Malignant Lesions Pediatrics

Question 1

Most Common tumors in Kids

Answer 1

Osteosarcoma
Ewings Sarcoma
Metastatics ( Neuroblastoma and rhabdomyosarc)
Hematologic ( lyphoma and leukemia)

Question 2

Malignant bone Tumors by Age

0-5

Answer 2

Langerhance cell histocytosis
Metastisis ( neurblastoma, Rhabdo)
Hematologis- Leukemia and Lympohma)

Question 3

Malignant Bone tumor by Age

6-10

Answer 3

Ewings Sarcoma ( onion skinning, diaphysis,)

Question 4

Main Difference in Osteosarcoma and Ewings Sarcoma ?

Answer 4

Ewings is in the Diaphysis

Osteosarc- 90% is in metaphysis

Question 5

Things that cause secondary ABCs?

Answer 5

GCT

Chondroblastomas

Question 6

Criteria for Radiation Induced Osteosarcoma

Answer 6

1. Must be histologically differnt from primary tumor
2. Must arise in the radiated field
3. must haev latency of 3 years or greater

Question 7

Most Common Chemo Regiman for Osteosarc?

Answer 7

Doxirubicin ( cardiotoxicity)
Cisplatin ( ototoxicity)
High Dose MTX

Question 8

Huvos Grading of Chemo Response in Osteo

Answer 8

Grade I <50%
Grade II 51-90%
Grade III 91-99%
Grade IV

Question 9

What are staging studies for Osteosarcoma?

Answer 9

CT of chest
MRI of compartment or entire bone
Bone scan

Question 10

What are staging studies for Ewings Sacroma

Answer 10

CT chest
MRI of bone
PET scan or bone scan
BONE MARROW BIOPSY ( small blue cell tumor)

Question 11

Typcial for Ewings Sarcoma

Answer 11

Pelvis/ Flat bones, scapula
Diaphysis
Onion Skinning 
Circumferential with soft tissue mass 
CD 99 positive 
EWS-FLI1  11:22

Question 12

AJCC Staging System

Answer 12

IA: Low grade ,8cm
IB: Low grade >8cm
IIA: High Grade <8cm
IIB: high grade >8cm
III: Skip lesions
IV: Distant mets

Question 13

Ewings Tx

Answer 13

1. Pre Op Chemo
2. Radiation for Surgery for Local Control
   (Radiation 45-50Gy for 5 weeks)
3. Post Op Chemo
   ALL SMALL ROUND BLUE CELL TUMORS ARE sensitive to radiation