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Файл:Pediatric_Oncology_A_Comprehensive_Guide.pdf
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- •Pediatric Oncology
- •Foreword
- •Preface
- •Contents
- •Contributors
- •Abbreviations
- •Introduction
- •Incidence and Management of Childhood Cancer
- •1: General Aspects of Childhood Leukemia
- •1.1 Definition and General Characteristics
- •Abbreviations
- •1.2 Incidence
- •1.3 Etiology and Predisposing Factors
- •1.3.1 Genetics
- •1.3.2 Ionizing Radiation
- •1.3.3 Chemicals and Drugs
- •1.3.4 Infection
- •1.3.5 Immunodeficiency
- •1.3.6 Socioeconomic Situation
- •1.4.1 Molecular Pathogenesis
- •1.4.2 Minimal Residual Disease (MRD)
- •2: Acute Lymphoblastic Leukemia
- •2.1 Incidence
- •2.2 Clinical Manifestation
- •2.2.1 General Aspects
- •2.2.2 Specific Signs and Symptoms
- •2.2.2.1 Skin
- •2.2.2.2 Central Nervous System
- •2.2.2.4 Ear, Nose, and Throat
- •2.2.2.5 Cardiac Involvement
- •2.2.2.6 Mediastinum
- •2.2.2.7 Pleura/and Pericardium
- •2.2.2.8 Gastrointestinal Involvement
- •2.2.2.9 Renal Involvement
- •2.2.2.10 Testicular Involvement
- •2.2.2.11 Penis
- •2.2.2.12 Bone and Joint Involvement
- •2.3 Laboratory Findings and Classification
- •2.3.1 Hematology
- •2.3.1.1 Red Cells
- •2.3.1.2 White Blood Cell Count
- •2.3.1.3 Platelets
- •2.3.2 Coagulopathy
- •2.3.3 Serum Chemistry
- •2.3.4 Bone Marrow Analysis
- •2.4 Leukemic Cell Characterization and Classification
- •2.4.1 Morphology
- •2.4.2 Cytochemistry
- •2.4.3 Immunological Characterization
- •2.4.4 Biochemical Characterization
- •2.4.4.1 Terminal Deoxynucleotidyl Transferase
- •2.4.4.2 5-Nucleotidase
- •2.4.5 Cytogenetic Characterization
- •2.4.6 Cytometry
- •2.4.7 Cell Kinetics
- •2.5 Prognostic Factors of All
- •2.6 Characteristics and Prognosis of ALL in Infants
- •2.7 Differential Diagnosis
- •2.8 Therapy
- •2.8.1 Induction of Remission
- •2.8.2 Consolidation Treatment
- •2.8.3 Maintenance Treatment
- •2.9 Prognosis
- •2.10 Management of Complications and Side Effects
- •2.11 Relapse
- •2.12 Special Forms
- •2.12.1 CNS Leukemia
- •2.12.2 Testicular Leukemia
- •3: Acute Myeloid Leukemia
- •3.1 Epidemiology
- •3.2 Predisposing Factors
- •3.3 Differential Diagnosis
- •3.4 Classification
- •3.4.2 Histochemical Classification and Frequency
- •3.4.3 Immunophenotyping
- •3.4.4 Cytogenetics
- •3.5 Clinical Presentation
- •3.5.1 Bleeding
- •3.5.2 Leukostasis
- •3.5.3 Tumor Lysis Syndrome
- •3.5.4 Infection
- •3.6 Therapy
- •3.6.1 Induction Therapy
- •3.6.2 Remission and Postremission Therapy
- •3.6.3 Allogeneic Hematopoietic Stem Cell Transplantation
- •3.6.4 Autologous Hematopoietic Stem Cell Transplantation
- •3.7 Characteristics of and Therapy for AML Subtypes
- •3.7.1 Acute Promyelocytic Leukemia (APL, M3)
- •3.7.2 Acute Myelomonocytic and Acute Monocytic Leukemia (M4, M5)
- •3.7.3 Erythroleukemia (Di Guglielmo Syndrome, M6)
- •3.7.4 Acute Megakaryocytic Leukemia (AMKL)
- •3.7.6 Eosinophilic Leukemia
- •3.7.7 Congenital Leukemias
- •3.7.8 Inherited AML
- •3.8 Relapse of AML
- •3.9 Detailed Reference
- •4: Myelodysplastic Syndrome
- •4.1 Introduction
- •4.2 Definition
- •4.3 Classification
- •4.4 Epidemiology
- •4.5 Predisposing Factors
- •4.6 Etiology
- •4.7 Clinical Manifestations
- •4.8 Laboratory Findings
- •4.9 Differential Diagnosis
- •4.10 Treatment
- •References
- •5.1 Juvenile Myelomonocytic Leukemia (JMML)
- •5.1.1 Clinical Manifestations
- •5.1.2 Laboratory Findings
- •5.1.3 Natural History
- •5.1.4 Prognosis
- •5.1.5 Therapy
- •5.2 Chronic Myelogenous Leukemia (Adult Type)
- •5.2.1 Clinical Manifestations
- •5.2.2 Laboratory Findings
- •5.2.3 Natural History
- •5.2.4 Management
