Pediatric Malignancies

Abstract

The most common childhood malignancy is leukemia (30%), followed by brain tumors (20%), lymphomas, both Hodgkin’s (HL) and non-Hodgkin’s lymphoma (NHL) (14%), neuroblastoma (7%), soft tissue sarcoma (7%), Wilms’ tumor (6%), bone tumors (5%), germ cell tumors (3%), melanoma (3%), and hepatic tumors (1%). Their incidence varies according to patient age. Less common pediatric malignancies include head and neck cancer, Langerhans cell histiocytosis (LCH), germ cell tumors, neurofibromatosis type 1 with suspected malignant transformation, adrenocortical carcinoma, gastrointestinal stromal tumor (GIST), hepatoblastoma, hepatocellular carcinoma, carcinoid, insulinoma, and pheochromocytoma (Steliarova-Foucher et al., Lancet Oncol 18(6):719-731, 2017; Institute, NC. https://nccrexplorer.ccdi.cancer.gov/). Neuroblastoma is the second most common solid tumor in young children. It is a NET derived from the primitive neural crest. Although currently MIBG is embedded and required by international therapy protocols for patients with neuroblastoma and has a large body of evidence proving its validity and usefulness, PET tracers such as FDOPA, FDG, and 68Ga-peptides are increasingly used in imaging of neuroblastoma (Pai Panandiker et al., Clin Nucl Med 40(9):737-739, 2015). Additional pediatric NETs include ganglioneuroma, bronchial carcinoid (most common primary malignant pulmonary tumor in children), abdominal carcinoid (rare), pheochromocytoma, and PPGL. Approximately 75% of juvenile nasopharyngeal carcinomas also express surface membrane SSTRs. FDG-PET/CT is the scintigraphic study of choice for the assessment of lymphoma and sarcoma.