Hanna Carolyn,  Rajderkar Dhanashree,  Baxi Ameya,  Sharma Priya

Final Pr. ID: Poster #: EDU-022

In this educational exhibit we plan:
1. To identify and illustrate the spectrum of blastomas on various imaging modalities
2. To review the pathogenesis of these tumors
3. To describe and illustrate the typical and atypical imaging appearances and organ-wise differential diagnosis Read More

Authors:  Hanna Carolyn , Rajderkar Dhanashree , Baxi Ameya , Sharma Priya

Keywords:  Blastomas, Rare neoplasms, Primitive tissues

Hall Chase,  Germaine Colton,  Richards Allyson,  Tocchio Shannon

Final Pr. ID: Poster #: EDU-046

Overview:
Although rare, with only about 100 de novo cases reported a year, hepatoblastoma is the most common primary pediatric liver tumor in children under 3 years of age. The imaging findings of hepatoblastoma can be difficult to identify, especially for trainees, since not many radiologists have the opportunity to diagnose patients with this condition. Additionally, given the high rate of metastases, often to the skeletal system, at the time of diagnosis there is overlap with findings of non-accidental trauma. Treatment for hepatoblastoma requires specialized teams and prompt diagnosis with appropriate referrals resulting in improved management and prognosis. In this educational exhibit we review a de novo case of hepatoblastoma diagnosed at The University of New Mexico, with a focus on essential ultrasound, CT and MRI findings. Additionally, we will discuss associated gene mutations and congenital disorders, common sites of metastasis and how to use the PRETEXT method to risk stratify and guide management.

Outline:
Overview of hepatoblastoma
Review gene mutations and congenital disorders associated with hepatoblastoma
Review important findings of hepatoblastoma on ultrasound, CT and MRI, using unique images obtained at the University of New Mexico
Discuss common sites of metastasis and how osseous metastases can raise concerns non-accidental trauma
Checklist of how to use PRETEXT and brief review of treatment options

Goals:
Improve understanding of hepatoblastoma
Provide radiologist, especially trainees, with the tools necessary to recognize hepatoblastoma across multiple imaging modalities
Discuss how radiologists can provide focused management recommendations for treatment teams Read More

Authors:  Hall Chase , Germaine Colton , Richards Allyson , Tocchio Shannon

Keywords:  Hepatoblastoma, Rare Neoplasms, MRI

Ocal Selin,  Tivnan Patrick,  Alizadeh Houman

Final Pr. ID: Poster #: CR-039

Infantile myofibromatosis (IM) is rare and often enigmatic. We present the case of a 4mo ex-33-week male with a history of twin-twin transfusion syndrome, recurrent intussusception, rectal prolapse, and pancreatic insufficiency who was transferred to our hospital for persistent failure to thrive. Initial radiograph shortly after transfer revealed focal lytic lesions in the proximal bilateral femurs. This prompted a review of a CT done 2 months earlier at an outside hospital which revealed subtle mildly expansile lytic lesions within the ribs, iliac bones, and proximal femurs. On follow up CT and MRI at our hospital, these lesions had increased in size and number with newly apparent multilevel thoracolumbar spinal lesions with associated fractures. There was also bowel wall thickening and new hepatomegaly, suggestive of visceral involvement. Biopsy of a lesion in the left tibia was consistent with infantile myofibromatosis. After treatment with vinblastine/methotrexate and imatinib, CT demonstrated decrease in extent of osseous lytic disease, improvement in bowel wall thickening, and reduced hepatomegaly. About 90% of IM cases occur within the first two years of life and are subdivided into three categories: 1. solitary (50-80% of cases); 2. multicentric without visceral involvement; or 3. Generalized/multicentric with visceral disease. The most commons sites of solitary disease are the head/neck or trunk, and multicentric disease typically involves additional regions of skin/subcutaneous tissue, muscle, or bone (skull, femur, tibia, spine, ribs). One third of multicentric IM also manifests with visceral involvement, or generalized IM, like in this patient with osseous as well as bowel/visceral involvement. Though most cases are sporadic, IM can also rarely be familial. Though solitary and multicentric IM are considered benign and typically regress over 1-2 years, visceral involvement in generalized IM is associated with poor outcomes with reported mortality rates as high as 76%; it is usually treated with chemotherapy, as done here. Radiologist suspicion is critical for diagnosis, as in this case with the lytic bone lesions on radiograph. Imaging detection is thus also critical for accurately describing the extent of disease and to help direct treatment. With variable imaging findings described in past reports, we elucidate the imaging characteristics of IM seen on radiography, CT, MRI, and ultrasound. Read More

Authors:  Ocal Selin , Tivnan Patrick , Alizadeh Houman

Keywords:  Musculoskeletal, Multimodality Guidance, Rare Neoplasms