Prenatal intrarenal neuroblastoma mimicking a mesoblastic nephroma: a case report

• Published in: Journal of pediatric surgery Vol. 47; no. 8; pp. e21 - e23
• Main Authors: Garnier, Sarah, Maillet, Olivier, Haouy, Stéphanie, Saguintaah, Magalie, Serre, Isabelle, Galifer, René-Benoit, Forgues, Dominique, Guibal, Marie-Pierre, Allal, Hossein, Sabatier, Edith, Kalfa, Nicolas
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.08.2012
• Subjects: Biomarkers, Tumor - urine; Calcinosis - congenital; Calcinosis - etiology; Cesarean Section; Diagnostic Errors; Fetal tumor; Heart Failure - congenital; Heart Failure - etiology; Humans; Hypertension, Renal - congenital; Hypertension, Renal - etiology; Infant, Newborn; Intrarenal; Kidney Neoplasms - complications; Kidney Neoplasms - diagnostic imaging; Kidney Neoplasms - embryology; Kidney Neoplasms - pathology; Kidney Neoplasms - surgery; Kidney Neoplasms - urine; Liver Neoplasms - secondary; Magnetic Resonance Imaging; Male; Mesoblastic nephroma; Nephrectomy; Nephroma, Mesoblastic - diagnosis; Neuroblastoma; Neuroblastoma - complications; Neuroblastoma - diagnostic imaging; Neuroblastoma - embryology; Neuroblastoma - pathology; Neuroblastoma - secondary; Neuroblastoma - surgery; Neuroblastoma - urine; Normetanephrine - urine; Pediatrics; Prenatal diagnosis; Surgery; Ultrasonography, Prenatal; Vanilmandelic Acid - urine; Mesoblastic nephroma; Fetal tumor; Prenatal diagnosis; Neuroblastoma; Intrarenal
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1016/j.jpedsurg.2012.03.090

Abstract Mesoblastic nephroma is by far the most frequent intrarenal fetal tumor. To the best of our knowledge, we report the first case of a newborn with an intrarenal neuroblastoma that was discovered prenatally. An intrarenal echogenic and homogenous mass was observed on routine prenatal ultasonography, corroborated by magnetic resonance imaging, in a 30-week gestation fetus. A male weighing 3280 g was born with elevated blood pressure and cardiac failure. Postnatal ultrasound confirmed a left intrarenal tumor with microcalcifications and perirenal adenopathy. An open total left nephrectomy by laparotomy was performed. The pathologic study reported that the mass was an intrarenal neuroblastoma with local and regional invasion. Immediate postoperative urine analysis revealed a high level of vanillylmandelic acid, and blood samples showed high levels of normetanephrine. The purpose of this report is to demonstrate that prenatal intrarenal neuroblastoma can clinically and radiologically mimick a mesoblastic nephroma. High blood pressure, calcifications, and lymphadenopathy on ultrasound should raise the index of suspicion for a possible malignant process. Preoperative measurement of urinary vanillylmandelic acid (VMA) and metanephrines should be performed if the diagnosis is in doubt.