Pleuropulmonary blastoma: a report from the TREP (Tumori Rari in Età Pediatrica) Project

INTRODUCTION

Pleuropulmonary blastoma (PPB) is a rare, aggressive mesenchymal tumor of childhood. The Italian Tumori Rari in Età Pediatrica (TREP) Registry was the first in Europe dedicated to prospective data collection on rare pediatric tumors. We analyzed data from an Italian series of patients with PPB, focusing on the role of the TREP Project.

METHODS

We considered patients aged 0-14 with histologically confirmed diagnosis, registered in population-based cancer registries (before 2000) or the TREP Registry (2000 to 2014), and analyzed data on clinical characteristics, treatment, and outcome. Event-free survival (EFS) and overall survival (OS) were estimated. Relevant prognostic factors were identified performing a univariate analysis.

RESULTS

Thirty-seven cases were included (7 type I, 13 type II, 17 type III). The average diagnosis rate rose from 1.10 to 1.73 cases/year after the TREP Project started. All patients underwent surgery, 33 received chemotherapy, and 9 had radiotherapy. The median follow-up was 8.7 years. For type I, II, and III, respectively, the 5-year OS was 85.7% (33.4-97.9), 52.7% (23.4-75.5), and 57.8% (31.1-77.3); the 5-year EFS was 85.7% (33.4-97.9), 52.7% (23.4-75.5), and 52.9% (27.6-73.0). Favorable prognostic factors for EFS were Intergroup Rhabdomyosarcoma Study (IRS) stage I (p = 0.03) and T1 tumor (p = 0.05). A total of 78.3% of patients who had chemotherapy after 2000 received a standardized treatment.

CONCLUSIONS

The TREP Registry showed an excellent capacity for registering cases of PPB. Patients received homogeneous treatment after the TREP Project started. Long-term outcomes were excellent for type I and unsatisfactory for type II and III. Tumor invasiveness and IRS stage were of prognostic value.

Pediatric lung adenocarcinoma presenting with brain metastasis: a case report

BACKGROUND

Diagnosis and treatment of primary lung adenocarcinoma in children remains challenging given its rarity. Here we highlight the clinical history, pathological evaluation, genomic findings, and management of a very young patient with metastatic lung adenocarcinoma.

CASE PRESENTATION

A 10-year-old white girl presented with brain metastases due to primary pulmonary adenocarcinoma. Next generation sequencing analysis with "Comprehensive Cancer Panel" highlighted the presence of multiple non-targetable mutations in the FLT4, UBR5, ATM, TAF1, and GUCY1A2 genes. She was treated aggressively with chemotherapy, surgery, and radiation therapy for local and distant recurrence. Eventually, therapy with nivolumab was started compassionately, and she died 23 months after diagnosis.

CONCLUSIONS

Extremely rare cancers in children such as lung adenocarcinoma need accurate and specific diagnosis in order to develop an optimal plan of treatment. It is also necessary to underline that "children are not little adults," thus implying that an adult-type cancer in the pediatric population might have a different etiopathogenesis. Diagnostic confirmation and primary treatment of such rare conditions should be centralized in reference centers, collaborative networks, or both, with multidisciplinary approaches and very specific expertise.

Gastrointestinal tract carcinoma in pediatric and adolescent age: The Italian TREP project experience

BACKGROUND

Gastrointestinal (GI) carcinomas are very rare in the pediatric and adolescent age range. We report the clinical features, treatment, and outcome of a series of children and adolescents with GI carcinoma prospectively registered in the Italian Tumori Rari in Età Pediatrica (TREP) project.

METHODS

The TREP project developed diagnostic and therapeutic guidelines based on recommendations currently in use for adults. Clinical data were centrally registered and reviewed.

RESULTS

Fifteen patients were registered over the years 2000-2016. Most of the tumors were colorectal carcinomas (12 cases). All but one patient had advanced-stage disease (American Joint Committee on Cancer stages III-IV), and the majority of patients had aggressive histological subtypes, i.e. poorly differentiated (G3) (five patients), mucinous (four patients), and signet ring (two patients) adenocarcinomas. Surgery was performed in 13 of 15 patients, and was radical in nine of 13 patients. Only one patient received postoperative radiotherapy. All patients received chemotherapy, with the addition of bevacizumab in two cases. Nine patients were still alive at the time of the present report, but two of them had only just completed their treatment program and one patient is still on treatment. Six patients died due to disease progression.

