Avoiding misdiagnosing neuroblastoma as Wilms tumor

Paxton V. Dickson, Thomas L. Sims, Christian J. Streck, M. Beth McCarville, Victor M. Santana, Lisa McGregor, Wayne L. Furman, Andrew M. Davidoff

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

Purpose: Although occasionally difficult, distinguishing abdominal neuroblastoma (NBL) from Wilms tumor (WT) at presentation is important, as surgical management differs significantly. We reviewed our 20-year experience (1987-2006) treating patients with NBL, focusing on those with an initial diagnosis of WT, to determine presenting features that would have suggested the correct preoperative diagnosis. Methods: Retrospective case cohort study reviewing charts and imaging of patients with NBL initially diagnosed clinically with WT. Preoperative symptoms, laboratory studies, and imaging were evaluated. Similar variables were assessed in the 20 patients with WT most recently treated at our institution. Results: Nine patients with NBL were identified as those who had an exploratory laparotomy with a preoperative diagnosis of WT; 8 underwent nephrectomy at exploration. Children with NBL had symptoms such as fever and weight loss at presentation (67%) more often than patients with WT (20%). Preoperative computed tomography demonstrated intratumoral calcifications, vascular encasement, or both in 78% of patients with NBL but were never seen in WT patients. Of interest, preoperative urinary catecholamines were elevated in 5 patients ultimately diagnosed with NBL. Conclusion: Although NBL can be mistaken for WT at presentation, the presence of constitutional symptoms, or intratumoral calcification or vascular encasement on preoperative imaging should heighten suspicion for NBL. In addition, laboratory evaluation, including urinary catecholamines, should be completed before surgery when the etiology of an abdominal tumor is uncertain.

Original languageEnglish (US)
Pages (from-to)1159-1163
Number of pages5
JournalJournal of pediatric surgery
Volume43
Issue number6
DOIs
StatePublished - Jun 1 2008

Fingerprint

Wilms Tumor
Diagnostic Errors
Neuroblastoma
Vascular Calcification
Catecholamines
Nephrectomy
Laparotomy
Weight Loss
Cohort Studies
Fever
Tomography

All Science Journal Classification (ASJC) codes

  • Surgery
  • Pediatrics, Perinatology, and Child Health

Cite this

Dickson, P. V., Sims, T. L., Streck, C. J., McCarville, M. B., Santana, V. M., McGregor, L., ... Davidoff, A. M. (2008). Avoiding misdiagnosing neuroblastoma as Wilms tumor. Journal of pediatric surgery, 43(6), 1159-1163. https://doi.org/10.1016/j.jpedsurg.2008.02.047
Dickson, Paxton V. ; Sims, Thomas L. ; Streck, Christian J. ; McCarville, M. Beth ; Santana, Victor M. ; McGregor, Lisa ; Furman, Wayne L. ; Davidoff, Andrew M. / Avoiding misdiagnosing neuroblastoma as Wilms tumor. In: Journal of pediatric surgery. 2008 ; Vol. 43, No. 6. pp. 1159-1163.
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abstract = "Purpose: Although occasionally difficult, distinguishing abdominal neuroblastoma (NBL) from Wilms tumor (WT) at presentation is important, as surgical management differs significantly. We reviewed our 20-year experience (1987-2006) treating patients with NBL, focusing on those with an initial diagnosis of WT, to determine presenting features that would have suggested the correct preoperative diagnosis. Methods: Retrospective case cohort study reviewing charts and imaging of patients with NBL initially diagnosed clinically with WT. Preoperative symptoms, laboratory studies, and imaging were evaluated. Similar variables were assessed in the 20 patients with WT most recently treated at our institution. Results: Nine patients with NBL were identified as those who had an exploratory laparotomy with a preoperative diagnosis of WT; 8 underwent nephrectomy at exploration. Children with NBL had symptoms such as fever and weight loss at presentation (67{\%}) more often than patients with WT (20{\%}). Preoperative computed tomography demonstrated intratumoral calcifications, vascular encasement, or both in 78{\%} of patients with NBL but were never seen in WT patients. Of interest, preoperative urinary catecholamines were elevated in 5 patients ultimately diagnosed with NBL. Conclusion: Although NBL can be mistaken for WT at presentation, the presence of constitutional symptoms, or intratumoral calcification or vascular encasement on preoperative imaging should heighten suspicion for NBL. In addition, laboratory evaluation, including urinary catecholamines, should be completed before surgery when the etiology of an abdominal tumor is uncertain.",
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Dickson, PV, Sims, TL, Streck, CJ, McCarville, MB, Santana, VM, McGregor, L, Furman, WL & Davidoff, AM 2008, 'Avoiding misdiagnosing neuroblastoma as Wilms tumor', Journal of pediatric surgery, vol. 43, no. 6, pp. 1159-1163. https://doi.org/10.1016/j.jpedsurg.2008.02.047

Avoiding misdiagnosing neuroblastoma as Wilms tumor. / Dickson, Paxton V.; Sims, Thomas L.; Streck, Christian J.; McCarville, M. Beth; Santana, Victor M.; McGregor, Lisa; Furman, Wayne L.; Davidoff, Andrew M.

In: Journal of pediatric surgery, Vol. 43, No. 6, 01.06.2008, p. 1159-1163.

Research output: Contribution to journalArticle

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T1 - Avoiding misdiagnosing neuroblastoma as Wilms tumor

AU - Dickson, Paxton V.

AU - Sims, Thomas L.

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AU - McGregor, Lisa

AU - Furman, Wayne L.

AU - Davidoff, Andrew M.

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N2 - Purpose: Although occasionally difficult, distinguishing abdominal neuroblastoma (NBL) from Wilms tumor (WT) at presentation is important, as surgical management differs significantly. We reviewed our 20-year experience (1987-2006) treating patients with NBL, focusing on those with an initial diagnosis of WT, to determine presenting features that would have suggested the correct preoperative diagnosis. Methods: Retrospective case cohort study reviewing charts and imaging of patients with NBL initially diagnosed clinically with WT. Preoperative symptoms, laboratory studies, and imaging were evaluated. Similar variables were assessed in the 20 patients with WT most recently treated at our institution. Results: Nine patients with NBL were identified as those who had an exploratory laparotomy with a preoperative diagnosis of WT; 8 underwent nephrectomy at exploration. Children with NBL had symptoms such as fever and weight loss at presentation (67%) more often than patients with WT (20%). Preoperative computed tomography demonstrated intratumoral calcifications, vascular encasement, or both in 78% of patients with NBL but were never seen in WT patients. Of interest, preoperative urinary catecholamines were elevated in 5 patients ultimately diagnosed with NBL. Conclusion: Although NBL can be mistaken for WT at presentation, the presence of constitutional symptoms, or intratumoral calcification or vascular encasement on preoperative imaging should heighten suspicion for NBL. In addition, laboratory evaluation, including urinary catecholamines, should be completed before surgery when the etiology of an abdominal tumor is uncertain.

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Dickson PV, Sims TL, Streck CJ, McCarville MB, Santana VM, McGregor L et al. Avoiding misdiagnosing neuroblastoma as Wilms tumor. Journal of pediatric surgery. 2008 Jun 1;43(6):1159-1163. https://doi.org/10.1016/j.jpedsurg.2008.02.047