Biomedical subjects

Kenneth W Gow

Publications and source records attributed to Kenneth W Gow.

25 records · Page 2Linked to original sources

PubMed2003

Metastatic testicular rhabdomyosarcoma--a report of two cases.

Rhabdomyosarcoma is the most common type of soft tissue sarcoma in children. The tumor spreads by local extension, to regional lymph nodes, or by distant metastases. Metastatic spread to the testicle has been rarely described. The authors describe 2 boys who were found to have intratesticular metastases after presenting with primary tumors in their extremities. The first patient, an 11-year-old boy presented with primary disease in his left foot and an enlarged testicle. Rhabdomyosarcoma was found histologically in both the foot and the testicle. A second boy 17 years of age had a primary tumor involving the left upper extremity treated with amputation, chemotherapy, and radiotherapy. A relapse was noted 2 years later in the left testicle and was treated with orchiectomy. The authors discuss the implications and the management of this rare presentation of metastatic rhabdomyosarcoma.

Adolescent↗

PubMed2003

Benefit of surgical resection of invasive pulmonary aspergillosis in pediatric patients undergoing treatment for malignancies and immunodeficiency syndromes.

PURPOSE: The aim of this study was to evaluate the outcome of children undergoing treatment for malignancy and immunodeficiency syndromes in whom invasive pulmonary aspergillosis (IPA) developed. METHODS: The authors reviewed the medical records of all patients treated at their institution from January 1990 to August 1999 for culture-proven pulmonary aspergillus infection. RESULTS: Among the 43 patients studied, the median age at the time of diagnosis of IPA was 13.1 years. The most common primary diagnoses were acute myelogenous leukemia (n = 18) and acute lymphoblastic leukemia (n = 14); 27 patients (63%) had received a bone marrow transplant (BMT). Of the 18 patients who underwent surgical intervention for IPA, 14 (78%) had one operation, whereas the remaining 4 patients had 2. The 4 patients alive at the time this report was written had undergone surgical intervention 2, 10, 23, and 44 months previously respectively. Surgical resection of the involved lung parenchyma was significantly prognostic for survival (P <.001). Other factors that influenced outcome were the extent of pulmonary invasion, steroid use, and the timing of bone marrow transplantation (BMT) in regard to the diagnosis of IPA. CONCLUSIONS: The overall mortality rate of children treated for malignancies and immunodeficiency syndromes in who IPA develops remains high, and antifungal therapy alone may not be curative. Surgical resection may provide a small but possibly the only chance for survival. Therefore, we would advocate for resection of all involved tissue, even if it requires reoperation.

Adolescent↗

PubMed2003

Thyroid carcinoma presenting in childhood or after treatment of childhood malignancies: An institutional experience and review of the literature.

BACKGROUND/PURPOSE: Thyroid carcinomas can occur as a primary malignancy (PTM) or secondary after another malignancy (STM). Information about the presentations and outcomes of patients with STM are limited. The authors sought to compare the clinical characteristics, course, and outcomes of patients with primary or secondary thyroid malignancies. METHODS: The authors reviewed the medical records of 8 children with PTM and 17 children with STM referred to St Jude Children's Research Hospital between February 1962 and February 2002 for evaluation and treatment of malignant thyroid carcinoma. RESULTS: The 8 children who had primary thyroid carcinoma had it diagnosed at a median age of 12.5 years (range, 7.3 to 16.3 years). Seven patients had papillary carcinoma, and 1 patient had follicular carcinoma. Three of the 8 (37.5%) had metastatic disease involving regional lymph nodes; 2 patients (25.0%) had lung metastases. Six patients required radioactive iodine (I 131) ablation for residual or metastatic disease after surgical resection. All 8 patients remain alive a median of 22.6 years after diagnosis (range, 0.7 to 30.5 years); 1 continues to receive radioactive iodine (I 131) ablation for persistent disease. Seventeen patients had thyroid carcinoma as a second malignant neoplasm after treatment for acute lymphoblastic leukemia (n = 6), Hodgkin's disease (n = 5), central nervous system tumor (n = 2), Wilms' tumor (n = 1), retinoblastoma (n = 1), non-Hodgkin's lymphoma (n = 1), or neuroblastoma (n = 1). Patients with secondary thyroid carcinoma presented at a median age of 21.5 years (range, 15.3 to 42.6 years), a median of 16.2 years (range, 0.9 to 29.2 years) after diagnosis of the primary cancer. Twelve of the 17 patients (70.6%) had received radiation to the thyroid gland during therapy for the primary cancer. Four patients (23.5%) had metastatic disease involving regional lymph nodes. Six patients (35.3%) required I(131) ablation for residual or metastatic disease after thyroidectomy. At the time of this report, all 17 patients are alive and in continue to be free of disease. CONCLUSIONS: Pediatric thyroid carcinoma is uncommon and responds well to current therapy. Given the limited period of follow-up of our cohort of secondary malignant thyroid tumors that arise after childhood cancer, these lesions appear to have similar presentations and outcomes when compared with primary carcinomas and can therefore be managed in the same manner.

Adenocarcinoma, Follicular↗

PubMed2003

Massive benign thymic hyperplasia in a six-month-old girl: case report.

A 6-month-old girl presented with respiratory symptoms with a large right-sided mediastinal mass noted on diagnostic imaging. Percutaneous biopsy revealed normal thymic tissue. Steroids were administered with no response. Right thoracotomy and complete thymectomy were performed. The specimen weighed approximately eight to ten times normal weight, and histology and flow cytometry revealed normal thymic tissue consistent with benign hyperplasia. The child has remained tumor free for a year since surgery. The rare nature of this tumor leads us to report this case and review the current literature.

