Local Invasion

Extension of disease to lymph nodes adjacent to primary abdominal NB tumors in the renal hila, porta, and retroperitoneum is commonly seen. Separation of the primary tumor from the adjacent involved nodes is often not possible, regardless of the imaging modality utilized. Distant nodal disease, particularly in the neck where they are readily accessible to biopsy, should be identified on CT scans or on coronal MR scans in patients with large unresectable primary tumors, possibly sparing the patient an open biopsy (Abramson et al. 1996). Mediastinal, hilar, paratra-cheal, subcarinal, and azygoesophageal adenopathy can be due to direct extension of large thoraco-abdominal primary tumors or may represent metastatic disease.

Direct invasion of abdominal organs, including liver and kidney, can occasionally be seen. Invasion of the psoas muscle is not uncommon. Pleural effusions are uncommon and are typically observed in the presence of tumor masses that are pleural based or rib lesions. Epidural involvement may be partially identified on CT. Magnetic resonance is necessary for full evaluation of foraminal and epidural tumor extension and possible cord compression (Sofka et al. 1999; Siegel et al. 1986) (Fig. 10.1).

0 0

Post a comment