Type:
Educational Exhibit
Keywords:
Neoplasia, Cysts, Congenital, Barium meal, Barium enema, Ultrasound, MR, CT, Paediatric, Oncology, Abdomen
Authors:
S. K. J. Flores Quispe, A. Cavaliere, M. Zuliani, T. Toffolutti, R. Stramare; Padua/IT
DOI:
10.1594/ecr2018/C-2905
Background
Abdominal masses in children are often incidentally discovered by a parent,
palpated unexpectedly on routine physical examination or detected on abdominal imaging.
The underlying causes of such masses are several and can range from benign to malignant conditions including congenital anomalies,
trauma,
infections,
inflammatory diseases and neoplasms.
A methodical approach to an abdominal mass first of all contemplates patient-related information:
- Age
- Sex
- History and clinical findings [1]
AGE: pediatric abdominal masses have characteristic age of onset.
- Newborn: typical masses are represented by adrenal hemorrhage,
sacrococcygeal teratoma and congenital mesoblastic nephroma [2,
3].
- < 2 years: neuroblastoma is the most frequent infantile malignancy.
Hepatoblastoma is the most common primary liver tumor in children,
with frequency peak between 6 months and 2 years.
- >2 years: Wilms tumor is the most common renal malignancy of childhood,
its frequency peak is between 2 and 4 years.
In older children and adolescents, the genitourinary tract can be affected by ovarian cysts,
germ cell tumors,
teratomas,
or rhabdomyosarcomas [4,
5].
SEX: in case of pelvic masses it is necessary to differentiate between males and females.
In females benign masses are follicular cysts,
the most common benign tumor is teratoma and ovarian malignancy is in 85% of cases a germ cell tumor.
In males pelvic rhabdomyosarcoma (bladder and prostatic) is more common (m:f=2:1) [6].
HISTORY AND CLINICAL FINDINGS: provide important information to the underlying etiology and can direct appropriate evaluation[7-9].
- Perinatal history: adrenal hemorrhage can occur as a prenatal or postnatal lesion; often in newborn large for gestational age.
- Malformative anomalies: biliary atresia has higher incidence of hepatoblastoma.
Kidney abnormalities,
such as the horseshoe kidney or a duplex collecting system,
is more frequently associated with Wilms tumor.
- Genetic syndromes: Beckwith-Wiedemann syndrome is related to an increase in the incidence of abdominal tumors such as Wilms tumor,
hepatoblastoma and adrenal tumors,
less frequently neuroblastoma.
Neurofibromatosis is related to an increased incidence of Wilms tumor. Angiomyolipoma is associated with tuberous sclerosis,
neurofibromatosis and von Hippel–Lindau syndrome.
- Clinical onset: mass-related information,
such as site,
progression and history of trauma.
- Symptoms: gastrointestinal,
genitourinary or paraneoplastic symptoms.
- Laboratory analysis: urine analysis can suggest renal involvement.
Serum B chorionic gonadotropin and alfa-feto protein are useful in suspected cases of teratoma,
liver and germ cell tumor.