Adult-type epithelial neoplasms in children and adolescents- A retrospective analysis on a subgroup of very rare tumors
Gazel Sainulabdin®, V. P. Krishnan®, Smitha Bhaskarano, Yamini Krishnan®
Department of Pediatric Hematology Oncology and Bone Marrow Transplantation, MVR Cancer Centre and Research Institute, Kozhikode, Kerala, India Correspondence to: Gazel Sainulabdin, E-mail: gazelsain@gmail.com
Abstract
Background: Epithelial malignancies, which constitute the majority of adult cancers, are relatively rare in the pediatric population, accounting for only 2% of all childhood tumors. In contrast to common childhood cancers-which typically arise from embryonal or mesenchymal tissues-epithelial malignancies originate from the epithelial lining of glands and include carcinomas of the lung, breast, colon, and genitourinary tract. Understanding the occurrence, behavior, and treatment outcomes of adult-type epithelial malignancies in children is essential for developing age-appropriate management strategies and improving long-term survival. This emerging subset of pediatric cancers warrants further investigation and collaborative efforts to establish optimal diagnostic criteria, staging systems, and therapeutic approaches tailored to younger patients. We undertook a 5-year retrospective analysis of children diagnosed with adult-type epithelial malignancies at our center.
Methods: Study Design: This is a retrospective data analysis conducted at MVR Cancer Centre and Research Institute (MVRCCRI), focusing on pediatric patients below 18 years of age who presented between the years January 2019 and December 2024. Inclusion criteria: All children under 18 years of age who presented to MVRCCRI provided they had an adult-type neoplasm of epithelial origin were included in this study. Statistical analysis was performed. The mean, intervals and percentages in each group were calculated. Institutional ethical committee approval was obtained for this retrospective review.
Results: A total of 69 children who were younger than 18 years were included in the study. There were 18 males and 51 females in the study giving a male to female ratio of 1:2.8. Three children had a family history of malignancy: one had a history of consanguinity was diagnosed with CMMRD on genetic evaluation, and the other had a mother with breast cancer and a pathological variant in the ATM gene. The third child with adrenocortical carcinoma had a pathological variant in TP53 diagnosed in mother. The children were analyzed based on the primary diagnosis. The largest group of epithelial malignancies in our cohort was thyroid malignancy, and the second largest group was carcinoma of the salivary glands. Children who presented with early stages of disease fared well in all the groups.
Conclusion: Adult-type epithelial neoplasms in children and adolescents are distinct entities, characterized by unique biological behaviors and genetic signatures. Treatment approaches should integrate principles from adult oncology and collaborative studies are essential to define the epidemiology, for staging and prognostic markers, and also to develop pediatric-specific treatment protocols for these malignancies.
Keywords:
Childhood and adolescence, epithelial neoplasms, rare tumors
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| DOI: 10.4103/ijc.ijc_96_25 | |
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How to cite this article: Sainulabdin G, Krishnan VP, Bhaskaran S, Krishnan Y. Adult-type epithelial neoplasms in children and adolescents-A retrospective analysis on a subgroup of very rare tumors. Indian J Cancer 2025;62:528-34.
Submitted: 03-Dec-2025 Accepted: 24-Dec-2025
Revised: 22-Dec-2025 Published: 07-Mar-2026
Epithelial neoplasms in children and adolescents-retrospective analysis
Background
Epithelial malignancies, which constitute the majority of adult cancers, are relatively rare in the pediatric population, accounting for only 2% of all childhood tumors.[1] In contrast to common childhood cancers- which typically arise from embryonal or mesenchymal tissues, such as leukemia, brain tumors, and sarcomas-epithelial malignancies originate from the epithelial lining of glands and include carcinomas of the lung, breast, colon, and genitourinary tract. However, with increasing cancer surveillance and advancements in diagnostic capabilities, sporadic instances of adult-type epithelial tumors are being reported in children and adolescents.[2]
For early diagnosis, it is essential to increase awareness among both parents and healthcare providers that these tumors can also occur in children. Due to atypical clinical presentations and pathological features-including molecular characteristics that differ from their adult counterparts-these rare neoplasms often pose diagnostic and therapeutic challenges. The absence of pediatric-specific guidelines and limited familiarity among pediatric oncologists and surgeons further complicates treatment.[2] Additionally, many of these children have underlying genetic predispositions or syndromic associations, such as Li-Fraumeni syndrome, Lynch syndrome, or constitutional mismatch repair deficiency (CMMRD).