- •5.3 Polycythemia Vera
- •5.3.1 Diagnosis
- •5.3.2 Clinical Manifestations
- •5.3.3 Management
- •5.4 Essential Thrombocythemia
- •5.4.1 Differential Diagnosis
- •5.4.2 Diagnosis
- •5.4.3 Management
- •5.5 Idiopathic Myelofibrosis
- •5.5.1 Clinical Manifestations
- •5.5.2 Natural History
- •5.5.3 Management
- •5.6 Hypereosinophilic Syndrome
- •5.7 Transient Myeloproliferative Syndrome Associated with Down Syndrome
- •5.8 Mast Cell Disease (Mastocytosis)
- •References
- •6: Non-Hodgkin Lymphoma
- •6.1 Definition
- •6.2 Incidence
- •6.3 Etiology, Pathogenesis, and Molecular Genetics
- •6.4 Pathology and Classification
- •6.5 Histological, Immunological, and Cytogenetic Characteristics of the Different Forms of NHL
- •6.5.1 Burkitt Lymphoma (BL) and Burkitt Like Lymphoma (BLL)
- •6.5.3 Lymphoblastic Lymphoma (LL)
- •6.5.4 Anaplastic Large Cell Lymphoma (ALCL)
- •6.5.5 Unclassifiable NHL
- •6.6 Clinical Manifestations
- •6.6.1 General Symptoms
- •6.6.2 Symptoms in Relation to Location of NHL
- •6.6.2.1 Abdomen
- •6.6.2.2 Mediastinum
- •6.6.2.3 Peripheral Lymph Nodes
- •6.6.2.4 Other Locations
- •6.7 Differential Diagnosis Among the Different Forms of NHL (In Ranking of Frequency)
- •6.7.1 Differential Diagnosis of Other Disorders
- •6.8 Diagnosis
- •6.8.2 Radiological Diagnosis
- •6.9 Staging (Murphy, St. Jude)
- •6.9.1 Frequency
- •6.10 Therapy
- •6.10.1 Therapy and Prognosis of BL, BLL, and LBCL
- •6.10.2 Therapy and Prognosis of LL
- •6.10.3 Therapy and Prognosis of ALCL
- •6.11 Novel Immunologic Treatment
- •6.12 Patients with Partial Response or with Relapse of NHL
- •7: Hodgkin Disease
- •7.1 Definition
- •7.2 Incidence
- •7.3 Etiology and Pathogenesis
- •7.4 Pathology and Immunology
- •7.4.1 Macroscopic Features
- •7.4.2 Microscopic Features
- •7.4.3 Molecular Biology
- •7.4.4 Immunophenotype
- •7.4.5 Histological Classification (WHO)
- •7.4.6 Approximate Frequency of Histological Subtype and Stage
- •7.5 Staging Classification
- •7.5.1 Ann Arbor Staging Classification
- •7.5.2 A/B Staging
- •7.6 Clinical Presentation
- •7.6.1 Involvement of Organs and Organ Systems
- •7.6.1.1 Spleen
- •7.6.1.2 Lungs
- •7.6.1.3 Bone Marrow
- •7.6.1.4 Bone
- •7.6.1.5 Liver
- •7.7 Laboratory Analyses
- •7.7.1 Blood
- •7.7.2 Chemistry
- •7.7.3 Immunological Analyses
- •7.8 Radiological Evaluation
- •7.8.1 Chest
- •7.8.2 Abdomen
- •7.8.3 Bone
- •7.9 Differential Diagnosis
- •7.10 Treatment
- •7.10.1 Chemotherapy
- •7.10.2 Radiotherapy
- •7.11 Prognosis
- •7.13 Relapse
- •7.14 Side Effects and Sequelae
- •7.14.1 Biochemical or Clinical Hypothyroidism
- •7.14.2 Gonadal Dysfunction
- •7.14.3 Decrease in Bone Growth of Irradiated Area
- •7.14.4 Pneumonitis and Pericarditis
- •7.14.5 Infection After Splenectomy
- •7.14.6 Secondary Tumors
- •8: Histiocytoses
- •8.1 Definition and Overview
- •8.2 Langerhans Cell Histiocytosis
- •8.2.1 Incidence
- •8.2.2 Etiology and Pathogenesis
- •8.2.3 Histopathology
- •8.2.4.1 Bone
- •8.2.4.2 Skin
- •8.2.4.3 Lungs
- •8.2.4.4 Lymph Nodes
- •8.2.4.5 Liver
- •8.2.4.6 Spleen
- •8.2.4.7 Endocrine Organs
- •8.2.4.8 Central Nervous System
- •8.2.4.9 Blood
- •8.2.4.10 Immune System
- •8.2.4.11 Gastrointestinal Tract
- •8.2.5 Differential Diagnosis
- •8.2.6 Prognosis
- •8.2.7 General Therapeutic Approach
- •8.2.7.1 Surgery
- •8.2.7.2 Radiotherapy
- •8.2.7.3 Chemotherapy
- •8.2.7.4 Stem Cell Transplantation
- •8.2.8.1 Endocrine Sequelae
- •8.2.8.2 Pulmonary Sequelae
- •8.2.8.3 Hepatic Sequelae
- •8.2.8.4 Psychosocial Problems
- •8.2.8.5 Secondary Tumor
- •8.2.9 Special Clinical Presentations of LCH
- •8.2.9.2 Chronic-Disseminated or Multifocal LCH (Formerly Hand–Schüller–Christian Syndrome)
