L7 - Masses And Lymphadenopathy In Children Flashcards
What is lymphadenopathy?
LNs that are abnormal in size, number or consistency
What is the most important part of the work up of a child with LAD?
History and physical
It is a necessity in every patient with LAD
What are important questions to ask during a work up for LAD?
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
What are reassuring qualities when examining LNs?
Nodes where you expect them, soft, mobile, not warm, not red, not tender, pt feeling okay overall
What are more concerning qualities when evaluating LNs?
Multiple locations of nodes, very large nodes, matted and stuck down, fluctuant, tender, associated with big liver/spleen
What should you always check during a PE for work up of LAD?
Always check liver/spleen size
Enlargement may be indicative of a malignancy or systemic infection
Which viral infections can cause LAD?
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)
Which bacterial infections can cause LAD?
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)
What are the B sx?
Fever, night sweats, weight loss
What sx are associated with lymphoma?
B signs
Fatigue
SOB/dyspnea
Any child presenting with LAD and SOB needs to have what?
A CXR
Lymphoma loves the mediastinum!
What is the best biopsy to perform?
Excisional
What is the most common tumor like lesion in infancy?
Hemangioma
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?
MRI or US to check for spinal cord of vertebral abnormality
What is the most common malignancy in kids <10 years old?
Leukemia
What is the most common malignancy in adolescents 15-19 y/o?
Hodgkin lymphoma
What is the most common primary ocular malignancy in childhood?
Retinoblastoma
What is the most common primary renal tumor of childhood?
Wilms tumor
What are 5 common malignant tumors seen in childhood?
Neuroblastoma Wilms tumor Retinoblastoma Ewing sarcoma Fibrosarcomas
What is neuroblastoma?
Tumor of sympathetic ganglia and adrenal medulla
Elevated urine VMA and HVA (both breakdown products of catecholamines)
If there is cutaneous dissemination with neuroblastoma, what is the classic appearance of the baby?
Blueberry muffin baby (term is no longer used but helps you to remember the appearance)
When is the peak incidence for Wilms tumor?
2-5 years of age
Risk of Wilms tumor increases with which 3 groups of congenital malformations?
Beckwith-Wiedemann syndrome
WAGR syndrome
Denys-Drash syndrome
What is Beckwith-Wiedemann syndrome?
Associated with macroglossia, organ enlargement, hemi-hypertrophy and omphalocele
What is WAGR syndrome?
Wilms tumor, aniridia, genital anomalies and mental retardation
What is Denys-Drash syndrome?
Gonadal dysgenesis in affected males, early onset of nephropathy, 90% chance of developing Wilms tumor
Why is it important to check for the red reflex in children and infants?
Retinoblastoma will give a dull, irregular, whitish gray light reflex
What is Ewing sarcoma?
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)
What are fibrosarcomas?
Fibroblasts that divide excessively without cellular control
