Diagnostic and therapeutic dilemma with large prenatally detected cystic adrenal masses.
OBJECTIVE
The prenatal finding of a large cystic adrenal mass raises the dilemma of the differential diagnosis between adrenal hemorrhage and cystic neuroblastoma. The possibility of a neuroblastoma usually leads to surgical excision of such tumors. Nevertheless, an adrenal hemorrhage has to be recognized, so that unnecessary surgery may be avoided.


METHODS
Three cases of large prenatally detected adrenal masses managed nonoperatively are reported. Data studied were: age at the diagnosis, prenatal and postnatal ultrasonographic consistency, and tumor marker levels. Size and sonographic evolution were also studied.


RESULTS
In all 3 cases, a cystic mass, measuring more than 40 mm in size, was detected during the 3rd trimester of pregnancy. The sonographic appearance evolved from a sonolucent tumor to a heterogeneous mass with hyperechoic areas. The tumor marker levels were normal. All infants had a documented decrease in mass size at birth and were managed nonoperatively. All these tumors were considered adrenal hemorrhages.


CONCLUSIONS
Prenatal ultrasonography rarely permits to distinguish an adrenal hemorrhage from a cystic neuroblastoma. The differential diagnosis, even in large masses, is based on close postnatal follow-up with serial sonography. Surgery is not mandatory, unless the size does not decrease. However, without pathologic proof, it is not possible to differentiate an adrenal hemorrhage from a spontaneously resolved neuroblastoma.
de Luca
J L
JL
Department of Pediatric Surgery, Dijon University School of Medecine, Dijon, France.
Rousseau
T
T
Durand
C
C
Sagot
P
P
Sapin
E
E
D000307:Adrenal Gland Diseases / Q000175:diagnosis* / Q000628:therapy*; D000310:Adrenal Gland Neoplasms / Q000175:diagnosis; D000328:Adult; D003937:Diagnosis, Differential; D005260:Female; D006470:Hemorrhage / Q000175:diagnosis* / Q000628:therapy*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D009447:Neuroblastoma / Q000175:diagnosis; D011247:Pregnancy; D014057:Tomography, X-Ray Computed; D016216:Ultrasonography, Prenatal