Studies In Clinical And CT Features Of Renal Tumors And Adrenal Occupying Lesions In Children

PartⅠ Study On Clinical And CT Features of Renal Tumors In ChildrenPurpose: To investigate the CT features of renal tumors in children,combining with the clinical data,we could be better aware of these tumors,and improve the diagnostic level before surgery.Materials and Method:121 cases of renal tumors,treated in Xin Hua Hospital,was reviewed retrospectively with their clinical and CT features.All these cases were proved by surgery and pathology.This research was made to maintain the histopathologic types of renal tumors and their age of onset according to their clinical data.Meanwhile,we analyzed the CT manifestations of each type of renal tumors to confirm whether they were related to the clinical characteristics.Results: 73 male cases and 48 female cases consist of all renal tumors.The age ranges from 1month to 10 years.There are 95 cases of Wilms Tumor,61 male cases and 34 female cases.The age ranges from 5 months to 9 years.The initial symptoms include abdominal mass,hematuria,fever,abdominal pain and so on.CT shows a intrarenal tumor with mixed density and relatively clear border,accompanying with obvious necrosis and cystic degeneration,28 cases are with calcification(28.9%),10 cases are with tumor thrombus in the renal vein or inferior vena cava,10 cases of which are with metastasis in the lung or liver.8 cases are Botroyid Wilms tumors.6 cases are Cystic partially differentiated Wilms tumors,1case is teratoid Wilms Tumor.1 case with nephrogenic rests.6 cases are mesoblastic nephroma,each case is under 1 year old,four of them are detected via prenatal ultrasound,the CT manifestation is similar to the WT with no calcification,tumor thrombus and metastatic foci.There are 4 cases of rhabdoid tumor,CT image presents as a slightly lobulated mass with relatively mixed density and no calcification.Peripheral subcapsular fluid collection could be seen in 3 cases.There are multiple metastatic focuses,tumor thrombus in the inferior vena cava and involvement of pancreas in 3 cases.8 cases of the renal tumors are clear cell sarcoma,the age range from 3 months to 7 years and 1month old.The CT feature is similar to the Wilms tumor,but the necrosis of this disease is more apparent.Distant metastasis could be seen in 2 cases and adjacent organ involved in 1 case.2 cases were ossifying renal tumor of infancy(ORTI),one was 4 months old,the other was 6 months old.The clinical manifestation was hematuria.The small tumors located in kidney calices with calcification taking up more space.CT enhancement scan shows that a lesion with moderate enhancement and a lesion with no enhancement.There are 2 cases of renal involvement with non-Hodgkin’s lymphoma,Both cases were confirmed by pathology with B cell lymphoma.Multiple lesions could be detected in both kidneys in the abdominal CT scan.There is a case of clear cell carcinoma in kidney and the patient is 3 years old.1 case was renal mature teratoma,the multiocular cyst lesion is presented with patchy calcification and some fat tissue.There is a case of cystic renal tumor and a case of metanephric adenoma in all the renal tumors.In the 118 cases,the number of patients who come to hospital for hematuria is 33.Which include Wilms tumor(26/33),ossifying renal tumor of infancy(2/33),rhabdoid tumor(2/33),clear cell sarcoma(3/33).This study analyzes the relationship between hematuria and whether the renal pelvis is involved,the occurrence of hematuria is associated with the involvement of renal pelvis(p-value=0.00<0.05),the coefficient of correlation,R,is 0.04516.Conclusion: The Wilms tumor takes a major part(95/121,78.5%)and the number of patients whose ages range between 1 to 3 years old holds the most proportion(35/40,87.5%).Mesoblastic nephroma takes up a major part while the age is younger than 3 months old.Ossifying renal tumor of infancy is more likely to be below 1 year old.The clinical presentation of Wilms tumor is painless abdominal mass.Hematuria is more commonly presented in BWT,ORTI and rhabdoid tumor.The importance of gross hematuria should be attached to for children,especially those younger than 5 years old.Careful physical and assistant examination are needed to exclude renal tumors.The clear cell sarcoma and rhadoid tumor are aggressive malignant tumor,metastatic focuses often have occurred when treated.Most renal occupying lesions,combining the CT manifestations with clinical