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Sahni S, Rastogi S, Yadav R, Barwad A. Limb salvage of an infant with infantile fibrosarcoma using TRK inhibitor larotrectinib. Ecancermedicalscience 2023; 17:1575. [PMID: 37533946 PMCID: PMC10393313 DOI: 10.3332/ecancer.2023.1575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Indexed: 08/04/2023] Open
Abstract
Infantile fibrosarcoma (IFS) is an extremely rare locally aggressive soft tissue tumour of childhood. Primary therapy involves complete surgical resection with or without chemotherapy. However complete surgical resection might not be feasible in all cases and so requires other modalities for further management. We report the case of a male infant from Bangladesh with a locally advanced IFS of the leg which was partially resected. The patient received adjuvant chemotherapy which was complicated by the development of chemotherapy-related veno-occlusive disease and had to be discontinued. Thereafter he was referred to our dedicated sarcoma oncology clinic in India for further management. The parents of the child refused amputation of the limb. The tumour tested positive for NTRK3-ETV6 gene fusion and after discussion in multidisciplinary clinic, targeted therapy using oral NTRK inhibitor larotrectinib was started. The patient had complete response at the end of 8 months of treatment with larotrectinib. This is the first report from the Indian subcontinent and we encourage that these children should be referred to specialist clinics for appropriate multidisciplinary management for best outcomes.
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Affiliation(s)
- Shubham Sahni
- Department of Medicine, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Sameer Rastogi
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Richa Yadav
- Department of Radio-diagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Adarsh Barwad
- Department of Pathology, All India Institute of Medical Sciences, New Delhi 110029, India
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Case report: A rare case of congenital non-metastatic low-grade fibrosarcoma of the pleura in a 6-month-old infant manifested as pneumonia. Int J Surg Case Rep 2022; 99:107714. [PMID: 36183591 PMCID: PMC9568840 DOI: 10.1016/j.ijscr.2022.107714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 09/25/2022] [Accepted: 09/26/2022] [Indexed: 11/21/2022] Open
Abstract
Introduction and importance Congenital Infantile fibrosarcoma is a rare tumor in children and accounts for only 10 % of various malignant tumors in this age group. Manifestations vary according to the site of occurrence. Symptoms of the tumor located in unusual places can be misleading and obscure the actual diagnosis, which in turn may waste precious effort and time until the correct diagnosis is established. Infant malignancies should be considered to reduce the morbidity and mortality associated with this pathology. Case presentation We present the case of a 6-month-old infant, who was admitted to our hospital with a one-month history of high fever and dry cough, with no improvement in symptoms after treatment with antibiotics. Computed tomography showed a heterogeneous mass in the pleural cavity compressing the lung tissue, in addition to bilateral mild pleural effusion. Thoracotomy was indicated and the tumor was completely resected. Clinical discussion Histopathological and Immunohistochemical approach is crucial because this type of tumor can overlap with many soft tissue sarcomas. After searching in medical literature, no published evidence of a similar case was found, and thus we managed the patient empirically, depending on the usual approach for congenital fibrosarcoma. Complete surgical resection is the golden standard of treatment, followed by chemotherapy depending on pathological findings. Conclusion Clinical awareness is important in any unresponsive pneumonia and malignancies should be taken into consideration. Congenital infantile fibrosarcoma (CIFS) is a rare tumor and is often seen after birth and evolve during the early years of life. CIFS can manifest in several places in the body but rarely in chest cavity. Immunohistochemistry is a significant assistant in the diagnosis of soft tissue neoplasms. Complete surgical resection is the golden standard in treatment followed by chemotherapy depending on pathological findings. Local recurrence is a common phenomenon and occurs in 20–40 % of cases.
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Huerta CT, Quinn K, Saberi RA, Rao KA, Quiroz HJ, Brady AC, Thorson CM, Sola JE, Perez EA. Radical Resection of Pediatric Fibrosarcoma Is Not Associated With Survival Benefit: A Nationwide Database Analysis. J Surg Res 2022; 279:639-647. [PMID: 35930817 DOI: 10.1016/j.jss.2022.06.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 05/27/2022] [Accepted: 06/13/2022] [Indexed: 10/31/2022]
Abstract
INTRODUCTION Fibrosarcoma is one of the most common nonrhabdomyosarcoma soft tissue sarcomas in the pediatric population. Surgical resection is the cornerstone of treatment; however, optimal factors regarding the extent of fibrosarcoma resection in localized versus regional disease is poorly understood. METHODS The Surveillance, Epidemiology, and End Results database was queried for patients who are 19 y old or younger with a diagnosis of fibrosarcoma from 1975 to 2016. Kaplan-Meier analyses were performed for disease-specific survival on clinical and pathologic variables. Multivariate analysis was performed based on significant predictors of disease-specific survival. RESULTS There were 1290 patients (median age 13 [7-17] y) identified with fibrosarcoma. The overall survival rate at 20 y was 93%. Radical resection was performed on 22%, 40%, and 52% of patients with localized, regional, and distant Surveillance, Epidemiology, and End Results disease stage, respectively. Chemotherapy (P < 0.001), radiation (P < 0.001), histology (P < 0.001), and stage (P = 0.004) were significant predictors of increased mortality using univariate Kaplan-Meier analysis. Most patients (86%) with localized or regional stage who underwent radiation had fibrosarcomas of nondermatofibrosarcoma histology (P < 0.001). Dermatofibrosarcoma subtype comprised most radical resections (41%). Excluding distant stage, nondermatofibroma histology (hazard ratio 16.94, 95% confidence interval 3.77-76.01) and regional stage (hazard ratio 8.15, 95% confidence interval 2.93-22.69) were independent prognostic factors of mortality (both P < 0.001). Radical resection was not a significant independent prognostic indicator of survival. CONCLUSIONS Nondermatofibrosarcoma subtype is independently associated with increased mortality. Although surgery remains the mainstay of treatment, the extent of resection is not a predictor of survival for patients with the localized and regional stage of disease.
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Affiliation(s)
- Carlos Theodore Huerta
- DeWitt Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Kirby Quinn
- University of Miami Miller School of Medicine, Miami, Florida
| | - Rebecca A Saberi
- DeWitt Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Krishnamurti A Rao
- DeWitt Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Hallie J Quiroz
- DeWitt Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Ann-Christina Brady
- DeWitt Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Chad M Thorson
- DeWitt Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Juan E Sola
- DeWitt Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Eduardo A Perez
- DeWitt Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, Florida.
