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Irtan S, Brisse HJ, Minard-Colin V, Schleiermacher G, Canale S, Sarnacki S. Minimally invasive surgery of neuroblastic tumors in children: Indications depend on anatomical location and image-defined risk factors. Pediatr Blood Cancer 2015; 62:257-261. [PMID: 25284263 DOI: 10.1002/pbc.25248] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 08/11/2014] [Indexed: 01/29/2023]
Abstract
BACKGROUND Minimally invasive surgery (MIS) is still not a well-accepted surgical approach to remove neuroblastic tumors. We aimed to assess the indications and limits of MIS in this childhood tumor according to tumor location and image-defined risk factors (IDRFs). PROCEDURE Between 2006 and 2012, 39 patients underwent MIS for neuroblastic tumors, using thoracoscopic (n = 20), retroperitoneoscopic (n = 1) or laparoscopic approaches (n = 18). The tumor locations were paravertebral (n = 18; thoracic n = 15, lumbar n = 3), perivascular (n = 5; abdominal n = 2; thoracic n = 3), adrenal (n = 13), pleural (n = 2) and pelvic (n = 1). Two patients were treated for relapses. According to the INRG staging system, IDRFs were absent in 20 patients and present in 19 patients. Ten patients received chemotherapy preoperatively. Mean largest diameter was 35 mm for thoracic tumors (range: 7-85 mm) and 34 mm for abdominal tumors (range: 10-75 mm). Mean follow-up was 25 months (range: 5-116 months). RESULTS Resection was macroscopically incomplete (R2) for six thoracic tumors and one adrenal tumor. Conversion was necessary for three thoracic L2 tumors. Postoperative complications consisted of chylothorax in three patients with L2 paravertebral thoracic tumors, Horner's syndrome in a patient with a cervicothoracic tumor, and renal atrophy in a patient with a L2 abdominal tumor. No perioperative or postoperative complications occurred in patients with adrenal and abdominal paravertebral tumors. The overall survival rate was 98%. CONCLUSION In carefully selected cases, MIS permits safe and efficient resection of neuroblastic tumors in children. Open surgical approach should be considered if organ or vascular control or quality of resection is jeopardized. Pediatr Blood Cancer 2015;62:257-261. © 2014 Wiley Periodicals, Inc.
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Affiliation(s)
- Sabine Irtan
- Department of Pediatric Surgery, Necker Enfants-Malades Hospital, Paris Descartes University, Paris, France
| | | | | | | | - Sandra Canale
- Department of Radiology, Gustave Roussy Institute, Villejuif, France
| | - Sabine Sarnacki
- Department of Pediatric Surgery, Necker Enfants-Malades Hospital, Paris Descartes University, Paris, France
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Brisse HJ, McCarville MB, Granata C, Krug KB, Wootton-Gorges SL, Kanegawa K, Giammarile F, Schmidt M, Shulkin BL, Matthay KK, Lewington VJ, Sarnacki S, Hero B, Kaneko M, London WB, Pearson ADJ, Cohn SL, Monclair T. Guidelines for imaging and staging of neuroblastic tumors: consensus report from the International Neuroblastoma Risk Group Project. Radiology 2011; 261:243-57. [PMID: 21586679 DOI: 10.1148/radiol.11101352] [Citation(s) in RCA: 268] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Neuroblastoma is an enigmatic disease entity; some tumors disappear spontaneously without any therapy, while others progress with a fatal outcome despite the implementation of maximal modern therapy. However, strong prognostic factors can accurately predict whether children have "good" or "bad" disease at diagnosis, and the clinical stage is currently the most significant and clinically relevant prognostic factor. Therefore, for an individual patient, proper staging is of paramount importance for risk assessment and selection of optimal treatment. In 2009, the International Neuroblastoma Risk Group (INRG) Project proposed a new staging system designed for tumor staging before any treatment, including surgery. Compared with the focus of the International Neuroblastoma Staging System, which is currently the most used, the focus has now shifted from surgicopathologic findings to imaging findings. The new INRG Staging System includes two stages of localized disease, which are dependent on whether image-defined risk factors (IDRFs) are or are not present. IDRFs are features detected with imaging at the time of diagnosis. The present consensus report was written by the INRG Imaging Committee to optimize imaging and staging and reduce interobserver variability. The rationales for using imaging methods (ultrasonography, magnetic resonance imaging, computed tomography, and scintigraphy), as well as technical guidelines, are described. Definitions of the terms recommended for assessing IDRFs are provided with examples. It is anticipated that the use of standardized nomenclature will contribute substantially to more uniform staging and thereby facilitate comparisons of clinical trials conducted in different parts of the world.
