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Treffy RW, Rajan SG, Jiang X, Nacke LM, Malkana UA, Naiche LA, Bergey DE, Santana D, Rajagopalan V, Kitajewski JK, O'Bryan JP, Saxena A. Neuroblastoma differentiation in vivo excludes cranial tumors. Dev Cell 2021; 56:2752-2764.e6. [PMID: 34610330 DOI: 10.1016/j.devcel.2021.09.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 05/28/2021] [Accepted: 09/13/2021] [Indexed: 01/05/2023]
Abstract
Neuroblastoma (NB), the most common cancer in the first year of life, presents almost exclusively in the trunk. To understand why an early-onset cancer would have such a specific localization, we xenotransplanted human NB cells into discrete neural crest (NC) streams in zebrafish embryos. Here, we demonstrate that human NB cells remain in an undifferentiated, tumorigenic state when comigrating posteriorly with NC cells but, upon comigration into the head, differentiate into neurons and exhibit decreased survival. Furthermore, we demonstrate that this in vivo differentiation requires retinoic acid and brain-derived neurotrophic factor signaling from the microenvironment, as well as cell-autonomous intersectin-1-dependent phosphoinositide 3-kinase-mediated signaling, likely via Akt kinase activation. Our findings suggest a microenvironment-driven explanation for NB's trunk-biased localization and highlight the potential for induced differentiation to promote NB resolution in vivo.
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Affiliation(s)
- Randall W Treffy
- Department of Biological Sciences, University of Illinois at Chicago, Chicago, IL 60607, USA
| | - Sriivatsan G Rajan
- Department of Biological Sciences, University of Illinois at Chicago, Chicago, IL 60607, USA
| | - Xinghang Jiang
- Department of Biological Sciences, University of Illinois at Chicago, Chicago, IL 60607, USA
| | - Lynne M Nacke
- Department of Biological Sciences, University of Illinois at Chicago, Chicago, IL 60607, USA
| | - Usama A Malkana
- Department of Biological Sciences, University of Illinois at Chicago, Chicago, IL 60607, USA
| | - L A Naiche
- Department of Physiology and Biophysics, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Dani E Bergey
- Department of Biological Sciences, University of Illinois at Chicago, Chicago, IL 60607, USA
| | - Dianicha Santana
- Department of Pharmacology, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Vinodh Rajagopalan
- Department of Cell and Molecular Pharmacology and Experimental Therapeutics, Hollings Cancer Center, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Jan K Kitajewski
- Department of Physiology and Biophysics, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - John P O'Bryan
- Department of Pharmacology, University of Illinois at Chicago, Chicago, IL 60612, USA; Department of Cell and Molecular Pharmacology and Experimental Therapeutics, Hollings Cancer Center, Medical University of South Carolina, Charleston, SC 29425, USA; Jesse Brown VA Medical Center, Chicago, IL 60612, USA; Ralph H. Johnson VA Medical Center, Charleston, SC 29401, USA
| | - Ankur Saxena
- Department of Biological Sciences, University of Illinois at Chicago, Chicago, IL 60607, USA.
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Abstract
Neuroblastoma accounts for approximately 8% of all pediatric cancers, with 5% diagnosed during the neonatal period. Despite the disproportionate contribution of neuroblastoma to childhood cancer deaths, neonatal neuroblastoma has a favorable prognosis, often with little or no therapy required. Therefore, minimizing therapy and mitigating complications/toxicities are emphasized, including using a watch-and-wait approach for patients at low risk for disease progression/relapse. However, stage MS neuroblastoma exhibits a unique pattern of disseminated disease, can be challenging to manage, and may require early intervention with systemic chemotherapy. In this review, the epidemiology, treatment options, and anticipated outcomes for neonatal neuroblastoma are discussed.
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Affiliation(s)
- Andrew M Davidoff
- Department of Surgery, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105-3678, USA.
