Case
General Data:
K.P. 2/M , sees you for the first time with the chief complaint of abdominal distention
History of Present Illness
4 week history of intermittent low grade undocumented fever, malaise, weight loss, anorexia
3 weeks history of progressive abdominal enlargement with note of vomiting and anorexia. Consult with a
pediatrician, Abdominal CT scan done showed abdominal solid mass with stippled calcifications. They were advised
to seek further consult with a specialist
2 weeks PTA, noted with constipation and difficulty urination. Progression of abdominal enlargement prompted
consult
PHYSICAL EXAMINATION
BP 90/60 HR 110 RR 24 Temp 37
Weight for age below -3 , Length for age below -3
Pink conjunctiva, anicteric sclerare, no cervical lymphadenopathy
ECE, clear breath sounds
Distended abdomen AG = 50cm, 20x20cm firm nonmoveable mass
Pink nailbeds, (-) edema
Normal external genitalia
Tanner of Breast - 1; Tanner of Pubic Hair – 1
Lab Results:
CBC
Hgb
Hct
RBC
MCV
MCH
RDW
WBC
Segmenters
Lymphocytes
Monocytes
Platelet Count
Tumor Markers
Urine VMA
Urine HVA
AFP
B – HCG
9.0 (LOW)
28 (LOW)
5
80
30
12
9.0
60
25
10
350
12.0- 15.0 g/dL
36 – 48%
3.5 – 5.5 ml/UL
80-100 FL
25-35 PG
11 – 16 FL
4.5 -11.0 K/UL
40-74
14-46
4-13
150 – 450 K/UL
Patient Value
50
18
25
0.3
Reference Range
2-4 years: <13.0 mg/g creatinine
2-4 years: <13.5 mg/g creatinine
<100ng/L
3 months-18 years - 0.8 IU/L or less
Urinalysis: normal
CXR: normal
Abdominal CT scan with Contrast: shows a large heterogeneous low attenuating lesion with calcification in the
right suprarenal area
Bone scan: shows multiple randomly distributed focal lesions scattered throughout the skeleton, particularly the
spine, ribs, and pelvis.
Bone marrow biopsy: small, round, blue cell tumor cells
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