Pons gliomlu çocuk hastada ifosfamide bağlı gelişen hemorajik sistitin tedavisi

Year 2013, Volume: 2 Issue: 3, 229 - 231, 01.09.2013

Ahmet Akça Oktay Akça Nagihan İnan Ahmet Kaya Muhammet Dönmez Sema Büyükkapubay

https://doi.org/10.5505/abantmedj.2013.47450

Abstract

Bu yazıda pons gliomu nedeni ile ifosfamid kullanan ve profilaktik olarak mesna kullanmasına rağmen tedavi sonunda hemorajik sistit gelişen 5 yaşında erkek olgu sunulmuştur. Ultrason ve doppler ultrasonda mesane sağ lateral duvarda vasküler kitle izlendi. Manyetik rezonans görüntülemede MRG mesane sağ lateral duvarda belirgin kalınlaşma ve kontrast tutulumu mevcut iken detrusor kas intensitesi normal izlendi. Sistoskopi ve biyopsi sonrasında biyopsi sonucu ‘malign transformasyon izlenmedi’ şeklinde raporlanan hasta mesna daha yüksek dozda tekrar kullanılarak tedavi edildi. Böylece pediatrik hastalarda daha zor olan sistoskopinin tekrarlanmasına ve mesane irrigasyonuna ihtiyaç duyulmadı.

Keywords

Ifosfamid, pons gliomu, hemorajik sistit, Mesna, cerrahi

Management of ifosfamide induced hemorrhagic cystitis in a pediatric patient with pontine glioma

Abstract

We present the case of a 5 year old boy with hemorrhagic cystitis HS who diagnosed after the use of Ifosfamide due to Pons glioma. Although Mesna used for prophylaxis during treatment, developed HS at the end of the chemotherapy CT . USG and Doppler USG showed a vascularized mass at the right wall of the bladder. Magnetic resonance imaging showed rigth bladder wall thickenign with significant enhancement and normal apperance of detrusor msucle. The mass evaluated by urologic endoscopic surgery and taken biopsy reported as "no any malign transformation". Mesna used once again in higher dosage and we did not need additional urologic endoscopic surgery or bladder irrigation which were very troublesome in pediatric age group.

Keywords

Ifosfamide, pontine glioma, hemorrhagic cystitis, Mesna, surgery

References

• Wong-You-Cheong JJ, Woodward PJ, Manning MA, Davis CJ. From the archives of the AFIP: Inflammatory and nonneoplastic bladder masses: radiologic-pathologic correlation. Radiographics 2006;26(6):1847-1868.
• Manikandan R, Kumar S, Dorairajan LN. Hemorrhagic cystitis: A challenge to the urologist. Indian J Urol 2010;26(2):159–166.
• Decker DB, Karam JA, Wilcox DT. Pediatric hemorrhagic cystitis. J Pediatr Urol 2009;5(4):254-264.
• Bogris SL, Johal NS, Hussein I, Duffy PG, Mushtag I. Is it safe to use aluminum in the treatment of pediatric hemorrhagic cystitis? A case discussion of aluminum intoxication and review of the literature. J Pediatr Hematol Oncol 2009;31(4):285-288.
• Korkmaz A, Topal T, Oter S. Pathophysiological aspects of cyclophosphamide and ifosfamide induced hemorrhagic cystitis; implication of reactive oxygen and nitrogen species as well as PARP activation. Cell Biol Toxicol 2007;23(5):303- 312.
• deVries CR, Freiha FS. Hemorrhagic cystitis: a review. J Urol 1990;143(1):1-9.
• Huppman AR, Pawel BR. Polyps and masses of the pediatric urinary bladder: a 21-year pathology review. Pediatr Dev Pathol 2011;14(6):438-444.
• Agrons GA, Wagner BJ, Lonergan GJ, Dickey GE, Kaufman MS. From the archives of the AFIP. Genitourinary rhabdomyosarcoma in children: radiologic-pathologic correlation. Radiographics 1997;17(4):919-937.
• Ritch CR, Poon SA, Sulis ML, Schlussel RN. Cutaneous vesicostomy for palliative management of hemorrhagic cystitis and urinary clot retention. Urology 2010;76(1):166- 168.
• Stillwell TJ, Benson RC Jr. Cyclophosphamide-induced hemorrhagic cystitis. A review of 100 patients. Cancer 1988;61(3):451-457.
• Kijima T, Masuda H, Suzuki M, et al. Cyclophosphamide- induced bladder cancer: three case reports. Hinyokika Kiyo 2003;49(8):483-486.