presentation and data tightly,could be diagnosed correctly so that the important messages could be provided for the plan of clinical treatment.Part Ⅱ Study on Clinical And CT Features of Adrenal Occupying Lesions In ChildrenPurpose: To investigate the CT features of adrenal occupying lesions in children,combining with the clinical data,we can be better aware of these tumors and improve the diagnostic level before surgery.Materials and Method:126 cases of adrenal occupying lesions,treated in Xin Hua Hospital,were reviewed retrospectively with their clinical and CT features within 8 years.All tumors were proved by surgery and pathology and all hematomas were proved by clinical treatment.The clinical manifestations and CT features in each disease were analyzed for the test of the correlation and the difference via SPSS22.0.Results: There were 91 cases of neuroblastoma,the ratio was 1.8:1 male to female(59:32).The ages of these patients ranged from 15 days to 8 years old.The initial symptoms included abdominal mass,abdominal pain,fever,accompanying with anemia,diarrhea,vomiting and so on.18 cases were found metastatic focuses in other organs.One case was detected via prenatal ultrasound.CT image showed that slightly lobulated masses with different sizes with calcification and necrosis in them commonly and cystic degeneration uncommonly in them.The masses encased retroperitoneal vessels and their branches.Tumor thrombus in the vein was common,but we could see the tumors involve the adjacent organs.2 cases of cystic neuroblastoma were existed.The value of serum NSE before treatment ranged from 18.8ug/L to 1586 ug/L in 60 cases.The mean value was 361.9±387.8ug/L.The value of LDH in 77 cases ranges from 208U/L to 4993U/L,and the mean value was 651±1297 U/L.Urinary VMA was measured in 75 cases,among which the value of VMA increased in 36 cases.8 cases were proved for ganglioneuroma.The ages of the patients ranged from 3 to 8 years old.There was no palpable abdominal mass in them.5 cases of patients present with abdominal pain,and one with fever.The masses all showed clear border,the density was homogeneous in the plain CT scan(5/8).Calcification could be seen in 3 cases(3/8).Necrosis could be seen in only 1 case.All the masses in the 8 patients could present with cystic degeneration.There were 8 cases of adrenal cortical tumors.There were 7 cases of adrenocortical carcinoma and 1 case of adrenal adenoma.Their ages ranged from 2 years old to 8 years old.The clinical presentations were abdominal pain(4/8),sexual precocity(6/8),Cushing’s syndrome(1/8).CT image showed that the border of adrenal adenoma was relatively clear with homogeneous density.The shape of adrenocortical carcinoma was basically regular with heterogeneous density with some necrosis or calcification in it,tortuous supply vessels could be seen on post-contrast CT(6/7).There were 4 cases of pheochromocytoma.The ages of these patients ranged from 2 months to 8 years old.There were 6 cases of mature teratoma,1 case of immature teratoma and 1 case of mixed germ cell tumors.The clinical presentation was painless abdominal mass.3 cases were detected via prenatal ultrasound.The ages of 7 cases of neonatal adrenal hematoma ranged from 8 days to 4 months.Pathologic jaundice occurred in most patients.The adrenal occupying mass showed clear border and low density on unenhanced CT with some hemorrhage in it and some calcification focuses surrounding the mass.Peripheral enhancement could be seen on contrast CT.Comparing the value of NSE measured in the adrenal neuroblastoma and other adrenal occupying lesions but not neuroblastoma,It is statistically significant(p<0.05).The value of LDH is statistically significant in the comparison of benign and malignant adrenal tumors.Conclusion: Neuroblastoma is the most common tumor of all the adrenal occupying lesions in children(71.7%),the serum NSE is a specific parameter for the diagnosis.The size of the tumor,the supply artery and tumor thrombus in the vein are helpful for the differentiation from adrenal cortical carcinoma.We should take more attention to the differentiation between hematoma and neuroblastoma,the follow-up examination could be helpful for the diagnosis.In a word,there are so many types of adrenal occupying lesions,The lesions,combining the CT manifestations with clinical presentation and data tightly,could be diagnosed correctly so that the important messages could be provided for the plan of clinical treatment.