Pediatric surgical oncology
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quote from "Pediatric Surgery (Springer Surgery Atlas)" by Prem Puri, Michael E. Höllwarth - "If, based on the AFP level, a tumour is felt to be malignant, then an inguinal orchiectomy is performed. Tumours that are likely to be benign based on AFP level should be managed initially with an excisional biopsy and frozen section analysis. Even tumors that appear on ultrasound to replace the testis may be enucleated, leaving significant residual testicular tissue. If a benign histology is confirmed, then the testis is closed with absorbable suture and returned to the scrotum. If the biopsy reveals a malignant tumour (usually yolk sac) or potentially malignant tumour (such as …
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quote from "Pediatric Surgery (Springer Surgery Atlas)" by Prem Puri, Michael E. Höllwarth - "Most testicular tumours present as a painless, hard mass, though rarely they may present with pain related to an acute bleed. On physical examination, a mass that cannot be separated from the testis is assumed to be a testis tumour until proven otherwise. Ultrasound is very helpful in making this distinction when the physical examination is unclear. Rarely, testis tumours may present with a reactive hydrocele. If a hydrocele is large and firm enough to preclude palpation of the testis, an ultrasound should be obtained."
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quote from "Pediatric Surgery (Springer Surgery Atlas)" by Prem Puri, Michael E. Höllwarth - "These lesions are best resected within the first 24 h after birth, because the gut is usually not colonized in the first 24 h, reducing the risk of infection if the field is contaminated by stool during the resection. Perioperative antibiotics are given immediately before surgery commences and continued for 24–48 h postoperatively."
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quote from "Pediatric Surgery (Springer Surgery Atlas)" by Prem Puri, Michael E. Höllwarth - "An abdominal ultrasound will determine the size and consistency of any pelvic or abdominal component. It may be necessary to fill the bladder with water to allow it to be used as a sonic window. MRI should clearly distinguish between sacrococcygeal teratoma and anterior meningocele, and may be able to detect the occasional extension of the tumour through the sacral hiatus into the spinal canal."
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Quote from "ESPES Manual of Pediatric Minimally Invasive Surgery" by Ciro Esposito, François Becmeur, Henri Steyaert, Philipp Szavay - "Consecutive SIOP protocols and trials have consistently considered open radical nephroureterectomy as the gold standard approach for treating WT. According to surgical guidelines, the procedure should be performed through a long transverse abdominal or thoraco-abdominal incision, to allow careful inspection of the abdominal cavity and liver, retroperitoneal lymph node sampling, and radical nephroureterectomy outside of the Gerota’s fascia, including perirenal fat and sometimes the adrenal gland in monobloc resection." Quote from "ESPES M…
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video 1
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A schematic illustration of the IDRF evaluation. Regarding the arteries, in cases where a vessel is completely surrounded by the tumor (total encasement), or more than half of the circumference of the vessel is surrounded by the tumor (contact ≧ 50 %), the vessel is considered to be “encased,” and the patient is considered to be IDRF positive. Vessel “contact” is defined by the surrounding of less than half of the artery circumference by the tumor; such cases are considered to be IDRF negative. In the case of veins, “encased” means the complete compression of the vessel with no visible lumen. “Contact” means that the lumen is visible and that case is IDRF negative
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