Tumors In Pediatric Age Group Research Articles

Tumor DNA sampling from aqueous humor in retinoblastoma - A report from South Asia.

Retinoblastoma (RB) is the most common intraocular tumor in pediatric age group. The role of genetics has been explored in predicting survival prognosis, but its role in predicting globe salvage remains largely unexplored. We hereby aim to isolate cell-free DNA (cfDNA) from aqueous humor (AH) in RB eyes and validate its use for genetic studies. AH was obtained from 26 eyes undergoing enucleation (arm A) or intravitreal chemotherapy (arm B). Isolation of cfDNA was done using QIAamp ® Circulating Nucleic Acid kit, and the cfDNA was utilized for targeted sequencing of RB1 gene. We could isolate cfDNA in all eyes (72% unilateral and 28% bilateral) with a distribution peak between 140 and 160 bp and a mean concentration of 27.75 ng/µl for arm A and 14 ng/µl for arm B. Targeted sequencing done on four samples showed RB1 gene mutations, namely, inframe deletion (c. 78-80del, p.Pro29del), start-loss mutation (c.1A>T, p.Met1?), nonsense mutations (c.2236G>T, p.Glu746Ter), (c.1659T>A, p.Cys553Ter), and (c.2065C>T, p.Gln689Ter), and novel missense mutations (c.672C>A, p.Asp224Glu) and c.692C>T (p.Pro231Leu). Genetic profile of cfDNA extracted from AH and genomic DNA from the tumor tissue was comparable. Our study supports the previous reports that AH may be used as a source of tumor-derived cfDNA. This is the first report from South Asia on isolation and genetic analysis of cfDNA from AH of RB eyes and, therefore, a big step forward in paving the role of tumor genetics in RB. Further studies are required to elucidate concordance between the tumor and AH genetic profile.

Clinicopathological assessment of renal tumors in pediatric age group in a sample of Iraqi patients

Background: According to the Iraqi Cancer Registry, renal carcinoma is the 13th most common carcinoma, with 798 registered cases in 2020 and 418 deaths. Methods: This is a cross sectional retrospective study that includes the analysis of 116 randomly selected sample of pediatric patients (74 nephrectomies and 42 biopsies) sent to the Teaching Laboratories of AL-Emamain AL-Kadhmain city (AS), Baghdad medical city, and private laboratories from January 2019 to January 2023. Results: Histopathological diagnosis revealed a ratio from malignant to benign of 7.4:1. Wilm’s tumor was the most common malignant tumor (65.5%), while multicystic renal dysplasia was the most common benign tumor (7.8%). Abdominal pain was the most common clinical feature (67.2%), followed by abdominal mass (20.7%). Regarding malignant cases, Pathological stage I was the most common (39.0%). As for the histopathological subtype, triphasic type was the most common (57.1%), followed by the biphasic type (10.5%). Conclusions, Malignant tumors make up the vast majority of renal tumors. Wilm tumor is the predominant malignant tumor. Fortunately, most cases of Wilm tumors exhibited an early stage and favorable histology. Neuroblastoma was the second most common malignant tumor. The abdominal lump is the most common presentation of pediatric renal tumor.

Childhood Malignancies-Clinico-demographic Profile of Patients Attending the Department of Otorhinolaryngology at a Tertiary Care Centre in North-East India.

