Virtual Pediatric Hospital(tm) : A digital library of pediatric information

Home | About | FAQ | Reviews | Search

Virtual Pediatric Hospital: Correlapaedia - a Correlative Encyclopedia of Pediatric Imaging, Surgery, and Pathology: Case 21

Correlapaedia - a Correlative Encyclopedia of Pediatric Imaging, Surgery, and Pathology

Case 21

Michael P. D'Alessandro, M.D.,
Steven J. Fishman, M.D.,
Deborah E. Schofield, M.D.

Peer Review Status: Internally Peer Reviewed
Chief Complaint:
Eight month old male with an abdominal mass.

Clinical History:
The patient was an 8 month old male who 6 weeks ago developed fevers and was noted to be anemic with a hemoglobin of 3. He was treated with antibiotics and supplemental iron. Two weeks ago he was noted to have developed an abdominal mass.

Clinical Physical Exam:
Large, firm, non tender abdominal mass was palpated which was causing respiratory compromise.

icon gifImage 1

Clinical Labs:
White blood cell count of 26 with a differential of 30% polys and no bands, and a hematocrit of 17.8.

Clinical Differential Diagnosis:

Imaging Findings:
An abdominal film revealed a mass in the mid abdomen. This was better defined by CT and MRI, which demonstrated the mass to be homogeneous without an obvious organ of origin.

icon gifImage 2

icon gif icon gifImages 3 and 4

icon gifImage 5

icon gif Images 6 and 7

icon gifImage 8

Imaging Differential Diagnosis:
Inflammatory pseudotumor. Less likely is neuroblastoma, rhabdomyosarcoma and teratoma which would be more heterogenous when this size.

Operative Findings:
The child was taken to the operating room for a Tru-Cut needle biopsy. Three days later the child was taken back to the operating room for definitive excision of the mass. A long transverse incision was made. The mass was intimately associated to the terminal ileum and cecum and there were a large number of collateral blood vessels. The tumor was resected en bloc with the terminal ileum and cecum. The ileum and proximal colon were primarily anastomosed.

icon gifImage 9

Pathological Findings:
Examination of the surgical specimen revealed a tan to pink, firm, irregular mass measuring 14 x 13.5 x 8 cm. The mass was well encapsulated. No hemorrhagic necrosis or cystic degeneration was seen. The mass was felt to be a cellular, low-grade fibrous lesion, with inflammatory pseudotumor being the favored diagnosis.

icon gifImage 10

icon gifImage 11

icon gifImage 12

Final Diagnosis:
Inflammatory Pseudotumor

Follow-up and Prognosis:
The patient had an uncomplicated post-operative course. At his one year follow-up exam, he was noted to have recurrent tumor on US and CT examinations of the abdomen (not provided). An exploratory laparotomy performed one year after the first surgery showed multiple sites of recurrent tumor, particularly in the region of the ileocolic anastomosis, where the tumor had been extremely infiltrating in nature as noted during the prior surgery. Multiple mesenteric nodes, some of which were hard and some of which were soft, were noted. A decision was made not to resect the extensively affected area of the small bowel, since it would leave the patient with a short gut.

Similar Cases:


Title Page

Additional pediatric resources: | Facebook iconTwitter iconRSS icon |

Follow us on Twitter @pedseducationTwitter icon and @pedsimagingTwitter icon

About Us | FAQ | Reviews | Contact Us | Search

Virtual Pediatric Hospital is curated by Donna M. D'Alessandro, M.D. and by Michael P. D'Alessandro, M.D.

Please send us comments by filling out our Comment Form.

All contents copyright © 1992-2016 Donna M. D'Alessandro, M.D. and Michael P. D'Alessandro, M.D. and the authors. All rights reserved.

"Virtual Pediatric Hospital", the Virtual Pediatric Hospital logo, and "A digital library of pediatric information" are all Trademarks of Donna M. D'Alessandro, M.D. and Michael P. D'Alessandro, M.D.

Virtual Pediatric Hospital is funded in whole by Donna M. D'Alessandro, M.D. and Michael P. D'Alessandro, M.D. Advertising is not accepted.

Your personal information remains confidential and is not sold, leased, or given to any third party be they reliable or not.

The information contained in Virtual Pediatric Hospital is not a substitute for the medical care and advice of your physician. There may be variations in treatment that your physician may recommend based on individual facts and circumstances.