Neonatal Tumors: Imaging Findings and Differential Diagnosis

Tumors presenting in the neonatal period are uncommon and span several organ systems. Age, anatomic compartment, internal tissue composition, vascularity, and evidence of dissemination help narrow the differential. Ultrasound is often the first examination; MRI defines soft-tissue and central nervous system extent, while CT has a selective role when calcification, bone involvement, or urgent staging must be assessed.

Central nervous system

• Teratoma is often large and heterogeneous, with mixed cystic, fatty, and calcified components.
• A pilocytic astrocytoma may appear as a cystic mass with an enhancing mural nodule, although neonatal presentations are variable.
• Embryonal tumor with multilayered rosettes is typically hypercellular, restricts diffusion, and may disseminate through cerebrospinal fluid.
• Desmoplastic infantile ganglioglioma is usually a large superficial cystic-solid mass with dural contact and avid enhancement of the solid component.
• Choroid plexus tumors are vascular intraventricular masses and commonly present with hydrocephalus.

Head, neck, and chest

• An infantile hemangioma is a hypervascular enhancing lesion with flow-related features; a lymphatic malformation is usually multicystic, may contain fluid-fluid levels, and lacks central solid enhancement.