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Papadakis V, Segura V, Conte M, Plantaz D, Di Cataldo A, Schleiermacher G, Wheeler K, Bermúdez JD, Ash S, Brichard B, Ladenstein R, Combaret V, Sarnacki S, Fagnani AM, Granata C, Cañete A. Suprarenal Masses in Very Young Infants: Is It Safe to Watch and Wait? Report of a SIOPEN Observational Study Results. Cancers (Basel) 2022; 14:cancers14164007. [PMID: 36011005 PMCID: PMC9406882 DOI: 10.3390/cancers14164007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/12/2022] [Accepted: 08/14/2022] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Optimal management of small suprarenal masses (sSRMs) is not clearly defined in the literature. Among the differential diagnosis of these sSRMs without a clearly defined clinical management, neuroblastoma is the malignant neuroblastic tumor, with very good prognosis in most cases at this age and a very intriguing biology. The concept of the sSRM study is to attempt to safely minimize invasive procedures (including surgery) without jeopardizing the final outcome. We report the first International Society of Paediatric Oncology European Neuroblastoma (SIOPEN) cooperative prospective study of expectant observation as primary approach for neonates and infants less than or equal to 90 days of age with small localized suprarenal masses. In most cases, patients avoided surgery and, consequently, morbidity and mortality related to surgery. The study contributes to improving knowledge about the natural history and biology of neuroblastoma during early infancy. Abstract Background: To assess whether expectant observation of infants ≤ 90 days old with small suprarenal masses (sSRMs) could avoid unnecessary surgery without impacting outcome. Methods: Infants ≤ 90 days with a ≤ 5 cm mass, without midline extension or lymph node or distant spread were registered (ClinicalTrials.org:NCT01728155). Once staging was completed, they were followed with ultrasound, MRI and urinary catecholamines. Surgical resection was only planned if there was a ≥40% mass volume increase or for a mass persisting after 48 weeks of the planned observation. Results: Over a 5-year period, 128 infants were registered. No infant had detectable MYCN amplification in the peripheral blood. Surgery was performed in 39 (30.5%) patients, in 18 during and in 21 after the planned 48-week observation, and 74% were confirmed to be neuroblastomas. Non-life-threatening surgical complications occurred in two cases. The 3-year overall survival and event-free survival were 100% and 87.1%, respectively. The 16 events observed were volume increase (N = 11) and progression to neuroblastoma stage MS (N = 5). Patients with solid masses or MIBG-positive masses had lower EFS. Conclusions: Expectant observation for infants with sSRMs with clinical follow-up and timely imaging (including MRI scan) is safe and effective, allowing surgery to be avoided in the majority of them.
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Affiliation(s)
- Vassilios Papadakis
- Department of Pediatric Hematology-Oncology, Aghia Sophia Children’s Hospital, Levadias Street 8, 11527 Athens, Greece
| | - Vanessa Segura
- Instituto de Investigación Sanitaria La Fe, Fernando Abril Martorell 106, 46026 Valencia, Spain
| | - Massimo Conte
- Department of Hematology-Oncology, Giannina Gaslini Children’s Hospital, Via Gerolamo Gaslini 3, 16148 Genoa, Italy
| | - Dominique Plantaz
- Department of Pediatrics, University Hospital Centre of Grenoble, Av. des Maquis du Grésivaudan, 38700 La Tronche, France
| | - Andrea Di Cataldo
- Department of Clinical and Experimental Medicine, Unit of Pediatric Hematology and Oncology, University of Catania, Piazza Università, 2, 95124 Catania, Italy
| | - Gudrun Schleiermacher
- Siredo Pediatric Oncology Center, and RTOP (Recherche Translationelle en Oncologie Pédiatrique) U830 Inserm, Institut Curie, 26 rue d’Ulm, 75005 Paris, France
| | - Kate Wheeler
- Department of Paediatric Haematology and Oncology, Oxford Children’s Hospital, Headington, Oxford OX3 9DU, UK
| | - Jose D. Bermúdez
- Department of Statistics and O.R., University of Valencia Av. de Blasco Ibáñez, 13, 46010 Valencia, Spain
| | - Shifra Ash
- Pediatric Hematology Oncology and Bone Marrow Transplantation Division, Ruth Rappaport Children’s Hospital, Rambam Health Care Campus, Efron St. 19-27, Haifa 3109601, Israel
