University of Mosul�College of Medicine

Lecture: 1

Subject/year: Pediatric Diseases 2022/2023

Assistant Lecturer: Dr. Elaf Abdulwahhab

Department: Pathology

Date:30.11.2022

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The AIM of this lecture is

• Definition of Pediatric diseases.
• Congenital anomalies.
• Perinatal infections.
• Prematurity and fetal growth restriction.
• Respiratory distress syndrome of the newborn.
• Necrotizing enterocolitis.
• Sudden infant death syndrome (SIDS).

• Intended learning outcomes:

• By the end of this lecture the student will be able to:
• Define pediatric diseases.
• Know the congenital anomalies and its causes
• Differentiate between transcervical and trnasplacental infections.
• Compare between Prematurity and fetal growth restriction.
• Discuss Respiratory distress syndrome of the newborn.
• Define Necrotizing enterocolitis.
• Know Sudden infant death syndrome (SIDS).

Pediatric diseases:

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• They are diseases of infancy and childhood many of them are of genetic origin. Others, although not genetic, either unique to children or take distinctive forms in this patient population.

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• infancy.

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• The neonatal period.

• Congenital anomalies:

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• They are structural defects present at birth.

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• I= 1:33.

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• importance.

The pathogenesis of congenital anomalies:

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The pathogenesis of congenital anomalies is complex and still poorly understood, but two general principles are relevant regardless of the etiologic agent:

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1. The timing of the prenatal teratogenic insult.

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• The complex interplay between environmental teratogens and genetic defects.

• Perinatal infections:

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Infections of the fetus and neonate.

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1. Transcervical (ascending) infections:

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• Most bacterial infections and a few viral infections (e.g., Herpes simplex).

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• The fetus acquires the infection by inhaling infected amniotic fluid or by passing through an infected birth canal during delivery.

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2. Transplacental:

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• Most parasitic and viral infections, and a few bacterial infections.

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• TORCH

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• Zika virus microcephaly and brain damage.

• Prematurity and fetal growth restriction:

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Prematurity:

• Gestational age less than 37 weeks.

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• Second most common cause of neonatal mortality.

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• <2500 gm BUT appropriate for gestational age.

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Fetal growth restriction:

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weigh less than 2500 gm are born at term.

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These small-for-gestational age (SGA) infants suffer from fetal growth restriction.

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• Fetal abnormalities:

- intrinsically Such as chromosomal disorders, congenital anomalies, and congenital infections (TORCH).

- symmetric.

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• Placental abnormalities:

- uteroplacental blood supply.

- asymmetric (i.e., the brain is spared).

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• Maternal factors:

• Most Common Cause Of SGA.
• Vascular Diseases.
• Avoidable causes.

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The growth-restricted infant is handicapped.

• Respiratory distress syndrome of the newborn:

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• It is primarily a disorder of premature infants.

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• There are also associations with male gender, maternal diabetes, and delivery by cesarean section.

MORPHOLOGY:

microscopic examination characteristic eosinophilic hyaline membranes.

• Necrotizing enterocolitis(NEC) :

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• most commonly premature infants.

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• NEC typically involves the terminal ileum, cecum, and right colon.

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• NEC is associated with high perinatal mortality.

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• Sudden infant death syndrome (SIDS):

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• SIDS is defined as the sudden death of an infant under 1 year of age which remains unexplained after a thorough case investigation

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• Crib death and cot death.

Pathogenesis:

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• SIDS is multifactorial condition.
• Delayed development of arousal and cardiorespiratory control.

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MORPHOLOGY:

• hypoplasia of the arcuate nucleus or a subtle decrease in brain stem neuronal populations.

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Sudden Unexpected Death In Infancy (SUID).

-Infections are the most common causes of SUID,

-Congenital anomaly.

-SIDS

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To summarize:

• Congenital anomalies can result from multifactorial causes and the timing of the in utero insult has profound influence on the extent of congenital anomalies

• Neonatal RDS (hyaline membrane disease) is a disease of prematurity due to insufficient pulmonary surfactant•
• SIDS is a disorder of unknown cause, defined as the sudden death of an infant younger than 1 year of age that remains unexplained after a thorough case investigation including performance of an autopsy.

HOME WORK

• Q1- Write Short Note About Teratogenic Effect Of Alcohol.

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• Q2- Compare the hyaline membrane disease in childhood and adult.

