Neonatal Tumors

Key Points

• Incidence: 1-2 per 1000 live births
• Different biology from older children
• May be detected prenatally
• Unique management challenges
• Better overall prognosis than adult tumors

Special Considerations

• Unique Features
  • Embryonic origin
  • Rapid growth potential
  • Different natural history
  • Complex management decisions
• Diagnostic Challenges
  • Limited radiation exposure
  • Tissue sampling risks
  • Complex differential diagnosis
  • Need for specialized expertise

Classification & Types

Common Tumor Types

• Extracranial Teratomas
  • Sacrococcygeal (most common)
  • Cervical
  • Mediastinal
  • Retroperitoneal
• CNS Tumors
  • Teratomas
  • Astrocytomas
  • Choroid plexus tumors
  • Medulloblastomas
• Soft Tissue Tumors
  • Infantile hemangiomas
  • Fibrosarcomas
  • Rhabdomyosarcomas
  • Myofibromatosis
• Other Types
  • Neuroblastoma
  • Hepatic tumors
  • Leukemia
  • Renal tumors

Classification Systems

• By Origin
  • Mesenchymal
  • Neurogenic
  • Germ cell
  • Embryonal
• By Behavior
  • Benign
  • Borderline
  • Malignant

Diagnostic Approach

Clinical Presentation

• Common Signs
  • Visible mass
  • Organ dysfunction
  • Respiratory distress
  • Feeding difficulties
• Associated Findings
  • Hydrops fetalis
  • Paraneoplastic syndromes
  • Compression symptoms
  • Constitutional symptoms

Imaging Studies

• Initial Evaluation
  • Ultrasound
  • Chest X-ray
  • Limited CT/MRI
• Advanced Imaging
  • Focused MRI protocols
  • Nuclear medicine studies
  • PET scan (selected cases)

Laboratory Studies

• Tumor Markers
  • AFP
  • β-hCG
  • VMA/HVA
  • NSE
• Basic Studies
  • Complete blood count
  • Liver function tests
  • Coagulation profile
  • Renal function

Treatment Principles

General Approach

• Initial Management
  • Stabilization
  • Supportive care
  • Pain control
  • Multidisciplinary planning
• Treatment Modalities
  • Surgery
  • Chemotherapy
  • Observation (selected cases)
  • Targeted therapy

Surgical Considerations

• Timing
  • Emergency vs. elective
  • Age-appropriate approach
  • Organ preservation
• Technical Aspects
  • Minimally invasive options
  • Complete resection goals
  • Reconstruction needs

Chemotherapy Principles

• Special Considerations
  • Dose modifications
  • Organ toxicity monitoring
  • Growth/development impact
  • Long-term effects
• Support Requirements
  • Infection prophylaxis
  • Nutrition support
  • Growth factor support

Prognosis & Follow-up

Prognostic Factors

• Tumor-Related
  • Histology type
  • Stage/extent
  • Molecular features
  • Response to therapy
• Patient-Related
  • Age at diagnosis
  • Associated conditions
  • Organ function

Follow-up Care

• Monitoring
  • Growth/development
  • Organ function
  • Tumor markers
  • Imaging surveillance
• Late Effects
  • Endocrine function
  • Neurocognitive development
  • Secondary malignancies
  • Quality of life

Specific Tumor Types

Sacrococcygeal Teratoma

• Features
  • Most common neonatal tumor
  • Female predominance
  • Altman classification
  • AFP monitoring essential
• Management
  • Complete surgical resection
  • Coccyx removal essential
  • Chemotherapy for malignant elements

Neuroblastoma

• Characteristics
  • Most common malignant tumor
  • Adrenal origin common
  • Stage 4S unique to infants
  • Spontaneous regression possible
• Treatment
  • Risk-stratified approach
  • Observation for selected cases
  • Surgery ± chemotherapy

Infantile Hemangioma

• Features
  • Most common benign tumor
  • Natural history of growth/involution
  • PHACE syndrome association
• Management
  • Observation vs. intervention
  • Beta blockers first line
  • Laser therapy role