Editing Pediatrics: Renal and Adrenal Oncology (section)

=== Diagnosis and Evaluation ===

==== History and Physical Exam ====
* '''Clinical manifestations vary widely'''
** '''<span style="color:#ff0000">Most children have abdominal pain or a palpable mass'''
*** '''Most primary tumors arise within the abdomen (65%)'''
**** Physical examination often reveals a fixed, hard abdominal mass
*** '''Pelvic neuroblastoma arising from the organ of Zuckerkandl account for 4% of tumors.'''
**** Extrinsic compression of the bowel and bladder can produce symptoms of urinary retention and constipation.
** '''<span style="color:#ff0000">Other are identified because of manifestations of metastatic disease, including bone or joint pain and periorbital ecchymosis.'''
*** '''Metastases are present in 70% of patients with neuroblastoma at diagnosis'''
** '''<span style="color:#ff0000">Symptoms produced by catecholamines'''
*** '''<span style="color:#ff0000">Release may mimic those seen in pheochromocytoma: paroxysmal hypertension, palpitations, flushing, and headache'''
*** '''Secretion of vasoactive intestinal peptide (VIP) can produce severe watery diarrhea and hypokalemia'''

==== Labs ====
* '''<span style="color:#ff0000">Urinary metabolites of catecholamines, vanillylmandelic acid (VMA) and homovanillic acid (HVA)'''
**'''Increased levels are found in 90-95% of patients'''
*** These metabolites can be monitored to detect tumor relapse and response to therapy
* '''CBC'''
**'''Anemia''' '''is found with widespread bone marrow involvement'''
[[File:Neuroblastoma 103.jpg|alt=Axial CT scan of Neuroblastoma|thumb|500x500px|Axial CT scan of Neuroblastoma. Source: [[commons:File:Neuroblastoma_103.jpg|Wikipedia]]]]

==== Imaging ====
* '''<span style="color:#ff0000">CT or MRI'''
** '''Provide more information about the local extent of the primary tumors and vascular involvement'''
** '''Advantages of MRI over CT'''
*** '''Evaluating intraspinal tumor extension, which is not uncommon in paravertebral lesions'''
*** Demonstrating the relationship between the major vessels and the tumor
** '''<span style="color:#ff0000">CT findings'''
**# '''<span style="color:#ff0000">Crossing midline'''
**# '''<span style="color:#ff0000">Vascular encasement'''
**# '''<span style="color:#ff0000">Intra-tumoral stippled calcifications'''
**#* '''Note that egg-shell calcifications are found in adrenal hemorrhage, which may also present in the neonate as an abdominal mass'''
*** '''<span style="color:#ff0000">These imaging characteristics are absent in Wilms tumor'''
*'''Plain radiographs'''
** May demonstrate a '''calcified abdominal or posterior mediastinal mass'''
* '''Radionuclide bone scan and metaiodobenzylguanidine (MIBG) scans for can be used staging'''

==== Other ====
* '''Bone marrow biopsies'''
**'''Marrow biopsies add substantially to the detection of marrow involvement by tumor,''' compared with marrow aspirates alone.
*** '''2 marrow aspirates and 2 biopsies are recommended'''