Imaging and compartmental classification of solid pelvic tumours in children

Ultrasound-guided core needle biopsy in diagnosis of abdominal and pelvic neoplasm in pediatric patients

BACKGROUND

Ultrasound-guided core needle biopsy of abdominal and pelvic masses in adults has gained tremendous popularity. However, the application of the same treatment in children is not as popular because of apprehensions regarding inadequate tissues for the biopsy and accidental puncture of vital organs.

METHODS

Data of the application of ultrasound-guided core needle biopsy in 105 pediatric patients with clinically or ultrasound-diagnosed abdominopelvic masses were reviewed. Diagnostic procedures were conducted in our institution from May 2011 to May 2013.

RESULTS

The biopsies were conducted on 86 malignant lesions and 19 benign lesions. 86 malignant tumors comprised neuroblastomas (30 cases), hepatoblastomas (15 cases), nephroblastomas (11 cases), and primitive neuroectodermal tumors/malignant small round cells (6 cases). Among malignant tumor cases, only a pelvic primitive neuroectodermal tumor did not receive a pathological diagnosis. Therefore, the biopsy accuracy was 98.8 % in malignant tumor. However, the biopsies for one neuroblastomas and one malignant small round cell tumor were inadequate for cytogenetic analysis. Therefore, 96.5 % of the malignant tumor patients received complete diagnosis via biopsy. 19 benign tumors comprised mature teratoma (10 cases), hemangioendothelioma (3 cases), paraganglioma (2 cases), and infection (2 cases). The diagnostic accuracy for benign neoplasm was 100 %. Five patients experienced postoperative complications, including pain (2 patients), bleeding from the biopsy site (2 patients), and wound infection (1 patient).

CONCLUSION

Ultrasound-guided core needle biopsy is an efficient, minimally invasive, accurate, and safe diagnostic method that can be applied in the management of abdominal or pelvic mass of pediatric patients.

Magnetic resonance imaging of nongynecologic pelvic masses in children

Pelvic neoplasms can arise from the genitourinary tract, gonads, soft tissues, or bone. The role of imaging is to confirm the presence of tumor, determine the site of origin, delineate the extent for staging and treatment planning, and serve as a baseline for monitoring response to therapy. MR imaging is well suited for the characterization and staging of pediatric pelvic tumors. This article reviews the imaging findings and staging evaluation of the common nongynecologic neoplasms in children. Prostatic, bladder, gonadal, and sacrococcygeal tumors are discussed. Gynecologic tumors are discussed elsewhere in this issue.

Non-Hodgkin lymphomas of the ovaries: MR findings

PURPOSE

The goal of this work was to describe MR findings (morphology, structure, signal intensity) of ovarian non-Hodgkin lymphoma (NHL).

METHOD

We reviewed the MR images of five female patients aged 13-70 years (mean 46 years) with histologically proven NHL of the ovaries. We evaluated morphological and signal intensity findings of the lesions. MR features were correlated with pathologic parameters.

RESULTS

All the patients were affected by B-cell NHL; one patient showed a primary involvement of the ovaries; in one patient, ovarian disease was diagnosed 30 months after surgical resection of a primary uterine lymphoma; the remaining three had a systemic lymphoma. In three cases, the ovarian involvement was bilateral. The mean size of the lesions was 7.9 cm. All the lesions showed homogeneous low signal intensity on T1-weighted images and intermediate to high intensity on T2-weighted images. The postgadolinium images showed mild to moderate heterogeneous enhancement. The peripheral enhancement was better demonstrated in fat-suppressed images.

CONCLUSION

The diagnosis of primary ovarian lymphoma should be considered in the presence of large bilateral solid ovarian masses with homogeneous appearance (low signal on T1 and mildly high on T2) without infiltrative pattern of growth or regressive changes (necrosis, hemorrhage, calcifications) and with little contrast enhancement.