STEPTRACKERCROSS-SYSTEM | PATHOLOGY + CLINICAL | RAPID-FIRE REVIEW

Pathology by Age

Classic presentations from newborn to old age — the patient's age is often the strongest clue in the stem.

FOCUS ON
Read the age first. Newborns: congenital obstruction and genetic disease. Children: embryonal tumors (neuroblastoma, Wilms, medulloblastoma), leukemia, post-infectious immune disease. Young adults: autoimmunity, germ cell tumors, lymphoma, trauma. Older adults: carcinomas, degeneration, vascular disease, metastases.
AGE · SETTING
CLASSIC PRESENTATION
DIAGNOSIS
PAGE
Newborn, first day
Bilious vomiting, double bubble, Down syndrome
Duodenal atresia
10.09
Newborn, 48 hours
No meconium, distension, explosive stool on exam
Hirschsprung disease (or meconium ileus — CF)
10.09
Newborn, < 24 hours
Jaundice
Hemolysis (pathologic jaundice)
11.04
Infant, 2–6 weeks
Projectile nonbilious vomiting, olive mass
Pyloric stenosis
10.09
Infant
Floppy with tongue fasciculations
Spinal muscular atrophy
16.02
Toddler
Colicky pain, currant jelly stool, sausage mass
Intussusception
10.07
Child < 2
Abdominal mass crossing midline, ↑ HVA/VMA
Neuroblastoma
15.10
Child 2–4
Flank mass not crossing midline, aniridia
Wilms tumor
12.12
Child 2–6
Periorbital edema, heavy proteinuria after a cold
Minimal change disease
12.04
Boy 3–5
Gowers sign, big calves, ↑↑ CK
Duchenne muscular dystrophy
17.09
School-age child
Cola urine 2–4 weeks after strep throat
Post-streptococcal GN
12.06
Child
Truncal ataxia, morning vomiting, midline cerebellar mass
Medulloblastoma
16.12
Adolescent
Knee pain, metaphyseal mass, sunburst
Osteosarcoma
17.05
Obese adolescent
Knee pain and limp, ↓ internal rotation
Slipped capital femoral epiphysis
17.01
Young woman
Painful monocular vision loss, later limb numbness
Multiple sclerosis
16.08
Young man
Painless firm testicular mass
Germ cell tumor (seminoma)
14.03
Young man
Inflammatory low back pain, uveitis
Ankylosing spondylitis
17.07
Middle-aged woman
Itching, fatigue, ↑ ALP, AMA ⁺
Primary biliary cholangitis
11.09
Older man
Nocturia, weak stream, smooth enlarged prostate
BPH
14.05
Older adult
Painless jaundice, palpable gallbladder, weight loss
Pancreatic head adenocarcinoma
11.02
Older adult
Gradual memory loss
Alzheimer disease
16.09
Older adult
Large painless rectal bleed
Diverticulosis (or angiodysplasia)
10.10

Mechanism — why age shifts the diagnosis

NewbornCongenital, genetic, infection from mother
→
ChildEmbryonal tumors, leukemia, post-infectious immunity
→
Young adultAutoimmunity, germ cell tumors, trauma
→
Older adultAccumulated mutations, atherosclerosis, degeneration

Carcinomas need decades of mutations, so they cluster late; embryonal tumors come from developmental cells that only exist early.

Tumors by age

AGE
TUMORS
CLUE
0–5
Neuroblastoma, Wilms, retinoblastoma, hepatoblastoma, ALL
"-blastomas"
5–15
ALL, medulloblastoma, pilocytic astrocytoma, Ewing
Posterior fossa
15–35
Germ cell, Hodgkin, osteosarcoma, papillary thyroid
Young and curable
35–60
Breast, cervix, colorectal, melanoma
Screening ages
> 60
Prostate, lung, colon, pancreas, CLL, myeloma, bladder
Carcinomas, metastases

How it's tested

COMMON CONFUSIONA bone tumor at 15 is osteosarcoma or Ewing; at 70 it is metastasis or myeloma. The same image means different things at different ages.
THE TRAPClassic age ranges are tendencies, not rules — use them to rank the differential, then confirm with a specific clue.
YOUR APPROACHAge and sex → common disease group → the one finding that separates the top two → mechanism → next step.

If you see… think…

Neonate with cyanosis that doesn't improve with oxygen → cyanotic congenital heart disease
Premature infant, bloody stools, pneumatosis → necrotizing enterocolitis
Child with bone pain, pallor, petechiae → acute lymphoblastic leukemia
Child with purpura on buttocks and abdominal pain → IgA vasculitis
Teen boy with nosebleeds and nasal mass → juvenile nasopharyngeal angiofibroma
Young woman with malar rash and arthritis → SLE
Young adult with painless neck node, Reed-Sternberg cells → Hodgkin lymphoma
Middle-aged smoker with painless hematuria → urothelial carcinoma
Postmenopausal woman with bleeding → endometrial carcinoma until proven otherwise
Elderly patient with hip fracture after a minor fall → osteoporosis