BACKGROUND: Pancreatoblastoma (PB) is a rare malignant pancreatic tumor in children and approximately 200 cases have been reported in the literature. The overall 5-year survival rate in PB is 43-50% and no standard treatment for PB has been established. This report presents the case of a 6-year-old female with advanced PB treated successfully by a pylorus-preserving pancreatoduodenectomy (PPPD) after induction chemotherapy, radiation and stem cell transplantation (SCT). CASE REPORT: A 6-year-old girl was hospitalized for abdominal pain, fever, and vomiting. Abdominal computed tomography (CT) scan showed a 9-cm heterogeneous mass located at the pancreatic head and body, and the duodenum was completely compressed. The inferior vena cava, superior mesenteric artery, and vein were encased by the tumor. The tumor had well-defined margins and calcification. She showed severe anemia and her hemoglobin level was 4.0 g/dl, and the serum alpha-fetoprotein (AFP) level was elevated (884.8 ng/ml). Initially, a resection of the tumor was impossible. An open biopsy was performed and the histopathological diagnosis was PB. She underwent five cycles of the induction chemotherapy regimen for advanced neuroblastoma (cyclophosphamide, etoposide, vincristine, pirarubicin and cisplatin), and the tumor size was decreased to a diameter of 7.5 cm. Furthermore, chemotherapy with irinotecan and vincristine, radiotherapy (40 Gy) and SCT (etoposide, carboplatin, melphalan) was administered. The serum AFP level decreased to 41.1 ng/ml, and the tumor size was decreased to a diameter of 6.5 cm. Then she underwent a PPPD and the tumor was completely resected. The patient's recovery was uneventful, and the AFP returned to the normal values (6.2 ng/ml) after surgery. The child was administered mild postoperative chemotherapy using irinotecan and has been disease-free for 4 months and, and her serum AFP levels remain within normal values. CONCLUSION: This is the first case of PB that was treated with SCT effectively before surgery. The combined therapy including the intensive chemotherapy with SCT and the radiation followed by surgical treatment is thought to be effective for the treatment of advanced PB.
BACKGROUND:Pancreatoblastoma (PB) is a rare malignant pancreatic tumor in children and approximately 200 cases have been reported in the literature. The overall 5-year survival rate in PB is 43-50% and no standard treatment for PB has been established. This report presents the case of a 6-year-old female with advanced PB treated successfully by a pylorus-preserving pancreatoduodenectomy (PPPD) after induction chemotherapy, radiation and stem cell transplantation (SCT). CASE REPORT: A 6-year-old girl was hospitalized for abdominal pain, fever, and vomiting. Abdominal computed tomography (CT) scan showed a 9-cm heterogeneous mass located at the pancreatic head and body, and the duodenum was completely compressed. The inferior vena cava, superior mesenteric artery, and vein were encased by the tumor. The tumor had well-defined margins and calcification. She showed severe anemia and her hemoglobin level was 4.0 g/dl, and the serum alpha-fetoprotein (AFP) level was elevated (884.8 ng/ml). Initially, a resection of the tumor was impossible. An open biopsy was performed and the histopathological diagnosis was PB. She underwent five cycles of the induction chemotherapy regimen for advanced neuroblastoma (cyclophosphamide, etoposide, vincristine, pirarubicin and cisplatin), and the tumor size was decreased to a diameter of 7.5 cm. Furthermore, chemotherapy with irinotecan and vincristine, radiotherapy (40 Gy) and SCT (etoposide, carboplatin, melphalan) was administered. The serum AFP level decreased to 41.1 ng/ml, and the tumor size was decreased to a diameter of 6.5 cm. Then she underwent a PPPD and the tumor was completely resected. The patient's recovery was uneventful, and the AFP returned to the normal values (6.2 ng/ml) after surgery. The child was administered mild postoperative chemotherapy using irinotecan and has been disease-free for 4 months and, and her serum AFP levels remain within normal values. CONCLUSION: This is the first case of PB that was treated with SCT effectively before surgery. The combined therapy including the intensive chemotherapy with SCT and the radiation followed by surgical treatment is thought to be effective for the treatment of advanced PB.
Authors: Rosa Muguerza; Alberto Rodriguez; Emilia Formigo; Margarita Montero; José L Vázquez; Cristina Páramo; Carmen Campos Journal: J Pediatr Surg Date: 2005-08 Impact factor: 2.545
Authors: Nicholas A Shorter; Richard D Glick; David S Klimstra; Murray F Brennan; Michael P Laquaglia Journal: J Pediatr Surg Date: 2002-06 Impact factor: 2.545
Authors: Patrizia Dall'igna; Giovanni Cecchetto; Gianni Bisogno; Massimo Conte; Pierluigi Lelli Chiesa; Paolo D'Angelo; Francesco De Leonardis; Gianluca De Salvo; Francesca Favini; Andrea Ferrari Journal: Pediatr Blood Cancer Date: 2010-05 Impact factor: 3.167
Authors: Alberto S Pappo; Elizabeth Lyden; Phillip Breitfeld; Sarah S Donaldson; Eugene Wiener; David Parham; Kristine R Crews; Peter Houghton; William H Meyer Journal: J Clin Oncol Date: 2007-02-01 Impact factor: 44.544
Authors: Sarah Pfrommer; Achim Weber; Philipp Dutkowski; Niklaus G Schäfer; Beat Müllhaupt; Jean-Pierre Bourquin; Stefan Breitenstein; Bernhard C Pestalozzi; Frank Stenner; Christoph Renner; Giannicola D'Addario; Hans-Jörg Graf; Alexander Knuth; Pierre-Alain Clavien; Panagiotis Samaras Journal: Case Rep Oncol Date: 2013-09-28