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Matthyssens LE, Nuchtern JG, Van De Ven CP, Gabra HOS, Bjornland K, Irtan S, Stenman J, Pio L, Cross KM, Avanzini S, Inserra A, Chacon JG, Dall'igna P, Von Schweinitz D, Holmes K, Fuchs J, Squire R, Valteau-Couanet D, Park JR, Eggert A, Losty PD, La Quaglia MP, Sarnacki S. A Novel Standard for Systematic Reporting of Neuroblastoma Surgery: The International Neuroblastoma Surgical Report Form (INSRF): A Joint Initiative by the Pediatric Oncological Cooperative Groups SIOPEN∗, COG∗∗, and GPOH∗∗∗. Ann Surg 2022; 275:e575-e585. [PMID: 32649454 DOI: 10.1097/sla.0000000000003947] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To create the first structured surgical report form for NBL with international consensus, to permit standardized documentation of all NBL-related surgical procedures and their outcomes. SUMMARY OF BACKGROUND DATA NBL, the most common extracranial solid malignant tumor in children, covers a wide spectrum of tumors with significant differences in anatomical localization, organ or vessel involvement, and tumor biology. Complete surgical resection of the primary tumor is an important part of NBL treatment, but maybe hazardous, prone to complications and its role in high-risk disease remains debated. Various surgical guidelines exist within the protocols of the different cooperative groups, although there is no standardized operative report form to document the surgical treatment of NBL. METHODS After analyzing the treatment protocols of the SIOP Europe International Neuroblastoma Study Group, Children's Oncology Group, and Gesellschaft fuer Paediatrische Onkologie und Haematologie - German Association of Pediatric Oncology and Haematology pediatric cooperative groups, important variables were defined to completely describe surgical biopsy and resection of NBL and their outcomes. All variables were discussed within the Surgical Committees of SIOP Europe International Neuroblastoma Study Group, Children's Oncology Group, and Gesellschaft fuer Paediatrische Onkologie und Haematologie - German Association of Pediatric Oncology and Haematology. Thereafter, joint meetings were organized to obtain intercontinental consensus. RESULTS The "International Neuroblastoma Surgical Report Form" provides a structured reporting tool for all NBL surgery, in every anatomical region, documenting all Image Defined Risk Factors and structures involved, with obligatory reporting of intraoperative and 30 day-postoperative complications. CONCLUSION The International Neuroblastoma Surgical Report Form is the first universal form for the structured and uniform reporting of NBL-related surgical procedures and their outcomes, aiming to facilitate the postoperative communication, treatment planning and analysis of surgical treatment of NBL.
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Affiliation(s)
- Lucas E Matthyssens
- Department of Gastrointestinal and Pediatric Surgery, Princess Elisabeth Children's Hospital, Ghent University Hospital, Ghent, Belgium
| | - Jed G Nuchtern
- Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Cees P Van De Ven
- Department of Pediatric Surgery, Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Hany O S Gabra
- Department of Pediatric Surgery, The Great North Children Hospital, Newcastle University Teaching Hospitals, Newcastle Upon Tyne, United Kingdom
| | - Kristin Bjornland
- Department of Gastrointestinal and Pediatric Surgery, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Sabine Irtan
- Department of Pediatric Surgery, Hôpital d'enfants Armand-Trousseau, Assistance Publique-Hôpitaux de Paris, Sorbonne University, Paris, France
| | - Jakob Stenman
- Department of Pediatric Surgery and Urology, Astrid Lindgren Children's Hospital, Karolinska University Hospital and Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Luca Pio
- Department of Visceral and Urological Pediatric Surgery, Hôpital Universitaire Robert-Debré, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - Kate M Cross
