Pediatric tumor
Dr.Omar A. Ajaj
Associate professor
F.I.C.M.S
The most common abdominal tumor
in infants and children
Neuroblastoma(most
common).
Renal tumors
The differential diagnosis for a malignant abdominal
mass in a child
Neuroblastoma
WT.
Hepatoblastoma.
Rhabdomyosarcoma.
Lymphoma.
WILMS TUMOR
Also referred to as nephroblastoma
or renal embryoma
WT is the most frequent tumor of
the kidney in infants and children.
One case per 10,000 infants.
Most children presenting between the ages of 1 and 4
years.
Pathology:- WTs are currently divided into those with
‘favorable’histology(90%) and those with ‘unfavorable’
histology.
Clinical Presentation and Diagnosis
WT is often noted during a bath or by doctor at a
routine visit as painless abdominal mass.
Examination:- the mass mostly not cross the
middline
This is in marked contrast to neuroblastoma,
which is frequently presents with painful
abdominal mass.
Radiographic imaging is confirm a renal origin to the
mass.
WT arise from within the kidney and distort its
internal configuration.
The treatment for WT includes operation,
chemotherapy, and in some cases, radiation therapy
(RT).
Neuroblastoma is the most common
solid extra cranial malignancy of
childhood and the most common
malignant tumor in infants.
Neuroblastoma is an embryonal tumor
of the sympathetic nervous system.
Patients with neuroblastoma
usually present with signs and
symptoms that reflect the
primary site and extent of
disease
As 75% of neuroblastoma occurs in the abdominal
cavity, an abdominal mass detected on physical
examination is a common clinical feature, as is the
complaint of abdominal pain.
The mass cross the middline.
Neuroblastoma is characterized by secretion of
catecholamine products, which can be detected in the
urine of more than 90% of patients with
neuroblastoma.
Hepatic tumors
The most common malignant hepatic neoplasms are
metastatic lesions.
Infantile hepatic hemangioma (IHH) is the most
common benign solid hepatic tumor in children.
The most common primary liver tumors occurring in
the first two years of life:-
1-Hepatoblastoma.
2-Infantile hepatic hemangioma.
TERATOMAS
Teratomas are generally divided into
gonadal and extragonadal types.
The extragonadal locations, the most
common being sacrococcygeal teratomas
(SCT).
Teratomas are having three embryonic
layers (endoderm, mesoderm, and
ectoderm).
Sacrococcygeal Teratoma (SCTs) account for
40–60% of teratomas.
En bloc excision, including the coccyx, is preferable.
The term acute scrotum is defined as acute scrotal pain
with or without swelling and erythema.
Differential Diagnoses of the
Acute Scrotum:
Torsion of the testis
Torsion of the appendix testis/epididymis
Epididymitis/orchitis
Hernia/hydrocele
Trauma/sexual abuse
Tumor
Idiopathic scrotal edema (dermatitis, insect bite)
Cellulitis
Vasculitis (Henoch–Schِ nlein purpura)
Torsion of the testis results from twisting of the
spermatic cord which compromises the testicular
vasculature and results in infarction.
There appears to be a 4-8-hours window before
significant damage occurs once torsion develops.
Two types of torsion occur: intravaginal and
extravaginal. Intravaginal torsion is more common in
children and adolescents (compared to neonates).
Testicular torsion typically occurs before age 3 years or
after puberty.
Patients present with the sudden onset of severe,
unilateral pain in the testis, lower thigh, or lower
abdomen, often associated with nausea and vomiting.
Physical examination may reveal an enlarged testis
that is retracted up toward the inguinal region with a
transverse orientation.
The cremasteric reflex is often absent with testicular
torsion.
The diagnosis of testicular torsion is usually clinically
apparent and managed by immediate scrotal
exploration.
An inguinal hernia in a child usually refers to an
indirect inguinal hernia.
It is failure of the PPV to close that results in an
indirect inguinal hernia.
The diagnosis is clinical and rests squarely on the
history and physical examination.
Pediatric indirect inguinal hernias are usually repaired
through an inguinal herniatomy.
UNDESCENDED TESTES
Any deviation from the normal process can result in a
cryptorchid or undescended testis.
classification divides testes into palpable and
nonpalpable.
Diagnosis
A careful history and physical examination is thus
paramount.
Treatment
Timing of intervention…….after age of 6 months.
UDT appears to be associated with a two- to eightfold
increased risk of malignancy.
Risk of torsion and infertility????
THANK YOU
