage 1 nodular lymphocytic predominant Hodgkin's Disease relapsing after 32 years is described. Recent immunophenotyping suggests that this is a low grade B-cell lymphoma.
Assuntos
Doença de Hodgkin/patologia , Adulto , Humanos , Masculino , Recidiva , Fatores de TempoRESUMO
Malignant pilomatrixoma is a rare malignant tumour of the hair matrix, which was first described in 1980. Only five patients with distant metastases have been reported. We report a sixth case with metastatic disease in a 52-year-old male, who also developed multiple local recurrences. We also review the previous five cases.
Assuntos
Pilomatrixoma/patologia , Coxa da Perna , Neoplasias de Cabeça e Pescoço/secundário , Neoplasias de Cabeça e Pescoço/terapia , Humanos , Neoplasias Pulmonares/secundário , Neoplasias Pulmonares/terapia , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Pilomatrixoma/terapiaRESUMO
Nasal Natural Killer-Cell Lymphoma is an aggressive subtype of NHL even when it presents with localized disease. It is more common in Oriental than Western population. We report the case history of a white Caucasian male patient with this disease who died 5 months from diagnosis despite aggressive treatment with 2 different chemotherapy regimes and radiotherapy. We discuss the diagnosis, presentation, treatment and prognosis of this rare disease.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Linfoma não Hodgkin/tratamento farmacológico , Neoplasias Nasais/tratamento farmacológico , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Terapia Combinada , Ciclofosfamida/administração & dosagem , Desbridamento , Doxorrubicina/administração & dosagem , Evolução Fatal , Humanos , Células Matadoras Naturais , Linfoma não Hodgkin/diagnóstico , Linfoma não Hodgkin/radioterapia , Masculino , Pessoa de Meia-Idade , Neoplasias Nasais/diagnóstico , Neoplasias Nasais/radioterapia , Prednisona/administração & dosagem , Prognóstico , Terapia de Salvação , Tomografia Computadorizada por Raios X , Vincristina/administração & dosagemRESUMO
High grade non-Hodgkin's lymphoma accounts for only 5%-10% of all non-Hodgkin's lymphoma. Infection with the human immunodeficiency virus increases the risk of developing high grade, usually B-cell, lymphoma, which has been noted to occur more commonly in homosexual men. These lymphomas often have unusual clinical presentations. We report five cases of high grade non-Hodgkin's lymphoma in HIV negative homosexual men who presented to our hospital in a 13-month period. As a major centre for the treatment of the acquired immune deficiency syndrome, there may be a self-selected homosexual population attending for medical care, and thus a bias in the relative incidence of lymphoma seen in this group.
Assuntos
Soronegatividade para HIV , Linfoma de Células B/etiologia , Linfoma não Hodgkin/etiologia , Linfoma de Células T/etiologia , Adulto , Western Blotting , Ensaio de Imunoadsorção Enzimática , Homossexualidade , Humanos , Incidência , Linfoma de Células B/epidemiologia , Linfoma de Células B/patologia , Linfoma não Hodgkin/epidemiologia , Linfoma não Hodgkin/patologia , Linfoma de Células T/epidemiologia , Linfoma de Células T/patologia , Masculino , Fatores de RiscoRESUMO
Sixteen patients with advanced AIDS-related Kaposi's sarcoma received liposomal doxorubicin (Doxil, Liposome Technology, Menlo Park, California) at 20 mg/m2 every 2 or 3 weeks in an open label study, and were evaluated for efficacy and toxicity. Eleven patients achieved a partial remission and five had stable disease. The median time to achieve a maximum response was two cycles (range 1-3) and the median duration of response was 14 weeks (range 6-30). Myelosuppression was the commonest adverse event; one patient was withdrawn because of neutropenia. Other adverse events were uncommon and mild. Liposomal doxorubicin is an effective and safe single agent treatment for advanced AIDs-related Kaposi's sarcoma.
Assuntos
Síndrome da Imunodeficiência Adquirida/complicações , Doxorrubicina/administração & dosagem , Sarcoma de Kaposi/tratamento farmacológico , Adulto , Alopecia/induzido quimicamente , Doxorrubicina/efeitos adversos , Portadores de Fármacos , Seguimentos , Doenças Hematológicas/induzido quimicamente , Humanos , Lipossomos , Masculino , Pessoa de Meia-Idade , Náusea/induzido quimicamente , Sarcoma de Kaposi/etiologia , Resultado do TratamentoRESUMO
Angiosarcoma of the head and neck is a rare malignant vascular tumour that predominantly affects elderly men and generally has a poor prognosis. Complete responses to treatment for larger tumours are uncommon. A patient with an extensive tumour that showed a complete response to combination therapy with liposomal daunorubicin and radiotherapy is presented. The rationale for using liposomal chemotherapy agents in the treatment of vascular tumours such as angiosarcoma is discussed.
Assuntos
Antibióticos Antineoplásicos/uso terapêutico , Daunorrubicina/uso terapêutico , Neoplasias de Cabeça e Pescoço/tratamento farmacológico , Neoplasias de Cabeça e Pescoço/radioterapia , Hemangiossarcoma/tratamento farmacológico , Hemangiossarcoma/radioterapia , Idoso , Idoso de 80 Anos ou mais , Terapia Combinada , Humanos , Masculino , Resultado do TratamentoRESUMO
Lymphangioma circumscriptum is a rare non-malignant skin tumour, conventionally treated by surgical resection, but with variable results. We report two cases, which, although unsuitable for excision, were treated successfully by radiotherapy and consider the place of this modality in managing this disorder. We conclude that radiotherapy is an effective treatment for unresectable lesions, or for patients who are unwilling to consider surgery.
