Abstract
Purpose
With the widespread use of the obstetrical ultrasound, identification of a fetal suprarenal mass has become more common. Most of these masses prove to be congenital neuroblastomas (CNB), but the diagnosis is often confused with other benign lesions and the postnatal management remains to be controversial.
Methods
The medical records of 18 patients that underwent primary surgical excision for an antenatally detected suprarenal mass, between January 1995 and April 2009, were reviewed. The clinical, radiological, surgical, and pathological data were collected. Staging evaluation was performed after histological confirmation of the CNB.
Results
There were 13 cases of CNB, 1 adrenal cyst, 2 adrenal hemorrhages, and 2 pulmonary sequestrations. The differential diagnosis was impossible before surgery. Most of the CNBs were stage I (N = 11), with 1 stage IV and 1 stage IV-S. Four patients (3 stage I and 1 stage IV-S) had more than one copy of N-myc gene. The stage I patients were cured by surgery alone, and stage IV patients underwent nine cycles of adjuvant chemotherapy and currently have no evidence of disease. The five benign lesions were cured with excision alone. There were no postoperative complications.
Conclusion
For early diagnosis and treatment, surgical excision should be considered as the primary therapy for an antenatally detected suprarenal mass. The surgery can be safely performed during the neonatal period and provides a cure in most cases.
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References
Nadler EP, Barksdale EM (2000) Adrenal masses in the newborn. Semin Pediatr Surg 9:156–164
Rubenstein SC, Benacerraf BR, Retik AB et al (1995) Fetal suprarenal masses: sonographic appearance and differential diagnosis. Ultrasound Obstet Gynecol 5:164–167
Fénart D, Deville A, Donzeau M et al (1983) Retroperitoneal neuroblastoma diagnosed in utero. Apropos of 1 case. J Radiol 64:359–361
Granata C, Fagnani AM, Gambini C et al (2000) Features and outcome of neuroblastoma detected before birth. J Pediatr Surg 35:88–91
Acharya S, Jayabose S, Kogan SJ et al (1997) Prenatally diagnosed neuroblastoma. Cancer 80:304–310
Sauvat F, Sarnacki S, Brisse H et al (2002) Outcome of suprarenal localized masses diagnosed during the perinatal period: a retrospective multicenter study. Cancer 94:2474–2480
Lin JN, Lin GJ, Hung IJ et al (1999) Prenatally detected tumor mass in the adrenal gland. J Pediatr Surg 34:1620–1623
Hamada Y, Ikebukuro K, Sato M et al (1999) Prenatally diagnosed cystic neuroblastoma. Pediatr Surg Int 15:71–74
Fang SB, Lee HC, Sheu JC et al (1999) Prenatal sonographic detection of adrenal hemorrhage confirmed by postnatal surgery. J Clin Ultrasound 27:206–209
Erbil Y, Salmaslioğlu A, Barbaros U et al (2008) Clinical and radiological features of adrenal cysts. Urol Int 80:31–36
Lee SY, Chuang JH, Huang CB et al (1998) Congenital bilateral cystic neuroblastoma with liver metastases and massive intracystic haemorrhage. Br J Radiol 71:1205–1207
Eklöf O, Mortensson W, Sandstedt B (1986) Suprarenal haematoma versus neuroblastoma complicated by haemorrhage: a diagnostic dilemma in the newborn. Acta Radiol Diagn 27:3–10
Chen CP, Chen SH, Chuang CY et al (1997) Clinical and perinatal sonographic features of congenital adrenal cystic neuroblastoma: a case report with review of the literature. Ultrasound Obstet Gynecol 10:68–73
Shen MR, Lin YS, Huang SC et al (1997) Rapid growth of a fetal abdominal mass: a case report of congenital neuroblastoma. J Clin Ultrasound 25:39–42
Yamagiwa I, Obata K, Saito H (1998) Prenatally detected cystic neuroblastoma. Pediatr Surg Int 13:215–217
Kohdera U, Hattori K, Hattori Y et al (1998) Cystic neuroblastoma identified by prenatal ultrasonography. Pediatr Radiol 28:198
van Noesel MM, Hählen K, Hakvoort-Cammel FG et al (1997) Neuroblastoma 4S: a heterogeneous disease with variable risk factors and treatment strategies. Cancer 80:834–843
Hero B, Simon T, Spitz R et al (2008) Localized infant neuroblastomas often show spontaneous regression: results of the prospective trials NB95-S and NB97. J Clin Oncol 26:1504–1510
Nuchtern JG (2006) Perinatal neuroblastoma. Semin Pediatr Surg 15:10–16
Sklair-Levy M, Lebensart PD, Applbaum YH et al (2001) Percutaneous image-guided needle biopsy in children—summary of our experience with 57 children. Pediatr Radiol 31:732–736
Chen CP, Shih SL, Chuang CY et al (1998) In utero adrenal hemorrhage: clinical and imaging findings. Acta Obstet Gynecol Scand 77:239–241
Mittelstaedt CA, Volberg FM, Merten DF et al (1979) The sonographic diagnosis of neonatal adrenal hemorrhage. Radiology 131:453–457
Pradeep PV, Mishra AK, Aggarwal V et al (2006) Adrenal cysts: an institutional experience. World J Surg 30:1817–1820
Curtis MR, Mooney DP, Vaccaro TJ et al (1997) Prenatal ultrasound characterization of the suprarenal mass: distinction between neuroblastoma and subdiaphragmatic extralobar pulmonary sequestration. J Ultrasound Med 16:75–83
Chowdhury M, Samuel M, Ramsay A et al (2004) Spontaneous postnatal involution of intraabdominal pulmonary sequestration. J Pediatr Surg 39:1273–1275
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Moon, SB., Shin, HB., Seo, JM. et al. Clinical features and surgical outcome of a suprarenal mass detected before birth. Pediatr Surg Int 26, 241–246 (2010). https://doi.org/10.1007/s00383-009-2531-7
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DOI: https://doi.org/10.1007/s00383-009-2531-7