Clinical features and surgical outcome of a suprarenal mass detected before birth.
OBJECTIVE
With the widespread use of the obstetrical ultrasound, identification of a fetal suprarenal mass has become more common. Most of these masses prove to be congenital neuroblastomas (CNB), but the diagnosis is often confused with other benign lesions and the postnatal management remains to be controversial.


METHODS
The medical records of 18 patients that underwent primary surgical excision for an antenatally detected suprarenal mass, between January 1995 and April 2009, were reviewed. The clinical, radiological, surgical, and pathological data were collected. Staging evaluation was performed after histological confirmation of the CNB.


RESULTS
There were 13 cases of CNB, 1 adrenal cyst, 2 adrenal hemorrhages, and 2 pulmonary sequestrations. The differential diagnosis was impossible before surgery. Most of the CNBs were stage I (N = 11), with 1 stage IV and 1 stage IV-S. Four patients (3 stage I and 1 stage IV-S) had more than one copy of N-myc gene. The stage I patients were cured by surgery alone, and stage IV patients underwent nine cycles of adjuvant chemotherapy and currently have no evidence of disease. The five benign lesions were cured with excision alone. There were no postoperative complications.


CONCLUSIONS
For early diagnosis and treatment, surgical excision should be considered as the primary therapy for an antenatally detected suprarenal mass. The surgery can be safely performed during the neonatal period and provides a cure in most cases.
Moon
Suk-Bae
SB
Division of Pediatric Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, #50 Ilwon-dong, Gangnam-gu, Seoul, 135-710, Korea.
Shin
Hyun-Baik
HB
Seo
Jeong-Meen
JM
Lee
Suk-Koo
SK
D000307:Adrenal Gland Diseases / Q000151:congenital / Q000000981:diagnostic imaging / Q000601:surgery; D000310:Adrenal Gland Neoplasms / Q000151:congenital* / Q000000981:diagnostic imaging / Q000601:surgery*; D001998:Bronchopulmonary Sequestration / Q000000981:diagnostic imaging / Q000601:surgery; D003937:Diagnosis, Differential; D005260:Female; D005865:Gestational Age; D006470:Hemorrhage / Q000151:congenital / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009367:Neoplasm Staging; D009447:Neuroblastoma / Q000151:congenital* / Q000000981:diagnostic imaging / Q000601:surgery*; D011247:Pregnancy; D016896:Treatment Outcome; D016216:Ultrasonography, Prenatal