2006-04-04-16 Neuroblastoma, prenatal regression © Cuillier www.thefetus.net/
Neuroblastoma, prenatal regression
Cuillier F, MD*, Michel JL, MD**
** Department of Gynecology, Félix Guyon’Hospital, 97400 Saint-Denis, Ile de la Réunion, France.
** Department of Neonatal Surgeryy, Félix Guyon’Hospital, 97400 Saint-Denis, Ile de la Réunion, France
Prenatal diagnosis of neuroblastoma is a rare event. Over the last decade, advances in the technology of prenatal diagnosis have enabled the sonographer to detect rare fetal disorder, such as fetal tumors.
This is a G2P2 patient with a normal first trimester scan perfomred at 12 weeks. The triple test was also normal. She was scanned at 20 weeks and the scan revealed a fetal intra-abdominal mass, hyperechoic, heterogeneous, located on the left abdominal side (20 x 18mm). Until 30 weeks, the mass did not change.
A color Doppler test showed the perfusion of the tumor and a neuroblastoma seemed the most likely diagnosis. An adrenal hemorrhage could be ruled out. The mass was heterogeneous and mostly solid. No large vessel was seen. The mass displaced no bowel and seemed to be located in the retro-peritoneum. There was no evidence of either adenopathy or metastasis. Because of the localization of the mass, close to inferior-anterior pole of the left kidney, and the failure to identify the left adrenal gland, the lesion was suspected to be a neuroblastoma.
A serial scan performed at 32 weeks showed a decreased in size (Figure N°3-4). Fetal biometry, biophysical profile and Doppler were normal. At 34 and 38 weeks, the mass disappeared. The mother did not experience any complications, in particular no evidence of hypertension.
The baby was delivered at 40 weeks (female, 3200g, Apgar 10). The postnatal clinical examination was normal. At day 3, an ultrasound examination did not reveal any abdominal or retro-peritoneal anomaly. Concentrations of catecholamine metabolites (vanillylmandelic acid (VMA) and homovanillic acid (HVM) were in a normal range in the neonatal blood. Now, the child is sixth-month-old with normal development. The tumor was not detected anymore. After discussion with pediatric surgeon, we suspected the diagnosis of neuroblastoma with prenatal regression.