11_abdominal_masses_resident_lecture_series_v3

11_abdominal_masses_resident_lecture_series_v3 - Assessment...

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Assessment and Diagnosis of Abdominal Masses in Children Resident Education Lecture Series
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General approach to solid tumors What is it? Where is it? Where can it go? The answer to any one of these questions will help answer the other two
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Work up – two components Staging X-ray of primary site CT chest, abdomen, & pelvis CXR (baseline) bone scan Specialty tests Gallium, MIBG, PET Bone marrow ESR Evaluate for complications of the tumor CBC with diff TPN panel LDH, uric acid – tumor lysis, rapid cell growth Lytes, creatinine – renal function Transaminases – hepatic involvement Specialty tests Tumor markers HCG, AFP HVA/VMA ….
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Tissue diagnosis Incisional biopsy Excisional biopsy Special cases… Calicified suprarenal mass + bone scan – might consider getting dx from bone marrow FNA vs excisional biopsy Bias towards excisional → sufficient sample to be representative and to send for special research studies (histology, chromosomes, special studies, research studies)
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Abdominal Masses
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Trends Abdominal masses are most common in children under the age of 5 years Most abdominal masses in neonates are retroperitoneal, of kidney origin and are not malignant The older the child the more likely the mass represents a malignant process
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Possible Diagnoses of Abdominal Masses in Infancy and Childhood Atlas of Pediatric Physical Diagnosis, Fourth Edition
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Abdominal Masses in Older Children Renal 55% 25% Hydronephrosis 20% Cystic disease 5% Non Renal Retroperitoneal 23% Neuroblastoma 21% Teratoma 1% Other 1% Gastrointestinal 12% Appendiceal Abscess Lymphoma Hepatobiliary 6% Tumors Hepatoblastoma HCC Genital 4% Ovarian Cysts and Teratoma Kirk et al., 1981 Radiol. Clin. North Am., 19:527-545
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Neonatal Abdominal Masses Renal 55% Hydronephrosis 35% Cystic disease 10% Multicystic dysplastic Polycystic dysplastic Solid Tumors 10% Mesonephric nephroma nephroblastomatosis Pelvic / Genital 15% Teratoma Ovarian Cysts Hydrometrocolpos Obstructed bladder non-Renal Retroperitoneal 10% Adrenal Hemorrhage neuroblastoma Gastrointestinal 15% Duplication Mesenteric omental cyst Pseudocyst from complicated obstruction Meconium ileus Hepatobiliary 5% Hepatic tumors Hemangioendothelioma Cystic mesenchymal hamartoma Hepatoblastoma Neuroblastoma Choledochal cyst Kirk et al., 1981 Radiol. Clin. North Am., 19:527-545
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Examination of the Pediatric Abdomen History – time the mass has been present, rapidity of growth, symptoms Undress patient: evaluate for genetic or inherited predisposition as well as the belly Palpate from the pelvis toward the thorax Describe location Size Consistency Ascites Venous congestion of surface Golden and Feusner, 2002, Pediatr Clin N Am, 49:1369-1392
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11_abdominal_masses_resident_lecture_series_v3 - Assessment...

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