Quiz 3

(Ref: Harrison 20th edition, p 1849; Nelson 18th edition ch. 441)
Primary malignant cardiac tumors in children are almost exclusively sarcomas. These tumors are usually located in the right side of the heart, atrial septum, right atrial wall, or root of the pulmonary artery. They may extend either into the adjacent chamber and cause obstruction to blood flow or into the pericardial cavity and produce effusion or tamponade

(Ref: Harrison 19th p 511/609)
 Ectopic ACTH production is predominantly caused by occult carcinoid tumors, most frequently in the lung, but also in thymus or pancreas.
 Advanced small cell lung cancer can cause ectopic ACTH production. In rare cases, ectopic ACTH production has been found to originate from medullary thyroid carcinoma or pheochromocytoma, the latter co-secreting catecholamines and ACTH.

(Ref: Harrison 20th edition, p 541, Table 74-4; Harrison 19th p 510; Table 107-4)
 Most common symptom of lung cancer is cough (not given in choices) followed by weight loss.
 Symptoms of lung cancer (incidence wise) cough > weight loss > dysnea> chest pain > hemoptysis.

(Ref: Harrison's 18th edition ch. 500)
Rhabdomyosarcoma may occur at virtually any anatomic site but usually are found in the head and neck (25%), genitourinary tract (22%), extremities (18%); retroperitoneal and other sites account for the remainder of primary sites.

(Ref: Harrison 20th edition, p 567; Harrison 19th p 583)
 Dysphagia may he associated with pain on swallowing, pain radiating to the chest and/or back, regurgitation or vomiting, and aspiration pneumonia. . The disease most commonly spreads to adjacent and supraclavicular lymph nodes, liver, lungs, pleura, and bone.
 Tracheoesophageal fistulas may develop as the disease advances, leading to extreme suffering.
 As with other squamous cell carcinomas, hypercalcemia may occur in the absence of osseous metastases, probably from parathormone-related peptide secreted by tumor cells

(Ref: Harrison 20th edition, p 519; O.P Ghai, 7th edition pg. 597, Harrison 19th p 1795)

The most common cause of tumor lysis syndrome in children is Burkitt lymphoma > T cell lymphoblastic lymphoma.