Presentation
Pain and progressive increase of abdominal volume in the last 6 months.
Patient Data
There is a large and heterogeneous solid mass in the right adrenal, that besides displacing the kidney inferiorly and posteriorly, it is also crossing the midline. It approximately measures 89 x 56 x 105 mm (anteroposterior, laterolateral and craniocaudal, respectively).
Note the presence of multiple stippled calcification throughout the lesion.
The tumor extends itself for almost 30 mm along the inferior vena cava, circumferentially encasing it and, consequently, causing some extrinsic compression. It also enclasps the right renal vein and penetrates through its hilum.
Case Discussion
It is widely known that neuroblastoma may have similar imaging features to Wilms tumors. However, just like what happened in the case presented above, there are some features that, if present, highly favor the diagnosis of neuroblastoma, such as a large mass that crosses the midline; encases vessels, and presents with stippled calcification.
The next crucial step after diagnosis is staging, through the International Neuroblastoma Risk Group Staging System (INRGSS). The patient presented above was classified into localized disease and, more specifically, a case of L1 stage.
Contributed by Dr. Guilherme Pioli Resende M.D. and Dr. Erica Fabiana Queiroz Mariano M.D.
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