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Abdominal tumors in children

Abdominal tumors in children. Abdominal tumor ≠ abdominal neoplasm. In neonatal and infantile period the majority of palpable masses in abdomen are anomalous or enlarged o rgans .

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Abdominal tumors in children

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  1. Abdominal tumors in children

  2. Abdominal tumor ≠ abdominal neoplasm In neonatal and infantile period the majority of palpable masses in abdomen are anomalous or enlarged organs . Congenital abnormalities of kidneys are the cause of 55% of all unilateral and 90% of bilateral abdominal masses in newborns and infants

  3. Newborns and infants (< 2 year of life) • Unilateral abdominal tumours: • Kidneys – 55%hydronephrosismulticystic dysplastic kidneymesoblastic nephroma • Retroperitoneal cavity (besides kidneys) – 15%adrenal haematomaneuroblastomateratoma • Gastrointestinal system – 15%duplications • Genital system – 10%ovary cyst • Hydromethrocolpos • Liver – 5%hepatoblastoma • Bilateral abdominal masses: • Kidneys (90%) polycystic kidneys diseases ADPKD, ARPKD

  4. Toddlers and older children (>2 year of life) • Kidneys (45%) Wilms tumour (nephroblastoma) hydronephrosis • Retroperitoneal cavity (40%)(adrenal glands, autonomic ganglions, lymph nodes) neuroblastoma teratona lymphoma • Gastrointestinal system (15%) - liver, splen, bowels lymphoma duplications hepatoblastoma

  5. Retroperitoneal cavity BENIGN TUMOURS: Adrenal - haematoma Kidney enlargement – hydronephrosis, abscess, renal veins thrombosis MALIGNANCIES: Renal – Wilms tumour Lymph nodes – lymphoma adrenals and autonomic ganglions – neuroblastoma

  6. Diagnostic algorithm in children with palpable abdominal tumour USG and plain abdominal rentgenogram – cystic mass:

  7. Diagnostic algorithm in children with palpable abdominal tumour USG and plain abdominal rentgenogram – solid mass:

  8. Abdominal tumors in children Hydronephrosis in infant bilateral, more pronounced on the right

  9. Abdominal tumors in children Unilateral hydronephrosis

  10. Abdominal tumors in children Newborn – adrenal haematoma

  11. Abdominaltumorsinchildren • ADRENAL HEMATOMA • detection by ultrasound (hypoechoic mass above the upper pole of the kidney, mixed echogenicity • with hyperechoic areas are possible) • follow up examination to demonstrate volume regression • calcifications in follow-up studies • difficult to distinguish from neuroblastoma (laboratory findings- catecholamine metabolites in • urine can help) • MRI or CT is not necessary in early detection after birth.Only in suspicious neuroblastoma for • any other reason, isfurther imaging necessary. If volume regression is absent,MRI becomes • necessary. Hyperintense T1w signal is indicative of hemorrhage.

  12. Abdominal tumors in children Autosomal recessive policystic kidney disease urography:bilateral massive enlargement of kidneys

  13. Abdominaltumorsinchildren Autosomal recessive policystic kidney disease CT

  14. Abdominal tumors in children WILMS tumour

  15. Case 1: This well 5-year-old child presented with a left-sidedabdominal mass. Ultrasound revealed a large rounded softtissue mass arising from the kidney. A CT examination was performed . • What are the imaging features shown? • What are thedifferentiating features that • allow a provisional diagnosisto be made? • What other investigation should beperformed?

  16. post contrast CT shows a well definedsoft tissue mass in the left upper quadrant • there isnormal enhancing renal tissue inferior to the mass • there is some displacement of the surroundingstructures but no encasement • there is no visiblecalcification • the diagnosis of a Wilm’s tumour is made upon the ageof the child, the fact that the • child is relatively well, thetumour is displacing surround structures rather than • encasing them and there is an absence of calcificationseen on the CT examination. • the staging Wilm’s tumour is open to debate. In somecentres the presence of chest • metastases is determinedby a chest X-ray while other centres may perform chest • CT. With all abdominal imaging is important to stage thetumour and in particular to • look for the presence oftumour spread of the renal vein and into the inferior vena • cava.

