title: Laparoscopic Adrenalectomy is Feasible for Suspected Adrenal Tumors in Children Younger than 24 Months of Age - But is it Always Justified?
abstract: BACKGROUND
  Tumors of the adrenal gland are rare in children younger than 24 months of age. While neuroblastomas are most important in this age group, adrenal hemorrhage and other tumors are sometimes difficult to distinguish. Harvesting biopsies is mandatory in these young patients to obtain information on molecular markers, namely, MYCN and 1p deletion.
  
  
  METHODS
  Between 03/2012 and 10/2013, 11 patients younger than 24 months of age with suspicious adrenal tumors were operated on laparoscopically.
  
  
  METHODS
  The diagnostic workup was coordinated by our pediatric oncologists according to the terms of the NB2004 trial protocol.
  
  
  RESULTS
  9 out of 11 had a diagnosis of neuroblastoma, the others were adenoma respective complete necrosis of the adrenal gland. All of the neuroblastomas were negative for both MYCN amplification and 1p deletion. A complete resection was successful in 9 out of 11 cases. 3 complications occurred, 1 major and 2 minor.
  
  
  CONCLUSIONS
  Behind the recognition that laparoscopic adrenalectomy is technically feasible, the fact that all neuroblastomas were negative for MYCN amplification and 1p deletion raises the issue of whether biopsy is mandatory for risk stratification in this age group.
authors.affiliation: Pediatric Surgery, Ludwig-Maximilians University, Munich, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Hubertus
authors.affiliation: Department of Pediatric Surgery, Dr. von Hauners' childrens hospital, Munich, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Pohl
authors.affiliation: Abteilung Onkologie, Haunersche Kinderklinik und Kinderpoliklinik, München, Germany.
authors.forename: I
authors.initials: I
authors.lastname: Schmid
authors.affiliation: Kinderchirurgie, Klinikum der LMU, Dr. von Haunersches Kinderspital, München, Germany.
authors.forename: D
authors.initials: D
authors.lastname: von Schweinitz
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000235:genetics / Q000473:pathology / Q000601:surgery*; D000311:Adrenal Glands / Q000473:pathology; D000315:Adrenalectomy / Q000379:methods*; D014408:Biomarkers, Tumor / Q000097:blood; D001706:Biopsy; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D033183:Interdisciplinary Communication; D000070516:Intersectoral Collaboration; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D000071447:N-Myc Proto-Oncogene Protein / Q000235:genetics; D009447:Neuroblastoma / Q000235:genetics / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology
chemical_list: D014408:Biomarkers, Tumor; C459801:MYCN protein, human; D000071447:N-Myc Proto-Oncogene Protein