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Yeh PJ, Chen SH, Lai JY, Lai MW, Chiu CH, Chao HC, Chen SH, Wu RC, Wang CJ, Chen CC. Rare Cases of Pediatric Vasoactive Intestinal Peptide Secreting Tumor With Literature Review: A Challenging Etiology of Chronic Diarrhea. Front Pediatr 2020; 8:430. [PMID: 32850544 PMCID: PMC7419468 DOI: 10.3389/fped.2020.00430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 06/22/2020] [Indexed: 12/25/2022] Open
Abstract
Vasoactive intestinal peptide (VIP) secreting tumor (VIPoma) is a rare disease, presenting with profuse diarrhea, electrolyte imbalance, and possibly fatal outcome. The diagnosis and treatment are challenging, and no consensus guideline of management is available. The pediatric incidence remains unclear. This study comprises two pediatric case reports from a tertiary center and a literature-based case series investigating the characteristics among children. The two reported cases both presented with severe diarrhea and laboratory abnormalities, including electrolyte imbalance and elevated plasma VIP level. Case 1 received several imaging investigations, partial pancreatectomy, octreotide, and everolimus, reflecting her complicated and refractory course. Case 2 underwent total excision of suprarenal ganglioneuroblastoma, and the clinical response was significant. In both cases, varied degrees of symptomatic control, reduced plasma VIP level, and correction of electrolyte imbalance were achieved. A literature review-based case series analyzed 45 pediatric cases retrieved from the PubMed database until December 31, 2019. Demographics, clinical features, diagnostic modalities, treatments, and outcomes were presented.
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Affiliation(s)
- Pai-Jui Yeh
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University College of Medicine, Taoyuan City, Taiwan
| | - Shih-Hsiang Chen
- Division of Hematology and Oncology, Department of Pediatrics, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University College of Medicine, Taoyuan City, Taiwan
| | - Jin-Yao Lai
- Department of Pediatric Surgery, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University College of Medicine, Taoyuan City, Taiwan
| | - Ming-Wei Lai
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University College of Medicine, Taoyuan City, Taiwan
| | - Cheng-Hsun Chiu
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University College of Medicine, Taoyuan City, Taiwan
| | - Hsun-Chin Chao
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University College of Medicine, Taoyuan City, Taiwan
| | - Shih-Hsin Chen
- Department of Nuclear Medicine and Molecular Imaging Center, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University College of Medicine, Taoyuan City, Taiwan
| | - Ren-Chin Wu
- Department of Pathology, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University College of Medicine, Taoyuan City, Taiwan
| | - Chao-Jan Wang
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University College of Medicine, Taoyuan City, Taiwan
| | - Chien-Chang Chen
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University College of Medicine, Taoyuan City, Taiwan
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Singh AK, Sargar K, Restrepo CS. Pediatric Mediastinal Tumors and Tumor-Like Lesions. Semin Ultrasound CT MR 2016; 37:223-37. [DOI: 10.1053/j.sult.2015.11.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Abstract
Neuroblastoma (NB) is the third most common pediatric cancer. Although NB accounts for 7% of pediatric malignancies, it is responsible for more than 10% of childhood cancer-related mortality. Prognosis and treatment are determined by clinical and biological risk factors. Estimated 5-year survival rates for patients with non-high-risk and high-risk NB are more than 90% and less than 50%, respectively. Recent clinical trials have continued to reduce therapy for patients with non-high-risk NB, including the most favorable subsets who are often followed with observation approaches. In contrast, high-risk patients are treated aggressively with chemotherapy, radiation, surgery, and myeloablative and immunotherapies.
