L7 - Masses And Lymphadenopathy In Children

Question 1

What is lymphadenopathy?

Answer 1

LNs that are abnormal in size, number or consistency

Question 2

What is the most important part of the work up of a child with LAD?

Answer 2

History and physical

It is a necessity in every patient with LAD

Question 3

What are important questions to ask during a work up for LAD?

Answer 3

Age of pt
Location of enlarged nodes
Are the nodes painful?
Localized and generalized sx that can be associated with LAD
Other things that may be important to ask such as travel, meds, dental problems, bites or high risk behaviors
Ever had LAD before?
Exposures such as uncooked meats, animals (rabbits, tularemia), unpasteurized milk/soft cheese and sick people

Question 4

What are reassuring qualities when examining LNs?

Answer 4

Nodes where you expect them, soft, mobile, not warm, not red, not tender, pt feeling okay overall

Question 5

What are more concerning qualities when evaluating LNs?

Answer 5

Multiple locations of nodes, very large nodes, matted and stuck down, fluctuant, tender, associated with big liver/spleen

Question 6

What should you always check during a PE for work up of LAD?

Answer 6

Always check liver/spleen size

Enlargement may be indicative of a malignancy or systemic infection

Question 7

Which viral infections can cause LAD?

Answer 7

Epstein-Barr virus (causes mononucleosis; severe pharyngitis, cervical LAD, spleen enlargement, fatigue)
HIV (think of this when you see a child that is wasting away and has diffuse LAD)

Question 8

Which bacterial infections can cause LAD?

Answer 8

Cat scratch disease (Bartonella henselae infection resulting in axillary LAD, cat scratch on ipsilateral side)
Tularemia (associated with rabbits)
Staph/strep (super common cause of bacterial lymphadenitis, look for lesion on skin in region of body that drains into enlarged node)
Strep pyogenes (causes strep throat, cervical LAD with HA, stomach, ache and sore throat)

Question 9

What are the B sx?

Answer 9

Fever, night sweats, weight loss

Question 10

What sx are associated with lymphoma?

Answer 10

B signs
Fatigue
SOB/dyspnea

Question 11

Any child presenting with LAD and SOB needs to have what?

Answer 11

A CXR

Lymphoma loves the mediastinum!

Question 12

What is the best biopsy to perform?

Answer 12

Excisional

Question 13

What is the most common tumor like lesion in infancy?

Answer 13

Hemangioma

Question 14

If you ever see any growth or deep dimple that you cant see the bottom of over a baby’s lumbar/sacral area what should you do?

Answer 14

MRI or US to check for spinal cord of vertebral abnormality

Question 15

What is the most common malignancy in kids <10 years old?

Answer 15

Leukemia

Question 16

What is the most common malignancy in adolescents 15-19 y/o?

Answer 16

Hodgkin lymphoma

Question 17

What is the most common primary ocular malignancy in childhood?

Answer 17

Retinoblastoma

Question 18

What is the most common primary renal tumor of childhood?

Answer 18

Wilms tumor

Question 19

What are 5 common malignant tumors seen in childhood?

Answer 19

Neuroblastoma 
Wilms tumor 
Retinoblastoma 
Ewing sarcoma 
Fibrosarcomas

Question 20

What is neuroblastoma?

Answer 20

Tumor of sympathetic ganglia and adrenal medulla

Elevated urine VMA and HVA (both breakdown products of catecholamines)

Question 21

If there is cutaneous dissemination with neuroblastoma, what is the classic appearance of the baby?

Answer 21

Blueberry muffin baby (term is no longer used but helps you to remember the appearance)

Question 22

When is the peak incidence for Wilms tumor?

Answer 22

2-5 years of age

Question 23

Risk of Wilms tumor increases with which 3 groups of congenital malformations?

Answer 23

Beckwith-Wiedemann syndrome
WAGR syndrome
Denys-Drash syndrome

Question 24

What is Beckwith-Wiedemann syndrome?

Answer 24

Associated with macroglossia, organ enlargement, hemi-hypertrophy and omphalocele

Question 25

What is WAGR syndrome?

Answer 25

Wilms tumor, aniridia, genital anomalies and mental retardation

Question 26

What is Denys-Drash syndrome?

Answer 26

Gonadal dysgenesis in affected males, early onset of nephropathy, 90% chance of developing Wilms tumor

Question 27

Why is it important to check for the red reflex in children and infants?

Answer 27

Retinoblastoma will give a dull, irregular, whitish gray light reflex

Question 28

What is Ewing sarcoma?

Answer 28

Occurs in bone or soft tissue around bone
Causes chronic bone pain in the area of the tumor
May be associated with fracture (called a pathologic fracture when it is due to the pathology of the bone itself)

Question 29

What are fibrosarcomas?

Answer 29

Fibroblasts that divide excessively without cellular control