Images

Doctor's Information

Name : Babak
Family : Salavatipour
Affiliation :Radiologic department of Hasheminejad hospital
Academic Degree : Radiology Assistant Professor,IUMS
Email : This email address is being protected from spambots. You need JavaScript enabled to view it.
Resident : Fatemeh Soati

Case Section

Urology&Genital Male Imaging

Patient's Information

Gender : Female
Age : 1

Clinical Summary

a 12 month female with abdominal enlargement

Imaging Findings

Images demonstrate multiple bilateral hypodense faint enhancing mass lesions in kidneys 

Differential Diagnosis

nephroblastomatosis, lymphoma, wilm's tumor, ARPKD

Final Diagnosis

nephroblastomatosis

Discussion (Related Text)

Nephrogenesis is normally complete by 34 to 35 weeks of gestation. However, metanephric blastema may persist into infancy and childhood. Foci of persistent metanephric tissue are designated as nephrogenic "rests." The presence of multiple nephrogenic rests is termed nephroblastomatosis. There is wide acceptance of nephroblastomatosis as a precursor lesion to Wilms' tumor. Thirty percent to 34% of Wilms' tumors arise from these rests. Approximately 35% of patients with diffuse nephroblastomatosis eventually have Wilms' tumor. Hyperplastic nephrogenic rests are macroscopic and plaquelike. Any macroscopic nephrogenic rest that is nodular and enlarges over time is considered neoplastic. Nephroblastomatosis occurs most often in neonates and is characterized by multiple, often bilateral, subcapsular masses. In CT is the technique of choice for detection of this disorder. On contrast-enhanced CT, in addition to nephromegaly, the kidney may show striate enhancement. The rests enhance less than adjacent normal parenchyma. CT is particularly useful for evaluating the other kidney in the child with Wilms' tumor, for renal screening in children with syndromes associated with Wilms' tumor, and for follow-up evaluation for neoplastic changes in patients with known nephroblastomatosis. The hallmark of neoplastic transformation of a benign nephrogenic rest is enlargement on serial CT scans.

References

CT and MR imaging of whole body/[edited by John R.Hagga et al.]page 1903

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