Cancer
Permanent URI for this collectionhttps://hdl.handle.net/20.500.12503/21618
Browse
Browsing Cancer by Author "Bowman, Paul"
Now showing 1 - 4 of 4
- Results Per Page
- Sort Options
Item Bone Pain as a Clinical Presentation of Acute Lymphoblastic Leukemia(2019-03-05) Bowman, Paul; Hamby, Tyler; Vivatson, SaraIntroduction: Acute lymphoblastic leukemia (ALL) is the most common malignancy in children, accounting for approximately 1/3 of pediatric cancers. Treatment of ALL has progressed extensively over the years, and approximately 85% of pediatric ALL cases achieve remission. Many factors are used in determining the treatment for individuals, including central nervous system infiltration, chromosomal abnormalities, and various mutations. Most patients present with systemic signs and symptoms that lead the pediatrician towards the diagnosis of ALL, but some present with the chief complaint of bone pain. Case Information: Case 1: A 5-year-old female presented to an urgent care clinic complaining of low back pain for the past 2 weeks. Initially, an X-ray was performed which showed anterolisthesis and diminished vertebral height. Following the X-ray, she was evaluated and found to have additional symptoms including a low-grade fever, headache, nasal discharge, and cough. Labs drawn revealed pancytopenia and an MRI scan revealed an infiltrative process of the L3 vertebral body. Bone marrow biopsy confirmed the diagnosis of B-cell ALL. The patient was started on standard risk therapy, but had positive minimal residual disease (MRD) at day 29 of treatment. Patient was then placed on the high risk treatment protocol. Patient is now in maintenance therapy. Case 2: A 4-year-old female presented to an emergency department with left upper arm pain and a recent episode of strep throat. Exam showed some lymphadenopathy and painful range of motion testing in the left arm. X-ray was unremarkable. Labs showed the patient to be anemic. White blood cell numbers were within normal range, however the differential count identified abnormal lymphocytes to be present. Bone marrow biopsy confirmed diagnosis of B-cell ALL. Patient was started on standard risk therapy, achieved MRD negative remission, and is currently in maintenance therapy. Conclusions: This case study reviews 2 cases out of many that presented with similar complaints of bone pain. Often children experience minor trauma, such as falling out of a chair, which may cause pain. Pediatricians may see many such cases, but sometimes the bone pain is a manifestation of something more serious. Lack of awareness can lead to a delay in diagnosis of ALL. Therefore, ALL should always be considered when evaluating a child for bone pain.Item Delayed Diagnosis of Ewing Sarcoma: A Case Series(2019-03-05) Bowman, Paul; Hamby, Tyler; Richie-Gillespie, Mayme; St. Louis, BlakeBackground: Ewing Sarcoma, the second most common bone cancer in adolescents, affects young adults between the ages of 15 to 24. Ewing Sarcoma presents with a variety of non-specific symptoms, including pain and possible mass; the average delay in diagnosis is 6 months. Physician-related delays, defined as the time when a patient first presents to a physician to the time of diagnosis, account for 63.6% of delays. Adolescent (15-19 years old) patients have a notably longer patient-related delay, defined as the time when a patient first notices a symptom to the time they present to a physician, contributing to an overall longer delay in diagnosis. Patients diagnosed without metastasis have a 70% survival rate, whereas patients with metastasis present have only a 20% survival rate. By reviewing three cases of delayed diagnosis in Ewing Sarcoma, we aim to increase awareness of providers to improve earlier diagnosis of Ewing Sarcoma. Methods: Electronic medical records of three patients were reviewed at Cook Children’s Medical Center. Case Information: Three cases of adolescent Ewing Sarcoma diagnosed between 2010-2018 were evaluated. One patient was diagnosed with sciatica followed by a herniated disc after a car accident and had a six-month delay. The patient did not respond to treatment and was referred to a pain management specialist. At diagnosis, the patient had metastasis to multiple areas and is currently undergoing treatment. The other two patients had delays of approximately 12 months and were being treated by either a chiropractor or physical therapist. Both patients associated their pain to the musculoskeletal system and delayed going to a physician. One patient had metastasis to multiple sites at diagnosis, while the other patient had no metastasis. Both patients are currently in remission. Conclusions: Ewing Sarcoma presents with nonspecific symptoms and can have lengthy delays in diagnosis. Timely diagnosis is important because longer delays can result in metastasis, a need for more intensive therapy, and a worse prognosis. As demonstrated by these cases, pain onset, proper imaging guidelines, age-specific statistics, avoiding specialty bias, and enhanced provider awareness are important considerations in developing an appropriate differential diagnosis and earlier recognition of Ewing Sarcoma. In presenting these cases we seek to improve awareness and suspicion of Ewing Sarcoma among practitioners evaluating patients such as we have described.Item Diffuse Cutaneous Mastocytosis and its potential comorbidities in pediatric patients – a case study.