Objectives. The relationship between the development of the number of malignant tumors in children and viruses is well known. The etiological role of the EpsteinBarr virus in the development of undifferentiated nasopharyngeal cancer (NPC) has been well studied. The effect of human papillomavirus (HPV) on the occurrence and development of NPC in children is not sufficiently understood. Aim. The description of the clinical case of the Epstein Barr virus and HPV infection in 16-year-old patient with the consistent development of NPC and oropharyngeal papillomatosis. Description of the clinical case. The clinical observation of the boy who was diagnosed with NPC. The full clinical effect in the form of reduction of the primary tumor and metastases in the lymph nodes of the neck was noted after chemo- and radiotherapy. 18 months after the cure according to the positron emission tomography, combined with computed tomography, with 18F-deoxyglucose we marked the accumulation of radiopharmaceuticals in the area of the left palatine and lingual tonsils. The examination revealed clinical signs of the soft palate papillomatosis. The resection of the soft palate was carried out. The morphological study confirmed squamous cell papilloma. HPV type 16 DNA was found in the papilloma. Conclusion. The accumulation of the information concerning childhood pharynx lesions caused by HPV would help to expand understanding of the most common types of the virus in the paediatric population. It would be possible to identify the groups of risk for the development of malignant tumors on the grounds of the detection HPV types of highly carcinogenic risk.
204ОБМЕН ОПЫТОМ ВВЕДЕНИЕ Удаление опухолей и коррекция пороков раз-вития эндоскопическим эндоназальным методом у детей активно развивается. Метод является малотравматичным и хорошо переносится больны-
Malignant tumors of parameningeal localization are various morphological neoplasms located in the nasal cavity, nasopharynx, paranasal sinuses and middle ear. As a result of tumor growth, conditions are created for the development of chronic inflammation. Studies of the microbiome of the upper respiratory tract in children with malignant tumors were practically not conducted. Objective of the research: to identify changes in the microbiome of the nasal cavity in children with malignant tumors of parameningeal localization during chemoradiotherapy. Materials and methods: the study included 29 patients with parameningeal tumors, 2–17 years old. Among the included in the study there were 18 boys (62%) and 11 girls (37%). Morphologically, the following were verified: embryonic rhabdomyosarcoma (ERMS) – 17 (58%), alveolar rhabdomyosarcoma (arms) – 3 (10%), other sarcomas – 4 (13%), nasopharyngeal cancer – 5 (17%). All patients received induction chemotherapy. Simultaneous radiotherapy (LT) and chemotherapy (CT) – in 24 (82%) cases. After completing the chemoradiotherapy stage, consolidation therapy continued in 20 (70%) patients. Results: before the start of LT (after the induction stage of chemotherapy), a variety of microflora was observed in the nasal secretions, gram-positive and gram-negative bacteria were isolated in an equal ratio. The absence of growth of microorganisms was determined in 4 (13%) cases before the start of LT. Methicillin-resistant Staphylococcus epidermidis and Staphylococcus haemolyticus were more frequently detected after LT. Colonization of the nasal cavity of Candida albicans occurred before the start of LT in 4 (13%) and persisted after irradiation in 5 (17%) patients. In the delayed period, there was an increase in the percentage of patients who ridiculed gram-negative microorganisms – Pseudomonas aeruginosa in 4 (13%) cases. After 12 months, 3 (10%) patients showed a return of nosocomial flora (S. epidermidis MRSE and S. haemolyticus MRS), a decrease in colonization of P. aeruginosa and the preservation of C. albicans. Conclusion: at different stages of chemoradiotherapy, the nasal mucosa is colonized by various microorganisms that differ in their properties and pathogenicity. The continuation of this study will clarify the clinical significance of certain types of opportunistic microorganisms in the pathogenesis of inflammatory diseases of the upper respiratory tract in children with malignant tumors.
