Publications by authors named "Kanita Kayasut"

21 Publications

  • Page 1 of 1

IgG4-related disease in patients with idiopathic orbital inflammation.

BMC Ophthalmol 2021 Oct 8;21(1):356. Epub 2021 Oct 8.

Department of Ophthalmology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand.

Background: To identify the prevalence of positive IgG4 immunostaining in orbital tissue among patients previously diagnosed with nongranulomatous idiopathic orbital inflammation (IOI) and to compare the clinical characteristics of patients with and without IgG4-positive cells.

Methods: A retrospective review of all patients with a histopathologic diagnosis of IOI was performed. Immunohistochemical staining was performed to identify IgG-positive cells and IgG4-positive cells. Multivariate analysis was performed using likelihood ratio-test logistic regression on the differences between IgG4-related disease (IgG4-RD) and non-IgG4-RD.

Results: Of the 45 patients included, 21 patients (46.7%) had IgG4-positive cells, with 52.4% being male and a mean age of 55.9 ± 13.4 years. Bilateral ocular adnexal involvement (adjusted odds ratio [aOR] = 9.45; P = 0.016) and infraorbital nerve enlargement (aOR = 12.11; P = 0.008) were frequently found in IgG4-RD patients. Complete remission occurred in 23.8% of IgG4-RD patients and 41.7% of non-IgG4-RD patients. IgG4-RD patients had more frequent recurrent disease than non-IgG4-RD patients.

Conclusions: Nearly 50% of IgG4-RD patients were previously diagnosed with biopsy-proven IOI. IgG4-RD was more frequent in patients with bilateral disease and infraorbital nerve enlargement, showing the importance of tissue biopsy in these patients. Immunohistochemistry studies of all histopathology slides showing nongranulomatous IOI are highly recommended to evaluate for IgG4-RD.
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http://dx.doi.org/10.1186/s12886-021-02115-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8499436PMC
October 2021

Anti-cancer effect of engineered recombinant interleukin 18.

Adv Clin Exp Med 2020 10;29(10):1135-1143

Department of Biomedical Sciences, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.

Background: Interleukin 18 (IL-18) is an inflammatory cytokine belonging to the interleukin 1 (IL-1) superfamily, and is known for its role in anti-cancer activity by promoting type 1 immune response, and thus may be applied to cancer immunotherapy. Our previous report has showed 16 times higher activity of engineered E6K+T63A IL-18 than of native IL-18 in vitro. However, no data has been acquired for its anti-cancer effect in animal model.

Objectives: To investigate the anti-cancer effect of engineered E6K+T63A IL-18 as an immune stimulant in vivo.

Material And Methods: Tumor-bearing mice were treated with native IL-18 or E6K or E6K+T63A IL-18 once a day for 10 days after the tumor reached the volume of 100 mm3. Tumor volume and the number of certain immune cell type in the tumor microenvironment were investigated in this study.

Results: The results showed that tumor progression in mice treated with E6K+T63A was slower than in mice treated with E6K and native IL-18. The volume of the tumor was also smaller and the lifespan longer in the E6K+T63A IL-18-treated mice. The proportions of type 1 helper T cell (Th1) and cytotoxic T lymphocyte (CTL) were significantly higher in mice treated with E6K+T63A IL-18.

Conclusions: These results suggest that our engineered IL-18 conferred strong anti-tumor immunity in the animal model.
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http://dx.doi.org/10.17219/acem/126298DOI Listing
October 2020

Variants Associated with Infantile Cholestatic Syndromes Detected in Extrahepatic Biliary Atresia by Whole Exome Studies: A 20-Case Series from Thailand.

J Pediatr Genet 2018 Jun 16;7(2):67-73. Epub 2018 Feb 16.

Pediatric Surgery Unit, Department of Surgery, Prince of Songkla University, Hat Yai, Songkhla, Thailand.

