1. Malignancies

2. Malignancy and Fever Pyrogenic cytokines: IL-1, IL-6, TNF- , INF INF activate macrophages against tumor cells and these macrophages in turn produce TNF which is a pyrogenic cytokine Associated bleeding, ulceration, rupture or infarction, secondary infection

3. HEMATOLOGIC TUMORS HODGKIN’S LYMPHOMA NON-HONDGKIN’S LYMPHOMA LEUKEMIA

4. HODGKIN’S LYMPHOMA Hodgkin’s Lymphoma is a neoplasm of lymphoid tissue that is defined histopathologically by the presence of the malignant Reed Sternberg cells.

5. HL - Epidemiology more common in males common among individuals with few or no siblings Common among those having higher education Common among urban than rural dwellers. Bimodal, mid to late 20’s and >50 years Rare before age 5

6. HL - pathogenesis presence of characteristic giant cells of the Reed Sternberg type

7. HL – Clinical Manifestations fever in excess of 38°C (Pel Ebstein pattern) drenching night sweats weight loss >10% of body weight in the last 6 months Generalized pruritus Cough CXR  mediastinal enlargement Fever, anorexia, weight loss

8. NON-HODGKINS LYMPHOMA A malignant proliferation of cells From lymphocytic or histiocytic lineage Spread in a pattern similar to the migration of normal lymphoid cells

9. NHL - Epidemiology 3 rd most common childhood malignancy Occurs in 1 st two decades of life, though uncommon in <3 years old. Male:Female = 3:1

10. NHL – Clinical manifestations Chest pain fever night sweats weight loss Adenopathy not responsive to anibiotics fatigue appetite loss

11. Leukemia Lymphoid neoplasms that present with widespread involvement of the bone marrow, usually accompanied by the presence of large numers of tumor cells in the peripheral blood

12. - slow onset, insidious or very rapid – Initially, children begin to tire easily and rest often –Frequently, have a fever which comes and goes –loss of appetite & weight –pale skin and occasional bruising –back, leg, and joint pain, difficult to walk –lymph nodes in the neck or groin become enlarged – upper abdomen protrudes due to enlargement of the spleen and liver. –Children become cranky and irritable, and occasional nosebleeds develop

13. SOLID TUMORS NEUROBLASTOMA WILM’S TUMOR RETINOBLASTOMA

14. Neuroblastoma Description: Neuroblastoma is a malignant neural tumor that affects very young children.

15. Neuroblastoma Clinical The most common finding upon physical examination is a nontender, firm, irregular abdominal mass that crosses the midline. Complaints of fatigue, bone pain, and changes in bowel or bladder habits

16. Neuroblastoma Infants often present with compression of the sympathetic ganglia in the thoracic region, which might result, for example, in Horner syndrome (myosis, anhydrosis, and ptosis) or superior vena cava syndrome.

17. Wilm’s Tumor nephroblastoma 8 cases/million children <15 years old usually occurs in children between 2-5 years of age 2nd most common malignant abdominal tumor in childhood fifth most common pediatric malignancy

18. Wilm’s Tumor Clinical Manifestations asymptomatic abdominal mass Hypertension gross hematuria fever are observed in 5-30% of patients. hemorrhaged into their tumor may present with signs of hypotension, anemia, and fever (few cases only) advanced-stage disease - respiratory symptoms related to the presence of lung metastases.

19. RETINOBLASTOMA most common intraocular malignancy of infancy and childhood arises in the retina and accounts for about 3% of the cancers occurring in children younger than 15 years most often occurs in younger children, usually before the age of 2 years 95% of cases are diagnosed before the age of 5 years

20. RETINOBLASTOMA Leukocoria "white-pupil" caused by large retinoblastoma in the left eye Clinical Features: Primary presentation: crossed eyes (strabismus) abnormal pupillary reflex (leukocoria) or decreased vision *with that, patients are referred to ophthalmologists