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Montero Domínguez C, Ortiz Temprado A, Martínez Figueras L, Guillamón Seoane A, Fernández Ruano M. Biochemical analysis in congenital neuroblastoma. ADVANCES IN LABORATORY MEDICINE 2023; 4:120-127. [PMID: 37359903 PMCID: PMC10197188 DOI: 10.1515/almed-2022-0112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 10/05/2022] [Indexed: 06/28/2023]
Abstract
Objectives The incidence of congenital neuroblastoma has increased in the recent years. The purpose of this study was to describe the clinical and biochemical characteristics of cases of congenital neuroblastoma diagnosed in our center. Case presentation We report three cases of congenital neuroblastoma diagnosed in our hospital. In two, diagnosis was made prenatally, whereas the other case was detected in the immediate neonatal period. In the three cases, neuroblastoma was located in the abdominal region and exhibited elevated concentrations of catecholamines or their metabolites in single voided urine samples. Two tumors were classified as stage M, and one as stage L2. The N-MYC oncogen was not amplified in any of the cases studied. Histopathological analysis was favorable in the three cases. The tumor was resected in two patients. The three received chemotherapy. Conclusions The measurement of catecholamines and their metabolites is essential in the diagnosis of neuroblastoma. When 24 h urine cannot be collected, single voided urine can be used to calculate the index based on creatinine concentrations.
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Affiliation(s)
| | - Alicia Ortiz Temprado
- Service of Clinical Biochemistry, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Laura Martínez Figueras
- Service of Clinical Biochemistry, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Alba Guillamón Seoane
- Service of Clinical Biochemistry, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Miguel Fernández Ruano
- Service of Clinical Biochemistry, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Lazow SP, Richman DM, Dionigi B, Staffa SJ, Benson CB, Buchmiller TL. Prenatal Imaging Diagnosis of Suprarenal Lesions. Fetal Diagn Ther 2021; 48:235-242. [PMID: 33730724 DOI: 10.1159/000512689] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 10/28/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Prenatal suprarenal lesions represent diverse pathologies. This study investigated prenatal imaging features and regression patterns associated with specific lesion diagnoses. METHODS This is a multicenter retrospective review of fetuses with prenatally diagnosed suprarenal lesions between 2001 and 2019. Prenatal ultrasound and MRI characteristics, postnatal imaging, and clinical course were reviewed. Prenatal imaging findings were compared by the most common diagnoses and regression patterns. RESULTS Forty-four fetuses were prenatally diagnosed with suprarenal lesions. Diagnoses included pulmonary sequestration (n = 12; 27.3%), adrenal hemorrhage (n = 12; 27.3%), upper quadrant cyst (including 2 duplication cysts, 1 splenic cyst, and 3 indeterminate cysts), neuroblastoma (n = 4), adrenal hyperplasia (n = 3), bilateral adrenal calcifications (n = 1), and indeterminate lesions (n = 6). Sequestrations were uniformly left-sided (100 vs. 50%; p = 0.014) and diagnosed earlier in gestation than adrenal hemorrhages (p = 0.025). Sequestrations were also significantly more likely to have a prenatal feeding vessel (p = 0.005), low T1 MRI signal (p = 0.015), and no MRI blood products (p = 0.018) compared to adrenal hemorrhages. When comparing all 44 patients, a prenatal feeding vessel and low T1 signal on prenatal MRI were significantly associated with lesion persistence (p = 0.003; p = 0.044). DISCUSSION/CONCLUSION Imaging findings on prenatal ultrasound and MRI aid in the diagnosis of suprarenal lesions, including differentiating pulmonary sequestrations and adrenal hemorrhages.
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Affiliation(s)
- Stefanie P Lazow
- Department of Surgery, Boston Children's Hospital/Harvard Medical School, Boston, Massachusetts, USA
| | - Danielle M Richman
- Department of Radiology, Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts, USA
| | - Beatrice Dionigi
- Department of Surgery, Boston Children's Hospital/Harvard Medical School, Boston, Massachusetts, USA.,Department of Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Steven J Staffa
- Department of Anesthesiology, Critical Care and Pain Medicine Research, Boston Children's Hospital/Harvard Medical School, Boston, Massachusetts, USA
| | - Carol B Benson
- Department of Radiology, Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts, USA
| | - Terry L Buchmiller
- Department of Surgery, Boston Children's Hospital/Harvard Medical School, Boston, Massachusetts, USA,
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Masmejan S, Baud D, Ryan G, Van Mieghem T. Management of fetal tumors. Best Pract Res Clin Obstet Gynaecol 2019; 58:107-120. [PMID: 30770283 DOI: 10.1016/j.bpobgyn.2019.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 01/07/2019] [Accepted: 01/08/2019] [Indexed: 12/28/2022]
Abstract
In this review article, we discuss the most common fetal tumors, their prenatal management, and outcomes. Overall, the most important outcome predictors are tumor histology, size, vascularity, and location. Very large lesions, lesions causing cardiac failure, and hydrops and lesions obstructing the fetal airway have the poorest outcome, as they may cause fetal death or complications at the time of delivery. Fetal therapy has been developed to improve outcomes for the most severe cases and can consist of transplacental therapy (sirolimus for rhabdomyomas or steroids for hemangiomas and microcystic lung lesions) or surgical intervention (shunting of cystic masses, tumor ablation, occlusion of blood flow or airway exploration, and protection). Given the rarity of fetal tumors, patients should be referred to expert centers where care can be optimized and individualized to allow the best possible outcomes.
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Affiliation(s)
- Sophie Masmejan
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, Mount Sinai Hospital and University of Toronto, Toronto, Canada; Obstetrics Unit, Mother-Child Department, University Hospital Lausanne, Switzerland
| | - David Baud
- Obstetrics Unit, Mother-Child Department, University Hospital Lausanne, Switzerland
| | - Greg Ryan
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, Mount Sinai Hospital and University of Toronto, Toronto, Canada
| | - Tim Van Mieghem
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, Mount Sinai Hospital and University of Toronto, Toronto, Canada.
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Swift CC, Eklund MJ, Kraveka JM, Alazraki AL. Updates in Diagnosis, Management, and Treatment of Neuroblastoma. Radiographics 2018. [DOI: 10.1148/rg.2018170132] [Citation(s) in RCA: 103] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Caroline C. Swift
- From the Department of Radiology and Radiological Science (C.C.S., M.J.E.) and Department of Pediatrics (J.M.K.), Medical University of South Carolina, 96 Jonathan Lucas St, MSC 323, Suite 210, Charleston, SC 29425; and Department of Radiology and Imaging Sciences, Emory University, Atlanta, Ga (A.L.A.)
| | - Meryle J. Eklund
- From the Department of Radiology and Radiological Science (C.C.S., M.J.E.) and Department of Pediatrics (J.M.K.), Medical University of South Carolina, 96 Jonathan Lucas St, MSC 323, Suite 210, Charleston, SC 29425; and Department of Radiology and Imaging Sciences, Emory University, Atlanta, Ga (A.L.A.)
| | - Jacqueline M. Kraveka
- From the Department of Radiology and Radiological Science (C.C.S., M.J.E.) and Department of Pediatrics (J.M.K.), Medical University of South Carolina, 96 Jonathan Lucas St, MSC 323, Suite 210, Charleston, SC 29425; and Department of Radiology and Imaging Sciences, Emory University, Atlanta, Ga (A.L.A.)
| | - Adina L. Alazraki
- From the Department of Radiology and Radiological Science (C.C.S., M.J.E.) and Department of Pediatrics (J.M.K.), Medical University of South Carolina, 96 Jonathan Lucas St, MSC 323, Suite 210, Charleston, SC 29425; and Department of Radiology and Imaging Sciences, Emory University, Atlanta, Ga (A.L.A.)
