Intratumoral angiogenesis quantified by microvessel density (MVD) has been shown to be a strong prognostic indicator in a number of malignant tumors. Its association with prognosis in bone sarcomas has been subject to less extensive research. The aim of this study was to investigate prognostic significance of angiogenesis in osteosarcoma. Thirty-nine patients with osteosarcoma were included in a retrospective immunohistochemical study. Sections from diagnostic biopsies were immunostained using anti-von Willebrand factor antibody and microvessels were counted at 400 x magnification on 3 microscopic fields per patient. MVD was correlated with overall and disease-free survival by Kaplan-Meier and log-rank analysis. Correlation between clinicopathological variables and the degree of angiogenesis was tested using a chi 2 test. Significant statistical difference was found regarding overall survival and disease-free survival between patients with high (> 32.3 vessels/field) and low (< or = 32.3 vessels/field) microvessel counts (log-rank test p = .0196 and p = .0147, respectively). The rate of metastasis was significantly higher in patients with high microvessel counts (p = .042). These findings strongly suggest that angiogenesis quantified by microvessel density is predictive of metastasis and poor prognosis in osteosarcoma.

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Objective: To present a case of a 6-month-old infant with melanotic neuroectodermal tumor of infancy (MNTI) in the upper arm. Clinical Presentation and Intervention: A 6-month-old female presented with a well-circumscribed lesion of the upper arm at the Children's Hospital Zagreb. A biopsy was performed and microscopy revealed 2 cell populations consisting of small neuroblastic cells and larger melanin-containing epithelial cells. An excisional biopsy performed 1 month later confirmed the initial diagnosis of MNTI, but the tumor had increased in size since the initial biopsy. After complete surgical excision the patient recovered well with no recurrence. Conclusion: The MNTI located in the upper arm was diagnosed on first biopsy and surgically excised completely. The patient recovered without recurrence in a follow-up of 2.5 years.

AimTo determine the activity of pseudocholinesterase (PChE) in cerebrospinal fluid (CSF) and serum in children with solid central nervous system (CNS) tumor and to assess whether PChE activity could be a valid biomarker for solid CNS tumors in children.MethodsThe study and control group included 30 children each. Children in the study group had a solid CNS tumor, while those from the control group had never suffered from any tumor diseases. CSF and serum samples were collected from all participants and PChE activity was determined using the Ellman’s spectrophotometric method. PChE activity in CSF was shown as a cerebrospinal fluid/serum ratio expressed in percentage, ie, PChE CSF/serum ratio. Receiver operating characteristic (ROC) curve was used to assess whether PChE activity can be used as a biomarker for identifying children with solid CNS tumors.ResultsChildren with solid CNS tumor had significantly higher PChE activity in CSF and serum, as well as PChE CSF/serum ratio (P = 0.001). PChE CSF/serum ratio in the study group was 2.38% (interquartile range [IQR] 1.14-3.97) and 1.09% (IQR 0.95-1.45) in the control group. ROC curve analysis of PChE CSF/serum ratio resulted in an area under the curve (AUC) value of 0.76 (95% confidence interval [CI] 0.63-0.88) and a cut-off of 1.09. Twenty five of 29 patients with elevated PChE CSF/serum ratio had a tumor, corresponding to a sensitivity of 83% and a specificity of 53%.ConclusionPChE CSF/serum ratio may be used as a test or biomarker with good sensitivity for solid CNS tumors in children.

An 8-year-old boy, diagnosed with autism, was referred to our department from another hospital due to profound normocytic anemia, without manifest bleeding. Problems started 4 months prior to admission, when he refused to stand on his feet after a minor fall, although an x-ray of his legs excluded fractures and other significant bone pathology. Initially, the refusal to walk was explained by a psychological reaction to fall. However, in the following period his condition progressively worsened; he stopped communicating, became incontinent, apathetic, inappetent, and generally very dissatisfied. Finally, he was hospitalized in critical condition and received urgent erythrocyte transfusion (Hb 4.3 g/dL).On admission, he was in poor general condition, agitated, tachycardic, and pale. Although the patient's body mass index (BMI) was 15.4 kg/m 2 (body height 130 cm, body weight 26 kg), placing the BMI-for-age at the 40th percentile, he seemed severely malnourished, he was sarcopenic and edematous. He had a diffuse perifollicular rash, gingival swelling, multiple dental caries, as well as signs of nutritive deficiency on his nails-leukonychia and Beau's lines. In addition, the patient presented with massive swelling of the left thigh (Figure 1). The skin above the swelling was tense and warm, while all arterial pulsations on the distal extremities were well palpable. Initial laboratory findings revealed normocytic anemia with reticulocytosis (post-transfusion Hb was 10.3 g/dL), severe hypoalbuminemia, hyponatremia, and elevated d-dimer levels. We conducted a Doppler ultrasound examination of both of his legs and abdomen, which excluded venous thrombosis, but detected 2 inhomogeneous soft tissue changes, one along the entire length of the left femur, from the trochanter minor to the femoral condyles, and the other along the left iliac bone. To clarify the etiology of those structures, the patient underwent a whole-body magnetic resonance imaging (MRI) scan which revealed multiple soft tissue changes (skin, subcutaneous mass,