technetium-tc-99m-sulfur-colloid and Wilms-Tumor

Two hundred six technetium-99m sulfur colloid bone marrow scans in 110 pediatrics patients were reviewed. The normal distribution of sulfur colloid in the lower extremities in various age groups was established. There was progressive loss of uptake with increasing age from less than two years to greater than ten years. Tumor replacement was seen as regions of decreased radioactivity, and the extent of the scan defect paralleled the response of the disease to therapy. Both chemotherapy and irradiation resulted in an extension of the Tc-99m SC to peripheral marrow sites. In irradiated areas, marrow scan defects were demonstrated and generally recovered normal activity by six months after the completion of therapy. Marrow scan abnormalities caused by tumor replacement were present in four patients despite normal bone scans and radiographs. Ultimate confirmation of tumor involvement was by needle aspiration or biopsy. Persistent marrow defects were seen in two patients with neuroblastoma who had remission of their disease: biopsy revealed myelofibrosis. Technetium-99m sulfur colloid bone marrow scanning is a sensitive monitor of altered marrow activity associated with pediatric hematologic or oncologic diseases.

Topics: Bone Marrow; Child; Child, Preschool; Hodgkin Disease; Humans; Lymphoma; Neoplasms; Neuroblastoma; Prospective Studies; Radionuclide Imaging; Reference Values; Sarcoma, Ewing; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid; Wilms Tumor

Two children being treated with combination chemotherapy and irradiation for localized, rightsided Wilms' tumor developed sudden enlargement of the liver with defects on liver scintigram resembling liver metastases. One child also developed pancytopenia. When chemotherapy was temporarily withheld in both children, hepatomegaly and scintigram abnormalities resolved. The planned courses of chemotherapy were subsequently completed without complications. The clinical course in our patients is compared to previously published experiences. Awareness of this complication could prevent the mistaken diagnosis of metastatic disease and emphasizes the care necessary when administering cytotoxic drugs to children receiving irradiation to all or a portion of the liver.

Topics: Antineoplastic Agents; Child, Preschool; Dactinomycin; Diagnostic Errors; Doxorubicin; Drug Therapy, Combination; Female; Hepatomegaly; Humans; Kidney Neoplasms; Liver Neoplasms; Male; Radionuclide Imaging; Radiotherapy Dosage; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid; Vincristine; Wilms Tumor