Presentation
For routine third trimester scan at a gestational age of 36-37 weeks. Incidental finding.
Patient Data
Pre-natal and post-natal ultrasound reveals a complex mass with minimal cystic components around the expected position of the fetal right adrenal gland.
Case Discussion
Neuroblastoma is a poorly differentiated embryonal nerve cell tumor, most commonly found in the adrenal gland (90%).
It is the second most common tumor in neonatal period.
Incidence of 1 in 10,000 to 1 in 100,000 of all live births.
Neuroblastoma is most frequently cystic, right-sides, and is usually identified in the third trimester.
Differentiating neuroblastomas from other fetal suprarenal masses such as:
- Extralobar pulmonary sequestration
- Congenital adrenal hyperplasia
- Renal duplication
- Urinoma
- Gastric duplication cyst
- And splenic cyst may be very difficult.
However, improvements in ultrasound technology have made early detection possible and, combined with fetal MRI, facilitate differential diagnosis.
Finally, prenatal diagnosis of neuroblastoma is associated with a better prognosis, as it can resolve spontaneously either in utero or shortly after birth.