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Cho YH, Kim SH, Kim HY, Han YM, Lee NR, Bae MH, Park KH, Byun SY. Clinical Implication of Surgically treated Abdominoperineal Soild Tumor in the Newborn : A Single-Center Experience. NEONATAL MEDICINE 2018. [DOI: 10.5385/nm.2018.25.1.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Yong-Hoon Cho
- Division of Pediatric Surgery, Department of Surgery, Pusan National University School of Medicine, Yangsan, Korea
| | - Soo-Hong Kim
- Division of Pediatric Surgery, Department of Surgery, Pusan National University School of Medicine, Yangsan, Korea
| | - Hae-Young Kim
- Division of Pediatric Surgery, Department of Surgery, Pusan National University School of Medicine, Yangsan, Korea
| | - Young-Mi Han
- Division of Neonatology, Department of Pediatrics, Pusan National University School of Medicine, Yangsan, Korea
| | - Na-Rae Lee
- Division of Neonatology, Department of Pediatrics, Pusan National University School of Medicine, Yangsan, Korea
| | - Mi-Hye Bae
- Division of Neonatology, Department of Pediatrics, Pusan National University School of Medicine, Yangsan, Korea
| | - Kyung-Hee Park
- Division of Neonatology, Department of Pediatrics, Pusan National University School of Medicine, Yangsan, Korea
| | - Shin-Yun Byun
- Division of Neonatology, Department of Pediatrics, Pusan National University School of Medicine, Yangsan, Korea
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Fatal Congenital Retroperitoneal Neuroblastoma Diagnosed by Fetal Magnetic Resonance Imaging. J Comput Assist Tomogr 2016; 41:651-652. [PMID: 27997441 DOI: 10.1097/rct.0000000000000563] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Congenital extra-adrenal neuroblastoma is a rare condition, which typically has a favorable prognosis. We present a unique case of extra-adrenal retroperitoneal neuroblastoma diagnosed by fetal magnetic resonance imaging, which ultimately leads to fetal hydrops and neonatal death.
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7
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Congenital Adrenal Neuroblastoma With and Without Cystic Change: Differentiating Features With an Emphasis on the of Value of Ultrasound. AJR Am J Roentgenol 2016; 207:1105-1111. [PMID: 27556888 DOI: 10.2214/ajr.16.16452] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to compare the features of congenital adrenal neuroblastomas with and without cystic changes and to emphasize the value of ultrasound in the diagnostic evaluation of cystic congenital adrenal neuroblastoma. MATERIALS AND METHODS A total of 41 patients with surgically confirmed congenital adrenal neuroblastoma were enrolled. We divided the patients into two groups according to presence or absence of cystic change in the tumor, as determined from the initial ultrasound findings. Clinical and laboratory findings, disease stage, and patient outcome were investigated with a statistical comparison between the two groups. The imaging findings for cystic congenital adrenal neuroblastoma were reviewed to compare the additional diagnostic value of CT and MRI when paired with ultrasound. RESULTS There were 22 patients (54%) in the group without cystic changes and 19 patients (46%) in the group with cystic changes. Prenatal detection and absence of metastasis were significantly more common in the cystic group than in the noncystic group (p < 0.05). Sensitivities of tumor marker levels were also significantly lower in the cystic group. Patient outcome was excellent, and there was no significant difference between the groups. With regard to imaging of cystic congenital adrenal neuroblastoma, in the 15 cases in which CT or MRI was paired with ultrasound, no additional diagnostic information was discerned with CT or MRI. CONCLUSION Nearly one-half of congenital adrenal neuroblastomas are cystic, and these tumors have clinical and laboratory features that distinguish them from noncystic congenital adrenal neuroblastoma. Diagnostic tests, including CT, MRI, and assessment of tumor markers, have low diagnostic value in the evaluation of cystic congenital adrenal neuroblastoma.
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Abstract
BACKGROUND Prior research on trends in neuroblastoma incidence has conflicted. We aimed to compare how ganglioneuroblastoma and neuroblastoma incidence have changed. PROCEDURE Using the Surveillance Epidemiology and End Results (SEER) 9 population-based registry, we identified 2081 malignant peripheral neuroblastic tumors in patients 0 to 14 years from 1973 to 2009. Age-adjusted annual incidence rates were calculated using SEER*Stat, and Joinpoint Regression Program was used to calculate annual percent change (APC) and analyze trends. Data were stratified by histology, age, and stage. RESULTS Overall peripheral neuroblastic tumor incidence increased by an APC of 0.47 (P=0.045). However, ganglioneuroblastoma incidence decreased (APC=-1.48; P=0.003), whereas neuroblastoma incidence increased (APC=0.79; P=0.008). When divided by age and stage, locoregional neuroblastoma incidence increased in infants until a significant inflection point in 1996 (APC=4.19; P<0.001) and then decreased sharply (APC=-6.80; P=0.160). CONCLUSIONS Ganglioneuroblastoma incidence has decreased, whereas neuroblastoma incidence has increased. These changes could be real, or reflect bias from classification changes or increased detection. Neuroblastoma incidence increased most markedly in infants with locoregional disease only until 1996, then declined, which may reflect changes in tumor ascertainment and folate supplementation.
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Koh V, Soh SY, Chan MY, Tan AM. Neuroblastoma in Children Under 12 Months in Singapore--15-Year Experience and Outcomes From KKH. Fetal Pediatr Pathol 2015; 34:155-61. [PMID: 25616021 DOI: 10.3109/15513815.2014.999392] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Expectant observation of small adrenal lesions has shown promising results in recent studies. We present our 15 years outcome of managing infant neuroblastoma. METHODS All patients with neuroblastoma below the age of 1 year treated at the largest pediatric hospital in Singapore between 1998 and 2012 were identified. RESULTS Twenty-two patients were included in our study. Six were antenatally diagnosed. Nineteen (86%) patients had surgical resection of the tumor. Eight (36%) patients received chemotherapy as part of their treatment. Six patients were observed three of which had large adrenal tumors. Median follow-up in our series was 2.6 years. The 5 year overall survival was 90%. There were no recurrences and there were 2 deaths in our series. CONCLUSION Our series shows excellent outcomes of infant neuroblastoma at our center. Careful observation of large tumors may be an option to avoid the morbidity of surgery.
