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Odone-Filho V, Cristofani LM, Maluf PT, Almeida MTA, Halley N, Vince CSC, de Azambuja AMP, Brumatti M, Lubraico P, da Camara Lopes LHA, Leite KRM, Silva JLF, Plese JPP, Weltman E. Involvement of the central nervous system in neuroblastomas: A potential direct pathway. Med Hypotheses 2019; 136:109479. [PMID: 31778890 DOI: 10.1016/j.mehy.2019.109479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 10/25/2019] [Accepted: 11/08/2019] [Indexed: 11/24/2022]
Abstract
Although frequently disseminated to other anatomical sites, neuroblastoma (NB) is rarely reported as involving the central nervous system (CNS), which may reflect insufficient research in poorly controlled systemic disease. Here we demonstrate the involvement of the CNS in patients with NB over 18 months of age at diagnosis of extensive systemic disease. Meningeal metastases were observed even in the presence of complete systemic control. Although no improvement in patient's survival was observed, radiotherapy was effective in preventing CNS recurrence after observation of actual or previous dural disease. In conclusion, this study uncovered the uncommon pathologic involvement of the CNS in children with advanced NB and underscores the meningeal surface as a potential pathway for this to occur.
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Affiliation(s)
- Vicente Odone-Filho
- Sao Paulo University Medical School, Pediatric Department, Hematology-Oncology Division, Brazil.
| | - Lilian Maria Cristofani
- Sao Paulo University Medical School, Pediatric Department, Hematology-Oncology Division, Brazil
| | - Paulo Taufi Maluf
- Sao Paulo University Medical School, Pediatric Department, Hematology-Oncology Division, Brazil
| | | | - Nathalia Halley
- Hematology-Oncology Division, Pediatric Department, Sao Paulo University Medical School, Brazil
| | | | | | - Melina Brumatti
- Hematology-Oncology Division, Pediatric Department, Sao Paulo University Medical School, Brazil
| | - Priscilla Lubraico
- Hematology-Oncology Division, Pediatric Department, Sao Paulo University Medical School, Brazil
| | | | | | | | | | - Eduardo Weltman
- Hospital Israelita Albert Einstein, Department of Radiotherapy, Brazil
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Souza AMDES, Barbuto TM, Freitas FA, Vianna NF, Zanchetta CMC, Forsait S, Borba C, Azambuja AMPD, Cristofani LM, Odone V. An unusual abdominal wall mass in a child. Rev Inst Med Trop Sao Paulo 2017; 59:e16. [PMID: 28423091 PMCID: PMC5398188 DOI: 10.1590/s1678-9946201759016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Accepted: 02/14/2017] [Indexed: 11/22/2022] Open
Abstract
Abdominal tumors are one of the most common types of pediatric cancer. Therefore, they should always be included in the differential diagnosis of abdominal masses. Here, we present the case of a child whose initial hypothesis of diagnosis contemplated this possibility. Later, it was demonstrated that the abdominal mass found was secondary to a common parasitosis. A 2-year old, moderately malnourished and pale white boy was referred with a history of a rapidly growing, well-limited, middle abdominal mass. The mass was 10 by 3 cm, hard and poorly movable, apparently involving both abdominal rectus muscles. A complete resection was performed, revealing an abdominal wall abscess, with intense eosinophilic proliferation, secondary to a local and intense reaction to innumerous Ascaris lumbricoides eggs. Extra luminal infestations with Ascaris, that usually form peritoneal granulomas have been previously described. However, neither external trauma nor fistula, that could explain the superficial presence of the eggs, was found. This description reinforces the relevance of infectious diseases within the differential diagnosis of abdominal masses, particularly in areas with high prevalence of parasitic infestations.
