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Virtual Pediatric Hospital: Correlapaedia - a Correlative Encyclopedia of Pediatric Imaging, Surgery, and Pathology: Case 33

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

Case 33

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 year old female with abdominal distension.

Clinical History:
The patient was an 8 year old female with a 5 day history of flu like symptoms and a 3 day history of abdominal distension. She was seen in her pediatrician's office where she was found to be orthostatic and her abdominal distension was noted and she was referred to the hospital.

Clinical Physical Exam:
Febrile to 38.9 C. Abdomen was distended with superficial collateral veins and a large mass was palpable. A fluid wave was present, along with tympany.

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Clinical Labs:
A paracentesis done upon admission to the hospital was negative for tumor cells. Serum tumor markers obtained prior to surgery revealed an AFP of 12,254 and a beta HCG of 3.6.

Clinical Differential Diagnosis:
Ovarian mass, rhabdomyosarcoma

Imaging Findings:
An abdominal film from the day of admission showed a pelvic mass. An abdominal ultrasound exam from the day of admission showed a large heterogeneous mass in the lower abdomen with no clear organ of origin. An MRI exam from the third hospital day pointed to the right ovary as the organ of origin of the mass. A chest CT obtained post operatively (not provided) showed no evidence of metastatic disease in the chest, and a bone scan obtained post operatively (not provided) showed no evidence of bone metastases.

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Imaging Differential Diagnosis:
Ovarian mass

Operative Findings:
On the fourth hospital day the patient underwent an exploratory laparotomy through a midline incision. The tumor was seen to arise from the right ovary, and a portion of the omentum was adherent to the tumor. The left ovary had two firm nodules within it that were wedge biopsied. The tumor was delivered from the peritoneal cavity without spillage of tumor. The patient had a right salpingo-oophorectomy with partial omentectomy, left ovary biopsy, peritoneal biopsy, and nodal biopsies. Frozen sections of the tumor were positive for malignancy. A small peritoneal implant was noted at the dome of the bladder and was excised, with frozen section examination suggesting the presence of malignant cells.

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Pathological Findings:
Examination of the surgical specimen revealed findings characteristic of endodermal sinus tumor.

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Final Diagnosis:
Ovarian Endodermal Sinus Tumor with peritoneal metastases.

Follow-up and Prognosis:
The patient had an uncomplicated post-operative course. She received chemotherapy.

Similar Cases:
Case 40, Case 42

References:
None

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