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Image-guided radiofrequency ablation is a well-accepted technique of interventional oncology in adults. To evaluate the efficacy and safety of CT-guided radiofrequency ablation as a minimally invasive treatment for metastatic neoplasms in children. A total of 15 radiofrequency ablation sessions were performed in 12 children and young adults (median age 9.5; range 5–18 years) with metastatic malignancies. Seven children and young adults had secondary hepatic lesions, three had pulmonary and two had bone lesions. Radiofrequency ablation was performed under conscious sedation. The median lesion size was 1.7 cm (range 1.3–2.8 cm). The median time for ablation was 8 min (range 7–10 min). Radiofrequency procedures were technically successful in all tumors. Postablation imaging immediately after, and 1 month and 3 months after radiofrequency ablation showed total necrosis in all patients. At 6-month follow-up, three patients (all with lesion size >2 cm) had local recurrence and underwent a second radiofrequency ablation session. At 2-year follow-up no patient had recurrence of the treated tumor. Post-ablation syndrome occurred in four children. No major complication occurred. CT-guided radiofrequency tumor ablation was safe and efficient for palliative treatment in our cohort of patients.

1. The magnetic resonance (MR) study shows a wedgeshaped area in the right kidney (black arrows), which had homogeneous early arterial enhancement, similar to that of the renal cortex (black arrows). The appearance is consistent with a hypertrophied column of Bertin. Magnetic resonance is helpful in differentiating renal masses that have been found by ultrasound to be suggestive of malignancy. 2. The renal scan shows normal size, shape and contour of both kidneys, with normal homogeneous uptake of the isotope and no photopenic areas. 3. The renal mass represents columns of Bertin, as the wedge-shaped area in the MR study showed arterial enhancement similar to that of the cortex and the renal scan was normal. Commentary

A 6-year-old girl was admitted because of a low-grade fever of 5 days’ duration. She had an isolated, bulging, block of tender, firm, cervical lymph nodes, without erythema or increased temperature of the overlying skin. A full blood count showed white blood cells of 5.7×10/μl, with neutrophils 39%, lymphocytes 51%, monocytes 6%, and eosinophils 4%; hemoglobin level 12.7 g/dl; hematocrit 37.4%; platelets 340×10/μl. The findings of urine analysis were normal. The child was given clindamycin intravenously for 10 days, and the block of lymph nodes gradually resolved. Looking for abdominal masses or para-aortic lymph nodes, we found a discrete mass in the middle right kidney, incidentally identified by ultrasonography (Fig. 1a). We further explored this finding with color Doppler ultrasonography (Fig. 1b), technetium-99m dimercapto-succinic acid (Tc-DMSA) scan, and magnetic resonance (MR) imaging. Pediatr Nephrol (2010) 25:441–442 DOI 10.1007/s00467-009-1216-8