Background: Germ cell tumors (GCTs) constitute a highly heterogeneous group of neoplasms that develop across a wide age range and vary in site and histological and clinical behaviors. We examined the outcomes at our institution to determine the clinical features of pediatric GCTs.

Patients and Methods: We retrospectively reviewed the medical records of 63 patients with extracranial GCTs from 2003 to 2017.

Results: The median age at diagnosis was 6.6 years (range, 10 days–14 years). The primary tumor sites were the ovary (40), testis (9), sacrococcygeal region (7), and mediastinum (7). As for histopathological findings, mature teratoma was identified in 41 patients, immature teratoma in 6 patients, yolk sac tumor in 11 patients, mixed GCT with yolk sac tumor components in 3 patients, and choriocarcinoma in 1 patient. One patient did not undergo any surgical tissue sampling because of cerebral hemorrhage from brain metastasis. Thirteen patients, including those with recurrence, were treated with platinum-based chemotherapy, and remission was achieved in 11 patients (85%).

Conclusions: Malignant germ cell tumors are sensitive to platinum-based chemotherapy, and thus, it is possible to manage patients with relapse with salvage chemotherapy and to reduce the tumor volume with neoadjuvant chemotherapy. In our patient, neoadjuvant chemotherapy can help achieve complete surgical resection. Therefore, neoadjuvant chemotherapy and delayed tumor resection should be considered in patients in whom complete resection would be difficult at initial surgery because of large tumor size or peritoneal dissemination.

Objective: The aim of this study was to determine the economic situation of parents with cancer-stricken children and their satisfaction with financial support.

Method: A questionnaire survey was carried out on 197 parents with cancer-stricken children obtained from The Japanese Research into Treatment for Specific Child Chronic Disease in Okayama. Questions included those on demographic characteristics, use of the medical expense subsidy system, satisfaction with economic support, economic burden, and anxiety levels. Logistic regression analyses were used to assess the factors associated with satisfaction with the economic support provided to families with cancer-stricken children.

Results: About 70% of 108 parents were satisfied with the public economic support, although they had economic burden due to costs other than medical treatment, such as their food expenses when hospitalized and transportation expenses during outpatient visits. Additionally, families who aggressively provided information on financial support by medical staff were significantly more satisfied than those who were passively (odds ratio, 10.3; 95% CI, 2.5 to 42.3). On the other hand, they felt anxious about economic burden after the expiration of the public financial support. Okayama Prefecture, which has more children and lower income than the national average, will therefore have a higher economic burden after the economic support expires.

Conclusion: Our findings highlight the importance of the positive attitudes of medical staff in providing information about financial, and economic support considering economical regional characteristics and economical situations.

[Background] The educational achievements of high school (HS) students with cancer are particularly important, since these may affect their future. In this article, we review their school performance. [Methods] We surveyed HS students receiving cancer treatment that required hospital admission longer than three months at our institution between April 2012 and March 2018. We reviewed their medical records and assessed the outcomes of their school performance status. E-mail questionnaires were sent to determine the educational support provided by other hospitals. [Results] There were seven boys and four girls. Five had hematologic malignancies and six had solid tumors. Four received chemotherapy only, four received chemotherapy plus surgery with or without radiotherapy, and three received stem cell transplantation. The median duration of treatment since enrollment into HS was six (range, 3–18) months. As for the final outcomes of their school performance, two patients dropped out, five repeated the same grade, three returned to the previous school without repeating the same grade, and one who did not go back to the previous school graduated from HS. Since 2015, we have initiated a support program for patients with teachers as volunteers during hospital admission. Regarding educational support at other institutions, only one had a HS support program in the hospital and another three had a system similar to ours. [Discussion] HS students receiving cancer treatment have a tendency to drop out or repeat the same grade and their school performance is poor. Educational support is insufficient. Establishment of a support system for cancer patients and supporting their reentry to HS are urgent.

An aberrant right subclavian artery (ARSA)–esophageal fistula is rare but highly fatal. A 4-year-old female patient with diffuse intrinsic pontine glioma presented with sudden massive hematemesis. Upper gastrointestinal endoscopy revealed massive pulsing bleeding from an ulcer in contact with a nasogastric tube (NGT) in the upper esophagus. A balloon in the esophagus stopped the bleeding temporally, and computed tomography revealed an ARSA–esophageal fistula. Transarterial embolization (TAE) stopped the bleeding completely, and she was saved. This is the first case of a pediatric cancer patient of its kind. Mucosal damage induced by chemotherapy might contribute to fistular development. Furthermore, this is the first report of a successful rescue of a patient with an ARSA–esophageal fistula by TAE. Therefore, we suggest evaluating the existence of ARSA in pediatric cancer patients with NGT insertion and treated with chemotherapy. TAE is effective in stopping the bleeding from an ARSA–esophageal fistula.

We report two rare cases of undifferentiated liver sarcoma (ULS). Case 1 was an 11-year-old girl presenting with fever and abdominal pain. Computed tomography (CT) revealed a large right-lobe liver tumor, and positron emission tomography-CT (PET-CT) demonstrated marked formation of tumor in the liver margin. A blood test showed a lactate dehydrogenase (LDH) level of 2145 U/ml and a CA 125 level of 178.8 U/mL, and biopsy revealed ULS. Tumor enucleation was performed after a five-course VAC regimen (namely, vincristine, actinomycin D, and cyclophosphamide). The patient underwent another eight courses of VAC postoperatively, and she is currently alive without recurrence 62 months after the completion of her treatment. Case 2 was 12-year-old boy presenting with distention of the upper right abdomen and abdominal pain. CT revealed a right-lobe liver tumor. PET-CT demonstrated the formation of tumor in the liver margin. A blood test showed an LDH level of 789 U/mL and a CA 125 level of 53.4 U/mL. With the presurgical diagnosis of ULS, the tumor was removed. The pathological finding of the excised tumor showed that the viable part of the liver showed polymorphic cell proliferation with severe hemorrhagic necrosis. Immunostaining revealed vimentin (−), α1ACT (+/−), and CD68 (−). Therefore, the final diagnosis was ULS. The patient underwent postoperative VAC (five courses), and he is currently alive without recurrence 16 months after the completion of his treatment. It is important to review the medical history when the LDH and CS 125 levels rise in older children.

The standard treatment for early-stage Hodgkin lymphoma (ESHL), either stage I or IIA without a bulky mass, comprises two to four courses of chemotherapy and involved-field radiation therapy (IFRT). To date, various chemotherapeutic regimens have been attempted for ESHL. In addition, omitting IFRT has been attempted to reduce late effects when a good treatment response is observed. We treated two pediatric ESHL patients with the VAMP regimen comprising vinblastine, doxorubicin, methotrexate, and prednisolone. Both patients achieved complete remission (CR), as confirmed by ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography, after two courses of the VAMP regimen, followed by two additional courses of the VAMP regimen without IFRT. Elevation of the levels of liver enzymes and neutropenia were the adverse events observed during treatment. Both patients maintained CR and did not develop late effects for more than four years after treatment. The findings of this study suggest that the VAMP regimen is safe for pediatric ESHL.