Biliary atresia (BA) is the most severe form of obstructive cholangiopathy occurring in infants. Definitive diagnosis of BA usually relies on operative findings together with supporting pathological patterns found in the extrahepatic bile duct. In infancy, overlapping clinical patterns of cholestasis can be found in other diseases including biliary hypoplasia and progressive familial intrahepatic cholestasis. In addition, BA has been reported as a phenotype in some rare genetic syndromes. Unlike BA, other cholangiopathic phenotypes have their own established genetic markers. In this study, we used these markers to look for other cholestasis entities in cases diagnosed with BA. DNA from 20 cases of BA, diagnosed by operative findings and histopathology, were subjected to a study of 19 genes associated with infantile cholestasis syndromes, using whole exome sequencing. Variant selection focused on those with allele frequencies in dbSNP150 of less than 0.01. All selected variants were verified by polymerase chain reaction-direct sequencing. Of the 20 cases studied, 13 rare variants were detected in 9 genes: 4 in (Alagille syndrome), 2 in (progressive familial intrahepatic cholestasis [PFIC] type 6), and one each in (Dubin-Johnson syndrome), (PFIC type 2), (Crigler-Najjar syndrome), (Kabuki syndrome), (Mitchell-Riley syndrome), (Fanconi anemia), and (Zimmermann-Laband syndrome). Genetic lesions associated with various cholestatic syndromes detected in cases diagnosed with BA raised the hypothesis that severe inflammatory cholangiopathy in BA may not be a distinct disease entity, but a shared pathology among several infantile cholestatic syndromes.
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http://dx.doi.org/10.1055/s-0038-1632395DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5916803PMC
June 2018

An Uncommon Cause of Small Bowel Bleeding from Appendiceal Carcinoma.

Case Rep Gastroenterol 2017 Jan-Apr;11(1):250-255. Epub 2017 Apr 28.

NKC Institute of Gastroenterology and Hepatology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand.

Massive hematochezia caused by a small bowel lesion is a rare entity. Currently, video capsule endoscopy and balloon-assisted enteroscopy are effective in identifying the source of small intestine bleeding. Herein, we report a case of small bowel bleeding caused by a nonmucinous appendiceal adenocarcinoma with ileal invasion which was detected by video capsule endoscopy and single-balloon endoscopy. Despite the advanced disease stage with hepatic and peritoneal metastases, as of September 2016 the patient has had 8 years' disease-free survival after surgical resection and chemotherapy.
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http://dx.doi.org/10.1159/000468512DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5437429PMC
April 2017

Non-Hodgkin lymphoma in South East Asia: An analysis of the histopathology, clinical features, and survival from Thailand.

Hematol Oncol 2018 Feb 23;36(1):28-36. Epub 2017 Mar 23.

Departmentof Pathology, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand.

Systemic reports on the descriptive epidemiology of non-Hodgkin lymphoma (NHL) from Southeast Asia are scarce. A nationwide multi-institutional registry was conducted to compare the histopathology, clinical features, and survival of Thai adult patients with NHL using large registries, especially those from Far East Asia (FEA). Using a web-based registry system, 13 major medical centers from the 4 geographic regions of Thailand prospectively collected, from 2007 to 2014, the diagnostic pathology, according to the World Health Organization classification, 2008, clinical features and survival of 4056 patients who were newly diagnosed with NHL. The median age of the patients was 56 years (range, 16-99 years). The male-to-female ratio was 1.3:1. From the total of 4056 patients, T/NK-cell lymphoma (TNKCL) accounted for 12.6% of cases, and 5.1% had human immunodeficiency virus-associated lymphoma. The four leading histological subtypes were diffuse large B-cell lymphoma, not otherwise specified (58.1%); follicular lymphoma (5.6%); extranodal mucosa-associated lymphoid tissue lymphoma (5.2%); and peripheral T-cell lymphoma, not otherwise specified (4.0%). With a median follow-up duration of 46.1 months, the median overall survival of B-cell NHL was significantly longer than that of patients with TNKCL (76.5 vs 28.8 months, P = .0001). Compared to FEA, the Thai registry had an approximately one-half lower relative frequency of TNKCL; the prevalence of extranodal mucosa-associated lymphoid tissue lymphoma was much lower than in Korea, and the frequency of extranodal TNKCL, nasal type, was strikingly low compared to China. It is concluded that while the median age of Thai patients with NHL was approximately a decade younger than for Caucasians, the long-term survival rates for most histological subtypes were comparable. While the histological distribution generally complied with the characteristic Asian features, some differences from FEA were observed.
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http://dx.doi.org/10.1002/hon.2392DOI Listing
February 2018

Erythema multiforme-like cutaneous lesions in monomorphic epitheliotropic intestinal T-cell lymphoma: a rare case report.

