SRP Discussion
Overview
The session discussed two cases: (1) a case of a 3-year-old child with a suspected Wilms tumor, a type of kidney cancer; and (2) a case of a child with neuroblastoma, a type of cancer that affects the nervous system. The surgical teams discussed the challenges of obtaining a tissue diagnosis for neuroblastoma cases and the factors that determine a patient's risk category in neuroblastoma. The session concluded with a discussion on the minimum tissue volume required for diagnostic molecular testing.
A case of a 3-year-old child from West Africa who was a recent immigrant to Canada was presented. The child had an increased abdominal extension and a palpable renal mass, leading to a differential diagnosis of Wilm's tumor, neuroblastoma, hepatoblastoma, retroperitoneal lymphoma, and large lymphoma. The first intervention was an ultrasound in the emergency room, which was discussed. The tumor was large and multilobulated, with possible extra capsular extension. The renal artery and vein were patent, with no tumor thrombus. The child's hypertension as a relevant factor. The next steps for the patient were not clearly outlined. Moderator Dr. Sherif Emil was interested in hearing about other colleagues' practices, particularly whether they would typically start with chemotherapy or surgery.
In this case, the abnormal images of bilateral shoulders, femurs, and humerus showed a primitive appearance to the proximal humerus metaphysis and a subtle periosteal reaction. The right femur also showed a permeative, moth-eaten pattern of the distal femoral metaphysis. These findings were concerning for osteomyelitis or occult pathological fracture. A whole body MRI revealed a voluminous suprarenal mass with multiple lymph nodes and extensions within the retroperitoneum. The MRI also showed involvement of multiple cranial bones, left humerus, proximal femur, and diffuse bone marrow involvement in the spine and pelvis. An MIBG nuclear medicine scan confirmed involvement of the whole or most of the skeleton, with a focal mass in the right suprarenal region. The findings were suggestive of neuroblastoma.