all pediatric abdominal tumors screening and follow up by imaging

1. PEDIATRIC
ABDOMINAL TUMORS
Passant abdul nasser dorgham
Senior radiology resident

2. D.D. OF ABDOMINAL
PEDIATRIC LUMPS

3. SCREENING FOR
ABDOMINAL TUMORS

4. If the cause was renal ..

5. Pediatric Renal Tumors :
incidence according to child
age

7. WILM’S TUMOR

8. WILM’S TUMOR

9. WILM’S TUMOR
MRI in Wilms tumor. The patient is a 4-year-old boy with left renal mass imaged by CT (a, b) and
MRI (c–f), including axial fast spin-echo T2-weighted (c, e) and axial post-contrast VIBE (d, f) MR
imaging. Both CT and MRI show an exophytic left renal mass with a thin rim of surrounding renal
cortex. MRI (d) better shows the disruption of the renal capsule by the mass (*) and better
delineates thrombus in the left renal vein (e, f; arrows), which was difficult to distinguish from
contrast mixing artifact by CT (b, arrow). Lung nodules are better characterized by CT (a),
although they are also evident on MRI (c). The patient underwent preoperative chemotherapy,
followed by left nephrectomy, with subsequent whole-lung and left nephrectomy bed radiation.

10. CYSTIC NEPHROMA

11. CYSTIC NEPHROMA

12. CYSTIC NEPHROMA

13. CYSTIC NEPHROMA
MRI findings :

14. Mesoblastic nephroma
Sonographic appearance can vary depending on the
pathological variant . In general it is a well-defined
mass with low-level homogeneous echoes. The
presence of concentric echogenic and hypoechoic
rings can be a helpful diagnostic feature in the classic
subtype, but may also be seen in the cellular subtype .
A more complex pattern due to hemorrhage, cyst
formation and necrosis can also be seen and tends to
favor the cellular variant. Color Doppler interrogation
may show increased vascularity. Uncommonly the
tumor may appear predominantly cystic.

15. Mesoblastic nephroma

16. Clear cell sarcoma
CT
These tumors usually enhance heterogeneously and to a lesser
extent than the adjacent kidney, with non-enhancing foci
representing hemorrhage and necrosis . They often cross the
midline. Calcification is uncommon .
MRI
Usually appears as:
T1: low to intermediate signal
T2: high signal with cystic areas

17. Clear
cell
sarcoma

18. RHABDOID TUMER
CT
• Rhabdoid tumors are large and heterogeneous,
usually located centrally within the kidney. They are
lobulated with individual lobules separated by
intervening areas of decreased attenuation, relating
to either previous hemorrhage or necrosis.
Enhancement is similarly heterogeneous.
• Calcification is relatively common.

20. Renal cell carcinoma
Ultrasound
markedly hyperechoic (70%)
posterior acoustic enhancement (50%), consistent with cystic nature
no internal vascularity on color Doppler
CT
variable attenuation so may appear solid or cystic
C+: contrast enhancement is usually mild or indeterminate given small amount of
solid tissue
MRI
T2: hyperintense due to cystic component, with septa
T1 C+ (Gd): mild enhancement in small solid components or wall

21. Renal cell carcinoma

22. What If the mass is not renal
in origin ?

23. neuroblastoma

24. Cystic type Paravertebral type

25. • Ultrasound
• On Ultrasound the tumor is generally echogenic
and inhomogeneous with bright calcifications.
• MRI
• MRI examination:
• T2 weighted 3D sequence
• Fat suppressed T1 before and after Gadolinium
injection
• Diffusion weighted imaging

27. Liver tumors
• Hemangio-endothelioma
• Mesenchymal hamartoma
• Hepato-blastoma
• Hepatocellular carcinoma

28. Hemangio-endothelioma
Ultrasound
• It can be hypoechoic or of mixed echogenicity. Unlike adult
hepatic hemangiomas.Calcifications are common.
• Large arteries and veins are seen.
CT
• On unenhanced CT calcifications are present in approximately
half of the patients.
• After intravenous contrast the tumor shows peripheral
enhancement with gradual filling-in. In larger tumors the center
may not enhance at all.
MRI
• as generally low signal intensity on T1 and high signal intensity
on T2. After contrast the same filling-in is seen as on CT.
• Most tumors will show spontaneous involution, and the
prognosis is good.

