Paediatric

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 5 x 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