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Neuroblastoma case presentat
- 1. CASE PRESENTATION DR ASHOK SHARMA-JRIII Dept of Radiology, BJMC, Pune.
- 2. A two year old male child came to sassoon hospital with swelling in right hypochondriac and central abdomen region since 5 month. presentes with swelling in bilateral lower limb. no history of fever no history of hematuria
- 6. • There was soft tissue radiopacity noted in right hypochondriac and lumbar region. It is crossing the mid line. Soft tissue density lesion with destruction of lower end of left femar. Above features s/o large mass in right hypochondriac and lumbar region with bony Mets.
- 7. • USG – There was large mass in the suprarenal region on right side which is involving the upper pole of the kidney and superiorly it is involving the inferior surface of liver, it is crossing the midline. there is enlarged lymphnodal midline mass in the pre/paraaortic and along bilateral iliac vessels.
- 11. ARTERIAL PHASE IMAGES SHOWS-
- 17. PORTAL PHASE
- 18. VENOUS PHASE
- 20. DELAYED PHASE-
- 21. SUMMERY- • There is large ill defined heterogeneously enhancing soft tissue density mass lesion in the retroperitoneum in the right suprarenal area with necrosis and foci of calcification and right adrenal is not separately visualized and displacing the right kidney inferiorly. the mass is seen crossing the midline and causing displacement and encasement of vessels. • There is multilobulated lymphnodal midline mass in the retroperitoneum involving the pre/paraaortic and aortocaval region and along the bilateral iliac vessels likely lymphnodal metastasis. • Large well-defined pelvic mass on left side. • Lytic lesion in the distal end of left femur likely metastasis.
- 22. • BASED ON THESE FINDINGS MY D/D ARE- 1. NEUROBLASTOMA 2.WILMS TUMOR 3. MESOBLASTIC NEPHROMA 4. NEPHROBLASTOMATOSIS 5.HEPATOBLATOMA 6. LYMPHOMA
- 23. Neuroblastoma •Calcification are very common •It encases vascular structures without invasion •More common in <2 years of age •Poorly marginated •Chest, bone, orbital and extradural extension is common. •Elevates the aorta and retroperitoneal structures away from the vertebral column • Cross the midline. • Increased urine homovanillic acid (HVA) and vanillylmandelic acid (VMA)
- 24. Wilms tumour •Calcification are not common •Displaces adjacent structures without involvement •Well circumscribed •Claw sign with the kidney •Peak age is 3-4 years. •Extension into IVC/renal vein
- 25. Mesoblastic Nephroma •Benign hamartoma of mesenchymal connective tissue in neonate •Calcification are not common •Well circumscribed •Claw sign with the kidney •Peak age is 3month.
- 26. Nephroblatomatosis •Diffuse or multifocal involvement of the kidneys with nephrogenic rests •Two pathologic subtypes of nephrogenic rest, perilobar rest (90%) and intralobar rest (10%), intralobar rest more associated with Wilms tumor •Both kidneys are markedly enlarged.
- 27. Hepatoblastoma • Associated with beckwith Wiedmann syndrome,hemihypertrophy, • Calcification are seen in 50% cases •More common in <5years of age • Alpha-fetoprotein (AFP) levels are commonly elevated •Well defined and unifocal •Lung, abdominal lymphnodes and skeleton mets are common.
- 28. Lymphoma • Multiple retrocrural, mesenteric and retroperitoneal lymphadenopathy surround but do not occlude the mesenteric vessels and displace bowel loops but do not occlude them. • Hepatosplenomegaly. • Confluent lymphadenopathy on both sides of the mesenteric vessels gives rise to an appearance described as the sandwich sign
- 29. • Final Diagnosis- Neuroblastoma
- 30. THANK YOU