Pediatric Abdominal Masses. Andrew Phelps MD Assistant Professor of Pediatric Radiology UCSF Benioff Children's Hospital

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1 Pediatric Abdominal Masses Andrew Phelps MD Assistant Professor of Pediatric Radiology UCSF Benioff Children's Hospital

2 No Disclosures

3 Take Home Message All you need to remember are the 5 common masses that shouldn t go to pathology: 1. Infection 2. Adrenal hemorrhage 3. Renal angiomyolipoma 4. Ovarian torsion 5. Liver hemangioma

4 Keys to (Differential) Diagnosis 1. Location? 2. Age? 3. Cystic?

5 OUTLINE 1. Kidney 2. Adrenal 3. Pelvis 4. Liver

6 OUTLINE 1. Kidney 2. Adrenal 3. Pelvis 4. Liver

7 Renal Tumor Mimic Any Age Infection (Pyelonephritis) Don t send to pathology!

8 Renal Tumor Mimic Any Age Abscess Don t send to pathology!

9 Peds Renal Tumors Infant: 1) mesoblastic nephroma 2) nephroblastomatosis 3) rhabdoid tumor Child: 1) Wilm's tumor 2) lymphoma 3) angiomyolipoma 4) clear cell sarcoma 5) multilocular cystic nephroma Teen: 1) renal cell carcinoma 2) renal medullary carcinoma

10 Peds Renal Tumors Infant: 1) mesoblastic nephroma 2) nephroblastomatosis 3) rhabdoid tumor Child: 1) Wilm's tumor 2) lymphoma 3) angiomyolipoma 4) clear cell sarcoma 5) multilocular cystic nephroma Teen: 1) renal cell carcinoma 2) renal medullary carcinoma

11 Renal Tumors - Infant 1) mesoblastic nephroma 2) nephroblastomatosis 3) rhabdoid tumor

12 Renal Tumors - Infant 1) mesoblastic nephroma 2) nephroblastomatosis 3) rhabdoid tumor - Most common - Can t distinguish from congenital Wilms.

13 Renal Tumors - Infant 1) mesoblastic nephroma 2) nephroblastomatosis 3) rhabdoid tumor Multiple or diffuse masses. Look for biggest and ugliest.

14 Renal Tumors - Infant 1) mesoblastic nephroma 2) nephroblastomatosis 3) rhabdoid tumor - Ugly - Subcapsular fluid - Metastases

15 Renal Tumors - Infant 1) mesoblastic nephroma 2) nephroblastomatosis 3) rhabdoid tumor Common Multi Ugly

16 Peds Renal Tumors Infant: 1) mesoblastic nephroma 2) nephroblastomatosis 3) rhabdoid tumor Child: 1) Wilm's tumor 2) lymphoma 3) angiomyolipoma 4) clear cell sarcoma 5) multilocular cystic nephroma Teen: 1) renal cell carcinoma 2) renal medullary carcinoma

17 Renal Tumors - Child 1) Wilms 2) Lymphoma 3) Angiomyolipoma 4) Clear cell sarcoma 5) Multilocular cystic nephroma

18 Renal Tumors - Child - Most Common - Nonspecific - Local invasion 1) Wilms - Metastases 2) Lymphoma 3) Angiomyolipoma 4) Clear cell sarcoma 5) Multilocular cystic nephroma

19 Renal Tumors - Child 1) Wilms - Nonspecific - Single Mass - Multiple Masses - Diffuse Infiltr. 2) Lymphoma 3) Angiomyolipoma 4) Clear cell sarcoma 5) Multilocular cystic nephroma

20 Renal Tumors - Child - Macroscopic Fat - Tuberous Sclerosis 1) Wilms Don t send to pathology! 2) Lymphoma 3) Angiomyolipoma 4) Clear cell sarcoma 5) Multilocular cystic nephroma

21 Renal Tumors - Child Looks just like Wilms! 1) Wilms 2) Lymphoma 3) Angiomyolipoma 4) Clear cell sarcoma 5) Multilocular cystic nephroma

22 Renal Tumors - Child Cystic! 1) Wilms 2) Lymphoma 3) Angiomyolipoma 4) Clear cell sarcoma 5) Multilocular cystic nephroma

23 Renal Tumors - Child Common Fat Wilms? Multi 1) Wilms 2) Lymphoma 3) Angiomyolipoma Cystic 4) Clear cell sarcoma 5) Multilocular cystic nephroma

24 Peds Renal Tumors Infant: 1) mesoblastic nephroma 2) nephroblastomatosis 3) rhabdoid tumor Child: 1) Wilm's tumor 2) lymphoma 3) angiomyolipoma 4) clear cell sarcoma 5) multilocular cystic nephroma Teen: 1) renal cell carcinoma 2) renal medullary carcinoma

25 Renal Tumors - Teenager 1) Renal cell carcinoma 2) Renal medullary carcinoma

26 Renal Tumors - Teenager 1) Renal cell carcinoma 2) Renal medullary carcinoma - Nonspecific - Invasion - Mets

27 Renal Tumors - Teenager 1) Renal cell carcinoma 2) Renal medullary carcinoma - Nonspecific - Sickle cell association

28 Renal Tumors - Teenager 1) Renal cell carcinoma 2) Renal medullary carcinoma Sickle cell Common

29 Peds Renal Tumors Infant: 1) mesoblastic nephroma 2) nephroblastomatosis 3) rhabdoid tumor Child: 1) Wilm's tumor 2) lymphoma 3) angiomyolipoma 4) clear cell sarcoma 5) multilocular cystic nephroma Teen: 1) renal cell carcinoma 2) renal medullary carcinoma

