This study was aimed to systematize magnetic resonance imaging (MRI) presentation of toxic leukoencephalopathy, to find the correlation between method of central nervous system (CNS) leukemia prevention and changes on MRI, to find relationship between existence leukoencephalopathy on imaging and neurocognitive deficits in pediatric patients after anti-leukemic therapy. Brain MRI data of 48 children, who underwent a therapy course according to the ALL-MB intermediate risk protocol, was evaluated. In accordance with two arms of this protocol, they received either radiation therapy, or additional intrathecal administration of chemotherapeutic agents as a prevention of CNS leukemia. Also, neurocognitive tests were performed. According to the results of the performed investigation, 10 (50%) out of 20 children, who received cranial irradiation and 18 (66.6%) out of 27 patients, who received only intrathecal therapy demonstrated abnormal brain changes (leukoencephalopathy) according to MRI data. Leukoencephalopathy was mostly presented by diffuse zones and localized predominantly in the frontal and temporal lobes. There was no correlation between method of CNS prevention and the existence of leukoencephalopathy on MRI. The analysis of our data did not show significant differences in brain damage and severity of cognitive impairment depending on the type of prevention of CNS leukemia. Moreover, in this study no statistical correlation was found between leukoencephalopathy on MRI and neurocognitive impairment according to clinical tests data. Further long-term prospective studies and examinations should be performed to assess late neurotoxic effects.
ВИЗУАЛИЗАЦИЯ ИЗМЕНЕНИЙ ГОЛОВНОГО МОЗГА У ПАЦИЕНТА С ОСТРЫМ ЛИМФОБЛАСТНЫМ ЛЕЙКОЗОМБондаренко В.П., Терещенко Г.В., Андрианов М.М., Жуковская Е.В.ель исследования. Оценить роль преморбидных состояний в развитии изо-лированного рецидива ЦНС у пациента с ОЛЛ в период ремиссии, описать лучевые характеристики лейкемического поражения зрительного нерва у данного пациента. Материалы и методы. Было проведено МРТ головного мозга пациенту, мальчику 9 лет, с ОЛЛ, на трех этапах: в период профилактики рецидива, сразу после манифе-стации симптомов (период ремиссии) и после трансплантации гемопоэтических стволо-вых клеток. Исследование проводилось на томографах GE Optima 360 1.5 T и Philips Achieva 3 T. Также был осуществлен анализ отечественной и зарубежной литературы.Результаты. У пациента с типичной МР-картиной постхимиотерапевтической лейкоэнцефалопатии и внутримозговыми геморрагиями развивается изолированный ЦНС-рецидив. Отмечается поражение сетчатки (диска зрительного нерва). Наличие рецидива было подтверждено клинико-лабораторными данными. После проведенной противорецидивной терапии данных за опухолевое поражение головного мозга не вы-явлено. Диффузные изменения белого вещества -без динамики.Выводы. Визуальные МР-феномены у данного пациента с ОЛЛ, осложненного развитием нейролейкоза (НЛ), диктуют необходимость изучения роли преморбидных патоморфологических изменений ЦНС в индукции НЛ.Ключевые слова: нейрорадиология, нейролейкоз, онкогематология, ЦНС-рецидив, зрительный нерв, лейкоэнцефалопатия. REJR 2017; 7(3):176-182. DOI:10.21569/2222 7(3):176-182. DOI:10.21569/ -7415-2017 VISUALIZATION OF BRAIN CHANGES IN THE PATIENT WITH ACUTE LYMPHOBLASTIC LEUKEMIABondarenko V.P., Tereschenko G.V., Andrianov M.M., Zhukovskaya E.V.urpose. To evaluate the role of premorbid conditions in development of isolated central nervous system (CNS) relapse in a patient with acute lymphoblastic leukemia (ALL) in remission, to describe radiologic features of optic nerve leukemic lesion in this patient.Materials and methods. MRI of the brain was performed in a boy of 9 years, with ALL, at three stages: during the prevention of relapse, immediately after the manifestation of symptoms (remission period) and after transplantation of hematopoietic stem cells. The study was carried out using GE Optima 360 1.5T and Philips Achieva 3T machines. The analysis of domestic and foreign literature was also carried out.Results.
The article describes a clinical case of a patient aged 15 years with a sequential transformation of the ameloblastoma of the upper jaw into ameloblastic fibrosarcoma and undifferentiated round-cell sarcoma as a result of frequent relapses against the background of standard anticancer treatment. This clinical example is of interest not only because of the preservation of the mutation in the BRAF gene at all stages of transformation, which made it possible to conduct successful therapy with BRAF and MEK inhibitors after the exhaustion of all standard therapeutic possibilities.Conflict of interest. The authors declare no conflict of interest.Funding. The study was performed without external funding
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