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Laparoscopic approach to ovarian pathology in children and adolescents
INTERNATIONAL
215
ABSTRACTS
nent catheterizable pouch. When four kidneys are present, the opposite ureter is reimplanted or crossed with transureteroureterostomy. Twins with two sets of genitalia usually can undergo separation and reconstruction appropriately. Occasionally, single external genitalia are present and secondary reconstructive genitoplasty is required. Although multiple staged genital reconstructions are required, with proper planning satisfactory outcomes will result.-George K Holcomb, Jr Laparoscopic Adolescents.
Approach S. Kanno,
to Ovarian Pathology in Children and S. Emil, L. Takeuchi, et al. Pediatr Surg Int
10:221-225, (April), 1995. The authors present their experience with six patients who had therapeutic laparoscopy for ovarian pathology. The age range was 7 to 18 years. The operating time ranged from 75 to 205 minutes. The mean hospital stay was 2 days. The authors used the open Hassan-type technique for placing the first port. An 18-year-old girl with primary amenorrhea underwent bilateral salpingo-oopherectomy and was found to have malignant tumors in both ovaries but with disease-free margins. A 7 year old had bilateral ovarian biopsy and was found to have a left dysgerminoma. She then had laparoscopic left salpingo-oopherectomy. A nine-year-old child had laparoscopic biopsy of the left ovary after treatment for dysgerminoma diagnosed earlier. Two children, aged 14 and 13, had left salpingooopherectomy for nonmalignant disease of the ovaries. A 11 year old with subacute abdominal pain had ovarian cystectomy and oopheropexy. All these children have remained disease-free and well throughout follow-up. Two patients had to have their umbilical incisions extended to deliver large ovarian lesions. The authors note that the role of laparoscopy in suspected malignant ovarian pathology is controversial. They believe that if there is no evidence of metastatic disease and a disease-free margin is obtainable, laparoscopic excision of malignant ovarian pathology is feasible (provided the size of the lesion does not warrant a large incision to remove it). A flow chart has been provided to help in the management of children with adnexal masses.-K Kalidasan NEOPLASMS Current Chest
Controversy: Is Computed Tomography Needed in Patients With Wilms’ Tumor?
Scan of the M.D. Cohen.
Am J Pediatr Hematol Oncol 16:191-193, (August), 1994. This report from the Department of Radiology at the J.W. Riley Hospital in Indianapolis takes issue with a report of the National Wilms’ Tumor Study III by Green et al, suggesting that chest computed tomography (CT) for workup of pediatric Wilms’ tumor patients is unnecessary. Green’s argument, based on retrospective analysis of a small number of children, suggested that chest CT was too sensitive, and that treating chest metastases too small to be picked up on chest x-ray did not affect survival. Cohen states that review of these data showed an increased relapse rate in children whose initial chest metastases were not recognized. He concludes that until more information is available, denying Wilms’ patients the chance to have chest metastases aggressively treated (especially after biopsy of metastases confirms tumor) is incorrect. Therefore, chest CT should be part of the routine workup for Wilms’ tumor.Michael
P. Hirsh
Ewing’s Sarcoma as a Second Malignant Neoplasm in a Child Previously Treated for Wilms’ Tumor. R. Fisher, S.C. Kaste, D.M. Parham, et al. J Pediatr Hematol Oncol 17:76-80, (February),
1995. This report from the St Jude’s Oncology group documents the first known case of Ewing’s sarcoma arising as a secondary neo-
plasm (SMN) from the radiation bed of a previously treated Wilms’ tumor. Although the overall SMN rate for childhood cancer survivors is between 3% and 12%, the SMN rate associated with Wilms’ tumor has been only about 1%. That risk increases with every passing year of survival. This report emphasizes the importance of vigilant long-term follow-up of Wilms’ tumor patients, especially because this tumor has such a successful treatment regimen.Michael
P. Hirsh
Detection of Neuroblastoma Cells in Bone Marrow and Peripheral Blood at Diagnosis by the Reserve TranscriptasePolymerase Chain Reaction for Tyrosine Hydroxylase mRNA. Y. Miyajima, K. Kate, S. Numata, et al. Cancer 75~2757-2761,
(June), 1995. Staging of neuroblastoma is important with regard to prognosis and treatment. Standard cytological examination of bone marrow biopsies as part of that staging is subject to sampling error. The authors suggest that a more sensitive assay could be helpful. Peripheral blood and bone marrow samples were obtained at the time of diagnosis from 38 patients with neuroblastoma. Eight healthy patients served as controls. Tissues were subjected to the reverse transcriptase-polymerase chain reaction (RT-PCR) to amplify mRNA for tyrosine hydro@ase, the first enzyme of catecholamine synthesis. Tyrosine hydroxylase mRNA was not detected in any normal controls. Tyrosine hydroxylase mRNA was detected in all 12 bone marrow samples that had cytological evidence of tumor cells. Six of the 26 caseswithout cytological evidence of tumor cells in the bone marrow were positive for tyrosine hydroxylase mRNA. Tyrosine hydroxylase mRNA was detected in 8 of 14 peripheral blood samples (7 of the 9 patients with stage IV or IVS neuroblastoma). The authors suggest that RT-PCR amplification of tyrosine hydroxylase mRNA is a sensitive and specific method for the detection of occult neuroblastoma cells in peripheral blood and bone marrow samples. They further suggest that large-scale longterm follow-up assessment of the technique will be needed to establish the clinical significance of these findings-Mark L. Silen Prenatal Detection phy. R.L. Saylors,
of Neuroblastoma S.L. Cohn, E.R.