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Neuroblastoma presenting as persistent postprandial emesis in a neonate. Pediatr Emerg Care 2013; 29:1273-5. [PMID: 24300469 DOI: 10.1097/pec.0000000000000029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Early identification and treatment of neuroblastoma, the most common malignant solid tumor in infants, (Atkinson et al. AJR Am J Roentgenol. 1986;146:113-117; Nuchtern. Semin Pediatr Surg. 2006;15:10-16; Lanzkowsky. Manual of Pediatric Hematology and Oncology. 4th ed. Burlington, MA: Elsevier Academic Press; 2005:530-547) can improve prognosis of this illness. Benign emesis as an initial presentation of infantile neuroblastoma is rare (Isaacs. Fetal Pediatr Pathol. 2007;26:177-184). We report a case of a 17-day-old healthy male who presented to the emergency department with persistent, nonprojectile emesis after feedings. A diagnosis of nonresectable stage IV thoracoabdominal neuroblastoma with invasion to the spine was made. We concluded that oncological processes, such as neuroblastoma, should be included in the differential diagnosis of persistent emesis in the neonatal period. Emergency physicians may have the opportunity to detect neuroblastoma earlier by contemplating a broader differential diagnosis of a vomiting infant and initiating the appropriate workup in the emergency department.
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Park JR, Eggert A, Caron H. Neuroblastoma: biology, prognosis, and treatment. Hematol Oncol Clin North Am 2010; 24:65-86. [PMID: 20113896 DOI: 10.1016/j.hoc.2009.11.011] [Citation(s) in RCA: 317] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Neuroblastoma, a neoplasm of the sympathetic nervous system, is the second most common extracranial malignant tumor of childhood and the most common solid tumor of infancy. Neuroblastoma is a heterogeneous malignancy with prognosis ranging from near uniform survival to high risk for fatal demise. Neuroblastoma serves as a paradigm for the prognostic utility of biologic and clinical data and the potential to tailor therapy for patient cohorts at low, intermediate, and high risk for recurrence. This article summarizes our understanding of neuroblastoma biology and prognostic features and discusses their impact on current and proposed risk stratification schemas, risk-based therapeutic approaches, and the development of novel therapies for patients at high risk for failure.
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Affiliation(s)
- Julie R Park
- Division of Hematology and Oncology, University of Washington School of Medicine and Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA 98105-0371, USA.
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Bourdeaut F, de Carli E, Timsit S, Coze C, Chastagner P, Sarnacki S, Delattre O, Peuchmaur M, Rubie H, Michon J. VIP hypersecretion as primary or secondary syndrome in neuroblastoma: A retrospective study by the Société Française des Cancers de l'Enfant (SFCE). Pediatr Blood Cancer 2009; 52:585-90. [PMID: 19143025 DOI: 10.1002/pbc.21912] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Neuroblastic tumors (NTs) are occasionally associated with watery diarrhea, due to Vasoactive Intestinal Peptide (VIP) secretion. Most reports are single cases and suggest a great homogeny within this sub-group of NTs. PROCEDURES We conducted a retrospective analysis of the French experience of NTs associated with watery diarrhea due to VIP-secretion. VIP secretion was confirmed by seric dosage and/or immunohistochemistry. RESULTS Twenty-two patients met the diagnostic criteria between 1988 and 2007. Most of patients suffered from weight loss and metabolic disorders. In 16 cases, digestive symptoms preceded the diagnosis of the tumor ("Primary VIP secreting NTs"); 15 were localized and all showed a differentiated histology. Interestingly, in another 6 patients with high-risk NT, diarrhea occurred at the time of chemotherapy or retinoic acid therapy ("Secondary VIP secreting NTs"). Differentiation in response to treatment was documented in 4 cases. In all cases, only surgical excision of the tumor was able to control the digestive symptoms. Twenty children are alive and 13 are disease-free. CONCLUSION VIP secreting NTs are usually associated with differentiation; they can also secondarily arise from a high-risk tumor upon treatment. Primary surgery constitutes first-line treatment.
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Abstract
Neuroblastoma, a neoplasm of the sympathetic nervous system, is the second most common extracranial malignant tumor of childhood and the most common solid tumor of infancy. Neuroblastoma is a heterogeneous malignancy with prognosis ranging from near uniform survival to high risk for fatal demise. Neuroblastoma serves as a paradigm for the prognostic utility of biologic and clinical data and the potential to tailor therapy for patient cohorts at low, intermediate, and high risk for recurrence. This article summarizes our understanding of neuroblastoma biology and prognostic features and discusses their impact on current and proposed risk stratification schemas, risk-based therapeutic approaches, and the development of novel therapies for patients at high risk for failure.