- Specialist Neonatal and Pediatric Surgery, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, United Kingdom
| | | | | | - Javier Gomez Chacon
- Department of Pediatric Surgery, Hospital Universitario y Politécnico La Fé, Valencia, Spain
| | - Patrizia Dall'igna
- Division of Pediatric Surgery, Department of Women's and Children's Health, University of Padova, Padova, Italia
| | - Dietrich Von Schweinitz
- Department of Pediatric Surgery, Dr. von Hauner Children's Hospital, University Hospital, LMU, Munich, Germany
| | - Keith Holmes
- Department of Paediatric Surgery, St George's Hospital, London, United Kingdom
| | - Jorg Fuchs
- Department of Pediatric Surgery and Pediatric Urology, University Hospital Tuebingen, Tuebingen, Germany
| | - Roly Squire
- Department of Paediatric Surgery, Leeds Children's Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | | | - Julie R Park
- Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine, Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Angelika Eggert
- Department of Paediatric Oncology & Hematology, Charité University Medicine Berlin, Germany
| | - Paul D Losty
- Academic Department of Pediatric Surgery, Division of Child Health, Alder Hey Children's Hospital, NHS Foundation Trust, University of Liverpool, Liverpool, United Kingdom
| | - Michael P La Quaglia
- Pediatric Surgical Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical School, New York, New York
| | - Sabine Sarnacki
- Department of Pediatric Surgery, Université de Paris, Hôpital Necker Enfants-Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
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Bausch B, Wellner U, Bausch D, Schiavi F, Barontini M, Sanso G, Walz MK, Peczkowska M, Weryha G, Dall'igna P, Cecchetto G, Bisogno G, Moeller LC, Bockenhauer D, Patocs A, Rácz K, Zabolotnyi D, Yaremchuk S, Dzivite-Krisane I, Castinetti F, Taieb D, Malinoc A, von Dobschuetz E, Roessler J, Schmid KW, Opocher G, Eng C, Neumann HPH. Long-term prognosis of patients with pediatric pheochromocytoma. Endocr Relat Cancer 2014; 21:17-25. [PMID: 24169644 DOI: 10.1530/erc-13-0415] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
A third of patients with paraganglial tumors, pheochromocytoma, and paraganglioma, carry germline mutations in one of the susceptibility genes, RET, VHL, NF1, SDHAF2, SDHA, SDHB, SDHC, SDHD, TMEM127, and MAX. Despite increasing importance, data for long-term prognosis are scarce in pediatric presentations. The European-American-Pheochromocytoma-Paraganglioma-Registry, with a total of 2001 patients with confirmed paraganglial tumors, was the platform for this study. Molecular genetic and phenotypic classification and assessment of gene-specific long-term outcome with second and/or malignant paraganglial tumors and life expectancy were performed in patients diagnosed at <18 years. Of 177 eligible registrants, 80% had mutations, 49% VHL, 15% SDHB, 10% SDHD, 4% NF1, and one patient each in RET, SDHA, and SDHC. A second primary paraganglial tumor developed in 38% with increasing frequency over time, reaching 50% at 30 years after initial diagnosis. Their prevalence was associated with hereditary disease (P=0.001), particularly in VHL and SDHD mutation carriers (VHL vs others, P=0.001 and SDHD vs others, P=0.042). A total of 16 (9%) patients with hereditary disease had malignant tumors, ten at initial diagnosis and another six during follow-up. The highest prevalence was associated with SDHB (SDHB vs others, P<0.001). Eight patients died (5%), all of whom had germline mutations. Mean life expectancy was 62 years with hereditary disease. Hereditary disease and the underlying germline mutation define the long-term prognosis of pediatric patients in terms of prevalence and time of second primaries, malignant transformation, and survival. Based on these data, gene-adjusted, specific surveillance guidelines can help effective preventive medicine.
