Case SummaryCase Summary

10 yr old female C.C.; intermittent abd. pain & lower abd.

mass Wt loss of 4 Kg Huge abd. Mass on CT

Mild hypercalcemia (11.4 mg/dL) CA-125↑

10 yr old female C.C.; intermittent abd. pain & lower abd.

mass Wt loss of 4 Kg Huge abd. Mass on CT

Mild hypercalcemia (11.4 mg/dL) CA-125↑

소아 종양 발생 빈도(한국중앙암등록, 1996-2001)

Other(15%)

Lymphoma(8%)

CNS(16%)

Eye(3%)

Kidney(4%)

Bone(5%)

Soft Tissue(5%)

Ovary/Testis(3%)

Non-gonadalGerm cell

Tumor(3%)

Thyroid(2%)

Neuro-blastoma

(7%)

AcuteLeukemia

(29%)

Most Common Cancers in Children

Clinical tumor markersClinical tumor markers

-

Fetoprotein

-hCG

LDH

CEA

CA-125

CA-19-9

-

Fetoprotein

-hCG

LDH

CEA

CA-125

CA-19-9

CA-125CA-125

Gold standard tumor marker for the evaluation of pelvic masses

Related to tissues of coelomic epithelium and Müllerian ducts

Ovarian tumors of germ cell, epithelial and stromal origin

Gold standard tumor marker for the evaluation of pelvic masses

Related to tissues of coelomic epithelium and Müllerian ducts

Ovarian tumors of germ cell, epithelial and stromal origin

Hypercalcemia in Cancer Patients

Hypercalcemia in Cancer Patients

Most common paraneoplastic syndrome

Serum calcium ≥ 10.5 mg/dL

Various symptoms and signs according to

serum calcium level

Marked hypercalcemia ≥ 13 mg/dL should be

treated immediately

Most common paraneoplastic syndrome

Serum calcium ≥ 10.5 mg/dL

Various symptoms and signs according to

serum calcium level

Marked hypercalcemia ≥ 13 mg/dL should be

treated immediately

Signs and Symptoms of HypercalcemiaNeurologic Gastrointesti

nalCardiovascul

arGenitourinary

Headache Nausea Hypertension

Polyuria

Irritability Vomiting Bradycardia Polydipsia

Seizures Anorexia Arrhythmia Nocturia

Lethargy Constipation

Hypotonia Ileus

Coma Abdominal pain

Clinical DiagnosisClinical Diagnosis

R/O Malignant ovarian

tumor

with hypercalcemia

R/O Malignant ovarian

tumor

with hypercalcemia

Histologic classification of pediatric gonadal and extragonadal tumors

Ovarian TesticularGerm cell Germ cell Teratoma Endodermal sinus tumor

Dysgerminoma Embryonal carcinoma Endodermal sinus tumor

Teratoma

Embryonal carcinoma Teratocarcinoma Mixed malignant germ cell tumor Gonadoblastoma Choriocarcinoma Others (seminoma,

choriocarcinoma, mixed germ cell)

Gonadoblastoma Non-germ cell Polyembryoma Sex cord-stromal

(Leydig cell, Sertoli cell)

Non-germ cell Extragonadal Germ Cell Epithelial (serous, mucinous) Teratoma Sex cord-stromal (granulosa, Sertoli-Leydig, mixed)

Germ cell tumorsGerm cell tumorsNormal fetal yolk sac

Germ cell production

Primordial germ cell

Migration

Neoplastic cell

Abnormal Cell deathGonads Normal

DifferentiationSuppressed differentiation

Embryonic Extra-embryonic

Germinoma(Seminoma)

(Dysgerminoma)

Embryonal carcinomaMatureor immature

teratoma

ChoriocarcinomaYolk sac tumor

(EST)

Small round blue cell tumor in childhood

Small round blue cell tumor in childhood

Non-Hodgkin

lymphoma

Neuroblastoma

Rhabdomyosarcoma

Ewing sarcoma/PNET

Non-Hodgkin

lymphoma

Neuroblastoma

Rhabdomyosarcoma

Ewing sarcoma/PNET