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Innocenti M, Delcroix L, Lucattelli E, Bastoni S, Daolio PA. Functional Forearm Reconstruction With a Latissimus Dorsi Free Flap and Tendon Transfer After Congenital Soft-Tissue Sarcoma Resection in a 29-Week-Old Girl: A Case Report. HSS J 2022; 18:161-165. [PMID: 35087346 PMCID: PMC8753537 DOI: 10.1177/1556331621994104] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 10/21/2020] [Indexed: 02/03/2023]
Affiliation(s)
- Marco Innocenti
- Plastic and Reconstructive Microsurgery, Careggi University Hospital, Florence, Italy
| | - Luca Delcroix
- Plastic and Reconstructive Microsurgery, Careggi University Hospital, Florence, Italy
| | - Elena Lucattelli
- Plastic and Reconstructive Microsurgery, Careggi University Hospital, Florence, Italy,Elena Lucattelli, MD, Plastic and Reconstructive Microsurgery, Careggi University Hospital, AOU Careggi Largo Piero Palagi 1, 50139 Florence, Italy.
| | - Stefano Bastoni
- C.O.O., Azienda Socio Sanitaria Territoriale Gaetano Pini, Milan, Italy
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Corral Sánchez MD, Galán Gómez V, Sastre Urgelles A, Plaza López de Sabando D, Rubio Aparicio P, Martínez Martínez L, Alonso Gamarra E, Pozo Kreilinger JJ, Regojo Zapata RM, López Gutiérrez JC, Antolín Alvarado E, Gómez Martín F, Sánchez Torres AM, Marín Manzano E, González Del Valle L, Pérez-Martínez A. Treatment of infantile fibrosarcoma associated to an abdominal aortic aneurysm with larotrectinib: a case report. Pediatr Hematol Oncol 2021; 38:504-509. [PMID: 33622165 DOI: 10.1080/08880018.2021.1889730] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Infantile fibrosarcoma (IFS) is a rare pediatric tumor which often presents the ETV6-NTRK3 gene fusion. NTRK3 encodes the neurotrophin-3 growth factor receptor tyrosine kinase, a druggable therapeutic target. Selective tropomyosin receptor kinase (TRK) inhibitors, such as larotrectinib, have shown efficacy and safety in the treatment of IFS. We report a case of an abdominal IFS diagnosed in a newborn associated with an aortic aneurysm that was successfully treated with larotrectinib without relevant adverse effects.
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Affiliation(s)
| | - Víctor Galán Gómez
- Pediatric Hematology and Oncology Service, University Hospital La Paz, Madrid, Spain
| | - Ana Sastre Urgelles
- Pediatric Hematology and Oncology Service, University Hospital La Paz, Madrid, Spain
| | | | - Pedro Rubio Aparicio
- Pediatric Hematology and Oncology Service, University Hospital La Paz, Madrid, Spain
| | | | | | | | | | | | | | | | | | | | | | - Antonio Pérez-Martínez
- Pediatric Hematology and Oncology Service, University Hospital La Paz, Madrid, Spain.,Universidad Autónoma de Madrid, Madrid, Spain
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Orbach D, Sparber-Sauer M, Laetsch TW, Minard-Colin V, Bielack SS, Casanova M, Corradini N, Koscielniak E, Scheer M, Hettmer S, Bisogno G, Hawkins DS, Ferrari A. Spotlight on the treatment of infantile fibrosarcoma in the era of neurotrophic tropomyosin receptor kinase inhibitors: International consensus and remaining controversies. Eur J Cancer 2020; 137:183-192. [DOI: 10.1016/j.ejca.2020.06.028] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 05/31/2020] [Accepted: 06/19/2020] [Indexed: 12/13/2022]
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Ingley KM, Cohen-Gogo S, Gupta AA. Systemic therapy in pediatric-type soft-tissue sarcoma. ACTA ACUST UNITED AC 2020; 27:6-16. [PMID: 32174753 DOI: 10.3747/co.27.5481] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Soft-tissue sarcoma (sts) is rare and represents approximately 7% of cancers in children and in adolescents less than 20 years of age. Rhabdomyosarcoma (rms) is most prevalent in children less than 10 years of age and peaks again during adolescence (16-19 years of age). Multi-agent chemotherapy constitutes the mainstay of treatment for rms. In other non-rhabdomyosarcoma soft-tissue tumours, such as synovial sarcoma, evidence for routine use of chemotherapy is less robust, and alternative treatment options, including targeted agents and immunotherapy, are being explored. In this review, we focus on chemotherapy for pediatric-type rms and discuss the advances and challenges in systemic treatment for select non-rhabdomyosarcoma soft-tissue tumours in children and adolescents. We support an increasingly cooperative approach for treating pediatric and adult sts.
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Affiliation(s)
- K M Ingley
- Department of Pediatric Oncology, Royal Children's Hospital, Melbourne, Australia.,Adolescent and Young Adult Cancer Service, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - S Cohen-Gogo
- Division of Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, Toronto, ON
| | - A A Gupta
- Division of Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, Toronto, ON.,Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON.,Division of Medical Oncology and Hematology, Sinai Health System, Toronto, ON
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8
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Yalçin B, Leblebicioğlu G, Güler E, Gedikoğlu G, Kutluk MT. Congenital Infantile Fibrosarcoma of the Thigh in a Newborn. TUMORI JOURNAL 2018; 87:436-8. [PMID: 11989601 DOI: 10.1177/030089160108700616] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Congenital/infantile fibrosarcoma occurs frequently in the first year of life and differs from fibrosarcoma in adulthood. The clinical course of congenital/infantile fibrosarcoma is more favorable and metastatic spread is rare. While adult fibrosarcomas are common in the thigh, congenital/infantile fibrosarcomas affect chiefly the distal portions of the extremities. Standard treatment is primarily wide surgical excision. Chemotherapy may be given as neoadjuvant or adjuvant treatment in order to avoid the morbidity associated with wide excision. In this case report we present our experience of a newborn affected by congenital/infantile fibrosarcoma of the left thigh.
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Affiliation(s)
- B Yalçin
- Department of Pediatric Oncology, Hacettepe University Institute of Oncology, Ankara, Turkey
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9
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Chandrasekaran A. Neonatal solid tumors. Pediatr Neonatol 2018; 59:65-70. [PMID: 28736178 DOI: 10.1016/j.pedneo.2016.12.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 11/02/2016] [Accepted: 12/30/2016] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Neonatal tumors are different from tumors of the older children and knowledge gained from treating older children can not be extrapolated to neonates. Neonates have immature physiology and their haematopoietic and immune systems are not fully developed and the response to therapy is unpredictable. Hence it is imperative to study these tumors as separate entity. The aim of this study is to analyse this rare set of tumors in terms of their incidence, clinical features and management. MATERIALS AND METHODS All babies admitted in our hospital with tumors from January, 2011 to January 2016 were studied. Tumor-like conditions like haemangioma, lymphangioma and hamartomas were included. The age, sex distribution, type of tumor and management were studied. RESULTS A total of 51 cases were registered out of which, 29 cases were haemangiomas and lymphangiomas. Of remaining 20 cases, 5 were benign ovarian cysts, 3 were neuroblastomas, 3 were congenital fibrosarcomas, 3 were sacrococcygeal teratomas. Wilm's tumor, congenital mesoblastic nephroma, haemangioendothelioma of liver and others formed the remaining six cases. CONCLUSION Our study insists that the neonatal tumors are distinct subset of pediatric tumors, requiring careful selection of treatment modalities and most of the solid tumors can be successfully managed if diagnosed and treated early. Neonatal tumors are defined as tumors which are diagnosed before the first month of life. Some of them can be congenital (present at birth). Neonatal tumors are different from tumors in older children in terms of etiopathogenesis, behavior and response to therapy as well as long-term outcomes.
