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Less than 28 days

malignancy unlikely (< 1%)

More than 28 days

malignancy likely (> 50%)

CONGENITAL HEMANGIOMA

CONGENITAL HEMANGIOMA

Acute Leukemia Neuroblastoma

CNS Tumors Retinoblastoma Mesoblastic Nephroma/Wilm’s Tumor Teratoma (CNS, non-CNS) Soft Tissue Sarcoma

Maternal Melanoma metastatic to fetus Langerhans Cell Histiocytosis (LCH)

Letter-SIWE

MELANOTIC PLACENTA

CONGENITAL MELANOMA

Down Syndrome Transient Myeloproliferative Disorder (TMD) Acute Megakaryocytic Leukemia Pre – B Acute Lymphocytic Leukemia Increased sensitivity to chemotherapy

DOWN SYNDROME TRANSIENT MYELOPROLIFERATIVE DISORDER (TMD)

DOWN SYNDROME TRANSIENT MYELOPROLIFERATIVE DISORDER (TMD)

DOWN SYNDROME TRANSIENT MYELOPROLIFERATIVE DISORDER (TMD)

DOWN SYNDROME TRANSIENT MYELOPROLIFERATIVE DISORDER (TMD)

DOWN SYNDROME TRANSIENT MYELOPROLIFERATIVE DISORDER (TMD)

DOWN SYNDROME TRANSIENT MYELOPROLIFERATIVE DISORDER (TMD)

DOWN SYNDROME ACUTE MEGAKARYOCYTIC LEUKEMIA

DOWN SYNDROME ACUTE MEGAKARYOCYTIC LEUKEMIA

DOWN SYNDROME ACUTE MEGAKARYOCYTIC LEUKEMIA (M7)

Non-Down Syndrome t (4;11) – Mixed lineage leukemia Poor survival (< 10%)

ACUTE LYMPHOCYTIC LEUKEMIA

NEONATAL LEUKEMIA

NEONATAL ACUTE LYMPHOCYTIC LEUKEMIA (ALL)

NEONATAL LEUKEMIA

ACUTE MYELOGENOUS LEUKEMIA (AML)

Beckwith-Wiedeman Syndrome Wilm’s Tumor Hepatoblastoma Adrenocortical carcinoma Soft tissue sarcoma

Hemihypertrophy Soto Syndrome

BECKWITH-WIEDEMAN SYNDROME

BECKWITH-WIEDEMAN SYNDROME

BECKWITH-WIEDEMAN SYNDROME

BECKWITH-WIEDEMAN SYNDROME

OMPHALOCELE IN BECKWITH- WIEDEMAN SYNDROME

Beckwith-Wiedeman Syndrome

Environmental Risk factors Weight < 1500 to 2500 gm Therapeutic interventions TPN, Intralipid Medications Plastic catheters

Clinical features Intrahepatic mass

Metastases to regional nodes Obstruction of porta hepatis – jaundice

Ascites Metastases to lungs

HEPATOBLASTOMA

HEPATOBLASTOMA

HEPATOBLASTOMA

Familial Wilm’s Tumor Infancy/early childhood Multifocal/bilateral Metachronous Favorable histology 15% of all Wilm’s tumor

WT (tumor suppressor gene)

WILM’S TUMOR

MESOBLASTIC NEPHROMA

MESOBLASTIC NEPHROMA

Familial Retinoblastoma Infancy/early childhood

Multifocal/bilateral Metachronous 40% of all Retinoblastoma tumor RB (tumor suppressor gene)

Presentation Leukocoria (white eye)

Strabismus (lazy eye) Impaired vision Irritation (red eye)

RETINOBLASTOMA

Li-Fraumeini Syndrome Rhabdomyosarcoma Soft tissue sarcoma Osteogenic sarcoma Breast cancer Bowel cancer

Brain cancer Acute Leukemia

SOFT TISSUE SARCOMA

SOFT TISSUE SARCOMA

SOFT TISSUE SARCOMA

RHABDOMYOSARCOMA

RHABDOMYOSARCOMA

Neurofibromatosis Type 1 Plexiform neurofibroma Optic nerve glioma Neuroma CNS hamartoma Acute Leukemia

NEUROFIBROMATOSIS TYPE 1

Stillbirth Intrauterine growth retardation Macrocephaly Dysmorphic features

Morbidity high Survival 28%

Choroid Plexus Papilloma Ganglioglioma Low grade astrocytoma Primitive Neuroectodermal tumor

Teratoma

CN S TERATOMA

Adrenal medulla Paravertebral sympathetic Thoracic Abdominal

NEUROBLASTOMA

NEUROBLASTOMA

Bone Bone marrow Lymph nodes Liver

Spleen Cutaneous Not CNS or lung

NEUROBLASTOMA

NEUROBLASTOMA

NEUROBLASTOMA

NEUROBLASTOMA

Teratos (monster) + oma (tumor) CNS and non-CNS (usually sacral) Benign (> 99%) High risk of malignant transformation

TERATOMA

Most common congenital germ cell tumor 1 in 35,000 to 40,000 Female predominance (3.1 to 4.1 ratio) Prenatally diagnosed 30-50% 36 to 41% require fetal intervention Survival rate of prenatally diagnosed SCT is 47-83% 50% have long term morbidity

SACRO-COCCYGEAL TERATOMA

SACRO-COCCYGEAL TERATOMA

SACRO-COCCYGEAL TERATOMA

SACRO-COCCYGEAL TERATOMA

SACRO-COCCYGEAL TERATOMA

Rare Present with Abdominal, thoracic or soft tissue mass Cutaneous lesions Intrauterine growth retardation Congenital anomalies

Most frequently include Acute leukemia CNS tumors Retinoblastoma

Mesoblastic Nephroma/Wilm’s Neuroblastoma

Teratoma Soft tissue tumors

Associations Down syndrome Beckwith-Wiedeman syndrome Hemihypertrophy, Soto syndrome

Neurofibromatosis type 1

Germ line tumor suppressor gene mutations Familial Wilm’s tumor Familial Retinoblastoma Li-Fraumeini Syndrome

Alcohol

Neuroblastoma

Marijuana

Acute Monocytic leukemia

Farm chemicals

Acute leukemia, lymphoma

Radiation from extra-terrestrial and environmental exposures Radiation from imaging studies (CT) Major risk of cancer later in life