Background Osteosarcoma (OS) and the Ewing sarcoma family of tumors (ESFT) are the most common primary pediatric bone malignancies. We sought to assess the diagnostic accuracy of initial tumor biopsies in patients with OS or ESFT at a pediatric cancer center. Methods All biopsies performed at initial presentation of patients with OS or ESFT at our institution from 2003 to 2012 were retrospectively reviewed. Diagnostic accuracy and incidence of complications were correlated with study variables using logistic regression analysis. Results One hundred forty-two biopsies were performed in 105 patients (median age 13.4 years, range: 1.8-23.0), 104 (73.2%) OS and 38 (27.8%) ESFT. Thirty-one (21.8%) were performed on metastatic sites. Eighty-five (76.6%) of 111 primary site biopsies were open procedures, and 26 were percutaneous (23.4%). Primary site biopsies were successful in 94.1% of open and 73.1% of percutaneous procedures. Odds of obtaining a successful diagnostic specimen were 7.8 times higher with open approach (CI: 1.6-36.8). Metastatic site biopsies were successful in 66.7% of percutaneous and 100% of open and thoracoscopic procedures. Conclusion Biopsy of metastatic sites was equal to primary site in obtaining diagnostic material with the added benefit of accurate staging, with few adverse events and high diagnostic yield.

The discovery of an appendiceal carcinoid tumor found incidentally or during the course of diagnostic or therapeutic procedures is a burden to both the patient and clinician. The role of the correct surgical operation is paramount for lesions suspected to be malignant. In the pediatric population, appendiceal carcinoids continue to challenge the clinician in choosing the optimal treatment when lesions are larger than 2 cm or involve the appendical base. While the criteria used to define these distinct lesions are available in most cases, the management and treatment are still debated and controversial when considering more radical surgical intervention. The purpose of this article is to give an overview regarding the history, diagnosis, histopathology, management, and controversies associated with appendiceal carcinoid in the pediatric population.

Purpose Tumor biopsies are central to the diagnosis and management of cancer and are critical to efforts in personalized medicine and targeted therapeutics. We sought to evaluate the safety and accuracy of biopsies in children with cancer. Patients and Methods All biopsies performed in children at our institution with a suspected or established diagnosis of cancer from 2003 to 2012 were retrospectively reviewed. Patient characteristics, and disease- and procedure-related factors were correlated with procedure-related complications and diagnostic accuracy, using logistic regression analysis. Results One thousand seventy-three biopsies were performed in 808 patients. Of 1025 biopsies with adequate follow-up, 79 (7.7%) were associated with an adverse event, 35 (3.4%) of which were minor (Grade 1–2) and 32 (3.1%) were major (Grade 3–4). The most common major adverse events were blood transfusion (>10cc/kg, 24 cases) and infection requiring intravenous antibiotics (6 cases). Eleven deaths (1.4%) occurred within 30 post-procedure days but the procedure may have contributed to the outcome in only two. Nine hundred twenty-six (90.3%) biopsies provided definitive histologic diagnoses. Using multivariable analysis, biopsy site, pre-procedure hematocrit, and body mass index (BMI) were associated with risk of post-procedural complications (P<0.0001, P<0.0001, and P=0.0029, respectively). Excisional biopsy and biopsy site were independently associated with obtaining a diagnostic result (P=0.0002 and P=0.0008, respectively). Conclusion Tumor biopsies in children with cancer are associated with a low incidence of complications and a high rate of diagnostic accuracy. The predictive factors identified for adverse outcomes may aid risk assessment and pre-procedural counseling.

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An 11.5-month-old male, diagnosed with bilateral Wilms tumor at 10 months of age, received 6 weeks of chemotherapy and subsequently underwent bilateral partial nephrectomies. On postoperative day 5, he had crampy abdominal pain and bilious vomiting. Abdominal ultrasound confirmed the presence of an intussusception in the right lower quadrant. Laparotomy demonstrated two separate areas of small intestinal intussusception located at jejuno-jejunal and ileo-ileal locations. The patient was successfully treated with manual reduction. A high index of suspicion is necessary to diagnose and treat patients with two different points of intussusception.