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Abstract
The authors describe a newborn diagnosed with localized neuroblastoma that evolved to stage 4s at the age of 5 months. Peculiar features of the case included a bilateral adrenal primary, the skin as the only metastatic site, and the development of a muscular lesion late in the clinical course. The patient underwent left adrenalectomy and all other lesions regressed without further therapy. The case prompted a search for similar cases both in the Italian Neuroblastoma Registry and in the literature. All patients identified, although variously treated, survived with the exception of the 2 with MYCN gene amplification. We conclude that infants with neuroblastoma who undergo a transition from a localized to stage 4s disease could be less rare than expected. In the absence of unfavorable biology, a wait-and-see policy with strict follow-up could be adopted for these patients, avoiding potentially damaging systemic therapy.
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Parodi E, Tirtei E, Bianchi M, Frigerio M, Morra I, Coppo P. Association of dystrophic epidermolysis bullosa and neuroblastoma in a newborn. Pediatr Neonatol 2020; 61:117-118. [PMID: 31806449 DOI: 10.1016/j.pedneo.2019.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 09/30/2019] [Accepted: 11/06/2019] [Indexed: 11/18/2022] Open
Affiliation(s)
- Emilia Parodi
- Pediatric and Neonatology Unit, AO Ordine Mauriziano Hospital, Turin, Italy.
| | - Elisa Tirtei
- Oncology Department, Regina Margherita Children's Hospital, Citta' della Salute e della Scienza, Turin, Italy
| | - Maurizio Bianchi
- Oncology Department, Regina Margherita Children's Hospital, Citta' della Salute e della Scienza, Turin, Italy
| | - Mario Frigerio
- Pediatric and Neonatology Unit, AO Ordine Mauriziano Hospital, Turin, Italy
| | - Isabella Morra
- Pathology Unit, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Paola Coppo
- Pediatric Department, Regina Margherita Children's Hospital, Citta' della Salute e della Scienza, Turin, Italy
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Prenatally detected thoracic neuroblastoma. Obstet Gynecol Sci 2018; 61:278-281. [PMID: 29564321 PMCID: PMC5854910 DOI: 10.5468/ogs.2018.61.2.278] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 07/24/2017] [Accepted: 07/24/2017] [Indexed: 11/08/2022] Open
Abstract
Neuroblastoma is the most common pediatric extracranial solid tumor derived from primitive neural crest cells of the sympathetic nervous system. Although one-fifths of all neuroblastomas occurs within the thorax, thoracic neuroblastomas detected in fetus have been rarely reported. We report a case of fetal thoracic neuroblastoma with massive pleural effusion detected with prenatal ultrasonography. A 34-year-old Korean second-gravida was referred to our hospital at 30 weeks of gestation for evaluation, after the right lung mass found in the fetus. Approximately 3 cm, well-defined, hyperechoic mass was found in the right thorax with right pleural effusion, with the initial suspicion of teratoma. However, as mass continued to grow with deteriorating pleural effusion and fetal hydrops, the mass was considered malignant after 3 weeks. After a cesarean delivery, an approximately 4 cm mass with peripheral calcification and hemothorax was found on neonatal ultrasonography. Neuroblastoma was diagnosed on excision biopsy.