Malignancies in children are different from those found in adults and are a significant cause of childhood mortality.They have varied clinical presentation depending on site and type of disease.It is essential to recognize the early signs and symptoms of malignancies in childhood, especially those involving head and neck region, so as to reduce childhood mortality and morbidity. A total of 2384 children were admitted over a period of 7 years. Out of these, 1004 fulfilled the inclusion criteria and were chosen for further evaluation.They were thoroughly evaluated by undertaking a detailed history and clinical examination.Whenever required, additional investigations were performed.After carrying out the necessary investigations, the cases were accordingly managed. Data was evaluated using proper statistical tools. Out of 1004 cases fulfilling the inclusion criteria, 42 turned out to be malignant, with a male-to-female ratio of 1:1.2. Malignancies in children were more common in the age group of 11-18 years, followed by 1-5 years,6-10 years and 0-1 years,with rates of 59.5%, 21.4%, 16.7% and 2.4% respectively. A wide variety of tumour types were recorded,e.g.,Hodgkin's lymphoma,non-Hodgkin's lymphoma,acute leukemia,papillary carcinoma thyroid, nasopharyngeal carcinoma,Langerhans cell histiocytosis,rhabdomyosarcoma, olfactory neuroblastoma and salivary gland neoplasm. Incidence of head and neck tumors in pediatric age group was found to be 1.76% with lymphoma being the most frequent.Commonest age of presentation was above 10 years. There was an overall female predominance with a male:female ratio of 1:1.2. Awareness of a potential malignancy and careful follow-up of children with suspicious head and neck cancers is mandatory for early diagnosis and prompt treatment.

Abdominal tumors in children: A comprehensive study on the diagnosis, management, and clinical outcome of pediatric patients with lymphoma in Kashmir

Background: Although primary abdominal tumors are rare but their diagnosis, high-cost treatment and psychological instability among both patients and parents are challenging. There are several types of abdominal tumors in pediatric age group which include neuroblastoma, Wilm’s tumor, hepatoblastoma, lymphomas, soft-tissue sarcomas, and germ cell tumors. Aims and Objectives: The present study was objectively conducted to identify Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL) tumors among all patients presented with abdominal tumors. In addition to this, histopatological profile, clinical profile and disease prognosis among such patients has also been analyzed. Materials and Methods: A total of 64 pediatric patients presented with primary abdominal tumors were included in the study but only 20 patients with lymphoma were identified. The study was conducted at the Department of Pediatric Division, SMHS Hospital Srinagar with effect from 2005 to 2008. Results: The Majority of NHL patients were found to have Stage II and Stage IV. Moreover, all the four cases of Hodkins lymphoma had Stage IV. Out of the 20 patients with lymphoma six died, of them five had NHL and one patient had HL, thus placing the overall survival rate as 70%. Conclusion: The present study demonstrated that both NHL and HL tumors may develop to advanced stage and even patient may die if the timely diagnosis and proper management is not there. We recommend collective team work of medicos from various departments for the precise diagnosis and optimal management of such patients.

Mesenchymal Hamartoma Liver Showing Malignant Transformation to Undifferentiated Embryonal Sarcoma- A Case Report

Mesenchymal hamartoma of liver is the third most common hepatic tumor in pediatric age group. Typically, it presents as a large multicystic mass in children. Gradually they get increases in size and some can undergo incomplete spontaneous regression and very rarely, few have shown malignant transformation to undifferentiated(embryonal) sarcoma. Here, we report a 6 year old female child with no relevant personal and family history, who presented with abdominal distension and vomiting. Radiology revealed a multiloculated large cystic lesion in the right lobe of liver with a possibility of hemangioendothelioma on ultrasonography and CT abdomen was suggestive of mesenchymal hamartoma of liver. Following worsening of symptoms, partial excision and marsupialisation of the cyst was performed. Histologically, it was diagnosed as mesenchynal hamartoma with undifferentiated embryonal sarcomatous component and immunohistochemical confirmation done.

Common Histopathological spectrum of Posterior Fossa Tumors in Pediatric Age Group

Objective: To know about the common posterior fossa tumors in the pediatric age group on basis of Histopathology in Neurosurgery Department, Hayatabad Medical Complex Peshawar.
 Material and Methods: This descriptive cross-sectional study was conducted in the department of MTI Hayatabad medical complex Peshawar from January 2017 to January 2020. We included a total of 52 patients who operated for posterior fossa tumors and biopsy reports were observed to know the histological pattern of the tumor. We included all those patients who have posterior fossa tumors except those tumors which involved or arise from brain stem and infections. The data was collected and analyzed using SPSS version 21.
 Results: Our study shows that the mean age was 6 years with a standard deviation ± 2.81. Fifty-eight percent of children were male and 42% of children were female. Histopathologic patterns were analyzed as 48% of children had Medulloblastoma, 25% of children had Astrocytoma, 19% of children had Ependymoma, 8% of patients had other histopathologic patterns.
 Conclusion: Our study concludes that common histopathologic patterns of posterior fossa tumors in children were medulloblastoma (48%), Astrocytoma (25%), ependymoma (19%) respectively.