Assuntos
Linfangioma/radioterapia , Neoplasias Cutâneas/radioterapia , Adulto , Pré-Escolar , Feminino , Humanos , Dosagem RadioterapêuticaRESUMO
Classical Kaposi's sarcoma and angiosarcoma are rare malignant tumours arising from vascular tissue. However, they have distinct histological features and appear also to differ in their epidemiology and pathogenesis. We present the case history of a patient in whom both these tumours occurred simultaneously. The relationship between these events is discussed in the light of the new virus, human herpes virus 8.
Assuntos
Doenças do Pé/etiologia , Hemangiossarcoma/etiologia , Neoplasias Primárias Múltiplas/etiologia , Sarcoma de Kaposi/etiologia , Neoplasias Vasculares/etiologia , Terapia Combinada , Herpesvirus Humano 8 , Humanos , Perna (Membro) , Masculino , Pessoa de Meia-Idade , Radioterapia de Alta EnergiaRESUMO
A patient with human immunodeficiency virus-related non-Hodgkin's lymphoma arising in the oral cavity is reported. The tumour had an unusual immunohistochemical profile that was negative for leucocyte common antigen and the B-cell antigen CD20 but positive for the plasma cell-reactive antibody VS38c. The features of this type of tumour, which has recently been categorized, are presented and discussed.
Assuntos
Leucemia Linfocítica Crônica de Células B/diagnóstico , Linfoma Relacionado a AIDS/diagnóstico , Neoplasias Bucais/diagnóstico , Adulto , Diagnóstico Diferencial , Humanos , Leucemia Linfocítica Crônica de Células B/classificação , Leucemia Linfocítica Crônica de Células B/patologia , Linfoma Relacionado a AIDS/classificação , Linfoma Relacionado a AIDS/patologia , Masculino , Neoplasias Bucais/classificação , Neoplasias Bucais/patologiaRESUMO
The axillae of 30 patients with primary breast cancer (Stage I and II) were prospectively examined in this pilot study using ultrasound. No patient had palpable axillary lymph nodes on clinical examination. Treatment had involved wide local excision, but no prior form of surgical dissection had been performed on the axilla. Using the contralateral axilla as an internal control, lymph nodes were observed in the ipsilateral axilla alone on ultrasound in 8/30 patients (27%). Following radical irradiation of the breast and local lymph drainage areas, 2/8 patients of the group with observed lymph nodes have relapsed, one with systemic disease and the other with local recurrence in the breast, after a minimum follow-up of 12 months. No patient without observed nodes has recurred. This difference does not reach statistical significance. This technique merits further investigation as an adjunct to current staging procedures for early breast cancer.
Assuntos
Neoplasias da Mama/patologia , Estadiamento de Neoplasias , Adulto , Idoso , Axila/diagnóstico por imagem , Neoplasias da Mama/diagnóstico por imagem , Feminino , Humanos , Metástase Linfática , Pessoa de Meia-Idade , Projetos Piloto , Estudos Prospectivos , UltrassonografiaRESUMO
The role of radiotherapy in the management of perianal Paget's disease (PPD) is not well defined in clinical practice or within the medical literature. We present 6 cases, document the radiotherapy details and review our results. A comprehensive literature search has been undertaken attempting to identify all published cases of PPD and survey the number receiving radiotherapy. To further define the role for radiotherapy in PPD these cases have been reviewed. Published results are sporadic and often poorly documented with respect to technical radiotherapy details. Two main roles for radiotherapy in PPD were found. One is as primary treatment for in situ or invasive disease and the other is following surgical relapse of in-situ or invasive disease. Other possible uses of radiotherapy in PPD such as neoadjuvant or adjuvant treatment or chemo-radiotherapy are discussed. Results of radiotherapy treatment for case of in situ and invasive disease are presented. We disagree with the view in some areas of the surgical literature that radiotherapy has no place in the management of the disease. Despite a thorough surveying of the literature however, precise recommendations on several areas of the technical radiotherapy treatment such as dose-fractionation schedules and field margins are difficult because of the small number of cases and poor general documentation. Our practice recommendations are presented. Radiotherapists should be encouraged to publish their experience in this disease to help define further a role for this treatment.
Assuntos
Neoplasias do Ânus/radioterapia , Doença de Paget Extramamária/radioterapia , Idoso , Idoso de 80 Anos ou mais , Neoplasias do Ânus/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doença de Paget Extramamária/mortalidade , Análise de Sobrevida , Resultado do TratamentoRESUMO
We retrospectively analysed serial pulmonary function tests in 14 HIV infected patients receiving either bleomycin and vincristine or liposomal doxorubicin therapy (Doxil) for AIDS related Kaposi's sarcoma. There was a significant reduction in the carbon monoxide transfer coefficient in bleomycin treated patients compared with patients treated with Doxil. No other significant changes in pulmonary function, including the carbon monoxide diffusing capacity, were observed. These preliminary findings suggest that HIV infected patients with Kaposi's sarcoma, who are receiving bleomycin, may be at risk of accelerated pulmonary dysfunction. A larger prospective study should be performed to enable further investigation.