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Affiliation(s)
- Vicky Koh
- Radiation Oncology, National University Cancer Institute , Singapore , Singapore
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10
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Saettini F, Agazzi R, Giraldi E, Foglia C, Cavalleri L, Morali L, Fasolini G, Spotti A, Provenzi M. Percutaneous transhepatic biliary drainage in an infant with obstructive jaundice caused by neuroblastoma. Pediatr Hematol Oncol 2015; 32:223-8. [PMID: 25551550 DOI: 10.3109/08880018.2014.981901] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Neuroblastoma presenting with obstructive jaundice is a rare event. Management of this condition includes surgery, chemotherapy, radiotherapy, temporary cholecystostomy tube, endoscopic retrograde cholangiopancreatography (ERCP), and internal biliary drainage (IBD). We herein describe our experience with one infant affected by neuroblastoma presenting with jaundice, who successfully underwent percutaneous transhepatic biliary drainage (PTBD). This report introduces PTBD as a viable treatment option for neuroblastoma and obstructive jaundice and provides a review of the pertinent literature.
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Affiliation(s)
- Francesco Saettini
- 1Department of Pediatrics, Oncohematology Unit, Ospedale Papa Giovanni XXIII - University of Milan-Bicocca , Bergamo , Italy
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11
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Agarwala S, Mandelia A, Bakhshi S, Srinivas M, Bajpai M, Gupta AK, Gupta DK, Bhatnagar V. Neuroblastoma: outcome over a 14 year period from a tertiary care referral centre in India. J Pediatr Surg 2014; 49:1280-5. [PMID: 25092090 DOI: 10.1016/j.jpedsurg.2014.03.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2013] [Revised: 03/18/2014] [Accepted: 03/20/2014] [Indexed: 11/27/2022]
Abstract
PURPOSE To evaluate the outcome of children with neuroblastoma (NB) from a tertiary care referral centre in India. METHOD All children with NB registered from October 1996 through July 2009 were included in the study. INSS was used for staging. All children included in the study received chemotherapy and radiation therapy appropriate for stage. Tumor resection was done when feasible. The final outcome was overall survival and it was categorized as Complete Response (CR), Partial Response (PR); No Response (NR) and Progressive Disease (PD). Analysis of three-year overall survival was done using Kaplan Meier method and Log Rank test of significance. Multivariate analysis for significance of age, site and stage was performed. RESULTS 144 children in the age range of 1-132months (median 36) were enrolled. Only 38 (26.4%) children were below 12months. 112 (77.8%) of the tumors were abdominal and 32 (22.2%) were extra-abdominal. Stage distribution was 1+2 in 6 (4.2%); 3 in 58 (40.3%); 4 in 68 (47.2%); 4s in 12 (8.3%). 83 (57.6%) underwent gross complete resection. At the time of last follow-up, 100 (69.4%) were alive [60 CR (41.7%); 33 PR; 7 PD/NR] and 44 (30.6%) were dead [1CR; 11PR; 32 PD/NR]. The three-year OS was 60.7% [95 CI 50.4-69.5]. The OS was 69.7% for those<12months of age [95 CI 51.8-82.0] and CR was achieved in 57.9%, while for those >12months the OS was 55.3% [95 CI 42.2-66.6] and CR was achieved in 35.8% (p=0.73). All 6 (100%) patients with Stage 1 and Stage 2 disease were alive and disease free. The OS was 71.5% for Stage 3[95 CI 55.3-82.7] and CR was achieved in 56.9%, while for Stage 4 the OS was 35.7%[95 CI 19.3-52.4] and CR was achieved in 17.6% (p=0.001). The OS was 83.3% for 4s [95 CI 48.2-95.6] and CR was achieved in 75%. CONCLUSION All the six children with Stage 1 & 2 achieved CR and were alive, while 57% of Stage 3 could achieve CR and had an OS of 71.5%. The OS (35.7%) and CR (17.6%) for Stage 4 were significantly less (p=0.001).
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Affiliation(s)
- Sandeep Agarwala
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi-110029, India.
| | - Ankur Mandelia
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi-110029, India
| | - Sameer Bakhshi
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi-110029, India
| | - M Srinivas
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi-110029, India
| | - Minu Bajpai
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi-110029, India
| | - Arun K Gupta
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi-110029, India
| | - Devendra K Gupta
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi-110029, India
| | - Veereshwar Bhatnagar
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi-110029, India
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Costa AD, Zerbini MCN, Cristofani L. Metastatic congenital neuroblastoma associated with in situ neuroblastoma: case report and review of literature. AUTOPSY AND CASE REPORTS 2014; 4:27-33. [PMID: 28580324 PMCID: PMC5448299 DOI: 10.4322/acr.2014.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 06/15/2014] [Indexed: 11/23/2022] Open
Abstract
Although neonatal tumors are rare, neuroblastoma is the most common neoplasia among them. These tumors, which usually involve children in early infancy, are derived from neural crest cells of adrenal gland medulla or sympathetic ganglia. Even though congenital metastatic neuroblastoma presents a favorable prognosis, it may lead to death if not recognized and treated early on. The authors report the case of a 2-month-old child who was born from in vitro fertilization, and whose diagnosis was made after birth. The form of presentation of this case as a metastatic disease concerning this age group is noteworthy.
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Affiliation(s)
- Andressa Dias Costa
- Pathology Department - Hospital das Clínicas - Faculdade de Medicina - Universidade de São Paulo, São Paulo/SP - Brazil
| | | | - Lilian Cristofani
- Department of Pediatrics - Faculdade de Medicina - Universidade de São Paulo, São Paulo/SP - Brazil
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Cho JY, Lee YH. Fetal tumors: prenatal ultrasonographic findings and clinical characteristics. Ultrasonography 2014; 33:240-51. [PMID: 25116458 PMCID: PMC4176115 DOI: 10.14366/usg.14019] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Revised: 06/19/2014] [Accepted: 06/20/2014] [Indexed: 11/03/2022] Open
Abstract
The incidence of fetal tumors has been increased due to generalization of prenatal evaluation and improvement of imaging techniques. The early detection of a fetal tumor and understanding of its imaging features are very important for fetal, maternal, and neonatal care. Ultrasonography is usually used for the detection and differential diagnosis of fetal tumors, and magnetic resonance imaging is increasingly being used as a complementary study. Many fetal tumors have different clinical and imaging features compared with pediatric tumors. Although several fetal tumors may mimic other common anomalies, some specific imaging features may carry early accurate diagnosis of fetal tumors, which may alter the prenatal management of a pregnancy and the mode of delivery, and facilitate immediate postnatal treatment.
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Affiliation(s)
- Jeong Yeon Cho
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea ; Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea ; Kidney Research Institute, Seoul National University Medical Research Center, Seoul, Korea
| | - Young Ho Lee
- Department of Radiology, Cheil General Hospital & Women's Healthcare Center, Kwandong University College of Medicine, Seoul, Korea
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Singh P, Jodicke C, Swanson T, Maulik D. Thoracic ganglioneuromas resulting in nonimmune hydrops fetalis. AJP Rep 2014; 4:49-54. [PMID: 25032061 PMCID: PMC4078144 DOI: 10.1055/s-0034-1371751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2013] [Accepted: 01/20/2014] [Indexed: 10/27/2022] Open
Abstract
Introduction Most often, ganglioneuromas affect older pediatric and adult patients. They are typically slow growing tumors that remain clinically silent until they become large enough to cause symptoms by compression of adjacent structures. Case We report a case of a 22-year-old Hispanic gravida 2 para 1 female patient who was found to have massive hydrops fetalis at 20 completed gestational weeks. Fetal echocardiography revealed a narrowed distal ductal arch and proximal descending aorta. Cesarean delivery was undertaken at 29 completed gestational weeks for refractory labor and nonreassuring fetal status. The neonate expired at 47 minutes of life despite aggressive resuscitation. At autopsy, multiple thoracic masses were found adjacent to a compressed proximal descending aorta. Histological and immunohistochemical analysis confirmed the diagnosis of a ganglioneuroma, a rare type of neural crest tumor. Discussion A variety of intrathoracic masses have previously been reported to cause hydrops fetalis including teratomas, fibrosarcomas, and lymphangiomas. To our knowledge, this case is the first description of hydrops fetalis caused by ganglioneuromas. We propose that multiple thoracic ganglioneuromas led to biventricular distal outflow tract obstruction and hydrops fetalis.
