Resident 360 Study Plans on AMBOSS

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Fast Facts

A brief refresher with useful tables, figures, and research summaries

Tumor Mass Effect

Rarely, the size and location of the tumor (hematologic or solid malignancies) can lead to compression of surrounding anatomic structures and necessitate emergency management. The following table describes scenarios related to mass effect (based on location of the tumor) as well as associated differential diagnoses and management strategies.

Emergencies Related to Mass Effect: Diagnosis and Management Strategies
Condition Symptoms Differential DIagnoses Management
Thoracic Emergencies
Airway
compression
(mediastinal mass)
  • Signs of respiratory distress
  • Hypoxia
  • Orthopnea
  • Lymphoma
  • T-cell leukemia
  • Germ-cell tumors
  • Close cardiorespiratory monitoring
  • Avoid supine position
  • Avoid sedatives or anesthesia
  • Impending airway collapse: glucocorticoids (consider urgent radiotherapy depending on diagnosis)
Superior vena
cava syndrome
(mediastinal mass)
  • Edema of face/upper extremities
  • Respiratory distress
  • Lymphoma
  • T-cell leukemia
  • Germ-cell tumors
  • Supportive care
  • Avoid sedatives or anesthesia
  • Chemotherapy (glucocorticoids/cyclophosphamide) radiotherapy, depending on diagnosis
Nervous System Emergencies
Increased
intracranial
pressure
(intracranial mass)
  • Somnolence
  • Seizures
  • Sixth cranial nerve palsy
  • Pupillary asymmetry
  • Central nervous system neoplasms
  • Supportive care, including measures to reduce intracranial pressure
  • Neurosurgical consultation
  • High-dose glucocorticoids ± radiotherapy
Spinal cord
compression
(spinal/paraspinal
mass)
  • Sensory and motor loss
  • Incontinence
  • Decreased deep-tendon reflexes
  • Neuroblastoma
  • Lymphoma
  • Surgical management
  • High-dose glucocorticoids ± radiotherapy
Abdominal Emergencies
Abdominal
compartment
syndrome
  • Abdominal distention
  • Hypertension
  • Respiratory compromise
  • Cardiac compromise
  • Acute kidney injury (obstruction)
  • Oliguria (obstruction)
  • Wilms tumor
  • Neuroblastoma
  • Germ-cell tumor
  • Burkitt lymphoma
  • Control hypertension (if present)
  • Surgical consultation/decompression
  • Radiotherapy ± chemotherapy
  • Other supportive care, as indicated

Research

Landmark clinical trials and other important studies

Research

Pediatric Superior Vena Cava Syndrome: An Evidence-Based Systematic Review of the Literature

Nossair F et al. Pediatr Blood Cancer 2018.

Researchers conducted this systematic review to determine the prevalence of pediatric superior vena cava subtypes and identify clinical characteristics and treatment strategies that may influence overall outcomes. Thrombosis was present in 36%, with multimodal anticoagulation showing improved outcomes in more than 50%.

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Reviews

The best overviews of the literature on this topic

Reviews

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Management of Posterior Fossa Tumors and Hydrocephalus in Children: A Review

Lin CT and Riva-Cambrin JK. Childs Nerv Syst 2015.

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