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The Child with an Abdominal Mass

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					The Child with an
Abdominal Mass
     Prof. Kais Al-Wattar
     The Child with an Abdominal Mass

    After full history and making general, local and
     rectal examination the steps towards a clinical
     diagnosis of a mass in the abdomen:

1.   Site, characteristics, size, consistency and
     mobility which will lead to a conclusion as to.

2.   The probable organ of origin.

3.   Age, knowledge of most likely pathological
     process arising in the organ affected and these
     are related to.

4.   The length of history and type of symptoms.
     The commonest malignant
     abdominal masses are:
1.    Neuroblastoma.
2.    Wilm’s tumor (Nephroblastoma).
3.    Malignant lymphoma (usually Non-Hodgkin
      lymphoma of the intestine).
4.    Lymphosarcoma.
5.    Hepatoblastoma.
6.    Other Suprarenal tumors (Non Neuroblastoma).
7.    Others .
The commonest benign masses
are those of:
1.   Hydronephrotic kidney (Peliviureteric
     junction obstruction), polycystic kidney.

2.   Mesenteric mass and cysts.

3.   Intestinal Duplication cysts.


4.   Hydatid cysts in the older children
    A mass in the loin in the toddlers
     (1-3 years).

    Triad of :
1.   Abdominal Neuroblastoma
2.   Wilm’s Tumor.
3.   Hydronephrosis.

    Minimal local or general symptoms,
     usually the mass discovered by the
     mother.
Investigations of an Abdominal Mass
    Palpation should be restricted to the minimum.

1.   X-Ray: plain X-Ray , calcifications, Renal
     angiogram, I.V.U. other kidney.

2.   U.S. , CT , MRI.

3.   Blood & urine.

4.   Bone Marrow aspiration or biopsy.

5.   Fine Needle Aspiration Cytology (FNAC) when
     indicated.
                 Neuroblastoma
                         Prof. Kais Al-Wattar

   Most common and most highly malignant arise from the
    cells of fetal neural crest, and the adrenal gland is the
    commonest.
   The peak age of incidence is usually at 2 years of age.
   The tumor tends to be ill-defined, firm, nodular, fixed and
    often extends to the midline, usually associated with
    fever and loss of weight.
                   Neuroblastoma…cont.
    Early metastasis to:

1.   Bone Marrow.
2.   Cortex of long bones.
3.   Skull, spine, orbit.
4.   Lymph Nodes.
5.   Liver.
6.   Periorbital metastasis.
     (the raccoon-like appearance)
                Neuroblastoma…cont.

    Outcome: -
   Spontaneous regression in 3% of cases but in
    65-75% of cases the dissemination is already
    present when the diagnosis is made.

   Another outcome is maturation to a benign
    Ganglioneuroma.

   Spread & Metastasis is common.

   Neuroblastoma is radiosensitive and responds
    favorably to cytotoxic agents.
                 Neuroblastoma…cont
    When the evidence suggests that the mass is a
     Nuroblastoma the investigations required are: -

1.   Bone marrow biopsy. (65-75%)
2.   Skeletal Survey.
3.   Biopsy of other suspicious sites of metastasis
     (Lymph Nodes).
4.   24 h collection of urine for VMA , MHMA,
     Catecholamine metabolites.
5.   Chest X-Ray.
6.   I.V.U., Ultrasound, MRI.
7.   Fine Needle Aspiration cytology ? Biopsy.
               Neuroblastoma…cont

Treatment :
    Surgical excision rare

    If it is extending behind the Aorta or Inferior
     Vena Cava it is non-resectable.

    The Treatment rests on:
1.   Chemotherapy.
2.   Radiotherapy.
3.   Immunotherapy.

				
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posted:4/9/2010
language:English
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