Pattern of computed tomography scan findings in children with Wilms’ tumor in a tertiary hospital in Lagos, Nigeria

Abstract

Context:Abnormal abdominal distension in a child is usually a source of great concern and apprehension in both the parents and the pediatric surgeon. Although Wilms’ tumor is the most common malignant abdominal childhood tumor, usually causing abdominal distension, many other less common causes can also result in abdominal distension. Therefore, early diagnosis of Wilms’ tumor and distinguishing it from all these other causes is essential.Aims:We intend to document the pattern of computed tomography (CT) scan findings in patients with Wilms’ tumor and the peculiarity of its radiological presentation in this environment, highlighting its accuracy and advantages over other imaging modalities.Settings and Design:This is a prospective descriptive study conducted between January, 2011 to January 2012, where all infants, 6-96 months of age, who were suspected to have Wilms’ tumor were made to undergo CT scan examination as part of their management work-up. It was carried out in a teaching hospital.Subjects and Methods:The study performed on 12 children age range of 6-96 months old underwent abdominal CT scans as part of their clinical work-up using a GE Hi-speed dual CT scanner®. Pre- and post-contrast images were acquired and assessed by the radiologists. They were operated and their radiological and histopathology results were correlated.Statistical Analysis:All data was entered into a Microsoft word excel spread sheet and analyzed by simple analysis. Percentages and proportions were determined for categorical variables.Results:Of the 12 patients seen, nearly 75% were males, with a male to female ratio of 3:1 and an average age of 37 months. The right sided tumors were slightly more than the left and nearly 25% were bilateral. Approximately 17% showed punctuate calcifications. Heterogeneous contrast enhancement was seen in all the cases, vascular encasement in three and lymphadenopathy in six cases. There was no bony involvement in any of them but 75% of the masses seen, crossed the midline. Histological confirmation of Wilms’ tumor was obtained in all cases.Conclusions:Majority of the tumors seen in this study crossed the midline and a few of them showed calcification. CT scan is relevant and accurate in investigating children with Wilms’ tumor as it reveals concomitant lesions with involvement of the abdominal vessels and lymph nodes.

Role of Computed Tomography in the Evaluation of Renal Masses

“…The mean age was 2.9 years. Our findings are similar to the findings of A. Adegboyega et al, 6 who found peak incidence of Wilms' tumour is at 37 months.…”

Childhood malignant tumours in owerri

“…The difference in mean age may be due to the late presentation of patients to hospital. [16] Rhabdomyosarcoma is said to be the commonest soft-tissue sarcoma of childhood worldwide. [19] Embryonal Rhabdomyosarcoma was the second most common neoplasm in this study constituting 22.22% (6 cases).…”

Role of computed tomography scan in diagnosis of retroperitoneal masses

“…27 CT is better than ultrasound in staging of Wilm's tumour. 28 Tumours are staged in order to provide patients with optimum therapy and prediction of prognosis. CT identify lymph node metastases, but it will miss tumour in normal sized lymph nodes.…”

“…CT is probably also the best modality for identification of liver metastases, chest metastasis and inferior vena cava involvement. 28 The pancreas has a uniform homogenous attenuation of 35-40 HU; it lies obliquely in the upper retroperitoneal region. Its oblique orientation does not allow all of it to be included in a single axial slice.…”