Pediatric Hematology/Oncology and ImmunopathologyPediatric Hematology/Oncology and ImmunopathologyВопросы гематологии/онкологии и иммунопатологии в педиатрии1726-17082414-9314Fund Doctors, Innovations, Science for Children28510.24287/1726-1708-2019-18-4-58-65CLINICAL OBSERVATIONSКЛИНИЧЕСКИЕ НАБЛЮДЕНИЯHepatoblastoma relapses with a normal level of alpha-fetoprotein: report of two casesРецидивы гепатобластомы с нормальным уровнем альфа-фетопротеинаhttps://orcid.org/0000-0002-3704-8783KachanovD. Yu.КачановД. Ю.
Russian Federation

Correspondence: Denis Yu.Kachanov,MD, Department of clinical oncology, Dmitriy Rogachev National Medical Research Center of Pediatric Hematology, Oncology, Immunology Ministry of Healthcare of Russian Federation.

Address: Russia 117997, Moscow, Samory Mashela st., 1

Контактная информация: Качанов Денис Юрьевич, д-р мед. наук, зав. отделением клинической онкологии, зам. директора Института онкологии, радиологии и ядерной медицины НМИЦ ДГОИ им. Дмитрия Рогачева Минздрава России.

Адрес: 117198, Москва, ГСП-7, ул. Саморы Машела, 1

https://orcid.org/0000-0003-1091-1521AlievT. Z.АлиевТ. З.
Russian Federation

Moscow

Москва

https://orcid.org/0000-0002-9654-084XMoiseenkoR. A.МоисеенкоР. А.
Russian Federation

Moscow

Москва

https://orcid.org/0000-0002-9375-7517RoschinV. Yu.РощинВ. Ю.
Russian Federation

Moscow

Москва

https://orcid.org/0000-0002-2399-6811MetelinA. V.МетелинА. В.
Russian Federation

Moscow

Москва

https://orcid.org/0000-0001-9424-1646UskovaN. G.УсковаН. Г.
Russian Federation

Moscow

Москва

https://orcid.org/0000-0002-3767-4477ShamanskayaT. V.ШаманскаяТ. В.
Russian Federation

Moscow

Москва

https://orcid.org/0000-0003-4205-5627FilinA. V.ФилинА. В.
Russian Federation

Moscow

Москва

https://orcid.org/0000-0001-6131-1783VarfolomeevaS. R.ВарфоломееваС. Р.
Russian Federation

Moscow

Москва

Dmitriy Rogachev National Medical Research Center of Pediatric Hematology, Oncology, Immunology Ministry of Healthcare of Russian FederationФГБУ «Национальный медицинский исследовательский центр детской гематологии, онкологии и иммунологии им. Дмитрия Рогачева» Минздрава РоссииB.V. Petrovsky Russian National Center of Surgery Russian Academy of ScienceФГБУ «Российский национальный центр хирургии им. акад. Б.В. Петровского»3112201918458653012201930122019Copyright ©; 2019, «D. Rogachev NMRCPHOI»Copyright ©; 2019, ФГБУ «НМИЦ ДГОИ им. Дмитрия Рогачева» Минздрава России2019«D. Rogachev NMRCPHOI»ФГБУ «НМИЦ ДГОИ им. Дмитрия Рогачева» Минздрава Россииhttps://creativecommons.org/licenses/by/4.0https://hemoncim.com/jour/article/view/285

Hepatoblastoma (HB) is the most common malignant liver tumor in children. The level of alpha-fetoprotein (AFP) is used for monitoring the response to antitumor therapy and for diagnosing relapses. The occurrence of HB relapses with normal AFP levels in patients who had elevated levels of this tumor marker at disease onset is considered to be an uncommon situation. The aim of this study was to describe cases in which AFP-negative hepatoblastoma relapses developed. The study participants included two HB patients who were initially stratified into high-risk and standard-risk groups and who received treatment at the Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology and the Petrovsky National Research Center of Surgery inMoscow. At the moment of relapse acknowledgement these patients had normal AFP levels, which was confirmed by serial measurements. Immunohistochemistry (IHC) tests were performed on paired samples of the tumor at disease onset and at disease relapse respectively to evaluate AFP expression. The presented clinical cases demonstrate that normal AFP levels, when accompanied by suspicious clinical symptoms, do not allow to exclude an HB relapse. The possibility of relapse with a normal AFP level reinforces the importance of following the current plan of screening tests, which includes not only an evaluation of AFP levels, but also other tests such as a chest X-ray and an abdominal ultrasound. Parents gave their consent to use information about the child in the article.

Гепатобластома (ГБ) – наиболее частая злокачественная опухоль печени у детей. Значения показателя альфа-фетопротеина (АФП) используются для мониторинга ответа на противоопухолевую терапию и диагностики рецидивов заболевания. Развитие рецидивов ГБ при нормальных значениях АФП в тех случаях, когда в дебюте заболевания у пациентов отмечали повышенные значения данного онкомаркера, – редкая ситуация. В статье описаны случаи развития АФП-негативных рецидивов ГБ. В исследование включены два пациента с ГБ, инициально стратифицированные в группы высокого и стандартного риска, получавших лечение в условиях НМИЦ детской гематологии, онкологии и иммунологии им. Дмитрия Рогачева и Российского национального центра хирургии им. академика Б.В. Петровского, у которых в момент констатации рецидива заболевания отмечены нормальные уровни АФП, подтвержденные повторными измерениями. На парных образцах опухоли в дебюте и рецидиве заболевания проведено иммуногистохимическое исследование для оценки экспрессии АФП. Представленные клинические случаи свидетельствуют о том, что нормальные значения АФП при сомнительной клинической симптоматике не исключают рецидива ГБ. Возможность развития рецидивов при нормальных значениях АФП подчеркивает важность следования текущему плану диспансерного наблюдения, включающему не только оценку уровня АФП, но и рентгенографию органов грудной клетки и УЗИ органов брюшной полости. Родители пациентов дали согласие на использование информации о детях в научных исследованиях и публикациях.

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