The Outcome of Prenatally Diagnosed Renal Tumors

Abstract

Several large-scale cohort studies suggest that obese mothers are at increased risk of having infants with neural tube defects and, possibly, other central nervous system (CNS) birth defects. Because obesity and diabetes share similar metabolic abnormalities, a study was planned to determine whether gestational diabetes influences the association between maternal obesity and CNS birth defects. In this population-based case-control study, covering the years 1997 to mid-2000, structured telephone interviews were conducted with mothers of offspring having anencephaly (n ϭ 120), spina bifida (n ϭ 184), holoprosencephaly (n ϭ 49), or isolated hydrocephaly (n ϭ 124). Control women whose infants were neurologically normal were randomly chosen from the same hospitals. Approximately 60% of both cases and control subjects responded. Maternal obesity was defined as a body mass index of 30 kg/m 2 or higher.Pregestational diabetes, both type 1 and type 2, correlated closely with holoprosencephaly (adjusted odds ratio [OR], 47; 95% confidence interval [CI],, and isolated hydrocephaly (OR, 12; 95% CI, 2.9-47). There was no increase in the risk of anencephaly or spina bifida.Gestational diabetes increased only the risk of holoprosencephaly (OR, 2.9; 95% CI, 1.0-8.4). Mothers of infants with anencephaly were less likely than control mothers to have gestational diabetes. Obese mothers were likelier than control subjects to have infants with any of the 4 CNS birth defects. Underweight women were less likely to have an infant with spina bifida. The association between maternal obesity and an increased risk of neural tube defects and isolated hydrocephaly held for all ethnic groups. Associations between maternal obesity and anencephaly (OR, 2.3; 95% CI, 1.2-4.3), spina bifida (OR, 2.8; 95% CI, 1.7-4.5), and isolated hydrocephaly (OR, 2.7; 95% CI, 1.5-5.0) persisted after adjusting for maternal age, ethnicity, education, smoking, alcohol use, and periconceptional vitamin use. For both spina bifida and holoprosencephaly, the joint effects of maternal obesity and gestational diabetes appeared to be interactive.These findings suggest that gestational diabetes and maternal obesity may increase the risk of CNS birth defects through common mechanisms, and they strongly support the need for ways of preventing these conditions. EDITORIAL COMMENT(The epidemic of obesity is worldwide. The prevalence of a body mass index (BMI) Ն30 kg/m 2 in women 18 years of age and older increased from 12% to 18% from 1991 to 1998 (Mokdad AH, et al. JAMA 1999282:1519). The relationship between obesity and diabetes is well known. Does the combination increase the risk of congenital malformations? To investigate the risk of neural tube defect (NTD)-affected pregnancies among obese women (BMI Ն29 kg/m 2 ) compared with women of average prepregnancy weight, Shaw performed a population-based case-controlled study of all hospitals in 55 of 58 counties in California. Compared OBSTETRICSVolume 60, Number 6 OBSTETRICAL AND GYNECOLOGICAL SURVEY ABSTRACTThe major concern...

Congenital mesoblastic nephroma in a premature neonate: A case report and review of literature

“…[14] In a study of 28 children with prenatally diagnosed renal tumors (26 with CMN and 2 with Wilms tumor), polyhydramnios were observed in 11 fetuses (39%). [17] Kim et al however, reported a case of CMN occurring in pregnancy with oligohydramnios. [18] CMN most commonly presents as an abdominal mass, but could also manifest with hypertension or hypercalcemia.…”

“…[43] The cellular variant of mesoblastic nephroma has been reported to share cytogenetic features with IFS. Both are associated with polysomies for chromosome 8,11,17,20 as well as translocation t (12;15) (p13;q25), which fuses the E-twenty six variant 6 (ETV 6) or translocation ETS leukemia gene. [1] In a study of five cases of IFS, two of CMN and one of mixed type (CMN and IFS), Adem et al reported that 3 of the 5 cases of IFS had ETV gene rearrangements, but normal copy number of chromosome 11, one case each of IFS, cellular CMN and mixed type had both abnormalities while in the case of classical CMN neither trisomy 11 nor gene rearrangements was found.…”

Yenidoğan Döneminde Nöron Spesifik Enolaz Yüksekliği ile Seyreden Atipik (Selüler) Konjenital Mezoblastik Nefroma Olgusu

“…Bazı olgularda tümör hücrelerinden prostaglandin veya parathormon benzeri proteinlerin salınımına bağlı olarak hiperkalsemi görülebilir (10). Olguların birçoğunda polihidramniyoz ve preterm eylem olduğu bildirilmiştir (11). Olgumuz da preterm eylem nedeniyle 31. gebelik haftasında doğmuştur.…”

Fetal Hydrops Associated with Tumors

“…Perinatal renal tumors are rare, comprising 5% of all neoplasms arising in the neonate. 11,124 Congenital mesoblastic nephroma is the leading member followed in order by Wilms tumor, rhabdoid tumor, and clear cell sarcoma 11,124,127,129 (Tables 1 and 12). Although hydramnios is common, development of fetal hydrops associated with a renal tumor seldom occurs.…”

“…[119][120][121][122][123][124][125][126][127][128][129] Factors contributing to the development of hydrops in fetuses with renal tumors include size (a large abdominal mass producing obstruction of the portocaval circulation), high output cardiac failure due to a shunt in a vascular portion of the tumor, or massive hemorrhage into the tumor. 120,122,124,126 Rhabdoid tumors of the kidney tend to be large, rapidly growing, and metastasize early; diaphragmatic elevation with secondary pulmonary insufficiency may occur. 127,128 Clear cell sarcoma of the kidney is the least common malignant tumor of the group that metastasizes to the lungs and bones.…”