- •8.2.9.3 Eosinophilic Granuloma
- •8.4 Familial Erythrophagocytic Lymphohistiocytosis (FEL)
- •8.4.1 Definition
- •8.4.2 Pathology and Genetics
- •8.4.3 Clinical Presentation
- •8.4.4 Laboratory Analyses
- •8.4.5 Clinical Course
- •8.4.6 Differential Diagnosis
- •8.4.7 Therapy
- •8.5 Malignant Histiocytosis
- •8.5.1 Incidence
- •8.5.2 Pathology
- •8.5.3 Clinical Presentation
- •8.5.4 Therapy
- •9: Brain Tumors
- •9.1 Overview
- •9.2 Incidence
- •9.3 Tumor Types and Frequencies
- •9.4 Etiology and Pathogenesis
- •9.5 Pathology and Classification
- •9.6 Clinical Manifestations
- •9.6.1 Hydrocephalus and Manifestations of High Intracranial Pressure
- •9.6.2 Focal Neurological Failures
- •9.6.3 Tumor Types and Symptoms According to Intracranial Location
- •9.6.3.1 Cerebral Hemisphere
- •9.6.3.2 Parasellar Optic Chiasma Area
- •9.6.3.3 Pineal Area
- •9.6.3.4 Posterior Fossa Tumors
- •9.6.3.5 Vermis Cerebelli
- •9.6.3.6 Fourth Ventricle
- •9.6.3.7 Brain Stem
- •9.6.3.8 Cerebellopontine Angle Tumors
- •9.6.3.9 Spinal Cord
- •9.7 Radiological Diagnosis
- •9.7.1 Magnetic Resonance Imaging (MRI) and Computed Tomography (CT)
- •9.7.2 Positron Emission Tomography (PET)
- •9.7.3 Conventional Radiography of the Skull
- •9.7.4 Special Methods for Special Indications
- •9.7.4.1 Bone Scintigraphy
- •9.7.4.2 Angiography
- •9.7.4.3 Ultrasonography (in Infancy)
- •9.7.4.4 Myelography
- •9.8 Additional Diagnostic Tools
- •9.8.1 Cerebral Fluid Analysis
- •9.8.2 Electroencephalography
- •9.8.3 Stereotactic Biopsy
- •9.9 Differential Diagnosis
- •9.10 Metastatic Spread
- •9.11 Therapy
- •9.11.1 Neurosurgical Procedure
- •9.11.2 Radiotherapy
- •9.11.3 Chemotherapy (for Details of Special Tumor Types See Below)
- •9.12 Special Tumor Types
- •9.12.1 Astrocytic Tumors
- •9.12.1.1 Incidence
- •9.12.1.2 Radiological Diagnosis
- •9.12.1.3 Characteristics of Low-Grade Astrocytoma (LGA I and II)
- •9.12.1.4 Characteristics of High-Grade Astrocytoma (HGA III/IV)
- •9.12.2.1 Incidence
- •9.12.2.2 Pathology
- •9.12.2.3 Clinical Presentation
- •9.12.2.4 Radiological Diagnosis
- •9.12.2.5 Histology
- •9.12.2.6 Therapy and Prognosis
- •9.12.3 Brain Stem Tumors
- •9.12.3.1 Incidence
- •9.12.3.2 Pathology
- •9.12.3.3 Location
- •9.12.3.4 Clinical Manifestations
- •9.12.3.5 Radiological Diagnosis
- •9.12.3.6 Therapy
- •9.12.4 Medulloblastoma and PNET
- •9.12.4.1 Incidence
- •9.12.4.2 Pathology
- •9.12.4.3 Clinical Manifestation
- •9.12.4.4 Radiological Diagnosis
- •9.12.4.5 Therapy
- •9.12.4.6 Prognosis
- •9.12.5 Atypical Teratoid Rhabdoid Tumors (ATRT)
- •9.12.6 Pineal Tumors
- •9.12.6.1 Frequency
- •9.12.6.2 Pathology
- •9.12.6.3 Clinical Manifestation
- •9.12.6.4 Laboratory Diagnosis
- •9.12.6.5 Radiological Diagnosis
- •9.12.6.6 Therapy
- •9.12.6.7 Prognosis
- •9.12.7 Ependymoma
- •9.12.7.1 Incidence
- •9.12.7.2 Pathology and Genetics
- •9.12.7.3 Clinical Manifestations and Diagnosis
- •9.12.7.4 Therapy
- •9.12.7.5 Prognosis
- •9.12.8 Craniopharyngioma
- •9.12.8.1 Incidence, Pathogenesis, and Pathology
- •9.12.8.2 Differential Diagnosis
- •9.12.8.3 Clinical Manifestations
- •9.12.8.4 Radiological Diagnosis
- •9.12.8.5 Therapy
- •9.12.8.6 Prognosis
- •9.12.9 Meningioma
- •9.12.9.1 Incidence and Pathology
- •9.12.9.2 Location
- •9.12.9.3 Clinical Manifestation
- •9.12.9.4 Therapy
- •9.12.10 Intramedullary Spinal Cord Tumors
- •9.12.10.1 Incidence
- •9.12.10.2 Pathology
- •9.12.10.3 Symptoms
- •9.12.10.4 Prognosis
- •9.12.10.5 Therapy
- •9.13 Adverse Late Effects from Brain Tumors and Their Treatment
- •10: Neuroblastoma
- •10.1 Definition
- •10.2 Incidence
- •10.3 Etiology and Pathogenesis
- •10.4 Molecular Cytogenetics
- •10.5 Pathology
