Prenatal diagnosis of fetal bilateral adrenal carcinoma

Abstract

Fetal malignancies that are capable of metastasizing to other fetal organs and the placenta are exceedingly rare. Fetal tumors are suspected on ultrasonography in the presence of structures of abnormal shape or size that are occasionally associated with polyhydramnios and hydrops. Most of the large abdominal masses detected antenatally are renal in origin, although adrenal tumors should also be kept in mind in their differential diagnosis. We report a case of a large-for-gestational-age fetus with abdominal distention secondary to bilateral adrenal carcinoma, polyhydramnios and placental enlargement. Postmortem histological findings included nesidioblastosis, (i.e. hyperplasia of the cells of the islets of Langerhans) and adrenocortical cytomegaly, suggestive of a form of Beckwith-Wiedemann syndrome.

Fetal Adrenal Haemorrhage – Two-Dimensional and Three-Dimensional Imaging

“…The main differential diagnoses of suprarenal masses are adrenal haemorrhage and neuroblastoma [1] . Suprarenal masses, however, may also be due to extralobular pulmonary sequestration, adrenal abscess, adrenal nodular hyperplasia, adrenal cyst, bronchogenic cyst [2] or rarely adrenal carcinoma [3] .…”

An unusual presentation of congenital adrenocortical carcinoma: a case report and review of the literature

“…The right adrenal was involved in 13 cases, left in 7, bilateral in 1 and laterality was not reported in 4 cases [39] . Three cases were diagnosed on antenatal ultrasonography: adenoma in 2 cases and 1 case of bilateral adrenal carcinoma on pathological evaluation [3,8,9] . Our case was a male who presented with recurrent pneumonia and paraparesis, without any signs of hypercortisolism or hyperaldosteronism or a palpable abdominal mass.…”

“…Radiography has a limited role, however it can reveal an abdominal mass or calcification [12] . On sonography the appearance of adrenocortical neoplasms is variable; small lesions are usually round to oval, homogeneous, solid masses isoechoic to the renal cortex but can be uniformly hypoechoic or hyperechoic; large tumors are heterogeneous with central necrotic areas and can mimic multicystic kidneys [6,8,13,14] . A complex, predominantly hyperechoic pattern with radiating linear echoes, described as the scar sign has also been reported in carcinoma [13] .…”

Neuroblastoma Presented with Polyhydramniosis

“…The differential diagnoses of fetal adrenal mass include adrenal hemorrhage, neuroblastoma, adrenal and cortical renal cysts, duplication of the renoureteral system, Beckwith-Wiedemann syndrome, and adrenal carcinoma and some of them (hemorrhage or neuroblastoma) can also be diagnosed prenatally by Doppler ultrasonagraphy [8][9][10].…”

“…Some benign or malignant tumors such as mesenchymal liver hamartoma, cervical and mediastinal teratomas, myofibroblastic tumor, congenital mesoblastic nephroma, and adrenal carcinomas can also present with polyhydramnios [10,[12][13][14]. So far, no neuroblastoma case who presented with polyhydramniosis was reported.…”