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Journal of Indian Association of Pediatric Surgeons
     Journal of Indian Association of Pediatric Surgeons
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Table of Contents   
LETTER TO THE EDITOR
Year : 2014  |  Volume : 19  |  Issue : 4  |  Page : 246
 

Intussusception following treatment for glioblastoma multiforme: A rare association


1 Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
2 Department of Medical Oncology, BRAIRCH, AIIMS, New Delhi, India

Date of Web Publication30-Sep-2014

Correspondence Address:
Sandeep Agarwala
Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi - 110 029
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-9261.142025

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How to cite this article:
Raman V S, Sharma A, Agarwala S, Bakshi S, Bhatnagar V. Intussusception following treatment for glioblastoma multiforme: A rare association . J Indian Assoc Pediatr Surg 2014;19:246

How to cite this URL:
Raman V S, Sharma A, Agarwala S, Bakshi S, Bhatnagar V. Intussusception following treatment for glioblastoma multiforme: A rare association . J Indian Assoc Pediatr Surg [serial online] 2014 [cited 2019 Nov 13];19:246. Available from: http://www.jiaps.com/text.asp?2014/19/4/246/142025


Sir,

Non-Hodgkins Lymphoma (NHL) as a lead point causing intussusception is very rare, though reported. [1] Our patient was a 6-year-old boy who was symptomatic for three months with a vague, ill-defined pain in the right lower abdomen with recurrent episodes of bilious vomiting. Two years ago, he had been diagnosed with Glioblastoma Multiforme grade IV, for which he had undergone craniotomy and tumor excision, followed by radiotherapy and chemotherapy with temozolomide (TMZ). Abdominal examination revealed a solitary globular, soft, nontender ill-defined fixed mass measuring about 5 × 5 cm in the right iliac fossa. Ultrasound revealed hypoechoic thick-walled concentric ring-like lesion in the right hypochondrium with vascularity in the region. Barium meal follow through was suggestive of chronic ileocolic intussusception [Figure 1]. The patient underwent laparotomy and, intraoperatively, a 2 × 2-cm intraluminal mass was noticed in the cecum with edematous terminal ileum and multiple mesenteric lymph nodes. A limited right hemicolectomy with ileo ascending end-to-end anastomosis was performed. Postoperative recovery was unremarkable. The histopathology of the resected cecal polyp revealed NHL, B cell immunophenotype with CD 20 positivity. The dissected lymph nodes also showed the features of NHL. The patient has been started on a chemotherapy regime for NHL.
Figure 1: Barium meal follow through showing a coiled spring sign in the right subhepatic location with a mild dilatation and abrupt narrowing of the terminal ileum and non-visualization of cecum along with the part of the ascending colon

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Temozolomide (TMZ) is a DNA-alkylating drug registered for the treatment of patients with newly diagnosed glioblastoma and recurrent gliomas. [2] It is an orally administered analog of dacarbazine whose activity is mediated primarily via DNA methylation at the O6 position of guanine. [3] It is relatively well tolerated and is increasingly administered in clinical studies over prolonged periods to patients with gliomas and several other malignancies. Secondary malignancy in the form of therapy-related leukemia and myelodysplastic syndrome (MDS) after treatment with TMZ has been reported in literature. Sharma et al. reported a 20-year-old woman with high-grade primary glioblastoma who received concurrent TMZ with radiation, and developed disseminated Burkitt's lymphoma within 60 days of starting on TMZ. [4] Temozolomide has mutagenic potential for bone marrow cells in vivo in the mouse model system, which may point toward the reported therapy-related leukemia and MDS after TMZ treatment. [5] As the survival of brain tumor increases with better treatment modalities and longer follow-up, there is a possibility of increased incidents of a second malignancy or other unusual side effects after therapy with TMZ.

 
   References Top

1.Singal R, Gupta S, Goel M, Jain P. A rare case of chronic intussusception due to non Hodgkin lymphoma. Acta Gastroenterol Belg 2012;75:42-4.  Back to cited text no. 1
    
2.Stupp R, Mason WP, van den Bent MJ, Weller M, Fisher B, Taphoorn MJ, et al. Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med 2005;352:987-96.  Back to cited text no. 2
    
3.Brada M, Judson I, Beale P, Moore S, Reidenberg P, Statkevich P, et al. Phase I dose-escalation and pharmacokinetic study of temozolomide for refractory or relapsing malignancies. Br J Cancer 1999;81:1022-30.  Back to cited text no. 3
    
4.Sharma A, Gupta D, Mohanti BK, Thulkar S, Dwary A, Goyal S, et al. Non-Hodgkin Lymphoma Following Temozolomide. Pediatr Blood Cancer 2009;53:661-2.  Back to cited text no. 4
    
5.Geiger H, Schleimer D, Nattamai KJ, Dannenmann SR, Davies SM, Weiss BD. et al. Mutagenic potential of temozolomide in bone marrow cells in vivo. Blood 2006;107:3010-1.  Back to cited text no. 5
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