- •10.5.1 Macroscopic Features
- •10.5.2 Microscopic Features
- •10.6 Clinical Manifestations
- •10.6.1 Common Symptoms
- •10.6.2 Symptoms Associated with Catecholamine Production
- •10.6.3 Paraneoplastic Syndromes
- •10.6.4 Local Symptoms and Classic Signs
- •10.6.4.1 Eyes
- •10.6.4.2 Neck
- •10.6.4.3 Chest, Posterior Mediastinum, and Vertebrae
- •10.6.4.4 Abdomen
- •10.6.4.5 Liver
- •10.6.4.6 Skin
- •10.6.4.7 Bone
- •10.6.4.8 Bone Marrow
- •10.7 Metastatic Spread
- •10.8 Laboratory Findings
- •10.8.1 Urinary Catecholamine Metabolites (Tyrosine Metabolism)
- •10.8.2 Other Laboratory Findings
- •10.8.3 Bone Marrow
- •10.9 Diagnostic Imaging
- •10.9.1 Conventional X-Ray
- •10.9.2 Methylisobenzyl Guanidinium (MIBG) Scintigraphy
- •10.9.4 Bone Scintigraphy (Technetium)
- •10.10 Differential Diagnosis
- •10.11 International Staging (Including the Classic Evans Staging)
- •10.11.1 The International Neuroblastoma Risk Group Classification
- •10.12 Therapy
- •10.12.1 Surgical Procedure
- •10.12.2 Chemotherapy
- •10.12.3 Radiotherapy
- •10.12.4.1 Low Risk
- •10.12.5 Therapy in Relapse
- •10.13 Prognosis
- •10.13.1 Futuristic Therapeutic Approaches
- •10.14 Special Forms
- •10.14.1 Ganglioneuroblastoma
- •10.14.2 Ganglioneuroma
- •10.14.3 Olfactory Neuroblastoma
- •10.14.4 Neuroblastoma Arising from Organ of Zuckerkandl (Location at the Bifurcation of the Aorta or Origin of the Inferior Mesenteric Artery)
- •10.14.5 Pheochromocytoma
- •11: Nephroblastoma (Wilms Tumor)
- •11.1 Definition
- •11.2 Incidence
- •11.3 Chromosomal Association
- •11.4 Pathology
- •11.4.1 Macroscopic Features
- •11.4.2 Microscopic Features
- •11.5 Clinical Manifestations
- •11.6 Laboratory Diagnosis
- •11.7 Radiological Diagnosis
- •11.8 Differential Diagnosis
- •11.9 Staging
- •11.10 Therapy
- •11.10.1 Surgical Procedures
- •11.10.2 Chemotherapy
- •11.10.3 Radiotherapy
- •11.11 Therapy in Relapse
- •11.12 Prognosis
- •11.13 Metastatic Nephroblastoma
- •11.14 Subtypes
- •11.14.1 Bilateral Wilms Tumor (Stage 5)
- •11.14.1.1 Therapy
- •11.14.1.2 Prognosis
- •11.14.2 Congenital Mesoblastic Nephroblastoma (Fetal Renal Hamartoma)
- •11.14.2.1 Pathology
- •11.14.2.2 Clinical Manifestations
- •11.14.2.3 Therapy
- •11.14.3 Renal Cell Carcinoma
- •11.14.3.1 Pathology
- •11.14.3.2 Clinical Manifestations
- •11.14.3.3 Therapy
- •11.14.3.4 Prognosis
- •11.14.4 Renal Rhabdoid Tumor
- •12: Soft Tissue Sarcoma
- •12.1 Overview
- •12.1.1 Definition
- •12.1.2 Incidence
- •12.2 Rhabdomyosarcoma (RMS)
- •12.2.1 Incidence and Localization
- •12.2.2 Etiology and Pathogenesis
- •12.2.3 Histopathology
- •12.2.3.1 Four Subtypes of Rhabdomyosarcoma
- •12.2.4 Cytogenetics
- •12.2.5 Clinical Manifestations
- •12.2.5.1 Head and Neck Area
- •12.2.5.2 Genitourinary Tract Including Sarcoma Botryoides
- •12.2.5.3 Extremities and Trunk
- •12.2.5.4 Retroperitoneal Area
- •12.2.5.5 Rare Locations
- •12.2.6 Laboratory Diagnosis
- •12.2.7 Radiological Diagnosis
- •12.2.8 Staging/Grouping
- •12.2.9 Metastatic Spread
- •12.2.10 Therapy
- •12.2.10.1 Overview
- •12.2.10.2 Surgical Procedure
- •12.2.10.3 Radiotherapy
- •12.2.10.4 Chemotherapy
- •12.2.11 Special Locations
- •12.2.11.1 Head and Neck Area
- •12.2.11.2 Parameningeal Site
- •12.2.11.3 Orbit
- •12.2.11.4 Pelvic Area
- •12.2.11.5 Paratesticular Rhabdomyosarcoma
- •12.2.11.6 Retroperitoneal Rhabdomyosarcoma
- •12.2.11.7 Extremities
- •12.2.12 Prognosis
- •12.2.13 Therapy and Prognosis in Nonresponding or Relapsing Rhabdomyosarcoma
- •12.2.14 Secondary Tumors
- •12.3 Fibrosarcoma
- •12.3.1 Incidence
- •12.3.2 Location
- •12.3.3 Pathology and Cytogenetics
- •12.3.4 Differential Diagnosis
- •12.3.5 Clinical Manifestations