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Affiliation(s)
- Birke Bausch
- 2nd Department of Medicine, University of Freiburg, Freiburg, Germany Department of Surgery, University Hospital Schleswig-Holstein, Campus Luebeck, Luebeck, Germany Department of Medicine, Familial Cancer Clinic and Oncoendocrinology, University of Padova, Padova, Italy Center for Endocrinological Investigations (CEDIE), Hospital de Ninos R. Gutierrez, Buenos Aires, Argentina Department of Surgery, Center of Minimally Invasive Surgery, Kliniken Essen-Mitte, Essen, Germany Department of Hypertension, Institute of Cardiology, Warsaw, Poland Department of Endocrinology, University of Lorraine, Nancy, France Division of Pediatric Surgery, Department of Pediatrics, University Hospital of Padova, Padova, Italy Pediatric Oncology, Division of Hematology and Oncology, Department of Pediatrics, University Hospital of Padova, Padova, Italy Department of Endocrinology, University Medical Center, University of Duisburg and Essen, Essen, Germany Department of Pediatrics, Hospital Great Ormond Street, London, UK 2nd Department of Internal Medicine, Semmelweis University, Budapest, Hungary Institute of Otorhinolaryngology, NAMS of Ukraine, Kiev, Ukraine Department of Endocrinology, University of Riga, Riga, Latvia Department of Endocrinology, La Timone Hospital, Aix-Marseille University, Marseille, France Department of Nuclear Medicine, University Hospital Timone, Marseilles, France Section for Preventive Medicine, Department of Nephrology and General Medicine, University of Freiburg, Freiburg, Germany Department of Visceral Surgery, University of Freiburg, Freiburg, Germany Department of Pediatrics, University of Freiburg, Freiburg, Germany Department of Pathology, University Medical Center, University of Duisburg and Essen, Essen, Germany Genomic Medicine Institute, Lerner Research Institute and Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Alaggio R, Coffin CM, Dall'igna P, Bisogno G, Olivotto A, Di Venosa B, Fassina A. Myxoinflammatory fibroblastic sarcoma: report of a case and review of the literature. Pediatr Dev Pathol 2012; 15:254-8. [PMID: 22372507 DOI: 10.2350/11-09-1090-cr.1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Myxoinflammatory fibroblastic sarcoma (MIFS) is a low-grade sarcoma generally arising in adults. We present a case of MIFS in a 5-year-old boy with a palpable nodule in the subcutaneous tissue of the scalp. We carried out a literature review to evaluate the diagnostic patterns based on histologic and cytologic features and possible pitfalls and misdiagnoses. A systematic search for articles of interest published between 1995 and 2011 was performed in MEDLINE and PubMed using the words "myxoinflammatory fibroblastic sarcoma," "myxohyaline tumor," and "inflammatory myxoid tumor." Histology and cytology have a pivotal role in the differential diagnosis between MIFS and other potential soft-tissue mimics, such as nodular and proliferative fasciitis and inflammatory myofibroblastic tumor. Fine-needle aspiration cytology is a safe and useful tool for the diagnosis of pediatric patients with MIFS and is important for an accurate and precise preoperative workup to optimize subsequent management and treatment.
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Affiliation(s)
- Rita Alaggio
- Department of Diagnostic Medical Sciences and Special Therapies, University of Padova, Padova, Italy
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Cesca E, Garetto G, Frascella E, Cesaro S, Dall'igna P, Cecchetto G. Hyperbaric oxygen treatment of superficial soft tissue lesions in children with oncologic disease. Pediatr Rep 2012; 4:e1. [PMID: 22690301 PMCID: PMC3357608 DOI: 10.4081/pr.2012.e1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2011] [Accepted: 10/24/2011] [Indexed: 12/03/2022] Open
Abstract
This study aimed to assess the feasibility and results of hyperbaric oxygen therapy (HOT) as supportive treatment of lesions of superficial soft tissues in children with oncological diseases. This was a retrospective analysis and review of all records of children observed at the Pediatric Hematology-Oncology Department of the University of Padova and treated adjuvantly with HOT. Between 1996 and 2010, 12 patients (5 males and 7 females, median age 7 years, range 0.5-16) underwent HOT. The effectiveness of HOT varied according to the lesion treated. Ten out of 12 patients were cured. Efficacy was most questionable in 2 patients with skin graft and flaps at risk. Compliance to therapy was close to 100%. In just one case, HOT was interrupted for the appearance of local skin metastases close to the site of primary tumor. HOT showed itself to be safe and effective in most patients even those immunocompromised or critically ill.