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10
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Demirbolat GM, Altintas L, Yilmaz S, Degim IT. Development of Orally Applicable, Combinatorial Drug-Loaded Nanoparticles for the Treatment of Fibrosarcoma. J Pharm Sci 2018; 107:1398-1407. [PMID: 29339136 DOI: 10.1016/j.xphs.2018.01.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 11/16/2017] [Accepted: 01/03/2018] [Indexed: 12/15/2022]
Abstract
Nanoparticulate systems have been receiving a significant attention especially for the treatment of cancer but one of the main hurdles is to produce these developed and high-tech nanosystems in large quantities. Anticancer drug formulations are generally designed for parenteral administrations but oral administration is still the most convenient route. In this study, orally applicable nano-sized chitosan nanoparticles (NPs) were successfully prepared using Nano Spray Dryer. It is possible to produce these NPs in large quantities by simply increasing the processing time using the machine without changing any parameter. A chemotherapeutic agent (imatinib mesylate; IMA) and nonsteroidal anti-inflammatory drug (dexketoprofen trometamol) were loaded together in these NPs. NPs were also functionalized with polyethylene glycol and folic acid to obtain long circulating NPs and tumor targeting. The antitumoral activities of formulations showed that these developed NPs can enhance the effectiveness. Animal experiments were performed on fibrosarcoma-bearing mice model, and the treatment with 0.8 mg/μL/kg IMA-loaded chitosan NPs was found to be successful to slow down the growth of tumors. The tumor tissues were removed from the animals and enzymatic activities were evaluated. The inhibitory effect of tyrosine kinase was found to be enhanced from 36.4% to 68.4% when IMA was used in combination with dexketoprofen trometamol. Furthermore, all dried NPs were found to be stable for more than a year at 25°C. Presented results show that these developed combinatorial drug-loaded NPs can be used for the treatment of fibrosarcoma, and these data can provide an insight, new strategies for productions or alternatives in cancer treatment.
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Affiliation(s)
- Gulen Melike Demirbolat
- Department of Pharmaceutical Technology, Gazi University Faculty of Pharmacy, 06330, Ankara, Turkey
| | - Levent Altintas
- Department of Pharmacology and Toxicology, Ankara University Faculty of Veterinary Medicine, 06110, Ankara, Turkey
| | - Sukran Yilmaz
- Cells and Virus Bank Division, Food and Mouth Diseases Institute, 06520, Ankara, Turkey
| | - Ismail Tuncer Degim
- Department of Pharmaceutical Technology, Biruni University Faculty of Pharmacy, 34010, Topkapi, Istanbul, Turkey.
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Hirschfeld R, Welch JJG, Harrison DJ, Kremsdorf R, Chawla A. Two cases of humoral hypercalcemia of malignancy complicating infantile fibrosarcoma. Pediatr Blood Cancer 2017; 64. [PMID: 28371408 DOI: 10.1002/pbc.26511] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 02/07/2017] [Accepted: 02/07/2017] [Indexed: 11/09/2022]
Abstract
We report two infants with infantile fibrosarcoma (IFS) complicated by severe hypercalcemia. Assessment demonstrated suppressed parathyroid hormone and 1,25-dihydroxyvitamin D levels with elevated circulating levels of parathyroid hormone related protein, indicating the diagnosis of humoral hypercalcemia of malignancy (HHM). HHM is a paraneoplastic syndrome rarely associated with pediatric malignancies. Hypercalcemia manifested clinically with neurologic symptoms and soft tissue calcium deposition and required aggressive management with intravenous fluids, diuretics, and supplemental electrolytes. Following treatment with neoadjuvant chemotherapy, serum calcium levels precipitously declined requiring calcium repletion. These cases highlight the improvement of hypercalcemia secondary to HHM following chemotherapy.
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Affiliation(s)
- Ryan Hirschfeld
- Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Jennifer J G Welch
- Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Douglas J Harrison
- Division of Pediatrics, Department of Pediatric Care, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Robin Kremsdorf
- Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Anjulika Chawla
- Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, Rhode Island
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Hiradfar A, Pourlak T, Badebarin D. Primary Pulmonary Fibrosarcoma With Bone Metastasis: a Successful Treatment With Post-Operation Adjuvant Chemotherapy. IRANIAN JOURNAL OF CANCER PREVENTION 2015; 8:e2328. [PMID: 26413248 PMCID: PMC4581369 DOI: 10.17795/ijcp2328] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2014] [Accepted: 11/05/2014] [Indexed: 11/25/2022]
Abstract
Introduction: Pulmonary fibrosarcoma has been an extremely rare tumor in children. Wide surgical resection of infantile fibrosarcoma would be the treatment of choice. Case Presentation: Post-operative chemotherapy has shown the benefit in the cases of residual disease after initial surgery and metastatic disease in the literature. We have presented the case of a 70-days old male child with primary infantile fibrosarcoma of the left lung and distant metastasis of skull. Conclusions: The aim of this publication was to highlight the role of adjuvant chemotherapy to improve outcome of infantile fibrosarcoma with residual tumor and / or metastatic disease.
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Affiliation(s)
- Amirataollah Hiradfar
- Pediatric Health Research Center, Tabriz University of Medical sciences, Tabriz, IR Iran
| | - Tala Pourlak
- Pathology Department, Tabriz University of Medical Sciences, Tabriz, IR Iran
| | - Davoud Badebarin
- Pediatric Surgery Department, Tabriz University of Medical Sciences, Tabriz, IR Iran
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Kumar R, Jagdewan A, Sharma MC. Congenital Infantile Fibrosarcoma of Scalp. Is Adjuvant Therapy Essential ? Indian J Surg Oncol 2014; 5:297-9. [PMID: 25767343 DOI: 10.1007/s13193-014-0351-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 08/27/2014] [Indexed: 11/30/2022] Open
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Abstract
Clinical as well as radiologic diagnosis of infantile fibrosarcoma (IFS) is often a challenging problem due to similarities with tumors of vascular origin. Consequently, in the majority of cases, histological and immunohistochemical studies are considered gold standards for the final diagnosis. The two case reports and the review of literature discussed should increase the important features in the history and the presentation that increase the index of suspicion for IFS, as well as it highlights the important characteristics of imaging and laboratory studies that confirm its diagnosis.
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Jiao Q, Wu A, Liu P, Tang J, Yang M, Fan X, Zheng L. A young woman with a giant breast fibrosarcoma: a case report. J Thorac Dis 2013; 5:E199-202. [PMID: 24255792 DOI: 10.3978/j.issn.2072-1439.2013.09.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2013] [Accepted: 09/10/2013] [Indexed: 11/14/2022]
Abstract
We report a case of a 15-year-old female, no family history of huge fibrosarcoma. Computed tomography (CT) showed that there was no clearance between the lump and pectoralis major and that there were pathological fractures in the third and fourth ribs. Fine-needle aspiration result suggested that it might be a phyllodes tumor of the breast. According to the postoperative pathologic and immunohistochemical results, the final diagnosis was breast fibrosarcoma.
