Pediatric Abdominal Tumors

Solid Intra abdominal masses
:Prepared by
Salwa Mahdi
Kaheen Nooraldeen
Solid intra abdominal tumors
account for 10% of all death among children.
Childhood cancer account for only 2% of all cancer.
Overall cure rate 85%
solid intra abdominal tumors in children include the following:

Lymphoma
Neuroblastoma
Wilm`s tumor
Rhabdomyosarcoma
Teratoma
Liver tumors
Neuroblastoma
 Tumor arises from sympathetic neuroblast cell derived from
neural crest.
Sites:Because neuroblastoma can arise from any site along the
sympathetic nervous system explains the multiple anatomic sites
 1. adrenal gland 50%
 2. paraspinal ganglion origin
3. thoracic
 4. Pelvis.
 5. Neck
Epidemiology
Over half of the children present with metastatic disease
 >50% present below 2 years of age
 >90% present below 6 years of age
Clinical features
 chemokines:
 Fever, weight loss, sweating, fatigue
 Location:
Thoracic region> breathing difficulties
Neck> presses on facial nerves
Spine> neurological symptomps
Adrenal medulla> painful abdominal mass>
swelling
Bone> bone pain, fractures
Bone marrow> fatigue, easy bruising, frequent infections
catecholamine secretion: HTN, sweats, irritability; diarrhea;

Raccoon eyes
Diagnosis
A. laboratory investigation:
 Urinary VMA & HVA.
 biochemical marker : LDH and serum ferritin
B. imaging studies:

 US, CT, MRI & bone scan
C. Tissue biopsy:

 Biopsy of tumor and bone marrow aspiration
Staging
Stage 1: localized tumor with complete gross resection, -ve lymph node
 stage 2: incomplete gross resection or +ve ipsilateral lymph node
Stage 3: unresectable tumor infiltrating across midline
Stage 4: distant metastasis
Stage 4S: localized tumor with involvement of skin, liver and

bonemarrow in infant.
Treatment
Depends on the size and staging
Surgery: remove all the tumor in lower stages.
Chemotherapy: is the mainstay of treatment for
advanced disease.
Bone marrow transplantation.
Radiotherapy
Immunotherapy (increase survival by 20 %)
Lymphoma
Lymphomas are malignant neoplasms of lymphoid lineage.
Types : Hodgkin lymphoma& non-Hodgkin lymphoma.

Abdominal tumors are usually( non-Hodgkins).
Non-Hodgkin lymphoma:
Site : abdomen, mediastinum and cervical L.N
Clinical features:
 Painless lymphadenopathy, fever, night sweats, weight loss
 Abdominal palpable mass
 I.O
 Mediastinum......respiratory distress
Diagnosis
Diagnosis is by biopsy, the sample is also used for immunologic
and cytogenetic analysis
CBC, BME, LP
Imaging (CXR, CT of chest, abdomen, pelvis)
PET SCAN
Serum K. Ca, Ph, uric acid, LDH. LDH can be useful
prognostically,especially in patients with advanced stage
disease.
Treatment
1. Chemotherapy with steroid (mainstay).
2. Radiotherapy
 3. Surgery
Wilms tumor
Wilms tumor, or nephroblastoma, the most common primary
malignant renal tumor, and the second most common malignant
abdominal tumor in childhood after NB.
 Almost all cases of WT are diagnosed before the age of 10, with two-
thirds being found before age 5 and rarely in adults.
Clinical features
Asymptomatic abdominal mass (in 80% of children at
presentation)
Abdominal pain or hematuria (25%)
Hypertension, gross hematuria, and fever (5-30%)
Respiratory symptoms related to lung metastases (in patients with

advanced disease; rare)
Diagnosis
US, CT & MRI
CXR & CT chest to exclude secondaries
Staging
Stage 1: localied tumor and completely resected.
Stage 2: tumor extending outside the kidney and completely
resected.
Stage 3: tumor extending outside the kidney with incomplete
resection or lymph node involvement.
Stage 4: distant metastasis
Stage 5: bilateral tumor
Treatment:
Surgery initially, with exam of contralateral kidney
Radical nephrectomy
Chemotherapy and radiotherapy
Wilm’s Tumor
& Congenital Malformations
Cryptorchidism
Hypospadias
Hemihypertrophy
Aniridia
“Horsehoe” kidney
(WAGR syndrome: Wilms tumor, aniridia, genitourinary

anomalies, and mental retardation sy.)
Hepatoblastoma
Incidence:
Is the commonest liver tumor in pediatric.
Age:
Most patient are below 5 years
4% present at birth.
Clinical Features:
asymptomatic abdominal mass.
anorexia and FTT.
sextual precocity.
Diagnosis
lab. Anemia, thrombocytosis
increase AFP
imaging: US, CT, MRI
STAGING
I complete resection
II gross resection with microscopic residual
III unresectable tumor or lymph node involvement
IV distant metastasis
Treatment
surgery
chemotherapy.
chemoembolization.
liver transplantation
Thank you 

Pediatric Abdominal Tumors

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Solid Intra abdominal masses

solid intra abdominal tumors in children include the following:

catecholamine secretion: HTN, sweats, irritability; diarrhea;

B. imaging studies:

C. Tissue biopsy:

 stage 2: incomplete gross resection or +ve ipsilateral lymph node

Stage 3: unresectable tumor infiltrating across midline

Stage 4: distant metastasis

Stage 4S: localized tumor with involvement of skin, liver and

Types : Hodgkin lymphoma& non-Hodgkin lymphoma.

Abdominal pain or hematuria (25%)

Hypertension, gross hematuria, and fever (5-30%)

Respiratory symptoms related to lung metastases (in patients with

(WAGR syndrome: Wilms tumor, aniridia, genitourinary

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