BACKGROUND: Central neurocytoma (CN) is one of the rarest brain tumors which can cause considerable threats to the patient. Studies and trials regarding its treatment are scarce, and no official guidelines are dedicated to this disease. The main principle of treatment generally consists of surgery and radiotherapy. The choice of radiotherapy is divided into conventional fractionated radiotherapy and stereotactic radiosurgery (SRS). However, access to SRS in developing countries such as Indonesia is still limited. AIM: We report a case delineating the timeline and process of treatment in CN with a review of the literature. METHODS: We report the case of a 29-year-old woman with a solid inhomogeneous mass (AP 5.63 × CC 5.36 × LL 5.16 cm) in the right ventricle, attached to the septum pellucidum, as displayed on the magnetic resonance imaging (MRI). The patient had been vomiting for the past three weeks and presented with bidirectional horizontal nystagmus. RESULTS: Cognitive evaluation with Montreal Cognitive Assessment (MoCA-Ina) demonstrated a mild cognitive impairment. Biopsy was performed, and pathology analysis revealed some cells with fibrillary background and some with a honeycomb-like appearance. The immunohistochemistry staining showed positive results with synaptophysin and neuronal nuclear protein. According to the WHO classification of the central nervous system tumors, the profile favored CN Grade II. Subtotal resection (STR) was performed to reduce the tumor mass, which was measured with MRI 2-month post-surgery (AP 4.09 × CC 3.01 × LL 4.13 cm) and then followed by an external radiation program. Using intensity modulated radiation therapy (IMRT), a total dose of 54 Gy was given in 27 fractions, with the average planning target volume of 54.3 Gy. There was a minuscule reduction in tumor mass as seen in post-radiotherapy MRI (AP 4.00 × CC 3.86 × LL 3.63 cm). After the last session and at the 18-month follow-up, the patient did not have any complaints or abnormalities during clinical assessment. Reevaluation using MoCA-Ina showed an improved cognitive function. CONCLUSIONS: In line with recent evidence, we demonstrated that STR followed by IMRT with the dosage of 54 Gy in 27 fractions was a feasible treatment strategy for CN that resulted in cognitive improvement, with no side effects.
BACKGROUND: Central neurocytoma (CN) is an infrequent and non-malignant neuro-epithelial tumor. CN is mostly found in lateral ventricle and may generate obstructive hydrocephalus. Surgical-radiation can increase patient survival and prognosis. This case report presented a rare case about 30-year-old female with CN. CASE PRESENTATION: 30-year-old female came to the hospital with severe headache and vomiting. Brain MRI showed a heterogeneous mass in right lateral ventricle causing obstructive hydrocephalus. The patient undergone partial resection. CN confirmed from histopathological analysis. Afterward, patient received 54 Gy conventional radiotherapy. 3 months after radiation, patient remain asymptomatic and no neurological deficit. Brain MRI evaluation showed slightly reduction of tumor mass (from 4,09 x 3,01 x 4,13 cm before radiation to 4,00 x 3,86 x 3,63 cm after radiation). DISCUSSION: This case report was consistent clinically, radiologically, and histopathologically with intraventricular CN. Headache and vomiting in patient due to the raised intracranial pressure from tumor mass and obstructive hydrocephalus. Headache is a significant and most frequent symptom in intraventricular tumors, may be caused by traction or compression of the pain-sensitive structures such as meningen and intracranial vasculature. Optimal management of CN still remains controversial due to their rarity. However, surgical management with gross total resection is the gold standard of treatment modality, associated with good prognosis and longer progression-free survival. CONCLUSION: Based on clinical characteristic, radiographic finding and histopathological features; this case was consistent with CN of the lateral ventricle. Surgical as the treatment option followed by radiation has led to good clinical outcome in this patient. KEYWORDS: central neurocytoma, hydrocephalus, neuro-epethelial tumor, radiotherapy
Background: Keloid is a benign growth of connective tissue. There are several risk factors that play a role in keloid growth. Excision surgery is one of the modalities in the treatment of keloids. However, excision surgery alone has a recurrence rate of 45-100%.Case: Male, 37 years old, with complaints arising from a keloid lesions in the left earlobe since three years ago with a history of previous injuries. The lesions is then operated on but always grows back postoperatively. The number of surgeries that have been carried out three times with further treatment in the form of corticosteroid injection. However, keloid still recurrence. Finally it was decided to undergo treatment with surgery followed by radiotherapy within a period of no more than 24 hours postoperatively. Follow-up after six months gave good results without recurrence.Discussion: Keloid has a high recurrence rate after excision surgery. Surgery followed by radiotherapy has a low recurrence rate compared to surgery or surgery followed by administration of corticosteroid injections. Radiotherapy as adjuvant therapy for postoperative keloid excision has the role of sterilizing the connective tissue stem cell active fibroblasts and acute inflammatory cells that grow in the early postoperative period. A study states that administration of postoperative radiation with electrons in keloids in the earlobe at a dose of 15 Gy in three fractions gives a low recurrence rate and a low risk of side effects in the surrounding soft tissue.
Background: Cancer is the leading causes of death with a compar able number of mortality rate to coronary heart disease and stroke. The burden of cancer will continue to increase, especially in developing countries including Indonesia. This study reports the profile of cancer patients domiciled in the administrative area of North Jakarta and Kepulauan Seribu in 2008-2012. Materials and Methods: This was a descr iptive study. Patients data wer e collected from cancer registries all hospitals located in administrative area of North Jakarta and Kepulauan Seribu. This data was pooled and extracted from DKI Jakarta Cancer Registry Control Center at RSCM. The primary site and histology of malignancies were verified and coded based on the International Classification of Diseases for Oncology (ICD-O). Data were analyzed using descriptive statistics in SPSS 20.0 Results: Ther e ar e 2185 cases or ar ound 14.8% of all cases of cancer patients verified in the database. Of those, 740 were male and 1445 female. The most prevalent age group was 45-54 years old, which was 29%. The highest distribution of cancer stage was in stage 3, which is 21.1%. The most common cancer in all sex groups were breast cancer, cervical cancer, nasopharyngeal cancer, hematopoietic system malignancy, and ovarian cancer. In men, the top five most cancers were nasopharyngeal cancer, lung cancer, hematopoietic system, lymphoma, and liver cancer. Whereas in women, most cancer sequences were breast cancer, cervical cancer, ovarian cancer, thyroid cancer, and hematopoietic system.
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