Malignant Abdominal Mass

The most common malignant abdominal masses are of embryological origin, i.e., neuroblastoma, nephroblastoma (Wilms' tumor), and hepatoblastoma followed by lymphoma, germ cell tumor and soft tissue sarcoma (Table 2). Although it is usually possible to locate the site of origin of a retroperitoneal tumor as renal or ex-trarenal, there may be occasional morphological difficulties in the differentiation between neuroblastoma and nephroblastoma. As stated before, the clinical condition may be helpful in distinguishing the two entities, although biopsy will yield the diagnostic basis for further management and therapeutic decisions. The differential diagnoses of nephroblastoma are listed in Table 3. Lymphoma and leukemia have to be considered as differential diagnostic alternatives in some unusual morphological presentations (Fig. 6). Both may also be considered in the differential diagnosis of rhabdomyosarco-ma or a primitive neuroectodermal tumor (PNET). Depending on the differentiation, germ cell tumors are often benign. With regard to the ovary, the differential diagnoses of malignant germ cell tumors are listed in

Table 2. Common malignant abdominal tumors in the child Nephroblastoma (Wilms' tumor)

Neuroblastoma, including hepatic metastases in stage IVs

Hepatoblastoma

Lymphoma

Germ cell tumor

Soft tissue sarcoma (rhabdomyosarcoma, PNET, Ewing)

Table 3. Differential diagnosis of nephroblastoma

Nephroblastoma (favorable and unfavorable histology) Nephroblastomatosis (precursor of nephroblastoma, often bilateral, synchronous or not synchronous)

Clear cell sarcoma (formerly bone metastasizing tumor of kidney)*

Rhabdoid renal tumor (sarcoma)*

Renal cell carcinoma

Transitional cell carcinoma

Malignant renal lymphoma

Intrarenal growth of neuroblastoma

Congenital mesoblastic nephroma (benign)

Multilocular cystic nephroma (benign)

* high grade malignancy

Table 4. Tumor of the ovary

A) GERM CELL: Seminoma (i.e., dysgerminoma) 'Mature' teratoma (20% malignant) 'Immature' teratoma (100% malignant) Embryonal carcinoma

Yolk sac tumor (usually high grade malignancy) Choriocarcinoma

B) SPECIALIZED GONADAL STROMA: Granulosa-theca cell tumor

Sertoli cell tumor

C) OTHERS: Rhabdomyosarcoma Neuroectodermal tumor Lymphoma, leukemia

Table 4. The soft tissue sarcomas comprise the rhabdomyosarcoma, the primitive neuroectodermal tumor (PNET) and the Ewing sarcoma.

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