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Affiliation(s)
- Qingli Jiao
- Department of General Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou 510515, China
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16
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Salman M, Khoury NJ, Khalifeh I, Abbas HA, Majdalani M, Abboud M, Muwakkit S, Solh HE, Saab R. Congenital infantile fibrosarcoma: Association with bleeding diathesis. AMERICAN JOURNAL OF CASE REPORTS 2013; 14:481-5. [PMID: 24265847 PMCID: PMC3835170 DOI: 10.12659/ajcr.889489] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Accepted: 07/26/2013] [Indexed: 11/09/2022]
Abstract
PATIENT Male, 2 month FINAL DIAGNOSIS Congenital infantile fibrosarcoma Symptoms: Bleeding Medication: Vincristine • actinomycin • cyclophosphamide Clinical Procedure: Surgical resection Specialty: Pediatric Oncology. OBJECTIVE Diagnostic/therapeutic accidents. BACKGROUND Congenital infantile fibrosarcoma (CIF) is a soft-tissue tumor occurring during the first 2 years of life, most commonly in the extremities. CIF is frequently initially misdiagnosed as a vascular tumor, but its association with bleeding and coagulopathy has not been well characterized. CASE REPORTS We describe 2 infants with CIF presenting with bleeding and coagulopathy, requiring urgent intervention. Both patients did well; one underwent partial resection followed by chemotherapy, and the other received 2 cycles of chemotherapy followed by gross total resection. We also provide a review of all reported cases of coagulopathy in the setting of CIF in the English literature, uncovering an association that seems to be more prevalent in patients diagnosed in the neonatal period, with associated anemia and thrombocytopenia, and a significant mortality rate. CONCLUSIONS CIF needs to be considered in the differential diagnosis of vascular congenital tumors, especially when there is evidence of bleeding, anemia, or thrombocytopenia.
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Affiliation(s)
- Mayssaa Salman
- Department of Pediatric and Adolescent Medicine, American University of Beirut, Beirut, Lebanon
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Sulkowski JP, Raval MV, Browne M. Margin status and multimodal therapy in infantile fibrosarcoma. Pediatr Surg Int 2013; 29:771-6. [PMID: 23765394 DOI: 10.1007/s00383-013-3318-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/16/2013] [Indexed: 12/11/2022]
Abstract
PURPOSE The rarity of infantile fibrosarcoma (IF) has precluded comprehensive treatment evaluation. The purpose of this study was to better define the extent of surgical resection required and the role of chemotherapy. METHODS Patients (0-2 years) with IF were evaluated from the National Cancer Data Base (1985-2007). Survival was estimated using the Kaplan-Meier method stratifying patients by margin status and treatment with or without chemotherapy. RESULTS Of the 224 patients, 171 (76.3 %) were <1 year of age. Of the 64 (28.6 %) with positive margins, 36 (56.3 %) had microscopic disease, 12 (18.8 %) had macroscopic disease, and 16 (25 %) had unknown margin status; none were found to have metastases. Most were managed with surgical resection (171, 76.4 %). The proportion treated with both surgery and chemotherapy increased over time (18-40 %, p = 0.025). Disease-free survival was 90.6 %. No significant survival difference was noted in this retrospective, non-randomized cohort based on margin status, nodal involvement, tumor size, or treatment modality. CONCLUSIONS The use of multimodal therapy has increased over time. There was a small increase in survival associated with negative margins and the use of multimodal therapy, however, neither result reached significance. Future studies investigating tumor biology and chemosensitivity will likely determine the optimal management of IF.
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Affiliation(s)
- Jason P Sulkowski
- Division of Pediatric Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, 700 Children's Drive, Columbus, OH 43205, USA
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Clinical management of infantile fibrosarcoma: a retrospective single-institution review. Pediatr Surg Int 2013; 29:703-8. [PMID: 23708972 PMCID: PMC4825685 DOI: 10.1007/s00383-013-3326-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/14/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Infantile fibrosarcoma (IFS) is an uncommon soft-tissue sarcoma. Here we review our experience treating this tumor. PATIENTS AND METHODS We retrospectively reviewed records of patients with IFS treated at St. Jude Children's Research Hospital between 1980 and 2009. RESULTS We identified 15 patients, 8 girls and 7 boys; 13 white and 2 black. Median age at diagnosis was 3 months. Primary sites included the leg (n = 3), chest wall (n = 2), foot (n = 2), and one each in the tongue, occipital region, axilla, parascapular region, arm, forearm, retroperitoneum, and thigh. All patients underwent resection; 11 upfront surgery, and 4 delayed. Complications included loss of the posterior tibial nerve and artery, axillary vein, biceps, pectoralis major, gallbladder, and transverse/sigmoid sinus. Eight received chemotherapy and three radiotherapy. Seven experienced local recurrence and three lung metastasis. Median follow-up was 65 months. At the time of the review, 12 patients were alive and 3 had died. All deaths were in patients older than 1 year at diagnosis with an axial primary site. CONCLUSIONS Non-mutilating surgery should be the primary treatment for IFS. Neoadjuvant chemotherapy is indicated when upfront resection is unfeasible. Patients with positive surgical margins should receive adjuvant chemotherapy. Radiotherapy is indicated for axial primary sites where complete resection is impossible.
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19
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Shah NN, Price MR, Loeb DM. Cardiac metastasis and hypertrophic osteoarthropathy in recurrent infantile fibrosarcoma. Pediatr Blood Cancer 2012; 59:179-81. [PMID: 21853519 PMCID: PMC4273568 DOI: 10.1002/pbc.23321] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2011] [Accepted: 07/19/2011] [Indexed: 11/08/2022]
Abstract
Cardiac metastasis and hypertrophic osteoarthropathy are both quite rare. We describe a patient presenting with hypertrophic osteoarthropathy as the first symptom of recurrent infantile fibrosarcoma (IF). During surgical resection of lung metastasis, the patient suffered sudden cardiac arrest. Autopsy demonstrated a metastatic lesion in the intraventricular septum of the heart, which is previously undescribed in the literature. This case demonstrates that IF can be aggressive despite its more typical benign course.
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Affiliation(s)
- Nirali N. Shah
- Division of Pediatric Oncology, Department of Oncology, Johns Hopkins University, Baltimore, Maryland
| | - Mitchell R. Price
- Division of Pediatric Surgery, University of Illinois Medical Center, Chicago, Illinois
| | - David M. Loeb
- Division of Pediatric Oncology, Department of Oncology, Johns Hopkins University, Baltimore, Maryland,Correspondence to: David M. Loeb, MD, PhD, Division of Pediatric Oncology, Department of Oncology, Johns Hopkins University, 600 N. Wolfe Street, CMSC 800, Baltimore, Maryland 21287.