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Alfaar AS, Hassan WM, Bakry MS, Qaddoumi I. Neonates with cancer and causes of death; lessons from 615 cases in the SEER databases. Cancer Med 2017; 6:1817-1826. [PMID: 28639735 PMCID: PMC5504346 DOI: 10.1002/cam4.1122] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 05/03/2017] [Accepted: 05/11/2017] [Indexed: 01/15/2023] Open
Abstract
Neonatal tumors are rare with no standard treatment approaches to these diseases, and the patients experience poor outcomes. Our aim was to determine the distribution of cancers affecting neonates and compare survival between these cancers and older children. We analyzed SEER data (1973-2007) from patients who were younger than 2 years at diagnosis of malignancy. Special permission was granted to access the detailed (i.e., age in months) data of those patients. The Chi-square Log-rank test was used to compare survival between neonates (aged <1 month) and older children (>1 month to <2 years). We identified 615 neonatal cancers (454 solid tumors, 93 leukemia/lymphoma, and 68 CNS neoplasms). Neuroblastoma was the most common neonatal tumor followed by Germ cell tumors. The 5-year overall survival (OS) for all neonates was 60.3% (95% CI, 56.2-64.4). Neonates with solid tumors had the highest 5-year OS (71.2%; 95% CI, 66.9-75.5), followed by those with leukemia (39.1%; 95% CI, 28.3-49.9) or CNS tumors (15%; 95% CI, 5.4-24.6). Except for neuroblastoma, all neonatal tumors showed inferior outcomes compared to that in the older group. The proportion of neonates who died from causes other than cancer was significantly higher than that of the older children (37.9% vs. 16.4%; P < 0.0005). In general, the outcome of neonatal cancers has not improved over the last 34 years. The distribution of neonatal cancer is different than other pediatric age groups. Although the progress in neonatal and cancer care over the last 30 years, only death from noncancer causes showed improvement. Studying neonatal tumors as part of national studies is essential to understand their etiology, determine the best treatment approaches, and improve survival and quality of life for those patients.
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Affiliation(s)
- Ahmad S. Alfaar
- Ophthalmology DepartmentCharité ‐ Universitätsmedizin Berlin (Charité ‐ Berlin Medical University)BerlinGermany
| | - Waleed M. Hassan
- Research DepartmentChildren's Cancer Hospital EgyptCairo57357Egypt
| | | | - Ibrahim Qaddoumi
- Departments of OncologySt. Jude Children's Research HospitalMemphisTennessee
- International Outreach ProgramSt. Jude Children's Research HospitalMemphisTennessee
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Tonini GP. Growth, progression and chromosome instability of Neuroblastoma: a new scenario of tumorigenesis? BMC Cancer 2017; 17:20. [PMID: 28056863 PMCID: PMC5217541 DOI: 10.1186/s12885-016-2986-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 12/08/2016] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Neuroblastoma is a pediatric cancer with a low survival rate of patients with metastatic stage 4 disease. Tumor aggressiveness and progression have been associated with structural copy number variations (CNVs) that are observed in malignant cells. In contrast, localized Neuroblastomas, which are associated with a low number of structural CNVs but frequent numerical CNVs, are less aggressive, and patients have good outcomes. Finally, whole-genome and whole-exome sequencing of Neuroblastoma tissues have shown few damaging mutations in these tumors. CONCLUSIONS In the present report it is proposed that chromosome instability (CIN) plays a major role in Neuroblastoma tumorigenesis and that CIN is already present in the early phases of tumor development. High CIN can promote several types of chromosomal damage including chromothripsis, gene deletion, amplification and rearrangements, which deregulate gene expression. Indeed, gene rearrangements have been reported as a new scenario in the development of Neuroblastoma, which supports the hypothesis that CIN is an early step preliminary to the late catastrophic events leading to tumor development.
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Affiliation(s)
- Gian Paolo Tonini
- Neuroblastoma Laboratory, Italian Neuroblastoma Foundation, Pediatric Research Institute, Fondazione Città della Speranza, Corso Stati Uniti, 4, 35127, Padua, Italy.
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Marino S, La Spina M, Scuderi MG, Di Benedetto V, Magro G, Belfiore G, Coronella M, D'Amico S, Lo Nigro L, Russo G, Di Cataldo A. Bilateral adrenal neuroblastoma in the infant: Is it an image-defined risk factor? Pediatr Hematol Oncol 2016; 33:259-63. [PMID: 27285992 DOI: 10.3109/08880018.2016.1160169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The treatment of neuroblastoma is based on the International Neuroblastoma Risk Group stratification considering life-threatening symptoms, image-defined risk factors (IDRFs), presence and site of metastases, biology, and histopathology. The authors present an infant with bilateral nonmetastatic adrenal neuroblastoma with favorable biology. Both tumors were resectable and without IDRFs, but bilateral resection was considered mutilating, so it was decided to operate one side only. The authors suggest considering bilaterality among IDRFs.
