Pattern of computed tomography scan findings in children with Wilms’ tumor in a tertiary hospital in Lagos, Nigeria

Abstract

Abstract Context: Abnormal abdominal distension in a child is usually a source of great concern and apprehension in both the parents and the pediatric surgeon. Although Wilms′ tumor is the most common malignant abdominal childhood tumor, usually causing abdominal distension, many other less common causes can also result in abdominal distension. Therefore, early diagnosis of Wilms′ tumor and distinguishing it from all these other causes is essential. Aims: We intend to document the pattern of computed tomography (CT) scan findings in patients with Wilms′ tumor and the peculiarity of its radiological presentation in this environment, highlighting its accuracy and advantages over other imaging modalities. Settings and Design: This is a prospective descriptive study conducted between January, 2011 to January 2012, where all infants, 6-96 months of age, who were suspected to have Wilms′ tumor were made to undergo CT scan examination as part of their management work-up. It was carried out in a teaching hospital. Subjects and Methods: The study performed on 12 children age range of 6-96 months old underwent abdominal CT scans as part of their clinical work-up using a GE Hi-speed dual CT scanner ® . Pre- and post-contrast images were acquired and assessed by the radiologists. They were operated and their radiological and histopathology results were correlated. Statistical Analysis: All data was entered into a Microsoft word excel spread sheet and analyzed by simple analysis. Percentages and proportions were determined for categorical variables. Results: Of the 12 patients seen, nearly 75% were males, with a male to female ratio of 3:1 and an average age of 37 months. The right sided tumors were slightly more than the left and nearly 25% were bilateral. Approximately 17% showed punctuate calcifications. Heterogeneous contrast enhancement was seen in all the cases, vascular encasement in three and lymphadenopathy in six cases. There was no bony involvement in any of them but 75% of the masses seen, crossed the midline. Histological confirmation of Wilms′ tumor was obtained in all cases. Conclusions: Majority of the tumors seen in this study crossed the midline and a few of them showed calcification. CT scan is relevant and accurate in investigating children with Wilms′ tumor as it reveals concomitant lesions with involvement of the abdominal vessels and lymph nodes.