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Society for Pediatric Radiology – Poster Archive

Showing 3 Abstracts.

England Elizabeth,  Sarma Asha,  Thomas John,  Liang Jiancong,  Snyder Elizabeth

Final Pr. ID: Poster #: CR-011

Intrascrotal lipoblastomas are rare, benign paratesticular tumors that arise from embryologic adipose tissue and most often affect young children. Due to the rare nature of these tumors, preoperative diagnosis can be challenging, despite imaging features that are somewhat distinctive with respect to more common lesions (e.g., rhabdomyosarcoma). Prospective diagnosis, however, has potential to influence the operative management strategy (for example, minimally invasive mass excision versus radical inguinal orchidectomy). Since 2016, only two cases of preoperative imaging diagnosis of scrotal lipoblastoma have been published. This case report will describe a unique case of an incidentally found intrascrotal lipoblastoma and discuss the pertinent sonographic features of this rare entity. A 3-year-old boy initially presented for evaluation for an atrophic and undescended right testicle. During that evaluation, the patient was incidentally found to have a palpable left scrotal mass. Subsequent scrotal ultrasound showed an 2.7 x 1.9 x 2.4 cm well circumscribed ovoid mass inferior to the left testicle which was in the inguinal canal. The mass appeared predominantly hypoechoic with mild internal vascularity and also contained areas of hyperechogenicity resembling fat. The ultrasound appearance of the mass was not felt to be typical of a rhabdomyosarcoma (the most common paratesticular mass in children) and other fat-containing masses, including lipoblastoma, were suggested as diagnostic considerations. Complete excision of the left paratesticular mass was successful and subsequent scrotal orchidopexy was performed. Microscopic examination of the mass demonstrated lobules of adipocytes with occasional lipoblasts. Rearrangement of the PLAG1 (8q12.1) locus was detected, confirming the diagnosis of lipoblastoma. Although rare, prospective imaging detection of intrascrotal lipoblastoma may allow for less invasive and morbid surgical intervention and decreased risk for local recurrence. Read More

Authors:  England Elizabeth , Sarma Asha , Thomas John , Liang Jiancong , Snyder Elizabeth

Keywords:  Paratesticular tumor, Lipoblastoma

Emerson Miriam,  Isaacson Jared,  Chauvin Nancy,  Dahmoush Hisham

Final Pr. ID: Poster #: EDU-016

Lipoblastoma is a benign, rare pediatric mesenchymal tumor that develops in a myriad of anatomic locations. The imaging appearance of lipoblastoma sometimes overlaps with other tumors. Familiarity with lipoblastoma and a knowledge of benign and malignant tumors with similar imaging features will benefit practicing Radiologists, Pediatricians, and Surgeons. Our exhibit aims to expand awareness of lipoblastoma by providing a comprehensive pictorial review of cases showcasing representative MRI, CT, sonographic, and radiographic images. Suggestive imaging features of lipoblastoma that distinguish them from other fat-containing lesions will be highlighted and an emphasis on the discussion of lipoblastoma within the spectrum of pediatric lipomatous lesions will be detailed. Read More

Authors:  Emerson Miriam , Isaacson Jared , Chauvin Nancy , Dahmoush Hisham

Keywords:  Lipoblastoma, Tumor, Mass

Ledbetter Karyn,  Leino Daniel,  Trout Andrew

Final Pr. ID: Poster #: CR-007

Lipoblastomas are rare benign soft tissue tumors (6% of all pediatric soft tissue tumors) that are composed of immature lipoblasts and mature adipocytes. Lipoblastomas primarily occur in infants and children younger than three years of age and most frequently occur in the extremities. Less than 10 case reports exist of pelvic lipoblastomas. We report two children with pelvic lipoblastoma with the typical presentation of a rapidly enlarging, painless, fat-containing mass.

A 30-month-old girl presented with an enlarging gluteal mass over a period of four months. CT performed at an outside institution showed a large fat-containing intra-pelvic lesion anterior to the sacrum that extended to the perineum. An atypical sacrococcygeal teratoma was suspected. Subsequently, MRI demonstrated a large fairly-well-circumscribed intra-pelvic lesion that followed fat on all sequences with the exception of a few thin, enhancing septations.

A 14-year-old boy presented with a large firm scrotal/inguinal mass during a wellness visit. The child reported the lesion had been rapidly increasing in size over the past two months. Ultrasound showed a >15 cm inguinal mass that extended both into the pelvis and left hemiscrotum. The mass was homogeneous in echotexture and displaced but did not involve the epididymis and testicle. Based on concern for a malignant lesion, subsequent evaluation with PET-CT showed the lesion to be predominantly composed of fat with only low level F-18-FDG uptake in a few internal septations.

In both cases, lipoblastoma was confirmed after surgical excision with pathologic examination and immunohistochemistry.

Imaging serves to demonstrate the macroscopic fat content of lipoblastomas but cannot reliably differentiate lipoblastoma from liposarcoma. Therefore, imaging primarily contributes information about size and anatomic relationships relevant to surgical approach. Surgical excision is the treatment of choice; however, the lack of a capsule makes complete excision difficult and local recurrence is common. Close clinical follow-up is recommended for a minimum of five years, with imaging follow-up by MRI or CT utilized when the tumor’s anatomic location precludes or limits detection by physical examination.
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Authors:  Ledbetter Karyn , Leino Daniel , Trout Andrew

Keywords:  Lipoblastoma, Pelvic, Scrotal