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Affiliation(s)
- Silvia Marino
- a Unit of Pediatric Hematology and Oncology , Department of Clinical and Experimental Medicine , Hospital Policlinico, University of Catania , Catania , Italy
| | - Milena La Spina
- a Unit of Pediatric Hematology and Oncology , Department of Clinical and Experimental Medicine , Hospital Policlinico, University of Catania , Catania , Italy
| | - Maria Grazia Scuderi
- b Unit of Pediatric Surgery , Department GF Ingrassia , Hospital Policlinico, University of Catania , Catania , Italy
| | - Vincenzo Di Benedetto
- b Unit of Pediatric Surgery , Department GF Ingrassia , Hospital Policlinico, University of Catania , Catania , Italy
| | - Gaetano Magro
- c Unit of Anatomic Pathology , Department GF Ingrassia , Hospital Policlinico, University of Catania , Catania , Italy
| | - Giuseppe Belfiore
- d Unit of Radiology , Department GF Ingrassia , Hospital Policlinico, University of Catania , Catania , Italy
| | - Maria Coronella
- d Unit of Radiology , Department GF Ingrassia , Hospital Policlinico, University of Catania , Catania , Italy
| | - Salvatore D'Amico
- a Unit of Pediatric Hematology and Oncology , Department of Clinical and Experimental Medicine , Hospital Policlinico, University of Catania , Catania , Italy
| | - Luca Lo Nigro
- a Unit of Pediatric Hematology and Oncology , Department of Clinical and Experimental Medicine , Hospital Policlinico, University of Catania , Catania , Italy
| | - Giovanna Russo
- a Unit of Pediatric Hematology and Oncology , Department of Clinical and Experimental Medicine , Hospital Policlinico, University of Catania , Catania , Italy
| | - Andrea Di Cataldo
- a Unit of Pediatric Hematology and Oncology , Department of Clinical and Experimental Medicine , Hospital Policlinico, University of Catania , Catania , Italy
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Metastatic neuroblastoma in infants: are survival rates excellent only within the stringent framework of clinical trials? Clin Transl Oncol 2016; 19:76-83. [DOI: 10.1007/s12094-016-1505-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 03/24/2016] [Indexed: 10/22/2022]
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Darouich S, Boujelbène N, Kitova T, Jabnoun S. Congenital neuroblastoma: Report of an autopsy case. J ANAT SOC INDIA 2015. [DOI: 10.1016/j.jasi.2015.10.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
OBJECTIVE To determine outcome of neuroblastoma (NBL) in children under 18 mo of age who had been treated with national protocols. METHODS The characteristics and treatment outcomes of 27 children were evaluated retrospectively. RESULTS The event-free survival (EFS) at 60 and 108 mo were 84.7 % ± 7.7 and 72.6 % ± 7.7, respectively. The overall survival (OS) was 91.7 % ± 8 at 108 mo. The only significant risk factor for OS in children with neuroblastoma was the treatment response at the end of therapy (p = 0.001). "Wait and see" policy was applied to two infants with low risk NBL and one infant with stage 4S neuroblastoma and all 3 of these infants have been in remission at last followup. Four of the five patients with MYCN-amplified neuroblastoma were alive at a median follow-up time of 54 mo (range: 5-108 mo). CONCLUSIONS The EFS and OS of the present group were similar to that of the previous series which included children under 18 mo of age with neuroblastoma. Well known prognostic factors did not affect EFS and OS significantly; this may be related to the retrospective design of the present study and the small number of patients reviewed. High survival rate in infants with MYCN-amplified tumors suggests the difference in the biology of infant neuroblastoma.
