[Experiencia en el diagnóstico y tratamiento de 38 casos de cáncer de tiroides en población pediátrica]. / Experience in the diagnosis and treatment of pediatric thyroid cancer in 38 cases.

OBJECTIVE: To present our experience treating 38 patients with pediatric thyroid carcinoma. METHOD: We received 44 pediatric patients with thyroid cancer between 2008 and 2016 in a specialized cancer center. A team of two surgeons treated all patients. We reviewed patient charts, treatment, pathology report, recurrence, and mortality. Qualitative variables were analyzed using Chi-square. Quantitative variables have a 95% confidence interval. RESULTS: 82% (n = 31) of cases were female. Average age at diagnosis was 12 years. The most frequent symptom was a thyroid nodule (74%), and the most frequent method of diagnosis was fine needle aspiration. 11 patients (29%) had pulmonary metastasis. All patients underwent total thyroidectomy, and 33 cases (86%) also had lymph node dissection. There were 5 (13%) postoperative complications. 33 cases received radioactive iodine treatment after surgery. CONCLUSIONS: Pediatric thyroid cancer usually presents with multifocal disease. Female adolescents are affected more frequently than males. Differentiated thyroid cancer is the most frequent type, and it has excellent survival rates.

OBJETIVO: Presentar nuestra experiencia en el diagnóstico y tratamiento de 38 pacientes pediátricos con cáncer de tiroides. MÉTODO: Entre los años 2008 y 2016 recibimos 44 pacientes con cáncer de tiroides en un centro especializado de cáncer. Todos fueron tratados por un equipo de dos cirujanos. Se realizó una revisión retrospectiva de la historia clínica, el tratamiento recibido, los resultados histopatológicos, las recaídas y la mortalidad. Las variables cualitativas se analizaron con la prueba de ji al cuadrado. Las variables cuantitativas se trataron con medias e intervalos de confianza del 95%. RESULTADOS: El 82% (n = 31) de los casos fueron de sexo femenino. La edad promedio al diagnóstico fue de 12 años. El síntoma de presentación más frecuente (74%) fue un nódulo tiroideo. El método diagnóstico utilizado con mayor frecuencia fue el aspirado con aguja fina. Once pacientes (29%) tuvieron enfermedad metastásica, todos ellos en el pulmón. Todos los pacientes fueron sometidos a tiroidectomía total. Treinta y tres pacientes (86%) requirieron vaciamiento ganglionar. Hubo 5 pacientes (13%) con complicaciones posoperatorias. El 86% (n = 33) de los pacientes recibieron terapia complementaria con yodo. CONCLUSIONES: La presentación del cáncer de tiroides en la infancia generalmente es con enfermedad multifocal. Las adolescentes son las más afectadas. El cáncer diferenciado de tiroides es el tipo más frecuente y tiene una sobrevida excelente.

Hepatoblastoma and Abernethy Malformation Type I: Case Report.

A 2-year-old boy presented with pneumonia and an abdominal mass was noted incidentally. A right lobe hepatic mass classified as PRETEXT III and congenital absence of the portal vein with drainage of the superior mesenteric vein to the inferior vena cava (Abernethy malformation type I) were confirmed by computed tomography and angiography. After a clinical diagnosis of hepatoblastoma had been made, he was treated with 4 cycles of doxorubicin and cisplatin and hepatic arterial chemoembolization with doxorubicin, after which the tumor was classified as POSTEXT III. He underwent a right extended hepatic lobectomy with resection of the caudate lobe but died on postoperative day 4 due to hepatic failure. The Abernethy malformation type I is associated with the development of hepatic tumors, and the abnormal blood flow might predispose to hepatic failure after liver resection. Extensive study of the hepatic vasculature is warranted in patients with suspected malformations. Liver transplant could be considered in patients with congenital portosystemic shunt and malignant liver tumors.

A strategy to improve treatment-related mortality and abandonment of therapy for childhood ALL in a developing country reveals the impact of treatment delays.

BACKGROUND: Treatment-related mortality and abandonment of therapy are major barriers to successful treatment of childhood acute lymphoblastic leukemia (ALL) in the developing world. PROCEDURE: A collaboration was undertaken between Instituto Nacional de Cancerologia (Bogota, Colombia), which serves a poor patient population in an upper-middle income country, and Dana-Farber/Boston Children's Cancer and Blood Disorders Center (Boston, USA). Several interventions aimed at reducing toxic deaths and abandonment were implemented, including a reduced-intensity treatment regimen and a psychosocial effort targeting abandonment. We performed a cohort study to assess impact. RESULTS: The Study Population comprised 99 children with ALL diagnosed between 2007 and 2010, and the Historic Cohort comprised 181 children treated prior to the study interventions (1995-2004). Significant improvements were achieved in the rate of deaths in complete remission (13% to 3%; P = 0.005), abandonment (32% to 9%; P < 0.001), and event-free survival with abandonment considered an event (47% to 65% at 2 years; P = 0.016). However, relapse rate did not improve. Medically unnecessary treatment delays were common, and landmark analysis revealed that initiating the PIII phase of therapy ≥4 weeks delayed predicted markedly inferior disease-free survival (P = 0.016). Conversely, patients who received therapy without excessive delays had outcomes approaching those achieved in high-income countries. CONCLUSIONS: Implementation of a twinning program was followed by reductions in abandonment and toxic deaths, but relapse rate did not improve. Inappropriate treatment delays were common and strongly predicted treatment failure. These findings highlight the importance of adherence to treatment schedule for effective therapy of ALL.