J Cutan Pathol 2017 Feb 15;44(2):183-188. Epub 2016 Dec 15.

Hematology Unit, Bangkok-Hatyai Hospital, Songkhla, Thailand.

Monomorphic epitheliotropic intestinal T-cell lymphoma (MEITL), also known as Type II enteropathy-associated T-cell lymphoma (EATL), is an aggressive peripheral T-cell lymphoma. EATL generally presents in adults with gastrointestinal symptoms. Skin involvement is very rare, found only in approximately five percent of patients. The authors report a 67-year-old Asian male who presented with chronic diarrhea and developed erythema multiforme-like cutaneous lesions. A skin biopsy revealed extensive pagetoid spread of atypical lymphocytes in the epidermis. The results of an immunohistochemistry test led to a diagnosis of MEITL. This report points to the need for dermatologists and dermatopathologists to consider a possible diagnosis of MEITL when encountering similar cases.
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http://dx.doi.org/10.1111/cup.12864DOI Listing
February 2017

Senescence Process in Primary Wilms' Tumor Cell Culture Induced by p53 Independent p21 Expression.

J Cancer 2016 2;7(13):1867-1876. Epub 2016 Sep 2.

Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand 90110.

Wilms tumor (WT) is an embryonal tumor occurring in developing kidney tissue. WT cells showing invasive cancer characteristics, also retain renal stem cell behaviours. In-vitro culture of WT is hampered by limited replicative potential. This study aimed to establish a longterm culture of WT cells to enable the study of molecular events to attempt to explain its cellular senescence.

Methods: Primary cell cultures from fresh WT tumor specimen were established. Of 5 cultures tried, only 1 could be propagated for more than 7 passages. One culture, identified as PSU-SK-1, could be maintained > 35 passages and was then subjected to molecular characterization and evaluation for cancer characteristics. The cells consistently harbored concomitant mutations of CTNNB1 (Ser45Pro) and WT1 (Arg413Stop) thorough the cultivation. On Transwell invasion assays, the cells exhibited migration and invasion at 55% and 27% capability of the lung cancer cells, A549. On gelatin zymography, PSU-SK-1 showed high expression of the matrix metaloproteinase. The cells exhibited continuous proliferation with 24-hour doubling time until passages 28-30 when the growth slowed, showing increased cell size, retention of cells in G1/S proportion and positive β-galactosidase staining. As with those evidence of senescence in advanced cell passages, expression of p21 and cyclin D1 increased when the expression of β-catenin and its downstream protein, TCF, declined. There was also loss-of-expression of p53 in this cell line. In conclusion, cellular senescence was responsible for limited proliferation in the primary culture of WT, which was also associated with increased expression of p21 and was independent of p53 expression. Decreased activation of the Wnt signalling might explain the induction of p21 expression.
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http://dx.doi.org/10.7150/jca.16316DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5039371PMC
September 2016

The Expressions of P53, Bcl-2, and P-Glycoprotein and Prognostic Impact in Patients with Peripheral T-Cell Lymphoma (PTCL).

J Med Assoc Thai 2015 Oct;98(10):950-6

Objective: To define the expressions of p53, Bcl-2, and p-glycoprotein and prognostic impact in patients with peripheral T-cell lymphoma (PTCL).

Material And Method: Adult patients with newly diagnosed as PTCL were reviewedfrom 2001 to 2012. Clinical parameters and outcome data were extracted The specimens were stained for p53, Bcl-2, and p-glycoprotein. The results were analyzed for association with disease stage, International Prognostic Index (IPI), Prognostic Index for T-cell lymphoma (PIT), overall response rate (ORR), and overall survival (OS).