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Abstract
During recent years, minimally invasive surgery (MIS) has become the standard approach for various operations in infants and children. MIS in pediatric thoracic and abdominal tumors is a controversial approach in the surgical management of childhood cancer. Meanwhile, more and more oncological biopsies and resections are being performed laparoscopically or thoracoscopically. Despite its increasing role in pediatric tumor surgery, the different national and international multicenter trial groups have not yet implemented MIS within guidelines and recommendations in most of the current treatment protocols. An increasing number of retrospective reports describes a potential role of MIS in the management of different pediatric oncological entities. Over the time, there has been a diverse development of this approach with regard to the different neoplasms. Nevertheless, there is a lack of prospective randomized trails assessing MIS. This still represents a requirement for evidence-based medicine and judging the advantages and disadvantages of this approach. The purpose of this state-of-the-art article is to review the current literature to describe the application of MIS in pediatric solid tumors.
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Affiliation(s)
- Jörg Fuchs
- Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany,
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Zhou Y, Li K, Zheng S, Chen L. Retrospective study of neuroblastoma in Chinese neonates from 1994 to 2011: an evaluation of diagnosis, treatments, and prognosis. J Cancer Res Clin Oncol 2013; 140:83-7. [DOI: 10.1007/s00432-013-1535-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 10/02/2013] [Indexed: 11/25/2022]
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Romania P, Castellano A, Surace C, Citti A, De Ioris MA, Sirleto P, De Mariano M, Longo L, Boldrini R, Angioni A, Locatelli F, Fruci D. High-resolution array CGH profiling identifies Na/K transporting ATPase interacting 2 (NKAIN2) as a predisposing candidate gene in neuroblastoma. PLoS One 2013; 8:e78481. [PMID: 24205241 PMCID: PMC3808344 DOI: 10.1371/journal.pone.0078481] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Accepted: 09/13/2013] [Indexed: 02/06/2023] Open
Abstract
Neuroblastoma (NB), the most common solid cancer in early childhood, usually occurs sporadically but also its familial occurance is known in 1-2% of NB patients. Germline mutations in the ALK and PHOX2B genes have been found in a subset of familial NBs. However, because some individuals harbouring mutations in these genes do not develop this tumor, additional genetic alterations appear to be required for NB pathogenesis. Herein, we studied an Italian family with three NB patients, two siblings and a first cousin, carrying an ALK germline-activating mutation R1192P, that was inherited from their unaffected mothers and with no mutations in the PHOX2B gene. A comparison between somatic and germline DNA copy number changes in the two affected siblings by a high resolution array-based Comparative Genomic Hybridization (CGH) analysis revealed a germline gain at NKAIN2 (Na/K transporting ATPase interacting 2) locus in one of the sibling, that was inherited from the parent who does not carry the ALK mutation. Surprisingly, NKAIN2 was expressed at high levels also in the affected sibling that lacks the genomic gain at this locus, clearly suggesting the existance of other regulatory mechanisms. High levels of NKAIN2 were detected in the MYCN-amplified NB cell lines and in the most aggressive NB lesions as well as in the peripheral blood of a large cohort of NB patients. Consistent with a role of NKAIN2 in NB development, NKAIN2 was down-regulated during all-trans retinoic acid differentiation in two NB cell lines. Taken together, these data indicate a potential role of NKAIN2 gene in NB growth and differentiation.