Primary intracranial Ewing’s sarcoma/peripheral primitive neuroectodermal tumor in pediatric age group: A comprehensive review of literature

Primary intracranial Ewing’s sarcoma/peripheral primitive neuroectodermal tumor in pediatric age group: A comprehensive review of literature

Prevalence of Small Round Cell Tumors in Pediatric Age Group in the last 10 Years Registered in Al- Najaf Governorate

Malignant small round cell tumors (MSRCT) are referred to as tumors made up of malignant small round cells. The cells in this type of neoplasms are tiny, rounded, and largely undifferentiated. Ewing's sarcoma (ES), peripheral neuroectodermal tumor, rhabdomyosarcoma, non-Hodgkin lymphoma, retinoblastoma, neuroblastoma, hepatoblastoma, and nephroblastoma are a few of the more common ones. The aim of this study is to estimate the prevalence and types of pediatric small round cell tumors in Najaf Province/Iraq, over the 10 years period between 2010-2019. Method: This is a retrospective observational study. Cases were collected from pathology laboratories in As-Sadr Medical City and some private laboratories in Najaf over a 10 year-period extending from 2010 to 2019. Results: A 6366 pediatric surgical biopsy cases were reported during the study period and this represent 8.7% of all cases. Out of these cases, 108 cases with small round cell tumors (SRCT) have given a prevalence rate of 17 per 1000 pediatric cases and 1.5 per 1000 of total (73504) adult and pediatric cases during the same period. The mean age of these SRCT cases was 6.3± 1.6 (range: one month-19) years. The higher proportion of cases was reported in the age of 1-5 years, contributed for 43.5%. Male to female ratio is 59/108 vs. 49/108, respectively, the male to female ratio being at 1.2 to 1.0. Conclusions: The mean age of SRCTs cases was 6.3± 1.6, ranging from one month to 19 years. The higher proportion of SRCTs cases was reported in the age ranging from 1-5 years; with a ratio of males to females being 1.2 to 1.0.

Posterior Fossa Tumors in Pediatric Age Group, an Epidemiological Study

Background: There are no data so far relating posterior fossa brain tumors in pediatric age group in Bangladesh. We are dealing with this type of tumors regularly. So an attempt has been made to document these tumors in respect to their incidence in our country, mode of presentation, age and sex distribution, treatment offered to them and their complication and outcome. Methods: This study was conducted in the Department of Pediatric Neurosurgery, National Institute of Neurosciences and Hospital. It was a retrospective study and cases were collected from 2013-2020. Result: We dealt with 60 cases of posterior fossa brain tumors. Out of them 21 were medulloblastoma,19 pilocytic astrocytoma, 11ependymoma and rest are other tumors. Almost all patients presented with hydrocephalus and in most cases CSF diversion was done before definitive tumors surgery. Conclusion: This is only a partial picture of total posterior fossa tumors in pediatric age group. This type of study should be done in a larger scale and newer modalities of diagnostics should be widely practiced for a better post-operative treatment and better prognosis. Bang. J Neurosurgery 2021; 10(2): 182-184

Successful management of a recurrent hepatosplenic metastatic nasopharyngeal carcinoma in an adolescent boy: case report and review of literature

Nasopharyngeal carcinoma (NPC) is a rare tumor in pediatric age group and adolescents are the commonly affected age group. It generally presents as locoregionally advanced disease and 15-30% of them develop a recurrence or distant metastatic disease. The outcome of patients with recurrent metastatic nasopharyngeal carcinoma has been reported to be very poor, with a median overall survival of about 20 months. We present a case of adolescent boy who presented initially with locally advanced nasopharyngeal carcinoma, treated with local radiotherapy and cisplatin, 5 flurouracil and later presented with a recurrent metastatic disease in liver and spleen, within 2 months of completing treatment. He was managed with total splenectomy and paclitaxel and gemcitabine and he remains disease free for more than 18 months now. The case highlights that long term remission could be attained with conventional chemotherapy, combined with surgery in relapsed metastatic NPC even in a resource limited settings.

