Ectopic ACTH Syndrome in a Child With Abdominal Ewing Sarcoma: A Rare Paraneoplastic Phenomenon.

Ectopic adrenocorticotropic hormone syndrome is a paraneoplastic phenomenon rarely seen in pediatrics and rarely described in Ewing sarcoma. We report a 15-year-old boy with abdominal Ewing sarcoma and clinical and laboratory findings of ectopic adrenocorticotropic hormone syndrome that promptly resolved with treatment of the tumor.

Helicobacter pylori associated gastric Burkitt lymphoma.

Chronic Helicobacter pylori (H. pylori) infection has been linked to lymphoma of gastric mucosa-associated lymphoid tissue (MALT), a tumor that is typically localized at presentation. Sporadic Burkitt lymphoma (BL) frequently presents as an abdominal mass. However, primary gastric BL is unusual and the role of H. pylori in its pathogenesis is unclear. We describe a 12 year old with localized gastric BL and concurrent H. pylori infection. In this report, we discuss the potential association between H. pylori and gastric BL and also highlight certain similarities between gastric MALT lymphomas and BL arising in the stomach.

Thrombosis in children: current perspective and distinct challenges.

Coincident with a true increase in the incidence of thrombosis in childhood has come an appreciation of the impact of thromboembolic events upon children. In part, the greater awareness of childhood thrombosis reflects improved diagnostic imaging, which allows more sensitive identification of clots in infants and children. At the same time, advances in supportive care have meant that more children are being exposed to, surviving and living with thromboembolic risk factors and complications than previously. Because data regarding pediatric thrombosis have been lacking, treatment strategies have been extrapolated from experience in adults. This approach, however, results in diagnostic and therapeutic pitfalls. An understanding of issues unique to pediatric thrombosis is required; recent insights and the ongoing challenges are reviewed.

The abnormal measures of iron homeostasis in pediatric obesity are associated with the inflammation of obesity.

Objectives. To determine if the low iron state described in obese children is associated with the chronic inflammatory state seen in obesity. Study Design. Obese children age from 2 to 19 years seen at a weight management clinic were studied prospectively. Data were collected on age, gender, BMI, BMI z-score, serum iron, ferritin, transferrin saturation, free erythrocyte protoporphyrin, high sensitivity creactive protein (hs-crp), and hemoglobin concentration. Results. 107 subjects were studied. Hs-crp levels correlated positively with BMI (P < .001) and BMI z-score (P = .005) and negatively with serum iron (P = .002). 11.2% of subjects had low serum iron. Median serum iron was significantly lower for subjects with American Heart Association high risk hs-crp values (>3 mg/L) compared to those with low risk hs-crp (<1 mg/L), (65 mcg/dL versus 96 mcg/dL, P = .016). After adjusting for age, gender, and BMI z-score, serum iron was still negatively associated with hs-crp (P = .048). Conclusions. We conclude that the chronic inflammation of obesity results in the low iron state previously reported in obese children, similar to what is seen in other inflammatory diseases.

Emesis predicts bacteremia in immunocompromised children with central venous catheters and fever.

BACKGROUND: The objective of this study was to determine whether vomiting at presentation of a febrile illness in immunocompromised children with central venous catheters (CVCs) predicts bacteremia. METHODS: A chart review was conducted of children who were admitted to the hospital with a diagnosis of cancer or aplastic anemia, fever, and a CVC. Data were collected on the presence or absence of vomiting, catheter type, presence or absence of severe neutropenia, C-reactive protein (Crp) value, and culture results. RESULTS: There were 143 admissions for fever among 48 children. Among 35 admissions with emesis, 19 included bacteremia; whereas, among 107 admissions without emesis, 19 included bacteremia (P < .001). There was a 5-fold greater risk of bacteremia in children with children without vomiting (odds ratio, 5.50; 95% confidence interval, 2.20-13.67). Gram-negative organisms were more likely to be associated with vomiting than Gram-positive organisms (P = .008). Children with severe neutropenia did not have a significantly higher rate of bacteremia than children who had neutrophil counts >500 cells/mm(3). Other factors that were associated with higher rates of bacteremia were underlying diagnosis and catheter type. CONCLUSIONS: Immunocompromised children with a CVC and a fever who presented with vomiting were more likely to have bacteremia than similar children who presented without vomiting. Gram-negative organisms were more likely to be associated with emesis than Gram-positive organisms. The absence of severe neutropenia was not associated with a decreased likelihood of bacteremia. These findings may be useful in identifying children who are at high risk for bacteremia and in determining initial, empiric therapy.

Spindle cell lesions of the head and neck mimicking rhabdomyosarcoma in children.

Malignancies of the head and neck are uncommon among children. The most common solid tumors to occur in this region are rhabdomyosarcoma, Hodgkin disease, and non-Hodgkin lymphoma. Two children are described who presented with signs and symptoms consistent with rhabdomyosarcoma, but who were found to have benign spindle cell lesions. These rare lesions should be part of the differential of children with a head and neck mass.