Gastric teratomas are exceedingly rare tumors derived from one or more germ layers. These tumors predominantly occur in sacrococcygeal-gonadal locations but can occasionally manifest in midline regions such as the mediastinum, retroperitoneum, and the head/neck. Case Presentation: A 1-day-old male infant, born at 36 weeks and 4 days via a cesarean section due to multiple fetal anomalies, including large for gestational age (LGA), new-onset polyhydramnios and significant bilateral hydroceles, presented with a significantly distended and firm abdomen. The initial X-ray revealed extensive amorphous calcifications throughout the abdomen, suggestive of meconium peritonitis. However, a subsequent ultrasound examination revealed a large heterogeneous mass in the upper and mid abdomen, characterized by calcifications, cysts, and soft tissue components. In retrospect, the large mass was detected on the prenatal sonographic exam but misinterpreted as echogenic bowel loops. A subsequent CT scan unveiled a 13.4 x 7.6 x 9.9 cm mass originating from the gastric wall, extending into the gastric lumen as well as the peritoneal cavity. Interestingly, endoscopy revealed a normal mucosa covering the mass. The tumor was resected, including partial gastrectomy, and histology confirmed the presence of native gastric mucosa and an underlying mass composed of endodermal, ectodermal, and mesodermal tissues, consistent with mature teratomas. This case report presents a large mature teratoma within the gastric wall, exhibiting exophytic and endoluminal growth, which led to polyhydramnios, abdominal distention, and the development of large hydroceles in the newborn, feeding difficulty. Additionally, it emphasizes the importance of thorough prenatal and postnatal imaging evaluations for timely diagnosis and management. Read More

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

Authors: Wang Megan, Snyder Elizabeth, Schulman Marta, Luo Yu

Keywords: Gastric teratoma, computed tomography

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

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

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

Keywords: Paratesticular tumor, Lipoblastoma

The purpose of this exhibit is to describe the expected physiological post-mortem changes in the fetus and children using different imaging modalities. These post-mortem changes are affected by a variety of antemortem and postmortem factors, amongst all, the age of the fetus or child, the organ system in question, and the extent of fluid shifts and tissue changes are the most crucial and help to guide the imaging modality of choice in post-mortem period. It is imperative to understand organ-system-specific post-mortem changes for satisfactory reporting of post-mortem imaging in children. When in doubt, a review of perimortem clinical details and a correlation with antemortem/antenatal imaging findings may assist in reaching the final diagnosis. Read More

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

Authors: Gupta Neetika, Snyder Elizabeth, Victoria Teresa, Arthurs Owen, Miller Elka

Keywords: Postmortem Imaging, Physiological changes, Expected changes

The phakomatoses are neurocutaneous disorders arising from the abnormal development of cells of embryonic ectodermal and mesodermal origin. Although commonly involving central nervous system and cutaneous structures, these disorders can also involve the visceral organs, vascular system, and connective tissue. There are over 30 neurocutaneous entities, each with unique genetic and physical manifestations. Clinical diagnosis may be challenging, as the physical and imaging expressions of disease are variable and broad. Importantly, many affected individuals may present with less common manifestations of disease, and furthermore, less common disorders may be difficult to recognize. The goals of this educational exhibit are to: 1) Review the pathogenesis, genetic underpinnings, and clinical features of phakomatoses. 2) Emphasize lesser-known imaging manifestations of more commonly encountered phakomatoses (e.g., cortical dysplasia in NF2). 3) Detailed review of imaging manifestations of less common phakomatoses (e.g., Parry-Romberg syndrome). Covered conditions will include commonly encountered phakomatoses (neurofibromatosis types 1 and 2, tuberous sclerosis, Sturge-Weber syndrome, Von Hippel Lindau disease etc.), and less commonly encountered entities such as basal cell nevus syndrome and other phakomatosis groups such as vascular phakomatoses (e.g, hereditary hemorrhagic telangectasia, PHACE syndrome, meningioangiomatosis, diffuse neonatal hemangiomatosis); melanophakomatoses (e.g., neurocutaneous melanosis, incontinentia pigmenti); and overgrowth syndromes (PTEN hamartoma tumor syndromes). Read More