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20
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Abstract
Fibrosarcomas (FS) are rare malignant tumors in pediatrics, classified in the heterogeneous non-rhabdomyosarcomas group of malignant mesenchymal tumors. Infantile FS are found typically in children less than 2 years of age, and include congenital FS usually occurring in infants in the first 3 months of life. Histological diagnosis can be difficult; and confirmed with detection by molecular biology of the ETV6-NTRK3 fusion protein. FS is most often a localized disease at diagnosis, with involvement of an extremity. The management of these patients must be multidisciplinary, to define the different phases of treatment and avoid mutilating surgery. Cellular or atypical mesoblastic nephroma (MN) is a subtype of malignant pediatric renal tumors, most often present in children of less than 3 months. Histopathological characteristics of the cellular MN are very close to the congenital FS due to a fusion transcript common to both diseases. Treatment schedule is defined by initial local stage of the disease. FS called "adult-type" found exceptionally in childhood occur most often after 10 years old. Adult FS differ from infantile FS in their clinical presentation because of a strong local aggressiveness and problematic appearance of metastasis in 50% of cases, sometimes late. These three diseases present therefore histological similarities. Both have a common name but different clinical presentation and outcome: infantile FS and adult FS. Two have different names and initial location but similar histology, chromosomal rearrangement, sensitivity to chemotherapy and outcome: the congenital FS and cellular mesoblatic nephroma. Authors present a review of the literature of these entities.
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Hamidah A, Reena M, Halim ARA, Ibrahim S, Eguchi M, Zarina AL, Norazlin KN, Jamal R, Kanegane H. Successful treatment of very large congenital infantile fibrosarcoma. Pediatr Int 2011; 53:768-770. [PMID: 21955012 DOI: 10.1111/j.1442-200x.2011.03358.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Alias Hamidah
- Departments of PediatricsPathologyOrthopedic and Traumatology, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, MalaysiaDepartment of Pediatrics, Graduate School of Medicine, Ehime University, ToonDepartment of Pediatrics, Graduate School of Medicine, University of Toyama, Toyama, Japan
| | - MdZin Reena
- Departments of PediatricsPathologyOrthopedic and Traumatology, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, MalaysiaDepartment of Pediatrics, Graduate School of Medicine, Ehime University, ToonDepartment of Pediatrics, Graduate School of Medicine, University of Toyama, Toyama, Japan
| | - A R Abdul Halim
- Departments of PediatricsPathologyOrthopedic and Traumatology, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, MalaysiaDepartment of Pediatrics, Graduate School of Medicine, Ehime University, ToonDepartment of Pediatrics, Graduate School of Medicine, University of Toyama, Toyama, Japan
| | - Sharaf Ibrahim
- Departments of PediatricsPathologyOrthopedic and Traumatology, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, MalaysiaDepartment of Pediatrics, Graduate School of Medicine, Ehime University, ToonDepartment of Pediatrics, Graduate School of Medicine, University of Toyama, Toyama, Japan
| | - Mariko Eguchi
- Departments of PediatricsPathologyOrthopedic and Traumatology, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, MalaysiaDepartment of Pediatrics, Graduate School of Medicine, Ehime University, ToonDepartment of Pediatrics, Graduate School of Medicine, University of Toyama, Toyama, Japan
| | - A Latiff Zarina
- Departments of PediatricsPathologyOrthopedic and Traumatology, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, MalaysiaDepartment of Pediatrics, Graduate School of Medicine, Ehime University, ToonDepartment of Pediatrics, Graduate School of Medicine, University of Toyama, Toyama, Japan
| | - Kamal N Norazlin
- Departments of PediatricsPathologyOrthopedic and Traumatology, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, MalaysiaDepartment of Pediatrics, Graduate School of Medicine, Ehime University, ToonDepartment of Pediatrics, Graduate School of Medicine, University of Toyama, Toyama, Japan
| | - Rahman Jamal
- Departments of PediatricsPathologyOrthopedic and Traumatology, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, MalaysiaDepartment of Pediatrics, Graduate School of Medicine, Ehime University, ToonDepartment of Pediatrics, Graduate School of Medicine, University of Toyama, Toyama, Japan
| | - Hirokazu Kanegane
- Departments of PediatricsPathologyOrthopedic and Traumatology, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, MalaysiaDepartment of Pediatrics, Graduate School of Medicine, Ehime University, ToonDepartment of Pediatrics, Graduate School of Medicine, University of Toyama, Toyama, Japan
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22
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Gupta SS, Singh O, Sharma SS, Mathur RK. Congenital fibrosarcoma of the chest wall: report of a case. J Cutan Aesthet Surg 2011; 3:177-80. [PMID: 21430833 PMCID: PMC3047738 DOI: 10.4103/0974-2077.74497] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Congenital fibrosarcoma (CFS) is a rare soft tissue tumour that usually occurs before the age of 1, and involves the distal extremities. The literature regarding the precise diagnosis and treatment of these tumours is limited. We present and discuss a case of CFS which ended fatally due to lung metastasis after 2 years.
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Affiliation(s)
- Shilpi Singh Gupta
- Department of Surgery, MGM Medical College and MY Hospital, Indore, Madhya Pradesh, India
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23
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Behnke NM, Patel M, Davidson T, Arkader A. Orthopaedic case of the month: Rapidly progressive shoulder soft tissue mass in an 8-week-old girl. Clin Orthop Relat Res 2011; 469:624-9. [PMID: 21128034 PMCID: PMC3018191 DOI: 10.1007/s11999-010-1710-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2010] [Accepted: 11/17/2010] [Indexed: 01/31/2023]
Affiliation(s)
- Nicole Marie Behnke
- Department of Orthopaedic Surgery, Harbor-UCLA Medical Center, Torrance, CA USA
| | - Moneil Patel
- Department of Pathology, Keck School of Medicine, University of Southern California, Children’s Hospital of Los Angeles, Los Angeles, CA USA
| | - Tom Davidson
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Children’s Hospital of Los Angeles, Los Angeles, CA USA
| | - Alexandre Arkader
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Children’s Hospital of Los Angeles, 4650 W Sunset Boulevard, Mailstop #69, Los Angeles, CA 90027 USA
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24
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Lagree M, Toutain F, Revillon Y, Gaussin G, Marie-Cardine A, Lemoine F, Vannier JP. [Recurrent and metastatic infantile fibrosarcoma: a case report]. Arch Pediatr 2010; 18:28-32. [PMID: 21084177 DOI: 10.1016/j.arcped.2010.10.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2009] [Revised: 03/14/2010] [Accepted: 10/05/2010] [Indexed: 01/08/2023]
Abstract
Infantile fibrosarcoma is a rare malignant tumor that usually occurs during the 1st year of life. It accounts for approximately 5-10% of all sarcomas in infants younger than 1 year of age. It usually has indolent progression and metastatic spread is rare. We report the case of a patient who had infantile fibrosarcoma of the trunk. At birth, the baby presented a soft tissue mass of the scapulothoracic region. Histopathological examination after complete surgical resection at first suggested an angioma. Reanalysis of the histology after a metastatic relapse resulted in the diagnosis of infantile fibrosarcoma, which was confirmed by the presence of the specific translocation seen in infantile fibrosarcoma (ETV6/NTRK3). This patient's progression was uncommon because he developed 3 metastatic relapses. The treatment consisted of surgery, chemotherapy, and radiation therapy. The patient is alive with persistent complete remission. We discuss the diagnostic and therapeutic issues of infantile fibrosarcoma. There is a risk of erroneous diagnosis in newborn infants between benign angiomatous tumor and infantile fibrosarcoma. The fusion transcript ETV6-NTRK3 resulting from the specific chromosomal translocation t(12;15)(p13;q25) is now a useful diagnostic tool for infantile fibrosarcoma. Surgery with wide resection is the mainstay of treatment. However, infantile fibrosarcoma is a chemosensitive tumor. If initial surgery cannot be done without mutilation or is impossible, preoperative chemotherapy should be given. The role of radiation therapy is still debated.
