RESUMO
We report the case of a 3-year-old girl with stage I Wilms' tumor of favorable histology. During the course of chemotherapy 5 months post-diagnosis, an abdominal ultrasonogram revealed hypoechoic areas consistent with hepatic tumor recurrence. A liver biopsy performed to rule out recurrence of the malignancy was suggestive of toxocariasis and the diagnosis was confirmed by serologic testing. Although the patient had few classic signs of visceral larva migrans, her eosinophilia and family social history should have suggested this possibility. This case demonstrates that hepatic toxocariasis should be considered in evaluating hepatic hypoechoic lesions in a child, even when features typical of the disease are absent.
Assuntos
Larva Migrans Visceral/diagnóstico por imagem , Hepatopatias Parasitárias/diagnóstico por imagem , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/secundário , Tumor de Wilms/diagnóstico por imagem , Tumor de Wilms/secundário , Pré-Escolar , Diagnóstico Diferencial , Feminino , Humanos , Neoplasias Renais/patologia , Larva Migrans Visceral/tratamento farmacológico , Hepatopatias Parasitárias/tratamento farmacológico , Hepatopatias Parasitárias/parasitologia , Tiabendazol/uso terapêutico , UltrassonografiaRESUMO
In 1985 a new treatment regimen for advanced non-Hodgkin's lymphoma was started in the "Instituto da Criança-HC-FMUSP". The final results are remarkably better than those achieved with former programs. Two cases of children who developed a second neoplasm after the therapy was completed are described and discussed.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Leucemia Mielomonocítica Aguda/induzido quimicamente , Segunda Neoplasia Primária/induzido quimicamente , Leucemia-Linfoma Linfoblástico de Células Precursoras/induzido quimicamente , Neoplasias Abdominais/induzido quimicamente , Neoplasias Abdominais/tratamento farmacológico , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Linfoma de Burkitt/tratamento farmacológico , Criança , Pré-Escolar , Feminino , HumanosRESUMO
From January 1980 to December 1984, 22 children with non-Hodgkin's lymphoma were admitted to the "Instituto da Criança-HCFMUPS" and according to the LNH-I-80 Protocol including a remission induction phase (Cyclofosfamide day 1, Vincristine days 3, 10, 17, 24, Daunomycin days 12 and 13, Prednisone for 30 days), followed by a continuation phase (Cyclofosfamide x 7 days + Adriamycin day 8 ARA-C x 4 days + Vincristine day 5, Mercaptopurine x 4 days + Methotrexate day 5) alternating three pairs of drugs during 72 weeks. Mercaptopurine and Methotrexate given during additional 48 weeks completes therapy. Twenty-one out of 22 patients attained complete remission. One patient died after widespread infection. Six relapses occurred, five of them in Burkitt's lymphoma patients. Although highly effective in the non-Burkitt's patients, the LNH-I-80 Protocol failed in keeping Burkitt's patients in event free survival.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Linfoma não Hodgkin/tratamento farmacológico , Adolescente , Criança , Pré-Escolar , Ciclofosfamida/administração & dosagem , Daunorrubicina/administração & dosagem , Feminino , Humanos , Linfoma não Hodgkin/patologia , Masculino , Estadiamento de Neoplasias , Prednisona/administração & dosagem , Indução de Remissão , Resultado do Tratamento , Vincristina/administração & dosagemRESUMO
A case of multicentric synchronous osteosarcoma occurring in a 9 year old girl is reported. Some particular features of this rare disease namely its rapid progression despite intensive drug therapy is stressed. Current hypothesis for the occurrence of this unusual form of neoplasm are here discussed.
Assuntos
Neoplasias Ósseas/diagnóstico por imagem , Osteossarcoma/diagnóstico por imagem , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias Ósseas/tratamento farmacológico , Neoplasias Ósseas/patologia , Criança , Cisplatino/administração & dosagem , Doxorrubicina/administração & dosagem , Feminino , Humanos , Osteossarcoma/tratamento farmacológico , Osteossarcoma/patologia , CintilografiaRESUMO
From July 1985 to February 1987, of 46 consecutive children with cancer (26 male, 20 female; median age, 4 years) with no prior history of chickenpox, the initial 30 patients were randomized either to receive or not to receive live attenuated varicella vaccine (LAVV) before chemotherapy was started and the remaining 16 patients were all immunized without randomization. Before immunization, Varicella zoster (VZ) antibodies were detected by immunofluorescence and ELISA in 11 (34%) of 32 vaccinated children and two (14%) of 14 controls, indicating previous infection. A booster effect was evident in 70% of them and no side effects were noted. Ten (28%) of 32 vaccinees were excluded from the analysis because of early death due to cancer (1-4 weeks). Seroconversion was demonstrated in ten (77%) of 13 vaccinees, with high antibody titres. Only three of them lost their antibodies 2 years after immunization, as disclosed by serological follow-up. Eight out of 13 vaccinees had household contacts with VZ and none became infected. Zoster immunoglobulin (ZIG) was never given. Among controls, seven out of 14 were exposed to VZ and four (57%) became infected. Mild side effects were observed in four (12.5%) out of 32 vaccinees (three with papulovesicular rash, 6-30 lesions, and one with a 3-day intermittent fever). Local reactions, zoster and spreading of vaccinal virus did not occur. LAVV proved to be safe and effective when administered before starting chemotherapy to children with cancer and no history of varicella.
Assuntos
Varicela/prevenção & controle , Herpesvirus Humano 3/imunologia , Neoplasias/tratamento farmacológico , Vacinas Virais/administração & dosagem , Anticorpos Antivirais/sangue , Vacina contra Varicela , Criança , Pré-Escolar , Ensaio de Imunoadsorção Enzimática , Feminino , Imunofluorescência , Humanos , Lactente , Masculino , Vacinas Virais/efeitos adversos , Vacinas Virais/imunologiaRESUMO
Os autores apresentam um caso de aplasia medular prolongada, em crianca de 7 anos e 8 meses de idade, medicado com androgeno por 9 meses sem melhoria do quadro hematologico, ate que foram constatados 32% de celulas leucemicas ao hemograma o que permitiu, entao, o diagnostico de leucemia mielomonocitica, tendo sido possivel obter remissao completa. Os autores comentam a importancia da identificacao de estados pre-leucemicos