Assessment and Diagnosis of Abdominal Masses in Children：在儿童和腹部肿块的诊断评估.ppt

Assessment and Diagnosis of Abdominal Masses in Children Resident Education Lecture Series General approach to solid tumors What is it? Where is it? Where can it go? The answer to any one of these questions will help answer the other two Work up – two components Staging X-ray of primary site CT chest, abdomen, pelvis CXR (baseline) bone scan Specialty tests Gallium, MIBG, PET Bone marrow ESR Evaluate for complications of the tumor CBC with diff TPN panel LDH, uric acid – tumor lysis, rapid cell growth Lytes, creatinine – renal function Transaminases – hepatic involvement Specialty tests Tumor markers HCG, AFP HVA/VMA …. Tissue diagnosis Incisional biopsy Excisional biopsy Special cases… Calicified suprarenal mass + bone scan – might consider getting dx from bone marrow FNA vs excisional biopsy Bias towards excisional → sufficient sample to be representative and to send for special research studies (histology, chromosomes, special studies, research studies) Abdominal Masses Trends Abdominal masses are most common in children under the age of 5 years Most abdominal masses in neonates are retroperitoneal, of kidney origin and are not malignant The older the child the more likely the mass represents a malignant process Possible Diagnoses of Abdominal Masses in Infancy and Childhood Abdominal Masses in Older Children Renal 55% Wilms ( other) 25% Hydronephrosis 20% Cystic disease 5% Non Renal Retroperitoneal 23% Neuroblastoma 21% Teratoma 1% Other 1% Gastrointestinal 12% Appendiceal Abscess Lymphoma Hepatobiliary 6% Tumors Hepatoblastoma HCC Genital 4% Ovarian Cysts and Teratoma Neonatal Abdominal Masses Renal 55% Hydronephrosis 35% Cystic disease 10% Multicystic dysplastic Polycystic dysplastic Solid Tumors 10% Mesonephric nephroma nephroblastomatosis Pelvic / Genital 15% Teratoma Ovarian Cysts Hydrometrocolpos Obstructed b