  17. Abdominaltumorsinchildren Cystic nephroblastoma WILMS tumour

  18. Abdominaltumorsinchildren • NEPHROBLASTOMA (WILMS’ TUMOUR) • is the most commonrenal tumour in childhood • occur mainly in children of less than 5 years (peak incidence between 2 and 5 years of age) • asymptomatic,occasionally fever, pain and hypertension may be present • preferredlocations for metastases are the locoregional lymphnodes and the lung (‘cannonball’ • metastases). Livermetastases are possible. Other distant metastases, e.g. in the skeletal system, • are rare. • in the first 6 months of life, mesoblastic nephromaoccurs more often than Wilms’ tumour.

  19. Abdominaltumorsinchildren • NEPHROBLASTOMA (WILMS’ TUMOUR) • US is the fundamental imaging method • MRI preferred for local tumour extension and abdominal metastases • homogeneous or inhomogeneous renal mass (bilateral involvement in 10% of cases) • displacement of neighbouring anatomical structures • echogenic tumour thrombus in renal vein or inferior vena cava(as the tumor often grows directly • into the renal veins or IVC) • lymph node enlargement • tumour bleeding with central fluid/sedimentation levels • cystic tumours with tumour parenchyma are found inthe case of cystic nephroblastoma

  20. Abdominaltumorsinchildren • NEPHROBLASTOMA (WILMS’ TUMOUR) • MR • hypointense pseudocapsule in T2w sequences • in T2 hyper- and T1 hypointensive renal mass with displacement of other organs • - hyperintense tumour thrombus in hypointense vessel signal in T2w sequences • contrast enhancement of residual renal parenchyma, contrast enhancement of vital tumour areas, • hypointense tumour necrosis • hyperintensive bleeding in the tumour in T1w sequences • CT • hyperdense areas in case of bleeding in native scans • calcifications in about 14% of nephroblastomas • - inhomogeneous enhancement after contrast administration

  21. Abdominal tumors in children Adrenal neuroblastoma

  22. Case 2: A 2-year-old child presented with a large intra-abdominal mass. There was associated vomiting and weight loss. A CTand nuclear medicinestudywere performed. • What are the CT findings? • What is the nuclear medicine study and what does it show? • What is the overall diagnosis?

  23. the CT examination shows a large abdominal mass that iscalcified and encases the • great vessels. These are theimaging features of a neuroblastoma • the nuclear medicine study is a meta-iodo-benzyl-guanidine (MIBG) study. • An MIBG is used to detect skeletal metastases inchildren with neuroblastoma(MIBG • as an analogon of catecholamine precursors istaken up in neuroblastoma and other • neuro-endocrine tissue. • Normally the skeleton should have no areas of increased activity. In this case • there is marked uptake seen at the ends of the long bonesindicting skeletal • metastases. There is also activity in thecentre of the abdomen within the primary • tumour. • normal activity on an MIBG scan is seen within thesalivary glands, spleen, liver and • myocardium.This study involved the useof radioactive iodine, as such the thyroid • should beprotected by the use of blocking agents. In children this isusually • performed bygiving potassium perchlorate 3 days prior to the study

  24. Abdominaltumorsinchildren • NEUROBLASTOMA • is most frequently diagnosed in infants belowthe age of 5 years • originate in neuralcrest cells of the sympathetic nervous system. Nearly 70%of neuroblastomas • arise in the abdomen. A typical location(about 50%) is the adrenal gland. • the tumour extendsto surrounding tissue by local invasion and to regional lymph nodes. • metastatic spread in bone marrow, skeletonand liver is frequent. More than 50% of patients have • metastatic disease. • tumours localized to one side ofthe abdomen often cross the midline. • frequently secrete neurogenically derived substances, e.g.catecholamine metabolites or neuron • specific enolase.

  25. Abdominaltumorsinchildren • NEUROBLASTOMA • Primary diagnosis is performed with ultrasound. Imagingstudies include local staging with MRI or CT of the tumourregion and chest radiograph. Bone scan and meta-iodobenzylguanidine • (MIBG) scintigram define sites of metastases and demonstrate tumour response to chemotherapy. • Possible findings: • - encasement of retroperitoneal vessels • - ventral displacement of aorta and vena cava • - stippled tumour calcifications • - single tumour of the adrenal gland • extended tumour mass in the retroperitoneum • - infiltration of adjacent organs • - infiltration into neuroforamen

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