Precursor B-cell acute lymphoblastic leukemia presenting with isolated skin relapse: a pediatric case report

Abstract Background In childhood acute lymphocytic leukemia (ALL), relapse is most commonly seen in the bone marrow (10–20%), followed by the central nervous system (3–8%). Isolated skin relapse is very rare in ALL. We report an 8-year-old child presented with isolated skin relapse. Case presentation An eight-year-old female patient presented with swelling on the scalp 3 months after the completion of the ALLIC-BFM 2009 chemotherapy protocol administered due to the diagnosis of precursor B-cell (pre-B) ALL. Physical examination revealed a hard, painless, hyperemic, nodule-shaped lesion measuring 2 × 1 cm on the right parietal bone. Atypical hematopoietic cells with the prominent nucleolus, narrow cytoplasm, and immunohistochemically stained with CD 10, 19, 22, 79-a, and TdT were observed in the histopathological examination of the skin lesion. There was no blast in the bone marrow aspiration smear and cerebrospinal fluid. The patient was diagnosed with aleukemic leukemia cutis (LC) and pre-B ALL, presenting as an isolated relapse. Conclusion Aleukemic LC is a very rare finding after leukemia treatment. It may present with various cutaneous lesions, such as a papule, macule, plaque, nodule, palpable purpura, and ulcerative lesions. Leukemia cutis should be considered in the differential diagnosis of skin lesions developing during or after treatment in children with leukemia

Tandem high-dose chemotherapy followed by autologous stem cell transplantation: An infant with trilateral retinoblastoma

Background: Retinoblastoma (RB) is the most common intraocular malignancy in childhood. Advanced RB, associated with exceedingly poor prognosis, requires more intensive multiagent chemotherapy than conventional regimens. Rescue of the bone marrow after intensive chemotherapy is achieved with stem cell transplantation. The sequential courses (tandem transplantation) of high-dose chemotherapy followed by autologous stem cell transplantation allow for even greater dose intensity in consolidation with the potential to use different active chemotherapeutics at each transplant and have proven feasible and successful in treating children with recurrent/refractory solid tumors. Case Description: We report an infant with trilateral high-risk RB who received tandem high-dose chemotherapy (HDC) followed by autologous stem cell transplantation after the conventional chemotherapy. A 5-month-old female patient presented with strabismus, and the ophthalmoscopic examination showed intraocular tumoral lesions in both eyes. Magnetic resonance imaging (MRI) concluded the trilateral retinoblastoma diagnosis due to a tumoral mass in the optic chiasm. The follow-up ophthalmologic examinations and the MRI detected stable disease after six cycles of multiagent chemotherapy. Conclusions: Rescue with autologous stem cell transplantation after HDC allows for an increase in chemotherapy intensity. Tandem transplantation provides the chance to perform different chemotherapeutics at each transplant and enables an increase in the chemotherapy intensity, thus providing a positive effect on disease-free survival

Propranolol as a First-Line Treatment of Infantile Hemangioma: Single Center Experience

Copyright © 2015 by Türkiye Klinikleri.Objective: Infantile hemangiomas (IHs) are the most common benign vascular tumors in infancy. Spontaneous regression is expected in majority of IHs, so watchful waiting is the best management. Currently propranolol has taken the place of corticosteroids for the treatment of risky IHs. Herein we aimed to analyze our patients with IHs treated with propranolol. Material and Methods: There were 240 patients with diagnosis of IH, treatment was indicated in 11.3% (n:27) of them, and these 27 patients received propranolol as a first-line treatment between January 2012-January 2015. Medical records of these 27 patients were analized retrospectively. Clinical characteristics, physical examination findings, treatment indications, treatment details, responses and side effects of propranolol were analized retrospectively. Results: The median age at diagnosis was 3 months (1-15), and M/F ratio was 0.23. The most common hemangioma localization was skin and head-neck region in 55.6% of patients. Treatment indications were local complications (haemorrhage, ulceration, infection) (44.4%), life threating organ dysfunction (33.3%) and relative indications (22.2%). The median follow-up period was 12 months (1-26 months). Pallor and partially regression in hemangiomas were observed between the fourth and sixth weeks in all patients. Complete remission occured in 15 patients, treatment is going on with partial remission in remaining 12 cases. There was no observed side effects of propranolol. Conclusion: Propranolol is a well-tolerated, efficacious, and safe drug for treatment of IHs. It can be initiated and administered in the outpatient setting. Treatment indications of IHs may become more flexible taking into account of the safety profile of propranolol