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Affiliation(s)
- Paolo Romania
- Paediatric Haematology/Oncology Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Aurora Castellano
- Paediatric Haematology/Oncology Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Cecilia Surace
- Cytogenetics and Molecular Genetics Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Arianna Citti
- Pathology Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | - Pietro Sirleto
- Cytogenetics and Molecular Genetics Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Marilena De Mariano
- Immunological Therapy, IRCCS A.O.U. San Martino-IST, Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy
| | - Luca Longo
- Immunological Therapy, IRCCS A.O.U. San Martino-IST, Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy
| | - Renata Boldrini
- Pathology Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Adriano Angioni
- Cytogenetics and Molecular Genetics Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Franco Locatelli
- Paediatric Haematology/Oncology Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
- Pediatrics Department, University of Pavia, Pavia, Italy
| | - Doriana Fruci
- Paediatric Haematology/Oncology Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
- * E-mail:
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Long-term follow-up of the "wait and see" approach to localized perinatal adrenal neuroblastoma. World J Surg 2013; 37:459-65. [PMID: 23135423 DOI: 10.1007/s00268-012-1837-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Evidence-based guidelines for the management of localized perinatal adrenal neuroblastoma are not yet available. We describe our preliminary experience managing this tumor with a "wait and see" policy. METHODS A single-center prospective study (February 2002 to December 2009) was conducted with 12 consecutive patients in whom an adrenal mass was detected antenatally or within the first 3 months of life. Diagnostic workup included the following investigations: measurement of urine catecholamine metabolites, imaging studies (ultrasonography, magnetic resonance imaging, or computed tomography), metaiodobenzylguanidine scintigraphy, and/or core needle biopsy. RESULTS The male/female ratio was 1.4:1.0. Median tumor size at presentation was 29 mm (range 10-50 mm). Eight lesions were detected antenatally. Ten lesions were diagnosed as localized neuroblastoma. Of these ten lesions, four were excised because of parental preference (n = 2), tumor enlargement (n = 1) or tumor persistence (n = 1). The remaining six patients underwent watchful clinical observation, which showed progressive tumor shrinkage and complete regression within 10-39 months (median 12.5 months). The final two lesions were small predominantly cystic lesions without a clear-cut diagnosis. They were managed noninvasively. At an overall median follow-up of 109 months (range 30-122 months), all patients are alive and disease-free, although one patient progressed to stage 4 disease despite early excision of the primary tumor. CONCLUSIONS Spontaneous regression of localized perinatal adrenal neuroblastoma occurs often, and a "wait and see" strategy seems justified in these small infants. Patients with enlarging or stable lesions that have persisted for several months may benefit from surgery, although prompt excision may not prevent tumor progression.
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Prenatal diagnosis of adrenal neuroblastoma: a case report with a brief review of the literature. Case Rep Obstet Gynecol 2013; 2013:506490. [PMID: 23607014 PMCID: PMC3623461 DOI: 10.1155/2013/506490] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Accepted: 03/12/2013] [Indexed: 11/18/2022] Open
Abstract
A case of adrenal cystic neuroblastoma detected at 37 weeks of gestation is reported. Postnatal ultrasonographic examination showed slightly increased in size demonstrating marked septations within the cyst. After the tumor was resected, histopathological examinations confirmed the diagnosis. The patient is developing normally at 1 year of age.
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A prospective study of expectant observation as primary therapy for neuroblastoma in young infants: a Children's Oncology Group study. Ann Surg 2012; 256:573-80. [PMID: 22964741 DOI: 10.1097/sla.0b013e31826cbbbd] [Citation(s) in RCA: 112] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To demonstrate that expectant observation of young infants with small adrenal masses would result in excellent event-free and overall survival. BACKGROUND Neuroblastoma is the most common malignant tumor in infants, and in young infants, 90% of neuroblastomas are located in the adrenal gland. Although surgical resection is standard therapy, multiple observations suggest that expectant observation could be a safe alternative for infants younger than 6 months who have small adrenal masses. METHODS A prospective study of infants younger than 6 months with small adrenal masses and no evidence of spreading beyond the primary tumor was performed at participating Children's Oncology Group institutions. Parents could choose observation or immediate surgical resection. Serial abdominal sonograms and urinary vanillylmandelic acid and homovanillic acid measurements were performed during a 90-week interval. Infants experiencing a 50% increase in the volume of the mass, urine catecholamine values, or an increase in the homovanillic acid to vanillylmandelic acid ratio greater than 2, were referred for surgical resection. RESULTS Eighty-seven eligible patients were enrolled: 83 elected observation and 4 chose immediate surgery. Sixteen observational patients ultimately had surgery; 8 had International Neuroblastoma Staging System stage 1 neuroblastoma, 2 had higher staged neuroblastoma (2B and 4S), 2 had low-grade adrenocortical neoplasm, 2 had adrenal hemorrhage, and 2 had extralobar pulmonary sequestration. The 2 patients with adrenocortical tumors were resected because of a more than 50% increase in tumor volume. The 3-year event-free survival for a neuroblastoma event was 97.7 ± 2.2% within the entire cohort of patients (n = 87). The 3-year overall survival was 100%, with a median follow-up of 3.2 years. Eighty-one percent of patients on the observation arm were spared resection. CONCLUSIONS Expectant observation of infants younger than 6 months with small adrenal masses led to excellent event-free survival and overall survival while avoiding surgical intervention in a large majority of the patients.
