pediatric abdominal masses

Pediatric Abdominal Masses

Andrew Phelps MD

Assistant Professor of Pediatric Radiology

UCSF Benioff Children's Hospital

No Disclosures

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

Keys to (Differential) Diagnosis

1. Location?

2. Age?

3. Cystic?

OUTLINE

1. Kidney

2. Adrenal

3. Pelvis

4. Liver

Renal Tumor Mimic – Any Age

Infection (Pyelonephritis)

Don’t send to pathology!

Renal Tumor Mimic – Any Age

Abscess


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

Renal Tumors - Infant



3) rhabdoid tumor




3) rhabdoid tumor

- Most common

- Can’t distinguish

from congenital

Wilms.




3) rhabdoid tumor

Multiple

or diffuse

masses.

Look for

biggest

and

ugliest.




3) rhabdoid tumor

- Ugly

- Subcapsular fluid

- Metastases




3) rhabdoid tumor

Common Multi Ugly

Peds Renal Tumors

Infant:



3) rhabdoid tumor

Child:

1) Wilm's tumor

2) lymphoma

3) angiomyolipoma



Teen:



Renal Tumors - Child

1) Wilms

2) Lymphoma

3) Angiomyolipoma

4) Clear cell sarcoma

5) Multilocular cystic nephroma


1) Wilms

2) Lymphoma

3) Angiomyolipoma



- Most Common

- Nonspecific

- Local invasion

- Metastases


1) Wilms

2) Lymphoma

3) Angiomyolipoma



- Nonspecific

- Single Mass

- Multiple Masses

- Diffuse Infiltr.


1) Wilms

2) Lymphoma

3) Angiomyolipoma



- Macroscopic Fat

- Tuberous

Sclerosis



1) Wilms

2) Lymphoma

3) Angiomyolipoma



Looks just like Wilms!


1) Wilms

2) Lymphoma

3) Angiomyolipoma



Cystic!


1) Wilms

2) Lymphoma

3) Angiomyolipoma



Common

Multi

Fat

Cystic

Wilms?

Peds Renal Tumors

Infant:



3) rhabdoid tumor

Child:

1) Wilm's tumor

2) lymphoma

3) angiomyolipoma



Teen:



Renal Tumors - Teenager

1) Renal cell carcinoma

2) Renal medullary carcinoma




- Nonspecific

- Invasion

- Mets




- Nonspecific

- Sickle cell

association




Common

Sickle cell

Peds Renal Tumors

Infant:



3) rhabdoid tumor

Child:

1) Wilm's tumor

2) lymphoma

3) angiomyolipoma



Teen:



OUTLINE

1. Kidney

2. Adrenal

3. Pelvis

4. Liver

Peds Adrenal Tumors

Infant: Hemorrhage

Child: Neural crest tumor

Teen: Cortical carcinoma

Peds Adrenal Tumors - Infant

Infant: Hemorrhage



- Cystic

- Avascular

- Will resolve

Adrenal Hemorrhage Ultrasound

4 months 3 days 1 month


Peds Adrenal Tumors - Child

Infant: Hemorrhage



Neuroblastoma:

- Calcification

- Encase vessels

- Bone mets

- MIBG positive

Peds Adrenal Tumors - Teen

Infant: Hemorrhage



- Large adrenal

mass

- Calcification

- Precocious

puberty

OUTLINE

1. Kidney

2. Adrenal

3. Pelvis

4. Liver

Peds Pelvis Masses

Any age: infection

ovarian torsion

rhabdomyosarcoma

Peds Pelvis Masses

Any age: infection

ovarian torsion

rhabdomyosarcoma

After antibiotics:


Peds Pelvis Masses

Any age: infection

ovarian torsion

rhabdomyosarcoma

143 mL

Adnexal

mass?


Peds Pelvis Masses

Any age: infection

ovarian torsion

rhabdomyosarcoma

2013-10-21 - MR-11

- 1

Outlet

Obstruction

OUTLINE

1. Kidney

2. Adrenal

3. Pelvis

4. Liver

Peds Liver Tumors

Infant

1) hemangioma

Child:

1) metastasis

2) hepatoblastoma

3) mesenchymal hamartoma

4) embryonal sarcoma

Teen:

1) same ddx as adults

Hemangioma by Ultrasound

Lobular Hypervascular Mass

Hemangioma by CT

Centripetal

Enhancement


Peds Liver Tumors

Infant

1) hemangioma

Child:

1) metastasis

2) hepatoblastoma



Teen:


Peds Liver Tumors - Child

1) metastasis 2) hepatoblastoma 3) mesenchymal hamartoma 4) undifferentiated sarcoma



- Multiple

lesions

- Known

primary



Solid

AFP +++



Cystic

AFP -



Solid > Cystic

AFP –

Mets



Multi AFP Cystic Mets

Peds Liver Tumors

Infant

1) hemangioma

Child:

1) metastasis

2) hepatoblastoma



Teen:


OUTLINE

1. Kidney

2. Adrenal

3. Pelvis

4. Liver

REVIEW of CYSTIC TUMORS

Mesenchymal

Hamartoma

Multilocular

Cystic Nephroma

NOT FOR PATHOLOGIST:

Keys to (Differential) Diagnosis

1. Location?

2. Age?

3. Cystic?

QUESTIONS

QUESTION 1

Which of the following tumors is cystic?

a) Hemangioma

b) Hepatoblastoma

c) Mesenchymal hamartoma

d) Embryonal sarcoma

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. 2016

May;46(6):764-77

QUESTION 2

Which of following conditions can mimic

a tumor?

a) Adrenal hemorrhage

b) Cystitis

c) Ovarian torsion

d) All of the above.

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

pediatric abdominal masses

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