SQUAMOUS CELL CARCINOMA OF THE TONGUE AS A SECOND MALIGNANCY IN A PATIENT PREVIOUSLY TREATED FOR OSTEOSARCOMA

A 15-year-old girl was diagnosed with osteosarcoma; limb salvage surgery was performed after preoperative chemotherapy. Postoperatively, adjuvant chemotherapy was given for 2 years. One year after completion of chemotherapy, the patient was readmitted for systemic recurrence. Amputation of the lower extremity and wedge resection of lung metastasis were performed followed by combination chemotherapy. Two years after cessation of chemotherapy, ulcer of the tongue was noted and cervical lymph nodes were detected by palpation. Biopsy of the lesion showed squamous cell carcinoma. The patient underwent a radical partial tongue resection and postoperative irradiation, followed by chemotherapy. Six years after treatment for the second malignancy, the patient remains well without evidence of disease. Squamous cell carcinoma of the tongue as a second malignancy after treatment of osteosarcoma is quite rare. Long-term follow-up, with particular attention to the head and neck, may be warranted in children treated for osteosarcoma.     

Osteosarcoma as a second malignancy after treatment for neuroblastoma

A 4-month old girl was diagnosed as having stage IV neuroblastoma of the right adrenal gland. Preoperative chemotherapy was given, followed by local surgical excision. Postoperatively, irradiation of the tumor bed and adjuvant chemotherapy was given for 11 months. Nine years after cessation of chemotherapy, the patient developed left hip-joint pain. Biopsy of the ischium showed chondroblastic osteosarcoma. Limb salvage surgery was performed after preoperative chemotherapy. Postoperatively, adjuvant chemotherapy was given for 14 months. Twenty-two months after treatment for the secondary osteosarcoma, the patient has been remained in disease-free condition without any evidence of relapse. A second osteosarcoma occurring outside the radiation field after treatment for neuroblastoma is quite rare. This unusual case emphasized the need for close monitoring for development of second malignant neoplasms in survivors of neuroblastoma even in the absence of a known predisposing factor, such as radiation therapy.     

Olfactory neuroblastoma as a second malignant neoplasm in a patient previously treated for childhood acute leukemia

Various kinds of second malignant neoplasms after successful treatment for childhood acute leukemia have been reported. The authors describe an unusual case of an olfactory neuroblastoma in a patient previously treated for childhood acute leukemia including autologous bone marrow transplantation. The prophylactic cranial irradiation and the total body irradiation during autologous bone marrow transplantation may have induced the development of their patient's olfactory neuroblastoma. Although a second primary olfactory neuroblastoma is rare, it should be added to the list of second malignant neoplasmsin the sinonasal region.     

Bronchioloalveolar carcinoma as a second malignancy in osteosarcoma survivors

Second malignancies occur in 2–3% of survivors of pediatric osteosarcoma; treatment‐related hematologic and solid malignancies have both been described. We present two cases of patients with pulmonary nodules that developed more than 2 years after treatment of osteosarcoma. Both lesions were completely resected and pathology revealed bronchioloalveolar carcinoma (BAC). Primary BAC is extremely rare in children; however, cases of this malignancy have been described in survivors of pediatric cancer. BAC may present as a solitary pulmonary nodule indistinguishable from a metastatic lesion and should be included in the differential diagnosis of pulmonary nodules in survivors of pediatric cancer. Pediatr Blood Cancer 2009;53:499–501. © 2009 Wiley‐Liss, Inc.     

Renal cell carcinoma as a second malignant neoplasm in a patient with non-syndromic hemihypertrophy and previous Wilms tumor

Survivors of childhood Wilms tumors are at an increased risk of second malignant neoplasms. Recently, it has been postulated that renal cell carcinoma is among the malignancies for which this population is at risk. We present the unique case of an adult Wilms tumor survivor with non-syndromic hemihypertrophy (NSHH) who developed renal cell carcinoma. This case highlights the need for close follow-up in two populations: adults who have survived Wilms tumor and those with NSHH.     

Adenocarcinoma of the colon as a second malignancy in a child

 Solid tumors as second malignancies are not common in children who have been managed for lymphoproliferative disorders. We report a case of adenocarcinoma (AC) of the colon as a second malignancy in a patient who was on maintenance chemotherapy for acute lymphoblastic leukemia (ALL). In children, primary AC of the colon is very rare; colonic AC occurring as a second malignancy in a child is rarer still. A case of AC of the colon following chemotherapy for ALL has not yet been published. Accepted: 12 July 1999     

Seeding of osteosarcoma in the biopsy tract of a patient with multifocal osteosarcoma

We report a case of multifocal osteosarcoma in a 7-year-old boy who developed iatrogenic seeding of tumor along the biopsy tract. The results of the plain radiograph, CT, and histopathological correlation are presented.     

Squamous cell carcinoma of the tongue in a 13-year-old girl with Fanconi anemia

We report the case of a 13-year-old girl with squamous cell carcinoma (SCC) of the tongue. Fanconi anemia with a yet unknown complementation group had been diagnosed at the age of 5 years. Organ involvement included intestinal atresia, renal dysfunction due to crossed renal atopia, and tubular acidosis type II. Because of repeated bleeding complications frequent transfusions, and severe infections, bone marrow transplantation (BMT) from a matched unrelated donor was done at the age of 11 years. The girl did not suffer from graft-versus-host disease and had complete hematologic reconstitution after transplantation. Two years after BMT a SCC of the tongue developed without nodal or systemic metastasis. The tumor could be completely resected and no functional disturbances remained. No further treatment was given and the patient is in complete remission 6 months after diagnosis. This is one of the youngest children reported with SCC of the tongue after BMT for Fanconi anemia so far.     