- •12.3.6 Therapy
- •12.3.6.1 Surgical Procedures
- •12.3.6.2 Radiotherapy
- •12.3.6.3 Chemotherapy
- •12.3.7 Follow-Up
- •12.3.8 Prognosis
- •12.4 Synovial Sarcoma
- •12.4.1 Incidence
- •12.4.2 Location
- •12.4.3 Pathology and Cytogenetics
- •12.4.4 Clinical Manifestations
- •12.4.5 Radiological Diagnosis
- •12.4.6 Therapy
- •12.4.6.1 Surgical Procedure
- •12.4.6.2 Radiotherapy
- •12.4.6.3 Chemotherapy
- •12.4.7 Prognosis
- •12.5 Liposarcoma
- •12.5.1 Incidence
- •12.5.2 Pathology and Cytogenetics
- •12.5.3 Clinical Manifestations
- •12.5.4 Therapy
- •12.5.4.1 Surgical Procedure
- •12.5.4.2 Radiotherapy
- •12.5.4.3 Chemotherapy
- •12.5.5 Prognosis
- •12.6 Malignant Peripheral Nerve Sheath Tumor
- •12.6.1 Incidence
- •12.6.2 Location
- •12.6.3 Pathology and Cytogenetics
- •12.6.4 Clinical Manifestations
- •12.6.5 Therapy
- •12.7 Leiomyosarcoma
- •12.7.1 Incidence
- •12.7.2 Location
- •12.7.3 Pathology
- •12.7.4 Clinical Manifestations
- •12.7.5 Therapy
- •12.7.6 Prognosis
- •12.8 Hemangiopericytoma
- •12.8.1 Incidence
- •12.8.2 Location
- •12.8.3 Pathology and Cytogenetics
- •12.8.4 Therapy
- •12.8.5 Prognosis
- •12.8.6 Congenital Hemangiopericytoma Variant
- •12.9 Malignant Fibrohistiocytoma
- •13: Osteosarcoma
- •13.1 Definition
- •13.2 Epidemiology
- •13.3 Location
- •13.4 Etiology and Tumor Genetics
- •13.5 Pathology
- •13.6 Clinical Manifestations
- •13.7 Metastasis
- •13.8 Evaluation
- •13.9 Radiology
- •13.10 Differential Diagnosis
- •13.11 Treatment
- •13.11.1 Treatment of Relapsed Disease
- •13.12 Prognosis
- •13.13 Complications
- •14: Ewing Sarcoma Family of Tumors
- •14.1 Definition
- •14.2 Epidemiology
- •14.3 Localization
- •14.4 Pathogenesis
- •14.5 Genetics
- •14.6 Pathology
- •14.6.1 Macroscopic Aspects
- •14.6.2 Microscopic Aspects
- •14.6.3 Immunohistochemistry
- •14.7 Clinical Manifestations
- •14.8 Metastases
- •14.9 Evaluation
- •14.10 Differential Diagnosis
- •14.11 Treatment
- •14.12 Prognosis
- •14.12.1 Complications
- •15: Retinoblastoma
- •15.1 Definition
- •15.2 Incidence
- •15.3 Etiology, Genetics, and Pathogenesis
- •15.4.1 Macroscopic Features
- •15.4.2 Microscopic Features
- •15.5 Clinical Manifestations
- •15.6 Differential Diagnosis
- •15.7 Therapy
- •15.7.1 Surgical Management
- •15.7.2 Chemotherapy
- •15.7.3 Chemothermotherapy
- •15.7.4 Radiotherapy
- •15.7.5 Laser Photocoagulation
- •15.7.6 Cryotherapy
- •15.7.7 Brachytherapy
- •15.8 Management of the Different Manifestations of Retinoblastoma
- •15.8.1 Unilateral Intraocular Retinoblastoma
- •15.8.2 Unilateral Extraocular Retinoblastoma
- •15.8.3 Bilateral Retinoblastoma
- •15.9 Prognosis
- •15.9.1 Risk of Secondary Tumors
- •16: Germ Cell Tumors
- •16.1 Definition
- •16.2 Incidence
- •16.3 Pathogenesis
- •16.4 Genetics
- •16.5 Histological Classification
- •16.6 Diagnostics
- •16.7 Therapy: Overview
- •16.8 Testicular Germ Cell Tumors and Subtypes
- •16.8.1 Testicular Yolk Sac Tumor
- •16.8.1.1 Macroscopic Features
- •16.8.1.2 Microscopic Features
- •16.8.1.3 Therapy
- •16.8.2 Testicular Teratoma
- •16.8.2.1 Histopathology
- •16.8.2.2 Therapy
- •16.8.3 Testicular Embryonal Carcinoma
- •16.8.4 Testicular Teratocarcinoma
- •16.8.5 Testicular Seminoma (in Adults)
- •16.9 Ovarian Tumors and Subtypes
- •16.9.1 Ovarian Teratoma
- •16.9.2 Ovarian Dysgerminoma
- •16.9.2.1 Macroscopic Features
- •16.9.2.2 Microscopic Features
- •16.9.2.3 Therapy
- •16.9.3 Ovarian Yolk Sac Tumor
- •16.9.5 Embryonal Carcinoma of the Ovary
- •16.9.6 Ovarian Gonadoblastoma
- •16.10 Extragonadal Germ Cell Tumors Subtypes
- •16.10.1 Sacrococcygeal Teratoma
- •16.10.2 Intracranial Teratoma
- •16.10.3 Mediastinal Teratoma
- •17: Hepatic Tumors
