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Pediatrics 17

Lymphomas(illustration 1  illustration 2)

    1. Hodgkin's disease
      1. Definition: malignancy of the lymph nodes
      2. Pathophysiology
        1. neoplasm of lymphatic system
        2. characterized by giant, multinucleated cells (Reed-Sternberg cells) (illustration)
      3. Findings
        1. characterized by painless enlargement of lymph nodes, particularly in supraclavicular area
        2. anorexia, weight loss, malaise; painless; night sweats
        3. fever
      4. Diagnostics: lymph node biopsy
      5. Management
        1. chemotherapy and radiation
        2. treatment based on staging of disease (stages I-IV)
    2. Non-Hodgkin's lymphoma (illustration )
      1. Pathophysiology:
        1. proliferation of either B- or T- lymphocytes
        2. staging I-IV
      2. Findings
        1. painless, enlarged lymph nodes in cervical or axillary region
        2. bone marrow and/or mediastinal involvement
      3. Therapeutic management: combination of chemotherapy and radiation
    3. Brain tumors: medulloblastoma, astrocytoma, ependymoma, glioblastoma
      1. Pathophysiology
        1. solid tumors of the nervous system
        2. most common solid tumor in children
      2. Findings
        1. headache, vomiting, increased intracranial pressure, ataxia
        2. visual changes, seizures, bulging fontanel in infants, behavioral changes
      3. Therapeutic management
        1. surgical debulking
        2. radiation
        3. chemotherapy
    4. Neuroblastoma
      1. Pathophysiology
        1. solid tumor found only in children under four years old
        2. primary sites are adrenal gland or retroperitoneal because it starts from embryonic neural crest cells of the adrenal gland and sympathetic nervous system.
        3. often has metastasized by the time it is diagnosed
      2. Findings
        1. firm, nontender mass in the abdomen that crosses the midline
        2. distant metastasis may cause periorbital edema (swelling around eyes)
      3. Therapeutic management
        1. treatment is dependent on staging criteria
        2. surgical debulking, chemotherapy, radiation

Other Tumors

Summary Overview of Other Tumors in Children:


    1. Osteosarcoma (illustration )
      1. Pathophysiology
        1. originates from bone-forming mesenchyme
        2. creating malignant osteoid tissue
        3. most common in distal femur
        4. metastasis to lung
      2. Findings: localized pain, limp, decrease in physical activity
      3. Therapeutic management: surgical approach
        1. limb salvage with prosthetic bone replacement; or amputation
        2. plus combination chemotherapy before and/or after surgery
    2. Ewing sarcoma
      1. Pathophysiology
        1. arises not from osteoid tissue but in bone marrow spaces
        2. most common in shaft of femur, tibia, humerus, scapula
        3. more common in males
      2. Findings: localized pain, decrease in physical activity
      3. Therapeutic management
        1. intensive radiation therapy of the malignant bone
        2. combined with chemotherapy
        3. surgery not routinely recommended
    3. Wilm's tumor
      1. Pathophysiology
        1. solid tumor of the renal system
        2. possibly genetic in some cases
        3. most often affecting the left kidney
        4. tumor encapsulated for extended period
        5. is staged I-V at time of resection
      2. Findings
        1. abdominal mass
        2. characteristically firm, non-tender
        3. confined to one side
      3. Therapeutic management
        1. surgical resection
        2. combination chemotherapy, irradiation
        3. highest survival rate of all pediatric malignancies
    4. Rhabdomyosarcoma
      1. Pathophysiology
        1. soft tissue neoplasm
        2. grows from undifferentiated mesenchymal cells of skeletal muscle
        3. most common in head and neck, especially the orbit
        4. staging I-IV
        5. highly malignant; often metastasized when diagnosed
      2. Findings
        1. non-tender, firm mass
        2. related to site of tumor and compression of adjacent organs
        3. symptoms often vague, similar to otitis media or "runny nose"
      3. Therapeutic management
        1. high-dose irradiation of the primary tumor
        2. combination chemotherapy
        3. surgical resection
    5. Retinoblastoma
      1. Pathophysiology: congenital malignant tumor of the retina, with evidence of genetic inheritance in certain cases
      2. Findings: cat's eye reflex (whitish glow in pupil); strabismus; red, painful eye
      3. Therapeutic management
        1. radiation therapy, enucleation, chemotherapy
        2. treatment depends on stage of tumor, stages I-V
          Viral Infections
  • Viruses are parasites that cannot reproduce or meet own metabolic needs.
  • Skin cells react to virus with swelling, "vesiculation," or proliferation, sometimes warts.
  • Most viruses are associated with rashes (characteristic of each disorder, such as chicken pox, rubella, roseola)