Costello Syndrome and Umbilical Ligament Rhabdomyosarcoma in Two Pediatric Patients: Case Reports and Review of the Literature

Figure 2

Patient 2. (a) Photograph of the physical features of the patient with prominent forehead, low-set ears, lower palpebral fissures, hypertelorism, broad nasal bridge, thick lips, and anteverted slightly nostrils. (b) Initial abdominal ultrasound showing the presence of a tubular image caliber of 5.6 mm extending in the theoretical location of the right umbilical artery. ((c) and (d)) Follow-up abdominal ultrasound in the midline showing a multilobulated hypoechoic solid tumor with marked hypervascularization, extending from the proximity of the abdominal wall to the right supravesical region. (e) MRI onT2-weighted sequence confirms the presence of several nodular masses grouped with thickening of both medial umbilical folds, the right to 4 mm proximal to the umbilicus and 8 mm adjacent to the iliac vessels paravesical region portion. (f) Operative image indicating the presence of tumor originating in the right medial UL.

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