Maternal manifestation of Ballantyne's syndrome occurring concomitantly with the development of fetal congenital mesoblastic nephroma

Abstract

Various fetal or placental disorders cause Ballantyne's (mirror) syndrome. For the first time, we report a maternal manifestation of Ballantyne's syndrome occurring concomitantly with the development of fetal congenital mesoblastic nephroma (CMN). In a pregnant woman with a CMN fetus, lung edema, hypertension, hyperthyroidism, and high serum human chorionic gonadotrophin level occurred, all of which characterize maternal manifestation of Ballantyne's syndrome. The fetus and placenta were devoid of 'edema', lacking 'triple edema', and thus this condition was not diagnosed as Ballantyne's syndrome; however, we considered this condition as the maternal manifestation of Ballantyne's syndrome. We performed emergent cesarean section at 28 weeks. Delivery acutely ameliorated maternal symptoms. Tumor was resected and was confirmed as CMN. Maternal manifestations of Ballantyne's syndrome, such as lung edema and hypertension, can occur in a mother with fetal CMN even without fetal and/or placental edema. The clinical course of this patient may suggest an etiology of Ballantyne's syndrome.

Congenital mesoblastic nephroma 50 years after its recognition: A narrative review

“…Case reports additionally reported polyhydramnios in 40/270 cases (15%), hypercalcemia in 12/270 cases (4%), and hyperreninemia in 3/270 cases (1%) (Supplementary Table S2). Both hypercalcemia and hyperreninemia completely resolved with the removal of the tumor in all cases …”

Cellular congenital mesoblastic nephroma detected by prenatal MRI: a case report and literature review

“…Comparably, CMN was reported to have a relatively similar distribution in right and left kidneys, but never bilateral (1,2,13). Polyhydramnios was presented in (8/10) cases, and it was mentioned to be frequently associated with CMN (5,6,19). In 3 reports postnatal MRI was performed, but in one case the MRI was postoperatively done upon recurrence.…”

Síndrome en espejo como manifestación del desequilibrio angiogénico. A propósito de un caso

“…Llurba (8) comunica un feto afectado por hidrotórax bilateral que desarrolló hidropesía; luego de la colocación de shunt pleuro-amniótico se resolvió la hidropesía y los síntomas maternos desaparecieron, asocián-dose a un descenso de los niveles de sFlt-1 y endoglina, con elevación significativa del PlGF. Otros reportes refuerzan estos hallazgos (tabla 2) (5)(6)(7)(8)(9)(10)(11)(12) . Esta serie de casos permiten sugerir que el síndrome en espejo sería una manifestación del desequilibrio antiangiogénico generado por el edema placentario; al corregir la causa fetal que ocasiona la hidropesía se revierten los fenómenos fisiopatológicos y se restituye el equilibrio angiogénico.…”