Outcome of suprarenal localized masses diagnosed during the perinatal period

Abstract

BACKGROUNDThe 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.METHODSThe 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.RESULTSThirty 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.CONCLUSIONSIn 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. Cancer 2002;94:2474–80. © 2002 American Cancer Society.DOI 10.1002/cncr.10502

Antenatally Diagnosed Suprarenal Cystic Teratoma

“…1,7 In our patient, increasing size of the lesion was the indication for excision. Antenatal diagnosis of adrenal teratoma has been reported only once previously.…”

“…Neuroblastoma is the most common suprarenal mass detected during prenatal ultrasonography, but suprarenal masses also can represent adrenal hemorrhage, extrapulmonary sequestration, a bronchogenic cyst, or renal dysplasia. 1,2 Precise diag nosis of these antenatally detected lesions is not possible in all patients. Radiologic diagnosis of some tumors may not be possible and FNAC does not yield good results for cystic lesions.…”

Di erential diagnosis of congenital cystic neuroblastoma and prenatal adrenal hemorrhage in children of the rst months of life

“…При поступлении в неонатальное отделение на первых сутках жизни при пальпации в правых отделах живо-та было обнаружено безболезненное объемное обра-зование. После консультации онколога на 5-е сутки жизни выполнена инициальная компьютерная томо-графия (КТ) с контрастным усилением: в забрюшин-ном пространстве справа, в области надпочечника, выявлено массивное гиподенсивное образование раз-мером 51×50×59 мм, объемом 79 см 3 , неправильной округлой формы, плотностью 15-20 HU, не накапли-вающее контрастный препарат в основной своей мас-се, но с наличием перегородок в его нижней части, интенсивно накапливающих контраст. Образование деформирует верхний полюс правой почки, оттесняя ее книзу.…”

“…3). КТ в динамике: в забрюшинном пространстве справа, в проекции правого надпочечника, опреде-ляется объемное мягкотканное образование с чет-ким неровным контуром, неоднородной структуры за счет периферической кольцевидной кальцифика-ции и гиподенсивных центральных участков разме-ром 21×24×24 мм, объемом 6 см 3 . При контрастирова-нии усиления мягкотканного компонента не отмечено, плотностные характеристики -30-40 HU.…”

“…Так, фетальная водянка и преэклампсия описаны только при метастатических формах нейробластомы с высо-ким уровнем катехоламинов в кровеносном русле [3].…”