Toddler with an unusual appearing eye

Clinical image of aniridia in a patient with Wilms tumor — Clinical image shows absence of the iris.

The diagnosis was aniridia in a patient with Wilms tumor.

Preschooler with abdominal pain

Gross pathology image of cystic Wilms tumor — Gross pathological image shows a large left renal mass along with the left ureter with the upper part of the mass being ballotable, demonstrating its primarily cystic nature.

The diagnosis was cystic Wilms tumor.

Preschooler with abdominal pain

Gross pathology image of cystic Wilms tumor — Sectioned gross pathological image after drainage of fluid shows the preserved lower pole of the left kidney (above), the replacement of the upper and middle poles by a cystic tumor containing multiple septations which is now decompressed, and a mural nodule (center of image).

The diagnosis was cystic Wilms tumor.

Preschooler with abdominal pain

Surgical image of cystic Wilms tumor — Surgical image shows a large mass arising from the left kidney which is being effectively transilluminated by the overhead lights, demonstrating its primarily cystic nature.

The diagnosis was cystic Wilms tumor.

Preschooler with abdominal pain

Surgical image of cystic Wilms tumor — Surgical image shows a large fluid-filled mass arising from the left kidney just after it has been resected along with the left ureter.

The diagnosis was cystic Wilms tumor.

Toddler with a large right abdominal mass

Gross pathology image of Wilms tumor — Gross pathological image (left) shows a large, heterogenous mass arising from the inferior pole of the right kidney. Note the claw sign of the renal parenchyma draped along the medial and lateral margins of the mass on the sectioned gross pathological image (right).

The diagnosis was Wilms tumor.

Toddler with a large right abdominal mass

Gross pathology image of Wilms tumor — Sectioned gross pathological image shows a large, heterogenous, round mass arising from the inferior pole of the right kidney. Note the claw sign of the renal parenchyma draped along the lateral margin of the mass.

The diagnosis was Wilms tumor.

Toddler with a large right abdominal mass

Surgical image of Wilms tumor — Surgical image shows a large heterogenous mass in the right kidney (to the right of the surgical field) which was intimately adherent to the ileum and cecum (to the left of the surgical field).

The diagnosis was Wilms tumor.

Toddler with a large right abdominal mass

Gross pathology image of Wilms tumor — Gross pathological image after right nephroureterectomy and en bloc ileocolectomy shows a large heterogenous mass in the right kidney which was intimately adherent to the cecum (held by the forceps on the right) and the ileum (held by the forceps on the left).

The diagnosis was Wilms tumor.

Infant with a mass protruding from the vagina

Clinical image of sarcoma botryoides — Clinical image shows a tan mass with frond-like excrescences protruding from the vagina.

The diagnosis was genitourinary rhabdomyosarcoma (sarcoma botryoides).

Infant with a mass protruding from the vagina

Clinical image of hydrometrocolpos — Clinical image shows a large tan mass protruding from the vagina. Ultrasound of the mass showed it to be distended with fluid and in continuity with the uterus and vagina.

The diagnosis was hydrometrocolpos.

Infant with a mass protruding from the vagina

Clinical image of prolapsed ectopic ureterocele — Clinical image shows a purple mass protruding from the vagina. Ultrasound of the mass showed it to be cystic. Renal ultrasound showed the left kidney to be duplicated with hydronephrosis of the upper pole.

The diagnosis was a prolapsed ectopic ureterocele in a patient with a duplicated kidney.

Newborn with an enlarged left testis and left scrotal erythema and edema

Surgical image of testicular torsion — Surgical image (above) shows left extravaginal testicle torsion with the spermatic cord twisted 360 degrees. Surgical image (below) after left testicle detorsion shows the discrepancy in appearance between the two testicles with the now detorsed left testicle appearing congested, enlarged and necrotic. The left testicle did not appear viable. A left orchiectomy and right orchiopexy were performed.

The diagnosis was left testicle torsion.