Relationships of cytokine (GM-CSF) serum concentration to blood cell count and the inflammatory parameters in children with malignant diseases

This study examined both the endogenous and exogenous (therapy-related) pharmacokinetics of the cytokine granulocyte-macrophage colony-stimulating factor (GM-CSF) in neutropenic children with solid and systemic malignancies. The daily endogenous GM-CSF serum concentration before application was 29 pg/mL. During the 10 days of examination, the concentration rose to an average value of 1351 pg/mL 8 h after application. A significant stimulation of the neutrophils, monocytes, and eosinophils in peripheral blood was documented. No significant correlation between the GM-CSF concentration and peripheral blood cell counts could be documented. Paraclinically, there was no evidence for functional disturbance of either the liver or the kidneys, i.e., under the cytokine therapy. The therapy was well tolerated by all the children involved in the study.     

Mucoepidermoid carcinoma of the parotid gland in a child previously treated for acute lymphoblastic leukemia

Occurrence of second cancers is a major concern for the care of children cured of cancer. Children treated for acute lymphoblastic leukemia (ALL) have an increased risk for developing mucoepidermoid carcinomas (MEC) of the parotid gland. The latent period ranges from 5 to 16 years. A 3-year-old boy presented with pre-B ALL. Treatment included multidrug chemotherapy and prophylactic intrathecal injections of methotrexate and prednisolone. Low-grade MEC of the left parotid gland was diagnosed at the age of 7 years, only 1 year after completing treatment. Local lymph nodes were not metastatic, and course was favorable 8 years after complete surgical excision. This case report is remarkable for the early diagnosis of second cancer, only 4 years after diagnosis of ALL, and its occurrence in parotid gland without previous head and neck irradiation. It highlights the need for concern about second cancers of the parotid gland in children treated for ALL.     

Successful treatment of metachronous contralateral intratubular germ cell neoplasia with partial orchiectomy and low‐dose radiation in a patient previously treated for testicular carcinoma

Intratubular germ cell neoplasia (ITGCN) of the testis is a precursor to testicular germ cell tumor (TGCT), which can lead to the development of invasive cancer. In patients with a history of previously treated unilateral TGCT, treatment for ITGCN of the contralateral testis needs to be balanced with the risks of subsequent infertility. Here, we present a 17‐ year‐ old patient with ITGCN diagnosed after treatment of contralateral nonseminomatous TGCT who was successfully treated with a partial orchiectomy followed by low‐dose radiation with preservation of his testosterone production.      

Mucoepidermoid carcinoma of the parotid gland as a second malignant neoplasm

We report two second malignant neoplasms (SMNs) of the parotid gland. Patient 1 was initially diagnosed with precursor B-cell lymphoblastic lymphoma of the scalp. Eight years after her initial diagnosis she presented with a small, painless mass in the region of her parotid gland. Patient 2 was diagnosed with pre-B-cell acute lymphoblastic leukemia (ALL). Thirteen years after her initial diagnosis she presented with a painless mass in her right cheek. Both patients underwent superficial parotidectomies following excisional biopsies. Pathology revealed low-grade mucoepidermoid carcinoma (MEC) in both cases. Both patients are currently tumor free.     

Primary squamous cell carcinoma of the lung in childhood

A rapidly progressing fatal primary lung neoplasm in an adolescent girl is presented with a brief literature review.     

Transitional cell carcinoma of the bladder in first decade of life

This report describes two rare cases of well-differentiated, non-invasive transitional cell carcinomas in children (Grade 1 Stage pTa). One was 8-year-old girl with a polypoid lesion and the other 9-year-old girl with kissing bilateral paraureteral lesions. The initial presentation was haematuria and symptoms of urinary tract infection. Subsequent course and investigation confirmed the diagnosis. Complete resection of the lesion and follow-up with urine cytology, vesical ultrasound and check cystoscopy at 4 years has showed no evidence of recurrence.     

Stage 4 squamous cell carcinoma of the tongue in a child: complete response to chemoradiotherapy

This report describes a complete response to a chemoradiotherapy regimen in a child with an advanced and unresectable squamous cell carcinoma of the tongue. An 8-year-old girl had stage 4 squamous cell carcinoma of the tongue (T4N2M0), causing severe trismus and dysphagia. She received hyperfractionated external beam radiotherapy (total 74.4 Gy) and concomitant intravenous infusion of hydroxyurea (0.313 mg/m2 per min) for 43 days. Grade 3 mucositis and myelosuppression were the main toxicities. There was marked symptomatic improvement, and the patient achieved a complete response. She is disease-free 24 months after treatment, and all the acute symptoms have resolved. The regimen was well tolerated with acceptable toxicity and led to a complete objective response. This regimen needs further evaluation to confirm its efficacy and to ascertain its long-term effects in children.     

Same sibling marrow following cord allogeneic transplantation as therapy for second relapse acute promyelocytic leukemia in a pediatric patient

Optimal therapy for relapsed APL in pediatric patients is controversial. Allogeneic HSCT is an alternative, with event‐free survival of 70–75%. We report a pediatric patient with APL who relapsed 28 months after CBT from her sibling and then was treated with BMT from the same donor. Bone marrow was selected for higher cell dose, donor availability, and partial donor chimerism. Persistent molecular remission was achieved, currently at 65 months after BMT. This case suggests the potential role of GVL activity in APL and illustrates the use of different cell sources from the same donor in allogeneic transplantation for pediatric patients.