- •17.1 Forms and Frequencies
- •17.2 Incidence (Except Benign Hepatic Tumors)
- •17.3 Pathology and Genetics
- •17.3.1 Macroscopic Features
- •17.3.2 Microscopic Features
- •17.4 Clinical Manifestations
- •17.5 Laboratory Diagnosis
- •17.6 Radiological Diagnosis
- •17.7 Differential Diagnosis of Hepatoblastoma and Hepatocellular Carcinoma
- •17.8 Staging
- •17.9 Therapy
- •17.9.1 Surgical Management
- •17.9.2 Liver Transplantation
- •17.9.3 Radiotherapy
- •17.9.4 Chemotherapy
- •17.10 Prognosis
- •18: Emergencies in Pediatric Oncology
- •18.1 Tumor Lysis and Hyperleukocytosis
- •18.1.1 General
- •18.1.2 Diagnosis
- •18.1.3 Treatment
- •18.2 Fever and Netropenia
- •18.2.1 General
- •18.2.2 Diagnosis
- •18.2.3 Treatment
- •18.2.4 Outlook
- •18.3 Hyperkalemia
- •18.3.1 General
- •18.3.2 Diagnosis
- •18.3.3 Treatment
- •18.4 Hypercalcemia
- •18.4.1 General
- •18.4.2 Diagnosis
- •18.4.3 Treatment
- •18.5 Airway Compression
- •18.5.1 General
- •18.5.2 Diagnosis
- •18.5.3 Treatment
- •18.6 Spinal Cord Compression
- •18.6.1 General
- •18.6.2 Diagnosis
- •18.6.3 Treatment
- •18.7.1 General
- •18.7.2 Diagnosis
- •18.7.3 Treatment
- •18.8 Pleural and Pericardial Effusion
- •18.8.1 General
- •18.8.2 Diagnosis
- •18.8.3 Treatment
- •18.9 Cardiac Tamponade
- •18.9.1 General
- •18.9.2 Diagnosis
- •18.9.3 Treatment
- •18.10 Hemolysis
- •18.10.1 General
- •18.10.2 Diagnosis
- •18.10.3 Treatment
- •18.11 Abdominal Emergencies and Abdominal Tumor
- •18.11.1 General
- •18.11.2 Diagnosis
- •18.11.3 Treatment
- •18.12 Hemorrhagic Cystitis, Dysuria
- •18.12.1 General
- •18.12.2 Diagnosis
- •18.12.3 Treatment
- •18.13 Acute Alteration of Consciousness
- •18.13.1 General
- •18.13.2 Diagnosis
- •18.13.3 Treatment
- •18.14 Seizures
- •18.14.1 General
- •18.14.2 Diagnosis
- •18.14.3 Treatment
- •19: Oncological Nursing Care
- •19.1 The Role of the Nurse in Pediatric Oncology
- •19.1.1 Direct Care
- •19.1.2 Nursing Care
- •19.2 Side Effects of Treatment
- •19.2.1 Nausea and Vomiting
- •19.2.1.1 Cause
- •19.2.1.2 Forms of Nausea and Vomiting
- •19.2.1.3 Symptoms
- •19.2.1.4 Prophylactic Care
- •19.2.1.5 Treatment
- •19.2.2 Hair Loss
- •19.2.2.1 Causes
- •19.2.2.2 Symptoms
- •19.2.2.3 Treatment
- •19.2.2.4 Nursing Tips Concerning Hair Loss
- •Coverage of Costs for Hair Substitution
- •19.2.3 Stomatitis and Mucitis
- •19.2.3.1 Cause
- •19.2.3.2 Risk Factors
- •19.2.3.3 Symptoms
- •19.2.3.4 Prophylactic Care
- •19.2.3.5 General Tips on Nursing Care
- •19.2.3.6 Treatment
- •19.2.4 Myelosuppression
- •19.2.4.1 Causes
- •19.2.4.2 Leukopenia
- •Prophylactic Care
- •Risk Factors
- •Treatment
- •19.2.4.3 Thrombocytopenia
- •Symptoms
- •Prophylactic Care
- •Treatment
- •19.2.4.4 Anemia
- •Symptoms
- •Prophylactic Care
- •Treatment
- •19.2.5 Loss of Appetite
- •19.2.5.1 Causes
- •19.2.5.2 Prophylactic Care
- •19.2.6 Digestive Disorders (Constipation and Diarrhea)
- •19.2.6.1 Constipation
- •Causes
- •Prophylactic Care
- •Treatment
- •19.2.6.2 Diarrhea
- •Causes
- •Treatment
- •19.2.7 Neuropathy
- •19.2.7.1 Symptoms
- •19.2.7.2 Prophylactic Care
- •19.2.7.3 Treatment
- •19.2.8 Fatigue
- •19.2.8.1 Causes
- •19.2.8.2 Symptoms
- •19.2.8.3 Prophylactic Care
- •19.2.8.4 Treatment
- •Significance of Fatigue Nursing Care
- •19.2.9 Pain
- •19.2.9.1 Causes
- •19.2.9.2 Symptoms
- •19.2.9.3 Prophylactic Care
- •19.2.9.4 Treatment
- •19.3 Central Catheter Care
- •19.3.1.1 Complications
- •19.3.1.2 Considerations for Domestic PAC Management
- •19.3.1.3 Managing PAC
- •19.3.2 Broviac and Hickman Catheters
- •19.4 Chemotherapy
- •19.4.1 General
- •19.4.2 Administration
- •19.4.3 Protective Measures When Handling Chemotherapeutic agents
- •19.4.4 Extravasation
