Нейробластома является агрессивной и злокачественной опухолью, которая исходит из эмбриональной нейрогенной ткани. Нейробластома самая распространенная экстракраниальная солидная опухоль, встречающаяся в практике детского онколога, ее заболеваемость – около 10 детей на 1 млн детского населения до 15 лет, что составляет около 8% всех злокачественных новообразований у детей. Около 37% всех нейробластом диагностируется у детей до 1 года и около 90% – до 5 лет. В большинстве случаев опухоль локализуется в забрюшинном пространстве, преимущественно в надпочечниках, реже – в средостении и на шее. Согласно обобщенным эпидемическим данным у 32% детей нейробластома выявляется в надпочечнике, у 28% – в паравертебральном забрюшинном пространстве, у 15% – в заднем средостении, у 5,6% – в тазовой области и у 2% – на шее. В 17% случаев речь идет о нейробластомах с неустановленной первичной локализацией, но уже имеющей отдаленные метастазы. Клиника нейробластомы имеет неспецифические проявления. Опухоль может сочетаться с различными синдромами. Диагностика нейробластомы может проводиться на всех этапах врачебной помощи. Представлен современный взгляд на алгоритм диагностики нейробластомы. Приведены примеры дифференциальной диагностики опухоли с помощью лучевых методов. Диагностика нейробластомы возможна на ранних этапах, что позволит оказывать помощь пациентам на ранних стадиях заболевания.
Neuroblastoma is aggressive and malignant tumor that originates from embryonic neural tissue. Neuroblastoma is the most common extracranial solid tumor found in the practice of a pediatric oncologist, the incidence of which is about 10 children per 1 million children under 15 years, which is about 8% of all malignancies in children. About 37% of all neuroblasts are diagnosed in children under 1 year, and about 90% in children under 5 years. In most cases, the tumor is localized in the retroperitoneal space, mainly in the adrenal glands, less often – in the mediastinum and on the neck. According to the generalized epidemic data, 32% of children have neuroblastoma in the adrenal gland, 28% – in the paravertebral retroperitoneum, 15% – in the posterior mediastinum, 5.6% – in the pelvic area and 2% – on the neck. In 17% of cases we are talking about neuroblastomas with unknown primary localization, but already having distant metastases. Neuroblastoma clinic has nonspecific manifestations. The tumor can be combined with various syndromes. Diagnosis of neuroblastoma can be carried out at all stages of medical care. Presents a modern approach to the algorithm for the diagnosis of neuroblastoma. Examples of differential diagnosis of tumors using radiation methods are given. Diagnosis of neuroblastoma is possible in the early stages, which will help patients in the early stages of the disease.
1. Woodward PJ, Sohaey R, Kennedy A, Koeller KK. A comprehensive review of fetal tumours with pathologic correlation. RadioGraphics 2005; 25: 215–42.
2. Moore S, Satge D, Sasco A et al. The epidemiology of neonatal tumours. Report of an international working group. Pediatr Surg Int 2003; 19: 509–19.
3. Sandrasegaran K, Lall C, Aisen A. Fetal magnetic resonance imaging. Curr Opin Obstet Gynecol 2006; 18: 605–12.
4. Castel V, Grau E, Noguera R, Martinez F. Molecular biology of neuroblastoma. Clin Transl Oncol 2007; 9 (8): 478–83.
5. Everson TC, Lole WH. Spontaneus regression of cancer. Philladelphia P.A. WB Saunders, 1966; p. 6–7.
6. Beckwith JB, Perrin EV. In situ neuroblastoma. Am I. Path 43. 1963; p. 1089–104.
7. Дурнов Л.А. Голдобенко Г.В. Детская онкология. М.: Медицина, 2005; с. 327–41.
[Durnov L.A. Goldobenko G.V. Detskaia onkologiia. Moscow: Meditsina, 2005; p. 327–41 (in Russian).]
8. Cooper GJ, Willis AS, Clark A et al. Purification and characterization of a peptide from amyloid-rich pancreases of type 2 diabetic patients. Proc Nath Acad Sci USA. 1987; 84: 8628–32.
9. Evans AE, Angio GJ, Propert K et al. Prognostic factor in neuroblastoma. Cancer 1987; 59: 1853–9.
10. Hoefnagel CA, Smets LA, Voute PA et al. Iodin-125-MIBG therapy for neuroblastoma. J Nucl Med 1991; 32: 361–2.
11. Papathanasiou N, Gaze M, Sullivan K et al. 18F-FDG PET/CT and 123I-Metaiodobenzylguanidine Imaging in High-Risk Neuroblastoma: Diagnostic Comparison and Survival Analysis. J Nucl Med 2011; 52 (4): 519–25.
12. Fox H, Sebire N. Pathology of the Placenta (3rd edn). Saunders: London, 2007.
13. Perkins D, Kopp C, Haust M. Placental infiltration in congenital neuroblastoma: a case study with ultrastructure. Histopathology 1980; 4: 383–9.
14. Jennings R, LaQuaglia M, Leong K et al. Fetal neuroblastoma: prenatal diagnosis and natural history. J Pediatr Surg 1993; 28 (9): 1168–74.
15. Fenart D, Deville A, Donzeau M, Bruneton J. Neuroblastomer.etrop.eritoneal diagnostiqu.e in utero. A propos d`un cas. J Radiol 1983; 64: 359–61.
16. Heling K, Chaoui R, Hartung J et al. Prenatal diagnosis of congenital neuroblastoma. Analysis of 4 cases and review of the literature. Fetal Diagn Ther 1999; 14: 47–52.
