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Pediatric Surgery (Pg 68-81) - page 15 / 33

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Usually have an asymptomatic abd mass. Sometimes, they will have abd pain, hematuria, or HTN. Metastasis is less common. Investigations include U/S and CT scans of the abd/chest.

Resection of the tumor as a total or partial nephrectomy is the mainstay of treatment.  All children receive chemo postoperatively.  Radiation is added to those with unfavorable histology, residual tumor, or metastatic disease.

Survival rate of children has improved from 10 to 80% in several decades.  As with neuroblastoma, younger children fare better.

Teratomas

Originate early in embryonic cell division.  Tumor no longer required to contain all three germ layers to be classified as a teratoma.  

Often occur in the gonads or near the midline of the body.  Benign or malignant.  Benign tumors produce symptoms by compressing adjacent organs or by torsion.  

Most common teratomas in children occur in the sacrococcygeal region and the ovary.

Sacrococcygeal teratomas occur predominantly in girls and can be massive.  Arises from the coccyx and has an external component that is covered with skin.  Resection should be prompt because of the incidence of malignancy is only 10% in neonates, but increases to more than 50% by 2 months of age. Delivery by c-section is recommended for large tumors b/c rupture with exsanguination can occur during vaginal delivery.

Hepatic Tumors

Approximately ¾  of hepatic tumors in children are malignant.  Most common of these are the hepatoblastoma and hepatocellular carcinoma. Usually have an abd mass associated with discomfort, anorexia, weight loss, and occasionally jaundice. Serum a-fetoprotein levels are usually elevated.

Hepatoblastoma is more common in children less than three.  HCC is more common in older children and is usually more invasive. For HCC resection is the treatment of choice.  Liver transplantation should be considered for unresectable hepatoblastoma w/o metastasis.

Hemangiomas are the most common benign liver tumors of children.

Rhabdomyosarcoma

Most common soft tissue sarcoma in children. Derived from primitive mesenchymal cells.

Embryonal type found in the GU tract, head/neck, and orbit. The alveolar type occurs in older children and involves the trunk and extremities.

Presentation consists of an asymptomatic mass.  Dx is established by biopsy.  Overall the survival rate is 70%

Differences in Trauma Care Between Adults and Children

Blunt trauma predominates in children

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