Understanding the occurrence, behavior, and treatment outcomes of adult-type epithelial malignancies in children is essential for developing age-appropriate management strategies and improving long-term survival. This emerging subset of pediatric cancers warrants further investigation and collaborative efforts to establish optimal diagnostic criteria, staging systems, and therapeutic approaches tailored to younger patients.[3] We undertook a 5-year retrospective analysis of children diagnosed with adult-type epithelial malignancies at our center.
Materials and Methods
Study design
This is a retrospective data analysis conducted at MVR Cancer Centre and Research Institute (MVRCCRI), focusing on pediatric patients below 18 years of age who presented between the years January 2019 and December 2024.
Inclusion criteria
All children under 18 years of age who presented to MVRCCRI-either as newly diagnosed cases or as referrals after prior treatment were included, provided they had an adult type neoplasm of epithelial origin.
Data collection
Patient data were extracted from electronic medical records and analyzed for the following parameters: demographics, pathological diagnosis, staging of the malignancy was done as per TNM staging, treatments received, including surgery, chemotherapy, radiotherapy, or a combination (multimodal therapy), previous treatment history, including prior malignancies (first or second cancers), family history of malignancy, and follow-up details. Patients were categorized based on the primary site and pathological subtype of their malignancy. The stage at presentation and the treatment modality (single versus multimodal) were documented. The current status of the patient during follow-up was also assessed.
Statistical analysis was performed. The mean, intervals and percentages in each group were calculated.
Institutional ethical committee approval was obtained obtained for this retrospective review.
Results
A total of 69 children who met the inclusion criteria were included in the study [Table 1]. All were younger than 18 years, with a mean age at presentation was 14.2 years (range 1-17 years). There were 18 males and 51 females in the study giving a male to female
| Table 1: Patient characteristics of the cohort | |
|---|---|
| Patient characteristics | Number of Patients in each group |
| Total number | 69 |
| Age in years mean (range) | 14.2 (1-17 years) |
| Male:female | 1:2.8 |
| Diagnosis, n (%) | |
| EOCRC | 6 (8.7%) |
| GEC | 2(2.9%) |
| Thyroid | 30 (43.4%) |
| Salivary gland neoplasm | 8 (11.6%) |
| Breast cancer | 1 (1.4% |
| Nasopharyngeal carcinoma | 4 (5.8%) |
| Adrenocortical malignancy | 2 (2.9%) |
| Hepatocellular Ca | 1 (1.4%) |
| Ovarian neoplasm | 7 (10.2%) |
| Tongue carcinoma | 1 (1.4%) |
| Carcinoid tumor | 3 (4.4%) |
| Renal cell carcinoma | 2 (2.9%) |
| Choroid plexus Ca | 1 (1.4%) |
| Aesthesioneuroblastoma | 1 (1.4%) |
| Metastatic, n (%) | 15 (21.7 %) |
| Family, n (%) | 3 (4.4%) |
| Consanguinity, n (%) | 2 (2.9%) |
| Genetic predisposition, n (%) | 3 (4.4%) |
EOCRC, early onset colorectal cancer, GEC, gastroesophageal cancer
Key Message
Adult-type epithelial neoplasms in children and adolescents are distinct entities, characterized by unique biological behaviors and genetic signatures. Treatment approaches should integrate principles from adult oncology with insights derived from pediatric genetic profiling.
ratio of 1:2.8. A family history of malignancy was present in 3 (4.4%) children in the study (breast cancer in mother, medulloblastoma in sibling, and acute myeloid leukemia (AML) in mother respectively). A history of consanguinity was noted in 2 (2.9%) of the 69 children. At presentation, 15 (21.7%) children had metastatic disease. Germline mutations were detected in 3 (4.3%) children. The detailed characteristics of the TP53, ATM and PMS2 genes are described in Table 2.
The children were analyzed based on the primary diagnosis, and the detailed analysis is given in Table 3. The largest group of epithelial malignancies in our cohort was thyroid malignancy seen in 30 (43.4%) children. Females predominated with a male: female ratio of 1:3. Most children had localized disease at presentation (26; 86.6%). Of the 30 children, 29 (96.6%) had papillary carcinoma and majority of children required two modality of treatment: surgery and I 131 ablation. The second largest group was carcinoma of the salivary glands with 8 (11.6%) children. Males were more affected in this group. M: F is 3:1; and majority of children had localized disease (75%).
