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Abdominal Mass in Children A Simplified Approach

December 13, 2017

4-year-old boy with left sided abdominal lump, which was gradually increasing in size for the last 1 month. No complaints of bowel or bladder disturbance, fever, weight loss, or abdominal pain. Child is otherwise well. Systemic examination is otherwise normal

Diagnostic approach depends on

  1. Location of Mass
  2. Organ of Origin
  3. Description of Mass

1-Location of mass:

Right upper quadrant (RUQ) contains liver, right kidney, gallbladder, colon, pancreas.

Left upper quadrant (LUQ) contains Stomach, left kidney, spleen, colon, pancreas.

Right lower quadrant (RLQ) contains Colon, appendix, small intestine, ureter, major arteries and veins to right leg.

Left lower quadrant(LLQ) contains small intestine, colon, ureter, major arteries and veins to left leg.

2-Organ of origin:

 

Organ/Site of originMalignantBenign
LiverHepatoblastoma, HCCHemangioma
AdrenalNeuroblastomaAdrenal cyst/haemorrhage
KidneyWilms tumorPolycystic kidney, hydronephrosis
BowelNon-Hodgkin’s lymphomaMesenteric cyst, duplication cyst
PelivsRMS, GCT, Neuroblastoma, lymphomaOvarian cyst
RetroperitoniumNeuroblastoma, SarcomaTeratoma

Differential diagnosis:

NeuroblastomaWilms tumor
Younger age (<2 year age)Slightly older age (3-4year age)
Poorly marginatedWell circumscribed
Crosses midline more oftenLess common to cross midline
Calcification 90%Uncommon calicification:10-15%
Encases vascular structuresDisplaces adjacent structures, extends into IVC/renal vein

 

Diagnosis:

It is a case of Wilms tumor also known as nephroblastoma, it is the most common primary renal tumor of childhood. In 80% of cases, it is diagnosed before age of 5 years. Peak age of presentation is 2.5-3.5 years. Presents as painless upper abdominal mass (70-80%), haematuria (20%), hypertension (25%). It can be associated with congenital anomalies like WAGR and Beckwith Weidman syndrome. It can metastasis to lungs, liver, regional lymph nodes.

Management:

Multimodality, stage and risk adopted approach is the standard of care. It is a highly chemo and radiosensitive tumor. Surgery + Chemotherapy+/- radiotherapy forms the basis of treatment.

Underwent left radial nephrectomy and lymph node sampling, intraoperative tumor rupture

  • HPR – epithelial predominant Wilms tumor, St III
  • Completed radiotherapy and adjuvant chemotherapy 3 drugs for 24 weeks; Vincristine, actinomycin D, adriamycin
  • Doing well at present

Authored By – Dr Anand Kumar K (MD Pediatrics),Consultant, Pediatric Hematologist, Oncologist and BMT physician, Fortis Hospital, Bannerghatta road, Bengaluru.


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