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Affiliation(s)
- Amalia Maria do Espirito Santo Souza
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Pediatria, Instituto de Tratamento do Câncer Infantil (ITACI), São Paulo, São Paulo, Brazil
| | - Tomas Marzagão Barbuto
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Pediatria, Instituto de Tratamento do Câncer Infantil (ITACI), São Paulo, São Paulo, Brazil
| | - Flávia Alessandra Freitas
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Pediatria, Instituto de Tratamento do Câncer Infantil (ITACI), São Paulo, São Paulo, Brazil
| | - Nathalia Fernandes Vianna
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Pediatria, Instituto de Tratamento do Câncer Infantil (ITACI), São Paulo, São Paulo, Brazil
| | - Carla Maria Costa Zanchetta
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Pediatria, Instituto de Tratamento do Câncer Infantil (ITACI), São Paulo, São Paulo, Brazil
| | - Silvana Forsait
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Pediatria, Instituto de Tratamento do Câncer Infantil (ITACI), São Paulo, São Paulo, Brazil
| | - Claudio Borba
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Pediatria, Instituto de Tratamento do Câncer Infantil (ITACI), São Paulo, São Paulo, Brazil
| | - Alessandra Milani Prandini de Azambuja
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Pediatria, Instituto de Tratamento do Câncer Infantil (ITACI), São Paulo, São Paulo, Brazil
| | - Lilian Maria Cristofani
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Pediatria, Instituto de Tratamento do Câncer Infantil (ITACI), São Paulo, São Paulo, Brazil
| | - Vicente Odone
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Pediatria, Instituto de Tratamento do Câncer Infantil (ITACI), São Paulo, São Paulo, Brazil
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Eduardo FDP, Bezinelli LM, de Carvalho DLC, Lopes RMDG, Fernandes JF, Brumatti M, Vince CSC, de Azambuja AMP, Vogel C, Hamerschlak N, Correa L. Oral mucositis in pediatric patients undergoing hematopoietic stem cell transplantation: clinical outcomes in a context of specialized oral care using low-level laser therapy. Pediatr Transplant 2015; 19:316-25. [PMID: 25677170 DOI: 10.1111/petr.12440] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/15/2015] [Indexed: 01/27/2023]
Abstract
OM is a painful inflammatory condition of the oral mucosa, derived from the toxic effects of chemotherapy and radiotherapy. High OM severity is frequently present in HSCT pediatric patients, who exhibit multiple painful ulcers that limit their mastication and swallowing, leading to poor nutritional status. Few studies have demonstrated OM clinical outcomes in young patients undergoing HSCT. Feasibility of oral care and LLLT on OM prophylaxis and treatment is also poorly discussed. The aim of this study was to describe a specialized oral care protocol that included LLLT for pediatric patients undergoing transplantation and to demonstrate the clinical outcomes after OM prevention and treatment. Data from OM-related morbidity were collected from 51 HSCT pediatric patients treated daily with LLLT, followed by standard oral care protocols. All the patients, even infants and young children, accepted the daily oral care and LLLT well. The majority (80.0%) only exhibited erythema in the oral mucosa, and the maximum OM degree was WHO II. Patients who had undergone autologous and HLA-haploidentical transplants showed OM with the lowest severity. The frequency of total body irradiation and methotrexate prescriptions was higher in adolescents when compared with infants (p = 0.044), and adolescents also exhibited OM more severely than infants and young children. We found that good clinical outcomes were obtained using this therapy, mainly in regard to the control of OM severity and pain reduction in the oral cavity. Specialized oral care, including LLLT, is feasible and affordable for HSCT pediatric patients, although some adaptation in the patient's oral hygiene routine must be adopted with help from parents/companions and clinical staff.
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Fernandes JF, Kerbauy FR, Ribeiro AAF, Kutner JM, Camargo LFA, Stape A, Troster EJ, Zamperlini-Netto G, Azambuja AMPD, Carvalho B, Dorna MDB, Vilela MDS, Jacob CMA, Costa-Carvalho BT, Cunha JM, Carneiro-Sampaio MM, Hamerschlak N. Allogeneic hematopoietic stem cell transplantation in children with primary immunodeficiencies: Hospital Israelita Albert Einstein experience. Einstein (Sao Paulo) 2011; 9:140-4. [PMID: 26760806 DOI: 10.1590/s1679-45082011ao2007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To report the experience of a tertiary care hospital with allogeneic hematopoietic stem cell transplantation in children with primary immunodeficiencies. METHODS Seven pediatric patients with primary immunodeficiencies (severe combined immunodeficiency: n = 2; combined immunodeficiency: n = 1; chronic granulomatous disease: n = 1; hyper-IgM syndrome: n = 2; and IPEX syndrome: n = 1) who underwent eight hematopoietic stem cell transplants in a single center, from 2007 to 2010, were studied. RESULTS Two patients received transplants from HLA-identical siblings; the other six transplants were done with unrelated donors (bone marrow: n = 1; cord blood: n = 5). All patients had pre-existing infections before hematopoietic stem cell transplants. One patient received only anti-thymocyte globulin prior to transplant, three transplants were done with reduced intensity conditioning regimens and four transplants were done after myeloablative therapy. Two patients were not evaluated for engraftment due to early death. Three patients engrafted, two had primary graft failure and one received a second transplant with posterior engraftment. Two patients died of regimen related toxicity (hepatic sinusoidal obstruction syndrome); one patient died of progressive respiratory failure due to Parainfluenza infection present prior to transplant. Four patients are alive and well from 60 days to 14 months after transplant. CONCLUSION Patients' status prior to transplant is the most important risk factor on the outcome of hematopoietic stem cell transplants in the treatment of these diseases. Early diagnosis and the possibility of a faster referral of these patients for treatment in reference centers may substantially improve their survival and quality of life.
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Affiliation(s)
| | | | | | - Jose Mauro Kutner
- Blood Bank, Hospital Israelita Albert Einstein - HIAE, São Paulo, SP, BR
| | | | - Adalberto Stape
- Hospital Israelita Albert Einstein - HIAE, São Paulo, SP, BR
| | | | | | | | - Bruna Carvalho
- Hospital Israelita Albert Einstein - HIAE, São Paulo, SP, BR
| | - Mayra de Barros Dorna
- Children's Institute, Hospital da Clínicas of Medial College, Unversidade de São Paulo - USP, São Paulo, SP, BR
| | | | - Cristina Miuki Abe Jacob
- Children's Institute, Hospital da Clínicas of Medial College, Unversidade de São Paulo - USP, São Paulo, SP, BR
| | | | - Jose Marcos Cunha
- Universidade Federal do Rio de Janeiro - UFRJ, Rio de Janeiro, RJ, BR
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