31. Mesenchymal hamartoma
• Mesenchymal hamartomas are usually multicystic liver
lesions, although they can rarely be solid. They are often
large at presentation. Serum AFP levels are normal.
• Ultrasound will show a multicystic lesion. MRI will
demonstrate this as well. After Gadolinium some stromal
enhancement can be seen.

32. • T1 weighted fat suppressed coronal MRI provides
a better overview of the liver lesion, which was
almost 2 kilograms at resection.
• Pathology showed a mesenchymal hamartoma.
No further follow-up was necessary.
Mesenchymal hamartoma

33. Hepato-blastoma
• Hepatoblastoma is the most common malignant liver
tumor in young children, while hepatocellular carcinoma
presents in older children, mostly in their teens.
Hepatoblastoma usually presents with an enlarged
abdomen.
• Ultrasound will generally show a well demarcated tumor.
In larger tumors necrotic cysts and calcifications can be
seen.
• CT angiography is done preoperatively to define the
relation between the tumor and the hepatic vessels.

34. Hepato-blastoma

35. Hepatocellular carcinoma
• Tyrosinemia is a genetic disorder characterized
by the failure to break down tyrosine, a building
block of most proteins. Tyrosine and its
byproducts will build up in organs and can lead
to liver and kidney failure and an increased risk
for HCC.
• The tumor presents with abdominal mass, pain,
or jaundice. AFP levels are elevated (although
usually less elevated compared to AFP levels in
hepatoblastoma).

36. Hepatocellular carcinoma

37. Hodgkin and Non-Hodgkin
• There are two main types of lymphoma: Hodgkin lymphoma and non-Hodgkin
lymphoma.
• Hodgkin lymphoma more commonly manifests with cervical lymph node
enlargement and mediastinal masses, while it is rarely confined to the abdomen.
• Non-Hodgkin is more commonly located in the para-aortic and mesenteric lymph
nodes and the spleen .Non-Hodgkin lymphoma presents more frequently with
extra nodal disease than Hodgkin lymphoma.
Ultrasound
• On ultrasound enlarged lymph nodes are very hypo-echoic. The almost
anechoic aspect of the tumor is typical of malignant lymphoma. If the bowel is
affected the layering of the bowel wall is lost.
MRI
• On MRI masses are seen with some enhancement after Gadolinium and
remarkable strong diffusion restriction. Another tumor that can show this marked
diffusion restriction is a neuroblastoma, however these tumors are often much

38. Hodgkin and Non-Hodgkin
A 12-year-old girl presented with a large mass in the abdomen. Ultrasound
could not define an organ of origin.
MRI shows a large mesenterial mass and diffuse infiltration of the omentum.

39. the marked diffusion restriction of the
omentum, which makes a lymphoma the most
likely diagnosis.
Hodgkin and Non-Hodgkin

40. Leukemia
• Leukemia is the most common malignancy in children. It
can present with abdominal involvement.
• Leukemia can affect all solid abdominal organs.
• The organs can be diffusely infiltrated or have a more
nodular pattern.
• The kidneys are affected in almost half of the patients
with later stages of acute lymphoblastic leukemia. It can
be uni- or bilateral, and there can be focal lesions or
diffuse infiltration. The last has a rather typical
appearance with a striated pattern around the calices,

41. Leukemia
An eight-year-old girl
presented with weight loss
and severe pain in the legs.
An ultrasound examination
had shown multiple lesions in
both kidneys.
MRI demonstrates not only
the renal tumors, but also a
lesion in the pancreas, right
iliac wing, left sacrum and
multiple retroperitoneal
lymphnodes.

42. Rhabdomyosarcoma
Rhabdomyosarcomas (RMS) are the most common soft tissue tumors in
children and can develop almost anywhere but mostly in the head and
neck region, including the orbit and in the genitourinary tract.
• About 25% of all RMS arise in the lower abdomen, generally
originating from the bladder, prostate or vagina, but they can arise
almost anywhere, for instance along the biliary tract (where no striped
muscle is present!).
• The most common pathologic subtype is embryonal RMS, followed by
alveolar RMS. The alveolar type has a worse prognosis.
• The age of the patient, generally below 15 years and the location of
the tumor in the prostate, bladder or vagina will point towards the
diagnosis, while the imaging features are non-specific.

43. • A sagittal image
shows a tumor
anterior to the
bladder neck.
• There is patchy
enhancement.
• DWI showed
strong diffusion
restriction (not
shown).
• The location of
the tumor makes
a
rhabdomyosarco
ma the most
likely diagnosis.
Rhabdomyosarcoma