Rare tumors in pediatric age group: Single center experience from Saudi Arabia.

Rare pediatric tumors are heterogeneous group containing a variety of histopathological diseases, they represent approximately 10% of all childhood cancers. These rare tumors had a diversity of histology and clinical behaviors that pose different challenges to the investigators. Exploring different pediatric rare tumors. The data were reviewed, retrospectively, through the medical records of seven rare pediatric diseases between 2012 and 2019. Giant cell fibroblastoma (GCF) presented as painless swelling in the trunk, positive for CD34 with PTEN gene mutation. Neuroglial heterotopic tissue presented in 7 days old girl with facial asymmetry and bulging in the oral cavity, maximal de-bulking was done, histopathology was positive for GFAP and S100p. Left side neck mass, surgically excised revealed non-metastatic salivary grand mucoepidermoid carcinoma. Follow up without any chemotherapy or radiotherapy for 5 years with complete remission. Mesenchymal chondrosarcoma (MCS) presented in maxillofacial bones by persistent nasal bleeding, HEY1-NCOA2 fusion gene confirmed the diagnosis. Extra-osseous Ewing sarcoma (EES) presented as rubbery painless swelling in the scalp with fusion transcript involving EWSR1-FL11. Juvenile xanthogranuloma (JXG) presented by butter fly like skin patch in the face with foamy histiocytes in upper dermis with few Touton giant cells, extensive systemic involvement of lung and bone marrow. Metastatic ovarian choriocarcinoma with choriocarcinoma syndrome received induction two different lines of chemotherapy and consolidated with autologous stem cell transplant. Seven pediatric rare tumors, with different aspects of challenges in diagnosis and management, despite the absence of formal protocols and rarity of other center experiences.

CLINICAL EXPERIENCE IN THE MANAGEMENT OF PEDIATRIC WILMS TUMOR

Wilms tumor is the commonest renal tumor in children. This study aimed to evaluate the characteristics, diagnosis, treatment, and outcome of Wilms tumor in pediatric age group and to analyze factors affecting the outcome. This retrospective study included 61 children younger than 15 years with Wilms tumor who were managed at Basrah Children Specialty Hospital during the period between 2011 and 2016. Patients` characteristics, mode of diagnosis, treatment modalities, complications, relapse, and outcome were all reviewed. The results showed that Wilms tumor was the commonest tumor affecting the kidneys (85%). The median age of onset was 30 months, and mostly in children aged 2-4 years. The most common presenting feature was abdominal mass (44.3%). Twenty three patients were diagnosed as stage 1 (37.7%). Favorable histology Wilms tumor was encountered in only 65.6%. Tumor relapse was seen in 12 patients (19.7%), eight of them died (66.7%). The overall 2-year survival was 70.5% (43 cases). In conclusion, Wilms tumor is the most common renal tumor with high rate of unfavorable histology (anaplasia) in our society. Stage I tumor is the predominant stage but unfortunately carries a relatively high mortality. Advanced stages still represent a significant proportion which may reflect poor awareness and delayed diagnosis which thereafter worsens the outcome. Advanced stages, presence of anaplasia, and tumor relapse are the major factors affecting survival of children with Wilms tumor. Keywords: Renal tumors, Wilms, Staging, Histology, Outcome

Non-malignant fibroblastic/myofibroblastic tumors in pediatric age group: Clues and pitfalls to the cytological diagnosis.

