Ce diaporama a bien été signalé.
Nous utilisons votre profil LinkedIn et vos données d’activité pour vous proposer des publicités personnalisées et pertinentes. Vous pouvez changer vos préférences de publicités à tout moment.

Common Pediatric Solid Tumors

7 053 vues

Publié le

Pediatric Surgery Elective Course

College of Medicine, King Faisal University

Al-Ahsa, Saudi Arabia

Publié dans : Santé & Médecine
  • Login to see the comments

Common Pediatric Solid Tumors

  1. 1. Common Pediatric Solid Tumors Abdullatiff Sami Al-Rashed College of Medicine, King Faisal University Al-Ahsa, Saudi Arabia
  2. 2. Objectives • Definition. • Epidemiology. • Etiology. • Types. • Symptoms & Signs. • Staging. • Diagnosis. • Treatment. • Prognosis. • Definition. • Epidemiology. • Etiology. • Types. • Symptoms & Signs. • Staging. • Diagnosis. • Treatment. • Prognosis. • Definition. • Treatment.
  3. 3. Lymphoma (Hodgkin's & Non-Hodgkin's) Lymphoma (Hodgkin's & Non-Hodgkin's)
  4. 4. Definition • Neoplasia of the lymphatic system and its precursor cells with genetically distrusted regulation of proliferation, differentiation and apoptosis. • Characterized by painless, progressive enlargement of the lymph nodes with continues extension between lymph node regions.
  5. 5. Epidemiology • Lymphoma accounts 10% of all pediatric neoplasia. Hodgkin's lymphoma Non-Hodgkin's lymphoma 7 in 1 million children < age of 16 newly diagnosed with HL annually Ratio of boys to girls 2:1 Boys > Girls , but during adolescence the incidence is the same Peak incidence between 5 to 15 years old Peak incidence between 15 to 35 years old
  6. 6. Etiology • Unknown etiology in humans. • It has been found that there is correlation with infection “e.g Epstein-barr Virus”. • Correlation with Socioeconomic status: the higher SES the more frequently HL occur. • Genetic causes. • Unknown etiology in humans. • Predisposing factors include: – Autoimmune disorders. – Infections ( HIV, EBV, HTLV-1 ) – Congenital B-Cell defect. – Congenital T-Cell defect. – Drug induced (immunosuppressive treatment) HL NHL
  7. 7. Types Lymphoma Hodgkin's lymphoma Classical Hodgkin’s lymphoma (90- 95%). Nodular lymphocyte predominant HL Non Hodgkin's lymphoma Diffuse large B- cell lymphoma (30%) Peripheral T-call lymphoma Burkitt Lymphoma (Highly aggressive) Other types
  8. 8. Symptoms & Signs Painless enlarged lymph nodes (commonest cervical)
  9. 9. Symptoms & Signs
  10. 10. Staging
  11. 11. Diagnosis
  12. 12. Treatment • Treatment plan is assigned based on the type and stage of lymphoma. • Traditionally, management consists of a combination of chemotherapy drugs. • Combination of radiotherapy and chemotherapy can be used in Hodgkin's lymphoma.
  13. 13. Prognosis
  14. 14. Nephroblastoma (Wilms tumor) Nephroblastoma (Wilms tumor)
  15. 15. Definition • Malignant embryonal tumor of renal tissue. • First described in 1899 by max wilms.
  16. 16. Epidemiology
  17. 17. Etiology • Wilms tumor has been associated with loss of function mutations of a number of tumor suppressor and transcription genes. • These include mutations of the WT1, p53, FWT1, and FWT2 genes, and at the 11p15.5 locus. • Associated with some congenital syndromes. These syndromes include: – WAGR syndrome. – Denys-Drash syndrome. – Beckwith-Wiedemann syndrome.
  18. 18. Types • Histologically, the classic favorable histology Wilms tumor is comprised of three cell types:
  19. 19. Symptoms & Signs
  20. 20. Staging
  21. 21. Diagnosis
  23. 23. Treatment • Treatment plan is assigned based on results of the initial staging, histological, and molecular studies. • In General , lines of treatment include: Surgery Chemotherapy Radiotherapy
  24. 24. Prognosis
  25. 25. NeuroblastomaNeuroblastoma
  26. 26. Definition • Malignant embyronal tumor of precursor cells of sympathetic ganglia and adrenal medulla. • Commonly used to refer to a spectrum of neuroblastic tumors (including neuroblastomas, ganglioneuroblastomas, and ganglioneuromas)
  27. 27. Epidemiology
