Thoracic neuroblastoma presenting as recurrent empyema.

Neuroblastoma is the most common intra-abdominal and extracranial solid tumour in children, accounting for 7%–8% of all childhood cancers. It is a malignant tumour of the autonomic nervous system derived from the neural crest. Most children with neuroblastoma have distant metastatic disease at the time of diagnosis. Pulmonary metastasis at the time of diagnosis is rare, and rarer is the presence of associated pleural effusion. We present the case of a child with recurrent empyema, who was diagnosed to have a thoracic neuroblastoma.

Neuroblastoma torácico en la adolescencia: caso clínico / Thoracic neuroblastoma in adolescence: clinical case

Neuroblastoma is predominantly a tumor of early childhood, most cases occur in children under 5 years old. It originates in the adrenal gland and paravertebral ganglion cells (neural crest-derived), being the most common an extracranial solid tumor in children. It is characteristic a spontaneous regression, However in some cases it shows progression and dissemination to other organs. Objetive: To show a neuroblastoma in adolescence, with poor response to chemotherapy and radiotherapy, requiring surgery treatment. Clinical case: A 16 y.o. Female patient, previously asymptomatic, who after a body temperature rise up to 39 ° C, was found to have a tumor in the right hemithorax. Biopsy was compatible with neuroblastoma. Surgical removal of a large 20 x 19 cm tumor was achieved, the only complication presented 10 days postop was recurrent pneumothorax. Conclusion: Despite little or no response to standard treatment, surgical resection of this large tumor achieved complete remission for this patient.

El neuroblastoma es predominantemente un tumor de la infancia temprana que en la mayoría de los casos se presenta en menores de 5 años. Se origina en la glándula suprarrenal y células ganglionares paravertebrales (derivadas de la cresta neural), siendo el tumor sólido extracraneal más común en pediatría, presenta regresión espontánea en algunos casos y en otros progresión y diseminación a otros órganos. Objetivo: Analizar el caso de una adolescente portadora de un neuroblastoma resistente a quimioterapia y radioterapia, que requiere tratamiento quirúrgico. Caso clínico: Paciente asintomática, edad 16 años, que a raíz de alza febril se le detecta un tumor en hemitórax derecho. La biopsia fue compatible con un neuroblastoma. Se realizo la extirpación quirúrgica de un gran tumor con diámetro de 20 cm x 19 cm. A los 10 días se complica con neumotórax recidivante. Conclusión: A pesar de la poca o nula respuesta a las armas terapéuticas habituales: quimioterapia y radioterapia, la cirugía logró la resección del tumor torácico con remisión completa.

Propranolol en el tratamiento de los hemangiomas de la infancia / Propranolol in the treatment of infantile hemangioma

Infantile Hemangiomas (IH) are common vascular tumors in children. Only 10-15 percent) should be treated by any vital, functional or aesthetic complications. Oral corticosteroids are the treatment of choice. However, in the last two years an excellent response to treatment of hemangiomas with oral Propranolol has been reported. Objective: evaluate this new therapy in a limited number of chilean patients with IH with an indication of systemic treatment and present this experience. Patients and Methods: We present 30 cases of IH treated at our institution with oral Propranolol, using a dose of 2 mg/kg/day divided in 2 daily doses. Results: 11 percent of patients were female, 40 percent hemangiomas had segmental distribution, 90 percent were solitary, 61 percent were located in the head and neck and 23 percent were ulcerated. The treatment started at an average of 119 days of life and lasted for an average of 7 months. In all our patients the use of Propranolol accelerated the onset of involution of the hemangiomas and decreased color, brightness and growth too. 43 percent of the patients had irritability and sleep disorders. No significant adverse effects were reported in any of our patients. Conclusión: Propranolol treatment was highly effective and safe in our series of patients and we propose, taking into account published reports based on this data, it should become the treatment of choice for IH.

Los Hemangiomas de la Infancia (HI) son tumores vasculares frecuentes en la edad pediátrica. Sólo un 10-15 por cientoo debe ser tratado por eventuales consecuencias vitales, funcionales o estéticas. Los corticoides orales son el tratamiento de elección actual. Sin embargo, en los últimos 2 años se ha reportado la excelente respuesta de los hemangiomas al tratamiento con Propranolol oral. Objetivo: Evaluar esta nueva terapéutica en un número limitado de pacientes Chilenos con hemangiomas de la infancia con indicación de tratamiento sistémico y presentar esta experiencia. Pacientes y Método: Presentamos 30 casos de HI tratados en nuestra institución con Propranolol oral, usando una dosis de 2 mg/kg/día en 2 tomas diarias. Resultados: Un 77 por ciento de los pacientes eran de sexo femenino. El 40 por ciento de los hemangiomas eran segmentarios, 90 por ciento eran únicos, 67 por ciento estaban ubicados en cabeza y cuello y 23 por ciento estaban ulcerados. El tratamiento se inició en promedio a los 119 días de vida y duró en promedio 7 meses. En la totalidad de nuestros pacientes el uso de Propranolol aceleró el inicio de la involución del hemangioma y disminuyó el color, brillo y crecimiento. El 43 por ciento de los pacientes presentó irritabilidad y trastornos del sueño. No se presentaron efectos adversos importantes en ninguno de nuestros pacientes. Conclusión: El tratamiento con Propranolol fue altamente efectivo y seguro en nuestra serie de pacientes y proponemos, tomando en cuenta los reportes publicados al respecto, que debiera ser el tratamiento de elección para los hemangiomas de la infancia.

Bone scans in neuroblastoma.

Eighty-Six patients of neuroblastoma ranging in age from four months to 15 years were studied with 99m Tc-MDP for total skeletal survey over a period of seven years (1983-1990). The diagnosis of neuroblastoma was based on bone marrow examination, FNAC, lymph node biopsy, histopathology. Bone imaging was performed three hrs. after intravenous administration of 99m Tc-MDP. Out of 86 patients, 45 patients had positive bone scan showing osseous concentration in 122 sites and extraosseous concentration in 34 sites. Seven patients had liver metastases. None of these liver metastases showed concentration of MDP. Fourteen patients underwent surgery for the primary tumour at the time of bone scanning. Ten patients were studied at the time of follow up, of which four patients showed good response as bony metastases were not demonstrated on bone scintigraphy and X-rays. In conclusion, bone scan is an useful test in neuroblastoma in delineating the bony metastases and also in assessing the efficacy of chemotherapy in these patients.