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Affiliation(s)
- Julie R Park
- Division of Hematology and Oncology, University of Washington School of Medicine and Children's Hospital and Regional Medical Center, Seattle, WA 98105-0371, USA.
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Abstract
Neuroblastomas continue to remain a clinical challenge, despite advances in multimodal therapy. Currently, studies are aimed at novel targets for neuroblastoma directed toward poor prognostic indicators such as the MYCN oncogene and marked angiogenesis. There have also been recent discoveries in neuroblastoma pathogenesis involving epigenetic regulation and retinoic acid therapy. Understanding the intricate complexities of this tumor may lead to innovative agents for more effective combinational therapy.
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Affiliation(s)
- Sunghoon Kim
- Children's Hospital and Research Center Oakland, 747 Fifty-Second Street, Oakland, CA 94609, USA
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Abstract
One-fifth of all neuroblastomas are diagnosed either antenatally or in the first 3 months of life. Over the past two decades, routine prenatal ultrasound has significantly increased the rate of diagnosis of fetal neuroblastoma. More than 90% of these tumors arise in the adrenal gland, suggesting a link between perinatal tumors and the nodular collections of neuroblasts that are part of normal adrenal development. In fact, there is compelling evidence that the cystic variant of perinatal neuroblastoma is caused by a perturbation of the involution program of these neuroblastic nodules. The vast majority of these cases are localized tumors with favorable biological features, which correlates with a 4-year survival of greater than 95%. The high rate of spontaneous regression of these tumors, coupled with the significant risks of resectional surgery in small neonates, has prompted the development of a prospective clinical trail of expectant observation as primary therapy for infants with small, localized tumors. The ultimate goal of such studies is to define an ultra-low-risk group of neuroblastoma patients who do not require invasive procedures or chemotherapy to achieve an excellent outcome.
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Affiliation(s)
- Jed G Nuchtern
- Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA.
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Bourgois B, Boman F, Nelken B, Bonnevalle M, Turck D. [Intractable diarrhoea revealing a neuroblastoma hypersecreting the vasoactive intestinal peptide]. Arch Pediatr 2004; 11:340-3. [PMID: 15051093 DOI: 10.1016/j.arcped.2004.01.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2003] [Accepted: 01/19/2004] [Indexed: 10/26/2022]
Abstract
In children, the watery diarrhoea-hypokalemia-achlorhydria (WDHA) syndrome is uncommon and usually due to a neuroblastic tumour hypersecreting the vasoactive intestinal peptide (VIP). We report a case of WDHA syndrome secondary to hypersecretion of VIP that revealed a neuroblastoma in a 13-month-old girl. A secretory diarrhoea, characterised by the persistence of diarrhoea despite the cessation of oral feeding, led to the search of a neuroblastic tumour in the patient. The serum concentration of VIP decreased to normal values soon after the surgical excision of the tumour.
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Affiliation(s)
- B Bourgois
- Clinique de pédiatrie, hôpital Jeanne-de-Flandre, 2, avenue Oscar-Lambret, 59037 Lille, France
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Schellscheidt J, Baas S, Schmid KW, Vormoor J, Zimmer KP. Identification of two distinct subpopulations in a ganglioneuroblastoma: lack of co-localization of vasoactive intestinal polypeptide and calcitonin in ganglionic cells at the ultrastructural level. ACTA ACUST UNITED AC 2003; 41:571-3. [PMID: 14595721 DOI: 10.1002/mpo.10427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Jörn Schellscheidt
- Klinik und Poliklinik für Kinderheilkunde-Allgemeine Kinderheilkunde, Universitätsklinikum Münster, Münster, Germany
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Barbato M, Clerico A, Viola F, Dito L, Schiavetti A, Cucchiara S. Coeliac disease and ganglioneuroblastoma: an unusual association. MEDICAL AND PEDIATRIC ONCOLOGY 2002; 39:215-6. [PMID: 12210456 DOI: 10.1002/mpo.10091] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Maria Barbato
- Pediatric Gastroenterology Unit, Istitute of Pediatrics, University of Rome La Sapienza, Italy.
