Clinical experience of thoracoplasty with absorbable rib substitutes.

PURPOSE: Malignant chest wall tumors are rare in pediatrics. They require multimodal oncological treatment and local surgical control. Resections are extensive; therefore, thoracoplasty should be planned to protect intrathoracic organs, prevent herniation, future deformities, preserve ventilatory dynamics, and enable radiotherapy. METHODS: We present a case series of children with malignant chest wall tumors and our surgical experience with thoracoplasty using absorbable rib substitutes (BioBridge®), after local surgical control. BioBridge® is a copolymer made of a polylactide acid blend (70% L-lactic acid y 30% DL-lactide). RESULTS: In 2 years, we had three patients with malignant chest wall tumors. Resection margins were negative, without recurrence at follow-up. We achieved good cosmetic and functional results, and no postoperative complications. CONCLUSION: Alternative reconstruction techniques such as absorbable rib substitutes provide protection, guarantee a flexible chest wall, and do not interfere with adjuvant radiotherapy. Currently, there are no management protocols in thoracoplasty. This option represents an excellent alternative for patients with chest wall tumors. Knowledge of different approaches and reconstructive principles is essential to offer children the best onco-surgical option.

[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.

Mesenteric Primitive Myxoid Mesenchymal Tumor in a 7-Month-Old Boy.

Mesenteric tumors are rare, especially in the pediatric population. We present a case of a 7-month-old boy with an incidental abdominal mass identified as a Primitive Myxoid Mesenchymal Tumor of Infancy derived from the small bowel mesentery. This neoplasm is part of a spectrum of myofibroblastic lesions, with distinct clinical, morphologic, IHQ reactivity, and an aggressive clinical course. There is a paucity of evidence for the management of these tumors, and surgical resection remains the mainstay of treatment.

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.