| | - Bénédicte Brichard
- Department of Paediatric Haematology and Oncology, Cliniques Universitaires Saint Luc, Av. Hippocrate 10, 1200 Brussels, Belgium
| | - Ruth Ladenstein
- St. Anna Children’s Hospital, Department of Paediatrics, Medical University of Vienna and Children’s Cancer Research Institute, Department for Studies and Statistics and Integrated Research, Zimmermannplatz 10, 1090 Vienna, Austria
| | - Valérie Combaret
- Laboratoire de Recherche Translationnelle, Centre Léon Bérard, Léa et Napoléon Bullukian, 69008 Lyon, France
| | - Sabine Sarnacki
- Department of Pediatric Surgery, Necker Enfants-Malades Hospital, AP-HP, Université de Paris Cité, 149 rue de Sèvres, 75015 Paris, France
| | - Anna Maria Fagnani
- Pediatric Surgery Unit, Department Woman-Child-Newborn, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Commenda, 10, 20122 Milano, Italy
| | - Claudio Granata
- Department of Paediatric Radiology, IRCCS Giannina Gaslini Children’s Hospital, Via Gerolamo Gaslini, 3, 16147 Genoa, Italy
| | - Adela Cañete
- Pediatric Oncohematology Unit, University and Polytechnic la Fe Hospital, Department of Pediatrics, Fernando Abril Martorell 106, 46200 Valencia, Spain
- Facultad de Medicina, Universidad de Valencia, Av. de Blasco Ibáñez, 15, 46010 Valencia, Spain
- Correspondence: ; Tel.: +34-961244904
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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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Abstract
Neuroblastoma accounts for approximately 8% of all pediatric cancers, with 5% diagnosed during the neonatal period. Despite the disproportionate contribution of neuroblastoma to childhood cancer deaths, neonatal neuroblastoma has a favorable prognosis, often with little or no therapy required. Therefore, minimizing therapy and mitigating complications/toxicities are emphasized, including using a watch-and-wait approach for patients at low risk for disease progression/relapse. However, stage MS neuroblastoma exhibits a unique pattern of disseminated disease, can be challenging to manage, and may require early intervention with systemic chemotherapy. In this review, the epidemiology, treatment options, and anticipated outcomes for neonatal neuroblastoma are discussed.
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Affiliation(s)
- Andrew M Davidoff
- Department of Surgery, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105-3678, USA.
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Castro P, Paula Matos A, Werner H, Fazecas T, Nogueira R, Daltro P, Araujo Júnior E. Prenatal diagnosis of suprarenal mass by magnetic resonance imaging: a case series. J Matern Fetal Neonatal Med 2018; 32:3882-3886. [PMID: 29712514 DOI: 10.1080/14767058.2018.1471679] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Objective: The aim of this study was to evaluate the perinatal outcomes and postnatal follow-up of prenatally diagnosed suprarenal masses (SRMs) evaluated by magnetic resonance imaging (MRI). Methods: Thirteen fetuses with SRMs detected during routine prenatal ultrasound screening were evaluated by MRI between February 2007 and May 2015. The prenatal characteristics of the masses, complications of the pregnancies, and related malformations were collected as the postnatal clinical, radiological, and pathological data. Results: The median gestational age at MRI was 30 weeks (18-41), and birth weight was 3285 (1700-3750) g. The mean follow-up period was 6 years (1.3-10). We observed 69.2% of the masses, which were predominantly cystic (69.2%), located on the left side. Associated malformations were found in 23% of the fetuses, with congenital heart defects being more prevalent. During the pregnancy, 15.4% of the fetuses had involution of the SRM, and one fetus had surgical treatment and different ultrasound and MRI diagnoses. Of the 69.2% of the cases, spontaneous resolution occurred in 30.7% during the first year of life and 38.4% the masses presented without modifications or signs of regression since the neonatal period. Conclusions: Prenatal SRMs were associated with congenital heart defects. Spontaneous regression and absence of modifications in the masses were commonly observed in the long-term follow-up of the SRMs.