- •19.5 Giving Information to the Child and Parents
- •19.6 Care at Home
- •20.1 Significance for Contemporary Pediatric Oncology
- •20.2 Structure
- •20.2.1 Concepts
- •20.2.2 Staff
- •20.2.2.1 Medical and Nursing Staff
- •20.2.2.2 Child Psychiatry and Psychology
- •20.2.2.3 Social Work
- •20.2.2.4 Education in Hospital
- •20.3.1 Objectives
- •20.3.2 Procedure
- •20.3.2.1 Investigative Phase
- •Areas Investigated
- •20.3.2.2 Treatment Phase
- •20.3.3 Basic Attitudes
- •20.4 Problems and Possible Interventions
- •20.4.1 Before Diagnosis
- •20.4.1.1 Problems
- •20.4.1.2 Requirements
- •20.4.1.3 Reactions
- •20.4.1.4 Interventions
- •20.4.2 After Diagnosis
- •20.4.2.1 Problems
- •20.4.2.2 Requirements
- •20.4.2.3 Reactions
- •20.4.2.4 Interventions
- •20.4.3 Start of Therapy
- •20.4.3.1 Problems
- •20.4.3.2 Requirements
- •20.4.3.3 Reactions
- •20.4.3.4 Interventions
- •20.4.4 Course of Therapy
- •20.4.4.1 Problems
- •20.4.4.2 Requirements
- •20.4.4.3 Reactions
- •20.4.4.4 Interventions
- •20.4.5 Surgical Intervention
- •20.4.5.1 Problems
- •20.4.5.2 Requirements
- •20.4.5.3 Reactions
- •20.4.5.4 Interventions
- •20.4.6 Radiotherapy
- •20.4.6.1 Problems
- •20.4.6.2 Requirements
- •20.4.6.3 Reactions
- •20.4.6.4 Interventions
- •20.4.7 Hematopoietic Stem Cell Transplantation
- •20.4.7.1 Problems
- •20.4.7.2 Requirements
- •20.4.7.3 Reactions
- •20.4.7.4 Interventions
- •20.4.8 End of Therapy
- •20.4.8.1 Problems
- •20.4.8.2 Requirements
- •20.4.8.3 Reactions
- •20.4.8.4 Interventions
- •20.4.9 Long-Term Remission and Cure
- •20.4.9.1 Problems
- •20.4.9.2 Requirements
- •20.4.9.3 Reactions
- •20.4.9.4 Interventions
- •20.4.10 Relapse
- •20.4.10.1 Problems
- •20.4.10.2 Requirements
- •20.4.10.3 Reactions
- •20.4.11 Dying, Death, Mourning
- •20.4.11.1 Problems
- •20.4.11.2 Requirements
- •20.4.11.3 Reactions
- •20.4.11.4 Interventions
- •20.5 Treatment Team
- •20.6 Further Reading
- •Index
22 |
P. Imbach |
|
|
3.1Epidemiology
•Incidence: 15–20% of all leukemias in children
•Seven in one million children develop AML each year
•Frequency of AML remains stable throughout childhood, with a slight increase during adolescence
•There is no gender difference in incidence of AML
•There is a slightly higher incidence in white children than in other groups
3.2Predisposing Factors
See Chap. 1.
3.3Differential Diagnosis
•Infectious mononucleosis
•Juvenile rheumatoid arthritis
•Aplastic anemia
•Acquired neutropenia
•Megaloblastic anemia
•Autoimmune cytopenia
•Leukemoid reaction
•Transient myeloproliferative syndrome in infants with Down syndrome
•Acute mixed-lineage leukemia (AMLL): ALL and AML characteristics combination in children with ALL or in children with AML
•Metastatic neuroblastoma, rhabdomyosarcoma, retinoblastoma, non-Hodgkin lymphoma
•Myelodysplastic syndrome (MDS)
•Myeloproliferative syndrome (MPS)
•Juvenile myelomonocytic leukemia (JMML)
•Chronic Myelogenous Leukemia (CML)
In cases of difficult bone marrow aspiration (“dry” taps), bone marrow biopsy is
recommended.
3.4Classification
AML is heterogeneous concerning the predisposing condition, pathogenesis, genoand phenotype, and response to therapy. Prognosis depends on age, initial presentation, and subtype.
3 Acute Myeloid Leukemia |
23 |
|
|
3.4.1French–American–British Classification of AML
The French–American–British (FAB) classification is based on morphological and histochemical characteristics and is supplemented by immunophenotypical and cytogenetic characteristics. The FAB classification was many years in use. It still describes the morphological features of cells. It is now substituted by the WHO classification: see WHO publications center.
