Masses And Lymphadenopathy Pediatric - Dr. Newman

Question 1

Definition of LAD (lymphadenopathy)

Answer 1

LN abnormal in size and number and consistency

Question 2

LAD from normal cell proliferation

Answer 2

Viral and bacterial infection

Question 3

LAD rm infiltration of foreign or abnormal cells

Answer 3

Lymphoma
Leukemia
Other cancer

Question 4

Reason you ask : are the LNs painful

Answer 4

Malignant enlarged LN : usually not painful

Infection enlarged LNs : usually painful

Question 5

Reason you ask : 
Weight loss
Fatigue
Arthralgias
Sight sweats
Pruritis 
Rash

Answer 5

Weight loss : B sign 
Fatigue : infection or malignancy 
Arthralgia : onset of rheumatologic disorder 
Sight sweats : B- sign
Pruritis : Lymphoma 
Rash : tick illness

Question 6

Reason you ask :MX in LAD

Answer 6

Seziures medication and bactrim/ septra, and some BP medications can cause LAD if you’re having a side effect

Question 7

Exposure to uncooked meat and LAD

Answer 7

Trichinosis, salmonella, E. Coli

Question 8

LAD and Animals around the pt

Answer 8

Rabbits : tularemia **

Question 9

Unpasteurized milk / soft cheese and LAD

Answer 9

Brucellosis **

Question 10

Size that makes a LN be considered enlarged

Answer 10

2cm

Question 11

Good signs of a LAD quality

Answer 11

Soft, mobile, not warm, not red, not tender, pt feels okay

Question 12

Not good signs of LAD quality

Answer 12

Multiple locations, vary large nodes, matted (stuck down and not moving), fluctuating, tender, if also splenomegaly or hepatomegaly

Question 13

What does a localized LAD mean and what should I do

Answer 13

Figure out the field that drains into that LN (also see if there is an infection)

1. Malignant childhood tumor : neuroblastoma, lymphoma/ leukemia
2. Kawasaki disease : cervical lymphadenopathy that is usually very big

Question 14

Generalized LAD means what could it be

Answer 14

1. Systemic viral or bacterial infection
2. HIV
3. Leukemia/ Lymphoma

Question 15

Splenohepatomegally can show what

Answer 15

Malignancy or systemic infection

= always check for this

Question 16

Viral cause of LAD in children

Answer 16

1. EBV : mono, severe pharyngitis, cervical LAD, splenomegally, fatigue
2. HIV : diffuse LADs band wasting ( weaker and more and more unhealthy)

Question 17

Bacteria cause of LAD in children

Answer 17

1. Cat-scratch disease : Bartonella henselae, axillary LAD on side of scratch
2. Tularemia : usually from skinning rabbits
3. Staph/Strep : bacterial lesions on skin area that drains to the LAD
4. Strep pyogenes: strep throat, CERVICAL LAD, headache, stomach ache, sore throat

Question 18

When should you order a chest X-ray for a child **

Answer 18

LAD + SOB

Lymphoma can be in the mediastinum

Question 19

Lymphoma cause of LAD in children SX

Answer 19

B-signs (night sweats, fever, weight loss)
Fatigue
SOB ——> order chest X-ray

Question 20

Which should make you worried

1. Time of LAD
2. Generalized or localized

Answer 20

1. More then 4weeks

2. Generalized

Question 21

When to do a biopsy of a LAD

Answer 21

1. Follow up and it gets bigger or worse, or stays past 4 weeks (only systemically healthy children)
2. If anything is seen in chest X-ray , labs (children with B-signs, SOB, systemically ill) ** find results as fast as you can**

Question 22

What biopsy should you always try to do

Answer 22

Excisional biopsy

Question 23

2 tumor-like lesions is children

Answer 23

1. Heterotopic : normal cells or tissues in abnormal place in body (rarely become malignant, not a problem)
2. Hamartoma : excessive , focal overgrowth of cells and tissues in the organ it is from just maybe not same layer or area in the organ (can cause issues, benign)
3. Hemangiomas *

Question 24

Hemangiomas **

Answer 24

Most common tumor like lesion in infancy (5%)
= port wine stain that is permanent (even after regression)
= cavernous (big, dilated, deformed vessels) or capillaries involved
= regressed usually with age (can become necrotic)

Question 25

Sturgeon Weber syndrome

Answer 25

In hemangiomas = you get facial port wine stain**** = leptomeningeal angiomas = can cause intellectual / development disability

Question 26

When should you be concerned about a hemangiomas and what do I do then

Answer 26

If I see any growth or deep dimple (esp. cant see the bottom of) over the lumbar and sacral area = do MRI or US to check for spinal cord or vertebral abnormalities

Question 27

Lymphangiomas

Answer 27

Lymphatic malformation = not cancer = can be from hamartomatous (disorganized growth of normal cells)

Question 28

Lymphangiectasis

Answer 28

Dilation of Lymph Vessels

Question 29

Fibromatosis

Answer 29

= fibrous tumor = soft tissue tumor Non malignant = invasive (infiltration growth pattern)—> growing into surrounding

Question 30

Teratoma what and locations

Answer 30

Germ cell tumor of many tissue types = common in ovaries, testicles, coccyx = benign or malignant

Question 31

5 most common places of pediatric cancer origins

Answer 31

1. Hematopoietic system 2. Nervous tissue 3. Soft tissue 4. Bone 5. Kidney

Question 32

Neuroblastoma

Answer 32

Malignant = sympathetic ganglia and adrenal gland = high urine VMA, HVA (catacholamine breakdown products) = blueberry muffin baby ——> cutaneous dissemination

Question 33

Wilms Tumor is what , age, and risks

Answer 33

``` Malignant = primary renal tumor (peak 2yo-5yo) 1. Beckwith- Wiedenann syndrome 2. WAGR syndrome 3. Denys-Drash syndrome ```

Question 34

Beckwith- Wiedenann syndrome

Answer 34

= macroglossia : enlarged tongue = organ enlargement = hemi-hypertrophy : overgrowth of one side of the body = omphalocele : GI covered by transparent sac and outside umbilicus

Question 35

WAGR syndrome

Answer 35

= wilms tumor = aniridia : abnormal or no IRIS in eye, usually bilateral, enlarged pupil (can effect other parts of the eyes also) = genital anomalies = mental problems

Question 36

Denys-Drash syndrome

Answer 36

= gonadal dysgenesis (males) = early onset nephropathy : kidney failure = 90% chance of wilms tumor

Question 37

Retinoblastoma what and how to test for it

Answer 37

Malignant (most common primary ocular) = retinal malignancy (very young or infant children) = CHECK red reflex in infant and children : you see white-gray dull irregular reflex**

Question 38

Ewing sarcoma

Answer 38

``` Malignant = bone and soft tissue around bone = rare = Chronic bone pain in area of tumor**** = can be cause fracture (pathologic caused fracture) ```

Question 39

Fibrosarcoma ****

Answer 39

= malignant | = fibroblasts divide excessively with no control

Question 40

Most common malignancy in kids under 10yo

Answer 40

Leukemia (ALL)

Question 41

Most common malignancy in adolescents 15yo-19yo

Answer 41

Hodgkin’s lymphoma