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Affiliation(s)
- Paul Singh
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Missouri Kansas City School of Medicine, Kansas City, Missouri
| | - Cristiano Jodicke
- Division of Maternal Fetal Medicine and Staff Physician, Department of Obstetrics and Gynecology, Children's Mercy Hospital, Fetal Health Center, University of Missouri Kansas City School of Medicine, Kansas City, Missouri
| | - Tara Swanson
- Division of Pediatric Cardiology, Department of Pediatrics, Children's Mercy Hospital, University of Missouri Kansas City School of Medicine, Kansas City, Missouri
| | - Dev Maulik
- Department of Obstetrics and Gynecology, UMKC School of Medicine, Kansas City, Missouri ; Department of Obstetrics and Gynecology, Truman Medical Center, Kansas City, Missouri ; Department of Maternal Fetal Medicine, Children's Mercy Hospital, Kansas City, Missouri
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Prenatal diagnosis of adrenal neuroblastoma: a case report with a brief review of the literature. Case Rep Obstet Gynecol 2013; 2013:506490. [PMID: 23607014 PMCID: PMC3623461 DOI: 10.1155/2013/506490] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Accepted: 03/12/2013] [Indexed: 11/18/2022] Open
Abstract
A case of adrenal cystic neuroblastoma detected at 37 weeks of gestation is reported. Postnatal ultrasonographic examination showed slightly increased in size demonstrating marked septations within the cyst. After the tumor was resected, histopathological examinations confirmed the diagnosis. The patient is developing normally at 1 year of age.
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Abstract
PURPOSE OF REVIEW This review outlines the current approaches to prenatal imaging, differential diagnosis, antenatal natural history, and the available treatment options for the most commonly prenatally diagnosed malignant tumors. RECENT FINDINGS In-utero diagnosis of fetal tumors, although still a rare event, has become more common as prenatal imaging modalities have improved. In general, this prenatal diagnosis allows more informed prenatal counseling and better perinatal planning for potentially high-risk deliveries. There are rare indications for prenatal fetal intervention. SUMMARY Diagnosis of a fetal tumor should prompt referral to a specialized center. Further understanding of these rare patients will require multicenter collaboration.
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Garnier S, Maillet O, Haouy S, Saguintaah M, Serre I, Galifer RB, Forgues D, Guibal MP, Allal H, Sabatier E, Kalfa N. Prenatal intrarenal neuroblastoma mimicking a mesoblastic nephroma: a case report. J Pediatr Surg 2012; 47:e21-3. [PMID: 22901938 DOI: 10.1016/j.jpedsurg.2012.03.090] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Revised: 01/26/2012] [Accepted: 03/10/2012] [Indexed: 11/29/2022]
Abstract
Mesoblastic nephroma is by far the most frequent intrarenal fetal tumor. To the best of our knowledge, we report the first case of a newborn with an intrarenal neuroblastoma that was discovered prenatally. An intrarenal echogenic and homogenous mass was observed on routine prenatal ultrasonography, corroborated by magnetic resonance imaging, in a 30-week gestation fetus. A male weighing 3280 g was born with elevated blood pressure and cardiac failure. Postnatal ultrasound confirmed a left intrarenal tumor with microcalcifications and perirenal adenopathy. An open total left nephrectomy by laparotomy was performed. The pathologic study reported that the mass was an intrarenal neuroblastoma with local and regional invasion. Immediate postoperative urine analysis revealed a high level of vanillylmandelic acid, and blood samples showed high levels of normetanephrine. The purpose of this report is to demonstrate that prenatal intrarenal neuroblastoma can clinically and radiologically mimick a mesoblastic nephroma. High blood pressure, calcifications, and lymphadenopathy on ultrasound should raise the index of suspicion for a possible malignant process. Preoperative measurement of urinary vanillylmandelic acid (VMA) and metanephrines should be performed if the diagnosis is in doubt.
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Affiliation(s)
- Sarah Garnier
- Département de chirurgie viscérale et urologique pédiatrique, Pôle enfant, Hôpital Lapeyronie, 34295 Montpellier, France
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Bhatnagar SN, Sarin YK. Neuroblastoma: a review of management and outcome. Indian J Pediatr 2012; 79:787-92. [PMID: 22528697 DOI: 10.1007/s12098-012-0748-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Accepted: 03/19/2012] [Indexed: 12/14/2022]
Abstract
Solid tumors in children are a major cause of death in the developed countries and now even in the developing countries. Of these tumors, neuroblastoma, the most common tumor in children, despite extensive and on-going research and clinical trials still remains an enigma. About 50 % of children with neuroblastoma overall succumb to the disease. This tumor generates lot of curiosity in developing newer therapies for management, but creates equal amount of frustration albeit a risk-stratification system, patients with the same clinical-pathologic parameters and being treated with the same protocols may have markedly different clinical courses and outcomes. Most of the neuroblastomas are sporadic but some are familial. This article aims at understanding the different protocols existing for the risk stratification and management of neuroblastomas. Further, it also aims to study the outcomes of the several different stages of the tumor all across the country as well as in India.
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Affiliation(s)
- Sushmita Nitin Bhatnagar
- Department of Pediatric Surgery, B.J. Wadia Hospital for Children, Acharya Donde Marg, Parel, Mumbai, Maharashtra, 400 012, India.
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19
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20
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Kostyrka B, Li J, Soundappan SV, Cassey J, Alvaro F, Dalla Pozza L, Kumar R. Features and outcomes of neonatal neuroblastoma. Pediatr Surg Int 2011; 27:937-41. [PMID: 21710243 DOI: 10.1007/s00383-011-2937-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/30/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE Neonatal neuroblastoma (NNBL) is a rare tumour with few reported cases in the literature. The prognosis of NNBL is unclear with reported survival between 76 and 91%. The growing use of ante-natal ultrasound (USS) in recent years has resulted in an increasing incidence of NNBL. The purpose of this study is to review our experience with incidence, clinical features and outcome of NNBL in those children diagnosed ante-natally compared to those diagnosed post-natally. METHODS Twelve cases of NNBL were detected ante-natally or in the neonatal period (0-28 days) from a cohort of 120 children diagnosed with neuroblastoma (10%) over a 10-year period at the study institutions. Review of these 12 children forms the basis of this report. RESULTS Ante-natal diagnosis (ADNB) was made in six children (50%) and post-natal diagnosis (PDNB) in six (50%). Tumour site in both cohorts were predominantly adrenal and tumour staging was similar in both groups. There was no difference in outcome in ADNB compared to PDNB with overall 100% survival for the entire group. CONCLUSIONS NNBL is a subset of neuroblastoma with apparent excellent outcome irrespective of the time of diagnosis. Clinical features and outcomes of ADNB are no different to PDNB.
