2 years old boy with a large abdominal mass

 

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Doctor's Information

Name :  Mehdi
Family :Bitarafan
Email :  ----------------
Resident :  Hussein Soleiman Tabar

 

Patient's Information

Gender :  Male
Age :  2

 

Case Section

Pediatric Radiology

 

Clinical Summary

2 years old boy with a large abdominal mass.

 

 

Imaging Procedures and Findings

A large right abdominal mass with lobulated margin,some areas of tumor necrosis and heterogenous enhancement is evident which crosses the midline. Also note posterior displacement of right kidney and encasement of IVC( at the center of the mass).

 

Discussion

Neuroblastoma belongs to a group of neural crest origin tumors that range from the benign ganglioneuroma to the highly malignant neuroblastoma. Neuroblastoma arises from the adrenal gland or from sympathetic ganglia in the retroperitoneum, posterior mediastinum, neck, or pelvis. It is a neoplasm of early childhood, presenting in children younger than 5 years of age. Most children present with advanced disease and large abdominal masses. Symptoms are often related to bone metastases or intraspinal extension. In contrast to Wilms tumor, neuroblastoma is a poorly marginated mass that frequently extends across the midline and into the chest. The kidney may be invaded, causing the tumor to be mistaken for an intrarenal mass. Neuroblastomas have a tendency to encase or invade adjacent structures, such as blood vessels or neural foramina. Calcifications are much more common in neuroblastoma than in Wilms tumor, with an incidence as high as 50% to 75% . Most neuroblastomas appear echogenic and heterogeneous on US. In some cases, a characteristic echogenic nodule can be identified within the larger part of the tumor mass. CT and MR can be used to better define the extent of involvement of large tumors and to detect metastatic deposits . Neuroblastoma metastasizes to the liver, lymph nodes, and bone marrow. MR demonstrates intraspinal extension, bone marrow infiltration, and encasement of blood vessels without using IV contrast. Skeletal metastases are shown with technetium bone scintigraphy. Iodine-131-meta-iodobenzylguanidine is a tracer that resembles norepinephrine and is metabolized by neuroblastoma, pheochromocytoma, and other catecholamine-producing tumors. Octreotide is a ligand for G-protein receptor cell membranes. These two tracers have improved detection of primary tumor and metastases in some cases.

 

Final Diagnosis

neuroblastoma

 

References

Brant, William E.; Helms, Clyde A. Fundamentals of Diagnostic Radiology, 3rd Edition

 

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