The role of second-look surgery in the management of advanced germ cell malignancies

Article Abstract:

It is obvious that germ cells, the sperms and eggs, carry within them the ability to form all adult tissues. Tumors can develop from the primordial germ cells in children, and these tumors can also contain signs of a variety of tissues of the body. Most germ cell tumors occur in the ovaries or the testes, but some occur outside the gonads. Since the primordial germ cells do not arise in the gonads but migrate there during embryonic development, it is presumed that the extragonadal germ cell tumors represent a failure of normal migration. Germ cell tumors often secrete measurable amounts of substances like alpha-fetoprotein (AFP) and beta-human chorionic gonadotrophin (HCG). These substances may serve as tumor markers, which provide useful indication of the activity of tumor cells within the body. Children with germ cell tumors are generally treated with surgery followed by chemotherapy. Controversy exists, however, whether there is any value in taking a surgical second look for recurrent tumor in such children. A study was therefore conducted to determine if second-look surgery adds any useful information to that which can already be obtained from the measurement of tumor markers and from CT scans. A total of 27 children with advanced germ cell cancer were studied. Nineteen patients had elevated tumor markers on diagnosis; the tumor markers fell to normal after chemotherapy in 12. In these 12 patients, second-look surgery merely confirmed the complete response, and therefore added no clinically useful information. In the remaining seven patients, the markers fell but did not normalize; all these patients had residual disease, and again second-look provided no useful information. In the eight patients who did not have elevated markers at diagnosis, second-look surgery revealed nothing in the four patients with complete responses. However, in the four patients with residual masses which could be seen using CT scan, two were found to have only necrotic tissue and two were found to have living tumor cells. The results suggest that second-look surgery might be most appropriate for patients with residual masses visible on CT scan. For the majority of cases, the surgery accomplishes only a confirmation of information available from other, less invasive, diagnostic techniques. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Cases, Measurement, Germ cell tumors, Germinoma, Tumor markers, Diagnosis, Surgical, Surgical diagnosis

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Candida tropicalis and Candida albicans fungemia in children with leukemia

Article Abstract:

Infections are a constant threat to cancer patients. Several factors increase the risk of infections: the use of venous catheters, the suppression of immunity that occurs with chemotherapy, and the breakdown of the mucosal membranes that can result from chemotherapeutic treatment. Fungal infections pose a particular threat, since they are more difficult to combat than bacterial infections. Data from case records were tabulated for 822 children with leukemia and 290 children with lymphoma. The study focussed on infection with fungi of the Candida species, often referred to as 'yeasts'. The children were monitored regularly for colonization and fungemia, the spread of the fungi throughout the bloodstream. Among the patients with lymphoma, 89 were colonized with Candida albicans and 23 with Candida tropicalis. However, in none of these cases did fungemia develop. The same was not true for the leukemia patients, however. Twelve of the 107 patients colonized with C. tropicalis developed fungemia, as did 14 of the 700 children colonized with C. albicans. The patients were treated with the antifungal drug amphotericin B, either with or without the drug 5-flucytosine. In each group, two children died of their fungal infection. Fungal infections are so serious and so frequently fatal that the initiation of antifungal therapy should begin as soon as a fungal infection is suspected, even before the infection is confirmed by laboratory diagnosis. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Chemotherapy, Candida albicans, Childhood leukemia, Leukemia in children

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Peripheral primitive neuroectodermal tumor (peripheral neuroepithelioma) in children: a review of the St. Jude experience and controversies in diagnosis and management

Article Abstract:

Primitive neuroectodermal tumors (PNET) are a class of soft tissue tumors. They arise from neuroectodermal tissue, which refers to the set of tissues arising from the neuroectoderm of the embryo and includes peripheral nerves, sense organs, and related tissues. Histologically, PNETs are not easy to distinguish from neuroblastoma (NBL) or extraosseous Ewing's sarcoma (EOE). In a review of 26 tumors occurring in children between 1962 and 1987, 16 were diagnosed as PNET, 7 were rediagnosed as PNET or EOE after histopathological examination, and 3 were diagnosed as EOE. The use of antibodies to neuron-specific enolase, Leu-7, muscle-specific actin, and beta-2-microglobulin for specific staining can help clarify the differences between these tumors, but no single criterion seems to be diagnostic in this regard. Although the tumors are similar under the microscope, their clinical behavior is different; further research should be performed to clarify the distinctions. (Consumer Summary produced by Reliance Medical Information, Inc.)

Neuroblastoma, Tumors in children, Pediatric tumors, Ewing's sarcoma

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