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Affiliation(s)
- B Kostyrka
- Department of Paediatric Surgery, John Hunter Children's Hospital, Hunter Region Mail Centre, Newcastle, NSW, Australia
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21
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Haupt R, Garaventa A, Gambini C, Parodi S, Cangemi G, Casale F, Viscardi E, Bianchi M, Prete A, Jenkner A, Luksch R, Di Cataldo A, Favre C, D'Angelo P, Zanazzo GA, Arcamone G, Izzi GC, Gigliotti AR, Pastore G, De Bernardi B. Improved survival of children with neuroblastoma between 1979 and 2005: a report of the Italian Neuroblastoma Registry. J Clin Oncol 2010; 28:2331-8. [PMID: 20351331 DOI: 10.1200/jco.2009.24.8351] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To describe treatment, clinical course, and survival of a cohort of Italian patients with neuroblastoma. PATIENTS AND METHODS The study includes data from 2,216 children (age 0 to 14 years) diagnosed between 1979 and 2005. Overall survival (OS) was analyzed by clinical and biologic features at presentation and periods of diagnosis: 1979 to 1984, 1985 to 1991, 1992 to 1998, and 1999 to 2005. The relative risk of second malignant neoplasm (SMN) was assessed by the standardized incidence ratio (SIR), with the Italian population selected as referent. RESULTS Yearly patient accrual increased over time from 58 to 102. Patients age 0 to 17 months represented 45.6% of the total population, and their incidence increased over time from 36.5% to 48.5%. The incidence of stage 1 patients increased over time from 5.8% to 23.2%. A total of 898 patients (40.5%) developed disease progression or relapse, 19 patients developed SMN, and two patients developed myelodysplasia. The cumulative risk of SMN at 20 years was 7.1%, for an SIR of 8.4 (95% CI, 5.1 to 13.2). A total of 858 patients (39%) died (779 of disease, 71 of toxicity, six of SMN, and two of tumor-unrelated surgical complications). Ten-year OS was 55.3% (95% CI, 53.0% to 57.6%) and increased over time from 34.9% to 65.0%; it was significantly better for females and patients age 0 to 17 months at diagnosis, with extra-abdominal primary, and stage 1 and 2 disease. OS improved significantly over time in stage 1 and 3 patients. In patients with stage 4 disease, the improvement occurred between the first and second time cohorts (6.7% v 23.5%), but not afterward. CONCLUSION The outcome of children with neuroblastoma has progressively improved. Long-term survivors bear a significant risk of SMN.
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Affiliation(s)
- Riccardo Haupt
- Epidemiology and Biostatistics Section, Scientific Directorate, Department of Hematology-Oncology, and Laboratories of Diagnostic Pathology and Clinical Chemistry, Giannina Gaslini Children's Hospital, Genova, Italy.
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22
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Moon SB, Shin HB, Seo JM, Lee SK. Clinical features and surgical outcome of a suprarenal mass detected before birth. Pediatr Surg Int 2010; 26:241-6. [PMID: 19908050 DOI: 10.1007/s00383-009-2531-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/27/2009] [Indexed: 11/29/2022]
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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Affiliation(s)
- Suk-Bae Moon
- Division of Pediatric Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, #50 Ilwon-dong, Gangnam-gu, Seoul, 135-710, Korea
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23
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Kumar HR, Sandoval JA, Lovell MA, Fenton LZ, Bealer JF. Primary pancreatic neuroblastoma: an unusual tumor in infancy. J Pediatr Surg 2010; 45:642-6. [PMID: 20223336 DOI: 10.1016/j.jpedsurg.2009.12.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2009] [Revised: 12/22/2009] [Accepted: 12/23/2009] [Indexed: 11/26/2022]
Abstract
Fetal imaging has dramatically impacted neonatal care by providing an advanced warning of many different congenital anomalies. The advancements and widespread use of fetal imaging has, however, increased the identification of various incidental findings that is creating new challenges for neonatal diagnosis and treatment. We report such a case where a fetal pancreatic neuroblastoma (NB) was incidentally detected by computed tomographic scan of the maternal abdomen. Primary pancreatic NB is a very uncommon childhood neoplasm that, to our knowledge, has never been previously reported in the English language presenting in either the prenatal or neonatal periods. A 21-year-old woman complaining of acute abdominal pain and carrying a 35 weeks' gestation fetus was referred for computed tomographic scan because of the concern of maternal appendicitis. That scan was inconclusive for appendicitis but did incidentally detect a fetal mass in the general region of the pancreas. At 36 weeks' gestation, the fetus developed signs of distress, which prompted a cesarean delivery. Neonatal workup confirmed the presence of an abdominal mass in the region of the pancreas, but precise anatomic localization was not possible. Also noted on neonatal workup were elevated urinary catecholamines consistent with a hormonal active tumor. These findings prompted an abdominal exploration of this neonate, which revealed a solid tumor contained in the distal pancreas. The mass was managed by an uncomplicated distal pancreatectomy. The neonate fully recovered, and histologic diagnosis revealed NB, whereas the postoperative urine catecholamines normalized. This case underscores the unintended clinical challenges created by widespread fetal imaging, while presenting the first prenatally diagnosed case in the English language medical literature and earliest treated patient with pancreatic NB.
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Affiliation(s)
- Hari R Kumar
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA
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24
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Gigliotti AR, Di Cataldo A, Sorrentino S, Parodi S, Rizzo A, Buffa P, Granata C, Sementa AR, Fagnani AM, Provenzi M, Prete A, D'Ippolito C, Clerico A, Castellano A, Tonini GP, Conte M, Garaventa A, De Bernardi B. Neuroblastoma in the newborn. A study of the Italian Neuroblastoma Registry. Eur J Cancer 2009; 45:3220-7. [PMID: 19767197 DOI: 10.1016/j.ejca.2009.08.020] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2009] [Accepted: 08/21/2009] [Indexed: 11/19/2022]
Abstract
AIM Presenting features, treatment and outcome of 134 newborns with neuroblastoma diagnosed over a 27-year period are described. METHODS Analyses were performed on the entire cohort and on patients distributed over three periods of diagnosis. RESULTS Twenty-seven tumours (20.1%) were detected prenatally. Localised disease prevailed (65.7%) with an increase of stage 1 patients over time from 18.8% to 46.5%. Disseminated disease accounted for 34.3% of tumours with only one stage 4 and 45 stage 4S. Five-year overall survival (OS) of the entire cohort was 88.3%. Five/88 patients with localised disease died, including three who died of complications (OS, 95.3%). The only stage 4 patient survived. Eleven/45 stage 4S patients died, including 7/18 symptomatic and 4/27 asymptomatic (OS, 74.1%). CONCLUSION The outcome of neuroblastoma in newborns is excellent. In localised tumours, surgery-related deaths outnumbered deaths due to disease. Symptomatic stage 4S patients were at greater risk of dying.
