Fragkandrea et al reported a number of physical findings that may be red flags identifying a pediatric patient with an underlying malignancy. These can help to identify a patient who may benefit from a more in-depth evaluation. The authors are from The Royal Marsden Hospital, Epsom and St. Helier NHS University Hospital, and Panagiotis and Aglaia Kyriakou Children’s Hospital in Athens.


Patient selection: pediatric patient


Abdominal and genital findings that may be red flags for an occult malignancy:

(1) hepatosplenomegaly

(2) palpable intra-abdominal mass with vomiting and/or constipation

(3) palpable intra-abdominal mass with hematuria, enuresis, urine retention and/or hypertension

(4) palpable intra-abdominal mass with abdominal pain

(5) persistent palpable intra-abdominal mass after the neonatal period

(6) persistent vomiting associated with morning headaches

(7) scrotal swelling or mass in male

(8) right sided varicocele in male

(9) urine retention or enuresis with neurologic deficits


The presence of one or more of these findings may identify a pediatric patient who may need a more complete evaluation to exclude an occult neoplasm.


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