Newborn with a sacral mass

Gross pathology image of sacrococcygeal teratoma — Gross pathological images (above) and cut gross pathological images (below) show the lesion to have a variable appearance with soft, tan areas, multiple small cysts and foci of hemorrhage. No hair or teeth were seen. A single soft tissue focus that resembled brain tissue was noted. Microscopic foci of embryonal carcinoma and endodermal sinus tumor were noted. The findings were consistent with a diagnosis of immature teratoma.

The diagnosis was sacrococcygeal teratoma.

Newborn with a sacral mass

Clinical image of sacrococcygeal teratoma — Clinical image shows a large exophytic soft tissue mass in the region of the sacrum.

The diagnosis was sacrococcygeal teratoma.

Fetus with a large buttock mass on prenatal ultrasound

Gross pathology image of sacrococcygeal teratoma — Postmortem open (left) and sagittally sectioned (right) gross pathological images show the extent of the intrapelvic extension of the massive tumor arising from the sacrococcygeal region.

The diagnosis was sacrococcygeal teratoma.

Fetus with a large buttock mass on prenatal ultrasound

Gross pathology image of sacrococcygeal teratoma — Postmortem gross pathological images show a massive tumor arising from the sacrococcygeal region.

The diagnosis was sacrococcygeal teratoma.

School ager with 3 days of abdominal distension

Gross pathology image of ovarian endodermal sinus tumor — Gross pathological image (above) shows a large lesion adjacent to the fallopian tube. The cut surface of the lesion (below) is hemorrhagic and cystic.

The diagnosis was ovarian endodermal sinus tumor.

School ager with 3 days of abdominal distension

Clinical image of ovarian endodermal sinus tumor — AP (above) and lateral (below) clinical images show the abdomen to be distended with superficial collateral veins. A large mass was palpable. A fluid wave was present, along with tympany.

The diagnosis was ovarian endodermal sinus tumor.

Infant with an incidental calcification noted on an AXR

Gross pathology image of in-utero ovarian torsion — Gross pathological image shows the mass to be circular and cystic (above). Upon sectioning, the thin-walled cyst was filled with hemorrhagic and fibrinous material (below).

The diagnosis was in-utero ovarian torsion resulting in an infarcted ovary.

School ager with diffuse abdominal pain

Surgery image of ovarian torsion — Surgical image (above) shows the right ovary to be enlarged and purple in color (upper right of image), while the normal left ovary is small in size and white (middle of the image). Surgical image (below) further shows the enlarged right ovary twisted 360 degrees upon its pedicle.

The diagnosis was right ovarian torsion.

Infant with an ovarian cyst on prenatal ultrasound

Gross pathology image of in-utero ovarian torsion — Gross pathological image (above) shows the mass to be circular and cystic. Upon sectioning, the thin-walled cyst was filled with hemorrhagic, fibrinous material (below). Solid areas were not present.

The diagnosis was in-utero ovarian torsion due to a neonatal ovarian cyst resulting in an infarcted ovary.

Toddler with weight loss and respiratory distress

Surgery image of thoracic neuroblastoma — Surgical image taken through a left thoracoabdominal incision shows a large tumor adherent posteriorly to the chest wall and spine. The lungs are superior to the tumor. The tumor was seen to be entering the tenth through twelfth neural foramina. The tumor was also adherent to the diaphragm and could be felt going through the diaphragm into the retroperitoneum. The tumor was resected in block.

The diagnosis was thoracic neuroblastoma.

Toddler with weight loss and respiratory distress

Gross pathology image of thoracic neuroblastoma — Gross pathological image (left) shows a mass which is tan, measuring 12 x 10 x 5 cm in size, with focal areas of hemorrhage and calcification on its exterior. The cut surface of the mass (right) was whitish gray to hemorrhagic with numerous foci of yellow calcification. The “tails” at the superior aspect of the specimen correspond to tumor infiltration of intervertebral neural foramina.

The diagnosis was thoracic neuroblastoma.

Toddler with an abdominal mass

Gross pathology image of adrenal neuroblastoma — Gross pathological image shows a hemorrhagic tumor mass with a thin rim of residual normal adrenal gland. The yellowish areas are foci of calcification.

The diagnosis was adrenal neuroblastoma.