CONCLUSIONS

This prospective report on pediatric GI tract carcinomas confirms the rarity and biological aggressiveness of these diseases in pediatric and adolescent age. Further prospective studies are needed to explore the distinct biology of tumor in this age group in order to find new therapeutic targeted agents.

Papillary Thyroid Carcinoma in Pediatric Age: An Example of a Rare Tumour Managed Within a Cooperative Comprehensive Project

Though rare in childhood, thyroid cancers represent the most frequent tumours of endocrine glands in childhood and adolescence. Papillary thyroid carcinoma is a nonmedullary, follicular-derived differentiated tumour of the thyroid. There is still controversy concerning the therapeutic approach to be adopted of PTCs in the paediatric population, regarding the extent of the surgical approach, and the need for radioactive iodine (RAI) therapy. The cooperative TREP project (Tumori Rari in Età Pediatrica [Rare Tumours in Paediatric Age]) was launched in Italy in 2000 (under the patronage of AIEOP - Associazione Italiana Ematologia Oncologia Pediatrica) with a view to improving both researches on the clinical management of the less common paediatric cancers. The aim of the project is to merge clinical data and elaborate diagnostic and therapeutic guidelines for everyone of these rare tumours within a single framework: of course papillary thyroid carcinoma have been analysed in the TREP project. The cooperative model of TREP led to the establishment of a larger cooperative group, EXPeRT (European Cooperative Study Group for Pediatric Rare Tumors), seeking to create collaboration and communication within European members. EXPeRT aims to promote clinical and biological research in paediatric rare tumours by strengthening collaboration between the founder national groups and international partners. The studies have demonstrated that international cooperation in childhood rare tumours is not only achievable, but may be of great advantage.

Management and follow-up of urothelial neoplasms of the bladder in children: a report from the TREP project

BACKGROUND

Urothelial neoplasms of the bladder (UNB) are rare in patients under 20 years of age, and even rarer in the first decade of life. The present series was investigated to provide recommendations on patient management in terms of therapeutic strategy and follow-up.

PROCEDURE

This is a retrospective analysis on 12 patients with UNB under 18 years of age. Data were extracted from the national database of the TREP (Tumori Rari in Età Pediatrica) Project.

RESULTS

Ten of the 12 patients presented with a single episode of hematuria, while the discovery of the lesion was incidental in two. Eleven of the 12 lesions were G1 and one was G2/G3; none of the lesions invaded the lamina propria. All lesions were removed completely by transurethral resection. No further treatment was administered in nine children but three received a single dose of intravesical chemotherapy (epirubicin in 2, mitomycin in 1). Only one patient experienced a recurrence and all patients are alive in complete remission with a median follow-up of 30 months (range 4-112). Follow-up investigations varied at the different centers and included abdominal ultrasound in nine patients, cystoscopy in seven, and additional radiological investigations in a few cases.

CONCLUSIONS

UNB in children seems to be a low-grade, scarcely aggressive disease with an excellent prognosis. The role of intravesical chemotherapy is debatable. Follow-up can be based on ultrasound. The adoption of shared recommendations should enable unnecessary treatment and invasive investigations to be avoided.

Cutaneous melanoma in children and adolescents: the Italian rare tumors in pediatric age project experience

OBJECTIVE

To describe a series of cutaneous melanoma in children collected by the Italian Rare Tumors in Pediatric Age project.

STUDY DESIGN

From 2000 to 2012, 54 patients younger than 18 years of age were prospectively registered and treated at 12 Italian pediatric centers on the basis of the same diagnostic/therapeutic recommendations and with the same forms to record clinical data.

RESULTS

Considering the estimated annual incidence in Italy, the registered cases accounted for 30% of those expected in children and 10% of adolescents. Clinically, 47% of the tumors were amelanotic and 81% were raised, 39% of cases had tumor thickness >2 mm, and 36% had lymph node involvement. For the whole series, 5-year event-free survival and overall survival rates were 75.2% and 84.6%, respectively. Patient survival correlated with tumor stage and ulceration. No relapses were recorded for T1-2 (thickness <2 mm), N0, and stage 0-I-II cases.

CONCLUSION

We suggest that the variables influencing survival in children with melanoma are the same as for adults, the clinical approach used in adults is feasible in children, and pediatric cases are more likely to have advanced disease at diagnosis but similar survival. New effective drugs are needed for advanced disease, and biological studies and international cooperative schemes are warranted.