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Affiliation(s)
- M Lagree
- Service d'hémato-oncologie pédiatrique, CHU Charles-Nicolle, 1 rue de Germont, Rouen cedex, France
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25
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Pediatric extremity soft-tissue sarcomas: from diagnosis to surgical treatment. CURRENT ORTHOPAEDIC PRACTICE 2010. [DOI: 10.1097/bco.0b013e3181e575bf] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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26
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Demir HA, Akyüz C, Varan A, Ergen FB, Büyükpamukçu M. Right foot congenital infantile fibrosarcoma treated only with chemotherapy. Pediatr Blood Cancer 2010; 54:618-20. [PMID: 19998472 DOI: 10.1002/pbc.22389] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Congenital infantile fibrosarcoma (CIF) is a rare tumor in childhood. The 5-year survival rate for CIFs is high and has been reported between 84% and 93%, but limb-amputation/disarticulation is still a major problem. We report the case of a male newborn with a mass in his right foot. X-ray and MRI revealed a mass destroying all tarsal, metatarsal, and phalangeal bones. The patient was treated only with VAC chemotherapy and is able to walk normally.
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Affiliation(s)
- Haci Ahmet Demir
- Department of Pediatric Oncology, Institute of Oncology, Hacettepe University, Ankara, Turkey.
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27
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A newborn with infantile fibrosarcoma of foot: treatment with chemotherapy and extremity-sparing surgery. J Perinatol 2010; 30:63-5. [PMID: 20038940 DOI: 10.1038/jp.2009.92] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Infantile fibrosarcoma represents less than 1% of all childhood cancers, but it is the most common soft-tissue sarcoma in those under 1 year of age. We report an infant with congenital infantile fibrosarcoma diagnosed as hemangiopericytoma. He was treated with chemotherapy and extremity-sparing surgery. Amputation was avoided.
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28
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Nam SH, Cho MJ, Kim DY, Kim SC, Kim IK. Infantile Fibrosarcoma in Neonate. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2010. [DOI: 10.4174/jkss.2010.79.suppl1.s62] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- So-Hyun Nam
- Department of Surgery, Inje University Haeundae Paik Hospital, Busan, Korea
| | - Min-Jung Cho
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dae-Yeon Kim
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seong-Chul Kim
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - In-Koo Kim
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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29
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Orbach D, Rey A, Cecchetto G, Oberlin O, Casanova M, Thebaud E, Scopinaro M, Bisogno G, Carli M, Ferrari A. Infantile fibrosarcoma: management based on the European experience. J Clin Oncol 2009; 28:318-23. [PMID: 19917847 DOI: 10.1200/jco.2009.21.9972] [Citation(s) in RCA: 165] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
PURPOSE To retrospectively analyze the clinical features and results of treatment in 56 infants with fibrosarcoma enrolled onto cooperative European protocols between 1979 and 2005 and treated with a combination of surgery and chemotherapy. PATIENTS AND METHODS We performed a retrospective case review of infants under the age of 2 years with fibrosarcoma treated between 1979 and 2005 in six European studies. Patients were staged according to the Intergroup Rhabdomyosarcoma Staging System international classification as a function of the type of initial surgery and the extent of disease and were treated with surgery and chemotherapy. Survival was calculated using the Kaplan-Meier method. RESULTS Primary tumor site was the limbs in 66% of patients; median tumor diameter was more than 5 cm in 63% of patients; and postoperative staging was as follows: group I, 22%; group II, 27%; group III, 47%; and group IV, 4%. Response rate to chemotherapy was 75%, and the specific response rate to vincristine-dactinomycin was 71%. Local control was obtained in 84% of patients. At the end of follow-up, 45% of survivors had been treated by surgery alone, 6% by chemotherapy alone, 46% by surgery and chemotherapy, and 2% by surgery, chemotherapy, and radiotherapy. The 5-year overall survival (OS) rate was 89%. The 5-year OS and event-free survival rates for localized patients were 89% and 81%, respectively. CONCLUSION Although complete resection is rarely feasible at diagnosis, conservative surgery remains the mainstay treatment for infantile fibrosarcoma. An alkylating agent-free and anthracycline-free regimen is usually effective and should be chosen as first-line chemotherapy for inoperable tumors. Overall prognosis is good, but progression or relapse, mainly local, remains possible.
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Affiliation(s)
- Daniel Orbach
- Département de Pédiatrie, Institut Curie, 26 rue d'Ulm, 75005 Paris, France.
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30
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Abstract
The development of a new soft tissue lesion in an otherwise healthy child, adolescent, or young adult can present many challenges for pediatric or medical oncology teams. Although uncommon, the diagnosis of a soft tissue malignancy should always be considered in the differential diagnosis of persistent pain, even if no mass is palpable. The definitive diagnosis and treatment of a soft tissue mass is aided by timely scans, appropriate biopsy for anatomic and molecular pathology, and a treatment approach guided by the specific diagnosis. Because pediatric soft tissue sarcomas are rare, cooperative groups play a crucial role in defining the standard of care through retrospective series and well-designed prospective clinical trials. Enrollment of newly diagnosed patients in clinical studies should be encouraged in order to continue to improve outcomes and understanding of these rare tumors. This review focuses on the current recommendations for management of sarcomas that typically occur in the soft tissues of pediatric and young adult patients.
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Affiliation(s)
- Melinda S Merchant
- Pediatric Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892, USA.
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31
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Canale S, Vanel D, Couanet D, Patte C, Caramella C, Dromain C. Infantile fibrosarcoma: Magnetic resonance imaging findings in six cases. Eur J Radiol 2009; 72:30-7. [DOI: 10.1016/j.ejrad.2009.05.036] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2009] [Accepted: 05/04/2009] [Indexed: 10/20/2022]
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32
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Infantile fibrosarcoma successfully treated with chemotherapy, with occurrence of calcifying aponeurotic fibroma and pleomorphic/spindled celled lipoma at the site 12 years later. J Pediatr Hematol Oncol 2009; 31:448-52. [PMID: 19648795 DOI: 10.1097/mph.0b013e3181a1c0c4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The treatment of infantile fibrosarcoma has traditionally been wide resection. Chemotherapy has been investigated as an adjuvant and primary treatment in cases in which surgery would cause unacceptable morbidity. Recurrences normally occur within a year of completion of the chemotherapy and display the same histology. We present a child with an infantile fibrosarcoma of the elbow, successfully treated with chemotherapy alone, who developed a calcifying aponeurotic fibroma and a spindle cell/pleomorphic lipoma at the tumor site 12 years later.
