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Chapter 17.2 - Fetal tumors

Clinical management

from Section 2 - Fetal disease

Published online by Cambridge University Press:  05 February 2013

By
Sundeep G. Keswani  and
Timothy M. Crombleholme
Edited by
Mark D. Kilby ,
Anthony Johnson  and
Dick Oepkes
Mark D. Kilby
Affiliation:
Department of Fetal Medicine, University of Birmingham
Anthony Johnson
Affiliation:
Baylor College of Medicine, Texas
Dick Oepkes
Affiliation:
Department of Obstetrics, Leiden University Medical Center
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Summary

Introduction

Neonatal and pediatric tumors have a range of outcomes depending on the anatomical origin of the tumor, its malignant potential, and response to treatment. Significant advances in prenatal imaging such as high resolution ultrasound and ultrafast MRI have allowed us to more accurately diagnose these same tumors in utero. This increase in prenatal diagnostic capability has significant benefits for the parents, the fetus, and the perinatal team taking care of these patients. For the parents of a fetus diagnosed with a neoplastic process, it affords more comprehensive prenatal counseling so that parents know what to expect for the duration of the pregnancy and can help prepare them for the challenges that the baby will face in the perinatal period and beyond. For the fetus, prenatal diagnosis has allowed us to identify a subset of these babies that historically have had a very poor prognosis. These patients may benefit from an in-utero intervention that can potentially salvage the pregnancy. Lastly for the perinatal team, prenatal diagnosis helps identify those high-risk patients that will have significant issues in the perinatal period to ensure that the baby is delivered in the appropriate setting, at an optimal gestational age, and with advanced delivery techniques, such as the ex-utero intrapartum treatment (EXIT) procedure, to allow the best possible outcome for the sickest of these patients.

In this context, the goals of this chapter are to outline the prenatal imaging and clinical diagnoses, discuss the antenatal natural history, and review available treatment options during the pre- and postnatal period for fetuses with prenatally diagnosed tumors. As the histology of these tumors is only confirmed postnatally after resection, we have organized this chapter by anatomical site at prenatal diagnosis.

Keywords

mesenchymal hamartomahepatic tumorhepatoblastomaintracranial tumorfetal tumorsbronchopulmonary sequestrationschest lesions
Type
Chapter
Information
Fetal Therapy
Scientific Basis and Critical Appraisal of Clinical Benefits
 , pp. 329 - 340
Publisher: Cambridge University Press
Print publication year: 2012

