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

Case 43

Clinical History:
The patient was a 15 month old male with a history of opsoclonus and myoclonus which was worked up with a Brain MRI which was unremarkable. A previous body CT from 6 months earlier was negative. The symptoms improved for a while, but have recently worsened.

Clinical Physical Exam:
Opsoclonus and myoclonus

Clinical Labs:
Non-contributory

Clinical Differential Diagnosis:
Neuroblastoma

Imaging Findings:
A computed tomography scan of the abdomen and pelvis demonstrated a new midline presacral mass. A bone scan was negative for metastases. An MRI exam of the pelvis performed 1 month after the computed tomography exam showed the mass to be invading the lowest sacral neural foramina on the left side.

Image 1

Images 2 and 3

Imaging Differential Diagnosis:
Neuroblastoma most likely. Other presacral masses are teratoma, meningocele, rhabdomyosarcoma.

Operative Findings:
Two weeks after the initial diagnosis the patient was taken to the operating room for transrectal biopsy of the mass, which revealed it to be neuroblastoma. After receiving several cycles of chemotherapy which slightly decreased the size of the tumor, two months after the initial diagnosis, the tumor was surgically removed through a posterior sagittal trans sacral approach.

Image 4

Pathological Findings:
Examination of the surgical specimen revealed it to have findings characteristic of a neuroblastoma.

Image 5

Final Diagnosis:
Neuroblastoma, Presacral with metastatic spread to the upper sacral lymph nodes.

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

Similar Cases:
Case 41, Case 49

References:

• Paediapedia
• Cornell University Pediatric Pathology
• WebPath
• WebPath

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