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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