Neuroblastoma .


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Neuroblastoma. TUMOR BORD. History. 10 month old male. Previously healthy. The history started 1 month before admission. Patient developed fever ,on-off, documented 39 C relieved by antipyretics, with no history of sweating, no rigor. History of poor feeding and decreased activity.
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´╗┐Neuroblastoma TUMOR BORD

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History 10 month old male. Beforehand sound. The history began 1 month before confirmation. Understanding created fever ,on-off, reported 39 C diminished by antipyretics, with no history of sweating, no thoroughness. History of poor bolstering and diminished action. 2 weeks before admission,the mother saw that her child had left upper eyelid swelling. The swelling expanded in size and after that the infant couldn\'t open his left eye.

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She look for restorative prompt at numerous fringe focuses in west bank, then she was alluded to al-makassed healing facility. In the doctor\'s facility the infant was found to had stomach mass. Stomach u/s and afterward CT output was done which demonstrated stomach mass began from suprarenal organ suspected to be neuroblastoma. FNA biopsy was taken from the mass and the conclusion was neuroblastoma. The patient HB was 6 and he got PRBC.

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No history of vomitting,no history of looseness of the bowels, no skin rash, no adjustment in pee sum or colour,no unusual development, no weight reduction. Formative history: up to age. Immunization history : state-of-the-art as indicated by the Palestinian national inoculation program. Past-therapeutic history and family are not critical.

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Examination Vital signs: - Temp.:37.1C axillary. - HR: 140 beat/m. - RR: 25 breath/m. - B.P. 150/110. - O2 : 98%. Development parameters: - Wt.:8.5 kg - Length: 71CM - Head perimeter: 46 CM.

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Growth diagram: Wt./age:10 th .percentile Length/age: 25 th percentile. Head outline/age: 50 th percentile. General appearance: Conscious,allert,pale,active,left eyelid swelling which cover eye and eye ball can\'t seen. No obvious LAP. No skin rash. ENT: free. Mid-section and heart: free.

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Abdomen Distended, reversed umbilicus, unmistakable veins. Substantial mass can be felt on the left lumbar territory, not joined to skin, not mobile,hard,smooth,ill characterized edges ,10x5cm ,upper fringe can\'t be palpated liver and spleen are not discernable. The mass is dull by percussion. Neurological examination: free.

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Investigations CBC: - HB:7.5 - WBC:9.7 - N.63% - L.25% CRP:164 - ESR:64 - LDH:3500 KFT : NL LFT :NL 24 hour pee accumulation: - Catecholamines:55 - VMA:3.5 - metanephrine:0.2 (all are NL) bone marrow yearning and biopsy: Metastatic neuroblastoma.

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Bone output: Increased take-up on skull, sternum and right more prominent trochanter and distal end of femur. MIBG check: - Multiple dynamic injuries on skull, mid-section and stomach area steady with neuroblastoma. - Left upper midriff diffuse mass. CT examine mid-section and cerebrum. CT check mid-region which was done in al-makassid healing facility was surveyed in our doctor\'s facility.

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Treatment Tumor lyses safety measure: - IV liquid 1.5 maintenance+NAHCO3 40meq/liter. - Allopurinol po. Antihypertensive medicines: as indicated by the educate with respect to pediatric nephrologist) - Propronolol po. - Furosemide IV. Chemotherapy as indicated by convention.

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Neuroblastoma Embryonic tumor of the fringe thoughtful sensory system with heterogeneous clinical presentation and course. Epidemilogy: Third most normal pediatric malignancy. 8% of adolescence malignancies. Most regular neoplasm in newborn children.. 28%-39% of neonatal malignancies. 90% of cases are analyzed by 5 yr. of age. Frequency is somewhat higher in young men and in whites.

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Pathology Variable degrees of neural separation, running from undifferentiated little round cells to develop ganglion cells (ganglioneuroblastoma or ganglioneuroma ) The tumor may take after other little round cell tumors, for example, rhabdomyosarcoma ,Ewing sarcoma, and non-Hodgkin lymphoma. Hereditary qualities: Prognostic significance. Enhancement of MYCN is firmly connected with cutting edge tumor stage and poor result autonomous of stage and age. Hyperdiploidy presents better forecast if the kid is more youthful than 1 year of age at analysis.

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Clinical indications May create at any site of thoughtful sensory system tissue. Most cases emerge in the midriff either in the adrenal organ or in retroperitoneal thoughtful ganglia. Firm nodular mass tangible in the flank or midline creating stomach distress. Begins from cervical ,thoracic, or pelvic ganglia in 30% of cases. Metastatic illness can be connected with fever,irritability,FTT,bone torment, orbital proptosis ,and periorbital echymosis.

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Metastasis: long bones and skull ,BM ,liver ,lymph hubs and skin. lung mets are uncommon. Horner disorder if area in sup. Cervical ganglion. Spinal line or nerve root pressure if attack the neural foramina. Opsomyoclonus. Expanded sweating and hypertension by creating catecholamines. Secretory the runs by VIP.

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Diagnosis Mass or different masses on plain radiograph ,CT or MRI. HVA and VMA are hoisted in 95% of cases. Neurotic analysis by biopsy. Cytogenetic. NB can be analyzed without tumor biopsy if neuroblasts are seen in BM and hoisted HVA and VMA in pee. Assessment of metastatic malady ought to incorporate BM suction and biopsies ,bone output and MIBG check.

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Treatment Depends on period of patient at finding ,phase of infection ,MYCN STATUS and shimada histology. Okay NB : surgery for stage1 and 2 and perception for stage4S . Middle of the road chance NB : surgery , chemotherapy and now and again radiation treatment. High hazard NB :enlistment chemotherapy to accomplish finish reaction or great fractional reaction , with halfway reaction ,resection of the essential tumor took after by central radiation to the leftover tumor. acceptance is then trailed by high measurements chemotherapy and autologous undifferentiated cell transplantation.

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