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一名5岁儿童原发性中枢神经系统神经内分泌癌的独特发现:病例报告

Unique Finding of a Primary Central Nervous System Neuroendocrine Carcinoma in a 5-Year-Old Child: A Case Report.

作者信息

Stepien Natalia, Haberler Christine, Theurer Sarah, Schmook Maria-Theresa, Lütgendorf-Caucig Carola, Müllauer Leonhard, Gojo Johannes, Azizi Amedeo A, Czech Thomas, Slavc Irene, Peyrl Andreas

机构信息

Department of Pediatric and Adolescent Medicine, Medical University of Vienna, Vienna, Austria.

Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria.

出版信息

Front Neurosci. 2022 Mar 23;16:810645. doi: 10.3389/fnins.2022.810645. eCollection 2022.

Abstract

Neuroendocrine tumors (NETs) are rare neoplasms predominantly arising in the gastrointestinal-tract or the lungs of adults. To date, only ten cases of primary central nervous system (CNS) NETs have been reported, with just three of them describing a neuroendocrine carcinoma (NECA) and none occurring in a child. We report on a previously healthy 5-year-old boy, who presented with headaches, nausea and vomiting, and was diagnosed with a left cerebellar solid mass with a cystic component. After gross-total resection, histology revealed a neuroendocrine carcinoma. Molecular analysis of the tumor tissue showed a -splice-site mutation (c451-3C > T). The -mutation was discovered to be a maternal germline mutation, previously described as likely benign. After extensive search for an extracranial primary tumor, including Ga-68 DOTANOC-PET-CT, the diagnosis of a primary CNS NECA was established, and proton irradiation was performed. Unfortunately, the patient developed an in-field recurrence just 5 weeks after the end of radiotherapy. The tumor was re-resected with vital tumor tissue. Six cycles of chemotherapy were initiated, consisting of cisplatin, carboplatin, etoposide and ifosfamide. The patient remains disease free 22 months after the end of treatment, supporting the beneficial effect of platinum- and etoposide-based chemotherapy for this tumor entity.

摘要

神经内分泌肿瘤(NETs)是一种罕见的肿瘤,主要发生于成人的胃肠道或肺部。迄今为止,仅报道过10例原发性中枢神经系统(CNS)NETs,其中仅有3例为神经内分泌癌(NECA),且均未发生于儿童。我们报告了一名此前健康的5岁男孩,他出现头痛、恶心和呕吐症状,经诊断为左小脑实性肿块伴囊性成分。在进行全切除术后,组织学检查显示为神经内分泌癌。对肿瘤组织进行分子分析发现了一个剪接位点突变(c451-3C>T)。该突变被发现是一种母系生殖系突变,此前被描述为可能是良性的。在对颅外原发性肿瘤进行广泛检查,包括Ga-68 DOTANOC-PET-CT后,确诊为原发性CNS NECA,并进行了质子放疗。不幸的是,患者在放疗结束仅5周后就出现了野内复发。对肿瘤进行了再次切除,切除了有活性的肿瘤组织。开始进行6个周期的化疗,化疗方案包括顺铂、卡铂、依托泊苷和异环磷酰胺。在治疗结束22个月后,患者仍无疾病复发,这支持了基于铂类和依托泊苷的化疗对该肿瘤实体的有益效果。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d9aa/8984181/3fb0bb0a2fb2/fnins-16-810645-g001.jpg

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