Results: Of eligible 159 patients (113 males, 46 females), median age was 53 years old The histological subtypes included peripheral T-cell lymphoma, not otherwise specified (PTCL, NOS) 35.8%, angioimmunoblastic T-cell lymphoma (AITL) 18.2%, extranodal NK/T-cell lymphoma (ENKL) 17.0%, subcutaneous panniculitis-like T-cell lymphoma (SPTCL) 12.6%, cutaneous T-cell lymphoma (CTCL) 11.3%, anaplastic large cell lymphoma (ALCL) 4.4%, and enteropathy-associated T-cell lymphoma (EATL) 0.6%. Tissue samples were obtainedfor analysis in 135 patients. P53, Bcl-2, and p-glycoprotein were positive in 87%, 49%, and 28%, respectively. Median OS was 25 months. The expressions of p53, Bcl-2, and p-glycoprotein were not significantly correlated with advanced stage, high prognostic scores, ORR, and OS. However Bcl-2 expression was statistically associated with histological subtypes. From Cox regression analyses, advanced stage, high prognostic scores, and histological subtypes were independent prognostic factors for OS.

Conclusion: The biomarker expressions varied in different types of PTCL and did not show any correlation with prognostic factors, ORR, or OS.
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October 2015

Interobserver variation in classifying lymphomas among hematopathologists.

Diagn Pathol 2014 Aug 22;9:162. Epub 2014 Aug 22.

Department of Pathology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.

Background: Lymphomas are common malignancies that have various subtypes with many overlapping histologic, immunophenotypic and genetic features. Therefore, discordance in classifying lymphoma among pathologists may be encountered. But this issue is not well characterized. We conducted the present study to demonstrate discordances among Thai hematopathologists as well as to highlight common arguing points for classifying lymphomas.

Methods: The 117 lymphoma cases were randomly retrieved and individually reviewed by 7 hematopathologists, members of the "Thai Hematopathologist Group," without knowing the original diagnoses. The consensus diagnoses were given from a discussion by all members. In each case, the diagnosis from each participant was compared with the consensus diagnosis and classified into 4 categories as follow: 1) concordance, 2) minor discordance, 3) major discordance and 4) serious discordance.

Results: There were approximately 11% discordances between original and consensus diagnoses. The average discordances among all pathologists according to minor, major and serious discordances were 10%, 3.5% and 0.3%, respectively. Diffuse large B-cell lymphoma had the least discordance (7%). Small biopsies had been found to increase discordances in some lymphoma subtypes.

Conclusions: The present study reveals some degrees of interobserver variation in classifying of lymphoma by using the 2008 WHO classification among hematopathologists. Some types of lymphomas on small biopsies were found to have a significant higher discordance rate. This study also described some common diagnostic discordances regarded as potential pitfalls in classifying lymphomas.

Virtual Slides: The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/13000_2014_162.
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http://dx.doi.org/10.1186/s13000-014-0162-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4159536PMC
August 2014

A rare case of primary muscular non-Hodgkin's lymphoma and a review of how imaging can assist in its diagnosis.

Singapore Med J 2013 Sep;54(9):e179-82

Department of Radiology, Faculty of Medicine, Prince of Songkla University, 15 Kanchanavanich Road, Hat Yai, Songkhla, 90110, Thailand.

Primary malignant non-Hodgkin's lymphoma of the muscle is rare. Currently, imaging tools are necessary to enable its diagnosis. Herein, we report the case of a patient who presented with swelling and pain in the right thigh and pelvis. Computed tomography findings revealed isodense masses in the patient's right thigh and left iliacus muscle, leading to the initial diagnosis of either primary muscular lymphoma or soft tissue sarcoma. Further investigation with magnetic resonance imaging was done, and a biopsy was performed. The ensuing histological diagnosis was that of diffuse large B-cell lymphoma.
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http://dx.doi.org/10.11622/smedj.2013179DOI Listing
September 2013

Clinical presentation, treatment, and prognosis of periocular and orbital amyloidosis in a university-based referral center.

Clin Ophthalmol 2013 30;7:801-5. Epub 2013 Apr 30.

Department of Ophthalmology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand.

Objective: The purpose was to present the demographic data, clinical presentation, and treatment options, and to evaluate prognosis, for periocular and orbital amyloidosis in patients at the Songklanagarind Hospital, Thailand.

