LEUKEMIAS OF CHILDHOOD

Question 1

ACUTE LYMPHOBLASTIC LEUKEMIA age and sex

Answer 1

Peak incidence between 2-6yr of age;

boys > girls

Question 2

clinical manifestation of ALL

Answer 2

1- Nonspecific symptoms: anorexia, fatigue, irritability, low grade fever, bone pain or joint pain, limping.
Unexplained persistence of any of these common signs or symptoms should prompt consideration of malignancy as a possible cause.
2- Signs and symptoms of bone marrow failure: (4 Ps) pallor, pyrexia, purpura and pain
- epistaxis-bleeding tendency
- Generalized LNE, HSM > 50% of cases
Tenderness on bone palpation
Signs of increased ICP, due to leukemic infiltration of CNS, cranial nerve palsies.(CNS disease in less than 5% and frequently asymptomatic)
Resp. Distress in T cell leukemia due to a mediastinal tumor.
Testicular involvement

Question 3

Mature-B cell ALL

Answer 3

may be associated with extramedullary masses in the abdomen or head and neck and central nervous system (CNS) involvement.

Question 4

B-precursor ALL

Answer 4

bone pain, arthritis, and limping may be presenting symptoms .( 5%
only symptoms)

Question 5

Differential Diagnosis

Answer 5

Infectious mononucleosis :Acute onset of fever and Lymphadenopathy .
2- Rheumatoid arthritis; Acute onset of fever and joint pain
3- AML.
4- Bone marrow failure, invasion by other malignant disease, neuroblastoma.
5- Primary bone marrow failure, Aplastic anaemia.
6- Failure of single cell line, ITP.

Question 6

Physical Examintion

Answer 6

Bone marrow infiltration ( pallor , petechiae and bruising )
Extramedullary Leukemic infiltration :
-lymphadenopathy ,hepatosplenomegaly .
- (CNS): papilledema, nuchal rigidity, and cranial nerve palsy .
unilateral painless testicular enlargement.
Stridor (mediastinal mass)

Question 7

Diagnosis

Answer 7

CBC  and blood film : 
   - WBC > 10 × 109/L ,with blasts
          > 50,000 in 20% of cases
   -neutropenia/anemia/thrombocytopenia
   - (20% with no blasts) 

BM aspirate and biopsy :25% of BM as blast (immunohistochemistry), immunophenotyping, cytogenetic analysis,and moleculalymphoblasts )
CXR :exclude mediastinal masses

U/S to evaluated testicular enlargement

Baseline echo , ECG

LP: to evaluate CNS involvement
Metabolic abnormalities:
-Elevated uric acid ,K , PO4 , and LDH
- decrease ca