Diagnostic Difficulties and Management of Childhood Lymphoma: A Case Report

Primary dural lymphoma is a rare pathology, it is part of the malignant lymphoma of the central nervous system and it can reach the extradural or subdural space. We report a case of a little boy of three years and two months admitted to the Department of Neurosurgery CHU JRA for multiple swellings in the scalp associated with an altered general condition. The CT scan revealed a multiple extra-axial expansive process with retro-orbital extension responsible for an important exophthalmos as well as at the scalp level. Anatomopathological examination of the dura mater biopsy revealed a malignant non-Hodgkin's small cell lymphoma. The patient underwent chemotherapy of 05 sessions and the evolution was marked by the persistence of the symptoms. The post chemotherapy brain scan showed considerable extension of the lesions. The next step would be radiotherapy.

CONSEQUENCES OF LATE DIAGNOSIS OF LYMPHOMAS IN CHILDREN

Lymphoma is the third leading cause of malignant neoplasms (MNs) in children. Childhood lymphoma is characterized by the prevalence of highly aggressive variants with high proliferation activity and rapid tumor dissimilation. Prolonged diagnosis becomes a reason of advanced-stage therapy. Despite the good results of long-term survival rate in patients, exceeding 90% even with late (III-IV) stages of lymphomas, the persistence of pathogenic (including multi-drug resistant) microorganisms in the patient's body becomes a major therapeutic problem, contamination of which occurs during the patient's stay in various medical organizations at the stage of diagnostics. The case reports of fatal infectious complications with the development of sepsis caused by polyresistant microorganisms in 2 children with anaplastic large cell lymphoma stage IV are presented in this article. Both case reports are unfavourable, despite the use of all medications and effective treatments. The analysis of diagnostic errors and necessity of cancer alarm generation in medical staff and patients' parents will make it possible to reduce the duration of diagnosis and probability of contamination of patient’s body with multi-resistant flora.

T cell ALL in a child with Ataxia telangiectasia; diagnosis and management challenge

Ataxia telangiectasia (A-T) is a rare childhood autosomal recessive neurodegenerative chromosomal instability disorder. It is characterized by high risk of hematological malignancies with T-cell phenotype being the most common, which can present first before the diagnosis of A-T made. The chromosomal instability in A-T increases the toxicity to radio- chemotherapeutic agents, creating the treatment modification challenges and the deviation from the optimal management protocols. In this case report we present a 14-month-old boy diagnosed as T cell –ALL. Based on his early presentation, family history of childhood lymphoma, and high AFP, inherited predisposition was suspected, and genetic testing confirm A-T. This report represents the crucial part of clinical suspicion of A-T in similar cases as well as highlighting the importance of an early A-T diagnosis that prevents toxic death due to the extensive regimen of radio- chemotherapeutic agents. The report summarizes the toxicity and modification challenges during management with literature review for the chemotherapy modification experience in such cases.

Improving the Brain Delivery of Chemotherapeutic Drugs in Childhood Brain Tumors

The central nervous system (CNS) may be considered as a sanctuary site, protected from systemic chemotherapy by the meninges, the cerebrospinal fluid (CSF) and the blood-brain barrier (BBB). Consequently, parenchymal and CSF exposure of most antineoplastic agents following intravenous (IV) administration is lower than systemic exposure. In this review, we describe the different strategies developed to improve delivery of antineoplastic agents into the brain in primary and metastatic CNS tumors. We observed that several methods, such as BBB disruption (BBBD), intra-arterial (IA) and intracavitary chemotherapy, are not routinely used because of their invasiveness and potentially serious adverse effects. Conversely, intrathecal (IT) chemotherapy has been safely and widely practiced in the treatment of pediatric primary and metastatic tumors, replacing the neurotoxic cranial irradiation for the treatment of childhood lymphoma and acute lymphoblastic leukemia (ALL). IT chemotherapy may be achieved through lumbar puncture (LP) or across the Ommaya intraventricular reservoir, which are both described in this review. Additionally, we overviewed pharmacokinetics and toxic aspects of the main IT antineoplastic drugs employed for primary or metastatic childhood CNS tumors (such as methotrexate, cytosine arabinoside, hydrocortisone), with a concise focus on new and less used IT antineoplastic agents.