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• Excellent article, but a slight error in Figure One
  Thomas J Jackson
  Published on: 17 May 2019

• Published on: 17 May 2019

  Excellent article, but a slight error in Figure One

  • Thomas J Jackson, Academic Clinical Fellow UCL Great Ormond Street Institute of Child Health

  I congratulate Uzuna, Bailie and Murray on an excellent summary of common oncological abdominal masses and an approach for the general paediatrician. Ensuring that children with abdominal masses are correctly identified, investigated and referred by their local paediatrician is crucial, particularly as there is evidence of later diagnosis in the UK compared to other European countries (Pritchard-Jones et al., 2016)

  They note that urinary catecholamines can be a useful rule-in test for suspected neuroblastoma (90% sensitivity). The Childrens Cancer and Leukaemia Group in the UK recommends that all children with a suspected renal tumour should also have urinary catecholamines assessed to reduce the risk of incorrectly treating a neuroblastoma as it may be difficult to determine if a mass is renal or adrenal by imaging alone. Biopsy of renal tumours in young children without features atypical of Wilms tumour is no longer recommended as it rarely changes clinical management, but this approach will only be successful if the child is fully assess for "atypical features", such as raised urinary catecholamines. In my experience there can be a significant wait for urinary catecholamine results and so having a sample sent by the local team is valuable.

  I would also like to highlight a small error in the legend that they have included for the Figure I provided (Figure 1). The National Cancer Registration and Analysis Service does not routinely include all...

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  I congratulate Uzuna, Bailie and Murray on an excellent summary of common oncological abdominal masses and an approach for the general paediatrician. Ensuring that children with abdominal masses are correctly identified, investigated and referred by their local paediatrician is crucial, particularly as there is evidence of later diagnosis in the UK compared to other European countries (Pritchard-Jones et al., 2016)

  They note that urinary catecholamines can be a useful rule-in test for suspected neuroblastoma (90% sensitivity). The Childrens Cancer and Leukaemia Group in the UK recommends that all children with a suspected renal tumour should also have urinary catecholamines assessed to reduce the risk of incorrectly treating a neuroblastoma as it may be difficult to determine if a mass is renal or adrenal by imaging alone. Biopsy of renal tumours in young children without features atypical of Wilms tumour is no longer recommended as it rarely changes clinical management, but this approach will only be successful if the child is fully assess for "atypical features", such as raised urinary catecholamines. In my experience there can be a significant wait for urinary catecholamine results and so having a sample sent by the local team is valuable.

  I would also like to highlight a small error in the legend that they have included for the Figure I provided (Figure 1). The National Cancer Registration and Analysis Service does not routinely include all benign tumours (such as congenital mesoblastic nephroma) in the database, so the "other cancers" group does not include CMN as stated in the figure legend. Instead, these are neuroendocrine tumours (e.g. PNET), non Hodgkin lymphomas and sarcomas where the initial mass assessed was felt to be renal in origin.

  Based on data from the UK Wilms tumour trials and the SIOP Renal Tumour Study Group trials, mesoblastic nephroma is the most common renal tumour in children under 3 months, but is very rare after 6 months of age. Interested readers wanting to know more about the epidemiology and clinical features of mesoblastic nephroma should read England et al., 2011 or Gooskens et al, 2017.

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  Conflict of Interest:
  None declared.

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