Case report: ballotable abdominal mass in a child – Definitely renal in origin?

• Main Authors: Guan Tatt Lim, Teh, Yong Guang, Ng, Chiak Yot, Hazlina Mohd Khalid, Firdaus Hayati
• Format: Article
• Language: English; English
• Published: Elsevier Ltd 2021
• Online Access: https://eprints.ums.edu.my/id/eprint/29991/3/Case%20report_Ballotable%20Abdominal%20Mass%20in%20a%20child%20%E2%80%93%20definitely%20renal%20in%20origin%20FULL%20TEXT.pdf; https://eprints.ums.edu.my/id/eprint/29991/4/Case%20report_Ballotable%20Abdominal%20Mass%20in%20a%20child%20%E2%80%93%20definitely%20renal%20in%20origin%20ABSTRACT.pdf; https://eprints.ums.edu.my/id/eprint/29991/; https://reader.elsevier.com/reader/sd/pii/S2049080121000017?token=879999CDFC2F3A018FCB0B0A1DFBBAB2155BBE6F96045998ACA114831F8892ED626AA316EC57044D95523EE6C053E7AA&originRegion=eu-west-1&originCreation=20210716041235; https://doi.org/10.1016/j.amsu.2021.01.003

Introduction and importance: The differential diagnosis of a paediatric abdominal mass can be extensive, as it potentially involves multiple organs including gastrointestinal, genitourinary, endocrine, and gynaecological systems. Hence, a systematic approach to history taking and physical examination is needed to clinch the diagnosis. Specifically, the approach for assessing, investigating, and managing a ballotable left hypochondrial mass in a child can be challenging. Case presentation: We report a 10-year-old Dusun girl presenting with left hypochondrial pain and noted a left hypochondrial mass on examination. This report highlights the role of clinical imaging during the pre-operative and post-operative phases. Clinical discussion: Ultrasound and CT imaging was useful in determining that the tumor originated from the tail of the pancreas. The presence of a definite capsule with internal solid-cystic components helped narrowed the differential diagnosis to solid pseudopapillary neoplasm (SPN) of the pancreas. MR liver was useful to rule out liver metastasis in this child. Intervention and outcome: The patient was scheduled for laparotomy and tumour excision at a regional paediatric centre. Successful excision of the tumor en-mass was performed and the child’s subsequent recovery was uneventful. Conclusion: Clinical imaging plays a critical role in the diagnosis and management of paediatric solid organ tumours. Other than renal origin, suspicion of pancreatic tail origin should be considered by clinicians when encountering a ballotable left abdominal mass