Presentation
Abdominal and pelvic masses.
Patient Data
Bilateral hypodense suprarenal masses, left larger than right, containing stippled calcifications and areas of necrosis with heterogeneous enhancement following IV contrast. The right one shows loco-regional extension to adjacent hepatic parenchyma with encasement of the IVC and right hepatic vein which are laminated. Retro-caval extension of the lesion with downward displacement of the right kidney.
Mass effect of the left suprarenal mass leading to anterior displacement of the corporeocaudal segment of the pancreas and spleen as well as lateral displacement of the left kidney. Both kidneys show enhancing nodules of various size.
Right off-midline intraperitoneal abdominal mass with heterogeneous enhancement showing pockets of necrosis. A similar soft tissue mass is seen in Douglas pouch, suggesting bilateral ovarian metastases.
Multiple retroperitoneal enlarged lymph nodes with mild ascites.
Bilateral rib metastases as well as vertebral, left humerus with right cervical mass encasing the brachial plexus with extension into the adjacent cervical canal.
Case Discussion
Bilateral adrenal neuroblastoma, as well as bilateral renal metastases from neuroblastoma, are rarely reported in the literature 1-3. Also, only a few sporadic cases of gonadal metastasis were reported in the literature 4-6.
According to our knowledge, there are no cases reported in the literature of bilateral neuroblastoma with bilateral renal and ovarian metastases at diagnosis. This is perhaps the first demonstrated case of bilateral renal and ovarian metastases from bilateral neuroblastoma stage 4 in a child less than 1 year.
Additional Contributors: R. Bouguelaa MD, A. Ramdani MD, Z. Boudiaf MD.
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