Anemia:

 Bleeding:

 Bone tenderness:

It is a feature of acute leukemia or neuroblastoma. It tends to be intermittent and its severity increases with time.

 Lymphadenopathy: -

Generalized lymphadenopathy is seen in acute leukemias and Non-Hodgkin's lymphoma. Hodgkin's disease presents with progressive enlargement of one group of lymph nodes that are firm and rubbery

When do you suspect malignancy?

1. Progressive increase in size of the lymph nodes.
   
   
2. Nodes at unusual sites like posterior auricular, epitrochlear or supraclavicular.
   
   
3. Nodes persisting for 4-6 weeks or more.
   
   
4. Mediastinal lymphadenopathy.
   
   
5. Nodes not responding to antibiotic or antitubercular therapy.
   
   
6. Nodes associated with hepatosplenomegaly anemia, fever.
   
   
7. Localized lymphadenopathy that is firm & rubbery.

Wilm's tumor and neuroblastoma are seen in a younger child (<4 years) while lymphomas predominate in older patients. Abdominal tumors may have associated hypertension.


Patients may be asymptomatic (mass is discovered during routine chest X-rays) or may present with symptoms due to compression of adjacent structures such as the respiratory tract (cough, dyspnea, stridor), esophagus (dysphagia) and superior vena cava (engorged neck and chest wall veins, facial puffiness).

The commonest malignancies that involve the mediastinum are lymphomas, acute lymphatic leukemia and neuroblastoma.


It is seen with intracranial tumors. It presents predominantly with early morning headache or as headaches that may awaken the child. It may be associated with vomiting, visual defects, papilledema, neurological deficits etc.



Embryonal tumors, neuroblastoma, retinoblastoma and hepatoblastoma.


Acute lymphatic leukemia and brain tumors.


Lymphomas, rhabdomyosarcoma and Ewing's tumor.

When to do Bone Marrow Examination?

It is done under following conditions:

1. Significant depression of one or more cell lines or abnormal blood counts in absence of infection/inflammation.
   
   
2. Abnormal blood counts with unexplained lymphadenopathy or hepatosplenomegaly.
   
   
3. Presence of atypical or blast cells in peripheral blood smears.

* Both aspiration and trephine bone biopsies are recommended in cases of acute leukemia to determine morphology and marrow cellularity.

When to do fine needle aspiration cytology (FNAC)?

It is used for any mass lesion or enlarged lymph nodes. It could even be used safely for deep-seated masses/mediastinal nodes either by USG or CT scan. It must, however, be followed by a biopsy if results are inconclusive or reported as reactive hyperplasia.

When to do excisional/ incisional biopsy?

1. When mass is localized to an organ e.g. adrenal gland or kidneys, with no evidence of metastatic disease. Total removal should be the aim.
   
   
2. When FNAC is inconclusive.

• Do not administer steroids in a suspected case of JRA without doing a BM aspiration.
  
  
• Do not start anti TB therapy/antibiotics in patients with lymphadenopathy without a definite diagnosis.
  
  
• Do a lymph node biopsy if FNAC is inconclusive and neoplasia is suspected.
  
  
• Give a blood transfusion prior to a definite diagnosis only if Hb is <5gm/dl or if there are impending features of CCF.
  
  
• Refer children suspected to have a neoplastic disease as early as possible. Remember, CHILDHOOD CANCERS ARE CURABLE.

Last created on 13-07-2001
Last updated on 01-07-2006