Masses And Lymphadenopathy Pediatric - Dr. Newman Flashcards
Definition of LAD (lymphadenopathy)
LN abnormal in size and number and consistency
LAD from normal cell proliferation
Viral and bacterial infection
LAD rm infiltration of foreign or abnormal cells
Lymphoma
Leukemia
Other cancer
Reason you ask : are the LNs painful
Malignant enlarged LN : usually not painful
Infection enlarged LNs : usually painful
Reason you ask : Weight loss Fatigue Arthralgias Sight sweats Pruritis Rash
Weight loss : B sign Fatigue : infection or malignancy Arthralgia : onset of rheumatologic disorder Sight sweats : B- sign Pruritis : Lymphoma Rash : tick illness
Reason you ask :MX in LAD
Seziures medication and bactrim/ septra, and some BP medications can cause LAD if you’re having a side effect
Exposure to uncooked meat and LAD
Trichinosis, salmonella, E. Coli
LAD and Animals around the pt
Rabbits : tularemia **
Unpasteurized milk / soft cheese and LAD
Brucellosis **
Size that makes a LN be considered enlarged
2cm
Good signs of a LAD quality
Soft, mobile, not warm, not red, not tender, pt feels okay
Not good signs of LAD quality
Multiple locations, vary large nodes, matted (stuck down and not moving), fluctuating, tender, if also splenomegaly or hepatomegaly
What does a localized LAD mean and what should I do
Figure out the field that drains into that LN (also see if there is an infection)
- Malignant childhood tumor : neuroblastoma, lymphoma/ leukemia
- Kawasaki disease : cervical lymphadenopathy that is usually very big
Generalized LAD means what could it be
- Systemic viral or bacterial infection
- HIV
- Leukemia/ Lymphoma
Splenohepatomegally can show what
Malignancy or systemic infection
= always check for this
Viral cause of LAD in children
- EBV : mono, severe pharyngitis, cervical LAD, splenomegally, fatigue
- HIV : diffuse LADs band wasting ( weaker and more and more unhealthy)
Bacteria cause of LAD in children
- Cat-scratch disease : Bartonella henselae, axillary LAD on side of scratch
- Tularemia : usually from skinning rabbits
- Staph/Strep : bacterial lesions on skin area that drains to the LAD
- Strep pyogenes: strep throat, CERVICAL LAD, headache, stomach ache, sore throat
When should you order a chest X-ray for a child **
LAD + SOB
Lymphoma can be in the mediastinum
Lymphoma cause of LAD in children SX
B-signs (night sweats, fever, weight loss)
Fatigue
SOB ——> order chest X-ray
Which should make you worried
- Time of LAD
- Generalized or localized
- More then 4weeks
2. Generalized
When to do a biopsy of a LAD
- Follow up and it gets bigger or worse, or stays past 4 weeks (only systemically healthy children)
- If anything is seen in chest X-ray , labs (children with B-signs, SOB, systemically ill) ** find results as fast as you can**
What biopsy should you always try to do
Excisional biopsy
2 tumor-like lesions is children
- Heterotopic : normal cells or tissues in abnormal place in body (rarely become malignant, not a problem)
- Hamartoma : excessive , focal overgrowth of cells and tissues in the organ it is from just maybe not same layer or area in the organ (can cause issues, benign)
- Hemangiomas *
Hemangiomas **
Most common tumor like lesion in infancy (5%)
= port wine stain that is permanent (even after regression)
= cavernous (big, dilated, deformed vessels) or capillaries involved
= regressed usually with age (can become necrotic)
Sturgeon Weber syndrome
In hemangiomas
= you get facial port wine stain**
= leptomeningeal angiomas
= can cause intellectual / development disability
When should you be concerned about a hemangiomas and what do I do then
If I see any growth or deep dimple (esp. cant see the bottom of) over the lumbar and sacral area
= do MRI or US to check for spinal cord or vertebral abnormalities
Lymphangiomas
Lymphatic malformation
= not cancer
= can be from hamartomatous (disorganized growth of normal cells)
Lymphangiectasis
Dilation of Lymph Vessels
Fibromatosis
= fibrous tumor
= soft tissue tumor
Non malignant
= invasive (infiltration growth pattern)—> growing into surrounding
Teratoma what and locations
Germ cell tumor of many tissue types
= common in ovaries, testicles, coccyx
= benign or malignant
5 most common places of pediatric cancer origins
- Hematopoietic system
- Nervous tissue
- Soft tissue
- Bone
- Kidney
Neuroblastoma
Malignant
= sympathetic ganglia and adrenal gland
= high urine VMA, HVA (catacholamine breakdown products)
= blueberry muffin baby ——> cutaneous dissemination
Wilms Tumor is what , age, and risks
Malignant = primary renal tumor (peak 2yo-5yo) 1. Beckwith- Wiedenann syndrome 2. WAGR syndrome 3. Denys-Drash syndrome
Beckwith- Wiedenann syndrome
= macroglossia : enlarged tongue
= organ enlargement
= hemi-hypertrophy : overgrowth of one side of the body
= omphalocele : GI covered by transparent sac and outside umbilicus
WAGR syndrome
= wilms tumor
= aniridia : abnormal or no IRIS in eye, usually bilateral, enlarged pupil (can effect other parts of the eyes also)
= genital anomalies
= mental problems
Denys-Drash syndrome
= gonadal dysgenesis (males)
= early onset nephropathy : kidney failure
= 90% chance of wilms tumor
Retinoblastoma what and how to test for it
Malignant (most common primary ocular)
= retinal malignancy (very young or infant children)
= CHECK red reflex in infant and children : you see white-gray dull irregular reflex**
Ewing sarcoma
Malignant = bone and soft tissue around bone = rare = Chronic bone pain in area of tumor**** = can be cause fracture (pathologic caused fracture)
Fibrosarcoma **
= malignant
= fibroblasts divide excessively with no control
Most common malignancy in kids under 10yo
Leukemia (ALL)
Most common malignancy in adolescents 15yo-19yo
Hodgkin’s lymphoma
