Imaging spectrum of primary malignant renal neoplasms in children

Abstract

Wilms’ tumor (WT) is the most common abdominal tumor in children. Many pediatric renal tumors in the past were categorized as WT; however, in recent years, several specific renal tumors have been recognized as distinct pathological entities. The age and clinical presentation of the child and distinctive imaging features may help in reaching a specific diagnosis in most cases. This is important as it has implications on the pre-operative diagnostic work-up and prognosis of the child. However, it is often not possible to differentiate one from the other pediatric renal tumor on the basis of imaging alone, and the final diagnosis is often made at histological examination of the surgical specimen. This article reviews the imaging features of primary malignant renal neoplasms in children along with their clinical presentation and pathological features.

Acute Lymphocytic Leukemia with Bilateral Renal Masses Masquerading as Nephroblastomatosis

“…They may present as enlargement of the kidneys, either unilateral or bilateral, or as low-attenuation focal parenchymal lesions, either unilateral or bilateral and either solitary or multiple [ 6 ]. These focal lesions can be difficult to distinguish from nephroblastomatosis, which has a similar radiological picture [ 6 , 7 ]. In this case, CT imaging showed bilateral renal enlargement with multiple small subcortical and cortical medullary lesions that were hypoenhancing and overall more consistent with nephrogenic rests.…”

“…In this case, CT imaging showed bilateral renal enlargement with multiple small subcortical and cortical medullary lesions that were hypoenhancing and overall more consistent with nephrogenic rests. Nephroblastomatosis is multifocal or diffuse nephrogenic rests which are defined as persistent foci of embryonic cells beyond 36 weeks' gestation and have the potential to transform into Wilms' tumor [ 7 ]. Therefore, this patient was closely followed in the nephrology clinic with repeat imaging studies every 3 months for monitoring for transformation.…”