BONE PAIN intermittent fever fatigue, parlor petechiae, purpura hepatomegaly lymphadenopathy
Acute Lymphoblastic Leukemia
Proliferation of IMMATURE LYMPHOCYTES
Down syndrome
viral infections
Acute Lymphoblastic Leukemia
DX: anemia, thrombocytopenia (low platelets)
WBC = normal or low
neutropenia (low neutrophils?)
peripheral smear : lymphoblasts
Dx: bone marrow biopsyAcute Lymphoblastic Leukemia
Acute Lymphoblastic Leukemia (ALL) Tx
Chemotherapy, HSCT
Anticipate tumor lysis syndrome: massive tumor lysis -> hyperkalemia, hyperurecemia, hyperphosphatemia, renal failure
MOST COMMON MALIGNANCY OF CHILDHOOD
ALL
“ALL kids could get ALL”
Unable to differentiate precursor myeloid cells into mature cells/elements
Acute Meyloid Leukemia (AML)
fatigue, pallor
bleeding
infection (fever)
AML Acute Myeloid Leukemia
Hyperleukocytosis!!! (WBC > 75,000) can be associated with LIFE THREATENING COMPLICATIONS = MEDICAL ER
WBC > 100,000 at Dx !!! in 25% OF PTS
Acute Meyloid Leukemia AML
AUER RODS (granular structures in cytoplasm) in peripheral smear
Acute Myeloid Leukemia AML
Tx for AML
Chemotherapy
HSCT (hematopoietic stem cell transplant)
(Risk factors for AML)
often none
Down syndrome
exposure to radiation, benzene (smoking), chemotherapy drugs
Philadelphia Chromosome
Chronic Myelogenous Leukemia (CML)
Myeloproliferative dz
Chrom Philadelphia
CML
DX of CML
Labs: anemia, thrombocytosis, leukocytosis (>100,000)
Philadelphia Chrom
SOLID TUMOR
Younger: vomit, lethargy, irritable, macrocephaly
Older: HA, visual sx, sz, personality change, neuro deficits
Brain tumors
Dx: measure head
observe gait
MRI
Brain tumor
most common solid tumor of childhood
brain
Tx brain tumor
surgery, chemo, radiation
M>F
starts in lymph and spreads
germinal center B CELLS mutation
Hodgkin Dz
PAINLESS CERVICAL OR SUPRACLAVICULAR ADENOPATHY, MEDIASTINAL MASS fever, sweats, wgt loss, fatigue spleno/hepatomegaly
Hodgkin Dz
REED-STERNBERG cell in bone marrow biopsy
Hodgkin Dz
Hodgkin dz tx:
chemo, radiation
KIDS HAVE BETTER RESPONSE TO TX THAN ADULTS in which dz?
Hodgkin Dz
FAST (1-3 WEEKS)
enlarging non-tender lymphadenopathy
B sx: cough, dyspnea, orthopea, abd pain, vomiting, fever
Non Hodgkin Lymphoma (NHL)
Dx of Non Hodgkin Lymphoma
Biopsy
Arise from any lymphoid tissue, B cell derived, risk with immunodeficiency syndromes and EBV
Non Hodgkin Lymphoma
RAPIDLY PROLIFERATING, HIGH-GRADE, DIFFUSE MALIGNANCIES
NON Hodgkin Lymphoma (NHL)
sympathetic nervous tissue - predominantly adrenal gland (no PNS innervation)
Neuroblastoma
ABDOMINAL MASS
bone pain
faver, wgt loss, irritable
Neuroblastoma
Labs: URINARY CATECHOLAMINES
skeletal survey, bone scan, biopsy
Neuroblastoma
Neuroblastoma tx
surgery and chemo, sometimes radiation
MOST COMMON ABDOMINAL TUMOR IN KIDS (OUTSIDE CNS)
90% dx before age 5
Neuroblastoma
Asymptomatic abdominal mass
fever, hematuir, HTN
Nephroblastoma
U/S CT abd
CT chest
Nephroblastma
SECOND MOST COMMON ABDOMINAL TUMOR IN KIDS
Nephroblastoma
Tx nephroblastoma
surger, chemo, radiation
occurs in LONG BONES
peaks in growth spurt/adolescence
Osteosarcoma
bone pain with or w/o soft tissue swelling
osteosarcoma
Tx: SURGERY AND CHEMO = CRITICAL TO PREVENT METASTASIS
in Osteosarcoma
MOST COMMON PRIMARY MALIGNANCY OF BONE
Osteosarcoma
Wilms Tumor
Nephroblastoma
occurs in long bones or soft tissues
NIGHT BONE PAIN
fatigue, fever, wgt loss
swelling/pain localized
Ewing Sarcoma
Dx of osteosarcoma with
bone scan
Tx Ewing sarcoma
chemo, surgery, radiation or combo of all 3
SECOND MOST COMMON PRIMARY BONE TUMOR
Ewing Sarcoma
WHITE PAPILLAR REFLEX
retinoblastoma
90% dx'd before 5 yo sporatic vs inherited detailed ophtthalm exam several vision sparing therapies MOST COMMON INTRAOCULAR TUMOR
retinoblastoma
PAINLESS, ENLARGING MASS
any body part (usu head/neck)
Rhabdomyosarcoma
soft tissue sarcoma
Rhabdomyasarcoma
MOST COMMON SOFT TISSUE SARCOMA IN KIDS
70% dx bf 10 yo
Rhabdomyosarcoma
enlarging abd
check serum Alpha Fetal Protein (AFP)
Abd US, CT, MRI
Surgery, chemo, radiation, liver transplant
Hepatic tumor
