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2001-07-19-20 Answer to the case of the week #54 © Capelanes http://www.thefetus.net/

Answer to case #54

July 6-19,  2001

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

*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:

 

 

 

The mass in sagittal view

 

Doppler of the mass:

 

 

 

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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