References :

-Robbins BASIC PATHOLOGY 10^th edition

-ROBBINS & COTRAN PATHOLOGIC BASIS OF DISEASE 10^th edition

The end

University of Mosul�College of Medicine

Lecture: 2

Subject/year: Environmental Diseases 2022/2023

Assistant Lecturer: Dr. Elaf Abdulwahhab

Department: Pathology

Date:30.11.2022

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The AIM of this lecture is

• Definition and Causes of hydrops fetalis
• Types of childhood tumors.

• Intended learning outcomes:

• By the end of this lecture the student will be able to:
• Define hydrops fetalis and enumerate its types.
• Differentiate between tumors and tumor like lesions of childhood.
• Compare between retinoblastoma and neuroblastoma.

• Fetal hydrops:
• Refers to the accumulation of edema fluid in the fetus during intrauterine growth.
• Immune hydrops or nonimmune hydrops
• Localized or generalized.

• The mechanism of immune hydrops:

• Tumors and tumorlike lesions of infancy and childhood:

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• Malignant neoplasms constitute the second most common cause of death in children between the ages of 4 and 14 years.

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• Benign tumors more common than cancers.

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• tumorlike lesions:

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1. Heterotopia or choristoma.
2. Hamartoma.

Benign Neoplasms:

Any neoplasm may be encountered in the pediatric age group,

1. Hemangiomas: are the most common neoplasms of infancy.

Congenital capillary hemangioma (A) at birth and (B) at 2 years of age after the lesion had undergone spontaneous regression.

2. Lymphangiomas:

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• Lymphangiomas represent the lymphatic counterpart of hemangiomas.

• They tend to increase in size after birth.

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3. Teratomas:
1. mature teratomas or malignant teratomas
2. 75% of these tumors are mature teratomas with a benign course.
3. Most of the benign teratomas are encountered in younger infants (≥4 months).

Malignant Neoplasms:

-The organ systems involved most commonly in infancy and childhood are the hematopoietic system, neural tissue, and soft tissues.

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- Round blue cells(blast).

Neuroblastoma:

• Derived from primordial neural crest cells.

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• Most occur sporadically,

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• 1% to 2% are familial ( autosomal dominant , both of the adrenals or multiple primary autonomic sites).

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• Mutations ALK gene markers of adverse prognosis.

MORPHOLOGY:

Histologically,

primitive-appearing cells.

The background often demonstrates eosinophilic fibrillary material (neuropil).

Homer-Wright pseudorosettes can be found.

Retinoblastoma :-

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• Retinoblastoma is the most common primary intraocular malignancy of children.
• 40% heritable. multiple tumors that are bilateral, although they may be unifocal and unilateral.
• 60% sporadically. unilateral and unifocal. \
• RB (Retinoblastoma) gene mutations.

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MORPHOLOGY:

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• small, round cells,
• the most characteristic of these being FlexnerWintersteiner rosettes.

Clinical Features :

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The median age at presentation is 2 years, although the tumor may be present at birth.

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If untreated, the tumors usually are fatal, but when treated with chemotherapy, radiotherapy, and enucleation, survival is the rule, some tumors may regress spontaneously.

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Strabismus without leukocoria (early clinical sign)

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Leukocoria (white reflux) due to retinal tumor

�

Home work:��Q1: Mention in the staging system of neuroblastoma.��Q2: what are the types of hemangioma?����

To summarize:

• Fetal hydrops :accumulation of edema fluid in the fetus during intrauterine growth. The degree of fluid accumulation is variable, from generalized hydrops fetalis to localized cystic hygromas. The most common causes of fetal hydrops are whereas immune hydrops has become less frequent as a result of Rh antibody prophylaxis.

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• Neuroblastomas and related tumors arise from neural crest– derived cells in the sympathetic ganglia and adrenal medulla. HomerWright pseudorosettes are characteristic of neuroblastomas.

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• Retinoblastoma is the most common primary intraocular malignancy of children. Approximately 40% of the tumors are associated with a germline mutation in the RB gene and are therefore heritable. The remaining 60% of the tumors develop sporadically, and these have somatic RB gene mutations.

References :

-Robbins BASIC PATHOLOGY 10^th edition

-ROBBINS & COTRAN PATHOLOGIC BASIS OF DISEASE 10^th edition

Thanks