Lymphomas are the third most frequent malignant neoplasm in pediatrics. Although polychemotherapy, with or without radiotherapy, is the first-line treatment, relapsed or refractory patients still represent a major challenge, with no established therapeutic consensus. In this context, immunotherapy has emerged as a promising strategy, with growing evidence of its efficacy in adults but limited data in pediatric patients. We report three male patients, aged 13 to 16 years of age, diagnosed with advanced-stage HL and T/NK-cell NHL, all refractory to multiple prior lines of treatment. The use of checkpoint inhibitors enabled disease rescue in two of the three cases, both achieving complete remission followed by consolidation with allogeneic hematopoietic stem cell transplantation. Immunotherapy demonstrated potential in selected pediatric cases of refractory lymphomas, allowing remission and subsequent hematopoietic stem cell transplantation in two patients. Despite the inherent limitations of a small case series, our findings contribute to real-world experience with immunotherapy in the pediatric setting and reinforce its emerging role in the management of these challenging clinical scenarios.
Hodgkin's lymphoma (HL) is a lymphoproliferative malignancy with high cure rates; however, the evaluation of suspected relapse remains a clinical challenge, particularly in tuberculosis-endemic regions, where infectious diseases may mimic neoplastic activity. We herein report the case of a 16-year-old male patient with a history of classic HL in complete remission who presented with a hypermetabolic pulmonary lesion associated with lymphadenopathy, initially suggestive of relapse. A histopathological analysis revealed caseous necrosis without evidence of malignancy, and tuberculosis was confirmed by polymerase chain reaction for Mycobacterium tuberculosis. The patient received standard antituberculosis therapy, achieving complete clinical resolution. He remains asymptomatic, without evidence of disease recurrence during the follow-up. The case herein reported highlights the diagnostic limitations of imaging studies and reinforces the importance of histopathological confirmation before initiating potentially-toxic therapies.
Melanoma is regarded as a highly aggressive skin cancer due to its potential for early metastasis and poor outcomes in advanced stages. Early detection, accurate staging, follow-up imaging, and assessment of treatment response are critical for improving survival rates in melanoma patients. Positron-emission tomography/computed tomography (PET/CT), particularly utilizing 18F-fluorodeoxyglucose (18F-FDG), has become a gold standard imaging modality in the comprehensive management of melanoma. This review critically examines the current literature on the utility of PET/CT in melanoma, focusing on its diagnostic and prognostic role, current indications and rational use. By synthesizing evidence from recent studies, this article highlights the strengths and limitations of PET/CT in clinical practice and explores future directions for research in the field.
Abstract Methotrexate (MTX) is widely used in the treatment of acute lymphoblastic leukemia (ALL) in children but is associated with neurotoxic effects, including leukoencephalopathy (LE). These effects can profoundly affect quality of life and neurocognitive development. We conducted a literature review across multiple databases between 2014 and 2024. The study population included children and adolescents with cancer (under 22 years old) treated with MTX, focusing on LE. Case reports, case series, and reviews were excluded. We analyzed factors such as age, dose, and route of administration (intrathecal or intravenous), correlating clinical and imaging data with neurocognitive outcomes. We included 12 of the 262 identified studies. Most studies involved survivors of childhood cancer diagnosed with ALL (n = 11). LE presented heterogeneously, with clinical manifestations such as seizures, focal neurological deficits, and subtle cognitive declines, particularly in working memory and processing speed. A substantial portion of the lesions persisted even after treatment completion, emphasizing the link between white matter microstructural changes and MTX use. Results indicated that the combination of age and cumulative dose acted as the primary determinant of vulnerability. MTX-induced LE is a significant clinical challenge. Early detection and longitudinal monitoring are crucial to minimize neurocognitive impacts in pediatric survivors. Future research should focus on strategies to mitigate neurotoxicity and optimize quality of life for ALL survivors.
