Germ cell tumors of childhood are most often gonadal in origin. Extragonadal germ cell tumors are located characteristically in the midline arising intracranially, in the mediastinum, pelvis or retroperitoneum. These tumors are generally easily diagnosed due to typical sites of origin and characteristic imaging findings. However, germ cell tumors can be associated with unusual clinical syndromes or imaging features that can perplex the clinician/radiologist. We will review and illustrate atypical imaging/clinical manifestations and complications of germ cell tumors in childhood, based on our experience at two large children’s hospitals. These atypical findings include: Atypical metastatic disease: a) Burned out tumor – Testicular primary not typically evident with viable metastatic disease in retroperitoneal lymph nodes distant viscera, b) Growing teratoma syndrome (increasing size of tumor/pseudoprogression despite appropriate therapy), c) gliomatosis peritonei (maturation into glial tissue during therapy with pseudoprogression on FDG-PET), d) ossified pulmonary metastasis mimicking granulomas Antibody mediated paraneoplastic syndromes: a) anti–N-methyl-D-aspartate (NMDA)– receptor antibody–mediated encephalitis associated with ovarian teratomas, b) anti-Ma2 antibody-mediated encephalitis associated with testicular germ cell tumors Endocrine manifestations: a) Precocious puberty/gynecomastia due to hormonal (hCG) production, b) hyperthyroidism (TSH stimulation and struma ovarii) Local complications: a) ovarian torsion (common), b) ruptured teratoma or dermoid cyst (uncommon) Unusual primary tumors: a) Multifocal primary (e.g. pineal and suprasellar germinoma), b) Currarino triad, c) fetus-in-fetu, d) malignant transformation Read More

Meeting name: SPR 2022 Annual Meeting & Postgraduate Course , 2022

Authors: Gagnon Marie-helene, Parikh Ashish, Taylor Susan, Derenoncourt Paul-robert, Ponisio Maria, Khanna Geetika

Keywords: growing teratoma, gliomatosis peritonei, NMDA encephalitis

MR Urography is an advanced imaging technique with increasing utilization that allows the interpretation of both anatomic and functional urologic data. This allows for a more efficient study of renal parenchymal and collecting system abnormalities, however the complexity and volume of functional data can make for an intimidating task to the interpreting radiologist. Key factors to success include: adequate patient preparation, optimal imaging protocol in conjunction with sedation/anesthesia and complex advanced post-processing techniques. In this educational poster, we aim to provide an initial overview of MRU with practical points on appropriate patient preparation and study optimization, followed by a detailed overview of the myriad of functional data acquired with each study. Finally, we will review a series of image-rich cases along with the post-processed functional data in order to illustrate the approach to interpretation in the setting of anatomic abnormalities on MRU. Read More

Meeting name: SPR 2024 Annual Meeting & Postgraduate Course , 2024

Authors: Vey Brianna, Cho Joo, Taylor Susan, Mehollin-ray Amy, Alazraki Adina, Khanna Geetika, Linam Leann

Keywords: MRU, Functional, MR

Evolution of MR Lymphangiography has expedited diagnosis and advanced potential implications for treatment in lymphatic disorders. In particular, evaluation of the central conducting lymphatic channels with dynamic contrast enhanced MR provides better spatial resolution, while sparing ionizing radiation inherent in lymphangio-scintigraphy and catheter lymphangiography. We will review indications, technique with pearls and pitfalls, and overall success rates after MR lymphangiography at our institution. To discuss post-imaging clinical outcomes and implications for treatment. To illustrate imaging findings of various lymphatic pathology diagnosed on MR. Read More

Meeting name: SPR 2023 Annual Meeting & Postgraduate Course , 2023

Authors: Bodner Jeffrey, Khanna Geetika, Riedesel Erica, Gill Anne, Hawkins Matt, Shah Jay, Variyam Darshan, Alazraki Adina

Keywords: Lymphatic, Lymphangiography, MR

Pediatric stomach tumors encompass a broad range of pathologies. These tumors are rare in the pediatric and adolescent population and can be easily misdiagnosed. In addition, approach to imaging diagnosis in this population may differ from adults. In this educational exhibit, we will focus on stomach tumors. This exhibit will provide viewers with: 1. A visual differential diagnosis of common and uncommon tumors in each section of the stomach with a focus on multi-modality imaging. 2. Review of common imaging findings for each tumor, highlighting high-yield characteristic findings of each. 3. Key findings and tips that can help the practicing radiologist differentiated between benign and malignant tumors. Read More

Meeting name: SPR 2024 Annual Meeting & Postgraduate Course , 2024

Authors: Mulvey Tom, Gagnon Marie-helene, Richer Edward, Loewen Jonathan, Alazraki Adina, Khanna Geetika, Mitchell Sarah, Riedesel Erica

Keywords: Stomach, Tumor, Malignancy