Method: This was a retrospective study that reviewed the clinical records of six patients who were diagnosed with periocular and orbital amyloidosis between January 1, 2002 and December 31, 2011.

Results: The series included six patients (five female and one male). The mean age was 39.7 years (range 15-79 years). There were five cases of unilateral lesion and one case of bilateral lesion. The most common symptom was a mass lesion (83.3%), followed by irritation (66.7%), bloody tears (16.7%), epiphora (16.7%), eye pain (16.7%), and ptosis (16.7%). Five cases had periocular involvement and one case had orbital involvement. Five cases were investigated to rule out systemic amyloidosis, and no systemic involvement was found in these cases. The median duration of symptoms was 6 months, but the mean was 31 months. The main treatment option was surgical excision. The mean follow-up time was 41 months. There was disease progression in 20% of cases after definitive treatment.

Conclusion: Periocular and orbital amyloidosis presented with a variety of symptoms, depending on the location of the disease. A mass lesion was the most common symptom. The intent of the treatment modalities was to spare function.
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http://dx.doi.org/10.2147/OPTH.S41857DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3646475PMC
May 2013

Extranodal NK/T-cell lymphoma, nasal type, includes cases of natural killer cell and αβ, γδ, and αβ/γδ T-cell origin: a comprehensive clinicopathologic and phenotypic study.

Am J Surg Pathol 2012 Apr;36(4):481-99

Department of Pathology, Division of Hematopathology, University of Pittsburgh School of Medicine, Pittsburgh 15213-2582, USA.

Extranodal NK/T-cell lymphoma (ENKTL), nasal type, may be of NK or T-cell origin; however, the proportion of T-ENKTLs and whether they are of αβ or γδ type remains uncertain. To elucidate the cell of origin and detailed phenotype of ENKTL and assess any clinicopathologic associations, 67 cases of ENKTL from Thailand were investigated, together with 5 γδ enteropathy-associated T-cell lymphomas (EATLs) for comparison. In all, 70% of the ENKTL were T-cell receptor (TCR) β,γ and, in cases tested, δ negative (presumptive NK origin); 5% were TCR γδ, 3% were TCR αβ, 1% were TCR αβ/γδ, and 21% were indeterminate. Out of 17 presumptive NK-ENKTLs tested, 3 had clonal TCR rearrangements. All cases were EBV and TIA-1; >85% were positive for CD3, CD2, granzyme B, pSTAT3, and Lsk/MATK; and all were CD16. Presumptive NK-ENKTLs had significantly more frequent CD56 (83% vs. 33%) and CXCL13 (59% vs. 0%) but less frequent PD-1 (0% vs. 40%) compared with T-ENKTLs. Of the NK-ENKTLs, 38% were Oct-2 compared with 0% of T-ENKTLs, and 54% were IRF4/MUM1 compared with 20% of T-ENKTLs. Only αβ T-ENKTLs were CD5. Intestinal ENKTLs were EBV and had significantly more frequent CD30, pSTAT3, and IRF4/MUM1 expression but less frequent CD16 compared with γδ EATL. Significant adverse prognostic indicators included a primary non-upper aerodigestive tract site, high stage, bone marrow involvement, International Prognostic Index ≥2, lack of radiotherapy, Ki67 >40%, and CD25 expression. The upper aerodigestive tract ENKTLs of T-cell origin compared with those of presumptive NK origin showed a trend for better survival. Thus, at least 11% of evaluable ENKTLs are of T-cell origin. Although T-ENKTLs have phenotypic and some possible clinical differences, they share many similarities with ENKTLs that lack TCR expression and are distinct from intestinal γδ EATL.
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http://dx.doi.org/10.1097/PAS.0b013e31824433d8DOI Listing
April 2012

No Prognostic Impact of p53 and P-Glycoprotein Expression in Patients with Diffuse Large B-Cell Lymphoma.

ISRN Oncol 2011 22;2011:670358. Epub 2011 Dec 22.

Department of Pathology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand.