Propranolol as a first-line treatment of infantile hemangioma: Single center experience

Copyright © 2015 by Türkiye Klinikleri.Objective: Infantile hemangiomas (IHs) are the most common benign vascular tumors in infancy. Spontaneous regression is expected in majority of IHs, so watchful waiting is the best management. Currently propranolol has taken the place of corticosteroids for the treatment of risky IHs. Herein we aimed to analyze our patients with IHs treated with propranolol. Material and Methods: There were 240 patients with diagnosis of IH, treatment was indicated in 11.3% (n:27) of them, and these 27 patients received propranolol as a first-line treatment between January 2012-January 2015. Medical records of these 27 patients were analized retrospectively. Clinical characteristics, physical examination findings, treatment indications, treatment details, responses and side effects of propranolol were analized retrospectively. Results: The median age at diagnosis was 3 months (1-15), and M/F ratio was 0.23. The most common hemangioma localization was skin and head-neck region in 55.6% of patients. Treatment indications were local complications (haemorrhage, ulceration, infection) (44.4%), life threating organ dysfunction (33.3%) and relative indications (22.2%). The median follow-up period was 12 months (1-26 months). Pallor and partially regression in hemangiomas were observed between the fourth and sixth weeks in all patients. Complete remission occured in 15 patients, treatment is going on with partial remission in remaining 12 cases. There was no observed side effects of propranolol. Conclusion: Propranolol is a well-tolerated, efficacious, and safe drug for treatment of IHs. It can be initiated and administered in the outpatient setting. Treatment indications of IHs may become more flexible taking into account of the safety profile of propranolol

Assessment of sleep in pediatric cancer patients

The purpose of the study is to describe sleep habits, assess the prevalence of sleep disturbances in pediatric cancer patients and healthy controls, and to compare sleep patterns, sleep problems. One hundred-thirty-five patients and 190 healthy controls were evaluated. Healthy children matched for age, sex, economic status, parental education and family structure constituted the control group. Sleep was evaluated by using the Children's Sleep Habits Questionnaire (CSHQ). Sleep problems were detected in half of patients. There were no significant differences in total sleep score and subscale scores between patients and controls. Solely the wake-time was found significantly different between patients and controls. Although our results indicated that neither childhood cancer survivors nor patients with cancer during treatment period had more sleep problems than their healthy peers, sleep problems were not uncommon in whole study group. This study underlines the need to screen, assess and manage sleep problems in children with diagnosis of cancer

Assessment of sleep in pediatric cancer patients

The purpose of the study is to describe sleep habits, assess the prevalence of sleep disturbances in pediatric cancer patients and healthy controls, and to compare sleep patterns, sleep problems. One hundred-thirty-five patients and 190 healthy controls were evaluated. Healthy children matched for age, sex, economic status, parental education and family structure constituted the control group. Sleep was evaluated by using the Children's Sleep Habits Questionnaire (CSHQ). Sleep problems were detected in half of patients. There were no significant differences in total sleep score and subscale scores between patients and controls. Solely the wake-time was found significantly different between patients and controls. Although our results indicated that neither childhood cancer survivors nor patients with cancer during treatment period had more sleep problems than their healthy peers, sleep problems were not uncommon in whole study group. This study underlines the need to screen, assess and manage sleep problems in children with diagnosis of cancer