Clinical significance of vascular endothelial growth factor [VEGF] in sera of patients with pediatric malignancies

Angiogenesis is essential for solid tumor growth. It is induced by tumor cells through stimulatory angiogenic peptides, one such peptide is vascular endothelial growth factor [VEGF]. The ultimate aim of the work is to investigate the possible role of VEGF as an early biomolecule involved in the progression of pediatric malignant tumors with high metastatic potential. Forty-five pediatric patients were studied. They included four groups with malignant solid tumors suffering from Ewing's sarcoma, osteosarcoma, neuroblastoma and rhabdomyosarcoma. In addition, a healthy control group including fifteen age and sex matched children was included in the study. Serum VEGF levels were determined by ELISA technique. The level of VEGF was significantly higher in all types of solid tumors compared to normal healthy children. The mean values obtained for patients and controls were 429.44 +/- 258.55 pg/ml and 79.36 +/- 63.81 pg/ml, respectively. No significant difference was detected in the level of VEGF among males and females. Also, no statistically significant difference was detected among the different types of malignant tumors. However, a marked significant difference was elucidated between metastatic and non-metastatic cancer patients, the values recorded were 753.33 +/- 173.64 pg/ml and 267.5 +/- 75.54 pg/ml, respectively [p <0.001]. Furthermore, the results showed that 207 pg/ml of serum level of VEGF is the optimal cutoff value [mean +/- 2 SD of control] with sensitivity of 87% and specificity of 100%. Using the receiver operating characteristic [ROC] curve analysis, the area under the curve [0.917] indicated the validity of using serum VEGF level in the diagnosis of all different types of pediatric malignant solid tumors with high potentiality to metastasis. VEGF is an angiogenic stimulatory peptide. Its serum level colud be a reliable marker in assessing pediatric malignancies with high metastatic potentials

Carcinocythemia in a patient with rhabdomyosarcoma

Solid tumor cells are rarely seen in peripheral blood smears. When this occurs the term carcinocythemia is used. This report describes an 18 years old female who presented with a painless lump in the labia majora associated with pancytopenia. Tumor cells were identified int he peripheral blood smear and the bone marrow aspirate showed a predominant population of small round vacuolated primitive cells, many of which formed clumps of varying sizes. Biopsies of the vulvar mass and bone marrow were interpreted as alveolar rhabdomyosarcoma. Review of the literature revealed 12 previously reported cases in whom carcinocythemia had been documented; rhabdomyosarcoma was the specific cell type involved in only two of these. The median time between detection of the leukemic phase of the tumor and death was 8.5 weeks, reflecting the fact that carcinocythemia, when it occurs, represents the terminal event of the disease. To our knowledge, our case is the third well documented case of rhabdomyosarcoma in leukemic phase so far reported. The clinical evolution as well as the management of this patient will be described in detail along with a review of the partinent available literature