The aim of this study was to determine the clinical significances of p53 and p-glycoprotein (P-gp) expression on outcome predictors for patients with DLBC. We assessed the immunohistochemical expression of p53 and P-gp using formalin-fixed, paraffin-embedded specimens in 108 patients diagnosed with de novo DLBC. A high expression of p53 was found in 53.7% of the patients. No expression of P-gp was demonstrated in any of the specimens. There were no significant differences in the complete remission (CR) rate (P = 0.79), overall survival (OS) (P = 0.73), or disease-free survival (DFS) (P = 31) between the p53-positive and p53-negative groups. The final model from multivariate analysis that revealed poor performance status was significantly associated with CR (P < 0.001) and OS (P < 0.001). Moreover, the advanced stage was a significant predictor of DFS (P = 0.03). This study demonstrated no impact of the expression of p53 on either response or survival rates.
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http://dx.doi.org/10.5402/2011/670358DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3253489PMC
August 2012

Isolated orbital neurofibroma in NF-1 negative patients.

J Med Assoc Thai 2011 Oct;94(10):1281-2

Department of Ophthalmology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand.

Isolated orbital neurofibroma unassociated with systemic neurofibromatosis is relatively rare and may be difficult to clinically differentiate from other orbital tumors. The authors report a case of isolated orbital neurofibroma without neurofibromatosis type 1.
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October 2011

Cushing's syndrome in an infant secondary to malignant adrenocortical tumors with somatic mutation of beta-catenin.

Pediatr Dev Pathol 2010 May-Jun;13(3):238-42

Molecular Biology Laboratory, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand.

A role of beta-catenin (CTNNB1) in the molecular pathogenesis of adrenocortical carcinoma (ACC) has been suspected in adult ACC and pediatric pigmented nodular adrenocortical disease, but it has never been reported in pediatric ACC. We present the case of a 4-month-old Thai infant who had Cushing's syndrome secondary to bilateral adrenal tumors with hepatic metastasis. The child was successfully treated with a bilateral adrenalectomy and wedge resection of the liver nodule. Histopathology revealed bilateral adrenocortical tumors with different histologic grades; the right tumor had a higher score, according to modified Weiss criteria. On molecular study, a deletion mutation of beta-catenin involving codons 44 to 45 was detected in the right adrenal tumor. The same mutation was found in peripheral blood before treatment; this mutation disappeared after tumor removal. The left tumor harbored wild-type beta-catenin. Immunohistochemistry showed nuclear accumulation of beta-catenin on the right adrenal tumor and the metastatic nodule. In summary, we present evidence that supports the role of the Wnt-signaling pathway in the carcinogenesis of pediatric adrenocortical carcinoma.
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http://dx.doi.org/10.2350/09-07-0683-CR.1DOI Listing
September 2010

Outcomes of pediatric nephroblastoma in southern Thailand.

Asian Pac J Cancer Prev 2008 Oct-Dec;9(4):643-7

Pediatric Solid Tumor Care Team and Tumor Biology Research Group, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand.

Background And Aims: The outcomes of nephroblastoma (Wilms tumor, WT) in our institute and other developing countries are notably below results in most developed countries. The objective of this study was to review treatment outcomes of pediatric nephroblastoma in southern Thailand during the past decade and attempt to isolate factors associated with a poor prognosis.

Patients And Methods: The records of 34 WT patients, aged less than 16 years, who were operated on in Songklanagarind Hospital, Thailand, during the period from January 1996 to December 2007 were reviewed. The management protocol followed the scheme of the US National Wilms Tumor Study Group (NSWTG).

Results: Thirteen cases (38.2%) were diagnosed as stage I, 4 (11.8%) as stage II, 13 (38.2%) as stage III and 2 (5.9%) as stage IV. Two cases with bilateral disease (stage V) had stage I tumors in both kidneys. Four-year overall survival (OS) and event free survival (EFS) rates were 65.2% and 52.7%, respectively. Univariate analysis by Log-rank test revealed statistically significant associations between OS and nodal status (p-value <0.01), manifestation of gross hematuria (p-value 0.02), and tumor size of 10 centimeters or more (p-value 0.02). Multivariate analysis found only the nodal status to be independently associated with OS at a Hazard Ratio of 16.6 (p-value <0.01). Eight of 13 stage I cases and 6/13 stage III cases had relapsed, with two-year post-relapse survival of 42.8%. Significantly poorer outcome was found in cases with early relapse within 200 days after enrolment (p-value 0.02).

