Ultrasonografia dopplerowska w diagnostyce nowotworów jąder u dzieci

Malignant testicular tumors account for approximately 1-2% of all pediatric malignancies. We evaluated the usefulness of Color Doppler and contrast-enhanced Color Doppler ultrasonography in the detection and diagnostic differentiation of testicular tumors in children. Thirty boys were treated for testicular tumors. They ranged in age from 4 months to 16 years (mean: 4.6 years). All were staged according to the Pediatric Oncology Group/ Children Cancer Study Group staging system. Diagnostic assessment included in all cases conventional ultrasonography (US), Color Doppler (CD), and Power Doppler (PD) before and after the administration of contrast agent. Germinal tumors and tumor arising from the endodermal sinus (yolk sac tumors) were the most common. Eight patients had stage III, four stage IV, and eighteen stages I and II. Histologically, 13 patients had pure endodermal sinus tumor (EST), 4 had EST with embryonal carcinoma, 5 had embryonal carcinoma alone, 8 had teratoma, and 1 had non-germinal tumor. In the group of EST patients, the largest number of lesions were enhanced by 2-3 points, embryonal carcinoma by 4-5 points, and teratoma immatrum by over 4 points. EST and embryonal carcinoma presented peak enhancement in a time under 120 sec., and teratomas in a time under 180 sec. Teratomas and embryonal carcinoma had the longest enhancement times. Three patients with teratoma in stage 1 had only the tumor removed, sparing the testis. Twenty patients had unilateral orchiectomy and three had lymphadenectomy. All children received chemotherapy depending on the character of the tumors. We have observed much better prognosis in children with testicular tumors after surgery of the tumor and subsequent intensive chemotherapy. US examination with unenhanced and contrastenhanced Color Doppler is important in achieving the correct diagnosis and better treatment results. US contrast agent (Levovist) is very helpful in precise visualization of pathological vessels inside the tumor mass, and can be considered useful in the initial differentiation between testicular tumor types

Przydatność ultrasonografii w diagnostyce i monitorowaniu leczenia ostrych chorób jamy brzusznej u dzieci z chorobą nowotworową

Background: The aim of this study was to estimate the results of the diagnostic imaging modalities, especially ultrasonography (US) in children during the oncological therapy with the acute abdominal symptoms. Acute abdominal symptoms in children with neoplasms causing a very difficult clinical and diagnostic problems and can occure in any stage of disease. Materials/Methods: We analyzed 249 ultrasounds examinations of the abdominal cavity in 144 girls and 105 boys aged from 1 to 18 years (mean age 1o, 3 years). The more important indication for the US exam in 133 cases was acute abdominal symptoms. We took exams during pre- and postoperative chemotherapy, radiotherapy and after the hematopoietic stem cell transplantation. All the patients were under routine hematological control. Based on the clinical symptoms and the laboratory tests we analysed two groups of children with oncological disease and acute abdomen: I group-111 children with neutropenia, II group-22 children without neutropenia. In the patients who underwent operation procedure the final diagnosis was established on histopathology. In the other cases diagnosis was based on clinical, laboratory and radiological exams, especially ultrasonography. We analyzed clinical picture of disease, the results of therapy and the US changes in examed patients using statistic parameters as: sensitivity, specificity and efficiency. Results: In the group of 133 children with acute abdominal symptoms the most (92- 69,1%) patients suffer from ALL (acute lymphoblastic leukaemia) and 16(12%) - from AML (acute lympoblastic leukaemia), Ewing sarcoma-3(2,2%), osteosarcoma-3(2,2%), NHL-8(6,0%), HL-4(3%), nephroblastoma-4(3%), neuroblastoma- 3( 2,2%). Acute abdominal symptoms can have a very different etiology: bacterial, mycotic and virusal infections or continious infiltration of gastrointestinal tract by tumor. Clinical symptoms of the acute abdominal diseases are very severe, because the oncological patients usually have immunologic deficiency and oblige us to proper clinical observation or to operation procedure, very often as an emergency. The symptoms appeard in the different time of course of oncological diseases. Nonspecific gastrointestinal inflammation with haemorrhage and typhlitis were the main cause of the acute abdominal pain in 71 children with neutropenia during therapy of leucaemia, lymphoma, aplastic anemia and after hematopoietic stem cell transplantation. The accuracy of ultrasound findings verified intraoperatively and by histopathologic examinations was 84%. In all cases the morphological changes were directly related to the signs and symptoms duration. Conclusions: The high-resolution ultrasound has a very important role in diagnosis in all patients with acute abdominal pain and with neoplasms. The authors consider that the US should be the first imaging method in the differential diagnosis of the abdominal changes in children with neutropenia and oncological disease. Proper diagnosis should be established only with clinical information