RESUMO -OBJETIVO. Alertar para a necessidade do conhecimento e investigação dos sinais e sintomas iniciais do câncer infantil, bem como para a responsabilidade de todos envolvidos no processo do seu diagnóstico precoce a fim de melhorar os nossos índices de cura.MÉTODOS. Revisão da literatura através de consulta ao Medline. RESULTADOS. O diagnóstico do câncer infantil é um processo complexo e muitas são as variáveis que parecem influenciá-lo. A detecção precoce e o pronto início do tratamento têm importante papel na redução da mortalidade e morbidade do tratamento. O melhor entendimento da relação entre estes fatores é de fundamental importância para o desenvolvimento de estratégias de saúde pública para detecção precoce do câncer infantil.CONCLUSÃO. Muitos fatores parecem estar associados ao atraso do diagnóstico do câncer infantil. O tempo que decorre entre o primeiro sintoma e o diagnóstico depende da idade da criança e do tipo do tumor, principalmente. Determinar os sinais e sintomas que devem alertar para a possibilidade de doenças malignas ainda é um desafio.UNITERMOS: Câncer infantil. Diagnóstico. Sinais e sintomas.

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BackgroundSometimes, in pediatric oncology, it is difficult to differentiate the relapse of primary tumor from other diagnoses such as post-ischemic lesions or fungal abscess, without performing an organ biopsy. In addition, patients frequently are not under clinical conditions to be biopsied, mainly due to febrile neutropenia. A growing number of studies has focused on the use of Positron emission tomography/computed tomography with 18 Fluorodeoxyglucose ([18F]FDG-PET/CT) to distinguish tumor relapse from infectious lesions in patients with febrile neutropenia.Case presentationThis case report describes a 6 years-old girl with febrile neutropenia during the treatment of neuroblastoma. Blood culture showed Candida sp. Abdominal ultrasonography revealed multiple unspecific hypoechoic areas of variable sizes in spleen, which might be either tumor or Candida-induced abscesses. [18F]FDG-PET/CT was performed to help the diagnosis and revealed small splenic lesions highly suggestive of disseminated candidiasis. Patient was then treated with systemic antifungal agent. After the recovery from febrile neutropenia, a spleen biopsy was performed, confirming the diagnosis of fungal abscess. Due to the small size of lesions, modalities such as ultrasonography, CT and magnetic nuclear resonance were not able in distinguishing tumor relapse from infectious lesions.ConclusionThis case provides an excellent example in which the use of [18F]FDG-PET/CT is valuable in helping to localize potential sites of disseminated fungal infection to be diagnosed within clinical context. [18F]FDG-PET /CT seems to have a role in the evaluation of pediatric patients with febrile neutropenia.

Objective: To analyze clinical, laboratory and histopathological features and the path to diagnosis establishment and treatment of patients with adrenal carcinoma (AC).Methods: Retrospective study with 13 patients assisted at the pediatric oncology service of Hospital das Clínicas, Universidade Federal de Minas Gerais, Brazil, between 2004 and 2015.Results: Age at diagnosis ranged from 1.0 to 14.8 years (median: 2.0 years). Manifestations of hypercortisolism were identified in all cases and virilization in all girls. All patients met the Weiss criteria to AC histopathological diagnosis. Immunohistochemistry was performed in 61.5% of the cases. Most patients had stage I disease (76.9%). All subjects were submitted to total tumor resection. Two patients (stages III and IV disease) received chemotherapy associated to mitotane. The only death case was that of a patient with stage IV disease. The probability of overall survival for the entire group up to 5.0 years was 92.3±7.4%. The median time between the onset of symptoms and diagnosis was 9.5 months, and 6.0 months between first visit and start of treatment.Conclusions: Low age at diagnosis, predominance of cases with localized disease and complete tumor resection - with only one case of tumor capsule rupture - can possibly explain the favorable evolution of the studied population. The long period between onset of symptoms and diagnosis highlights the importance of training pediatricians for early recognition of AC signs and symptoms.