DDx
Leukemia
Neuroblastoma
Wilm's
Last two usually occur in < 5 year age group
Bone scan is method of choice for screening for metastasis
Leukemia
Epidemiology
Most common form of cancer in children 30%
- ALL five times more common than AML
- 3 : 100 000
History
Suspect in any child complaining of diffuse bone pain
Xray
Lytic transverse lines in epiphyses
- permeative infiltration of bone with periosteal reaction
- focal destructive lesions
- occasional diffuse sclerosis
Diagnosis
CBC
Blood smear
Bone marrow aspirate
Neuroblastoma
Background
Tumour of sympathetic nervous system
- arises anywhere in the sympathetic nervous system or adrenal medulla
- 10% primary site not found
- malignant small round cell tumour
Usually present with abdominal mass and fever
Xray
Multiple destructive lytic lesions in any part of the skeleton
- often associated with periosteal new bone
- may be permeative
- skull lesions common
Diagnosis
Elevated serum / urinary catecholamines and VMA
Bone Marrow Aspirate
Wilms Tumour
Background
Nephroblastoma
- arises in kidneys
- usually occurs in first 5 years of life
Associated with hemihypertrophy / Beckwith syndrome
Most present with abdominal mass
- may have abdominal pain
Diagnosis
Abdominal USS / CT
Management
Nephrectomy / chemotherapy
Others
Ewings
Lymphoma
Osteosarcoma
Rhabdomyosarcoma
Retinoblastoma