Sarcoma as Second Cancer in a Childhood Cancer Survivor: Case Report, Large Population Analysis and Literature Review

Abstract

The majority of pediatric patients are cured of their primary cancer with current advanced developments in pediatric cancer therapy. However, survivors often experience long-term complications from therapies for primary cancer. The delayed mortality rate has been decreasing with the effort to reduce the therapeutic exposure of patients with pediatric cancers. Our study investigates the incidence of sarcoma as second cancer in pediatric cancer survivors. We present a 9-year-old male who survived embryonal hepatoblastoma diagnosed at 22 months of age. At 4.5 years of age, he presented with a non-metastatic primitive neuroectodermal tumor (PNET) of the left submandibular area. He has no evidence of recurrence of either cancer for 51 months after finishing all chemotherapy and radiotherapy. We used the Surveillance, Epidemiology, and End Results (SEER) database to identify the current rate of second sarcomas in pediatric cancer survivors. Our literature review and large population analysis emphasize the impact of sarcoma as a second malignancy and provide help to physicians caring for pediatric cancer survivors.

Keywords: SEER; hepatoblastoma; pediatric; sarcoma; second cancer.

Figure 1

CT scan of the abdomen without contrast at the diagnosis of hepatoblastoma. It demonstrates the right liver mass measuring 10 × 10 × 15 cm. The white arrows show the line between normal and neoplastic liver tissue. The arrows are within the normal liver tissue.

Figure 2

MRI of the face and mandible with and without contrast at the diagnosis of secondary PNET. The images show Short-TI Inversion Recovery (STIR). They demonstrate the mandibular mass. (A) Axial, (B) Sagittal, (C) Coronal.