Abdominal Mass In Children - A Simple Approach

4-year-old boy with left sided abdominal lump, which was gradually increasing in size for the last 1 month. No complaints of bowel or bladder disturbance, fever, weight loss, or abdominal pain. Child is otherwise well. Systemic examination is otherwise normal

Diagnostic approach depends on

1. Location of Mass
2. Organ of Origin
3. Description of Mass

1-Location of mass:

Right upper quadrant (RUQ) contains liver, right kidney, gallbladder, colon, pancreas.

Left upper quadrant (LUQ) contains Stomach, left kidney, spleen, colon, pancreas.

Right lower quadrant (RLQ) contains Colon, appendix, small intestine, ureter, major arteries and veins to right leg.

Left lower quadrant(LLQ) contains small intestine, colon, ureter, major arteries and veins to left leg.

2-Organ of origin:

Differential diagnosis:

Diagnosis:

It is a case of Wilms tumor also known as nephroblastoma, it is the most common primary renal tumor of childhood. In 80% of cases, it is diagnosed before age of 5 years. Peak age of presentation is 2.5-3.5 years. Presents as painless upper abdominal mass (70-80%), haematuria (20%), hypertension (25%). It can be associated with congenital anomalies like WAGR and Beckwith Weidman syndrome. It can metastasis to lungs, liver, regional lymph nodes.

Management:

Multimodality, stage and risk adopted approach is the standard of care. It is a highly chemo and radiosensitive tumor. Surgery + Chemotherapy+/- radiotherapy forms the basis of treatment.

Underwent left radial nephrectomy and lymph node sampling, intraoperative tumor rupture

• HPR – epithelial predominant Wilms tumor, St III
• Completed radiotherapy and adjuvant chemotherapy 3 drugs for 24 weeks; Vincristine, actinomycin D, adriamycin

• Doing well at present

Authored By – Dr Anand Kumar K (MD Pediatrics),Consultant, Pediatric Hematologist, Oncologist and BMT physician, Fortis Hospital, Bannerghatta road, Bengaluru.