Multidisciplinary Approach for Management of Pediatric Tumors: a Case Series
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ORIGINAL ARTICLE
Multidisciplinary Approach for Management of Pediatric Tumors: a Case Series Dwarkanath V. Kulkarni 1 & Sandesh V. Parelkar 1 & Pooja Tiwari 1 & Beejal V. Sanghvi 1 & Rahul K. Gupta 1 & Kedar P. Mudkhedkar 1 & Satej S. Mhaskar 1 & Rujuta Shah 1 Received: 4 May 2019 / Accepted: 27 March 2020 # Indian Association of Surgical Oncology 2020
Abstract Pediatric solid tumors have wide range of presentations. Multidisciplinary approach is often needed for their optimum management. There are no reports discussing such an approach to pediatric tumors involving pediatric surgeons, oncologists and cardiothoracic surgeons together for the management. We report 5 such cases being managed in our institution from 2010 to 2016. All cases needed chemotherapy followed by resection with a team of surgeons involving pediatric surgeon and cardiothoracic surgeon Keywords pediatric . oncologists . chemotherapy
Introduction
Case Series
Pediatric solid tumors account for 2% of all tumor cases. They have wide range of presentations. Multidisciplinary approach is often needed for their optimum management. There are no reports discussing such an approach to pediatric tumors involving pediatric surgeons, oncologists, and cardiothoracic surgeons together for the management. We report 5 such cases being managed in our institution from 2010 to 2016. There were 2 cases of Wilms’ tumor with inferior vena cava (IVC) extension, an adrenocortical carcinoma, a pheochromocytoma with pancreatic neuroectodermal tumor (PNET), and a neuroblastoma encasing major vessels. All cases needed chemotherapy followed by resection with a team of surgeons involving pediatric surgeon and cardiothoracic surgeon.
Case 1 [a] A 1-year-9-month girl presented with abdominal distension for 15 days and was diagnosed as right sided Wilms’ tumor with invasion of IVC and thrombosis within it with engulfment of right renal vein by mass on CECT abdomen. It was a right upper pole mass of size 11 cm × 8 cm × 8 cm with inferior vena cava invasion by tumor thrombus from infrahepatic to retrohepatic extending to suprahepatic inferior vena cava into left atrium. 2D ECHO was normal. Considering unresectability, 4 cycles of chemotherapy (vincristine and adriamycine) was given after CT guided biopsy which was suggestive of biphasic Wilms’ tumor. Cardiothoracic surgeons’ opinion was taken for IVC thrombosis and atrial
* Pooja Tiwari [email protected]
Kedar P. Mudkhedkar [email protected]
Dwarkanath V. Kulkarni [email protected]
Satej S. Mhaskar [email protected]
Sandesh V. Parelkar [email protected] Beejal V. Sanghvi [email protected] Rahul K. Gupta [email protected]
Rujuta Shah [email protected] 1
Department of Pediatric Surgery, Seth G. S. Medical College and K.E.M. Hospital, ward 3, Old Building, Parel, Mumbai 400 012, India
Indian J Surg Oncol
extension and need for cardiopulmonary bypass during excision of mass. With meticulous team work, right radical nephrectomy with excision of inferior vena caval thrombus wa
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