Diagnosis. The heterogeneity of this disease makes it essential to perform diagnostic biopsy to identify the histopathology.Immuno-phenotyping and cytogenic studies are

The heterogeneity of this disease makes it essential to perform diagnostic biopsy to identify the histopathology.Immuno-phenotyping and cytogenic studies are essential to establish the diagnosis.

Since approximately 20% of these children have bone marrow involvement at the time of presentation, bone marrow biopsy and aspiration are required. Lumbar puncture is used to identify cerebrospinal involvement. Laboratory studies including complete blood cell count, liver function tests (LFTs) and serum levels of uric acid, electrolytes, lactate dehydrogenase, creatinine, calcium and phosphorus are required for appropriate staging and treatment.

Radiographic imaging is the principal means of evaluating the extent of the primary tumor.

Note!

The following tests and procedures may be used:

· Blood tests.

· Imaging tests. These may include a chest x-ray, MRI, CT scan, and PET scan.

· Biopsy: One of the following types of biopsies may be done:

* Excisional biopsy: The removal of an entire lymph node or lump of tissue.

* Incisional biopsy: The removal of part of a lump, lymph node, or sample of tissue.

* Core biopsy: The removal of tissue or part of a lymph node using a wide needle.

* Fine-needle aspiration (FNA) biopsy: The removal of tissue or part of a lymph node using a thin needle.

* Bone marrow aspiration and biopsy: The removal of bone marrow, blood, and a small piece of bone by inserting a hollow needle into the hipbone or breastbone (Image 9.24).

· Lumbar puncture.

· Thoracentesis.

Image 9.24 Bone marrow aspiration and biopsy

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