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Affiliation(s)
- Anna Rita Gigliotti
- Department of Haematology-Oncology, Giannina Gaslini Children's Hospital, Largo Gerolamo Gaslini, 5, 16147-Genova, Italy
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25
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Abstract
MRI is being increasingly used to assess for fetal abnormalities. Although significant progress in the field of fetal MRI has occurred during the past 20 years, continued technical advances will likely contribute to significant growth of the field. Moreover, with continued hardware and software improvements, additional MRI sequences will likely become available. Prenatal MRI complements ultrasound because of larger field-of-view, superior soft tissue contrast, easier and more precise volumetric measurement, and greater accuracy in the demonstration of intracranial and spinal abnormalities. While ultrasound remains the primary modality for fetal imaging, these advantages of MRI make it a valuable adjunct to fetal surgery. Because fetal MRI involves many disciplines, the future of fetal MR will best be achieved through collaborative efforts.
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Affiliation(s)
- Orit A Glenn
- Department of Radiology, University of California, San Francisco, CA 94143, USA.
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26
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Delahaye S, Doz F, Sonigo P, Saada J, Mitanchez D, Sarnacki S, Benachi A. Prenatal diagnosis of dumbbell neuroblastoma. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2008; 31:92-95. [PMID: 18058843 DOI: 10.1002/uog.5148] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
A neuroblastoma that develops in the sympathetic nodes can infiltrate the intervertebral foramina and invade the spinal canal, leading to spinal cord and nerve root compression and neurological impairment. Dumbbell neuroblastomas are now considered to be unresectable tumors and preoperative chemotherapy is recommended. We report the prenatal diagnosis of a dumbbell neuroblastoma successfully managed through premature delivery followed by immediate chemotherapy. We suggest that delivering prematurely in such cases is only of benefit if chemotherapy can be administered under favorable conditions. Chemotherapy should proceed immediately after delivery in order to reduce the size of the tumoral mass and its effects on the spine.
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Affiliation(s)
- S Delahaye
- Université Paris-Descartes, Faculté de Médecine, AP-HP, Maternité, Hôpital Necker-Enfants Malades, Paris, France.
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27
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Friedman GK, Castleberry RP. Changing trends of research and treatment in infant neuroblastoma. Pediatr Blood Cancer 2007; 49:1060-5. [PMID: 17943963 DOI: 10.1002/pbc.21354] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Neuroblastoma is the most common malignancy in infants and 40% of neuroblastomas are diagnosed in the first year of life. While generally neuroblastoma behaves less aggressively in this age group, tumors that have adverse biologic characteristics do not differ in their behavior from counterparts in older children. Clinical and biologic behavior of neuroblastoma in children up to 460 days of age is similar to that in children less than 1 year of age. Thus the categorization of children up to 18 months of age into risk category is critically dependent on biologic characterization and assignment to appropriate treatment intensity categories.
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Affiliation(s)
- Gregory K Friedman
- Department of Pediatrics, Division of Pediatric Hematology Oncology, University of Alabama at Birmingham, Birmingham, Alabama, USA.
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28
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Pränatal diagnostizierte zystisch-hämorrhagische Raumforderung der Nebenniere. Monatsschr Kinderheilkd 2007. [DOI: 10.1007/s00112-007-1546-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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29
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Abstract
Neuroblastoma is the foremost malignant neoplasm of the fetus and neonate. The tumor is unique because of its distinctive biologic behavior and many different clinical manifestations. The purpose of this review is to focus on the fetus and neonate to determine the various ways perinatal neuroblastomas differ clinically and morphologically and in their treatment from those found in the older child to show that some forms of the tumor have a better outcome than others. The report attempts to evaluate the influence of site, histology, stage, biologic markers, and treatment on survival.
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Affiliation(s)
- Hart Isaacs
- Department of Pathology, Children's Hospital San Diego, San Diego, California 92123, USA.
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30
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de Bouyn-Icher C, Minard-Colin V, Isapof A, Khuong Quang DA, Redon I, Hartmann O. [Malignant solid tumors in neonates: a study of 71 cases]. Arch Pediatr 2006; 13:1486-94. [PMID: 17137765 DOI: 10.1016/j.arcped.2006.08.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2006] [Accepted: 08/11/2006] [Indexed: 12/21/2022]
Abstract
UNLABELLED Malignant neonatal tumors are rare and comprise 2% of childhood malignancies. Clinical features, histologic types, prognosis were very different from those seen in older children, facing oncologists with diagnostic, therapeutic and ethical problems. PATIENTS AND METHODS In a retrospective study from January 1987 to January 2004, we reviewed the management of neonates treated at the Institute Gustave Roussy for a malignant solid tumor for whom symptoms started in the first month of life. RESULTS Seventy-one neonates were treated, comprising 1,2% of the overall patients treated during the same period of time. Of these 71 patients, 42 (59%) presented with neuroblastomas, 12 (17%) with mesenchymal tumors, 6(8%) with cerebral tumors and 11 with various other types of tumors. Fifty-nine patients underwent surgical resection. Thirty-eight neonates received chemotherapy, administered at a 30 to 50% reduced dose. Hematologic toxicities and infections were the main therapeutic complications. Very small doses of radiotherapy were used in only 5 children. There has been no therapy-related mortality. Twenty-two of the 57 survivors have sequelae, especially patients with intraspinal neuroblastoma. The 5 year overall survival was 79%. CONCLUSIONS Neonatal malignant solid tumors, except for cerebral tumors, have a good prognosis. The young age of patients resulted in problems of treatment tolerance. The therapeutic regimen should take into account the risk of acute iatrogenic toxicity and long term sequelae. Surgery remains the treatment of choice but chemotherapy, with dose reduction, managed by expert teams, is essential and safer in a lot of case.
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Affiliation(s)
- C de Bouyn-Icher
- Service d'Oncologie Pédiatrique, Institut Gustave-Roussy, rue Camille-Desmoulins, 94805 Villejuif cedex, France.
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31
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Abstract
One-fifth of all neuroblastomas are diagnosed either antenatally or in the first 3 months of life. Over the past two decades, routine prenatal ultrasound has significantly increased the rate of diagnosis of fetal neuroblastoma. More than 90% of these tumors arise in the adrenal gland, suggesting a link between perinatal tumors and the nodular collections of neuroblasts that are part of normal adrenal development. In fact, there is compelling evidence that the cystic variant of perinatal neuroblastoma is caused by a perturbation of the involution program of these neuroblastic nodules. The vast majority of these cases are localized tumors with favorable biological features, which correlates with a 4-year survival of greater than 95%. The high rate of spontaneous regression of these tumors, coupled with the significant risks of resectional surgery in small neonates, has prompted the development of a prospective clinical trail of expectant observation as primary therapy for infants with small, localized tumors. The ultimate goal of such studies is to define an ultra-low-risk group of neuroblastoma patients who do not require invasive procedures or chemotherapy to achieve an excellent outcome.
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Affiliation(s)
- Jed G Nuchtern
- Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA.
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32
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York D, Swartz A, Johnson A, Fielding J, Phillips JD. Prenatal detection and evaluation of an extralobar pulmonary sequestration in the posterior mediastinum. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2006; 27:214-6. [PMID: 16435323 DOI: 10.1002/uog.2667] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Extralobar pulmonary sequestration (EPS) is a rare developmental anomaly with aberrant nonfunctioning parenchymal tissue, associated with an increased risk of perinatal morbidity and, rarely, mortality owing to possible neonatal respiratory distress. In most cases supernumerary lobes are detected as isolated intra- or extrapleural lesions with independent systemic arterial blood supply. We report an atypical case of prenatal detection and perinatal outcome of a mediastinal EPS.
