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Immunosuppression is a serious side effect of chemotherapy which exposes the patient to significant complications from infection. Fungal infections are among the more serious potential infections, and candidiasis is the most common. In the last few years, microabscesses in the liver and spleen have been reported in increasing frequency. In a series of 60 children treated with intensive chemotherapy for acute lymphoblastic leukemia, systemic candidiasis was observed in seven. Of those, three children were diagnosed with hepatosplenic (liver and spleen) candidiasis. The patients developed a prolonged fever, and the neutrophils (type of white blood cell) in the blood were seriously reduced in number. However, the children did not have the toxic appearance normally associated with systemic infection. Blood cultures were negative, but colonies of candida albicans were evident in the patients' throat or in stool samples. A computerized tomography (CT) scan (diagnostic imaging technique) was performed on two patients, and numerous low-density lesions were visible; lesions were also observed using ultrasonography. The patients were treated with amphotericin B and 5-fluorocytosine. After two months, the 5-fluorocytosine was discontinued. One patient, for whom antifungal treatment was delayed, died before the infection was controlled. The other two patients are alive; one is in complete remission and the other is cured. These cases point out the need to be aware of the possibility of systemic candidiasis in these patients. Blood cultures are often negative and the small lesions do not appear on CT scan images or ultrasonograms until after the neutrophil count returns to normal. Successful treatment may depend on the initiation of therapy as soon as candidiasis is suspected. (Consumer Summary produced by Reliance Medical Information, Inc.)

Intratumoral heterogeneous MYCNamplification (hetMNA) is an unusual event in neuroblastoma with unascertained biological and clinical implications. Diagnosis is based on the detection of MYCNamplification surrounded by non-amplified tumor cells by fluorescence in situhybridization (FISH). To better define the genetic features of hetMNA tumors, we studied the Spanish cohort of neuroblastic tumors by FISH and single nucleotide polymorphism arrays. We compared hetMNA tumors with homogeneous MNA (homMNA) and nonMNA tumors with 11q deletion (nonMNA w11q-). Of 1091 primary tumors, 28 were hetMNA by FISH. Intratumoral heterogeneity of 1p, 2p, 11q and 17q was closely associated with hetMNA tumors when analyzing different pieces for each case. For chromosome 2, 16 cases showed 2p intact, 4 focal gain at 2p24.3 and 8 MNA. The lengths of the smallest regions of overlap (SROs) for 2p gains and 1p deletions were between the SRO lengths observed in homMNA and nonMNA w11q- tumors. Co-occurrence of 11q- and +17q was frequently found with the largest SROs for both aberrations. The evidence for and frequency of different genetic subpopulations representing a hallmark of the hetMNA subgroup of NB indicates, on one hand, the presence of a considerable genetic instability with different SRO of either gains and losses compared with those of the other NB groups and highlights and, on the other hand, the need for multiple sampling from distant and macroscopically and microscopically distinct tumor areas. Narrowing down the different SRO for both deletions and gains in NB groups would be crucial to pinpointing the candidate gene(s) and the critical gene dosage with prognostic and therapeutic significance. This complexity of segmental chromosomal aberration patterns reinforces the necessity for a larger cohort study using FISH and pangenomic techniques to develop a suitable therapeutic strategy for these patients.

Prognosis of relapsed and refractory neuroblastoma is uniformely fatal; new therapeutic approaches are needed. Relapsed and refractory neuroblastoma patients were treated with continuous infusion chemotherapy combined with MIBG. Over 4 years, 35 heavily pretreated patients were registered, 29 with bone or/and bone marrow metastases. Grade 3 or 4 hematologic toxicity was frequent, without toxic deaths. Sixteen patients responded. The probability of 5-year overall survival was 0.19. This approach is feasible and toxicity manageable; it rescued some patients and prolonged their survival. It merits assay in newly diagnosed high-risk neuroblastoma patients. Med. Pediatr. Oncol. 35:724–726, 2000. © 2000 Wiley-Liss, Inc.

A case report of ganglioneuroma secreting catecholamines is presented. The 131-I-MIBG gammagraphy was positive. We conclude that an uptake of 131-I-MIBG is not sinonimous of a malignant tumour.