Question 1432
{"accessible":false,"alternatives":[{"id":7136,"text":"Hodgkin lymphoma"},{"id":7137,"text":"neuroblastoma"},{"id":7138,"text":"renal abscess"},{"id":7139,"text":"renal cell carcinoma"},{"id":7140,"text":"Wilms tumor"}],"archived":false,"correctAlternativeId":7137,"explanation":"\u003cp\u003eThis is a typical description of a neuroblastoma, a tumor of neuroblastic origin that is common in young children (mean age of presentation is 22 months). They can arise anywhere along the sympathetic chain but most commonly arise from the adrenal glands. Wilms tumor and neuroblastoma can sometimes be difficult to tell apart but there are a number of features in the question that suggest neuroblastoma rather than Wilms tumor.\u003c/p\u003e\u003cp\u003eApproximately 90% of neuroblastomas demonstrate calcification. Calcification is less common in Wilms tumors (10-15%). Neuroblastomas are typically poorly marginated and may cross the midline, invade neural foramina and encase vessels. Unlike Wilms tumors (and renal cell carcinomas), neuroblastomas generally do not invade vessels. The question also implies that the lesion is arising superior to the kidney and displacing it rather than arising from the kidney.\u003c/p\u003e\u003cp\u003eHodgkin lymphomas generally presents in older patients, with a bimodal distribution (15-34 year olds or those of over 55 years of age). It typically presents with painless lymphadenopathy but ‘B symptoms’ e.g. weight loss and night sweats are common.\u003c/p\u003e\u003cp\u003eRenal abscess is very unlikely to present with an abdominal mass and the patient would be unwell with such a large abscess.\u003c/p\u003e\u003cp\u003eRenal cell carcinoma is very rare in this age group and would be arising from the kidney rather than displacing it.\u003c/p\u003e","id":1432,"imageUrl":null,"imageAttribution":null,"imageAttributionCaseInfo":null,"firstQuestionPath":"/questions/1672","nextQuestionPath":null,"relatedArticles":[{"id":1722,"title":"Neuroblastoma","link":"/articles/neuroblastoma?lang=us"},{"id":6220,"title":"Renal abscess","link":"/articles/renal-abscess?lang=us"},{"id":8152,"title":"Wilms tumor","link":"/articles/wilms-tumour?lang=us"},{"id":7534,"title":"Renal cell carcinoma","link":"/articles/renal-cell-carcinoma-1?lang=us"}],"alsoUsedIn":[],"stem":"\u003cp\u003eA 2-year-old girl presents with a painless left-sided abdominal mass. She is otherwise well. MRI demonstrates a 7.8 cm mass in the left upper quadrant that crosses the midline and displaces the left kidney inferiorly. It can be seen to be encasing the left renal vein without invading into it. What is the most likely diagnosis?\u003c/p\u003e","menuLinks":[{"text":"Report problem with question","url":"https://docs.google.com/forms/d/e/1FAIpQLSfO3soWYhOjJ7yErSysyCe5V4A1CqW7WK3rDA7MtAkecMGqNw/viewform?entry.1624461248\u0026entry.553583435=https://radiopaedia.org/questions/1432"}],"attemptsPercentages":[{"alternativeId":"7140","percentage":15},{"alternativeId":"7139","percentage":2},{"alternativeId":"7136","percentage":8},{"alternativeId":"7137","percentage":74},{"alternativeId":"7138","percentage":1}],"promptToLogin":false,"questionManager":false,"articleId":"hodgkin-lymphoma"}