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Abstract
The incidence of neonatal adrenal tumors is increasing due to the expanded use and accuracy of prenatal ultrasonography in routine obstetric care. Although adrenal and juxtarenal masses may represent benign lesions (adrenal hemorrhage, subdiapragmatic extralobar pulmonary sequestration), the majority of masses either are premalignant or malignant. Previous algorithms for the diagnosis and management of these lesions have been guided primarily by the high incidence of neuroblastomas within this group. Improved insight into the relatively benign behavior of many neonatal neuroblastomas has stimulated debate regarding the appropriate management schema for neonatal adrenal masses. Moreover, the increasing recognition of benign juxtarenal lesions further challenges the conventional dogma. This review discusses the major categories of adrenal masses to help generate a rational algorithm for diagnosis and therapy.
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Affiliation(s)
- E P Nadler
- Department of Surgery, Children's Hospital of Pittsburgh, and the University of Pittsburgh School of Medicine, Pennsylvania 15213, USA
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Affiliation(s)
- M M Rodriguez
- Departments of Pathology, Radiology, and Pediatrics, University of Miami School of Medicine, Jackson Memorial Hospital, Miami, FL 33136, USA
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Abstract
Neuroblastoma is an enigmatic tumor that has the highest rate of spontaneous regression of all human malignant neoplasms, yet has one of the poorest outcomes when occurring as disseminated disease in children. The emergence of neuroblastoma tumor biology, coupled with age and stage of diagnosis, has allowed more accurate routing of patients to risk-related therapy and refining of such therapy to minimize treatment for those with low risk for recurrent disease and searching out new treatment strategies for patients with high-risk disease. Continued assessment of tumor biologic features in all patients will provide new insights into tumorigenesis, cell differentiation, and death pathways, resulting in the potential for developing newer therapies for patients with high-risk disease.
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Affiliation(s)
- R P Castleberry
- Department of Pediatrics, University of Alabama at Birmingham, Children's Hospital, USA
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Affiliation(s)
- H Shimada
- Department of Pathology and Laboratory Medicine, Childrens Hospital Los Angeles, California 90027
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Nieder ML, Gauderer MW. Recent developments in the management of neuroblastoma. PROGRESS IN PEDIATRIC SURGERY 1991; 26:124-36. [PMID: 1904592 DOI: 10.1007/978-3-642-88324-8_15] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Neuroblastoma was first described in 1864 by Virchow. For the next 100 years, the primary approach to these patients was predominantly surgical resection. With the advent of multimodal adjuvant treatments using chemotherapy and irradiation in the 1950s and 1960s, coordination of multispecialty therapeutic interventions became important. By the late 1970s, effective neoadjuvant chemotherapeutic regimens enabled some inoperable tumors to be completely removed at the time of "second look" procedures. In the 1980s, advances in tumor biology and imaging gave new insight and novel prognostic indicators which helped determine the course of therapy. In the 1990s, treating poor risk patients with extremely high dose chemotherapy, irradiation, and allogeneic or autologous bone marrow rescue with or without surgical resection may finally improve the survival of these children.
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Affiliation(s)
- M L Nieder
- Divisions of Pediatric Hematology/Oncology, Rainbow Babies' and Children's Hospital, Cleveland, OH
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Mauer AM, Burgess JB, Donaldson SS, Rickard KA, Stallings VA, van Eys J, Winick M. Special nutritional needs of children with malignancies: a review. JPEN J Parenter Enteral Nutr 1990; 14:315-24. [PMID: 2112650 DOI: 10.1177/0148607190014003315] [Citation(s) in RCA: 88] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Nutrition support for the patient with cancer is an important part of the overall treatment regimen. Nutrition support for the child with cancer poses a special challenge. For the purpose of reviewing the special nutritional needs of children with cancer, a Task Force was formed by the American Academy of Pediatrics to review the current state of knowledge. The work of the Task Force was supported by the Food and Drug Administration through its Liaison Representative, Joginder Chopra, M.D., Staff support from the Academy was provided by Jean D. Lockhart, M.D., This review is prepared from the Task Force Report to the FDA. It is designed to review factors enhancing nutritional risks for the child with cancer and to discuss nutritional intervention strategies and their efficacies.
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Affiliation(s)
- A M Mauer
- Division of Hematology and Oncology, University of Tennessee, Memphis
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