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

Authors: England Elizabeth, Snyder Elizabeth, Pastakia Devang, Pruthi Sumit, Sarma Asha

Keywords: Phakomatosis, Neurocutaneous disorder

Megacystis microcolon hypoperistalsis syndrome (MMIHS) also known as Berdon syndrome is a rare genetic disorder with a poor prognosis characterized by hypoperistalsis of the bladder and bowel. When expediently diagnosed and managed, survival can be extended. The radiologist plays a role in the initial diagnosis and recommending further imaging based on the known constellation of findings in collaboration with the pediatric surgeon and pediatric urologist. The radiologist could be the first to appreciate characteristic findings and suggest the possibility of this syndrome. The purpose of this educational exhibit is to describe the imaging characteristics of Berdon syndrome from the fetal stage to early childhood with an emphasis on 1) main radiologic findings, 2) helpful imaging features to differentiate Berdon syndrome from other similar conditions, 3) appropriate imaging studies to assist in supporting the diagnosis, and 4) clinical findings, management, and outcome. We will review 9 cases and their corresponding imaging. Sources: Wymer KM, Anderson BB, Wilkens AA, Gundeti MS. Megacystis microcolon intestinal hypoperistalsis syndrome: Case series and updated review of the literature with an emphasis on urologic management. J Pediatr Surg. 2016;51(9):1565-1573. Puri P, Shinkai M. Megacystis microcolon intestinal hypoperistalsis syndrome. Seminars in Pediatric Surgery. 2005;14(1):58-63. Rolle U, O’Briain S, Pearl RH, Puri P. Megacystis-microcolon-intestinal hypoperistalsis syndrome: evidence of intestinal myopathy. Pediatr Surg Int. 2002;18(1):2-5. Read More

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

Authors: Maria Anthony Rayer Dhilip Andrew, Snyder Elizabeth, Singh Sudha, Johnstone Lindsey, Sarma Asha, Krishnasarma Rekha

Keywords: Berdon, intestinal hypoperistalsis, malrotation

The prevalence of pediatric cancers attributable to hereditary cancer predisposition syndromes (CPS) has grown in recent years due to the increasing recognition of links between germline mutations and pediatric cancers. As a result, a rapidly increasing population of patients with CPS are being seen in pediatric radiology practice. In collaboration with oncologists, surgeons, and other specialists, the radiologist plays an essential role in the management of these patients. For example, they may be the first to recognize the constellation of findings leading to the diagnosis of a CPS. In addition, the radiologist who is knowledgeable about pediatric CPS plays a pivotal role in the planning of imaging evaluations, which may need to be concise or comprehensive depending on the clinical situation, with judicious use of ionizing radiation, procedural sedation, and contrast. This is especially important because, although there are consensus screening and surveillance guidelines for the most common CPS, such guidelines have not been established for less common syndromes. This educational exhibit seeks to provide an overview of various CPS, emphasizing 1) genetic underpinnings and mechanisms related to cancer predisposition, 2) the common and uncommon imaging findings, 3) preferred imaging techniques, and 4) currently available screening and surveillance recommendations. Pediatric CPS that will be discussed here include Li-Fraumeni syndrome, neurofibromatosis type I, von Hippel Lindau disease, Beckwith-Wiedemann syndrome, DICER-1 related conditions, Familial adenomatous polyposis, and Gorlin syndrome, as well as neuroendocrine syndromes (e.g., multiple endocrine neoplasia). Less common cancer predisposition syndromes, including DNA-repair related syndromes such as Ataxia-telangectasia, as well as Rubenstein-Taybi syndrome, and PTEN hamartoma tumor syndrome will also be discussed. Read More

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

Authors: Patel Arjun, Sarma Asha, Krishnasarma Rekha, Benedetti Daniel, Pruthi Sumit, Snyder Elizabeth

Keywords: cancer predisposition syndrome, hereditary cancer