Fibroblastic/myofibroblastic tumors constitute 12% of all pediatric soft tissue tumors with the majority of them belonging to the benign and intermediate prognostic categories. They are often misdiagnosed owing to their variable clinical presentation and unusual microscopic features. The diagnosis, specially cytological diagnosis of benign and intermediate categories is difficult due to paucity of cellular component and increased amount of extracellular matrix as compared to malignant ones. We hereby discuss the Fine needle aspiration cytology (FNAC) findings of non-malignant fibroblastic/myofibroblastic lesion in the pediatric age group encountered at our institute. All the benign and intermediate fibroblastic/myofibroblastic/fibroadipocytic lesions (age 0-12years) diagnosed on FNAC over a period of 3½years (Jan 2016- July 2019), with availability of corresponding histopathology were included in the study. A total of seven pediatric benign and intermediate fibroblastic/myofibroblastic lesions with histopathological confirmation were identified which included Infantile digital fibromatosis (IDF) (n=2), Lipofibromatosis (n=1), Fibrous hamartoma of infancy (FHI) (n=1), Fibromatosis colli (FC) (n=2) and myofibroma/myofibromatosis (n=1). FNAC smears were mainly paucicellular with presence of benign spindle shaped cells in a collagenous stroma common to almost all the cases. A few additional findings such as degenerated skeletal muscle fibres, muscle giant cells and mature adipose tissue were also present in some cases. Fibroblastic/myofibroblastic tumors although uncommon, form an important category that must be considered in the differential diagnosis of pediatric soft tissue tumors. FNAC cytology features when assessed in a proper clinical setting (specially the age and site of presentation) are helpful in suggesting probable preoperative diagnosis in these lesions.

Malignant Ovarian Germ Cell Tumors in Pediatric Age Group: A Clinicopathological Study over 21 Years in Eastern Rajasthan (India)

Background: The aim of this study is to analyze the clinicopathological features, diagnosis and treatment outcome of rare cases of malignant ovarian germ cell tumors in a government tertiary care hospital centre keeping fertility preservation surgery as a goal in young girls below 21 years of age. Methods: This is a retrospective study comprising of 24 patients diagnosed to have malignant ovarian germ cell tumors who attend the department of Radiation Oncology from 1998 to 2019 over 21 years period. The patients were evaluated on the basis of their age, obstetric history, investigations, and serum tumor markers estimation. All patients were staged according to FIGO, ECOG score were noted. Unilateral Salphingo oophorectomy (USO) with or without staging laparotomy surgery was done and BEP chemotherapy regimen was given. Response to treatment was evaluated by regular clinical examination, radiological and tumor marker studies. Results: In our study 17 patients were in FIGO stage III and 6 patients were in stage IV. The size of the primary tumor was 10-20 cm. in 15 patients. The various histology observed was-dysgerminoma -8, malignant teratoma-5, mixed germ cell tumor-5, yok sac tumor-4 and embryonal carcinoma in 2 patients. Eighteen patients underwent fertility preservation surgery i.e. USO - 15, and 3 patients underwent USO with staging laparotomy. In 14 patients 3-4 cycles of adjuvant chemotherapy (BEP regimen) was administered and all of them achieved complete remission. Conclusion: Malignant ovarian germ cell tumors carries excellent prognosis in spite of advanced stage disease. Patients should be referred to oncology centre and to be operated by gynecologic oncologist/ oncosurgeon. Adjuvant chemotherapy should be given to achieve complete remission.

INCIDENCE OF MALIGNANT KIDNEY TUMOURS IN PAEDIATRIC AGE GROUP

Background: Cancer is essentially a disease of adults, yet it is one of the common killers in childhood. In western countries cancer is next only to trauma as a cause of mortality in children under 20 years of age In India.
 Methods: The material for present study is obtained from S. P. Medical College, Bikaner and referred cases for a period of five years from 2011-2014. The clinical history regarding duration of the disease, mode of presentation, symptoms and signs are recorded from the case papers, request forms, patient’s history, clinical data along with relevant details obtained from available hospital and departmental records. The histopathology slides and paraffin blocks are reviewed. Gross examination is done carefully noting the size, shape, extent and configuration, nodularity, consistency (solid, cystic or mixed). A minimum of 4-5 bits are selected from the representative areas of tumor. The tissue for routine microscopy is preserved and fixed in 10% neutral buffered formalin for 24 hours and processed in automatic tissue processor (Histokinette) and embedded in paraffin. The sections 3-5 μ thick, are cut and stained by haematoxylin and eosin in all cases and special stains like PAS, MTS, and RT done where ever feasible
 Results: The incidence of malignant tumour in our study was 6.66% found.
 Conclusion: The present study provides a fair insight into the histological patterns of lesion in paediatric age group. Most common incidence was that of wilms tumour in paediatric age group followed by renal cell carcinoma. Imaging and histologic characterization are crucial to avoid any delay in management.
 Keywords: Malignant, Wilms, Histopatological tumour.

