Limits...
Renal and adrenal tumours in children.

McHugh K - Cancer Imaging (2007)

Bottom Line: Benign renal masses predominate in early infancy but beyond the first year of life Wilms' tumour is the most common renal malignancy, until adolescence when renal cell carcinoma has similar or increased frequency as children get older.The most topical dilemmas in the radiological assessment of renal and adrenal tumours are presented.Topics covered include a proposed revision to the staging of NBL, the problems inherent in distinguishing nephrogenic rests from Wilms' tumour and the current recently altered approach regarding small lung nodules in children with Wilms' tumour.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Great Ormond Street Hospital for Children, London WC1N 3JH, UK. kmchugh@gosh.nhs.uk

ABSTRACT
The differential diagnosis of renal and supra-renal masses firstly depends on the age of the child. Neuroblastoma (NBL) may be seen antenatally or in the newborn period; this tumour has a good prognosis unlike NBL seen in older children (particularly NBL in those aged 2-4 years). Benign renal masses predominate in early infancy but beyond the first year of life Wilms' tumour is the most common renal malignancy, until adolescence when renal cell carcinoma has similar or increased frequency as children get older. Adrenal adenomas and carcinomas also occur in childhood; these tumours are indistinguishable on imaging but criteria for the diagnosis of adrenal carcinoma include size larger than 5 cm, a tendency to invade the inferior vena cava and to metastasise. The most topical dilemmas in the radiological assessment of renal and adrenal tumours are presented. Topics covered include a proposed revision to the staging of NBL, the problems inherent in distinguishing nephrogenic rests from Wilms' tumour and the current recently altered approach regarding small lung nodules in children with Wilms' tumour.

Show MeSH

Related in: MedlinePlus

Neuroblastoma. (a) Axial T2W MRI showing a large upper abdominal primary. (b) Planar MIBG scan showing a solitary metastasis in the sacrum superior to isotope in the bladder (arrows). Note the primary upper abdominal tumour is also MIBG avid. The lower limbs and knees are normal. (c) Sagittal T2W MRI showing abnormal signal in S2. This lesion was initially “hot” on positron emission tomography (PET)/CT, and later “cold” on PET/CT after chemotherapy, indicating a response to therapy, although it remained persistently MIBG avid throughout treatment. It is hoped the persisting MIBG avidity in this sacral lesion reflected differentiation into more mature disease.
© Copyright Policy
Related In: Results  -  Collection


getmorefigures.php?uid=PMC1828369&req=5

Figure 2: Neuroblastoma. (a) Axial T2W MRI showing a large upper abdominal primary. (b) Planar MIBG scan showing a solitary metastasis in the sacrum superior to isotope in the bladder (arrows). Note the primary upper abdominal tumour is also MIBG avid. The lower limbs and knees are normal. (c) Sagittal T2W MRI showing abnormal signal in S2. This lesion was initially “hot” on positron emission tomography (PET)/CT, and later “cold” on PET/CT after chemotherapy, indicating a response to therapy, although it remained persistently MIBG avid throughout treatment. It is hoped the persisting MIBG avidity in this sacral lesion reflected differentiation into more mature disease.

Mentions: NBL staging requires additional multi-modality imaging. CT or MRI, [123I]meta-iodobenzylguanidine (123I-MIBG), and laboratory investigations (bilateral bone marrow aspirates with histochemical tests and urine catecholamine level measurements) all need to be performed[4,7,8]. Additional routine 99mTc-methylene diphosphonate bone scan (99mTc-MDP) is also advocated by many. Overall MRI has become the most useful modality in staging of NBL. MRI is superior to CT in determining marrow infiltration and intra-spinal extension of tumour. Bone marrow disease is usually seen as diffuse infiltration but it may also present a nodular pattern with areas of low and high signal intensity on T1-weighted (T1W) and T2-weighted (T2W) images, respectively (Fig. 2).


Renal and adrenal tumours in children.

McHugh K - Cancer Imaging (2007)

Neuroblastoma. (a) Axial T2W MRI showing a large upper abdominal primary. (b) Planar MIBG scan showing a solitary metastasis in the sacrum superior to isotope in the bladder (arrows). Note the primary upper abdominal tumour is also MIBG avid. The lower limbs and knees are normal. (c) Sagittal T2W MRI showing abnormal signal in S2. This lesion was initially “hot” on positron emission tomography (PET)/CT, and later “cold” on PET/CT after chemotherapy, indicating a response to therapy, although it remained persistently MIBG avid throughout treatment. It is hoped the persisting MIBG avidity in this sacral lesion reflected differentiation into more mature disease.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC1828369&req=5

Figure 2: Neuroblastoma. (a) Axial T2W MRI showing a large upper abdominal primary. (b) Planar MIBG scan showing a solitary metastasis in the sacrum superior to isotope in the bladder (arrows). Note the primary upper abdominal tumour is also MIBG avid. The lower limbs and knees are normal. (c) Sagittal T2W MRI showing abnormal signal in S2. This lesion was initially “hot” on positron emission tomography (PET)/CT, and later “cold” on PET/CT after chemotherapy, indicating a response to therapy, although it remained persistently MIBG avid throughout treatment. It is hoped the persisting MIBG avidity in this sacral lesion reflected differentiation into more mature disease.
Mentions: NBL staging requires additional multi-modality imaging. CT or MRI, [123I]meta-iodobenzylguanidine (123I-MIBG), and laboratory investigations (bilateral bone marrow aspirates with histochemical tests and urine catecholamine level measurements) all need to be performed[4,7,8]. Additional routine 99mTc-methylene diphosphonate bone scan (99mTc-MDP) is also advocated by many. Overall MRI has become the most useful modality in staging of NBL. MRI is superior to CT in determining marrow infiltration and intra-spinal extension of tumour. Bone marrow disease is usually seen as diffuse infiltration but it may also present a nodular pattern with areas of low and high signal intensity on T1-weighted (T1W) and T2-weighted (T2W) images, respectively (Fig. 2).

Bottom Line: Benign renal masses predominate in early infancy but beyond the first year of life Wilms' tumour is the most common renal malignancy, until adolescence when renal cell carcinoma has similar or increased frequency as children get older.The most topical dilemmas in the radiological assessment of renal and adrenal tumours are presented.Topics covered include a proposed revision to the staging of NBL, the problems inherent in distinguishing nephrogenic rests from Wilms' tumour and the current recently altered approach regarding small lung nodules in children with Wilms' tumour.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Great Ormond Street Hospital for Children, London WC1N 3JH, UK. kmchugh@gosh.nhs.uk

ABSTRACT
The differential diagnosis of renal and supra-renal masses firstly depends on the age of the child. Neuroblastoma (NBL) may be seen antenatally or in the newborn period; this tumour has a good prognosis unlike NBL seen in older children (particularly NBL in those aged 2-4 years). Benign renal masses predominate in early infancy but beyond the first year of life Wilms' tumour is the most common renal malignancy, until adolescence when renal cell carcinoma has similar or increased frequency as children get older. Adrenal adenomas and carcinomas also occur in childhood; these tumours are indistinguishable on imaging but criteria for the diagnosis of adrenal carcinoma include size larger than 5 cm, a tendency to invade the inferior vena cava and to metastasise. The most topical dilemmas in the radiological assessment of renal and adrenal tumours are presented. Topics covered include a proposed revision to the staging of NBL, the problems inherent in distinguishing nephrogenic rests from Wilms' tumour and the current recently altered approach regarding small lung nodules in children with Wilms' tumour.

Show MeSH
Related in: MedlinePlus