Neuroblastoma na Criança: Relato de Caso/Neuroblastoma in Children: Case Report
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Abstract
Introdução: o neuroblastoma é uma neoplasia maligna, que apresenta ampla variedade em termos de localização, característica histopatológica e biológica. A apresentação clínica, extremamente variável, reflete as possíveis localizações do tumor primário dentro do sistema nervoso simpático. Os sintomas mais frequentes incluem, dor e distensão abdominais, dores ósseas localizadas, sintomas sistêmicos (anorexia, mal-estar geral, febre) e diarreia. É um tumor raro, com uma incidência de 10 casos por milhão de crianças entre zero e quatro anos de idade. Casuística: Relatou-se o caso de um paciente, atualmente com quatro anos e oito meses, com neuroblastoma, tumor primário de supra-adrenal esquerda, metastático para medula óssea bilateral e múltiplos ossos, que iniciou tratamento quimioterápico-neoadjuvante, imediatamente após o diagnóstico, com posterior avaliação para cirurgia, quimioterapia adjuvante e radioterapia, e transplante autólogo de medula óssea. O tratamento se baseia na estratificação do grupo de risco, podendo envolver: quimioterapia, radioterapia, cirurgia para ressecção do tumor e transplante autólogo de medula óssea. O prognóstico está relacionado com a idade da criança ao diagnóstico, determinadas características histológicas, estadiamento e com alterações genéticas do tumor. Discussão: Seguindo o protocolo, o tumor foi estadiado em nível 4, segundo o International Neuroblastoma Staging System (INSS), e proposto o tratamento com multimodalidade, que inclui quimioterapia intensiva com uma combinação de agentes, seguida de ressecção cirúrgica, doses elevadas de quimioterapia, e radioterapia para posterior transplante autólogo de medula óssea. Este tratamento foi iniciado pela paciente no dia 24/08/2011, e tem previsão de duração de no mínimo um ano.
Palavras chave: Neuroblastoma, dores ósseas, glândula adrenal.
ABSTRACT
Introduction: Neuroblastoma is a malignant neoplasm that presents a wide variety in terms of location, histopathological and biological characteristic feature. The clinical presentation is extremely variable, reflecting the possible locations of the primary tumor within the sympathetic nervous system. The most common symptoms include abdominal pain and distention, localized bone pain, systemic symptoms (anorexia, malaise, fever), diarrhea. Is a rare tumor, with an incidence of 10 cases per million children between zero and four years old. Case Report: We report the case of a patient, now four years and eight months, with Neuroblastoma, primary adrenal tumor left adrenal, metastatic to bone marrow bilateral and multiple bones, which started neoadjuvant chemotherapy, immediately after diagnosis, with further evaluation for surgery, adjuvant chemotherapy and radiotherapy, and autologous bone marrow. The treatment is based on stratification of risk group and may involve: chemotherapy, radiation, surgery to remove the tumor and autologous bone marrow. The prognosis is related to the child's age at diagnosis, certain histologic features, staging and tumor genetic alterations. Discussion: Following the protocol, the tumor was staged at level 4, according to the International Neuroblastoma Staging System (INSS) and proposed a treatment with multimodality, including an intensive chemotherapy with a combination of agents, followed by surgical resection, high doses of chemotherapy and radiotherapy for subsequent autologous bone marrow transplantation. This treatment was initiated by the patient on 24/08/2011, and is scheduled for a duration of at least one year.
Keywords: Neuroblastoma, bone, adrenal gland.
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