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Abstract
Paediatric soft tissue sarcomas (STS) are a group of malignant tumours that originate from primitive mesenchymal tissue and account for 7% of all childhood tumours. Rhabdomyosarcomas (RMS) and undifferentiated sarcomas account for approximately 50% of soft tissue sarcomas in children and non-rhabdomyomatous soft tissue sarcomas (NRSTS) the remainder. The prognosis and biology of STS tumours vary greatly depending on the age of the patient, the primary site, tumour size, tumour invasiveness, histologic grade, depth of invasion, and extent of disease at diagnosis. Over recent years, there has been a marked improvement in survival rates in children and adolescents with soft tissue sarcoma and ongoing international studies continue to aim to improve these survival rates whilst attempting to reduce the morbidity associated with treatment. Radiology plays a crucial role in the initial diagnosis and staging of STS, in the long term follow-up and in the assessment of many treatment related complications. We review the epidemiology, histology, clinical presentation, staging and prognosis of soft tissue sarcomas and discuss the role of radiology in their management.
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Affiliation(s)
- K Park
- Radiology Department, Great Ormond Street Hospital for Children, London, WC1N 3JH, UK.
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34
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Requena C, Miranda L, Cañete A, Almenar S, Nagore E, Llombart B, Sanmartín O, Botella R, Guillén C. Congenital fibrosarcoma simulating congenital hemangioma. Pediatr Dermatol 2008; 25:141-4. [PMID: 18304187 DOI: 10.1111/j.1525-1470.2007.00616.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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35
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Ahmed HU, Arya M, Levitt G, Duffy PG, Sebire NJ, Mushtaq I. Part II: Treatment of primary malignant non-Wilms' renal tumours in children. Lancet Oncol 2007; 8:842-8. [PMID: 17765193 DOI: 10.1016/s1470-2045(07)70276-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Renal-cell carcinoma, clear-cell sarcoma, (congenital) mesoblastic nephroma, rhabdoid tumour, and renal medullary carcinoma form a heterogeneous group of childhood renal malignancies known as non-Wilms' tumours. Progress has been slow in improving the management of these tumours to decrease morbidity and increase survival. However, greater cooperation between national and international centres should engender specialisation, and an increased knowledge of the molecular biology of these tumours will inevitably lead to substantial progress over the next decade. This review is the second of two parts: the first part provided an updated review of the clinical presentation, imaging, and pathology of non-Wilms' tumours and this second part provides an updated review of the treatment of these tumours.
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Affiliation(s)
- Hashim Uddin Ahmed
- Institute of Urology and Nephrology, University College London Hospitals NHS Foundation Trust, London, UK.
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36
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Germann G, Waag KL, Selle B, Jester A. Extremity salvage with a free musculocutaneous latissimus dorsi flap and free tendon transfer after resection of a large congenital fibro sarcoma in a 15-week-old infant. A case report. Microsurgery 2006; 26:429-31. [PMID: 16924620 DOI: 10.1002/micr.20266] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A case of complex microsurgical reconstruction of the dorsum of the foot, including tendon transfer following tumor resection, in a 15-week-old male infant is presented. After birth, a 5.5 x 4 cm large tumor was observed on the dorsum of the right foot. Biopsy showed a congenital malignant fibro sarcoma. After initial chemotherapy a radical excision of the tumor at the age of 14 weeks was followed. To cover the defect a musculocutaneous latissimus dorsi flap was taken, the cutaneous part being large enough to cover the defect. Extensor tendons were reconstructed with free tendon transplants. Amputation is usually indicated in these cases. To the best of our knowledge, microsurgical reconstruction in infants at this age with congenital malignant tumors has not yet been reported. The case shows that Plastic surgery can play an important role in pediatric oncology and should routinely be integrated into the multi-modal treatment concepts.
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Affiliation(s)
- G Germann
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG-Trauma Center, Plastic and Hand Surgery, University of Heidelberg, Ludwigshafen, Germany.
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37
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Coffin CM, Lowichik A, Zhou H. Treatment effects in pediatric soft tissue and bone tumors: practical considerations for the pathologist. Am J Clin Pathol 2005; 123:75-90. [PMID: 15762282 DOI: 10.1309/h0d4vd760nh6n1r6] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Dramatic improvements in survival for children with cancer have led to increased numbers of posttreatment pathologic specimens, particularly in bone and soft tissue sarcomas. Current therapeutic protocols in North America require specific pathologic classification and stratify patients based on clinical, biologic, and pathologic features. For osteosarcoma, the pathologic response to therapy predicts prognosis and modifies the treatment regimen. Ongoing studies aim to assess the response to therapy and outcome in other types of soft tissue and bone tumors. The pathologic evaluation of pretreatment and posttreatment specimens is critical for therapeutic decisions and prognostic assessment. A standardized approach to posttherapy pathologic specimens, with attention to appropriate use of ancillary tests, and assessment of clinical and biologic significance of therapy-induced pathologic changes has significance for patient management and treatment protocols.
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Affiliation(s)
- Cheryl M Coffin
- Department of Pathology, University of Utah School of Medicine, Salt Lake City, 84113-1100, USA
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38
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Coffin C, Boccon-Gibod L. Proliférations fibroblastiques et myofibroblastiques de l’enfance et de l’adolescence. Ann Pathol 2004; 24:605-20. [PMID: 15785406 DOI: 10.1016/s0242-6498(04)94022-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Fibroblastic-myofibroblastic proliferations of childhood and adolescents form a clinical and morphologic spectrum from benign reactive processes and pseudosarcomas, to fibromatoses, to various types of sarcoma. The diagnosis is challenging because of clinical and morphologic similarities, lack of specific immunohistochemical markers for different types of fibroblastic-myofibroblastic tumors, and limited molecular genetic information. Careful attention to clinical, macroscopic, and histopathologic features permits classification in most cases. This review focuses on the pathologic features of fibroblastic-myofibroblastic tumors with a predilection for children and adolescents.
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Affiliation(s)
- Cheryl Coffin
- Department of Pathology, School of Medicine, Salt Lake City, Utah, USA
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39
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Abstract
We report a case of a neonate with a congenital tumor on the left palm. The patient had a grapefruit-sized tumor and coagulopathy at birth and was presumed to have a hemangioendothelioma with associated Kasabach-Merritt phenomenon. When the tumor failed to respond to systemic steroids, a biopsy specimen was taken, revealing a fibrosarcoma. We describe this case to highlight the importance of including rare tumors, such as fibrosarcomas, in the clinical differential when evaluating a congenital tumor with associated coagulopathy. We discuss subtle differences in clinical presentations that might aid in differentiating vascular tumors from fibrosarcomas.
