Both neuroblastoma and Wilms tumor occur in early childhood and typically present as large abdominal masses closely related to the kidneys. Distinguishing between the two is important, and a number of features are helpful.
Neuroblastoma
- calcification very common: 90%
- encases vascular structures but does not invade them
- younger age group (<2 years of age)
- poorly marginated
- elevates the aorta away from the vertebral column
- more commonly crosses the midline, especially behind the aorta 2
- more common to have extension into the chest
- bone metastases are common (Hutchinson syndrome)
- extension into spinal canal can be seen
- retroperitoneal lymph nodes are more often seen
Wilms tumor
- calcification uncommon: 10-15% (10% rule of Wilms tumor)
- displaces adjacent structures without insinuating between them, also with displacement of the renal vessels
- slightly older age group: peak 3-4 years of age
- well-circumscribed
- claw sign with the kidney
- extension into IVC/renal vein
- bone metastases are rare, rather lung metastases are common
- extension into spinal canal never seen
- retroperitoneal lymphadenopathy is uncommon
- higher incidence of hemorrhage
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