A suprarenal mass in a child

Abstract

A 5-year-old boy was admitted to the hospital with complaints of abdominal pain, weight loss (2 kg lost in 2 months) and sweating lasting for 2 months. Past medical history was unremarkable. On physical examination his body temperature was 36.8°C (axillary), and the rest of the physical examination was unremarkable. The peripheral blood count showed a hemoglobin level of 14.2 g/dl, a hematocrit value of 41.7%, a platelet count of 318,000/ mm and a white blood cell count of 5,900/mm with normal differential. No atypical cells were seen in his peripheral blood smear. The erythrocyte sedimentation rate was 31 mm/h, and the serum biochemistries were normal except for a temporary increase in transaminases. Creactive protein was 64.2 mg/l (N: 0–10). Levels of urinary catecholamine metabolites, α-fetoprotein, and β-human chorionic gonadotropin were normal. Bone marrow aspiration revealed hypercellularity, but no malignant infiltration was seen. Abdominal computed tomography and magnetic resonance imaging studies showed a retroperitoneal pararenal soft tissue mass extending to the pre-aortic area and occupying mainly the left surrenal region (Fig. 1). The adrenal gland could not be discerned in the mass. The lesion consisted of cystic and solid components. There were also a few lymph nodes varying from 0.5 cm to 1 cm in size in the para-aortic region. At laparotomy, a 6 cm×5 cm×4 cm retroperitoneal mass was found in the left suprarenal region.