29 / 238
29
11–14 APRIL, 2018, HELSINKI, FINLAND
MATERIAL AND METHODS
We present a case of a 2-year-old boy who was admitted to the Pediatric Emergency Department
with a large mass occupying the right hemiabdomen and flank. Imaging with ultrasound and MRI
showed a renal tumor with tumor thrombus in the infradiadiaphragmatic subhepatic vena cava
inferior (VCI). Further radiological features were as well typical of Wilms tumor with local lymph
node involvement but without metastases. Correspondingly, no biopsy was performed, and six
weeks of nephroblastoma-specific chemotherapy were applied. Follow-up imaging then showed
tumor progression, combined with clinical deterioration. We decided to proceed to resection without
prior biopsy. Radical tumor nephrectomy with partial VCI resection including tumor thrombus was
performed, with a VCI reconstruction using a biograft interposition.
RESULTS
Histology of the resected tumor revealed a primary renal neuroblastoma, N-myc amplified, and
bone metastases were detected. Multimodal therapy according to the SIOPEN high-risk protocol
was started.
CONCLUSIONS
Primary renal neuroblastoma is an absolute rarity that can be misdiagnosed as Wilms tumor,
especially in the case of tumor thrombus with extension into VCI. In such cases detection of vanil-
lylmandelic acid and homovanillic acid in the urine can lead to the correct diagnosis.
14:26–14:28
S2-9 (CP)
STAGED LAPAROSCOPIC FOWLER STEPHENS
PROCEDURE FOR TRANSVERSE CROSSED TESTICULAR
ECTOPIA: AN UNUSUAL APPROACH FOR A RARE
CONDITION
Francisca YANKOVIC, Francisco REED, Nelly LETELIER, Ricardo ZUBIETA and
Pedro Jose LOPEZ
Hospital exequiel Gonzalez Cortes & Universidad de Chile, Paediatric Urology, Santiago De Chile, CHILE
PURPOSE
Transverse testicular ectopia (TTE) is an extremely rare condition in which both testicles tend to
migrate through the same inguinal canal. We describe two TTE cases with bilateral non-palpable
testis.
MATERIAL AND METHODS
Retrospective review of two patients with TTE. Prior endocrine and genetic evaluation confirmed
46XY karyotype and normal hormones. Patients were managed with a two-stage laparoscopic
Fowler Stephens procedure (FSP) and conjoined descend though a neo-inguinal canal (medial to
the medial umbilical ligament) at the second stage.
RESULTS
Diagnostic laparoscopy identified both intra abdominal testicles with partial fusion of the vas defer-
ens at the proximal end and abnormal localization (crossing the midline) of one of the gonads. A first
bilateral FSP was performed at 12 and 18 months. After 34 and 44 months the second stage was
performed. In both patients the gonads were vital and after preserving a single peritoneal strip from
the partially fused deferens, a conjoined descend of both testicles through the neo-inguinal canal
was made. Afterwards, via a trans-septal positioning, the gonads reached a tension free scrotal
site. Clinical and ultrasound follow up at 6 and 18 months shows adequate testicular position and
symmetrical volume.