Prenatally detected tumor mass in the adrenal gland

Background/Purpose: Screening programs using urinary vanillylmandelic acid have detected neuroblastomas in early infancy with some success. With the w idespread use of ultrasonography in modern obstetric practice, use of ultra sonography to screen for fetal neuroblastoma seems to be reasonable and pra ctical. Methods: Seven fetuses had suprarenal masses detected by maternal ultrasoun d scan at 32 to 37 weeks' gestation between 1993 and 1998. They were delive red normally if the pregnancy was uncomplicated, especially if it was witho ut maternal preeclampsia or fetal hydrops. Each mass was further confirmed by ultrasound scan, computed tomography, or magnetic resonance imaging in t he neonatal period. Tumor excision was performed at the age of 6 to 38 days of life. Results: The size of the masses measured ranged from 2.0 x 2.0 cm to 4.5 x 4.5 cm. The diagnosis was adrenal hemorrhage in 1 neonate, Evan's stage I n euroblastoma in 3, and stage IV-S neuroblastoma in 3. All of the specimens with a diagnosis of neuroblastoma showed a favorable histology by the Shima da classification system. Infants with stage I disease were treated with tu mor excision only, and they had survived without disease by 14, 18, and 25 months of follow-up. One infant with stage IV-S neuroblastoma was treated f urther with minimal chemotherapy and has survived without disease at the 66 -month follow-up examination. Another child with stage IV-S neuroblastoma h as survived with local recurrence and increasing liver metastasis and was s till on chemotherapy at the 2-month follow-up examination. The third child with stage IV-S disease presented with massive hepatomegaly and bone marrow involvement, and disseminated intravascular coagulopathy had developed. Th e patient died on the 5th day of life without surgical intervention. Conclusions: The increasing use of obstetric ultrasonography has made the p renatal screening of neuroblastomas possible. The prognosis of infants with a suprarenal mass may be improved with this early detection and early surg ical intervention. Copyright (C) 1999 by W.B. Saunders Company.