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Cecchetto G, Ferrari A, Bernini G, Alaggio R, Collini P, Virgone C, Terenziani M, Dall'igna P, Cozza R, Conte M, Bisogno G. Sex cord stromal tumors of the ovary in children: a clinicopathological report from the Italian TREP project. Pediatr Blood Cancer 2011; 56:1062-7. [PMID: 21488154 DOI: 10.1002/pbc.22918] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2010] [Accepted: 10/15/2010] [Indexed: 11/06/2022]
Abstract
BACKGROUND Ovarian sex-cord stromal tumors (SCST) are rare in childhood and include a variety of neoplasms with different clinical features and biologic behavior. Aim of the analysis was to report the clinical findings and treatment results of a series of patients with SCST of the ovary, registered in a multi-institutional Italian network on rare tumors in children and adolescent between 2000 and 2009. METHODS Data on 23 patients, 5-176 months old, from 13 Centers were reviewed. All patients were grouped on the basis of the results of the first surgical approach, according to the Children Oncology Group staging system. A cisplatin based chemotherapy was recommended in patients with a localized disease, who had undergone an incomplete excision/initial biopsy, and in case of metastatic spread. RESULTS A frequent symptom was abdominal pain; 9/23 cases had signs of hormonal secretion and two patients were hospitalized for acute pain following ovarian torsion. Twelve patients had a Juvenile-Granulosa Cell tumor, six a Sertoli-Leydig Cell tumor, three a Fibrothecoma, and two a Sclerosing-Stromal tumor. Twenty-one patients maintained the complete remission (follow-up: 9-91 months), 2 with a ST II Sertoli-Leydig Cell tumor relapsed and one of them died. Immonohistochemical studies could be done in 10 cases. CONCLUSIONS Completeness of resection and histology were important prognostic factors; in our series the Sertoli-Leydig Cell tumor was the most aggressive variety. Hormonal signs (precocious puberty, telarca, menarche) were common in younger patients and led to an early diagnosis. Cisplatin based chemotherapy seemed to be effective for locally advanced tumors.
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Affiliation(s)
- Giovanni Cecchetto
- Department of Pediatrics, Division of Pediatric Surgery, University of Padua, Padua, Italy.
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Bien E, Godzinski J, Dall'igna P, Defachelles AS, Stachowicz-Stencel T, Orbach D, Bisogno G, Cecchetto G, Warmann S, Ellerkamp V, Brennan B, Balcerska A, Rapala M, Brecht I, Schneider D, Ferrari A. Pancreatoblastoma: a report from the European cooperative study group for paediatric rare tumours (EXPeRT). Eur J Cancer 2011; 47:2347-52. [PMID: 21696948 DOI: 10.1016/j.ejca.2011.05.022] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2011] [Revised: 05/18/2011] [Accepted: 05/18/2011] [Indexed: 11/28/2022]
Abstract
BACKGROUND Pancreatoblastoma is a very rare malignant tumour typically occurring in the early years of life. Due to its rarity, standardised diagnostic and therapeutic guidelines are not available for pancreatoblastoma. METHODS The newborn cooperative group denominated EXPeRT - European cooperative study group for paediatric rare tumours - combined in a joint analysis of all cases registered between 2000 and 2009 by the national groups of Italy, France, United Kingdom, Poland and Germany. RESULTS Twenty patients <18years old (median age 4years) were analysed: nine had distant metastases at diagnosis. Seventeen patients had tumour resection, at initial or delayed surgery. Eighteen received chemotherapy (response rate 73%), seven received radiotherapy. For the whole series, 5-year event-free survival and overall survival were 58.8% and 79.4%, respectively. Outcome did not correlate with tumour site and size, but was strongly influenced by the feasibility of tumour complete resection. CONCLUSIONS This international study confirms the rarity of the disease, the critical role of surgical resection both as therapy and as a prognostic variable, and the potential efficacy of chemotherapy. The adoption of an intensive multidisciplinary approach is required, as well as the referral to highly experienced centres. Further international cooperation is needed to collect larger series and stimulate biological studies to improve our understanding of the biology and the natural history of PBL.
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Affiliation(s)
- Ewa Bien
- Department of Pediatrics, Medical University, Gdansk, Poland
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Soloni P, Cecchetto G, Dall'igna P, Carli M, Toffolutti T, Bisogno G. Management of unresectable solid papillary cystic tumor of the pancreas. A case report and literature review. J Pediatr Surg 2010; 45:e1-6. [PMID: 20438906 DOI: 10.1016/j.jpedsurg.2010.02.045] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2009] [Revised: 02/09/2010] [Accepted: 02/11/2010] [Indexed: 01/15/2023]
Abstract
Pancreatic solid papillary cystic tumor is a rare neoplasm with an excellent prognosis if surgical excision is complete. We report on a case and review 47 more cases extracted from the published literature to assess the treatment options when solid papillary cystic tumor is considered unresectable. Chemotherapy and radiotherapy were beneficial in a limited number of patients, but therapeutic decisions must be made bearing in mind that patients may be long-term survivors without any treatment because of the tumor's slow growth.
