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Case-Child with Left Forearm Mass PowerPoint Presentation

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Description : Department of Hematology & Oncology - CHILD WITH LEFT FOREARM MASS - Case presentation by Dr. M Fahim Ur rehman & Dr.shamaila rashid

Tags : Blood,Hematology,Oncology,FOREARM MASS

Published on : Nov 10, 2022 | Views : 1496 | Downloads : 11

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Slide 1-

Department of Hematology & Oncology CHILD WITH LEFT FOREARM MASS Case presentation by Dr. M Fahim Ur rehman &Dr.shamaila rashid
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DEMOGRAPHY Usman S/O Nasir 8years old Resident of Gojra Presented through OPD CHF November, 2019
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History of Patient PRESENTING COMPLAINTS: Swelling on left forearm - 3weeks Pain in left forearm - 1week
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Cont. Pt was in his usual state of health when he noticed swelling in left upper part of forearm. Swelling was initially small then progressively increasing in size. H/O pain in left forearm for last 1week which was gradual in onset confined to upper part of forearm intermittent, dull in character moderate in intensity aggravated by movement and relieved by taking rest and medication.
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Cont. There was no H/O fever, wt. loss, loss of appetite, Bone Pains, Cough, Breathlessness, bleeding manifestation, headache, fits or altered sensorium. Previous history of injury of same side due to fall 2 years back and plaster of paris was applied due to bone dislocation for 3weeks at some private hospital .
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Cont. No H/O drug allergy. Delivered through NVD uneventful. Development milelstones appropriate for age. Vaccinated according to EPI. Diet was adequate. No family history of such illness, tuberculosis, he has four elder siblings all alive and healthy. He is student of 4th class, belongs to low socioeconomic status.
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EXAMINATION
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General Physical Examination A cooperative boy, well oriented in time and space with following vitals: - OFC 55cm Height:116cm Weight 26kg
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Cont. No pallor, cyanosis, jaundice clubbing, Bruises, BCG Scar Present. A lymph node of approx 1.5x0.5cm was palpable in left axilla. No other lymph node was palpable.
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Local Examination A swelling on left upper part of forearm of approx. 3x4cm firm in consistency,adherent to underlying structures,feels warm,non tender.
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Systemic examination Resp: NVB With no added sound CVS: S1 + S2 + 0 GTI: Soft Abdomen, No Visceromegaly CNS: Gcs 15/15 Tone / Power / Reflexes _ N All joints were normal and mobile with normal range of motion.
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Differential Diagonosis Fibroma due to trauma Bone cyst Osteomyelitis
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INVESTIGATIONS
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INVESTIGATIONS Hb 10.6g/dl WBC 12.4 X 10³/µ PLT 409 X10³/µ BLOOD UREA 18mg/dl SERUM CREATININE 0.6 mg/dl TOTAL BILIRUBIN 0.7mg/dl
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INVESTIGATIONS SGPT 39U/L SGOT 26U/L S/Na 140 mEq/L S/K 3.9 mEq/L S/Cl 102 mEq/L URIANANALIYSIS NORMAL ESR 20 C reactive protein 3mg/L
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CHEST X-RAY
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FOREARM X-RAY
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MRI FOREARM
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MRI FOREARM
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Cont. An ill defied mass lesion involving proximal shaft of left radius associated with tissue component and bony deformity measuring 31*25*55mm suggesting residual/recurrent diseases. It also shows bowing of shaft of proximal ulna and elbow joint is unremarkable.
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HISTOPATHOLOGY
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FISH
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Cont. After these investigations our diagnosis is EWING SARCOMA.
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STAGING WORK UP
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CT CHEST
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CT CHEST
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CTCHEST
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BONE SCAN
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BONEMARROY BIOPSY
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Echo CardiographyStructurally and functionally normal Echo studyUSG Abdome Normal Scan
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TREATMENT Chemotherapy Started In DEC.2019 According to EURO.EWING 99 protocols including 6 cycles of VIDE and 8 cycles of VAI. Surgery was done after initial 6 cycles and re-evaluation by orthopedic department in CHF where wide marginal resection and bone excision was done. Limb was saved . Treatment completed in Nov.2020 now Patient is completely well.
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Cont.
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Histopathology After surgery histopathology shows 90% necrosis and margins free of tumor. No lymph node found
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INTRODUCTION Ewing sarcoma was first described in 1921 by James Ewing. It belongs to Ewing family of tumors which include Ewing Saroma, Askin tumor and Peripheral Primitive neuro-ectodermal tumors. They shared same Physiology and Chromosomal translocation t(11;22). The most common mutation that causes Ewing Sarcoma involves two genes, EWSR1 gene on Chromosome 22 and the fL11 gene on Chromosome 11. It mostly affects long bone of legs (femur), flat bones (Pelvis and chest wall).
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Cont. It is the second most common primary bone tumor in children and accounts 2% of all childhood Lancers. It affects males more than females. Common between 10 and 20 years of age. The annual incidence is 2.93 children per 1,000,000. It is aggressive tumor and can spread to other bones, lungs and bone marrow.
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CLINICAL PRESENTATION Localized pain. Back pain due to Paraspinal retro peritoneal or deep pelvic tumor. Palpable mass. Systemic symptoms - fever, weight loss.
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SIGNS Careful inspection and palpation of painful sites. Neurological examination to evaluate asymmetrical weakness, numbness, pain. Skin inspection for petechie or purpura due to bone marrow involvement. Pulmonay auscultation for asymmetrical breath sounds pleural signs due to lung metastasis.
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DIAGNOSIS CBC Blood Cultuves C-reactive Rotein ESR LDH Cytogenetic and molecular studies. History
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Cont. Imaging of primary lesiob MRI Computed tomography If metastasis then Bone Marrow Biophy Chest C.T Scan Bone Scan Fluoro deoxglucose positron emission tomography (FDG - PET) scan
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MANAGEMENT Chemotherapy Neutrophil support Blood products Surgery and Radiotherapy
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Thank YOU