Prenatally detected thoracic neuroblastoma

Abstract

Neuroblastoma is the most common pediatric extracranial solid tumor derived from primitive neural crest cells of the sympathetic nervous system. Although one-fifths of all neuroblastomas occurs within the thorax, thoracic neuroblastomas detected in fetus have been rarely reported. We report a case of fetal thoracic neuroblastoma with massive pleural effusion detected with prenatal ultrasonography. A 34-year-old Korean second-gravida was referred to our hospital at 30 weeks of gestation for evaluation, after the right lung mass found in the fetus. Approximately 3 cm, well-defined, hyperechoic mass was found in the right thorax with right pleural effusion, with the initial suspicion of teratoma. However, as mass continued to grow with deteriorating pleural effusion and fetal hydrops, the mass was considered malignant after 3 weeks. After a cesarean delivery, an approximately 4 cm mass with peripheral calcification and hemothorax was found on neonatal ultrasonography. Neuroblastoma was diagnosed on excision biopsy.

Keywords: Fetus; Mediastinum; Neoplasms; Neuroblastoma; Thorax.

Fig. 1

(A) An irregularly shaped hyperechoic solid mass with calcification was detected in the transabdominal sonographic image of the sagittal section of the right thorax of the fetus at 30 weeks of gestation. (B) The irregularly shaped hyperechoic solid mass increased in size compared with the previous examination, with massive hydrothorax at 33 weeks of gestation. (C) Ascites in the abdominal cavity was found around the fetal liver, with subcutaneous edema of the abdominal wall, and these were considered suggestive findings of malignancy.

Fig. 2

(A) Postnatal evaluation with chest computed tomography showed a highly attenuated mass with calcification and massive hydrothorax. (B) Neonatal magnetic resonance imaging of the liver showed multiple nodules with low signal intensity (arrows) in both lobes of the liver, suggesting multiple hepatic metastasis.