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Affiliation(s)
- D York
- Department of Surgery, University of North Carolina, School of Medicine, Chapel Hill, NC, USA
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33
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Duzovali O, Ozer C, Turhan AH, Arslankoylu AE, Yilgor E, Polat A, Aksoyek S. Bilateral adrenal cystic neuroblastoma with massive hepatomegaly and intracystic hemorrhage. Pediatr Blood Cancer 2005; 44:525-6. [PMID: 15503292 DOI: 10.1002/pbc.20247] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Affiliation(s)
- Victoria Castel
- Pediatric Oncology Unit, Hospital Infantil La Fe, Avda. Campanar 21, 48009 Valencia, Spain.
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35
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Hill BJ, Joe BN, Qayyum A, Yeh BM, Goldstein R, Coakley FV. Supplemental Value of MRI in Fetal Abdominal Disease Detected on Prenatal Sonography: Preliminary Experience. AJR Am J Roentgenol 2005; 184:993-8. [PMID: 15728631 DOI: 10.2214/ajr.184.3.01840993] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Our aim was to determine the supplemental value of MRI in fetal abdominal disease detected on prenatal sonography. CONCLUSION Our preliminary results suggest the primary supplemental value of MRI relative to sonography in fetal abdominal disease lies in improved tissue characterization rather than in improved anatomic characterization.
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Affiliation(s)
- Brook J Hill
- Department of Radiology, University of California San Francisco, 505 Parnassus Ave., Box 0628, M-372, San Francisco, CA, 94143-0628, USA
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36
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Abstract
Primary congenital cervical neuroblastomas are very rare. A history of upper aerodigestive compromise with Horner syndrome can be of value for the early diagnosis of this lesion. Congenital neuroblastomas usually have a favorable outcome. Like all the other clinically relevant groups of neuroblastomas, management should take into consideration the biological findings of each tumor, which predicts outcome than other clinical findings.
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Affiliation(s)
- Teresa M Cardesa-Salzmann
- Department of Pediatric Oncology, Unitat Integrada Hospital Sant Joan de Déu Barcelona-Hospital Clinic, Hospital of the University of Barcelona, Barcelona, Spain.
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Affiliation(s)
- Brian H Kushner
- Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, New York 10021, USA.
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38
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Michalowski MB, Rubie H, Michon J, Montamat S, Bergeron C, Coze C, Perel Y, Valteau-Couanet D, Guitard J, Guys JM, Piolat C, Munzer C, Plantaz D. [Neonatal localized neuroblastoma: 52 cases treated from 1990 to 1999]. Arch Pediatr 2004; 11:782-8. [PMID: 15234372 DOI: 10.1016/j.arcped.2004.01.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2003] [Accepted: 01/20/2004] [Indexed: 11/24/2022]
Abstract
UNLABELLED Neuroblastoma is the most frequent tumor observed in the newborn. The aim of this study was to review clinical features, treatment and outcome of newborns diagnosed with a localized neuroblastoma. POPULATION AND METHODS Data from 52 cases treated according to the NBL 90 and 94 protocols between 1990 and 1999 in 18 French centers of pediatric oncology were analyzed. RESULTS The median age at diagnosis was 12 days (range 0-28) with antenatal detection in 14 patients (27%). Tumor location was abdominal in 40 patients (adrenal in 20 of the 40), thoracic in eight, pelvic in three, and cervical in one. N-myc amplification was observed in one out of 40 evaluable cases. The size of the primary tumor was less than 5 cm in 25 cases, between 5 and 10 cm in 25 and more than 10 cm in two. Dumbbell tumor was observed in seven, of whom five had neurological deficit. One child died from hemorrhage after fine needle biopsy during diagnostic procedure. Primary surgical resection was attempted in 37 infants, of whom two died of surgery related complications and three had nephrectomy. Tumor was deemed as unresectable in 14 patients, and primary chemotherapy was given followed by surgical excision in 12. One of them died a few days after the beginning of chemotherapy. As a whole, continuous complete remission was achieved in 48 children, four of them after relapse. Overall survival was 92% with a median follow-up of 46 months (0-113 months). CONCLUSION The excellent prognosis of localized NB in neonates needs very restrictive surgical indications, with well-established anatomic and imaging criteria. Indeed, chemotherapy based on weight and managed by expert teams should allow to perform surgical excision in safer conditions for unresectable tumors.
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Affiliation(s)
- M B Michalowski
- Département de pédiatrie, hôpital Michallon, BP 217X, 38045 Grenoble, France
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39
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Houlihan C, Jampolsky M, Shilad A, Prinicipe D. Prenatal diagnosis of neuroblastoma with sonography and magnetic resonance imaging. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2004; 23:547-550. [PMID: 15098874 DOI: 10.7863/jum.2004.23.4.547] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Affiliation(s)
- Christopher Houlihan
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, St Joseph's Regional Medical Center, Paterson, New Jersey 07503, USA
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40
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Lee JY, Cho JY. Prenatal and Postnatal Imaging Findings of Congenital Adrenal Neuroblastoma. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2004. [DOI: 10.1177/8756479303259744] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Neuroblastoma is the most common solid tumorin childhood. There have been several casereports and reviews on the prenatal diagnosis ofcongenital neuroblastoma. The sonographicimaging findings of fetal adrenal neuroblastomaare variable. Most of them are cystic or complex,but uncommonly, solid neuroblastomas arereported. This case study presents prenatal andpostnatal findings of a purely solid echoicadrenal neuroblastoma.
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Affiliation(s)
- Jee Young Lee
- Department of Radiology, Samsung Cheil Hospital, 1-19, Mookjeong-dong, Jung-gu, Seoul 100- 380, Korea
| | - Jeong Yeon Cho
- Department of Radiology, Samsung Cheil Hospital, Seoul, Korea
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41
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Kang T, Dormans J, Maris J, Carpentieri D, Pawel BR, Adamson PC. Congenital neuroblastoma arising in the deltoid muscle. J Pediatr Hematol Oncol 2004; 26:101-3. [PMID: 14767196 DOI: 10.1097/00043426-200402000-00006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Neuroblastoma almost always arises in association with sympathetic neural crest tissues that flank the spinal axis, including the paravertebral sympathetic ganglia of the neck, mediastinum, retroperitoneum, and pelvis, or in the adrenal glands. Neuroblastoma in the newborn period, which can present as localized or metastatic disease, often resolves spontaneously and requires little or no therapy. The authors describe a 5-week-old infant with an isolated primary neuroblastoma arising in the deltoid muscle. Histologic and biologic characteristics were consistent with a favorable-prognosis stage 1 neuroblastoma. Following a complete local excision, the child remains in complete remission 3 years from diagnosis.
