Oncology

While bathing her 3-year old son, a mother feels a mass in his abdomen. You consider Wilms tumor. A thorough medical eval-uation of the child might reveal which of the following:
A. Coloboma
B. Hemihypertrophy
C. Epispadius
D. Duplication of the urinary collecting system
E. Cataracts

B. Genitourinary anomalies and hemihypertrophy is rela¬tively common in patients with Wilms tumors.

A l-week-old infant presents with a right mid-quadrant abdom¬inal mass, failure to thrive, and decreased urinary output. What is the most likely diagnosis?
A. Neuroblastoma
B. Hydronephrosis
C. Wilms tumor
D. Sepsis
E. Intussusception

B. Urinary tract obstruction is often silent. In the newborn, a palpable abdominal mass is commonly a hydronephrotic or mul¬ticystic dysplastic kidney.

To determine whether an abdominal mass is a neuroblastoma or a Wilms tumor, which of the following tests would be most helpful?
A. Routine urinalysis
B. Abdominal film
C. Chest radiograph
D. Urinary catecholamines
E. Complete blood count

D. Approximately 90% of patients with neuroblastomas have el¬evated urinary catecholamines.

A 13-year-old male complains of left knee pain, swelling, warmth, and tenderness for 1 week. He has sustained no trauma and has never had knee pain in the past. He has a temperature of 10 1.8°F (38.8°C). Examination reveals an erythematous, warm, swollen knee with reduced range of motion. A complete blood count (CBC) reveals a leukocyte count of 18,700/mm3 and a erythrocyte sedimentation rate (ESR) of 190 mm/h. What is the most likely diagnosis?
A. Ewing sarcoma
B. Osteomyelitis
C. Osteosarcoma
D. Eosinophilic granuloma
E. Neuroblastoma

B. Osteomyelitis. He has an elevated temperature and white blood cell (WBC) count, indicating infection. Definitely septic arthritis is considered but not mentioned here.

A 4-year-old female developed progressive swelling, warmth, stiffness and pain in her left knee beginning two weeks ago. She has become fatigued in the afternoons and has developed fevers spikes to I02.2°F (39°C) over the last week. Examination re¬veals a right knee that is swollen, nonerythematous, warm to the touch, and with decreased range of motion. She has a faint ery¬thematous macular rash over her trunk and proximal extremi¬ties. What is the most likely diagnosis?
A. Juvenile rheumatoid arthritis (JRA)
B. Acute lymphoblastic leukemia (ALL)
C. Osteosarcoma
D. Lymphoma
E. Osteomyelitis

A. Intermittent fever in association with a rash and arthritis is highly suggestive of systemic-onset JRA.

Which of the following factors is associated with an increased risk of developing osteosarcoma in children?
A. Prior radiation therapy
B. Medulloblastoma
C. Delayed adolescent growth spurt
D. Prior trauma to or abnormality of the involved bone
E. Short stature

A. Prior radiation, certain growth conditions such as retinoblas¬toma, and malignant transformation of Paget disease are risk factors for developing osteosarcoma

A 6-month-old infant male you have never seen before presents to your-clinic with an abdominal mass, discovered by his mother during the child’s bath. On close physical examination you note the infant to have macroglossia and history of macrosomia. This infant is likely to have:
A. Down syndrome with duodenal atresia
B. Alagille syndrome and biliary atresia
C. Beckwith-Wiedemann syndrome with Wilms tumor
D. Neurofibromatosis and abdominal neurofibromas
E. Zellweger syndrome and hepatomegaly

C. This infant with features of Beckwith-Wiedemann syndrome is at high risk of developing Wilms tumor, hepatoblastoma, and gonadoblastoma.

A 2-year-old child is brought to the emergency center by the fa¬ther who felt a mass in the child’s abdomen this morning while bathing her. She has had less energy than usual, a decreased ap¬petite, and is pale with dark circles under her eyes. Physical ex¬amination reveals a large abdominal mass that crosses the mid¬line. She also has periorbital ecchymoses and proptosis. What is the most likely diagnosis?
A. Wilm’s tumor
B. Lymphoma
C. Neuroblastoma
D. Teratoma
E. Hepatoblastoma

C. Children with neuroblastoma develop periorbital metastases, leading to periorbital ecchymoses and proptosis.

A 6-year-old male complains of right knee pain for 2 weeks. He has been fatigued and has developed bruising on his arms and thighs. Examination reveals a temperature of 99.8°F (37.7°C), gingival bleeding, and hepatomegaly. What is the most likely diagnosis?
A. Osteomyelitis
B. Osteosarcoma
C. Paget disease
D. Juvenile rheumatoid arthritis
E. Acute lymphoblastic leukemia (ALL)

E. This child has the classic signs of acute lymphoblastic leukemia (ALL) bone pain, low-grade fever, fatigue, bruises bleeding of gums, and hepatomegaly. Although each of the diagnosis listed may exhibit one or two of this child’s-symptoms, only ALL is likely to be responsible for all of the symptoms.