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Permanent URI for this collectionhttps://hdl.handle.net/20.500.14595/805
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Item Clear Cell Carcinoma of the Vagina in an 11-Year-Old Girl: A Case Report on Clinical, Imaging, and Immunophenotypic Features(Cureus part of Springer Nature, 2025-11-29) Amaranto Suárez Sr. , Alejandra Beatriz Tijo López , Yuli Natalia Otero Pabon , Oscar Mauricio Forero Cuellar , Adriana Bryon GallegoVaginal clear cell carcinoma (CCC) is a rare malignant tumor in the pediatric population and may occur even in the absence of in utero exposure to diethylstilbestrol (DES). We report the case of an 11-year-old girl without DES exposure who presented with persistent foul-smelling vaginal discharge, abdominal pain, and weight loss. Imaging revealed a large vaginal mass with regional lymph node involvement. Histopathology confirmed CCC with Müllerian immunophenotype. The disease was classified as advanced and unresectable, and the patient was treated with concurrent cisplatin-based chemoradiation followed by high-dose-rate interstitial brachytherapy. She achieved significant tumor reduction and remains clinically disease-free to date. This case underscores the diagnostic complexity of pediatric vaginal CCC and supports chemoradiation with brachytherapy as an effective strategy for unresectable disease.Item Adjuvant Chemotherapy in Children With Enucleated Retinoblastoma and Histopathologic High-Risk Features: Survival Outcomes From a Single Institution in a Middle-Income Country(Cureus part of Springer Nature, 2025-12-21) Amaranto Suárez , Fernando Rojas , Jennifer Camargo , Javier Muñoz , Nathalie Soler , Maria Alejandra Ágredo Lucio , David Garay , Martha PiñaAbstract Background: Retinoblastoma is the most common intraocular malignancy in children. Although primary enucleation continues to be a standard treatment for advanced disease, specific histopathologic high-risk features substantially increase the likelihood of extraocular dissemination. Adjuvant chemotherapy aims to reduce this risk; however, evidence from middle-income countries remains limited. Objective: To determine the prevalence of histopathologic high-risk features in enucleated retinoblastoma and to assess relapse risk and event-free survival (EFS) among patients treated with adjuvant chemotherapy. Methods: We conducted a retrospective analytical study of children with unilateral retinoblastoma treated with primary enucleation and of those with bilateral disease in whom the more affected eye was enucleated before any therapy, between January 2008 and December 2018. Patients presenting high-risk histopathologic features received adjuvant chemotherapy with vincristine, etoposide, and carboplatin (VEC). EFS was estimated using the Kaplan-Meier method and compared using the log-rank test. Results: A total of 101 patients were included; 74 (73%) had unilateral disease. The mean age at diagnosis was 2.1 years. Most eyes demonstrated advanced intraocular involvement (International Classification of Intraocular Retinoblastoma (ICRB) Group E: 82, 81.2%; Group D: 13, 12.9%). Histopathologic high-risk features were common: choroidal invasion occurred in 42 (41.6%) (17, 40.4% massive ≥3 mm), postlaminar optic nerve invasion in 11 (26.2%), and positive optic nerve margin in 16 (38%). Scleral invasion was identified in 20 (21.5%), and anterior chamber invasion in 14 (14%). Thirteen patients (13%) relapsed, all with fatal outcomes. Ten-year EFS was 83.3%. Massive choroidal invasion, scleral invasion, and postlaminar optic nerve invasion were the strongest predictors of poor outcome, and their coexistence was associated with the highest relapse risk. Conclusions: Histopathologic high-risk features are common among children undergoing enucleation for advanced retinoblastoma. Adjuvant chemotherapy is warranted in cases with massive choroidal invasion, scleral infiltration, or postlaminar optic nerve involvement, given their strong association with metastatic relapse.Item Tumor de Wilms: análisis de supervivencia en niños menores de 15 años tratados en una unidad de oncología pediátrica de una Institución para el tratamiento de cáncer(2025) Suárez Mattos, Amaranto; Suaza Vallejo, María Camila; Buitrago Escobar, Jorge; Pabón Sogamoso, Eddie; Durán Ochoa, Nelson; Blanco, Carlos; Luengas, Juan PabloIntroducción: En el Instituto Nacional de Cancerología (INC) Colombia, el tratamiento del tumor de Wilm´s (TW) se basa en estrategias del Grupo Nacional de Tumores de Wilm´s (NWTSG I a V). Describimos resultados de supervivencia global(SG) y libre de evento(SLE) de los menores de 15 años tratados entre el 2008 y 2018. Objetivo:Describir características clínicas, SG y SLE de los menores de 15 años con TW tratados con protocolo basado en NWTSG entre el 2008 y 2018. Pacientes y métodos: Estudio retrospectivo observacional de una cohorte de menores de 15 años con diagnóstico de TW tratados con los lineamientos del NWTSG, en el INC entre 1 de enero del 2008 y 31 de diciembre del 2018. Análisis descriptivo de variables demográficas y clínicas. La SLE y SG se calculó por método de Kaplan Meier. Resultados: Identificamos 48 pacientes con diagnóstico de TW, la media de edad fue 3.95 (±2.27), razón H:M 1.18. La mayoría (58%) con estadio avanzado (III y IV). Histología desfavorable represento el 16,7%, recayeron 31% y fallecieron 21%. La SLE y SG es del 62% y 77.3% respectivamente a 10.4 años; la causa más común de mortalidad fue la recaída. Conclusión: En el INC la mayoría de los niños con WT ingresan con enfermedad avanzada. Aunque en países con recursos económicos medios la supervivencia lograda con tratamiento multidisciplinario es inferior a países de altos ingresos, es razonablemente aceptables. Se requiere de mejor desarrollo en pruebas diagnósticas para lograr tratamientos adaptados a riesgo más precisos.Item Desafíos y aprendizaje: primera experiencia de fotoféresis en un niño con enfermedad de injerto contra receptor(Asociación Colombiana de Hematología y Oncología, 2024-07) Calderón Gasca, Alejandra; Bula Anichiarico, Doris Alexandra; Chaparro Alzogaray, Mauricio; Estupiñán Peñaloza, MarcelaGraft-versus-Host Disease (GVHD) is a serious and common complication following allogeneic hematopoietic stem cell transplants (allo-HSCT), accounting for approximately 25% of post-transplant deaths. Its incidence, which has increased over the past two decades, reaches around 50% in patients undergoing allogeneic hematopoietic progenitor cell transplants. Factors such as patient age, the use of unrelated donors, reduced-intensity regimens, and specific sources of stem cells contribute to this increase. Initial treatment involves corticosteroids and calcineurin inhibitors, but in refractory cases, extracorporeal photopheresis (ECP) emerges as an option. Clinical case: We present the case of a pediatric patient undergoing haploidentical allogeneic hematopoietic progenitor cell transplant for severe aplastic anemia, who subsequently developed severe refractory chronic GVHD, with severe liver, skin and mild lung involvement, who underwent extracorporeal photopheresis sessions as part of the second line of GVHD treatment, with a partial response. Conclusion: the approach and treatment of GVHD results in the impossibility of a single treatment for all patients with this pathology.