Malignant epithelial tumours in children: incidence and aetiology

Thyroid cancer, clinical and hystopathological study on patients under 25 years in Tabriz, Iran (2000-2012)

Thyroid cancer comprises a broad spectrum of diseases with variable prognoses. The aim of this study was to assess thyroid cancer in young population using the surveillance, epidemiology and end results database and whether radioactive fallout from the Chernobyl accident in 1986 influenced thyroid cancer incidence among children and adolescents in Tabriz, Iran. Patients aged 5-25 in Tabriz from April 2000 to April 2012 were studied. Using the surveillance and end results database, the study examined the overall incidence of thyroid cancer with variations based on tumor pathology, size and stage, as well as the current surgical therapy of thyroid carcinoma. This study demonstrated a positive correlation between thyroid carcinoma tumor size and stage of disease. Mortality rates were higher among men than women. Recurrence rates are also higher in men. Compared with women, men have greater likelihood ofloco regional lymph node involvement and more than twice the rate of distant metastases. Operative treatment for thyroid cancer also has shifted with Radical dissection+Total thyroidectomy replacing partial thyroidectomy as the most common surgical procedure. Our data indicate that the increasing incidence of thyroid cancer cannot be accounted for fully by an increased detection of small neoplasms. This study show the increasing in thyroid cancer incidence related to exposure to radiation from the Chernobyl accident.

Salivary gland anlage tumor: a clinicopathological study of two cases

We report two cases of salivary gland anlage tumor (SGAT), a nasopharyngeal lesion that affects newborns. The first case concerned a male newborn, presenting respiratory distress secondary to a nasopharyngeal mass. The second case was diagnosed in a 6-week-old girl, suffering from respiratory difficulties due to a nasal cavity mass. A magnetic resonance imaging (MRI) in the second case revealed the presence of several small round and linear fluid-like areas. Histologically, both lesions were suggestive of SGAT, characterized by epithelial structures that blended with spindle-cells, drawing highly cellular nodules. Connective tissue between nodules contained squamous cystic nests and ducts.

Adrenal cortical neoplasms in children: why so many carcinomas and yet so many survivors?

Adrenal cortical neoplasms in children are represented by a disproportionate number of cases that have been diagnosed pathologically as adrenocortical carcinomas (ACCs)-as many as 90% of all cortical tumors in some pediatric series. Like other solid malignancies of childhood, over half of ACCs present in the first 4 years of life in over 50% of cases. Most are sporadically occurring neoplasms, but ACCs are a manifestation of Beckwith-Wiedemann and Li-Fraumeni syndromes. Despite the fact that the microscopic features are often quite atypical and identical in many respects to ACCs in adults, the clinical outcome is favorable in 70% or more of cases. Tumor weight is seemingly a significant determinant in prognosis at a threshold of greater than 400 g. A risk assessment system is proposed that incorporates tumor weight, localization of tumor to the gland without invasion into the surrounding tissues or organs, and absence of metastasis.

The epidemiology of neonatal tumours. Report of an international working group

Neonatal tumours occur every 12,500-27,500 live births and comprise 2% of childhood malignancies, but there is little clarity as to their real prevalence, sites of origin and pathological nature as reported series vary. As an entity, neonatal tumours provide a unique window of opportunity to study tumours in which minimal environmental interference has occurred. The majority of tumours present with a mass at birth (e.g., teratomas, neuroblastomas, mesoblastic nephroma, fibromatosis), which are not infrequently identified on antenatal ultrasound. Histologically, teratoma and neuroblastoma remain the two main tumour types encountered with soft tissue sarcoma, renal tumours, CNS tumours and leukaemia being the next most common tumour types identified. Malignant tumours are uncommon in the neonatal period per se and benign tumours may have malignant potential. A particular problem exists in clinical classification, as histological features of malignancy do not always correlate with clinical behaviour. Benign tumours may also be life threatening because of their size and location. Other tumours may demonstrate local invasiveness, but no metastatic potential, and tumours that are clearly malignant may demonstrate unpredictable or uncertain behaviour. Screening programmes have brought more tumours to light, but do not appear to affect the overall prognosis. They may provide clues to the stage at which tumours develop in foetu. The aetiology of cancer in children is multifactorial and includes both genetic and environmental factors. The association between congenital abnormalities and tumours is well established (15% of neonatal tumours). Genetic defects are highly likely in neonatal tumours and include those with a high risk of malignancy (e.g., retinoblastoma), but also genetically determined syndromes with an increased risk of malignancy and complex genetic rearrangements. Tumours are mostly genetically related at a cellular level and factors influencing cellular maturation or apoptosis within the developing foetus may continue to operate in the neonatal period. Cytogenetics of neonatal neoplasms appear to differ from neoplasms in older children, thus possibly explaining some of the observed differences in clinical behaviour. Certain constitutional chromosome anomalies, however, specifically favour tumours occurring in the foetal and neonatal period. In support of this hypothesis, certain cytogenetic anomalies appear to be specific to neonates, and a number of examples are explored. Other environmental associations include ionizing radiation, drugs taken during pregnancy, infections, tumours in the mother and environmental exposure.

Carcinoid tumours of the appendix in children 1957-1986: incidence, treatment and outcome

Forty carcinoid tumours of the appendix were identified in children under 15 years of age between 1957 and 1986 from the records of the West Midlands Regional Children's Tumour Research Group. A significant excess of girls was observed (P = 0.02). All tumours were discovered incidentally and two patients underwent further surgery. Twenty-two of the 29 confirmed locations (76 per cent) were at the tip of the appendix and 34 of the 40 tumours (85 per cent) had invaded beyond the appendiceal submucosa. The reported incidence rate of 1.14 per million children per year remained constant throughout the study period. No recurrences, metastases or deaths from tumour were detected. Appendicectomy alone is confirmed as usually curative, although right hemicolectomy is occasionally necessary. Caution during routine appendicectomy is recommended to avoid possible tumour damage, as is consistent histological examination of all appendices in the paediatric age group. The importance of long-term follow-up is emphasized.