Colorectal carcinoma was diagnosed in 6 (8.8%) children with a mean age of 15 years (range: 12-17 years) and a male to female ratio of 1:5. Five out of the six children presented with stage III or higher disease. Two had a family history of malignancy: one had a history of consanguinity was diagnosed with CMMRD on genetic evaluation, and the other had a mother with breast cancer and a pathological variant in the ATM gene. Ovarian carcinoma was diagnosed in 7 (10.2%) children.
Four (5.8%) children had nasopharyngeal carcinoma. Males were predominantly affected in this group and all the children presented with advanced disease (Stage III: 50% and Stage: IV-50%). Two female children, both aged 17 years with gastroesophageal carcinoma, presented with advanced disease and died due to illness while on chemotherapy.
Three (4.4%) children had carcinoid at different sites. All had localized disease, underwent surgery alone, and remain alive on follow-up. Adrenocortical malignancy was found in 2 (2.9%) children with a mean age at presentation of 3.5 years (range: 3-4 years). One was a male child with metastatic disease and he had a family history of malignancy in mother (died of AML) and maternal aunts (Ca breast). His mother had a pathological variant in P53 gene. He died of a second malignancy (sarcoma). The other was a girl with localized disease, and she was managed with surgery alone.
Two (2.9%) children had renal cell carcinoma (RCC), both female children aged 17 years. The child with stage I papillary RCC fared well with surgery alone. The other child had metastatic clear cell RCC which progressed on treatment with tyrosine kinase inhibitors and succumbed to her disease. Single cases (1.4% each) were identified for breast carcinoma, hepatocellular carcinoma, carcinoma of tongue, choroid plexus carcinoma, and aesthesioneuroblastoma. The clinical and pathological characteristics are detailed in Table 3.
Discussion
In order to bring more attention and research to neoplasms that are uncommon, pediatric oncologists
| Malignancy in index case | Family history | Gene | Variant identified | Exon |
|---|---|---|---|---|
| Ca colon | Mother had Ca breast at 30 years of age | ATM | chr 11:g.108236057T>C c.8993T>C, p.Ile2998Thr Heterozygous | 63 |
| Adrenocortical Ca-1st malignancy 2nd-malignancy | Mother died of AML. She had adrenal tumor in childhood Aunt had leukemia | P53 | NA | NA |
| Follicular dendritic sarcoma | Breast and pancreatic malignancy in family | |||
| Ca colon with metastasis, 2nd | Sibling had medulloblastoma | PMS2 | c.778del (p.Ser260ProfsTer47) Homozygous | 7 |
| 1 st malignancy -medulloblastoma |
| Type of neoplasm | Total n (%) | Age in years Mean (range) | Male: Female | n (%) Stage | Pathology n (%) | Treatment | Survival | Family History | Genetic predisposition N |
|---|---|---|---|---|---|---|---|---|---|
| Early Onset Colorectal | 6 (8.8%) | 15 (12-17) | 1:5 | Stage I -1(16.6%) | -MD adenoCa - 2 | -SX-1 | Expired-3 | Yes | ATM-1 |
| Carcinoma | Stage III-2(33.4%) | -PD adeno Ca-1 | -SX + CTX-4 | Alive with | CMMRD-1 | ||||
| (Colon-5 | Stage IV-3 (50%) | -Mucinous Ca-1 | -CTX-1 | disease-1 | |||||
| Rectum-1) | -Signet cell Ca-1 | Alive-1 | |||||||
| -Adeno Ca (NOS)-1 | LTF-1 | ||||||||
| Gastro esophageal cancer | 2 (2.9%) | 17 (17) | 0:2 | Stage III-1(50%) | -PD Ca-1 | -CTX-2 | Expired-2 | No | None |
| (Esophagus-1, Stomach-1 | Stage IV-1(50%) | -Squamous cell carcinoma-1 | |||||||
| Thyroid cancer | 30 | 13.3 (4-17) | 1:3 | Localized-26(86.6%) | -Papillary Ca | -SX-8 (26.7%) | Alive-27 | No | None |
| (43.4%) | Metastatic-4 | -29 (96.6%) | -SX + | LTF-3 | |||||
| (14.4%) | -Follicular subtype-3 -Diffuse sclerosis-2 -Follicular Ca-1(4.4%) | I131ablation-22 (73.3%) | |||||||
| Salivary gland neoplasm | 8 (11.7%) | 14 (11-17) | 3:1 | Stage I -4 | -Mucoepidermoid Ca -5 | -SX-7 | All alive | No | None |
| Stage II-2 Stage III-1 | -Pleomorphic adenoma-3 | -SX + XRT-1 | |||||||
