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"Child`s Health" 6 (49) 2013

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Neuroblastoma is the pulmonological manifestation of children

Authors: Maksimova S.M, Samoylenko I.G. - Donetsk National Medical University; Bukhtiyarov E.V. - Donetsk hospital №3

Categories: Family medicine/Therapy, Pediatrics/Neonatology

Sections: Specialist manual

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children, pulmonology, neuroblastoma

Neuroblastoma - the most common extracranial solid malignant the tumor arising from embryonic neuroblasts predominantly in young-age, accounting for 14% of all malignant tumors are sometimes detected at birth. Neuroblastoma is recorded annually at 6-8 children per million child population under 15 years of age (mean age - 2 years), 50% of all cases occur before the age of 2 years, 75% - up to 4 years of age. In 72% of neuroblastoma is localized in the retroperitoneal space (in the adrenal medulla and sympathetic ganglia), 22% - in the posterior mediastinum, at least in the neck and Presacral areas. Tumor cells have the ability to synthesize betel-lamina, which is used in the laboratory diagnosis for about 4 decades.

An example of clinical observation may be the case in practice. Child, T., 3 years 4 months, was in the children's pulmonary department. Enrolled in the direction of the local doctor diagnosed with "community acquired right-hand traffic-sided polysegmental pneumonia" with complaints of fever up to 40,0 ° C, a rare dry cough, weakness, lethargy, emaciation, constipation, abdominal pain. A week before admission, when the body temperature rose to 39,0-40,0 ° C, there was a dry cough, weakness, paleness, worried about the past 5 days of periodic pain in the right upper quadrant, and constipation. Received: antipyretics. In the next 5 days remained high fever, increased abdominal pain. Re-turned to the doctor, made Ro-graphy of the chest cavity, diagnosed with right- polysegmental pneumonia. A child sent to hospital. From the medical history is known that a child was born from the first, normal pregnancy, normal childbirth, with entwined with a cord around the neck, in asphyxia, weighing 2300. There has been a neurologist at the perinatal CNS. Was breast-fed for over a year, would add enough weight. From 6 months of manifestations of atopic dermatitis. From the first year of life endured repeated SARS, obstructive bronchitis. Heredity is burdened: chronic gastritis in mother, grandmother on the mother - asthma, great-grandmother on his mother died of cancer. In April 2012 was with his parents on holiday in Dubai.

Upon admission to the Pulmonology Department of the child's condition heavy Loe due to respiratory failure and intoxication. Temperature of 37,3 ° C, BH - 52, HR - 150. Oxygen saturation - 95%. Proper constitution, low power supply. Shortness of breath mixed nature alone. Expressed pale skin, no rash. Palatal arch pink, clean, the rear wall of the pharynx granular, hyperemia-centered. Peripheral lymph nodes by type mikropoliadenii. Percussion over the lungs lung sounds, on the right, from top to bottom rib II - shortened. Auscultation breathing hard, in the area of ​​blunting sharply weakened. Rattling not listened to. The boundaries of the heart are not offset, the tones are muted. tachycardia. The abdomen is swollen, sensitive to palpation in the right upper quadrant, the iliac region. Liver by 5.0 cm below the costal margin. The spleen is on the edge. Chair delayed 2 days. Urinating freely.

On the Ro-gram of the chest cavity, confirmed community-acquired right-sided poly-segmental pleuropneumonia. In blood test: Hb - 108 g / l E - 3.4 T / L CP - 0.9, L - 7.2 g / l, e - 1% n - 1% to - 48%; L - 39%, M - 1% ESR - 42 mm / h Pronounced anisotropy and poykilozitozis. In the analysis of urine: color - light yellow, OP - 1015, protein - 0.016 g / L, white blood cells 17-20 in sight, no sugar. Procalcitonin: 0.104 ng / mL after - 0,306 ng / ml. Seromucoid - 8.13 units., Sialic acid - 405.00 USD

On the second day of stay in the department there was a sharp pain in the right. Advise surgeon performed pleural puncture, received 375 ml of serous-hemorrhagic but liquid. Produced by ultrasound of the abdomen. Conclusion: reactive changes of the liver. The gallbladder is reduced.  Pleurisy, pleuropneumonia right. Reinstall the pleural puncture, got 150 ml of serous-hemorrhagic effusion. All tumor markers in the study increased 50 times or more. Transabdominal scan of the abdominal wall and back: delimited education paravertebrally located dorsally to the right of the spine, previously may be considered as a neoplastic process - neuroblastoma. CT: neoplasm of the posterior mediastinum and retroperitoneum, extending paramediastinalno and into the lumen of the spinal canal on the right, the left n the mesentery. Diffuse changes in the liver. Changes in the posterior segments of ribs 6-10 on the right and in the vertebrae of the spine due to hyperostosis or secondary neoplastic origin. Magnetic resonance imaging of the cervical and lumbar spine: neoplasm of the posterior mediastinum and retroperitoneum, extending into the spinal canal at the level of Th6 - Th9. Changes in the spinal cord at the level Th7 - Th8 have compression character. Focal changes in the bodies of Th3, Th8, Th7, Th10 vertebral body in Th7 dominated by osteosclerosis, due to a secondary process.

The clinical diagnosis of neuroblastoma posterior mediastinum and retroperitoneum, IV century, community-acquired right-polysegmental pneumonia, complicated by exudative pleurisy, DNII. Received treatment: Fortum 600 mg twice a day, sumamed 120 mg once a day - seven days enterozhermina 5 ml twice daily; lipoferon 250 twice a day, analgin, dimedrol, papaverine; targotsid 130 mg twice a day; metrogil 175 mg twice a day. A child sent to a specialized cancer clinic, where he received polychemotherapy and prepared for surgery.

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