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Affiliation(s)
- Pietro Soloni
- Division of Hematology/Oncology, Department of Pediatrics, University Hospital of Padova, 35128 Padova, Italy
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Dall'igna P, Cecchetto G, Bisogno G, Conte M, Chiesa PL, D'Angelo P, De Leonardis F, De Salvo G, Favini F, Ferrari A. Pancreatic tumors in children and adolescents: the Italian TREP project experience. Pediatr Blood Cancer 2010; 54:675-80. [PMID: 19998473 DOI: 10.1002/pbc.22385] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Malignant pancreatic tumors are exceedingly rare in pediatric age and their clinical features and treatment usually go unappreciated by most pediatric oncologists and surgeons. METHODS From January 2000 to July 2009, 21 patients <18 years old with pancreatic tumors were prospectively registered in the Italian cooperative TREP project dedicated to very rare pediatric tumors. RESULTS Tumor types were 4 pancreatoblastomas, 2 pancreatic carcinomas, 3 neoplasms of the endocrine pancreas, and 12 solid pseudopapillary tumors. Three of the four patients with pancreatoblastoma had advanced disease at diagnosis and were given chemotherapy; at the time of this report, three patients were alive in first remission, while one died due to treatment toxicity. Both the cases of pancreatic carcinoma had the acinar cell subtype and successfully underwent pancreaticoduodenectomy with complete tumor resection, remaining without evidence of disease at the time of this analysis. The histological diagnoses of the three endocrine tumors were a malignant islet cell tumor, a gastrinoma, and a well-differentiated tumor. All 12 patients with solid pseudopapillary tumors underwent complete tumor resection and were given no adjuvant treatment; 11 were alive in first remission, while one experienced a local and distant relapse 5 years after diagnosis. CONCLUSIONS Surgery remains the keystone of treatment for pancreatic tumors in pediatric age as in adults. The TREP project shows that prospective cooperative studies are feasible even for such very rare tumors as these and may serve as a model for developing international cooperative schemes.
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Alaggio R, Cecchetto G, Bisogno G, Gambini C, Calabrò ML, Inserra A, Boldrini R, De Salvo GL, G d'Amore ES, Dall'igna P. Inflammatory myofibroblastic tumors in childhood: a report from the Italian Cooperative Group studies. Cancer 2010; 116:216-26. [PMID: 19852031 DOI: 10.1002/cncr.24684] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Inflammatory myofibroblastic tumors (IMTs) are myofibroblastic lesions with unpredictable biologic behavior that occur at a young age. For this report, the authors investigated clinicopathologic features in a series of pediatric IMTs. The objective of the study was to identify morphologic or immunohistochemical prognostic markers and the possible pathogenic role of human herpes virus 8 (HHV-8). METHODS Twenty-six patients were observed over a period of 18 years. Clinical/histologic data were reviewed, and immunohistochemical/molecular studies were performed. RESULTS Patients ages 8-216 months (median age, 60 months) presented with tumors of the lung-bronchus (8 patients), abdomen (17 patients), and thoracic wall (1 patient). Twenty-one patients underwent complete excision, and microscopic or macroscopic residual disease was present in 5 of those patients. Chemotherapy was received by 5 patients. After a median follow-up of 6.6 years, 24 patients were in complete remission, and 2 patients had died of disease. Local recurrences were observed in 6 patients (including 4 recurrences that occurred after a complete excision). Cytologic atypia, low inflammatory infiltrate, and a rich myxoid pattern were detected in patients who had recurrent disease or a poor prognosis. Anaplastic lymphoma kinase (ALK) was positive in 7 patients (including 2 patients with recurrent disease). No correlation between clusterin expression and prognosis was demonstrated. HHV-8 was identified in 1 pulmonary IMT. CONCLUSIONS IMTs are locally aggressive lesions. In this series, the local recurrence rate was 23%, and the 5-year and 10-year event-free survival rates were 87.4% and 72.8%, respectively. The results indicated that the treatment of choice is a complete, nonmutilating excision; chemotherapy may be given to patients who have microscopic or macroscopic residual disease, although the results are controversial; cytologic atypia and positive ALK status are more frequent in aggressive tumors, whereas metastatic tumors are negative for ALK; and HHV8 is not involved in the pathogenesis of IMT.
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Affiliation(s)
- Rita Alaggio
- Pathology Department, University Hospital of Padova, Padova, Italy.