| Stage IV-1 | |||||||||
| Breast cancer | 1 (1.4%) | 17 years | 0:1 | Stage IV | Invasive ductal carcinoma | -CTX+ | Expired | No | None |
| ER+PR-Her2neu3+ | Trastuzumab | ||||||||
| Nasopharyngeal carcinoma | 4 (5.8%) | 11.5 (5-16) | 3:1 | Stage III-2 | -PD carcinoma-3 | CTX +XRT - 4 | Alive-2 | No | None |
| Stage IV-2 | -Undifferentiated Ca-1 | Expired-2 | |||||||
| Adrenocortical malignancy | 2 (2.9%) | 3.5 (3-4) | 1:1 | Metastatic-1 | Adrenocortical carcinoma-1 | SX-2 | Expired 1 | Yes | TP53 -1 |
| Nonmetastatic-1 | Adrenocortical tumor-1 | Alive 1 | |||||||
| Hepatocellular carcinoma | 1 (1.4%) | 13 (13) | 1:0 | Stage IV-1 | LTF-1 | No | None | ||
| Ovarian neoplasm | 7 | 15 (13-17) | 0:7 | Stage I A-3 | Borderline mucinous-3(42.8%) | SX - 6 | Alive-5 | No | None |
| (10.2%) | Stage III-1 | Mucinous adeno Ca-3 (42.8%) | SX+CTX-1 | ||||||
| Borderline-3 | Endometrioid Ca-1(14.4%) | ||||||||
| Tongue carcinoma | 1 (1.4%) | 15 (15) | 1:0 | Stage I-1 | MD Squamous cell ca | SX+ XRT | Alive-1 | No | None |
| Carcinoid tumor | 3 (4.4%) | 15 (13-17) | 1:2 | Localized-3 | Appendix-1 | SX-3 | Alive with | No | None |
| Head of pancreas-1 | disease-1 | ||||||||
| Lungs-1 | Alive-1 LTF-1 | ||||||||
| Renal cell carcinoma | 2 (2.9%) | 17 (17) | 0:2 | Stage I-1 | Papillary renal cell carcinoma-1 | SX-1 | Alive-1 | No | None |
| Stage IV-1 | Clear cell renal cell carcinoma-1 | SX+ TKI-1 | Dead-1 | ||||||
| Choroid plexus carcinoma | 1 (1.4%) | 1 (1) | 0:1 | Localized-1 | Choroid plexus carcinoma 1 | Surgery-1 | Alive | No | None |
| Aesthesioneuroblastoma | 1 (1.4%) | 6 (1) | 0:1 | Stage IV | Aesthesioneuroblastoma | Chemo+XRT | Alive | No | None |
MD, moderately differentiated, PD, poorly differentiated, SX, surgery, CTX, chemotherapy, XRT, radiotherapy, LTF, lost to follow-up, TKI, tyrosine kinase inhibitors, CMMRD, constitutional mismatch repair deficiency
have coined the term “very rare tumors” (VRT). The annual incidence of these tumors is less than 2 per million per year and constitutes 11% of all cancers in children between 0 and 14 years of age.[4] These include tumors that are rare in both adults and the pediatric population, and a second group of adult-type rare tumors that are frequent in adults but very rare in children.[5] Adult-type epithelial tumors among this group are mainly treated with adult-derived treatment regimens, which leads to either worse prognosis or overtreatment in many cases.[6]
In adults, somatic gene alterations are responsible for the development of malignancy, mainly driven by long-term exposure to carcinogens. This hypothesis cannot be extrapolated to a child, given the time required for oncogenesis. Given the differences in the clinical, histopathological, genomic, epigenetic, and immunological landscape between adult and pediatric epithelial neoplasms, it is imperative that we elucidate the mechanisms underlying the development of these malignancies in children and develop specific targeted approaches different from those being followed in adults.[5]
Early efforts to focus research on very rare tumors (VRTs) began in 2000 with the launch of the “Rare Tumours in Paediatric Age Project” (TREP) in Italy. Subsequent coordinated initiatives led to the formation of large study groups, such as the EXPERT group, established by European investigators in 2008. This group included national working groups from Italy, France, Poland, the United Kingdom, and Germany. [7,8] The PARTNER project (Paediatric Rare Tumours Network - European Registry) was launched in 2016 with the aim of creating a unified European registry that links existing national databases to facilitate data collection on children and adolescents with VRTs.[7] In the United States, the Children’s Oncology Group (COG) formed the Rare Tumor Committee to explore the epidemiological landscape of rare childhood cancers using data from the SEER database. This committee is divided into two subcommittees: the Retinoblastoma Subcommittee and the Infrequent Tumor Subcommittee. The latter focuses on rare tumors such as adrenocortical carcinoma (ACC) and nasopharyngeal carcinoma (NPC), as well as tumors that are rare in young children but more common in adolescents and young adults, including colorectal carcinoma (CRC), thyroid carcinoma, and melanoma.[9] Additionally, the NCI’s My Paediatric and Adult Rare Tumor Network (MyPART), supported by the NCI Cancer Moonshot initiative, aims to define the natural history, biology, and clinical course of pediatric rare