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References

Oka, K, Okane, M, Okuno, S, et al. Congenital cervical immature teratoma arising in the left lobe of the thyroid gland. APMIS 2007;115(1):75–9.Google Scholar
Kelly, MF, Berenholz, L, Rizzo, KA, et al. Approach for oxygenation of the newborn with airway obstruction due to a cervical mass. Ann Otol Rhinol Laryngol 1990;99(3 Pt 1):179–82.Google Scholar
Trecet, JC, Claramunt, V, Larraz, J, et al. Prenatal ultrasound diagnosis of fetal teratoma of the neck. J Clin Ultrasound 1984;12(8):509–11.Google Scholar
Hubbard, AM, Crombleholme, TM, Adzick, NS. Prenatal MRI evaluation of giant neck masses in preparation for the fetal exit procedure. Am J Perinatol 1998;15(4):253–7.Google Scholar
Mochizuki, Y, Noguchi, S, Yokoyama, S, et al. Cervical teratoma in a fetus and an adult. Two case reports and review of literature. Acta Pathol Jp 1986;36(6):935–43.Google Scholar
Berge, SJ, von Lindern, JJ, Appel, T, Braumann, B, Niederhagen, B. Diagnosis and management of cervical teratomas. Br J Oral Maxillofac Surg 2004;42(1):41–5.Google Scholar
Marwan, A, Crombleholme, TM. The EXIT procedure: principles, pitfalls, and progress. Semin Pediatr Surg 2006;15(2):107–15.Google Scholar
Tonni, G, De Felice, C, Centini, G, Ginanneschi, C. Cervical and oral teratoma in the fetus: a systematic review of etiology, pathology, diagnosis, treatment and prognosis. Arch Gynecol Obstet 2010;282(4):355–61.Google Scholar
Vazquez, E, Castellote, A, Mayolas, N, et al. Congenital tumours involving the head, neck and central nervous system. Pediatr Radiol 2009;39(11):1158–72.Google Scholar
Adzick, NS. Management of fetal lung lesions. Clin Perinatol 2009;36(2):363–76, x.Google Scholar
Azizkhan, RG, Crombleholme, TM. Congenital cystic lung disease: contemporary antenatal and postnatal management. Pediatr Surg Int 2008;24(6):643–57.Google Scholar
Collin, PP, Desjardins, JG, Khan, AH. Pulmonary sequestration. J Pediatr Surg 1987;22(8):750–3.Google Scholar
Oepkes, D, Devlieger, R, Lopriore, E, Klumper, FJ. Successful ultrasound-guided laser treatment of fetal hydrops caused by pulmonary sequestration. Ultrasound Obstet Gynecol 2007;29(4):457–9.Google Scholar
Stocker, JT, Madewell, JE, Drake, RM. Congenital cystic adenomatoid malformation of the lung. Classification and morphologic spectrum. Hum Pathol 1977;8(2):155–71.Google Scholar
Diamond, IR, Wales, PW, Smith, SD, Fecteau, A. Survival after CCAM associated with ascites: a report of a case and review of the literature. J Pediatr Surg 2003;38(9):E1–3.Google Scholar
Crombleholme, TM, Coleman, B, Hedrick, H, et al. Cystic adenomatoid malformation volume ratio predicts outcome in prenatally diagnosed cystic adenomatoid malformation of the lung. J Pediatr Surg 2002;37(3):331–8.Google Scholar
Bailey, PV, Tracy, T, Connors, RH, et al. Congenital bronchopulmonary malformations. Diagnostic and therapeutic considerations. J Thorac Cardiovasc Surg 1990;99(4):597–602.Google Scholar
Makin, E, Davenport, M. Fetal and neonatal liver tumours. Early Hum Dev 2010;86(10):637–42.Google Scholar
Isaacs, H Jr. Fetal and neonatal hepatic tumors. J Pediatr Surg 2007;42(11):1797–803.Google Scholar
Kamata, S, Nose, K, Sawai, T, et al. Fetal mesenchymal hamartoma of the liver: report of a case. J Pediatr Surg 2003;38(4):639–41.Google Scholar
Foucar, E, Williamson, RA, Yiu-Chiu, V, Varner, MW, Kay, BR. Mesenchymal hamartoma of the liver identified by fetal sonography. AJR Am J Roentgenol 1983;140(5):970–2.Google Scholar
Jones, VS, Cohen, RC. Atypical congenital mesoblastic nephroma presenting in the perinatal period. Pediatr Surg Int 2007;23(3):205–9.Google Scholar
