Pediatric emergency medicine trisk 3791 3791

Rhabdomyosarcoma
Rhabdomyosarcoma can occur anywhere in the abdomen or pelvis where there is
striated muscle. Tumors are particularly common in the pelvis, involving the
prostate, uterus or vagina, and retroperitoneal structures, but they have also been
found in the common bile duct and other unusual sites. These tumors can reach a
large size before they become symptomatic, and each must be managed
individually, depending on the site of origin, extent of growth, and the degree of
spread.
Hepatomas
The most common primary GI tract neoplasm is hepatic in origin.
Hepatoblastoma and hepatocellular carcinoma are the two main subgroups of
liver tumors; they are clinically indistinguishable at presentation. Many are
asymptomatic, but symptoms such as early satiety, weight loss, and abdominal
pain may be seen, especially with very large tumors. More often, the tumor is
discovered after caregivers notice a change in the appearance of the abdomen.
They are usually seen in older infants and young children. Increased levels of
alpha-fetoprotein are associated with both types. Differential diagnosis should
include hemangioendothelioma, hamartoma, and renal and adrenal tumors.
These tumors are often initially diagnosed with US. Further radiologic imaging
is directed at diagnosis and the resectability of the tumor. CT or MRI with
angiography is often required to determine surgical approach ( Fig. 116.25 ).
Long-term survival is poor unless complete resection is possible. Liver tumors
commonly metastasize to the lungs, brain, and regional nodes.