Atypical manifestations of malaria

Abstract

Purpose: Neuroblastoma is the most common extracranial solid tumor in infancy and most often presents as a palpable abdominal mass. It is a malignancy derived from neural crest cells that form the sympathetic nervous system and thus can arise from anywhere along the sympathetic chain including the neck, thorax, adrenals/ retroperitoneum and/or pelvis. Common sites of metastatic involvement include the bones, regional lymph nodes, liver, dura, and in infants, the skin. However, both initial and recurrent presentations of neuroblastoma can occur in unusual sites and may manifest as symptoms and/or signs not commonly associated with this childhood malignancy. Such cases therefore carry the potential for delayed diagnosis. We aim to increase awareness among radiologists of alternative or unusual manifestations of this complex disease. Materials and methods: We present cases of: 1) unusual clinical presentations of either primary or recurrent neuroblastoma, and 2) imaging findings at unusual sites of primary and/or metastatic involvement. Results: Brief clinical scenarios of unusual presentations will be discussed and supported with plain film/CT/MRI/radionuclide images. Cases will include a back mass in a newborn, scrotal swelling in infancy, cheek swelling in an infant, facial swelling in a toddler, varicocele in a toddler, foot drop in a toddler, small bowel obstruction in an infant, inguinal mass, headaches, and right iliac fossa pain in an adult. Radiological images of atypical sites of neuroblastoma will include cerebral and cerebellar parenchymal lesions (solid, hemorrhagic and cystic lesions), lungs (nodules and consolidation), pleura, scapula, mandible, groin and testes. Conclusion: Neuroblastoma is a common pediatric tumor and radiologists should be aware of the unusual manifestations of this complex disease so as to reduce the potential for delay in the diagnosis of both the initial presentation and of recurrence.