solid tumors, with the goal of improving care and treatment outcomes.[10]
Although several investigators have published data on very rare tumors (VRTs), there is limited information specifically on the subgroup of adult-type epithelial neoplasms. In the data published by Al-Sheyyab et al.[11] from the United Kingdom, the most common tumor was carcinoid (44 cases), followed by skin tumors,[12] (12 cases) nasopharyngeal carcinoma,[13] (13 cases) salivary gland tumors,[14] (14 cases) and adrenocortical carcinoma (14 cases).[14] In our analysis from South India, the most common neoplasm was thyroid carcinoma, followed by salivary gland tumors, ovarian neoplasms, and early-onset colorectal cancers (EOCRC). In the FRACTURE database, maintained by the Very Rare Tumour Committee of the French Society of Paediatric Oncology (SFCE), among 97 histological subtypes registered, the most frequent adult-type epithelial neoplasms were carcinoid tumors, thyroid carcinoma, and pancreatic and pulmonary tumors.[12] In our cohort, carcinoid tumors were rare, accounting for only 4.4% of all neoplasms. In contrast to Western data, none of the children in our series had skin malignancies. While data from other centers in India have shown a predominance of nasopharyngeal carcinoma, this was not a common diagnosis in our population.[13,14]
Early-onset colorectal carcinoma (EOCRC) accounts for only 1% of all pediatric malignancies, with most affected children being older than 10 years of age.[15] Although the incidence is lower than in adults, EOCRC is the fourth most common cause of cancer-related death among adolescents and young adults.[16] EOCRC most frequently arises in the rectum, followed by the distal colon. Recent studies have highlighted a rising incidence of rectal cancer in the pediatric population, in contrast to colon cancer. Most cases of EOCRC present at advanced stages and exhibit aggressive histological subtypes, such as signet ring cell carcinoma, poorly differentiated adenocarcinoma, and mucinous carcinoma, leading to a poor prognosis. Contributing factors include lack of awareness, exclusion from standard screening programs, and delays in seeking medical care. Germline mutations- such as Lynch syndrome (including constitutional mismatch repair deficiency), familial adenomatous polyposis (FAP), and hereditary nonpolyposis colorectal cancer (HNPCC)-are more frequently identified in younger patients.[17] In our cohort, 85% of children presented with advanced-stage disease, and 50% had adverse pathological features. Among the six children evaluated, only one had rectal carcinoma. Two children had confirmed germline
Epithelial neoplasms in children and adolescents-retrospective analysis
mutations, both associated with a strong family history of cancer. In the gastroesophageal region, the most common malignancies in children are gastrointestinal stromal tumors (GISTs), lymphomas, and soft-tissue sarcomas. Carcinomas constitute less than 1% of cases. Adenocarcinoma is the most prevalent histological type and may be associated with HNPCC, previous treatment for gastric lymphoma, or occur de novo. Although studies on this rare entity are limited, a retrospective analysis from Japan reported an overall survival rate of only 20%.[18] In our series, both children diagnosed with gastroesophageal carcinoma presented with advanced disease and succumbed to it.
