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Virtual Pediatric Hospital: Correlapaedia - a Correlative Encyclopedia of Pediatric Imaging, Surgery, and Pathology: Case 30

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

Case 30

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

Peer Review Status: Internally Peer Reviewed
Chief Complaint:
Three year old male with an abdominal mass.

Clinical History:
The patient was a 3 year old male who presented with a palpable abdominal mass that was discovered by his parents.

Clinical Physical Exam:
A midline abdominal mass was easily palpable.

Clinical Labs:

Clinical Differential Diagnosis:
Wilms Tumor, Neuroblastoma

Imaging Findings:
An abdominal film from the day of admission showed a mid abdominal soft tissue mass. A computed tomography scan and ultrasound exam of the abdomen from the second hospital day showed a large heterogeneous mass in the mid abdomen superior to the bladder. A bone scan on the fifth hospital day demonstrated metastatic lesions to the right pelvis and right femur.

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Imaging Differential Diagnosis:
Ewing sarcoma, rhabdomyosarcoma, Burkitt's lymphoma

Operative Findings:
Two months and 4 days after the initial presentation, after receiving several cycles of chemotherapy, the patient underwent an exploratory laparotomy with resection of the mass and a partial cystectomy. The tumor was extraperitoneal in origin and was adherent to the anterior abdominal wall inferiorly but it did not appear to invade the rectus muscles. It originated from the left posterior aspect of the dome of the bladder, and did not appear to invade any normal structures except where it originated in the bladder.

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Pathological Findings:
Examination of the surgical specimen revealed findings characteristic for embryonal rhabdomyosarcoma.

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Final Diagnosis:
Rhabdomyosarcoma of Bladder

Follow-up and Prognosis:
The patient had an uncomplicated post-operative course. One year later he presented with multiple anal condylomata which he caught from his mother's fingernail while he was immune suppressed.

Similar Cases:
Case 54


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