P04.19 Analysis of tumor immune microenvironment and immune checkpoint modulators across infantile and pediatric pilocytic astrocytomas to elucidate the role of immunotherapy in these tumors

Abstract BACKGROUND Pilocytic astrocytomas are the most common central nervous system tumors in pediatric age-group. Although grade I, some of the cases show recurrence and progression, and few might not be amenable to surgery due to location or size, and hence have a less favorable prognosis. Drugs blocking immune check-point interactions such as those including programmed cell death ligand-1 (PD-L1) and cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) are now in clinical use for certain tumors. We performed this study to understand the potential candidature of pilocytic astrocytomas in infants and children for immunotherapy by analyzing the expression of immune checkpoint proteins and immune infiltrate, and correlating with clinical details, wherever possible. MATERIALS AND METHODS Cases with adequate tissue (2010–2017) diagnosed in pediatric age-group (<18 years) were retreived from the archives of Department of Pathology, AIIMS, New Delhi. Immunohistochemistry for PD-L1 (SP263, Ventana), CTLA-4, CD3, CD8, CD4 and CD68 was performed. Quantification of cytotoxic lymphocytes was done using digital imaging in the core of the tumor. RESULTS A total of 50 pilocytic astrocytomas were included, 14 of them were <3 years (infants), while 36 were of pediatric age-group (3–18 years). Overall, male preponderance was noted. Cerebellum was the most common location, followed by 4th venrticle, optic pathway, hypothalamus, cerebrum and thalamus. Almost all CD3 lymphocytes were cytotoxic T-lymphocyes (CD8 positive, CTLs). Helper T-lymphocyte infiltration was not seen. Median CTL density/mm3 was 13/mm3(Range:1–85/mm3). CTLA-4 was positive in 4 cases, positivity ranged from 1–4 cells/lpf. PD-L1 was found to be positive in 7 cases, and the positivity ranged from 1+ to 2+ in 1 to 5% of tumor cells. A median TAM (tumor associated macrophages) density of 44/hpf (range: 1–98/hpf) was noted. There was no correlation of CTL density with PD-L1 or CTLA-4 expression, and neither with TAM density. On correlation with clinical parameters, a higher density of CTLs and TAMs was noted in infants, and a higher proportion of cases revealed PD-L1 positivity, though not statistically significant. There was no correlation of TILs or TAMs with the tumor location. CONCLUSION Immune check point blockade using PD-(L)1 or CTLA4 inhibitors may not be a potential therapeutic option for unresectable or recurrent pilocytic astrocytomas, as low positivity rate as well as extremely low percentage of tumor/ immune cells found to be positive. However, alternate forms of immunotherapy might be helpful as most of the cases showed immune infiltrates and a high density of tumor-associated macrophages (TAMs). Large scale studies with larger numbers and longer follow-up periods including in-vitro and clinical studies are warranted for decoding the tumor immunogram.

Histopathological spectrum of pediatric supratentorial brain tumors in a tertiary care hospital

Histopathological spectrum of pediatric supratentorial brain tumors in a tertiary care hospital - IJPO- Print ISSN No: - 2394-6784 Online ISSN No:- 2394-6792 Article DOI No:- 10.18231/2394-6792.2019.0024, Indian Journal of Pathology and Oncology-Indian J Pathol Oncol

Surgical Role in Management of Intracranial Germ Cell Tumors in Pediatric Age Group

