RESUMEN
Thoracic actinomycosis with involvement of the vertebral column and chest wall is rare in children and may resemble malignant tumors. A 12-year-old girl was admitted to our clinic having B-symptoms, cachexia, and painful scoliosis (Karnofsky index 20%). Imaging showed a large thoracic left-sided paravertebral tumor with infiltration of the vertebrae, destruction of the chest wall and multiple intrapulmonary nodules. Initially, Ewing sarcoma was suspected and chemotherapy started without previous biopsies. Definite diagnosis of actinomycosis was established later upon histopathologic examination and successfully treated by ß-lactam antibiotics. Collectively, this case illustrates that actinomycosis can be an oncological pitfall and possible differential diagnosis.
Asunto(s)
Actinomicosis , Enfermedades de la Columna Vertebral , Enfermedades Torácicas , Actinomicosis/diagnóstico por imagen , Actinomicosis/tratamiento farmacológico , Niño , Femenino , Humanos , Sarcoma de Ewing/diagnóstico por imagen , Sarcoma de Ewing/tratamiento farmacológico , Enfermedades de la Columna Vertebral/diagnóstico por imagen , Enfermedades de la Columna Vertebral/tratamiento farmacológico , Enfermedades de la Columna Vertebral/microbiología , Enfermedades Torácicas/diagnóstico por imagen , Enfermedades Torácicas/tratamiento farmacológico , Enfermedades Torácicas/microbiologíaRESUMEN
Although the fate of nephrogenic rests varies, they are known to be precursors of Wilms tumour. Thus, nephrogenic rests require adequate treatment to prevent malignant transformation. We added 13-cis retinoic acid to the standard chemotherapy with vincristine and actinomycin-D in two patients with bilateral nephrogenic rests/nephroblastomatosis. Patient 1 also had a history of Wilms tumour. 46 (patient 1) and 81 (patient 2) months after end of treatment, both patients show stable conditions with no signs of relapse or progressive disease. Our observation supports further investigation of retinoic acid in patients with nephrogenic rests and nephroblastomatosis.