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Dall'igna P, d'Amore ESG, Cecchetto G, Bisogno G, Carretto E, Bitetti S, Famengo B, Alaggio R. Intraoperative examination (IOE) in pediatric extracranial tumors. Pediatr Blood Cancer 2010; 54:388-93. [PMID: 20052774 DOI: 10.1002/pbc.22309] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND OBJECTIVES Intraoperative evaluation of surgical specimens by frozen sections (IOE) is required to distinguish benign and malignant lesions, assess surgical margins, and determine sample adequacy of biopsies. In the last years, it has been used also for therapeutic decisions, particularly in children, who may need other ancillary procedures, in case of malignancies. Our purpose was the evaluation of diagnostic accuracy, limits, and different role of IOE in pediatric pathology. PATIENTS AND METHODS From 1990 to 2001, 416 IOEs were performed in 341 children, affected by lymph node pathology, soft tissue tumors, neuroblastic tumors, gonadal germ cell, and stromal tumors, hepatic lesions, renal tumors, and others; the technique was also used to assess surgical margins during major surgeries. IOEs were obtained from Tru-cut biopsies (<1 cm(3)), wide biopsies (>1 cm(3)), or from the whole lesions, and the subsequent final diagnoses were classified as conordant, discordant, and deferred. RESULTS Three hundred seventy cases (88.9%) were concordant, 10 (2.4%) discordant, and 36 (8.6%) deferred. The disagreement was found in two small lymph node samples, three soft tissue tumors, one hepatoblastoma, one metastasis, and three surgical margins. The deferred diagnoses were related to lymph node and soft tissue lesions. CONCLUSIONS IOE in pediatric oncology may integrate the diagnostic process and supports the therapeutic guidelines of different tumors. In our study, the diagnostic concordance was satisfactory. A rational use of the technique and the awareness of its limits are, however, prerequisites to avoid the risk of overtreatment.
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Affiliation(s)
- Patrizia Dall'igna
- Division of Pediatric Surgery, Department of Pediatrics, University-Hospital of Padua, Padua, Italy.
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Cillo U, Ciarleglio FA, Bassanello M, Brolese A, Vitale A, Boccagni P, Zanus G, Zancan L, D'Antiga L, Dall'igna P, Montin U, Gringeri E, Carraro A, Cappuzzo G, Violi P, Baldessin M, Bridda A, D'Amico DF, Perilongo G. Liver transplantation for the management of hepatoblastoma. Transplant Proc 2003; 35:2983-5. [PMID: 14697956 DOI: 10.1016/j.transproceed.2003.10.072] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Hepatoblastoma (HEP) is the most frequent liver malignancy occurring in childhood. Surgical resection currently represents the gold standard for treatment. In patients with initially unresectable tumors, chemotherapy may induce remarkable reductions in size. In nonresponder patients, liver transplantation (OLTx) may offer a chance of cure. MATERIALS AND METHODS From 1990 to 2003, a total of 400 OLTx (31 pediatric transplants) have been performed at Padua University. Seven patients (4 males and 3 females) underwent OLTx for hepatoblastoma. All patients presented with bilobar liver involvement and had received chemotherapy according to the SIOPEL-1. In all patients preoperative staging was negative for extrahepatic involvement. RESULTS The mean age of the pts was 8.2 years (range 6.4 months to 34 years). Mean follow-up after OLTx was 41.4 months (median 36, range 3 to 108 months). Actuarial patient survival rates after OLTx for hepatoblastoma are 83.3%, 83.3%, and 56% at 1, 3, and 5 years, respectively. Five of seven subjects with HEP are alive after transplant at 3, 12, 36, 65, and 108 months. Two patients died owing to recurrent disease after 6 and 60 months, respectively, from transplantation. Another subject, primarily treated with surgical resection, shows HEP recurrence at 40 months after OLTx. The remaining 4 patients are alive and well at a mean follow-up of 28 months (median 24, range 3 to 65 months). CONCLUSIONS Liver transplantation may represent a valid therapeutic option for patients with unresectable HEP, but it is contraindicated in cases of recurrence following previous resection surgery. Neo-adjuvant chemotherapy is of paramount importance to obtain good long-term results.
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Affiliation(s)
- U Cillo
- Clinica Chirurgica 1 and Liver Transplantation Unit, P.G. Cevese Department of Surgical and Gastroenterological Sciences, Padua University, Via Giustiniani 2, Padua 35128, Italy
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