by Petal UltrasonograMorgan, et al. Am J Pediatr
Hematol Oncol 16:356-360, (November), 1994. This report from Arkansas Children’s Hospital describes three cases of prenatally diagnosed neuroblastoma as well as 17 other cases in the literature. The authors emphasize that although tumors diagnosed at this young age should have a better prognosis, this is not always true. Prenatal diagnosis can lead to treatment at a more manageable stage.-Michael P. Hirsh The Role of Surgery Rhabdomyosarcoma.
J Urol154:540-545,
in the Management S.P. Lerner, A. Hayani,
of Pediatric P. O’Hollaren,
Pelvic et al.
(August), 1995.
The authors treated 11 children who had bladder and/or prostate rhabdomyosarcoma and 12 who had pelvic retroperitoneal tumors. Initial management was tumor resection in 6 cases, anterior pelvic exenteration in 5, and biopsy only in 12, combined with chemotherapy in 23 and radiotherapy in 20. The bladder salvage rate for surviving patients with pelvic tumors was 92%, compared with 27% for those with prostate/bladder tumors. The estimated five- and lo-year survival rates for patients with pelvic retroperitoneal tumors are 49% 2 50%, and 81% f 24% for those with bladder and/or prostate tumors (log-rank test, P = 0.11). The data from this small series of patients with rhabdomyosarcoma of the bladder, prostate, and pelvic retroperitoneum reflect the findings of larger randomized studies in demonstrating superior long-term
215
ABSTRACTS
nent catheterizable pouch. When four kidneys are present, the opposite ureter is reimplanted or crossed with transureteroureterostomy. Twins with two sets of genitalia usually can undergo separation and reconstruction appropriately. Occasionally, single external genitalia are present and secondary reconstructive genitoplasty is required. Although multiple staged genital reconstructions are required, with proper planning satisfactory outcomes will result.-George K Holcomb, Jr Laparoscopic Adolescents.
Approach S. Kanno,
to Ovarian Pathology in Children and S. Emil, L. Takeuchi, et al. Pediatr Surg Int
10:221-225, (April), 1995. The authors present their experience with six patients who had therapeutic laparoscopy for ovarian pathology. The age range was 7 to 18 years. The operating time ranged from 75 to 205 minutes. The mean hospital stay was 2 days. The authors used the open Hassan-type technique for placing the first port. An 18-year-old girl with primary amenorrhea underwent bilateral salpingo-oopherectomy and was found to have malignant tumors in both ovaries but with disease-free margins. A 7 year old had bilateral ovarian biopsy and was found to have a left dysgerminoma. She then had laparoscopic left salpingo-oopherectomy. A nine-year-old child had laparoscopic biopsy of the left ovary after treatment for dysgerminoma diagnosed earlier. Two children, aged 14 and 13, had left salpingooopherectomy for nonmalignant disease of the ovaries. A 11 year old with subacute abdominal pain had ovarian cystectomy and oopheropexy. All these children have remained disease-free and well throughout follow-up. Two patients had to have their umbilical incisions extended to deliver large ovarian lesions. The authors note that the role of laparoscopy in suspected malignant ovarian pathology is controversial. They believe that if there is no evidence of metastatic disease and a disease-free margin is obtainable, laparoscopic excision of malignant ovarian pathology is feasible (provided the size of the lesion does not warrant a large incision to remove it). A flow chart has been provided to help in the management of children with adnexal masses.-K Kalidasan NEOPLASMS Current Chest
Controversy: Is Computed Tomography Needed in Patients With Wilms’ Tumor?
Scan of the M.D. Cohen.