(2019-03-05) Basha, Riyaz; Bowman, Paul; Hamby, Tyler; Smith, JohnBackground: Mastocytosis is the pathologic proliferation and accumulation of mast cells in various tissues of the body. There are different forms of mastocytosis that can present in pediatric patients including systemic (SM), cutaneous (CM) and diffuse cutaneous mastocytosis (DCM). Both the CM and DCM forms have the potential to progress into SM as the patient reaches adulthood. Mastocytosis has been shown to be comorbid with joint pathologies including Ehlers-Danlos syndrome and inflammatory gastrointestinal conditions such as eosinophilic esophagitis. The greatest risk among patients with mastocytosis is anaphylaxis. Case information:A13-week-old male presented to his primary care physician with erythematous spots on his torso and arms, and was diagnosed with eczema. The spots grew and transformed morphologically over the next month and a referral to dermatology was made. Upon biopsy of the original lesion (on the torso), the diagnosis of DCM was made. Over the coming months, symptoms progressed and comorbidities—including joint hypermobility (diagnosed with Ehlers-Danlos syndrome), dysphagia and diarrhea—arose. The patient broke his distal radius while crawling, due to his mast cell disorder and severe vitamin D deficiency. Conclusions: In most children with DCM, symptoms will partially or fully resolve by adolescence. But for some patients, the disease can progress to SM. Numerous comorbidities can occur, as did in this case. Current treatment strategies are wide ranging, from topical glucocorticoids to specialized UV radiating therapy. The specific approaches to this disease are still being understood, with recent investigations into immunological treatment modalities. The individuality of each case is crucial for health care professionals to recognize.Item Metformin inhibits medulloblastoma cell growth and increases sensitivity to chemotherapy drugs(2019-03-05) Basha, Riyaz; Bowman, Paul; Sankpal, Umesh; Hong, JuliePurpose: Medulloblastoma (MB) is the most common malignant pediatric brain tumor. Standard treatment is chemotherapy and radiation, both of which can be associated with long-term toxicity for pediatric patients. This project is focused on the use of metformin in the treatment of medulloblastoma. Metformin (MET) is an anti-diabetic drug with low toxicity that has been shown to have anti-cancer properties. We hypothesize that MET will inhibit MB cell growth and enhance the effect of chemotherapy and anti-cancer agents such as vincristine (VCR) and valproic acid (VPA) when used in combination, possibly by inhibiting the expression of survivin protein. Methods: MB cells (DAOY) were treated with increasing doses of MET (1-30 mM), VCR (1-16 nM), and VPA (1-30 mM). For combination treatment, DAOY cells were treated with selected doses of VCR (1, 2, 4 nM) and VPA (0.9, 1.8, 3.5 mM) alone or in the presence of MET (10 and 20 mM). Cell viability was assessed at 48 h post-treatment using the CellTiter-Glo cell viability assay kit. For western blot analysis, DAOY cells were treated with increasing doses of MET (0, 5, 10, 20 mM) for 24 and 48 h. Cells were harvested and protein extracts were prepared and used for determining survivin expression. Results: Treatment with MET, VCR, and VPA alone resulted in a decrease in cell viability in a dose and time dependent manner. The combination of MET+VCR resulted in greater inhibition of cell proliferation with 78.99% inhibition in comparison to MET alone (51.5%) or VCR alone (46.02%). The combination of MET+VPA resulted in greater inhibition of cell proliferation with 84.88% inhibition in comparison to MET alone (52.6%) or VPA alone (47.81%). Western blot analysis of MET treated cells showed a dose and time dependent decrease in survivin expression. Conclusion: Our experiments demonstrate the potential of MET as a novel therapeutic agent for the treatment of MB based on its ability to inhibit proliferation and enhance the activity of anti-cancer agents. These results also suggest that MET’s effect could be partially mediated by the down-regulation of survivin, a protein known to be involved in the inhibition of apoptosis and resistance of cells to chemotherapy. The low toxicity of metformin and its ability to sensitize medulloblastoma cells could potentially result in lowering chemotherapy associated toxicities, leading to improved quality of life for long-term survivors.