FAB classification of acute myelogenous leukemia
M0 Immature myeloblastic leukemia
M1 Myeloblastic leukemia
•Blasts with few azurophile granules or Auer rods
•Positive peroxidase or Sudan black (>5% of blasts) reaction can be helpful
M2 Myeloblastic leukemia with signs of maturation
•Myeloblasts and leukemic promyelocytes represent the majority of nucleus-containing bone marrow cells
•Auer rods common
M3 Promyelocytic leukemia
•Mostly abnormal promyelocytes with lots of granulation; some Auer rods
M4 Myelomonocytic leukemia
•Mostly myeloblasts and promyelocytes, and promonocytes and monocytoid cells, with granulocytic and monocytic differentiation
M5 Monocytic leukemia
•Moderately differentiated to well-differentiated monocytic cells
•Esterase reaction may be positive
M6 Erythroleukemia
•More than 50% of the nucleus-containing cells of bone marrow are erythroblasts
•Erythroblasts show a bizarre morphology
M7 Megakaryocytic leukemia
3.4.2Histochemical Classification and Frequency
Histochemical characteristics |
|
|
|
Frequency (%) |
|||
M0 |
– |
SB |
– |
– |
– |
– |
<3 |
M1 |
MPO |
SB |
– |
– |
– |
– |
20 |
M2 |
MPO |
SB |
– |
– |
– |
– |
25 |
M3 |
MPO |
SB |
– |
– |
(NSE) |
– |
5–10 |
M4 |
MPO |
– |
– |
NASD |
NSE |
– |
25–36 |
M5 |
MPO |
– |
– |
NASD |
– |
– |
15 |
M6 |
– |
– |
PAS |
– |
– |
Glycophorin A |
<5 |
M7 |
–a |
– |
– |
NASD |
NSE |
– |
5–10 |
Parentheses: variable; underlining: pathognomonic
MPO myeloperoxidase, NASD naphthol-ASD, NSE nonspecific esterase, PAS periodic acid-Schiff, SB Sudan black
aIntraplasmatic MPO detectable by electron microscopy only
24
Myeloblasts |
Cluster determination |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
||
M0 |
– |
13 |
– |
15 |
33 |
34 |
(36) |
31/61 |
42 |
65 |
117a |
HLA-DR |
19 |
2 |
(4) |
(7) |
|
|
M1 |
– |
13 |
– |
15 |
33 |
34 |
– |
– |
– |
65 |
117 |
HLA-DR |
– |
2 |
– |
(7) |
(56) |
|
M2 |
– |
13 |
– |
15 |
33 |
34 |
– |
– |
– |
65 |
117 |
HLA-DR |
– |
2 |
– |
7 |
(56) |
|
M3 |
11b |
13 |
– |
15 |
33 |
34 |
– |
– |
– |
65 |
117 |
(HLA-DR) |
– |
2 |
– |
7 |
(56) |
|
M4 |
11b |
13 |
14 |
15 |
33 |
34 |
36 |
– |
– |
65 |
117 |
HLA-DR |
– |
2 |
4 |
7 |
56 |
|
M5 |
11b |
13 |
14 |
15 |
33 |
34 |
36 |
– |
– |
65 |
(117) |
HLA-DR |
|
– |
2 |
4 |
7 |
56 |
M6 |
– |
13 |
– |
– |
33 |
– |
– |
– |
– |
65 |
(117) |
– |
– |
– |
– |
7 |
– |
|
M7 |
– |
13 |
– |
– |
– |
34 |
36 |
41/61 |
42 |
65 |
117 |
HLA-DR |
|
– |
2 |
4 |
7 |
56 |
Parentheses: variable; underlining: pathognomonic
HLA human leukocyte antigen ac-kit oncoprotein
Imbach .P
3 Acute Myeloid Leukemia |
25 |
|
|
3.4.3Immunophenotyping
The cluster-determination (CD) classification has a high specificity and sensitivity for distinguishing acute lymphoblastic leukemia (ALL) and AML from normal hemopoietic precursor cells.
Biphenotypic leukemia expresses myeloid and lymphoid markers. Therefore more than one marker of the other cell lineage has to be expressed on the same leukemic blasts. Biphenotypic leukemia has to be distinguished from mixed-lineage leukemia, which shows blasts with more than one phenotype. An interesting example is erythromegakaryocytic leukemia that may differentiate along either lineage as a result of it arising in a precursor cell that can give rise to both megakaryocytes and erythroid precursor cells.
3.4.4Cytogenetics
Fluorescence in situ hybridization (FISH) and polymerase chain reaction (PCR) techniques (Chap. 2) detect subtypes of AML according to specific chromosomal abnormalities that correlate with alterations in cell survival, cell differentiation, and cell cycle regulation.
Some cytogenetic abnormalities in childhood AML
FAB |
Chromosomal |
Affected gene |
Comments |
|
abnormalities |
|
|
M1/M2 |
t(8;21) |
ETO-AML 1 |
Auer rods |
M3 |
t(15;17)(q22;q12) |
PML-RARA |
Promyelocytic leukemia with coagulopathy; |
|
|
|
ATRA responsiveness |
|
t(11;17)(q21;q23) |
RARA |
Coagulopathy, ATRA unresponsiveness |
M4 or M5 |
t(9:11) |
AF9-MLL |
Infants; high initial WBC |
M5 |
t(11q23) |
MLL |
Infants; high initial WBC |
M5 |
t(1b;11)or t(8,16) |
AF10-MLL |
Infants; high initial WBC |
|
(p11;p13) |
|
|
M5 |
t(11;17) |
AF17-MLL |
Infants; high initial WBC |
M6 |
|
|
Glycophorin-positive |
M7 |
t(1;22) |
|
Infants with Down syndrome |
ATRA all-trans retinoic acid, WBC white blood cell count
The combination of the characteristics described above helps determine the recommended type of treatment of AML subtypes.
•FLT3 tyrosine kinase receptor is highly expressed on myeloblasts
•FLT-ITD (internal tandem duplication) is expressed in 16–18% of children with AML characterized by normal cytogenetics and is associated with a poor prognosis. It is essentially not found in infants and the frequency of FLT-ITD increases with age. (see Table of prognostic factors page 28,29)
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