Conclusion: The poor outcome of pediatric nephroblastoma in southern Thailand seems to be related at least in part to failures in primary treatment in stage I patients. Large tumor size and gross hematuria were associated with risk of a poorer outcome.
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May 2009

Papillary carcinoma of the thyroid gland in a child of thyrotoxicosis patient receiving radioactive iodine therapy: report of a case.

Pediatr Surg Int 2008 Jun 15;24(6):747-50. Epub 2008 Apr 15.

Pediatric Surgery Unit, Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hatyai, Songkhla, 90110, Thailand.

Herein we present the case of a 9-year-old girl who had an enlarged right lobe of the thyroid gland and sub-clinical hypothyroidism (thyroid stimulating hormone at 9.24 mIU/L). The patient had a history of unintentional exposure to radiation while her mother was receiving radionuclide therapy for diffuse toxic goiter. Ultrasonography of the young girl showed right lobe enlargement with diffuse coarse heterogenous echogenicity, compatible with a microcalcification pattern identified in both lobes of the thyroid gland. Histopathology of the tissue from a thyroidectomy revealed papillary thyroid carcinoma in the right lobe and chronic lymphocytic thyroiditis in the remaining tissue. Molecular pathology demonstrated an RET/PTC1 rearrangement in both tumor and non-tumorous tissue harboring thyroiditis. Considering the history of exposure and the characteristics of the thyroid pathology together, the PTC in this patient was likely a secondary-to-genetic alteration induced by external radiation. This case emphasizes the importance of stringent restrictions when giving radioactive iodine therapy to a patient with small children.
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http://dx.doi.org/10.1007/s00383-008-2151-7DOI Listing
June 2008

A unique case of transient spontaneous regression complicated with tumor lysis syndrome of T-cell lymphoblastic lymphoma in HIV-infected patient without antiretroviral therapy.

J Med Assoc Thai 2007 Sep;90(9):1930-3

Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand.

Spontaneous regression in high-grade non-Hodgkin lymphoma is rare. Herein, the authors report the case of a 26-year-old asymptomatic HIV-infected patient presenting with bleeding per gum after a dental extraction. Initially, a complete blood count showed lymphoblasts and thrombocytopenia. Laboratory investigations were compatible with acute tumor lysis syndrome. Without any steroid or chemotherapy, both clinical and laboratory abnormalities were spontaneously returned to normal limits. However, three weeks later he developed generalized lymphadenopathy. A submandibular gland biopsy revealed to be T-cell lymphoblastic lymphoma. This was followed by the second episode of spontaneous tumor lysis syndrome and spontaneous regression of lymphadenopathy again. At this time, he was treated with cyclophosphamide, adriamycin, vincristine, and prednisolone (CHOP) with whole brain irradiation. During seven months of chemotherapy, the physical examination and blood chemistry were normal. Unfortunately, after seven courses of CHOP, the disease rapidly progressed and ultimately lead to his death.
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September 2007

Primary pigmented nodular adrenocortical disease with synaptophysin immunoreactivity in two thai children.

J Med Assoc Thai 2007 Jun;90(6):1208-13

Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand.

This paper reports the cases of two Thai children diagnosed with primary pigmented nodular adrenocortical disease (PPNAD). The first was a thirteen and a half year old male who presented with Cushing syndrome for three years and severe osteoporosis. He had hypercortisolemia, a non-suppressible dexamethasone suppression test, and low serum ACTH. A CT scan showed slight enlargement of both adrenal glands. A bilateral adrenalectomy was performed. The second case was a thirteen-year old female who presented with mild Cushing syndrome for one year with paradoxical response to high-dose dexamethasone suppression test. An MRI revealed suspected microadenoma of the left adrenal gland. Blood sampling showed a higher cortisol level from the left adrenal vein than from the right. A left adrenalectomy was performed, followed by a right adrenalectomy four months later. The pathologies were compatible with PPNAD. Immunostaining for synaptophysin was done in both patients. The cells in the adrenocortical micronodules of both cases were stained intensely with antiserum for synaptophysin, whereas the surrounding adrenal cortex did not.
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June 2007
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