Multidisciplinary Teams for Rare Diagnoses

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Oncology Update

Care improves when experts from different subspecialties communicate and work together on cases. Our teams focused on rare diagnoses can be valuable resources for referring physicians and their patients.

Pediatric Thyroid Center

This collaborative program includes nationally recognized experts from endocrinology, oncology, radiology, pathology, surgery, otolaryngology, and nuclear medicine. They consult and provide care for children and adolescents with all forms of thyroid disease, including:

Since opening in 2009, the center has evaluated 3,500 patients, with more than 350 requiring thyroid surgery; and has cared for more than 150 patients with thyroid cancer, making it the busiest pediatric thyroid center in the United States. The center provides single-point access and patient-focused care. Patient and family quality of life, including health, social and economic issues, is monitored and supported via oncology social work services and behavioral health.

The goals of the center are to optimize accuracy of diagnosis and individualize management to decrease complications, while maintaining excellent long-term outcomes. The center also has multiple ongoing research protocols.

Pigmented Lesions Clinic

Melanoma in children and adolescents, while rare, is rising in incidence. The Pigmented Lesions Clinic offers consistent evaluation, pathology, treatment, and follow-up for children who present with suspicious skin lesions.

The team includes a pediatric oncologist, a pediatric dermatologist, a dermatopathologist, a general surgeon, and a plastic surgeon. They consult together on referrals where there is suspicion of melanoma or melanocytic tumors of uncertain malignant potential (MelTUMP).

Varying classification by pathologists is one of the biggest obstacles to consistency in treatment path. At CHOP the same dermatopathologist evaluates every case. His expertise is crucial in determining treatment, such as whether lymph node biopsy is warranted. The team has been building a registry of pediatric melanomas and MelTUMPs since 2014.

When excision and lymph node biopsy are warranted, the same general pediatric surgeon performs the procedures. For lesions of the face, the plastic surgeon may be called upon. Children with melanoma or MelTUMP see the dermatologist every three months for one year, and every six months for at least five years.

In those rare cases where a child with melanoma requires systemic oncologic treatment, CHOP offers clinical trials evaluating drugs that have demonstrated benefit in adults with advanced melanoma. For more information: Mia Benson Smith, MS, 267-426-0762.

HLH Treatment Team

Speed in diagnosis and quick, careful decisions about treatment reduce mortality and morbidity in hemophagocytic lymphohistiocytosis (HLH) in children.

The HLH Treatment Team provides rapid, thorough, and integrative care for children suspected of having HLH. The team includes oncologists, immunologists, pathologists, neurologists, rheumatologists, critical care physicians, clinical pharmacologists, and basic scientists. Their work includes education for primary care physicians, who are often the first to spot symptoms.

Clinical features of HLH may include high fever, spleen enlargement, rash, irritability, or seizures. Immune function tests and mutational analysis of the HLH-associated genes are required to determine whether the child has HLH and whether it is primary (familial) or secondary (sporadic).

For children who don’t respond to the available combinations of chemotherapy, steroids, and stem cell transplantation, CHOP offers options including clinical trials evaluating hybrid immune therapy (ATG/dexamethasone/etoposide) and the IL-6R inhibitor tocilizumab with the standard HLH backbone of dexamethasone/etoposide. For more information: Mia Benson Smith, MS, 267-426-0762.