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Affiliation(s)
- Maryam Asgari
- Division of Dermatology, Department of Pediatrics, University of Washington, 4800 Sand Point Way NE, Seattle, WA 98105, USA
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40
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McCahon E, Sorensen PHB, Davis JH, Rogers PCJ, Schultz KR. Non-resectable congenital tumors with the ETV6-NTRK3 gene fusion are highly responsive to chemotherapy. MEDICAL AND PEDIATRIC ONCOLOGY 2003; 40:288-92. [PMID: 12652616 DOI: 10.1002/mpo.10272] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Recently, the ETV6-NTRK3 gene fusion has been identified in both infantile fibrosarcoma and cellular mesoblastic nephroma. For both these tumors standard curative treatment has been primarily surgical with wide local excision. This has frequently involved radical and even mutilating surgery. PROCEDURE This report discusses three infants with congenital tumors, two congenital fibrosarcomas, and one atypical congenital mesoblastic nephroma, not easily amenable to surgical intervention. RESULTS All three were treated with pre-operative chemotherapy with excellent responses negating the need for amputation in two patients. In each patient, the ETV6-NTRK3 gene fusion was identified by reverse transcriptase-polymerase chain reaction (RT-PCR) in the tumor specimens. CONCLUSIONS Our findings suggest that the ETV6-NTRK3 gene fusion may underlie the distinctive biological properties of these tumors and may also indicate tumor chemosensitivity. In this group of patients pre-operative chemotherapy may abrogate the need for morbid surgical procedures.
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Affiliation(s)
- Emma McCahon
- Oncology Department, The Children's Hospital Westmead, New South Wales, Australia
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Abstract
Infantile fibrosarcoma is a rare soft tissue tumor, predominately affecting young infants. It grows rapidly and is locally infiltrative but rarely metastases. Complete surgical removal is usually curative but is impossible in some patients and would result in significant functional or cosmetic consequences in many others. Neoadjuvant chemotherapy will cause many tumors to shrink significantly, allowing less mutilating surgical resections to be performed--this is the current recommendation where immediate surgical removal cannot be accomplished without unacceptable morbidity. In contrast, there is no defined role for adjuvant chemotherapy or radiation following complete surgical resection. Although there is a significant risk of local recurrence, most of these can be successfully treated with further surgery and the overall survival rate exceeds 90%.
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Affiliation(s)
- William S Ferguson
- Division of Pediatric Hematology-Oncology, Rhode Island Hospital, Providence 02903, USA.
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Surico G, Muggeo P, Daniele RM, Novielli C, Rigillo N, Minervini C. Chemotherapy alone for the treatment of congenital fibrosarcoma: is surgery always needed? MEDICAL AND PEDIATRIC ONCOLOGY 2003; 40:268-70. [PMID: 12555264 DOI: 10.1002/mpo.10150] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Abstract
Many of the soft tissue sarcomas that occur in children are of the same histology as those in adults; however, the relative prevalence of these sarcomas is different between children and adults. In some cases, the biologic behavior of pediatric sarcomas is more benign than that in adults. Treatment for sarcomas in children is also different. Pediatric sarcomas are more commonly responsive to chemotherapy. Furthermore, in children who are still growing, surgery and radiation are associated with higher morbidity than in adults. This article discusses the diagnosis and treatment of rhabdomyosarcoma and undifferentiated sarcomas, with an emphasis on surgical considerations, and the diagnosis and treatment of nonrhabdomyosarcomatous soft tissue sarcomas in children.
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Affiliation(s)
- Cynthia E Herzog
- Division of Pediatrics, University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Box 87, Houston, TX 77030, USA.
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Loh ML, Ahn P, Perez-Atayde AR, Gebhardt MC, Shamberger RC, Grier HE. Treatment of infantile fibrosarcoma with chemotherapy and surgery: results from the Dana-Farber Cancer Institute and Children's Hospital, Boston. J Pediatr Hematol Oncol 2002; 24:722-6. [PMID: 12468912 DOI: 10.1097/00043426-200212000-00008] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To retrospectively evaluate the treatment and outcome of patients diagnosed with infantile fibrosarcoma at the Dana-Farber Cancer Institute and Children's Hospital, Boston. PATIENTS AND METHODS Between 1982 and 1998, a total of 11 infants were diagnosed pathologically with infantile fibrosarcoma. A retrospective chart review was conducted to determine the extent of surgical therapy and chemotherapy required for a favorable clinical outcome. Cytogenetic findings were reviewed and archived tumor specimens were analyzed, when available, for the presence of the TEL/TRKC fusion gene. RESULTS Three patients had primary surgical resection with negative pathologic margins and have been lost to follow-up. Two patients received chemotherapy only after limited biopsy or subtotal resection and are alive with no evidence of disease 8 and 18 years from diagnosis. Four patients had limited biopsies followed by chemotherapy with delayed resection. One of these four patients had negative margins and received no further chemotherapy. The other three of these patients had positive microscopic margins; two of them received postoperative chemotherapy while the third did not. All four are currently alive with no evidence of disease. Two patients had progressive disease within 7 and 10 months of diagnosis while on chemotherapy after subtotal resections. One of these two patients is dead of disease; the other is alive after palliative radiotherapy. Seven patients had archived or frozen tissue available for molecular analysis. All seven had evidence of TEL gene rearrangement; six exhibited the TEL/TRKC fusion. Six patients had characteristic trisomies previously reported to be associated with infantile fibrosarcoma. CONCLUSIONS Previously reported series of treatment outcomes in infantile fibrosarcoma have been limited to very few patients due to the rare occurrence of this tumor. In our experience, initial chemotherapy combined with surgery has been successful for most cases. When disease progression occurred, it was within one year of diagnosis. There was no development of distant metastases in the patients with progressive disease. The role of additional chemotherapy for microscopic margins after local control is not clear. We found a high incidence of the TEL/TRKC fusion gene, confirming its utility in diagnosis. We propose a uniform approach to treatment to gather clinical and biologic information about this rare and curable disease.
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Affiliation(s)
- Mignon L Loh
- Department of Pediatric Hematology-Oncology, University of California-San Francisco, San Francisco, CA 94143-0519, USA.
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Loeb DM, Hill DA, Dome JS. Complete response of recurrent cellular congenital mesoblastic nephroma to chemotherapy. J Pediatr Hematol Oncol 2002; 24:478-81. [PMID: 12218597 DOI: 10.1097/00043426-200208000-00014] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Congenital mesoblastic nephroma (CMN) is usually cured by surgery. The sensitivity of this tumor to chemotherapy is unknown. The recent description of a t(12;15)(p13;q25) chromosomal translocation in both cellular CMN and congenital infantile fibrosarcoma suggests that these entities have a common pathogenesis, and that cellular CMN might respond to chemotherapy like congenital infantile fibrosarcoma does. The authors describe three patients with recurrent cellular CMN who showed a complete response to chemotherapy. Based on these patients and a review of the literature, the authors suggest that chemotherapy be considered as a part of the therapy for recurrent or unresectable cellular CMN.
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Affiliation(s)
- David M Loeb
- Department of Oncology Johns Hopkins University, Baltimore, Maryland, USA
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