Lecture 3: Lymphadenopathy in Children

Question 1

What is the most important component of the work-up for LAD?

Answer 1

History and Physical

Question 2

An enlarged LN in which location is always considered not normal?

Answer 2

Supraclavicular

Question 3

A LN of which size is considrered “enlarged?”

Answer 3

≥2 cm

Question 4

Firm and rubbery lymph nodes should make you think what?

Answer 4

Possibly lymphoma

Question 5

What are 3 indications for biopsying a LN?

Answer 5

• If watchful waiting is the plan, but the nodes never get better
• If plan included Abx, but 4-6 wks after treatment the nodes are no smaller (or if they are bigger)
• Right away if an enlarged supraclacvicular node palpated along w/ findings consistent w/ malignancy i.e., B-symptoms

Question 6

What is a complications which may arise in the eye associated with Cat Scratch Disease?

Answer 6

Neuroretinitis

Question 7

In regards to tumor-like lesions, what does Heterotopic refer to?

Answer 7

Microscopically normal cells or tissues that are present in abnormal locations i.e., pancreatic tissue in wall of stomach

Question 8

In regards to tumor-like lesions, what does Hamartoma refer to?

Answer 8

Excessive, focal overgrowth of cells and tissues native to the organ in which it occurs; benign histology

Question 9

What are the most common tumors of infancy; where are they most commonly seen?

Answer 9

• Hemangiomas: either cavernous or capillary
• Most commonly in the skin: if large/flat = port wine stain

Question 10

Differentiate fibromatosis from fibrosarcoma?

Answer 10

• Fibromatosis = sparsely cellular proliferation of spindle-shaped cells
• Fibrosarcoma = richly cellular lesions

Question 11

What is the most common location for Teratomas?

Answer 11

Sacrococcygeal

Question 12

List the 5 sites most frequnt sites of origin for the childhood cancer

Answer 12

• Hematopoietic system
• Nervous tissue
• Soft tissues
• Bone
• Kidney

Question 13

Which malignancy in children younger than age 15 accounts for more deaths than all other malignant tumors combined?

Answer 13

Leukemia

Question 14

What is the most common extracranial solid tumor of childhood?

Answer 14

Neuroblastoma

Question 15

In children <2 y/o, what is the usual presentation of Neuroblastoma?

Answer 15

• Fever + large abdominal mass + possible weight loss
• In infants, disseminated dz may present w/ multiple cutaneous metastases causing a blue color aka “blueberry muffin baby.”

Question 16

What do Neuroblastomas produce which can be an important diagnostic feature?

Answer 16

Catecholamines; ↑ urine VMA and HVA

Question 17

The peak incidence of Wilms tumor is btw what ages?

Answer 17

2-5 y/o; with 95% occurring before age 10

Question 18

The risk of Wilms tumor is increases with what 3 recognizable groups of congenital malformations?

Answer 18

• WAGR syndrome: Wilms tumor + Aniridia + Genital anomalies + Retardation
• Denys-Drash syndrome: gonadal dysgenesis + early-onset nephropathy
• Beckwith-Wiedemann syndrome: macroglossia + hemihypertrophy + omphalocele

Question 19

What are some of the potential presenting findings/sx’s of Wilms tumors?

Answer 19

• A large abdominal mass
• Hematuria
• Pain in the abdomen after some traumatic accident
• Intestinal obstruction
• HTN
• Pulmonary metastases after onset of dx