జర్నల్ ఆఫ్ ఆంకాలజీ మెడిసిన్ & ప్రాక్టీస్

Objectives: To determine the prevalence of sepsis-induced cardiac dysfunction (septic cardiomyopathy) in pediatric  oncology patients admitted to PICU, and to compare them to other oncology patients with sepsis/septic shock who have  no cardiac dysfunction regarding the risk of mortality, average length of stay, duration of inotropic/vasopressor support, ventilation free days, and the need for renal replacement therapy.
Design: a retrospective analysis of Sixty-six pediatric patients with underlying oncology disease who were admitted to the Pediatric critical care unit at King Fahad Specialist Hospital with the diagnosis of sepsis or septic shock between January 2014 and December 2015. Severe sepsis and septic shock were defined based on the definition of the Surviving Sepsis Campaign 2012. Sepsis-related cardiac systolic dysfunction (septic cardiomyopathy) was defined by High sensitive Troponin I, CK-MB and high BNP according to King Fahad Specialist Hospital-Dammam (KFSH-D) laboratory reference, Ejection fraction less than 50%, and shortening function less than 25% by transthoracic echocardiography, provided that transthoracic echocardiography is normal prior to PICU admission.
Results: The Prevalence of cardiac dysfunction in oncology patients having sepsis, severe sepsis or septic shock was 18.33%. (11 out of 60) (95% CI: 10.56, 29.92). The risk of mortality was higher in this group compared to those without cardiac dysfunction (54.5% versus 12.2%, p-value 0.005) regardless of the level of the cardiac enzymes (Troponin I, CK-MB and BNP). Oncology patients with cardiac dysfunction required more frequent mechanical ventilation, inotropic/ vasopressor support and renal replacement therapy (p-value is 0.037, 0.031, and 0.001 respectively) but no significant increase in the length of stay or the duration of mechanical ventilation and inotropes (p-value 0.483, 0.068 and 0.105 respectively).
Conclusion: Sepsis-induced cardiac dysfunction in pediatric oncology patients is more liable to have a higher risk of mortality; they required more frequent inotropic/vasopressor support, renal replacement therapy, and mechanical ventilation. Randomized controlled trials are necessary to determine the optimal timing for diagnosis and management strategy in septic patients having cardiac dysfunction.

Introduction: Wilms’ tumor is the most prevalent renal tumor of childhood that accounts for about 5% of all their cancers. It is also one of the successes of pediatric oncology with long term survival above 90% for localized disease. The aim is to evaluate the disease characteristics and the clinical outcome of children with Wilms’ tumor at King Fahad Specialist Hospital Dammam over six years from 2011 to 2016.

Methods: Our study is a retrospective review of the medical files of children (under 16 years) with Wilms’ tumor who were managed at King Fahad Specialist Hospital Dammam in the interval between January 2011 until December 2016. We analyzed all the Patients’ and disease features, histopathological results, staging, treatment modalities, and outcome, according to the system of the National Wilms Tumor Study Group (NWTSG). Descriptive analysis using frequencies was applied to describe the study variables.

Results: A total of 22 patients, 9 (40.5%) were males and 13 (59.5%) were females (male ratio=M/F=0.69). were identified, with median age of 37.2 months. The majority of the cases were stage III (31.8%), followed by stage 1 (27.3%) Around 70% had favorable histology, 10% had anaplasia, and 20% had mixed pathology. The relapse rate is 18.2%, and the mortality is about 9%, EFS In This Study Was Estimated As 80%, and the OS As 90%.

Conclusion: In a comparison of our results to that of NWTS-5, we noticed that the majority of our patients presented with stage 3, but despite that, the rate of relapse/progressive disease is comparable to international figures, and the overall survival of our patients of 90% is still comparable to the Western experience.

Plasmablastic lymphoma is a variant of diffuse large B-cell lymphoma, observed mainly in the oral cavity in the immune compromised. Pathologists poorly recognize plasmoblastic lymphoma, in part because of its relatively rare appearance and unusual immunophenotype.

We admitted a 63-year-old patient with a history of ischemic stroke 6 years ago to supplement the management of recurrent non-Hodgkin’s lymphoma a (NHL). A biopsy for pathological confirmation is requested and results as follows: Immunohistochemical profile in favor of plasmoblastic lymphoma (Tumor cells are of a lymphoid nature weakly expressing the leukocyte common antigen LAC-B117PD7/26-DAKO, antibodies anti-CD138 expressed diffuse, anti-CD20, CD3, CD5, CD10, CD30 negative, anti-cytokeratin antibodies AE1 negative, anti-HMB45 negative The proliferation index Ki67: 60%. Magnetic resonance imaging found: a residual polyolobed tumoral mass of 41 × 17 mm attached to the level of the tongue’s brake, then infiltrating the floor to the level of digastric muscles pouring right after administration of contrast medium. He has benefited from 6 cures of chemotherapy with the DAEPOCH protocol, first cure on 13/09/2017 and sixth on 27/12/2017. The reassessment report showed a good clinical response on the end-of-treatment CT scan on 15/01/2018. The patient presents himself 6 months later with another local recurrence. It benefits from radiotherapy on the oral floor at the dose of 40 gray. The plasmoblastic lymphomas represent a distinct new subtype among diffuse large B cell lymphomas. The individualization of this new class of lymphoma provides a solid foundation for other molecular analyzes to define its pathogen.