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Sung KW, Yoo KH, Koo HH, Kim JY, Cho EJ, Seo YL, Kim J, Lee SK. Neuroblastoma originating from extra-abdominal sites: association with favorable clinical and biological features. J Korean Med Sci 2009; 24:461-7. [PMID: 19543510 PMCID: PMC2698193 DOI: 10.3346/jkms.2009.24.3.461] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2008] [Accepted: 07/14/2008] [Indexed: 11/20/2022] Open
Abstract
Neuroblastomas originating from different sites might have different clinical and biological characteristics. In the present study, the clinical (age, sex and stage) and biological (N-myc amplification, Shimada pathology and levels of lactate dehydrogenase, ferritin and neuron-specific enolase) characteristics of patients with newly diagnosed neuroblastoma were compared according to the site of tumor origin (extra-abdominal versus abdominal). The event-free survival rate (EFS) was also compared between the two groups. Among 143 neuroblastomas, 115 tumors originated from the abdomen, 26 from extra-abdominal sites and 2 from unknown primary sites. Frequencies of stage 4 tumor and N-myc amplified tumor were lower in the extra-abdominal group than in the abdominal group (34.6% vs. 60.0%, P=0.019 and 4.2% vs. 45.0%, P<0.001, respectively). Levels of lactate dehydrogenase, ferritin and neuron-specific enolase were significantly lower in the extra-abdominal group than in the abdominal group. The probability of 5-yr EFS (+/-95% confidence interval) was higher in the extra-abdominal group than in the abdominal group (94.4+/-10.6% vs. 69.4+/-9.4%, P=0.026). Taken together, neuroblastomas originating from extra-abdominal sites might be associated with more favorable clinical and biological characteristics and a better outcome than neuroblastomas originating from abdomen.
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Affiliation(s)
- Ki Woong Sung
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Keon Hee Yoo
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hong Hoe Koo
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ju Youn Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun Joo Cho
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yeon Lim Seo
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jhingook Kim
- Department of Thoracic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Suk Koo Lee
- Department of Pediatric Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Subramanian A, Maker VK. Organs of Zuckerkandl: their surgical significance and a review of a century of literature. Am J Surg 2006; 192:224-34. [PMID: 16860635 DOI: 10.1016/j.amjsurg.2006.02.018] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2005] [Revised: 02/20/2006] [Accepted: 02/20/2006] [Indexed: 11/29/2022]
Abstract
BACKGROUND Organs of Zuckerkandl (O of Z) harbor the potential for deadly paragangliomas. Paragangliomas are one of the surgical causes of hypertension. Major treatises of medicine offer very little information on this topic. METHODS PubMed Medline and Google searches were performed to obtain reported cases of paragangliomas of the O of Z. A total of 135 cases of paragangliomas of the O of Z were found. Each case was reviewed and charted. Charts then were analyzed. RESULTS Seventy-four percent of patients with this neoplasm have hypertension. Eighty percent of patients undergo an operation with more than 30% having an incorrect preoperative diagnosis. These tumors have a 43% mortality when presenting acutely. CONCLUSIONS Individuals aged < or =50 years with hypertension should be considered for screening for pheochromocytoma/paraganglioma with uring and/or serum catecholamines. Twenty-four-hour collections for urinary metanephrines and vanillylmandelic acid are diagnostic of functional tumors. A high degree of suspicion should follow with radiologic and chemical diagnostic studies. Triple-phase helical computed tomographic scans, metaiodobenzyl-guanidine scans, and magnetic resonance imaging with gadolinium-diethylenetriaminepentaacetic acid infusion are the standard for radiologic diagnosis. Treatment is always surgical excision. Phase II trials are in order for neoadjuvant and adjuvant treatment options.
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Affiliation(s)
- Anuradha Subramanian
- Department of Surgery, Emory University School of Medicine, Atlanta, GA 30303, USA.
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Mithani SK, Marohn MR, Freischlag JA, Dackiw AP, Zeiger MA. Laparoscopic Resection of a Paraganglioma of the Organ of Zuckerkandl in a Patient with a Carotid Body Tumor. Am Surg 2006. [DOI: 10.1177/000313480607200113] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Paragangliomas of the organ of Zuckerkandl are rare tumors with only several case reports noted in the literature. Synchronous paraganglioma occur sporadically, and on occasion, in association with several genetic syndromes. Paraganglioma of the organ of Zuckerkandl with synchronous carotid body paraganglioma is described herein. Traditionally, surgical resection of abdominal paraganglioma involved an exploratory laparotomy. In this manuscript, we describe one of the first reported laparoscopic resections of this tumor and review the literature on multiple paragangliomas and their associated genetic syndromes.