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Affiliation(s)
- Pedro Castro
- a Department of Radiology , Clínica de Diagnóstico por Imagem (CDPI) , Rio de Janeiro , Brazil
| | - Ana Paula Matos
- a Department of Radiology , Clínica de Diagnóstico por Imagem (CDPI) , Rio de Janeiro , Brazil
| | - Heron Werner
- a Department of Radiology , Clínica de Diagnóstico por Imagem (CDPI) , Rio de Janeiro , Brazil
| | - Tatiana Fazecas
- a Department of Radiology , Clínica de Diagnóstico por Imagem (CDPI) , Rio de Janeiro , Brazil
| | - Renata Nogueira
- a Department of Radiology , Clínica de Diagnóstico por Imagem (CDPI) , Rio de Janeiro , Brazil
| | - Pedro Daltro
- a Department of Radiology , Clínica de Diagnóstico por Imagem (CDPI) , Rio de Janeiro , Brazil
| | - Edward Araujo Júnior
- b Department of Obstetrics, Paulista School of Medicine , Federal University of São Paulo (EPM-UNIFESP) , São Paulo , Brazil
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Angelis D, Mudduluru M, Joseph S, Ching C, Hughes A, Bennett R. Neonatal adrenal findings: significance and diagnostic approach. Description of two cases. Clin Case Rep 2018; 6:658-663. [PMID: 29636935 PMCID: PMC5889250 DOI: 10.1002/ccr3.1437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Revised: 01/15/2018] [Accepted: 01/23/2018] [Indexed: 11/09/2022] Open
Abstract
Abnormal adrenal findings such as hemorrhage or calcifications in the neonate can stem from a variety of etiologies. Clinical presentation can vary significantly based on the degree of hemorrhage or the associated condition. Thorough work‐up is important to rule out critical underlying conditions as well as adrenal insufficiency.
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Affiliation(s)
| | | | - Sonia Joseph
- Texas Tech University Health Sciences Center; Lubbock Texas
| | | | - Amanda Hughes
- Texas Tech University Health Sciences Center; Odessa Texas
| | - Robert Bennett
- Texas Tech University Health Sciences Center; Odessa Texas
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Neonatal suprarenal mass: differential diagnosis and treatment. J Cancer Res Clin Oncol 2012; 139:281-6. [DOI: 10.1007/s00432-012-1316-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Accepted: 09/12/2012] [Indexed: 10/27/2022]
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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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Abstract
The natural history, biologic and histological features, and the presenting symptoms of neuroblastoma are reviewed. The radiological findings of this neurogenic paediatric tumour are discussed.
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Affiliation(s)
- Georgia Papaioannou
- Department of Radiology, Great Ormond Street Hospital for Children, Great Ormond Street, London, UK
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Harris K. Extralobar sequestration with congenital diaphragmatic hernia: a complicated case study. Neonatal Netw 2004; 23:7-24. [PMID: 15612417 DOI: 10.1891/0730-0832.23.6.7] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
This article presents a case study of an infant (JG) with an antenatal diagnosis of a left diaphragmatic hernia and an extralobar sequestration of his right lung, which was noted postnatally. JG's course was complicated by persistent pulmonary hypertension of the newborn (PPHN) and suspected pulmonary hypoplasia, and he required support with extracorporeal life support (ECLS). JG's case was unusual in his presentation of extreme PPHN that was unresponsive to inhaled nitric oxide and ECLS. His PPHN was nearly intractable, requiring treatment with vasodilators combined with intravenous sildenafil, which had never been tried in our institution before this case. The article concludes with a discussion of the etiology, diagnosis, and management of congenital diaphragmatic hernia and extralobar sequestration, singly and in combination.
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Affiliation(s)
- Kathryn Harris
- Children's and Women's Health Centre of British Columbia, NICU, Vancouver, Canada.
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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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Affiliation(s)
- Claire Langston
- Department of Pathology, Texas Children's Hospital, Houston, TX 77030, USA
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12
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Raimondo G, Ridola V, Brugières L, Couanet D, Valteau-Couanet D, Grill J, Pein F, Hartmann O. [Pseudotumoral diseases: ten years of experience in a pediatric oncology department]. Arch Pediatr 2002; 9:1039-45. [PMID: 12462834 DOI: 10.1016/s0929-693x(02)00051-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE Among the 350 new patients per year treated in the pediatric oncology department of the Gustave-Roussy Institute, about 2% have no tumor. This study analyzes these children presenting a pseudotumoral disease. PATIENTS AND METHODS Ten-year-retrospective study. Patients for which no follow up in oncology was necessary after one consultation or hospitalization were selected. OUTCOME Between 1990 and 2000, 64 patients were seen in the pediatric department for pseudotumoral disease. The reasons of orientation were mainly a soft tissue mass (15 cases), an abdominal mass (14 cases), or a bone lesion (13 cases). Diagnosis was most often infectious diseases (33 cases), or post-traumatic lesions (10 cases). Diagnosis was established following several consultations or an hospitalization for 29 of 64 patients. In 75% of the cases new investigations were necessary to determine the diagnosis. A biopsy was performed in 19. For two children, diagnosis was corrected after the beginning of chemotherapy. CONCLUSION Pseudotumoral diseases leading to a consultation in pediatric oncology are rare and represent two per cent of the patients. For these difficult cases, only a pluridisciplinary discussion may lead to diagnosis.