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Affiliation(s)
- Tammy Kang
- Department of Pediatrics, The Children's Hospital of Philadelphia, The University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
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Gorincour G, Dugougeat-Pilleul F, Bouvier R, Lorthois-Ninou S, Devonec S, Gaucherand P, Pracros JP, Guibaud L. Prenatal presentation of cervical congenital neuroblastoma. Prenat Diagn 2003; 23:690-3. [PMID: 12913877 DOI: 10.1002/pd.671] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To describe a cervical neuroblastoma revealed in the prenatal period. METHOD We were recently confronted with a case of fetal solid neck mass suggestive of teratoma, which proved postnatally to be a neuroblastoma. Combining this case with a review of recent literature, we have evaluated the diagnostic tools required for increased precision in the prenatal diagnosis and perinatal management of fetal solid neck masses. RESULTS Detailed ultrasound and MRI of fetal neck and liver, in conjunction with amniocentesis for measurement of homovanillic acid levels, should enable fetal medical practitioners to consider the diagnosis of fetal cervical neuroblastoma. CONCLUSION Fetal cervical neuroblastoma is an extremely rare condition that has not been previously reported, but should be considered in the presentation of fetal solid neck masses.
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Affiliation(s)
- G Gorincour
- Department of Pediatric and Fetal Imaging, Hôpital Debrousse, Lyon, Cedex, France
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Girschick G, Singer D, Trusen A, Dietl J, Müller T. Intrauterine regression of an adrenal mass. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2003; 21:307-309. [PMID: 12666231 DOI: 10.1002/uog.50] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
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Sauvat F, Sarnacki S, Brisse H, Medioni J, Rubie H, Aigrain Y, Gauthier F, Audry G, Helardot P, Landais P, Michon J, Hartmann O, Nihoul-Fékété C. Outcome of suprarenal localized masses diagnosed during the perinatal period: a retrospective multicenter study. Cancer 2002; 94:2474-80. [PMID: 12015773 DOI: 10.1002/cncr.10502] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The growing use of abdominal ultrasonography during pregnancy and in the postnatal period is leading to the discovery of an increasing number of suprarenal masses. The optimal diagnosis and treatment of these masses has not yet been determined. METHODS The authors reviewed the files of patients with suprarenal masses detected prenatally or during the first 3 months of life, between 1986 and 1999, in the pediatric surgery and oncology departments of Paris hospitals. RESULTS Thirty masses were detected prenatally and 23 postnatally. In the latter group of patients, the diagnosis was based on ultrasound in 8 cases and on the palpation of a mass in 15 cases, 13 of which were neuroblastoma. At birth, the masses were cystic in 19 cases, solid in 17, and mixed in 13. Sensitivities of methyliodobenzylguanidine and urinary catecholamine assay were 70% and 52% respectively. Surgery was performed in 38 cases with a median age of 42 days. Histologic analysis showed 31 neuroblastomas, 1 adrenal hemorrhage, 2 necrotic masses, 1 bronchogenic cyst, and 3 sequestrations. All the patients were alive and disease free, at a follow-up ranging from 3 months to 13 years. CONCLUSIONS In this series, 58% of the suprarenal masses diagnosed perinatally were localized neuroblastoma with a favorable outcome. All other cases either regressed spontaneously or turned out to be benign lesion. Thus, the management of these masses must strike a compromise between aggressive treatment and a wait-and-see attitude. This requires appropriate initial assessment and a close follow-up in a specialized center.
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Affiliation(s)
- Frederique Sauvat
- Department of Pediatric Surgery, Hôpital Necker Enfants-Malades, Paris, France
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Abstract
Neuroblastoma and Wilms' tumor are the most common noncentral nervous system solid tumors in children. Imaging plays a crucial role in the evaluation of the primary tumor and regional and metastatic disease. There is a growing body of literature supporting the use of MRI as the technique of choice for the evaluation of local and regional disease in children with suspected neuroblastoma; however, in children with suspected Wilms' tumor, MRI will likely continue to play a role as a problem-solver when the results of CT are equivocal or indeterminant.
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Affiliation(s)
- James S Meyer
- Department of Radiology, Jefferson Medical College, Philadelphia, PA 19104, USA.
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Lee SH, Cho JY, Song MJ, Min JY, Han BH, Lee YH, Cho BJ, Kim SH. Prenatal ultrasound findings of fetal neoplasms. Korean J Radiol 2002; 3:64-73. [PMID: 11919481 PMCID: PMC2713989 DOI: 10.3348/kjr.2002.3.1.64] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
A variety of neoplasms can develop in each fetal organ. Most fetal neoplasms can be detected by careful prenatal ultrasonographic examination. Some neoplasms show specific ultrasonographic findings suggesting the differential diagnosis, but others do not. Knowledge of the presence of a neoplasm in the fetus may alter the prenatal management of a pregnancy and the mode of delivery, and facilitates immediate postnatal treatment. During the last five years, we experienced 32 cases of fetal neoplasms in a variety of organs. We describe their typical ultrasonographic findings with correlating postnatal CT, MRI, and pathologic findings.
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Affiliation(s)
- Soo-Hyun Lee
- Department of Radiology, Samsung Cheil Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong Yeon Cho
- Department of Radiology, Samsung Cheil Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Mi Jin Song
- Department of Radiology, Samsung Cheil Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jee-Yeon Min
- Department of Radiology, Samsung Cheil Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byoung Hee Han
- Department of Radiology, Samsung Cheil Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Ho Lee
- Department of Radiology, Samsung Cheil Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byung Jae Cho
- Department of Radiology, Samsung Cheil Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung Hyup Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
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Sbragia L, Paek BW, Feldstein VA, Farrell JA, Harrison MR, Albanese CT, Farmer DL. Outcome of prenatally diagnosed solid fetal tumors. J Pediatr Surg 2001; 36:1244-7. [PMID: 11479867 DOI: 10.1053/jpsu.2001.25785] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND/PURPOSE In the last 10 years, the ability to diagnose fetal tumors in the prenatal period has improved greatly because of technical advances in imaging. Early diagnosis and determination of tumor may affect prognosis. METHODS The authors retrospectively reviewed the records of 1316 fetuses who underwent sonographic evaluation for congenital defects at University of California-San Francisco over a 6-year period. Of these, 16 had fetal tumors and were followed up at our institution. There were solid or predominantely solid with small cystic component masses in one of 3 locations: cervical, mediastinal, or abdominal. Excluded from our study were those fetuses with either sacrococcygeal teratoma, congenital cystic adenomatoid malformation of the lung, or ovarian cyst, because these defects have been extensively reviewed elsewhere. In addition, masses that were primarily cystic also were excluded. Data collected included diagnosis, gestational age at diagnosis and at delivery, mode of delivery, fetal and neonatal survival, and disease confirmation. RESULTS Of the 16 fetuses, 4 had mediastinal tumors: 2 with pericardial teratomas (both of whom died in utero) and 2 with cardiac rhabdomyomas (1 died; the other presented tuberous sclerosis and is alive at 2 years of age). Four patients had cervical tumors (3 died; 1 survived and is alive and well), and 8 had abdominal tumors (3 with liver tumors, 4 with a left adrenal mass, and 1 with retroperitoneal teratoma). All eight patients with an abdominal tumor are alive and well. CONCLUSIONS Fetal tumors are rare, and the prognosis seems to depend on their location and size. Although easier to detect, cervical and mediastinal tumors have a worse prognosis. Abdominal masses are more difficult to detect but have a better prognosis.
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Affiliation(s)
- L Sbragia
- Fetal Treatment Center and the Department of Surgery, University of California San Francisco, CA 94143-0570, USA
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