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2007-01-15-18 Answer to the case of the week #192 © Quiroga www.TheFetus.net

Answer to the case of the week #192 

May 3 - May 17, 2007

Héctor Gonzalo Quiroga Pacheco, MD.

Centro Medico Profesional Rosancar. Barquisimeto. Venezuela.

 

A 28-years-old primigravida was referred at 31st week of gestation for a targeted ultrasound examination following visualization of a severe hydramnios. Fetal biometry was consistent with gestational age. The sex of the fetus was male. A complete fetal evaluation revealed an abdominal circumference over the 95th percentile and the presence of an intraabdominal solid tumor with well defined borders that displaced the fetal liver cranially. The size of the tumor was 83 mm x 62 mm x 47 mm. (Figure 1,2).  The right kidney could not be identified and the left kidney appeared normal. Because of this findings a Congenital Mesoblastic Nephroma vs. a Wilms’s tumor were proposed as possible diagnosis. There was also a severe polyhydramnios (Amniotic Fluid Index over 95th percentile).

Figures 1, 2.

 

Figure 3.

At 32 weeks the patient presented premature labor and spontaneous rupture of the amniotic membranes. A cesarean section was performed and a male baby was delivered. Two hours later the baby died.

Pathological findings

Postmortem examination reported a preterm male infant weighing 2320g (Figure 4). Left Kidney with the presence of fetal lobulations, corticomedular relation was conserved. Right kidney totally substituted by a solid tumor of 80 x 60 x 50 mm, with round and well defined borders,  the cut surface was yellow-grey, firm, rubbery and trabeculated, a smooth-walled cyst of 1,5 cm was present in the mid portion of the tumor.

Figure 4. Postnatal appearance of the baby.

Microscopic findings

Figures 5, 6. Right Kidney: The microscopic evaluation showed tight interlaced bundles of fibroblasts and myofibroblasts with eosinophilic and fibrillar cytoplasm and round to oval nuclei.

 

Figures 7. 8. Right Kidney: In focal areas dysplastic glomeruli and tubules (figure 7) and immature cartilage were present (figure 8).

 

The final diagnosis was Congenital Mesoblastic Nephroma.

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