Fetal Adrenal Cysts and Masses: Imaging Features

Page Links: Adrenal Cysts, Adrenal Cystic Masses, Neuroblastoma, References

Adrenal Cysts

Fetal adrenal cysts are rare and the diagnosis may not be made until the third trimester. [1]

Adrenal Cystic Masses

Adrenal Cystic Masses

Cystic masses in the adrenal area may evolve and change from an anechoic cystic mass to a mass increasing in size and becoming echogenic and subsequently decreasing in size. Such a course may be indicative of adrenal hemorrhage. [2]  The neonatal course of adrenal hemorrhage is similar, evolving from a sonolucent large mass to a heterogeneous mass with echogenic areas. [3]

fettal cases underwent surgery of which 31 were neuroblastomas

In a review of 53 suprarenal masses detected both prenatally and postnatally, the masses were cystic in 19 cases, solid in 17 and mixed in 13 cases. [4]   Thirty eight cases underwent surgery of which 31 were neuroblastomas, 1 adrenal hemorrhage, 2 necrotic masses, 1 bronchogenic cyst, and 3 sequestrations. [4]

Fetal Suprarenal Masses that are Neuroblastoma

Fetal Suprarenal Masses that are Neuroblastoma

Since masses of the adrenal gland or suprarenal masses are often neuroblastomas, careful assessment of this area is important whenever any abnormality is noted.  Prenatal ultrasound of neruoblastomas suggest findings which parallel postnatal assessment and these include masses with cystic, solid, or mixed echogenecity. [5]
Neuroblastoma is the most frequent solid malignant tumor in the neonatal period

Neuroblastoma is the most frequent solid malignant tumor in the neonatal period; detection is based upon recognition of a mass with mixed echogenicity in the adrenal area. [6]  A neuroblastoma may be cystic and large, 30 mm. to 50 mm. in greatest diameter, and may appear stable during the neonatal period. [7]

In addition, the adrenal mass in neuroblastoma may be echogenic and associated with both polyhydramnios and hydronephrosis. [8]

Furthermore, the ultrasound findings for neuroblastoma are variable.  In some instances the mass may evolve from cystic to solid, while in other cases the findings are those of a predominantly solid mass. [9]

Finally, it is not unusual for suprarenal mass to enlarge during pregnancy.  MRI under these circumstances can demonstrate fluid levels within the cyst, which may correlate with malignancy. [10]  Excellent additional reviews of the ultrasound diagnosis of neuroblastoma are available. [11]

References


 

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  5. Auber F, Larroquet M, Bonnard A, Boudjemaa S, Landman-Parker J, Ducou Le Pointe H, Boccon-Gibod L, et al.  Prenatal ultrasound diagnosis of neuroblastoma.  Gynecol Obstet Fertil.  2005 Apr;33(4):228-31.

    Abstract: PMID: 15894207

     

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  7. Araujo Júnior E, Sanchez Ayub E, Costa Santos EM, Moraes DJ, Rodrigues Pires C, Filho Sebastião MZ.  Prenatal ultrasound diagnosis of adrenal neuroblastoma.  Ginecol Obstet Mex. 2005 Aug;73(8):451-5.

    Abstract: PMID: 16304971

     

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  13. Abstract: PMID: 10423810