Introduction: Primary intracranial germ cell tumors (ICGCTs) are rare, histologically diverse, and diagnostically challenging tumors that are usually localized in the pineal and suprasellar regions of the brain. Advanced neurosurgical techniques such as neuroendoscopy and frameless stereotactic biopsy have made diagnosis of newly discovered cases of ICGCTs easier and safer. Material and methods: Seventeen patients with intracranial germ cell tumors operated upon between 2008 to 2012 at the Children's Cancer Hospital Egypt, were retrospectively reviewed and analyzed regarding the surgical decision, clinical outcome and surgical complications. Results: There were 9 cases of germinoma (53%), and 8 cases of non-germinomatous germ cell tumors (47%). Nine cases were in the pineal region, six in the suprasellar, and two in the thalamic region. Ten cases were operated upon initially by open surgery and frozen section with subtotal resection and seven cases were biopsied either endoscopically (3 cases) or by frameless guided stereotaxic (4 cases). Accurate pathology was achieved in all biopsied cases without major complications. In the germinoma group, the 4-year overall survival and progression free survival rate were 75% for both at a median follow up period of 26 (range 1 -50) months. For the non-germinomatous germ cell tumors group, the 4-year OS and PFS rates were 36.5% and 31.2% at a median follow up period of 11 (range 2-54) months, respectively. Conclusion: In cases of intracranial germ cell tumors with negative tumor markers the role of surgery is important in the establishment of proper histopathological diagnosis. However, in Non Germinomatous Germ Cell Tumors, further investigations should be done regarding the extent of resection owing to the poor long-term outcome.

National survey on current management of ovarian tumors in pediatric age group

Aim of the studyTo investigate the current management of ovarian tumors in children by the Egyptian pediatric surgical association (EPSA) consultants who are dealing with approximately 80% of these cases in our country. MethodsFollowing approval of EPSA executive board, an online questionnaire was sent via e-mails on EPSA online group mail to all registered consultants. Repeated reminders were sent biweekly for 6 weeks. ResultsResponses were received from 82 consultants (response rate 82/111, 73.87%). Diagnosis74.39% of respondents indicated abdomino-pelvic mass as most common presenting symptom. Concerning imaging requested, US and CT were reported by 60.98%. AFP and HCG were requested by 84.15% as serum tumor markers. SurgeryApproximately 50% of respondents perform 1–3 cases per year. Diagnostic laparoscopy was done by 70.73%. Transverse abdominal incision was the commonest in use during surgeries (81.71%). Out of all respondents, 65.85% never encountered intraoperative complications, whereas the remaining 34.15% had different complications (mainly rupture and spillage). Minimally invasive surgery (MIS) was adopted by 53.66% in only benign looking tumors. A total of 69.51% perform ovarian sparing surgery (OSS) in benign masses whenever possible. Follow upBenign tumors were the most common type observed by 86.59% of respondents. In benign lesions, 28.05% of surgeons never ask for follow up and the remaining 71.95% follow patients with different schedules. ConclusionsThere is a paradigm shift toward MIS and OSS in the current practice of EPSA consultants. No actual standard protocol of management is present for ovarian tumors in Egypt and they still fall at the edge between many subspecialties. The results of this survey urge for establishment of uniform guidelines with international reference to be adopted in our nation, in addition to start a national prospective registration system for these tumors which is currently lacking in Egypt.

Profile of Non-Hematological Pediatric Tumors: A Clinicopathological Study at a Tertiary Health Care Centre

ABSTRACTBackground: Tumors in pediatric age group are biologically different from tumors in adults and emerging as a significant contributor to morbidity/mortality in children. Objectives: This study evaluated the epidemiological profile of pediatric solid tumors in 0–18 years of age over a period of 5 years in a general hospital in India. Results: A total of 510 cases of tumors were included, which accounted for 5.1% of the total tumor burden of the hospital. Benign tumors were more common than malignant tumors. Most common age group affected was 14–18 years. Among benign tumors, vascular tumors were the most common, while malignant bone tumors outnumbered all other malignant tumors. Neuroblastomas comprised only 0.9% of our malignancies. Conclusion: Our study provides an insight into the patterns of childhood tumors for which exists little literature in India. With lack of a dedicated pediatric cancer registry from India, tracking of the diverse histological spectrum of tumors is difficult.