Differentiated thyroid carcinoma (DTC), though rare in children, remains the most common endocrine neoplasm in the pediatric population. The most frequent subtype is papillary carcinoma, followed by follicular carcinoma. The clinical presentation and biology of thyroid carcinoma in children and adolescents differ from those in adults, with children typically presenting at a more advanced stage but demonstrating a better response to treatment. Unlike adult-onset DTC, which commonly harbors BRAF and RAF point mutations, pediatric cases more often exhibit RET/PTC rearrangements. These rearrangements do not induce genomic instability, which is thought to contribute to the favorable response to radioactive iodine (RAI) therapy, improved survival rates, and a lower risk of anaplastic transformation. The authors have previously published a detailed analysis of children presenting with thyroid carcinoma, including clinical presentation, biological behavior, and outcomes.[19] Among the adult-type epithelial neoplasms analyzed, DTC was the most common in our cohort. The majority of patients (83.3%) presented with extensive nodal involvement and lung metastases; notably, all children survived despite the presence of metastatic disease. There is ongoing debate regarding whether children require treatment as aggressive as that administered to adults-specifically, total thyroidectomy followed by I-131 ablation. Whether the higher incidence of thyroid cancer observed in our series, compared to other reports, represents a regional variation or is part of a global increase in childhood thyroid cancer remains to be determined through detailed epidemiological studies.[20]
A retrospective analysis by the EXPERT group involving 121 children across Europe with salivary gland tumors identified mucoepidermoid carcinoma as the most common neoplasm in this population, with the majority of cases affecting the parotid gland.
In children, salivary gland neoplasms are typically confined to the primary site, with only 10% showing extension to regional lymph nodes. Surgery is the primary modality of treatment, while radiotherapy is generally reserved for cases with nodal metastasis or unfavorable histologies such as adenoid cystic carcinoma.[21] In our analysis, among the eight children affected, only one required radiotherapy, and all children remain alive.
The incidence of adrenocortical tumors (ACT), though rare, is characterized by two age peaks: one in children under 3 years of age and another during adolescence. The biological spectrum of ACTs ranges from benign adenomas to highly aggressive adrenocortical carcinomas. Due to the high prevalence of germline TP53 mutations, pediatric ACTs are considered distinct entities from their adult counterparts.[22] Certain populations, such as those in southern Brazil, have shown a higher incidence of ACTs compared to global data, with the majority of affected children harboring germline TP53 mutations.[23] In our series, one child with ACT was found to carry a germline TP53 mutation, with an increased incidence of cancer reported among family members.
Other rare neoplasms in children also exhibit unique biological features compared to adults. Pediatric lung cancer subtypes are typically mucoepidermoid carcinoma or adenocarcinoma and often harbor ALK or KRAS genetic alterations, in contrast to the broader spectrum of mutations seen in adults, including EGFR, BRAF, ERBB2, MET, ALK, RET, and ROS1.[5] Similarly, in hepatocellular carcinoma (HCC), the fibrolamellar variant is more common in children, along with increased CTNNB1 expression in well-differentiated HCC. Furthermore, international collaborative initiatives such as the Children’s Hepatic Tumour International Consortium (CHIC) and the Paediatric Hepatic International Tumour Trial (PHITT) are currently evaluating the use of chemotherapy combined with tyrosine kinase inhibitors in childhood HCC.[24] Pediatric nasopharyngeal carcinoma is more prevalent in certain populations and geographic regions. WHO Type III undifferentiated carcinoma is the most common histological subtype in children and is likely associated with Epstein-Barr virus (EBV) infection. Unlike adults, where TP53 and BCL2 mutations are more common, children with this disease more frequently exhibit c-KIT expression.[25] Consistent with existing literature, all children in our cohort presented with advanced Stage III/IV disease.
A limitation of our study is that it represents data from a single institution and has a relatively short follow-up period.
Conclusion
Adult-type epithelial neoplasms in children and adolescents are distinct entities, characterized by unique biological behaviors and genetic signatures. Treatment approaches should integrate principles from adult oncology with insights derived from pediatric genetic profiling. Large-scale collaborative studies are essential to define the epidemiology, refine staging and prognostic markers, and develop pediatric-specific treatment protocols tailored to the underlying biology of these malignancies.
Ethics approval
There are no ethical issues in the publication.
Institutional Ethics committe approval obtained. EC Ref No .: IEC/2025/V/08.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
ORCID iDs
Gazel Sainulabdin: https://orcid.org/0000-0001-8754-960X V.P Krishnan: https://orcid.org/0000-0003-4469-6866
Smitha Bhaskaran: https://orcid.org/0009-0005-2460-4022
Yamini Krishnan: https://orcid.org/0000-0001-7255-3382
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