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Affiliation(s)
- G Raimondo
- Département d'oncologie pédiatrique, institut Gustave-Roussy, 39, rue Camille-Desmoulins, 94800 Villejuif, France
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Chan KL, Tang MHY, Tse HY, Tang RYK, Lam HSW, Lee CP, Tam PKH. Factors affecting outcomes of prenatally-diagnosed tumours. Prenat Diagn 2002; 22:437-43. [PMID: 12001204 DOI: 10.1002/pd.324] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The outcomes of prenatally-diagnosed tumours affect obstetrical management and parental decisions. The present study reviews the factors affecting outcomes for fetuses with prenatally-diagnosed tumours. METHODS Medical records of all fetuses referred to our institutions with antenatally-diagnosed tumours were reviewed for the type and location of the tumours, results of treatment and/or causes of death. RESULTS From January 1994 to May 2001, there were 15 fetuses with antenatally- diagnosed tumours: mesoblastic nephroma (MN) (n=2); neuroblastoma (NB) (n=2); cystic hygroma (CH) (n=3); intracranial germ cell tumour (IGCT) (n=2); sacrococcygeal teratoma (SCT) (n=3) and haemangioma (liver, n=2; limb, n=1). One mother had termination of pregnancy for her fetal SCT. Three mothers had Caesarean section for large fetal heads (CH, n=2; IGCT, n=1). Three fetuses died; two with IGCT and one with SCT, who died of heart failure. Two newborns with CH needed emergency intubation and, later, one of them had tracheostomy. One baby had cardiac failure resulting from a lower limb haemangioma and needed drug therapy. All solid tumours (MN, NB, SCT) of the live births had no recurrence after surgery with or without adjuvant chemotherapy. CONCLUSION Prenatally-diagnosed tumours without any other associated abnormality cause morbidity and mortality because of their location and vascularity. Solid tumours are relatively benign.
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Affiliation(s)
- K L Chan
- Division of Paediatric Surgery, Department of Surgery, Queen Mary Hospital, Hong Kong SAR, China.
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de Luca JL, Rousseau T, Durand C, Sagot P, Sapin E. Diagnostic and therapeutic dilemma with large prenatally detected cystic adrenal masses. Fetal Diagn Ther 2002; 17:11-6. [PMID: 11803209 DOI: 10.1159/000047998] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The prenatal finding of a large cystic adrenal mass raises the dilemma of the differential diagnosis between adrenal hemorrhage and cystic neuroblastoma. The possibility of a neuroblastoma usually leads to surgical excision of such tumors. Nevertheless, an adrenal hemorrhage has to be recognized, so that unnecessary surgery may be avoided. METHODS Three cases of large prenatally detected adrenal masses managed nonoperatively are reported. Data studied were: age at the diagnosis, prenatal and postnatal ultrasonographic consistency, and tumor marker levels. Size and sonographic evolution were also studied. RESULTS In all 3 cases, a cystic mass, measuring more than 40 mm in size, was detected during the 3rd trimester of pregnancy. The sonographic appearance evolved from a sonolucent tumor to a heterogeneous mass with hyperechoic areas. The tumor marker levels were normal. All infants had a documented decrease in mass size at birth and were managed nonoperatively. All these tumors were considered adrenal hemorrhages. CONCLUSIONS Prenatal ultrasonography rarely permits to distinguish an adrenal hemorrhage from a cystic neuroblastoma. The differential diagnosis, even in large masses, is based on close postnatal follow-up with serial sonography. Surgery is not mandatory, unless the size does not decrease. However, without pathologic proof, it is not possible to differentiate an adrenal hemorrhage from a spontaneously resolved neuroblastoma.
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Affiliation(s)
- J L de Luca
- Department of Pediatric Surgery, Dijon University School of Medecine, Dijon, France
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