Case of the Week # 54

Angela Regina Capelanes, MD*, Gloria Valero, MD&, Philippe Jeanty, MD, PhD#

July 6-19, 2001

*Centro de Atendimento Materno-Fetal, Aracatuba Sao Paulo, Brazil;
&Magdalena Sonora, Mexico,
#Nashville, TN

This G1P0 patient was referred at 34 weeks and 3 days for an abdominal mass on the right side. The ultrasound examination confirmed the presence of a 37 by 36 by 29 mm mass.

The mass:

case0054_1
case0054_2
case0054_3
case0054_4
case0054_measure2
case0054_measure

The mass in sagittal view

case0054_abdomen
case0054_doppler4

Doppler of the mass:

case0054_doppler1
case0054_doppler2
case0054_doppler3
case0054_doppler5

There are also 3 video-clips of the lesion (1.8 MB, 2.2 MB, 2.3 MB)

What is (are) the finding(s) and diagnosis ?

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Answer

This G1P0 patient was referred at 34 weeks and 3 days for an abdominal mass on the right side. The ultrasound examination confirmed the presence of a 37 by 36 by 29 mm mass.

The mass:

case0054_1
case0054_2
case0054_3
case0054_4
case0054_measure2
case0054_measure

The mass in sagittal view

case0054_abdomen
case0054_doppler4

Doppler of the mass:

case0054_doppler1
case0054_doppler2
case0054_doppler3
case0054_doppler5

There are also 3 video-clips of the lesion (1.8 MB, 2.2 MB, 2.3 MB)

Findings:

The mass is heterogeneous, mostly solid. No large vessel feeder is seen. The mass displace the inferior vena cava anteriorly, revealing its retroperitoneal nature. The rest of the examination is unremarkable and in particular there was no evidence of either adenopathy or metastasis. Because of the intimate contact of this lesion with the upper pole of the right kidneys, the failure to identify the right adrenal gland and the anterior displacement of the vena cava we suspected (as did the referring physician) that this lesion represented a neuroblastoma.

The mother did not experience complications; in particular she had no evidence of hypertension. The baby was delivered at term and was followed-up in pediatric oncology. In spite of a rapid confirmation of the prenatal diagnosis and aggressive treatment, the child died at 3 months. This fatal evolution might suggest that in contrary to the commonly held belief that early detection of the neuroblastoma carries a favorable prognosis, it might also be tumors that are detected early are also more aggressive tumors.

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