Introduction More than 85% of childhood malignancies occur in developing countries with less than a 30% cure rate as opposed to more than 80% cure rate in developed countries. This disproportionately significant difference might be due to delays in diagnosis, treatment initiation, lack of adequate supportive care, and treatment abandonment. We aimed to determine the impact of overall treatment delay on induction mortality of children with acute lymphoblastic leukemia treated at Tikur Anbessa specialized hospital (TASH). Methods A cross-sectional study was conducted among children who were treated from 2016 to 2019. Children with Down syndrome and relapsed leukemia were excluded from this study. Results A total of 166 children were included; most patients were males (71.7%). The mean age at diagnosis was 5.9 years. The median time interval from the onset of symptoms to the first TASH visit was 30 days and the median period from TASH’s first clinic visit to diagnosis was 11 days. The median time to initiate chemotherapy after diagnosis was 8 days. The total median time from the first onset of symptoms to chemotherapy initiation was 53.5 days. Induction mortality was 31.3%. High-risk ALL and patients with an overall delay between 30 and 90 days were more likely to experience induction mortality. Discussion Patient and healthcare system delay is high compared to most studies done and a significant association has been noted with induction mortality. Efforts to expand the pediatric oncology service in the country and efficient diagnostic and treatment approach need to be established to reduce mortality associated with overall delay.

Childhood adrenocortical carcinoma is an extremely rare cancer with a poor prognosis. It usually presents during the first 5 years of life with a median age of 3–4 years, although there is a second smaller peak during the adolescence period. Here, we report a 4 – years-old female child diagnosed with childhood adrenocortical carcinoma with distant metastasis after she presented with features of Cushing syndrome and recent worsening of abdominal swelling of a month duration. Chest and abdomen CT scan showed a left adrenal mass with liver and lung metastasis. Serum ACTH was low and serum cortisol was high. Biopsy from the liver showed secondary deposits with malignant carcinoma. She started treatment with chemotherapy with EDP regimenwith palliative intent. Despite chemotherapy she had progression of disease with systemic multiorgan involvement.

Childhood adrenocortical carcinoma is an extremely rare cancer with a poor prognosis. It usually presents during the first 5 years of life with a median age of 3-4 years, although there is a second smaller peak during the adolescence period. Here, we report a 4 -years-old female child diagnosed with childhood adrenocortical carcinoma with distant metastasis after she presented with features of Cushing syndrome and recent worsening of abdominal swelling of month duration. Chest and abdomen CT scan showed a left adrenal mass with liver and lung metastasis. Serum ACTH was low and serum cortisol was high. Biopsy from the liver showed secondary deposits with malignant carcinoma. She started treatment with chemotherapy with EDP regimen with palliative intent. Despite chemotherapy she had progression of disease with systemic multiorgan involvement.