Pelvic neuroblastoma presenting with acute urinary retention
Published in the journal Urology Case Reports, the authors present a case of a ten-month-old girl who was diagnosed with a pelvic neuroblastoma causing acute urinary retention and acute kidney injury (AKI).

An abdominal ultrasound was significant for distention of the urinary bladder and renal pelvocaliectasis bilaterally. A pelvic ultrasound demonstrated a large soft tissue mass (7.5 × 4.1 × 4.8 cm) in the left pelvis with internal vascularity and numerous scattered calcified foci. A pelvic CT scan revealed a large heterogeneous presacral mass invading the sacral spinal canal and the left posterior paraspinal soft tissues.

Bladder outlet obstruction from the tumor with marked circumferential bladder wall thickening and moderate bilateral hydroureteronephrosis was observed. The rectum was also partially obstructed, with fecal stasis in the colon. A lumbar MRI scan confirmed a large presacral mass extending into and filling the spinal canal between S1-S5 via the neural foramen S2-S3, S3-S4, and S4-S5 on the left and S3-S4 on the right.

The patient underwent urinary catheterization with 260 mL of clear urine and subsequent Foley catheter placement. A biopsy of the presacral mass was performed on the fourth hospital day. Histological examination demonstrated tumor cells with scant cytoplasm which were PGP9.5+, Synaptophysin+, and Chromogranin+. Less than 5% of the tumor cells exhibited differentiation.

Highlights
• Neuroblastomas are tumors that arise from primitive sympathetic ganglion cells and are rarely seen in the pelvic region.

• Neuroblastomas are the most common extracerebral solid tumors in children under the age of five years.

• Acute urinary retention due to extrinsic compression from a pelvic mass is a rare phenomenon in infants.

• Pelvic neuroblastoma may cause acute urinary retention and acute kidney injury.

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