- Maria C. Velez, MD*
- *Associate Professor of Pediatrics, Department of Hematology/Oncology, Louisiana State University Health Sciences Center, New Orleans, LA
Lymphomas, which include both Hodgkin and non-Hodgkin, are the third most common childhood malignancy, accounting for approximately 12% of the newly diagnosed cancers seen in children younger than the age of 15 years. Approximately 60% of pediatric lymphomas are non-Hodgkin lymphoma (NHL). Although the incidence of both types of lymphoma increases with age throughout childhood and adolescence, Hodgkin disease (HD) accounts for a greater proportion of the lymphomas seen in adolescents. The crucial role of the pediatrician in the care of the child who has these or other suspected malignancies is maintenance of a high index of suspicion and prompt referral to a pediatric cancer specialist who can initiate the evaluation with dispatch and initiate appropriate diagnosis-directed therapy.
Case Presentation: A Tale of Two Masses
Patient A is a 16-year-old African-American male who is brought to the emergency department with a 5-day history of substernal chest pain and shortness of breath. His review of systems is positive for fatigue and cough but negative for fever, weight loss, or night sweats. On physical examination, he is afebrile but tachypneic and tachycardic. He has mild respiratory distress with no retractions, and his lungs are clear to auscultation bilaterally. Heart sounds are distant; peripheral pulses are adequate. There is no significant lymphadenopathy or hepatosplenomegaly.
Patient B is an 11-year-old Caucasian male who is brought to his pediatrician for evaluation of shortness of breath and fatigue of 2 to 3 weeks’ duration. His mother insists that the child is pale and has less energy than usual. On physical examination, the child is alert and in no distress. His lungs are clear to auscultation bilaterally. There is no significant lymphadenopathy or hepatosplenomegaly.
The initial evaluations for these patients include chest radiography (Figs. 1 and 2).