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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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