Am J Pediatr Hematol Oncol 16:191-193, (August), 1994. This report from the Department of Radiology at the J.W. Riley Hospital in Indianapolis takes issue with a report of the National Wilms’ Tumor Study III by Green et al, suggesting that chest computed tomography (CT) for workup of pediatric Wilms’ tumor patients is unnecessary. Green’s argument, based on retrospective analysis of a small number of children, suggested that chest CT was too sensitive, and that treating chest metastases too small to be picked up on chest x-ray did not affect survival. Cohen states that review of these data showed an increased relapse rate in children whose initial chest metastases were not recognized. He concludes that until more information is available, denying Wilms’ patients the chance to have chest metastases aggressively treated (especially after biopsy of metastases confirms tumor) is incorrect. Therefore, chest CT should be part of the routine workup for Wilms’ tumor.Michael
P. Hirsh
Ewing’s Sarcoma as a Second Malignant Neoplasm in a Child Previously Treated for Wilms’ Tumor. R. Fisher, S.C. Kaste, D.M. Parham, et al. J Pediatr Hematol Oncol 17:76-80, (February),
1995. This report from the St Jude’s Oncology group documents the first known case of Ewing’s sarcoma arising as a secondary neo-
plasm (SMN) from the radiation bed of a previously treated Wilms’ tumor. Although the overall SMN rate for childhood cancer survivors is between 3% and 12%, the SMN rate associated with Wilms’ tumor has been only about 1%. That risk increases with every passing year of survival. This report emphasizes the importance of vigilant long-term follow-up of Wilms’ tumor patients, especially because this tumor has such a successful treatment regimen.Michael
P. Hirsh
Detection of Neuroblastoma Cells in Bone Marrow and Peripheral Blood at Diagnosis by the Reserve TranscriptasePolymerase Chain Reaction for Tyrosine Hydroxylase mRNA. Y. Miyajima, K. Kate, S. Numata, et al. Cancer 75~2757-2761,
(June), 1995. Staging of neuroblastoma is important with regard to prognosis and treatment. Standard cytological examination of bone marrow biopsies as part of that staging is subject to sampling error. The authors suggest that a more sensitive assay could be helpful. Peripheral blood and bone marrow samples were obtained at the time of diagnosis from 38 patients with neuroblastoma. Eight healthy patients served as controls. Tissues were subjected to the reverse transcriptase-polymerase chain reaction (RT-PCR) to amplify mRNA for tyrosine hydro@ase, the first enzyme of catecholamine synthesis. Tyrosine hydroxylase mRNA was not detected in any normal controls. Tyrosine hydroxylase mRNA was detected in all 12 bone marrow samples that had cytological evidence of tumor cells. Six of the 26 caseswithout cytological evidence of tumor cells in the bone marrow were positive for tyrosine hydroxylase mRNA. Tyrosine hydroxylase mRNA was detected in 8 of 14 peripheral blood samples (7 of the 9 patients with stage IV or IVS neuroblastoma). The authors suggest that RT-PCR amplification of tyrosine hydroxylase mRNA is a sensitive and specific method for the detection of occult neuroblastoma cells in peripheral blood and bone marrow samples. They further suggest that large-scale longterm follow-up assessment of the technique will be needed to establish the clinical significance of these findings-Mark L. Silen Prenatal Detection phy. R.L. Saylors,
of Neuroblastoma S.L. Cohn, E.R.
by Petal UltrasonograMorgan, et al. Am J Pediatr
Hematol Oncol 16:356-360, (November), 1994. This report from Arkansas Children’s Hospital describes three cases of prenatally diagnosed neuroblastoma as well as 17 other cases in the literature. The authors emphasize that although tumors diagnosed at this young age should have a better prognosis, this is not always true. Prenatal diagnosis can lead to treatment at a more manageable stage.-Michael P. Hirsh The Role of Surgery Rhabdomyosarcoma.
J Urol154:540-545,
in the Management S.P. Lerner, A. Hayani,
of Pediatric P. O’Hollaren,
Pelvic et al.
(August), 1995.
The authors treated 11 children who had bladder and/or prostate rhabdomyosarcoma and 12 who had pelvic retroperitoneal tumors. Initial management was tumor resection in 6 cases, anterior pelvic exenteration in 5, and biopsy only in 12, combined with chemotherapy in 23 and radiotherapy in 20. The bladder salvage rate for surviving patients with pelvic tumors was 92%, compared with 27% for those with prostate/bladder tumors. The estimated five- and lo-year survival rates for patients with pelvic retroperitoneal tumors are 49% 2 50%, and 81% f 24% for those with bladder and/or prostate tumors (log-rank test, P = 0.11). The data from this small series of patients with rhabdomyosarcoma of the bladder, prostate, and pelvic retroperitoneum reflect the findings of larger randomized studies in demonstrating superior long-term