Introduction. Soft tissue tumors account for up to 8 % of all malignant neoplasms in children. According to the international histological classification, about 150 different morphological variants of soft tissue tumors have been registered, of which 45 % are rhabdomyosarcoma (RMS). Most often, RMS occurs in early childhood – the average age of patients at the time of diagnosis is 5 years. The incidence rate of RMS is 0.9 per 100,000 children. In 25 % cases, the initial diagnosis reveals distant metastasis to the lungs, bones, bone marrow, and 8 % – leptomeningeal metastasis. More than 7 % of patients with localized parameningeal RMS develop leptomeningeal metastasis, according to the Rhabdomyosarcoma Study Group. Purpose of the study – report the incidence, prognosis of leptomeningeal metastasis and treatment outcomes in children with intracranial spread of RMS. Materials and methods. The study included 45 patients aged 1 to 17 years with a diagnosis of RMS of parameningeal localization with intracranial spread, who received special treatment from 2003 to 2020. The study included 6 (20 %) patients in whom the tumor developed in early childhood (up to 3 years). The boys predominated – 25 (55.5 %) in the study. The primary tumor spread to the orbit in 7 (15 %) cases, the skull base in 7 (15 %) cases, the middle ear in 4 (8 %) cases, the nasopharynx in 3 (6 %) cases, and the brain substance was affected in 16 (35 %). Metastases in regional lymph nodes were determined in 7 (15 %) patients. Multiple metastatic lesions of bones and bone marrow – 4 (9 %) cases, leptomeningeal metastases – in 2 (4 %). 45 (100 %) patients received drug treatment according to the protocols approved by the Academic Council of the Research Institute of Pediatric Oncology and Hematology at N. N. Blokhin National Medical Research Centerof Oncology, Ministry of Health of Russia. Radiation therapy was performed in 33 (74 %) patients, while total focal dose of 50 Gy was administered to the primary tumor. Affected lymph nodes of the neck were irradiated in 10 (23 %) patients, total focal dose is 45.0 Gy. Surgical treatment was performed in 15 (34 %) patients. Multicomponent treatment was performed in 15 (34 %) patients. Results. During the observation period from 12 months to 14 years, 21 (49 %) patients are alive. 21 (51 %) patients died from tumor progression, 1 (2 %) died from complications of special treatment. Conclusions. The treatment of this group of patients is one of the urgent problems of pediatric oncology, which is based on polychemotherapy, supplemented by intrathecal administration of anticancer drugs and craniospinal irradiation. The development of new therapies requires a multidisciplinary approach to achieve a significant improvement in the survival of children with leptomeningeal metastases RMS of parameningeal localization.
Rhabdomyosarcoma is a malignant neoplasm that develops from embryonic mesenchymal cells, with an annual incidence of 4.3 cases per 1,000,000 children. The prevalence of the tumor process is estimated on the basis of data from a comprehensive examination, including magnetic resonance imaging with intravenous contrast, ultrasound examination of the primary focus of regional and distant metastasis zones, computed tomography and radioisotope studies. The overall 5-year survival rate for localized rhabdomyosarcoma reaches 70 %. During the initial diagnosis, distant metastasis to the lungs, bones, and bone marrow is detected, which significantly worsens the prognosis in 20–25 % of patients. The factors of an extremely unfavorable prognosis for the course of alveolar rhabdomyosarcoma are the occurrence of regional and distant metastases before the start of specific treatment, dissemination of the tumor lesion during treatment, and the presence of translocation of the 13q14 sector. Publications contain data on a high (11.2 %) prevalence of metastases of alveolar rhabdomyosarcoma in the pancreas. In the presence of metastatic lesions of the pancreas, surgical treatment is effective only in combination with chemoradiotherapy. Long-term results of treatment of this cohort of children are unsatisfactory due to the high risk of recurrence and dissemination of the tumor.Aim. To study risk factors, evaluate methods and prospects for the treatment of children with metastatic pancreatic lesions in parameningeal alveolar rhabdomyosarcoma. The article considers three clinical cases of such a lesion. We would like to draw the attention of pediatric oncologists and radiologists to the possible association of metastases in the pancreas in children with localization of rhabdomyosarcoma in the head and neck region, which requires improvement of examination protocols in this group of patients.
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