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Qaddoumi I, Carey SS, Conklin H, Jenkins J, Sabin N, Boop F, Pai-Panandiker A, Baker J, Wright K, Broniscer A, Gajjar A. Characterization, treatment, and outcome of intracranial neoplasms in the first 120 days of life. J Child Neurol 2011; 26:988-94. [PMID: 21532007 PMCID: PMC3174527 DOI: 10.1177/0883073811401398] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Little is known about brain tumors in early infancy. Investigators reviewed the records of 27 patients (12 boys and 15 girls) diagnosed within 120 days of birth. The median age was 66 days (range, 0-110 days) at diagnosis. All patients underwent surgery; 18 received adjuvant chemotherapy, and 3 received adjuvant chemotherapy and radiation therapy. The median follow-up was 2.1 years (range, 0.2-21.6 years). At last encounter, 15 patients were alive, and 11 had no evidence of disease. Ten patients died of progressive disease, and 2 died of treatment-related complications. All survivors experienced late effects, including endocrine, neurologic, and cognitive deficits. Of the 13 patients who completed neurocognitive assessments, 7 had an IQ score less than 70. Children in whom brain tumors arise during early infancy can be cured with conventional therapy; however, contemporary approaches can adversely affect long-term function, and families need to be aware of these effects when making therapeutic decisions.
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Affiliation(s)
- Ibrahim Qaddoumi
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee 38105-3678, USA.
| | - Steven S. Carey
- Pediatric Oncology Education Program, St. Jude Children’s Research Hospital, Memphis, TN 38105,University of Arizona College of Medicine, Tucson, AZ 85724
| | - Heather Conklin
- Department of Behavioral Medicine, St. Jude Children’s Research Hospital, Memphis, TN 38105
| | - Jesse Jenkins
- Department of Pathology, St. Jude Children’s Research Hospital, Memphis, TN 38105
| | - Noah Sabin
- Department of Radiological Sciences, St. Jude Children’s Research Hospital, Memphis, TN 38105
| | - Frederick Boop
- Department of Surgery, St. Jude Children’s Research Hospital, Memphis, TN 38105
| | - Atmaram Pai-Panandiker
- Department of Radiological Sciences, St. Jude Children’s Research Hospital, Memphis, TN 38105
| | - Justin Baker
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN 38105
| | - Karen Wright
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN 38105
| | - Alberto Broniscer
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN 38105
| | - Amar Gajjar
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN 38105
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Abstract
Neuroblastoma is the most common extracranial solid tumor in pediatric age group. Clinical presentation of neuroblastoma is mostly related to origin of the tumor, extent of disease, and the presence of paraneoplastic syndromes. Here the authors report a neonate with neuroblastoma with an atypical presentation, diagnosed with postnatal abdominal ultrasonography performed due to polyhydramniosis in her mother during pregnancy.
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Affiliation(s)
- Serhan Küpeli
- Department of Pediatric Oncology, Hacettepe University, Institute of Oncology, Ankara, Turkey.
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Affiliation(s)
- Sunita Dhir
- Department of Paediatric Haematology and Oncology, Oxford Children's Hospital, Oxford, OX3 9DU, United Kingdom
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