RESUMEN
We report the case of a child suffering from a neonatal cervicomediastinal neuroblastoma encasing the left subclavian artery and the left vertebral artery. There is only a few pediatric tumors extending from the neck to the upper part of the thorax. Because of the complex vascular and neurological anatomy of this area, the surgical excision of these cervicothoracic neuroblastomas is a real challenge. It is why, when we decided to propose a surgical management, we used the Transmanubrial Osteomuscular-Sparing Approach (TOSA), of which technique and benefits will be explained in this article.
Nous rapportons le cas d'un enfant présentant un neuroblastome cervico-médiastinal néonatal engaînant les artères sous-clavière et vertébrale gauches. Les tumeurs s'étendant du cou à la partie supérieure du thorax sont rares en pédiatrie. De plus, l'anatomie vasculo-nerveuse complexe de cette région rend l'exérèse difficile. C'est pourquoi, à l'âge de 20 mois, lorsqu'une prise en charge chirurgicale a été décidée, nous avons utilisé l'approche transmanubriale avec épargne ostéo-musculaire ou TOSA (Transmanubrial Osteomuscular-Sparing Approach) dont nous détaillons la technique et les avantages.
Asunto(s)
Neuroblastoma , Humanos , Recién Nacido , Neuroblastoma/cirugíaAsunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Quimiocina CXCL2/genética , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/diagnóstico , Sistema del Grupo Sanguíneo Duffy/genética , Proteínas de Neoplasias/genética , Polimorfismo Genético , Leucemia-Linfoma Linfoblástico de Células Precursoras/patología , Receptores de Superficie Celular/genética , Biomarcadores de Tumor/genética , Niño , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/etiología , Estudios de Seguimiento , Humanos , Quimioterapia de Inducción/mortalidad , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamiento farmacológico , Leucemia-Linfoma Linfoblástico de Células Precursoras/genética , Pronóstico , Estudios Retrospectivos , Tasa de SupervivenciaRESUMEN
UNLABELLED: The aim of this study was to show that steroid therapy taken before the diagnosis of acute lymphoblastic leukemia (ALL) can alter the management of the disease. PATIENTS AND METHODS: We conducted a multicenter retrospective study on 11 children treated between 2005 and 2011, who received oral steroids ranging from 0.6 to 3.3mg/kg/day prednisolone equivalent for a duration of 2 to 15 days during the 2 months prior to diagnosis of ALL. RESULTS: Four children had febrile pancytopenia. Among them, 2 had severe infections and a noncontributive bone marrow aspiration. One of them presented a severe tumoral lysis syndrome and was hospitalized twice in the intensive care unit. Two teenagers had central nervous system involvement at diagnosis of T-ALL, 1 having associated cutaneous locations, the second one showing pulmonary and central nervous system (CNS) leukostasis with renal failure and disseminated intravascular coagulation. One child died of septic shock during the induction phase of steroid-resistant T-ALL. Four children had no complications during the induction phase. Steroid resistance occurred in 5 cases and steroid sensitivity could not be evaluated in 3 cases. Three allogeneic bone marrow transplants were performed: the first one because of early CNS relapse, the 2 others because of initial treatment resistance. CONCLUSION: Steroids can induce a delay in the management of ALL and seem to favor initial complications, and possibly increase diffuse locations as well as steroid resistance. Their prescription needs to be carefully managed, especially for uncharacteristic infectious symptoms. Then a complete blood count should be done.