Female↗

PubMed2002

Interventional radiology techniques for the diagnosis of lymphoma or leukemia.

BACKGROUND: Fluid aspiration, percutaneous biopsy, and catheter drainage are standard minimally invasive methods of diagnosing lymphoma or leukemia in adults. OBJECTIVE: To determine the effectiveness of interventional radiologic techniques in diagnosing specific hematologic malignancies in children. METHODS: During a 4-year period, 22 patients (16 male, 6 female; median age, 13 years) underwent 25 percutaneous biopsies, 6 fluid aspirations, 3 catheter drainages, and 1 needle localization for diagnosing suspected hematologic malignancy. RESULTS: For Hodgkin's disease, the procedures yielded 6 true-positive (TP) results, 2 true-negative (TN) results, and 2 false-negative (FN) results; for non-Hodgkin lymphoma (NHL), 14 TP results, 1 TN result, and 3 FN results; and for leukemia, 4 TP results and 3 FN results. Percutaneous biopsies yielded 16 TP results, 3 TN results, and 6 FN results. Aspirations and drainages yielded 8 TP results and 1 FN result. The one needle localization yielded a FN result. Overall sensitivity was 75%+/-7.3%; specificity, 100%; and accuracy, 77%+/-7.1%. CONCLUSION: Percutaneous biopsy of lymphoma is usually diagnostic. Drainage or aspiration of a fluid collection associated with NHL or leukemia is often diagnostic and is less invasive than biopsy. These procedures are minimally invasive and effective for diagnosing pediatric hematologic malignancies.

Adolescent↗

PubMed2002

Perianal rhabdomyosarcoma presenting as a perirectal abscess: A report of 11 cases.

BACKGROUND PURPOSE: The organs and soft tissues of the pelvis are some of the most common primary sites for rhabdomyosarcoma (RMS) in children and adolescents. In most cases a mass is detectable on clinical examination, and the initial concern is focused on the possibility of a neoplasm. The current report concerns 11 patients, each presented with a painful perineal-perianal mass suggesting an abscess to the extent that each one of these patients was treated initially with antibiotics or incision and drainage for several weeks to months before the pathologic diagnosis of RMS was established. METHODS: The authors reviewed the clinical histories of all patients with perirectal/perianal RMS from their respective institutions to identify cases in which the initial clinical diagnosis or impression was that of a perirectal abscess. Pathologic material was reviewed in all cases. RESULTS: Eleven patients, 7 of whom were girls, ranged in age from 1 to 16 years at diagnosis (median age, 14 years). Fever accompanied the clinical presentation in 2 patients. None of the patients had a past medical history of illness that may have predisposed them to a perirectal abscess, although one patient had a family history of inflammatory bowel disease. Duration of symptoms ranged from 1 month to 1 year (mean, 4.6 months). Each patient presented with a tender perianal/perineal nodule or mass. Inguinal adenopathy was present in 6 patients at diagnosis. White blood cell counts ranged from 6,600/mm(3) to 24,500/mm(3). LDH levels ranged from 414 to 3,432 U/L. The average time from presentation to pathologic diagnosis of RMS was 2.1 months. Nine of the 11 cases showed an alveolar pattern. All were high-stage disease. Of 7 patients with follow-up longer than 1 year, 2 (29%) are alive without disease. CONCLUSION: This report presents the need to consider the possibility of a malignant neoplasm, in this case RMS, in a child or adolescent with a putative perirectal abscess that fails to respond in the expected manner to incision and drainage and antibiotic therapy.

Abscess↗

PubMed2002

Cytogenetic and histologic findings in Wilms' tumor.

PURPOSE: The cytogenetic abnormalities occurring in Wilms' tumors diagnosed and treated at the authors' institution were reviewed. Correlation with tumor histopathology, stage, and outcome were evaluated. METHODS: Sixty-seven Wilms' tumors were encountered between 1984 and 1997. Tissue culture was obtained in 63 (94%) cases. Charts were reviewed retrospectively to obtain tumor histopathology, stage, and outcome. RESULTS: All tumors were examined in accordance with the National Wilms' Tumor Study (NWTS). Sixty-one were unilateral (54 unicentric, 7 multicentric), and 6 were bilateral (2 multicentric). Five Wilms' tumors showed anaplasia, whereas 62 showed favorable histology. Twenty children were stage I, 17 stage II, 20 stage III, 4 stage IV, and 6 stage V. Forty-eight (72%) tumors showed an abnormal karyotype. Chromosomal gain was more common than chromosomal loss, because hyperdiploidy was seen in 30 cases and hypodiploidy in 4. The most common aneuploidies were gains of chromosomes 6, 7, 8, 12, 13, and 18. In general, there was no correlation between specific chromosomal abnormalities with either tumor stage or histologic subtype. The only exceptions were anaplastic changes that were associated with poor prognosis and showed a variety of chromosomal changes including hyperdiploidy, hypodiploidy, and structural rearrangements. The 3 tumors causing mortality exhibited tetraploidy, hypodiploidy, and diploidy with a t(1p:11q) karyotype, respectively. Clonal progression was identified in Wilms' tumors when compared with its accompanying nephrogenic rest. A normal karyotype was seen more commonly in younger patients. CONCLUSIONS: Wilms' tumors display a variety of chromosomal abnormalities. These are particularly seen in anaplastic tumors and are less likely seen in younger patients. Overall, chromosomal gain was more common than loss with trisomies of chromosomes 12, 8, and 6 being the most frequently seen.

Child↗