17. Soo-Hyun Lee, Jeong Yeon Cho, Mi Jin Song et al. Prenatal Ultrasound Findings of Fetal Neoplasms. Korean J Radiol 2002; 3 (1): 64–73.
18. Sebire NJ, Jauniaux E. Fetal and placental malignancies: prenatal diagnosis and management. Ultrasound Obstet Gynecol 2009; 33: 235–44.
19. Tihonenko I, Jeanty Ph. Fetal tumors. DVD, 2010.
20. Allen A, Dress A, Moore W. Mirror syndrome resulting from metastatic congenital neuroblastoma. Int J Gynecol Pathol 2007; 26: 310–2.
21. Acharya S, Jayabose S, Kogan S et al. Prenatally diagnosed neuroblastoma. Cancer 1997; 80: 304–10.
22. Grosfeld J, Rescorla F, West K, Goldman J. Neuroblastoma in the first year of life: clinical and biologic factors influencing outcome. Semin Pediatr Surg 1993; 2: 37–43.
________________________________________________
1. Woodward PJ, Sohaey R, Kennedy A, Koeller KK. A comprehensive review of fetal tumours with pathologic correlation. RadioGraphics 2005; 25: 215–42.
2. Moore S, Satge D, Sasco A et al. The epidemiology of neonatal tumours. Report of an international working group. Pediatr Surg Int 2003; 19: 509–19.
3. Sandrasegaran K, Lall C, Aisen A. Fetal magnetic resonance imaging. Curr Opin Obstet Gynecol 2006; 18: 605–12.
4. Castel V, Grau E, Noguera R, Martinez F. Molecular biology of neuroblastoma. Clin Transl Oncol 2007; 9 (8): 478–83.
5. Everson TC, Lole WH. Spontaneus regression of cancer. Philladelphia P.A. WB Saunders, 1966; p. 6–7.
6. Beckwith JB, Perrin EV. In situ neuroblastoma. Am I. Path 43. 1963; p. 1089–104.
7. Durnov L.A. Goldobenko G.V. Detskaia onkologiia. Moscow: Meditsina, 2005; p. 327–41 (in Russian).
8. Cooper GJ, Willis AS, Clark A et al. Purification and characterization of a peptide from amyloid-rich pancreases of type 2 diabetic patients. Proc Nath Acad Sci USA. 1987; 84: 8628–32.
9. Evans AE, Angio GJ, Propert K et al. Prognostic factor in neuroblastoma. Cancer 1987; 59: 1853–9.
10. Hoefnagel CA, Smets LA, Voute PA et al. Iodin-125-MIBG therapy for neuroblastoma. J Nucl Med 1991; 32: 361–2.
11. Papathanasiou N, Gaze M, Sullivan K et al. 18F-FDG PET/CT and 123I-Metaiodobenzylguanidine Imaging in High-Risk Neuroblastoma: Diagnostic Comparison and Survival Analysis. J Nucl Med 2011; 52 (4): 519–25.
12. Fox H, Sebire N. Pathology of the Placenta (3rd edn). Saunders: London, 2007.
13. Perkins D, Kopp C, Haust M. Placental infiltration in congenital neuroblastoma: a case study with ultrastructure. Histopathology 1980; 4: 383–9.
14. Jennings R, LaQuaglia M, Leong K et al. Fetal neuroblastoma: prenatal diagnosis and natural history. J Pediatr Surg 1993; 28 (9): 1168–74.
15. Fenart D, Deville A, Donzeau M, Bruneton J. Neuroblastomer.etrop.eritoneal diagnostiqu.e in utero. A propos d`un cas. J Radiol 1983; 64: 359–61.
16. Heling K, Chaoui R, Hartung J et al. Prenatal diagnosis of congenital neuroblastoma. Analysis of 4 cases and review of the literature. Fetal Diagn Ther 1999; 14: 47–52.
17. Soo-Hyun Lee, Jeong Yeon Cho, Mi Jin Song et al. Prenatal Ultrasound Findings of Fetal Neoplasms. Korean J Radiol 2002; 3 (1): 64–73.
18. Sebire NJ, Jauniaux E. Fetal and placental malignancies: prenatal diagnosis and management. Ultrasound Obstet Gynecol 2009; 33: 235–44.
19. Tihonenko I, Jeanty Ph. Fetal tumors. DVD, 2010.
20. Allen A, Dress A, Moore W. Mirror syndrome resulting from metastatic congenital neuroblastoma. Int J Gynecol Pathol 2007; 26: 310–2.
21. Acharya S, Jayabose S, Kogan S et al. Prenatally diagnosed neuroblastoma. Cancer 1997; 80: 304–10.
22. Grosfeld J, Rescorla F, West K, Goldman J. Neuroblastoma in the first year of life: clinical and biologic factors influencing outcome. Semin Pediatr Surg 1993; 2: 37–43.
Авторы
М.И.Пыков*1, Н.А.Кошечкина2, А.В.Тарачков2
1 ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России. 125993, Россия, Москва, ул. Баррикадная, д. 2/1;
2 Научно-исследовательский институт детской онкологии и гематологии ФГБУ «Национальный медицинский исследовательский центр онкологии им. Н.Н.Блохина» Минздрава России. 115478, Россия, Москва, Каширское ш., д. 23
*pykov@yandex.ru
________________________________________________
Mikhail I. Pykov*1, Natalia A. Koshechkina2, Andrei V. Tarachkov2
1 Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation. 2/1 Barrikadnaia st., Moscow, 125993, Russian Federation;
2 Research Institute of Pediatric Oncology and Hematology. 23 Kashirskoie h., Moscow, 115478, Russian Federation
*pykov@yandex.ru