Mahomed Nasreen

Final Pr. ID: Poster #: EDU-022

Pancreatic tumours are a rare and unusual entity in pediatric patients accounting for less than 0.2% of malignant paediatric deaths. The limited number of cases and the diversity of histopathologic subtypes have made it difficult to predict prognosis which differs significantly from adults. In general, pancreatic tumours that occur in children are well circumscribed and partially encapsulated. Their relatively soft nature and encapsulated rather than infiltrative growth pattern allow them to become large prior to clinical presentation. Owing to their large size, central necrosis is common.

Causes of pancreatic masses in children are usually benign and include pancreatic pseudocyst, congenital pancreatic cyst, dermoid cyst, hydatid cyst, islet cell tumours, lymphangioma, pancreatic hemangioendothelioma and cystadenomas. Causes of malignant pancreatic masses in children (which are rare) include pancreatoblastoma, lymphoma, neuroblastoma, solid-pseudopapillary tumour and rhabdomyosarcoma.

We present an algorithmic approach to a pancreatic mass in a child, describing the common imaging features in each of the benign and malignant causes of pancreatic mass in a child with radiologic cases. We also report a very rare case of a pancreatic kaposiform hemangioendothelioma in an 8 month old boy who presented with Kasabach Merritt syndrome.
Read More

Authors:  Mahomed Nasreen

Keywords:  pancreatic tumours, pancreatic kaposiform hemangioendothelioma, benign, malignant, children

Muthiyal Sreekumar,  Kini Viswanatha,  Koshy Sheeja

Final Pr. ID: Poster #: CR-005

Inflammatory myofibroblastic tumour is a rare quasineoplastic lesion in the gatrointensitnal tract ; often present with variable and nonspecific imaging features, which may mimic other more common lesions, including malignancy. Occurrence in early infancy involving mesentery has been only sparsely reported in literature. We present such a paradigm in a 4 months old infant with clinical, radiological and histopathological features and corroborative overview of literature.
On Ultrasound abdomen, a mass lesion measuring about 6x4cm with irregular lobulated margin in the left lumbar–iliac fossa regions , involving the mesenteric planes and contigous descending colonic wall, having heterogeneous echotexture was seen . No calcification or cystic component was evident . Left kidney and spleen were seen separately . On Doppler it showed a few areas of vascularity.
On MRI ,It measured about 6.1x5.1x5.2 cm in CC, TR and AP dimensions with lobulated margins, involving the mesentery. It was heterogeously hypo intense on T1 W images and hyper intense on T2W images. On DW sequences, a few areas of restricted diffusion , predominantly along the periphery of the lesion, while the central areas showed minimal/non-restriction ; which also reflected in ADC map. On post contrast, the lesion showed moderate heterogeneous enhancement corresponding to the areas of restricted diffusion and dominant non enhancing components, suggesting areas of necrosis. Apart from contiguous colonic wall involvement , no other evidence of loco regional infiltration or metastasis was seen. Based on these, a diagnosis of Inflammatory myofibroblastic tumor was made.with differential diagnosis of non Hodgkin's lymphoma
The patient subsequently underwent laparotomy. On Histopathology, it showed myofibroblastic spindle cells and inflammatory infiltrates of lymphocytes with no evidence of nuclear pleomorphism or atypical mitosis ; suggesting the diagnosis of inflammatory myofibroblastic tumour ; which matched the MRI diagnosis. Read More

Authors:  Muthiyal Sreekumar , Kini Viswanatha , Koshy Sheeja

Keywords:  Inflammatory myofibroblastic tumour, mesentery, infant

Din Farah,  Hadian Fatemeh,  Chavhan Govind

Final Pr. ID: Poster #: EDU-028

Imaging is crucial in the staging of primary pediatric liver tumors. Hepatoblastoma, pediatric HCC and transitional-type lesions (HCC/hepatoblastoma) should be pre-operatively staged at the time of diagnosis using the PRETEXT system. The PRETEXT (PRE-Treatment EXTent of tumor) criteria were first described in 1992 and updated most recently following an international consensus in 2017, and provide reproducible imaging-based prognostic information for patient survival prior to treatment.

The PRETEXT system consists of two criteria; the group and annotation factors. The PRETEXT stage (I-IV) describes the anatomical extent of tumor within the liver, categorized according to contiguous lesion-free liver sections, whilst the annotation factors describe associated features such as vascular involvement, extrahepatic disease and metastases. These are combined and patients are divided into two risk stratified groups. The standard risk group, mostly including Stage I and II tumors, are more likely to be managed by partial hepatectomy whilst higher risk groups including stage IV tumors are often unresectable and require liver transplantation. Its ultimate goal is to determine the feasibility of surgical resection.

At our institution, our hepatobiliary surgeons use the PRETEXT criteria for prognostication and patient management. International use of these consensus criteria is essential in order to unify management of this rare pediatric tumor subtype.

Our objective is to discuss pearls and pitfalls from our experience of using the PRETEXT criteria. Relevant imaging examples from our large specialist pediatric institute will be provided with discussion of variability of scoring between CT and MRI as well as technical challenges. Selected multi-modality case-based examples will be provided with reference to patient management and operative findings where available. Read More

Authors:  Din Farah , Hadian Fatemeh , Chavhan Govind

Keywords:  Liver tumours, PRETEXT, staging

Aslan Mine,  Arioz Habibi Hatice,  Kalyoncu Ucar Ayse,  Ozmen Evrim,  Aslan Ahmet,  Bakan Selim,  Yildirim Onur,  Kurugoglu Sebuh,  Adaletli Ibrahim

Final Pr. ID: Poster #: SCI-021

The diagnosis of Wilms tumor and adrenal gland neuroblastoma can be challenging, even with imaging methods such as computed tomography and magnetic resonance imaging (MRI). This study aimed to show the utility of diffusion weighted MRI (DW-MRI) in the differentiation of neuroblastoma and Wilms tumor. Read More

Authors:  Aslan Mine , Arioz Habibi Hatice , Kalyoncu Ucar Ayse , Ozmen Evrim , Aslan Ahmet , Bakan Selim , Yildirim Onur , Kurugoglu Sebuh , Adaletli Ibrahim

Keywords:  Wilms tumour, Neuroblastoma, Diffusion weighted imaging, Apparent diffusion coefficient

Tijerin Bueno Marta,  Martinez-rios Claudia,  Daneman Alan,  De La Puente Gregorio Alejandro,  Navarro Oscar

Final Pr. ID: Poster #: EDU-044

To review unusual sonographic findings of tumors and tumor-like conditions one can encounter in pediatric scrotal ultrasound and to design a diagnostic algorithm that can be useful with the challenges of differential diagnosis in this situation. Read More

Authors:  Tijerin Bueno Marta , Martinez-rios Claudia , Daneman Alan , De La Puente Gregorio Alejandro , Navarro Oscar

Keywords:  scrotal, ultrasound, testis, tumour