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Childhood malignancy is a challenging and emotive area of clinical practice. Radiological investigations such as computed tomography (CT) and magnetic resonance imaging (MRI) may reinforce the suspicion of malignancy and have a profound impact on parental counselling and treatment.
This report highlights recent cases of complex appendicitis where clinical and detailed radiological assessment initially indicated pelvic malignancy.
CASE 1
A post-menarchal 13 year old female presented with weight loss, a two week history of diarrhoea, and a one week history of dysuria. Her brother had been treated for a testicular teratoma. Ultrasound scan had shown a 14 cm pelvic mass and left hydronephrosis.
On assessment by paediatric oncologists, she was apyrexial, wasted, and had a pelvic mass. Provisional diagnosis of an ovarian tumour was made.
Investigations showed leucocytosis (13×109) with neutrophilia, normal serum α-fetoprotein (AFP) and β-HCG, and sterile pyuria. MRI showed a complex …