Powis, M. Neonatal renal tumours. Early Hum Dev 2010;86(10):607–12.Google Scholar
Linam, LE, Yu, X, Calvo-Garcia, MA, et al. Contribution of magnetic resonance imaging to prenatal differential diagnosis of renal tumors: report of two cases and review of the literature. Fetal Diagn Ther 2010;28(2):100–8.Google Scholar
Heaton, TE, Liechty, KW. Postnatal management of prenatally diagnosed abdominal masses and anomalies. Prenat Diagn 2008;28(7):656–66.Google Scholar
Leclair, M-D, El-Ghoneimi, A, Audry, G, et al. The outcome of prenatally diagnosed renal tumors. J Urol 2005;173(1):186–9.Google Scholar
Grundy, RG, Pritchard, J, Baraitser, M, Risdon, A, Robards, M. Perlman and Wiedemann-Beckwith syndromes: two distinct conditions associated with Wilms’ tumour. Eur J Pediatr 1992;151(12):895–8.Google Scholar
Crombleholme, TM, Murray, TA, Harris, BH. Diagnosis and management of fetal neuroblastoma. Curr Opin Obstet Gynecol 1994;6(2):199–202.Google Scholar
Nuchtern, JG. Perinatal neuroblastoma. Semin Pediatr Surg 2006;15(1):10–16.Google Scholar
Athanassiadou, F, Kourti, M, Papageorgiou, T, Drevelegas, A, Zaramboukas, T. Prenatally diagnosed cystic neuroblastoma. Pediatr Blood Cancer 2005;44(3):290–1.Google Scholar
Jennings, RW, LaQuaglia, MP, Leong, K, Hendren, WH, Adzick, NS. Fetal neuroblastoma: prenatal diagnosis and natural history. J Pediatr Surg 1993;28(9):1168–74.Google Scholar
Askin, J, Geschickter, C. Neuroblastoma of the adrenal in children. J Pediatr 1935;7:157–8.Google Scholar
Forrester, MB, Merz, RD. Descriptive epidemiology of teratoma in infants, Hawaii, 1986–2001. Paediatr Perinat Epidemiol 2006;20(1):54–8.Google Scholar
Altman, RP, Randolph, JG, Lilly, JR. Sacrococcygeal teratoma: American Academy of Pediatrics Surgical Section Survey-1973. J Pediatr Surg 1974;9(3):389–98.Google Scholar
Chervenak, FA, Isaacson, G, Touloukian, R, et al. Diagnosis and management of fetal teratomas. Obstet Gynecol 1985;66(5):666–71.Google Scholar
Danzer, E, Hubbard, AM, Hedrick, HL, et al. Diagnosis and characterization of fetal sacrococcygeal teratoma with prenatal MRI. AJR Am J Roentgenol 2006;187(4):W350–6.Google Scholar
Flake, AW, Harrison, MR, Adzick, NS, Laberge, JM, Warsof, SL. Fetal sacrococcygeal teratoma. J Pediatr Surg 1986;21(7):563–6.Google Scholar
Hedrick, HL, Flake, AW, Crombleholme, TM, et al. Sacrococcygeal teratoma: prenatal assessment, fetal intervention, and outcome. J Pediatr Surg 2004;39(3):430–8.Google Scholar
Adzick, NS, Harrison, MR. The unborn surgical patient. Curr Probl Surg 1994;31(1):1–68.Google Scholar
Bahlmann, F, Wellek, S, Reinhardt, I, et al. Reference values of fetal aortic flow velocity waveforms and associated intra-observer reliability in normal pregnancies. Ultrasound Obstet Gynecol 2001;17(1):42–9.Google Scholar
el-Qarmalawi, MA, Saddik, M, el Abdel Hadi, F, Muwaffi, R, Nageeb, K. Diagnosis and management of fetal sacrococcygeal teratoma. Int J Gynaecol Obstet 1990;31(3):275–81.Google Scholar
Adzick, NS, Crombleholme, TM, Morgan, MA, Quinn, TM. A rapidly growing fetal teratoma. Lancet 1997;349(9051):538.Google Scholar
Cowles, RA, Stolar, CJH, Kandel, JJ, et al. Preoperative angiography with embolization and radiofrequency ablation as novel adjuncts to safe surgical resection of a large, vascular sacrococcygeal teratoma. Pediatr Surg Int 2006;22(6):554–6.Google Scholar
Misra, D, Pritchard, J, Drake, DP, Kiely, EM, Spitz, L. Markedly improved survival in malignant sacro-coccygeal teratomas – 16 years, experience. Eur J Pediatr Surg 1997;7(3):152–5.Google Scholar

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