A Practical Approach to the Diagnosis of Common Hematopoietic and Solid Tumors of Childhood
D. Ashley Hill, M.D.
Washington University School of Medicine
St. Louis, MO
Mihaela Onciu, M.D.
St. Jude Children's Research Hospital
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A five-year-old female presented to her pediatrician with
hematuria after being struck in the flank. Physical examination identified a left-sided abdominal mass.
Radiographic studies showed a large left renal mass. A left radical nephrectomy was performed.
Peri-aortic lymph nodes were sampled.
A 14-month-old girl presented with an abdominal mass. CT
scan showed a 7.0 x 6.5 x 5.0 cm nodular left adrenal mass with focal calcifications. The mass did not
cross the midline. Bone marrow biopsies were normal. A left adrenalectomy was performed.
A 1 year-old male presented to his pediatrician with an
enlarging buttock mass. Physical examination showed a firm mass in the gluteal region. A pelvic CT scan
showed a 10.0 x 8.0 x 7.0 cm mass involving the gluteus muscle with extension into the pelvis. An
incisional biopsy was performed.
This five month old female presented acutely with fever,
tachypnea and labored respirations. She was diagnosed with Influenza B and admitted to the hospital.
Born at term with an uneventful neonatal course, she had no significant illnesses prior to admission,
although her mother stated that her breathing had not been "normal" for some time. The family history
was notable for two relatives with a history of childhood cancer including the patient's mother who had
acute B-cell leukemia as a child and a maternal cousin who was being treated for neuroblastoma. A chest
X-ray on admission showed hyperaeration of the left lung. A CT scan showed a markedly emphysematous left
upper lobe with compressive atelectasis of the left lower lobe and mediastinal shift. There were
multiple, fine septations in the hyperinflated lobe with no visible normal lung tissue. The radiographic
differential diagnosis included congenital pulmonary airway malformation (CPAM) and congenital lobar
emphysema. The patient recovered from her upper respiratory infection and returned approximately three
weeks later for resection of the abnormal left upper lobe. At surgery, the left upper lobe showed
massive overinflation with attenuation of the visceral pleura. The upper lobe was dissected off the
lower lobe with ligation of upper lobe branches of the pulmonary vascular structures and the left upper
lobe bronchus. No other cystic abnormalities involving the pleura, mediastinum or left lower lobe were
A15-year-old boy presented with three-week fever, not
responding to antibiotics, and isolated left inguinal lymphadenopathy. An excisional lymph node biopsy
was performed. The excised inguinal lymph node measured 2.5 cm in greatest dimension. No additional
disease was identified at staging work-up.
A 10-year-old boy presented with left cervical
lymphadenopathy. An excisional lymph node biopsy was performed. The excised cervical lymph node
measured 2.3 cm in greatest dimension. The staging work-up revealed additional lymphadenopathy in the
submandibular, paratracheal, axillary and inguinal areas.
18-year-old boy with a history of blunt trauma to the abdomen
followed by persistent abdominal pain. Physical examination prompted a clinical diagnosis of
appendicitis and the patient underwent appendectomy. Introperative findings included purulent ascites, a
massively enlarged appendix (18 cm in length and approximately 4 cm in diameter), and extensive small
bowel involvement by tumor. Further staging work-up revealed extensive bone marrow involvement (ALL, L3)
and many blasts present in the peritoneal fluid.
12-year-old boy with a large anterior mediastinal mass and
left cervical lymphadenopathy. A needle-biopsy of a left cervical lymph node was performed. Further
work-up showed normal bone marrow and peripheral blood.
17-year-old previously healthy boy presenting with small
bowel obstruction. An abdominal CT showed a terminal ileal mass. The patient underwent terminal ileal
resection. The resected mass measured 8 cm in greatest dimension and was situated 13-14 cm proximal to
the ileal-cecal valve. The margins of resection were grossly clear of tumor. No additional sites of
involvement were found at staging work-up.
14-year-old girl with large anterior mediastinal mass and
cervical lymphadenopathy. An incisional biopsy of the cervical lymph node was performed.
A 13-year-old girl who presented with headache. Examination
showed cranial nerve XI palsy. Radiographic studies showed an enhancing posterior fossa mass and
cerebrospinal fluid dissemination of tumor.
18-year-old boy who presented with symptoms of esophageal
dysfunction. Radiographic studies showed a lung/mediastinal mass.