  28. 28. Etiology • Etiology is unknown.  Risk factors: • Maternal factors: These include the following: – Opiate consumption – Folate deficiency – Toxic exposures – Congenital abnormalities – Gestational diabetes mellitus • Genetic factors: – A higher incidence of neuroblastoma has been suggested in girls with Turner syndrome, Hirschsprung's disease, central hypoventilation, and neurofibromatosis type 1 (NF1)
  29. 29. Types • Neuroblastomas can arise anywhere throughout the sympathetic nervous system. • The common primary sites: Adrenal gland (40%) Abdominal (25%) Thoracic (15%)
  30. 30. Types
  31. 31. Symptoms & Signs
  32. 32. Staging
  33. 33. Diagnosis
  34. 34. Diagnosis • Diagnostic criteria — Minimum criteria for establishing a diagnosis of neuroblastoma have been agreed upon by an international consensus panel. A definitive diagnosis of neuroblastoma requires one of the following: – An unequivocal histologic diagnosis from tumor tissue by light microscopy, with or without immunohistochemistry, electron microscopy, or increased urine (or serum) catecholamines or their metabolites. – Evidence of metastases to bone marrow on an aspirate or trephine biopsy with concomitant elevation of urinary or serum catecholamines or their metabolites.
  35. 35. Treatment • Treatment plan is assigned based on: – Stage of the disease. – Patient age. – Histologic appearance of the tumor. – Presence or absence of amplification of the MYCN oncogene. – Quantitative DNA content of the tumor (DNA index or ploidy).
  36. 36. Treatment •In General , lines of treatment include: Surgery Chemotherapy Radiotherapy
  37. 37. Prognosis
  38. 38. hepatoblastomahepatoblastoma
  39. 39. Definition • Hepatoblastoma is the most common primary hepatic malignancy in early childhood. • The majority of hepatoblastomas occur in the first two years of life and rarely in children older than five years.
  40. 40. Epidemiology • One percent of all pediatric neoplasias • The incidence of hepatoblastoma in boys is twice that in girls.
  41. 41. Etiology • Exact etiology is unknown. • Syndromes with an increased incidence of hepatoblastoma include: – Beckwith Wiedmann syndrome. – Trisomy 18 & 21. – Acardia syndrome. – Li-Fraumeni syndrome. – Goldenhar syndrome (a type of craniofacial microsomia). – Type 1a glycogen storage disease (von Gierke’s disease). – Familial adenomatous polyposis (FAP).
  42. 42. Types
  43. 43. Symptoms & Signs
  44. 44. Staging Stage Characteristics Stage I • The tumor is completely resectable via wedge resection or lobectomy. • The tumor has PFH results. • The AFP level is within reference range within 4 weeks of surgery. Stage IIA • The tumor is completely resectable. • The tumor has histologic results other than PFH (UH). Stage IIB • The tumor is completely resectable. • AFP findings are negative at time of diagnosis (ie, no marker to follow). Stage III (any of the following) • The tumor is initially unresectable but is confined to one lobe of liver. • Gross residual disease is present after surgery. • Tumor ruptures or spills preoperatively or intraoperatively. • Regional lymph nodes are involved. Stage IV Distant bone or lung metastasis is present.
  45. 45. Diagnosis
  46. 46. Treatment • Treatment plan is assigned based on results of the initial staging, histological, and molecular studies. • In General , lines of treatment include: Surgery Chemotherapy Radiotherapy
  47. 47. Prognosis
  48. 48. HemangiomaHemangioma
  49. 49. Definition • Infantile hemangiomas are benign vascular neoplasms that have a characteristic clinical course marked by early proliferation and followed by spontaneous involution. • Hemangiomas are the most common tumors of infancy and usually are medically insignificant.
  50. 50. Treatment • The vast majority of infantile hemangiomas do not require any medical or surgical intervention. • Intervention may be required for lesions with potential to interfere with a vital structure or function. These include, but are not limited to: – Lesions in the airway, liver, or gastrointestinal tract. – Lesions in the periorbital region. – Very large, rapidly growing cutaneous hemangiomas.
  51. 51. Treatment • Treatment choices are: – Drugs: Steroids and Beta-Blocker – Surgery: laser surgery or surgical excesion
  52. 52. References