2025 – PAGE 278 – HEMATOLOGY & ONCOLOGY

BRAIN TUMORS

In general, brain tumors are the most common solid tumors found in pediatrics. Look for a child with a headache that is worse in the morning. Most people with regular headaches like to lie down. These kids feel better when they stand up! They may also feel better after vomiting.

• CRANIOPHARYNGIOMA: This tumor will cause problems with the vision, the pituitary gland, or the hypothalamus. Look for calcifications near the pituitary if given a skull X-ray.
• POSTERIOR FOSSA TUMORS: These are common after age 2. Medulloblastomais the most common.

PEARL: Wilms tumor, neuroblastoma, and brain tumors are ALL solid tumors. Both Wilms tumor and neuroblastoma will present with abdominal masses, but the kids with a neuroblastoma will be much sicker.

(DOUBLE TAKE) LANGERHANS CELL HISTIOCYTOSIS (LCH) = HISTIOCYTOSIS X

Langerhans Cell Histiocytosis (LCH), AKA Histiocytosis X, is a PAPULAR rash that is sometimes associated with petechiae. The rash is located in the folds (inguinal folds, supra-pubic folds, perianal area). It can resemble eczema, but the petechiae or PAPULES should guide you towards this diagnosis. LCH is a type of cancer. You may be shown a lytic bone lesion (possibly of the skull). Diagnose by skin biopsy. LCH can also be associated with DIABETES INSIPIDUS. Treat by removing the lesion and giving steroids, ± chemotherapy.

PEARLS: Do not confuse this with Wiskott-Aldrich (WiXotT-Aldrich, X-linked, low IgM, high IgA, TIE = Thrombocytopenia, small platelets, Infections, and Eczema). Also, if they describe an eczema or seborrheic dermatitis type of rash in a patient with high urine output, LCH is your diagnosis.

IMAGE: www.pbrlinks.com/LANGERHANSCELL1
IMAGE: www.pbrlinks.com/LANGERHANSCELL2
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RHABDOMYOSARCOMA

Rhabdomyosarcoma is the most common SOFT TISSUE sarcoma in kids. It may present as unusual or worsening post-traumatic pain, a head/neck tumor, a rectal mass, a vaginal mass (grapelike), or another soft tissue mass. Diagnose with a biopsy.

TUMOR LYSIS SYNDROME

Tumor lysis syndrome is an ONCOLOGIC EMERGENCY. It occurs due to lysis of large tumors or “blood tumors” (lymphoma). Potassium, phosphorus, and uric acid levels are elevated due to release from lysed cells. Treat with allopurinol or rasburicase, aggressive hydration, and careful monitoring and management of electrolytes. Urine alkalinization by giving sodium bicarbonate is no longer generally recommended.

GRAFT VERSUS HOST DISEASE (GVHD)

GVHD occurs when donor immune cells attack recipient tissues post-transplant. Symptoms may include maculopapular rash, jaundice, diarrhea, and abdominal pain. Diagnosis is clinical, supported by skin biopsy, LFTs (elevated), and gut biopsy. Treat with immunosuppressives such as steroids and cyclosporine.

CORD COMPRESSION

Treat cord compression with IV steroids ± radiation therapy