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Desmoid tumors are a manifestation of familial adenomatous polyposis (FAP), associated with mutation of the APC gene. Although considered benign tumors, desmoids can be aggressive and cause considerable morbidity. Known risk factors for desmoid tumor growth include location of mutations within the APC gene, family history of desmoid tumors, previous surgery, female gender, and pregnancy. Desmoids occur at diverse sites, commonly within the abdomen or at sites of previous surgery; thoracic desmoids are relatively uncommon. Reported here is a highly desmoid tumor-prone FAP family with a truncating mutation in the APC gene at codon 1550 (c.4648G>T) in which female siblings developed remarkably similar thoracic desmoids with highly aggressive tumor behavior during the onset of puberty, throughout adolescence, and in one sibling during and following pregnancy. Both siblings had a fatal outcome. This case underscores the potential for aggressive behavior of desmoids during adolescence and the need for close vigilance during the adolescent and young adult (AYA) age range in desmoid-prone FAP kindreds.

Background: Features of clinical practice guideline (CPG) recommendations may affect understanding and consequently successful uptake and implementation. We aimed to develop a recommendation format to improve understandability among healthcare professionals involved in pediatric cancer care.Methods: We conducted a multi-center qualitative study of health care professionals at participating pediatric oncology sites. We developed an initial format based on the current literature and used the “think-aloud” technique in multiple rounds of one-on-one cognitive interviews to iteratively improve it. Interviews were conducted until the format was well understood and no new, substantive suggestions for revision were raised. We took a directed (deductive) approach to content analysis of the interview notes to identify concerns related to the understandability of the recommendation. Results: Five investigators interviewed 33 healthcare professionals from multiple disciplines in seven rounds. We identified important factors influencing how to communicate recommendations. Regarding the strength of the recommendation, participants found understanding weak recommendations more challenging than strong. Understanding was improved by using the word ‘conditional’ instead of ‘weak’. Participants believed the inclusion of a rationale section to be very helpful. More information was desirable when a recommendation entailed a practice change. Although participants wanted additional information, they were concerned that there could be too much information. They, therefore, suggested that key words and the studies included in the evidence synthesis be hyperlinked to explanatory data. In the final format, the recommendation strength is clearly indicated in the title, highlighted, and defined within a text box. The rationale for the recommendation is in a column on the left, with supporting evidence on the right. In a bulleted list, the rationale section describes the benefits and harms and additional factors, such as implementation, that were balanced by the CPG developers. Each bullet under the supporting evidence section indicates the level of evidence with an explanation and the supporting studies with hyperlinks when applicable. Conclusions: A well-understood recommendation format to present strong and conditional recommendations was created through an iterative interview process. The format is straightforward, making it easy for organizations and CPG developers to use it to communicate recommendations clearly to intended users.

Background Clinical practice guideline (CPG)-consistent care improves patient outcomes, but CPG implementation is poor. Little is known about CPG implementation in pediatric oncology. This study aimed to understand supportive care CPG implementation facilitators and barriers at pediatric oncology National Cancer Institute (NCI) Community Oncology Research Program (NCORP) institutions. Methods Healthcare professionals at 26 pediatric, Children's Oncology Group-member, NCORP institutions were invited to participate in face-to-face focus groups. Serial focus groups were held until saturation of ideas was reached. Supportive care CPG implementation facilitators and barriers were solicited using nominal group technique (NGT), and implementation of specific supportive care CPG recommendations was discussed. Notes from each focus group were analyzed using a directed content analysis. The top five themes arising from an analysis of NGT items were identified, first from each focus group and then across all focus groups. Results Saturation of ideas was reached after seven focus groups involving 35 participants from 18 institutions. The top five facilitators of CPG implementation identified across all focus groups were organizational factors including charging teams with CPG implementation, individual factors including willingness to standardize care, user needs and values including mentorship, system factors including implementation structure, and implementation strategies including a basis in science. The top five barriers of CPG implementation identified were organizational factors including tolerance for inconsistencies, individual factors including lack of trust, system factors including administrative hurdles, user needs and values including lack of inclusivity, and professional including knowledge gaps. Conclusions Healthcare professionals at pediatric NCORP institutions believe that organizational factors are the most important determinants of supportive care CPG implementation. They believe that CPG-consistent supportive care is most likely to be delivered in organizations that prioritize evidence-based care, provide structure and resources to implement CPGs, and eliminate implementation barriers. Trial registration ClinicalTrials.gov Identifier: NCT02847130. Date of registration: July 28, 2016.

Osteosarcoma is the most common primary bone tumor in children, and only 1 article in the literature describes a case of osteosarcoma in a patient with Down syndrome. Although osteosarcoma is generally treated with chemotherapy regimens that include high-dose methotrexate, patients with Down syndrome have heightened sensitivity to the toxicities of methotrexate. The patient from the aforementioned case study died from sepsis soon after treatment with high-dose methotrexate. This case report describes the successful treatment of osteosarcoma in a pediatric patient with Down syndrome without methotrexate.

