Rhabdomyosarcoma (RMS) of the biliary tree is a rare tumor in children that has a very poor prognosis. Preoperatively, it is often mistaken for a choledochal cyst. We report a case of RMS of the biliary tree in a 4-year-old girl who presented with abdominal pain and obstructive jaundice. The RMS was diagnosed at laparotomy; excision was not possible due to its size and localization. Chemotherapy achieved complete regression of the tumor observed at second-look surgery. Preoperative chemotherapy can now avoid mutilating surgical procedures and improve survival.
Desmoplastic small round cell tumour (DSRCT) is an extremely rare neoplasm. Adolescent males and young adults are most frequently affected. It is highly malignant, with only 29% of patients surviving up to 3 years. This paper documents two cases, one of which, at 4 years old, is the second youngest case documented. Case 1, a 10-year old boy, presented with a 20-day history of choluria, acholia, asthenia, anorexia, and right abdominal pain. Laboratory values were altered, and imaging showed multiples masses in the liver and retroperitoneum. A minilaparotomy was carried out, and a biopsy showed a stage III DSRCT. He was treated with chemotherapy but died of hepatic failure. Case 2, a 4-year-old boy, presented with a 2-month history of abdominal distension. Several hard masses were palpated in the abdomen, and a right inguinal mass that compressed the right testis was observed. Biopsy of the inguinal tumour showed a DSRCT. After treatment with chemotherapy, two operations were carried out to resect different intraabdominal masses. The patient died with peritoneal carcinomatosis 2 months after the last operation. The first patient died due to the advanced stage of the disease, and the second died after chemotherapy, peripheral blood stem transplantation, and multiple operations. The occurrence of this type of tumour in the paediatric age group as well as its high malignancy is noteworthy. Until more effective forms of treatment are found, we recommend treatment with chemotherapy, surgery, and radiotherapy, with close monitoring of the patient.
There have been few reports of Barrett's esophagus associated with chemotherapy in children. We report the case of a 3-year-old patient diagnosed with acute lymphoblastic leukemia who developed Barrett's esophagus after BMF-90 chemotherapeutic regimen. A stricture appeared as a complication of Barrett's metaplasia and Nissen fundoplication was performed. Symptoms improved shortly after surgery and regression of Barrett's esophagus was observed 2 years later. Children treated with antileukemic chemotherapy may develop Barrett's esophagus without previous clinical apparent gastroesophageal reflux. Endoscopic surveillance has been advised in these patients. Barrett's esophagus may regress after antireflux surgery.
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