30 OUTLINE 1. Kidney 2. Adrenal 3. Pelvis 4. Liver

31 Peds Adrenal Tumors Infant: Hemorrhage Child: Neural crest tumor Teen: Cortical carcinoma

32 Peds Adrenal Tumors - Infant Infant: Hemorrhage Child: Neural crest tumor Teen: Cortical carcinoma - Cystic - Avascular - Will resolve

33 Adrenal Hemorrhage Ultrasound 3 days 1 month 4 months Don t send to pathology!

34 Peds Adrenal Tumors - Child Infant: Hemorrhage Child: Neural crest tumor Teen: Cortical carcinoma Neuroblastoma: - Calcification - Encase vessels - Bone mets - MIBG positive

35 Peds Adrenal Tumors - Teen Infant: Hemorrhage Child: Neural crest tumor Teen: Cortical carcinoma - Large adrenal mass - Calcification - Precocious puberty

36 OUTLINE 1. Kidney 2. Adrenal 3. Pelvis 4. Liver

37 Peds Pelvis Masses Any age: infection ovarian torsion rhabdomyosarcoma

38 Peds Pelvis Masses Any age: infection ovarian torsion Don t send to pathology! rhabdomyosarcoma After antibiotics:

39 Peds Pelvis Masses Any age: infection ovarian torsion rhabdomyosarcoma Don t send to pathology! Adnexal mass? 143 ml

40 Peds Pelvis Masses Any age: infection ovarian torsion rhabdomyosarcoma MR-11-1 Outlet Obstruction

41 OUTLINE 1. Kidney 2. Adrenal 3. Pelvis 4. Liver

42 Peds Liver Tumors Infant 1) hemangioma Child: 1) metastasis 2) hepatoblastoma 3) mesenchymal hamartoma 4) embryonal sarcoma Teen: 1) same ddx as adults

43 Peds Liver Tumors Infant 1) hemangioma Child: 1) metastasis 2) hepatoblastoma 3) mesenchymal hamartoma 4) embryonal sarcoma Teen: 1) same ddx as adults

44 Hemangioma by Ultrasound Lobular Hypervascular Mass

45 Hemangioma by CT Centripetal Enhancement Don t send to pathology!

46 Peds Liver Tumors Infant 1) hemangioma Child: 1) metastasis 2) hepatoblastoma 3) mesenchymal hamartoma 4) embryonal sarcoma Teen: 1) same ddx as adults

47 Peds Liver Tumors - Child 1) metastasis 2) hepatoblastoma 3) mesenchymal hamartoma 4) undifferentiated sarcoma

48 Peds Liver Tumors - Child 1) metastasis 2) hepatoblastoma 3) mesenchymal hamartoma 4) undifferentiated sarcoma - Multiple lesions - Known primary

49 Peds Liver Tumors - Child 1) metastasis 2) hepatoblastoma 3) mesenchymal hamartoma 4) undifferentiated sarcoma Solid AFP +++

50 Peds Liver Tumors - Child 1) metastasis 2) hepatoblastoma 3) mesenchymal hamartoma 4) undifferentiated sarcoma Cystic AFP -

51 Peds Liver Tumors - Child 1) metastasis 2) hepatoblastoma 3) mesenchymal hamartoma 4) undifferentiated sarcoma Solid > Cystic AFP Mets

52 Peds Liver Tumors - Child 1) metastasis 2) hepatoblastoma 3) mesenchymal hamartoma 4) undifferentiated sarcoma Multi AFP Cystic Mets

53 Peds Liver Tumors Infant 1) hemangioma Child: 1) metastasis 2) hepatoblastoma 3) mesenchymal hamartoma 4) embryonal sarcoma Teen: 1) same ddx as adults

54 OUTLINE 1. Kidney 2. Adrenal 3. Pelvis 4. Liver

55 REVIEW of CYSTIC TUMORS Mesenchymal Hamartoma Multilocular Cystic Nephroma

56 NOT FOR PATHOLOGIST:

57 Keys to (Differential) Diagnosis 1. Location? 2. Age? 3. Cystic?

58 QUESTIONS

59 QUESTION 1 Which of the following tumors is cystic? a) Hemangioma b) Hepatoblastoma c) Mesenchymal hamartoma d) Embryonal sarcoma

60 QUESTION 1 Which of the following tumors is cystic? a) Hemangioma b) Hepatoblastoma c) Mesenchymal hamartoma d) Embryonal sarcoma Ref: Pugmire BS, Towbin AJ. Magnetic resonance imaging of primary pediatric livertumors. Pediatr Radiol May;46(6):764-77

61 QUESTION 2 Which of following conditions can mimic a tumor? a) Adrenal hemorrhage b) Cystitis c) Ovarian torsion d) All of the above.

62 QUESTION 2 Which of following conditions can mimic a tumor? a) Adrenal hemorrhage b) Cystitis c) Ovarian torsion d) All of the above. Ref: Donnelly LF, Jones BJ, O Hara SM, Anton CG. Diagnostic Imaging: Pediatrics. Elseveier Health Sciences. 2005

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