IMPACT: By assessing function of mutant (patient-specific) tp53 in zebrafish embryonal rhabdomyosarcoma will inform clinicians of the severity of mutant tp53 alleles. OBJECTIVES/GOALS: This study aims to define loss- and gain-of-function TP53 mutations by comparing effects in tp53-null and wild-type tumors. In addition, it aims to generate a rapid in vivo analysis platform to assign function to patient specific TP53 mutations in the clinic METHODS/STUDY POPULATION: To define tp53 function in ERMS pathogenesis, we previously generated a new tp53-null mutant (tp53-/-) in zebrafish by deleting the entire tp53 genomic locus using TALEN mutagenesis. tp53-/- zebrafish spontaneously develop a spectrum of tumors including sarcomas, leukemia and germ cell tumors (Ignatius…Baxi et. al., eLife) reminiscent of tumors observed in Trp53-null mice. Using the tp53-/- mutants to generate kRASG12D-induced ERMS, we discovered that tp53 is a potent repressor of metastases but rather surprisingly had no effect on self-renewal (Ignatius…Baxi et. al., eLife). Here, using tp53-/- zebrafish, we assessed effects of wild-type and mutant (patient specific) tp53 on tumor initiation, proliferation and apoptosis. RESULTS/ANTICIPATED RESULTS: ERMS tumor initiation in the tp53-/- background is observed in > 97% of animals whereas only

ObjectivesTo translate a symptom screening tool developed for paediatric patients receiving cancer therapies called Symptom Screening in Pediatrics Tool (SSPedi) into Argentinian Spanish and to evaluate the understandability and cultural relevance of the translated version of SSPedi among children with cancer and paediatric haematopoietic stem cell transplant (HSCT) recipients.MethodsWe conducted a multiphase, descriptive study to translate SSPedi into Argentinian Spanish. Using two translators, forward and backward translations were performed. The translated version was evaluated by Spanish-speaking paediatric patients 8–18 years of age receiving cancer treatments in two centres in Argentina and El Salvador.Primary and secondary outcome measuresThe primary outcome was patient self-reported difficulty with understanding of the SSPedi instructions and each symptom using a 5-point Likert scale. Secondary outcomes were incorrect understanding of the SSPedi instructions, symptoms and response scale determined by cognitive interviews with the patients and rated using a 4-point Likert scale. Cultural relevance was assessed qualitatively.ResultsThere were 30 children enrolled and included in cognitive interviews; 16 lived in Argentina and 14 lived in El Salvador. The most common types of Spanish spoken were Central American (17, 57%) followed by South American (10, 33%) and Castilian (3, 10%). No changes to Argentinian Spanish SSPedi were required based on the outcomes or qualitative comments. No issues with cultural relevance were identified by any of the respondents.ConclusionsWe translated and finalised Argentinian Spanish SSPedi. Future research will focus on its use to describe bothersome symptoms by Argentinian Spanish-speaking children.

Osteosarcoma is the most common malignant bone tumor in children, adolescents, and young adults, with about 400 new cases diagnosed each year in the United States. It accounts for approximately 60% of all malignant bone tumors diagnosed in patients before the age of 20 with the peak incidence associated with puberty.1 Although osteosarcoma can occur in the axial skeleton, it typically presents in the metaphysis of long bones, a site of rapid bone growth during adolescence. The standard treatment for high-grade osteosarcoma requires both surgery and chemotherapy given preoperatively (neoadjuvant) and/or postoperatively. Despite improved surgical outcomes and efforts to intensify therapy, the 5-year event-free survival (EFS) remains 65% with no significant improvement in the past 20 years.2 In studies conducted pertaining to osteosarcoma outcome in pediatrics, only 10% to 15% of the cohorts are Hispanics. A study by Mirabello et al3 based on data from the National Cancer Institute’s Surveillance, Epidemiology, and End Results Program, indicates a higher incidence and slightly poorer outcome of osteosarcoma in Hispanics when compared with non-Hispanics. Hispanic patients that are reported in this studies come from a variety of locations including Mexico, South America, Cuba, and Latin America. In this study we performed a retrospective analysis of the characteristics and outcomes in patients with localized high-grade osteosarcoma of the extremity diagnosed under the age of 30 treated at a single institution, University of Texas Health Science Center at San Antonio (UTHSCSA), over an 11-year period. The patients in this study were 70% Hispanic, homogenously of Mexican American ancestry, therefore giving us a unique cohort to study. To the best of our knowledge, this is the largest series composed of such patients. Interestingly, we found a decreased survival of preadolescent patients compared with the patients who were between 12 and 30 years old at diagnosis. Furthermore, our data suggests that tumor necrosis after neoadjuvant chemotherapy might not be directly predictive of outcome.

Malignant mesothelioma (MM) is a highly aggressive malignancy that is extremely rare in children. This case report documents a 7-year-old male without previous asbestos exposure with peritoneal MM that initially responded to chemotherapy with cisplatin and gemcitabine but ultimately metastasized to his chest. He was diagnosed with MM based on histology, extensive immunohistochemical analyses, and an elevated serum CA-125 level. Cytogenetics and comparative genomic hybridization (CGH) analysis of his tumor identified a single extra copy number of chromosome 11 with few other changes noted. Pediatr Blood Cancer 2013; 60: 146–148. © 2012 Wiley Periodicals, Inc.