Causes of abdominal masses
- Gastrointestinal
- Congenital hypertrophic pyloric stenosis
- Crohn's disease
- Intussusception
- Constipation
- Liver
- Biliary atresia
- Choledochal cysts
- Hepatitis
- Hepatoblastoma
- Genitourinary
- Hydronephrosis
- Nephroblastoma
- Urethral valves
- Other
- Neuroblastoma
- Splenomegaly
- Retroperitoneal sarcoma
- Teratoma
Nephroblastoma (Wilms' tumour)
- Originates from the embryonal kidney
- Pathologically contains renal tissue with various degrees of differentiation
- Affects about 1 in 10,000 live births
- 60% present before the age of three years
- 10% tumours are bilateral
- The presentation is with an:
- Abdominal mass (90%)
- Abdominal pain (20%)
- Haematuria (30%)
- Diagnosis can be confirmed by CT scan
- 40% have metastatic spread at presentation but do not prevent cure
- Treatment is with nephrectomy and postoperative chemotherapy and radiotherapy
- Stage 1 disease (localised to kidney) has 3-year survival of >80%
- Stage 4 disease (haematogenous spread) has 3-year survival less than 30%
Neuroblastoma
- Arises from neural crest tissue - usually adrenal medulla or sympathetic ganglia
- Show a range of malignancy from benign ganglioneuroma to malignant neuroblastoma
- Tumours in children are usually malignant
- 75% are abdominal
- 25% arise in thorax, pelvis or neck
- Affects about 1 in 8,000 live births
- Usually occur in first five years of life
- Clinical presentation depends on site of tumour and presence of metastases
- Bone and pulmonary metastases are relatively common
- Symptoms often due to metastases include:
- Pallor, weight loss, irritability (40%)
- Limb pain and hypertension (15%)
- Abdominal mass or pain (30%)
- 90% have increased urinary VMA and HVA
- Pain abdominal x-ray often shows diffused speckled calcification
- Diagnosis can be confirmed by CT scan
- Treatment is with surgery and post-operative radiotherapy
- Prognosis is best in children presenting before 2 years
- Stage 1 disease (localised to kidney) has 3-year survival of >90%
- Stage 4 disease (haematogenous spread) has 3-year survival less than 30%
Bibliography
Geller E, Smergel E M, Lowry
P A. Renal neoplasms of childhood.
Radiol Clin North Am 1997; 35:
1391-1413.
Petruzzi M J, Green D M. Wilms'
tumor. Pediatr Clin North Am 1997;
44: 939-952. |