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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.

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Wilms' tumour. (a) Longitudinal ultrasound showing a very cystic Wilms' mass which had few solid components. (b) Axial T1W MRI after gadolinium-enhancement showing a large heterogenous left renal tumour, with a reasonably well-defined “capsule”. (c) Coronal CT demonstrating bilateral tumours in a horseshoe kidney.
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Figure 6: Wilms' tumour. (a) Longitudinal ultrasound showing a very cystic Wilms' mass which had few solid components. (b) Axial T1W MRI after gadolinium-enhancement showing a large heterogenous left renal tumour, with a reasonably well-defined “capsule”. (c) Coronal CT demonstrating bilateral tumours in a horseshoe kidney.

Mentions: Wilms' tumour (nephroblastoma) is the most common malignant primary renal tumour in childhood. Wilms' tumour accounts for up to 12% of all childhood cancers with a peak incidence at around 3 years of age (Fig. 6). The commonest presentation is an asymptomatic abdominal mass. Haematuria, particularly after minor trauma, is another typical clinical manifestation; pain, fever or hypertension (in up to a quarter of cases) are unusual but recognised presenting features. Microscopic haematuria is present in 25% of cases. There is equal distribution between the sexes with the highest incidence being in the black population in the USA and Africa. Around 10% of Wilms' tumours are bilateral, of which two-thirds are synchronous and one-third metachronous.


Renal and adrenal tumours in children.

McHugh K - Cancer Imaging (2007)

Wilms' tumour. (a) Longitudinal ultrasound showing a very cystic Wilms' mass which had few solid components. (b) Axial T1W MRI after gadolinium-enhancement showing a large heterogenous left renal tumour, with a reasonably well-defined “capsule”. (c) Coronal CT demonstrating bilateral tumours in a horseshoe kidney.
© Copyright Policy
Related In: Results  -  Collection

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

Figure 6: Wilms' tumour. (a) Longitudinal ultrasound showing a very cystic Wilms' mass which had few solid components. (b) Axial T1W MRI after gadolinium-enhancement showing a large heterogenous left renal tumour, with a reasonably well-defined “capsule”. (c) Coronal CT demonstrating bilateral tumours in a horseshoe kidney.
Mentions: Wilms' tumour (nephroblastoma) is the most common malignant primary renal tumour in childhood. Wilms' tumour accounts for up to 12% of all childhood cancers with a peak incidence at around 3 years of age (Fig. 6). The commonest presentation is an asymptomatic abdominal mass. Haematuria, particularly after minor trauma, is another typical clinical manifestation; pain, fever or hypertension (in up to a quarter of cases) are unusual but recognised presenting features. Microscopic haematuria is present in 25% of cases. There is equal distribution between the sexes with the highest incidence being in the black population in the USA and Africa. Around 10% of Wilms' tumours are bilateral, of which two-thirds are synchronous and one-third metachronous.

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