Current prognostic classification of rhabdomyosarcoma in children requires precise measurements of the tumor. The purpose of the study was to compare the standard three-dimensional (3D) measurements with semi-automatic tumor volume measurement method concerning assessment of the primary tumor size and the degree of response to treatment for rhabdomyosarcoma in children. Magnetic Resonance Imaging data on 31 children with treated rhabdomyosarcoma based on the Cooperative Weichteilsarkom Studiengruppe (CWS) guidance was evaluated. Tumor sizes were measured by two methods: 3D standard measurements and semi-automatic tumor volume measurement (VOI) at diagnosis, and after 9 and 17/18 weeks of the induction chemotherapy. Response to treatment and prediction values were assessed. The tumor volume medians calculated using VOI were significantly higher in comparison with those calculated using the 3D method both during the diagnosis as well as after 9 weeks of the chemotherapy and during the 17–18th week of the treatment. The volume measurements based on the generalized estimating equations on the VOI method were significantly better than the 3D method (p = 0.037). The volumetric measurements alone can hardly be considered an unequivocal marker used to make decisions on modification of the therapy in patients with rhabdomyosarcoma.
Infantile choriocarcinoma is an extremely rare disease. We present a case study of a 1-month-old male with choriocarcinoma diagnosed simultaneously with his mother. On admission to hospital, the disease was very advanced and massive progression and multi-organ failure caused the death of the patient despite the implemented treatment. It was too late to save the child’s life, but early enough to save his mother. The authors believe that the serum levels of hCG should be determined in every newborn with anemia and liver tumor, especially when the mother has a positive history of miscarriage.
Renal and perirenal abscesses are very rare in children. They can be present as an acute emergency condition or insidiously as a chronic disease. The diagnosis is not so obvious, and it is a big challenge, especially when it can simulate a kidney tumor. The treatment can be conservative, preferably with targeted antibiotics, or surgical, consisting primarily of drainage. This publication aims to present a clinical case in which both diagnosis and treatment were a big challenge for the entire treatment team. A 10-year-old male patient was admitted to the hospital because of mild abdominal pain and a temperature of 37.5 °C. The symptoms lasted for a week. In the computed tomography (CT), the lesion’s dimensions were 11.1 × 8.2 × 25 cm, and inflammation, abscess, cyst, and abdominal tumor have been suggested. The decision about surgical treatment was made. An enormous abscess near the right kidney was localized. The patient’s condition stabilized after surgery. Unfortunately, due to persistent purulent reservoirs, a second laparotomy was necessary. During the extensive diagnostic cystourethrography performed, vesicoureteral reflux was visualized. In conclusion, though a perinephric abscess is very rare in children, it should be taken into consideration in patients with non-specific abdominal symptoms. The imaging using ultrasound and CT scan with contrast enhancement is crucial to recognize and properly treat the condition. In terms of a small abscess, the only antimicrobial treatment using antibiotics of a broad spectrum can be considered. However, the drainage of an abscess, either percutaneous or open, should be used. For the large abscess, the open drainage seems to be a primary method of treatment. The importance of cooperation in a multidisciplinary team is crucial, as the diagnosis and treatment of underlying causes are essential.
Neuroblastoma is the most common extra-cranial solid tumor in infants and young children, and accounts for approximately 8–10% of all childhood cancers. The International Neuroblastoma Staging System (INRGSS) is based on the age of patient and preoperative imaging, with attention paid to whether the primary tumor is affected by one or more of specific Image-Defined Risk Factors (IDRFs). Patients are classified into the following groups: locoregional L1 and L2 (absent or present IDRFs respectively), M stage (a disseminated form of neuroblastoma) and Ms (the stage present in children younger than 18 months of age with the disease spread to the bone marrow and/or liver, and/or skin). This publication is aimed to present an unexpected complication associated with an accidental ligation of the celiac trunk during resection of a neuroblastoma tumor in a 2.5-year-old boy after initial chemotherapy, initially with vascular IDRFs, stage L2. The consequences of this complication were pancreatic and spleen ischemia and necrosis, and ischemia and perforation of the common bile duct, gallbladder, stomach, and duodenum. Despite detailed diagnostic imaging (computed tomography, magnetic resonance), the presence of vascular IDRFs may result in an unexpected complication in the surgical treatment of neuroblastoma in children.
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