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Affiliation(s)
- Suhail K. Mithani
- From the Department of Surgery, Division of Endocrine and Oncologic Surgery and Division of Vascular Surgery, The Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Michael R. Marohn
- From the Department of Surgery, Division of Endocrine and Oncologic Surgery and Division of Vascular Surgery, The Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Julie A. Freischlag
- From the Department of Surgery, Division of Endocrine and Oncologic Surgery and Division of Vascular Surgery, The Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Alan P.B. Dackiw
- From the Department of Surgery, Division of Endocrine and Oncologic Surgery and Division of Vascular Surgery, The Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Martha A. Zeiger
- From the Department of Surgery, Division of Endocrine and Oncologic Surgery and Division of Vascular Surgery, The Johns Hopkins Medical Institutions, Baltimore, Maryland
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Abstract
Magnetic resonance (MR) plays a unique role in the diagnosis and management of pediatric abdominal masses. The "as low as reasonably achievable" (ALARA) radiation dose of CT is zero when substituted by MR. Whole body MR may also compete with PET imaging to stage abdominal tumors. Specific advantages of MR include determination of resectability of hepatic tumors using MRI and MRA; staging of neuroblastoma in the bone marrow, lymph nodes, liver, and spinal canal; response of bilateral Wilms tumor and nephroblastomatosis; detection of pelvic tumors with sagittal sectioning, and peritoneal tumors with contrast enhancement.
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Affiliation(s)
- Fredric A Hoffer
- Department of Radiological Sciences, Division of Diagnostic Imaging, St. Jude Children's Research Hospital, 332 N. Lauderdale St, Memphis, TN 38112, USA.
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Tateishi U, Hasegawa T, Makimoto A, Moriyama N. Adult neuroblastoma: radiologic and clinicopathologic features. J Comput Assist Tomogr 2003; 27:321-6. [PMID: 12794593 DOI: 10.1097/00004728-200305000-00004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of the current study was to define the imaging findings of adult neuroblastoma (ANB) and correlate them with clinicopathologic features. MATERIALS AND METHODS The CT scans and MR images of six patients with histologically confirmed ANB (mean age, 49 years) were retrospectively analyzed. RESULTS The arising sites of tumors included the retroperitoneum (n = 2), pelvis (n = 2), anterior mediastinum (n = 1), and adrenal gland (n = 1). The common CT finding was poorly marginated and heterogeneous mass without calcification. Cystic components were often found. On contrast-enhanced CT or MR images, tumors showed heterogeneous enhancement. On T2-weighted images, all masses demonstrated predominantly hyper signal intensity relative to skeletal muscle and the images showed heterogeneous appearance with focal areas of high intensity interspersed with septations of low signal intensity. Soft tissue masses with bone involvement were identified in one case on MR images. The CT findings in one tumor originating from mediastinum were similar to those of tumors arising from other sites. CONCLUSION ANB is an uncommon malignancy that often pursues an aggressive clinical course, involves multiple sites, and has a poor prognosis. Tumors usually manifest on CT or MR images as a poorly demarcated mass mainly in the retroperitoneum and pelvis. Imaging studies can depict aggressive characteristics and disease extent of ANB.
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Affiliation(s)
- Ukihide Tateishi
- Division of Diagnostic Radiology, National Cancer Center Hospital and Research Institute, Tokyo, Japan.
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Siegel MJ, Hoffer FA. Magnetic resonance imaging of nongynecologic pelvic masses in children. Magn Reson Imaging Clin N Am 2002; 10:325-44, vi. [PMID: 12424949 DOI: 10.1016/s1064-9689(01)00002-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Pelvic neoplasms can arise from the genitourinary tract, gonads, soft tissues, or bone. The role of imaging is to confirm the presence of tumor, determine the site of origin, delineate the extent for staging and treatment planning, and serve as a baseline for monitoring response to therapy. MR imaging is well suited for the characterization and staging of pediatric pelvic tumors. This article reviews the imaging findings and staging evaluation of the common nongynecologic neoplasms in children. Prostatic, bladder, gonadal, and sacrococcygeal tumors are discussed. Gynecologic tumors are discussed elsewhere in this issue.
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Affiliation(s)
- Marilyn J Siegel
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 South Kingshighway Boulevard, St. Louis, MO 63110, USA.
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Singh H, Jetley RK, Maurya V, Dhar AK, Malaviya AK. THORACIC NEUROBLASTOMA WITH SPONTANEOUS REMISSION. Med J Armed Forces India 2001; 57:165-6. [PMID: 27407328 DOI: 10.1016/s0377-1237(01)80145-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- H Singh
- Senior Advisor (Radiodiagnosis), Pune - 411040
| | - R K Jetley
- Director General Armed Forces Medical Services, Min. of Defence, M Block, New Delhi 110 001
| | - V Maurya
- Advance Course Trainee (Radiodiagnosis), Pune - 411040
| | - A K Dhar
- Classified Specialist (Oncology), Pune - 411040
| | - A K Malaviya
- Senior Advisor (Pathology), Command Hospital (Southern Command), Pune - 411040
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