Ch. 29 The Fetal Genitourinary system

Question 1

The fetal kidneys develop within the pelvis and ascend into their normal position by _____weeks. By the 10th week of gestation, fully functional kidneys exist. If the kidneys fail to ascend into the normal position, the result is an _____ kidney (renal ectopica), most often located within the pelvis. This is referred to as a _______.

Answer 1

9; ectopic; pelvic kidney

Question 2

The most common renal anomaly is the ________, also referred to as a duplicated, duplex, or double collecting system. In this variant, the kidney is composed of ______ separate collecting systems, divided into what is termed an upper pole moiety and a lower pole moiety.

Answer 2

duplex collecting system; two

Question 3

(renal) refers to a separate collecting system in the upper pole or the lower pole of the kidney in a duplex collecting system

Answer 3

moiety

Question 4

___________are kidneys that are attached at their lower poles.

Answer 4

Horseshoe kidneys

Question 5

Initially, the bladder is continuous with the _______, although eventually this channel closes and develops into a fibrous cord referred to as the _______.

Answer 5

allantois; urachus

Question 6

a membrane that is present during early embryonic development that contributes to urinary bladder formation and development

Answer 6

allantois

Question 7

canal connecting the fetal bladder with the allantois; normally closes during fetal development and becomes a fibrous cord

Answer 7

urachus

Question 8

the urachus is located between the ______ of the bladder and the _______. In newborns, occasionally, the urachus can remain patent or open.

Answer 8

apex; umbilicus

Question 9

The gonads develop in the _____ fetal abdomen and descend into the pelvis. The testicles move down into the scrotum during the _____ month of gestation.

Answer 9

upper; 7th

Question 10

The kidneys can be sonographically identified as early as 11 weeks with endovaginal imaging and by _____ weeks with transabdominal imaging. Indeed, by the second-trimester fetal anatomy screening examination, the kidneys should be consistently seen adjacent to the fetal ______ bilaterally

Answer 10

12; spine

Question 11

The fetal bladder can be seen as early as 12 weeks and should always be seen by ______ weeks and beyond

Answer 11

15

Question 12

It is important to note that the fetal urinary bladder normally fills and empties once in every ___ to ___minutes.

Answer 12

30 to 45 minutes

Question 13

Normal fetal ureters are _____ perceived with sonography. Therefore, visualization of the ureters would indicate some _______ process.

Answer 13

not; pathologic

Question 14

The adrenal glands are triangular-shaped hypoechoic structures located _______ to the upper pole of the kidneys. They are easily identified within the fetus

Answer 14

superior

Question 15

VACTERL stands for _______, _______, _________, _________ or _________, ________, and __________ Patients are considered to have this association if ______of the organ systems listed have abnormalities. Therefore, if an irregularity is noted within one structure or system, this should prompt the sonographer to further investigate the other systems for associated anomalies.

Answer 15

vertebral anomalies, anal atresia, cardiac anomalies, tracheoesophageal fistula or esophageal atresia, renal anomalies, and limb anomalies; three

*VACTERL association may also be referred to as VATER sequence, VATER, or VACTERL syndrome.

Question 16

Renal abnormalities are the most frequent cause of _______. Therefore, if ________ is discovered, a thorough analysis of the fetal urinary tract is warranted.

Answer 16

oligohydramnios; oligohydramnios

Question 17

During fetal development, around ____ weeks, the fetal kidneys begin to produce urine. ______ comprises the greater part of amniotic fluid after 14 weeks. ________ is a substance that contains valuable proteins that are essential for normal fetal development. It also contributes greatly to normal fetal growth and maturation.

Answer 17

9; Urine; Amniotic fluid

Question 18

The fetus ingests amniotic fluid by _________. The fluid passes through the esophagus, into the stomach, and travels through the small bowel and into the colon, where normal ________ takes place.

Answer 18

swallowing; absorption

Question 19

In circumstances in which the fetus has a renal abnormality, specifically those that are linked with bilateral renal agenesis, inadequately functioning kidneys, or obstruction of the urinary tract, ________ will be present, and, in some cases, anhydramnios may occur. Therefore, if a normal amount of fluid is noted during a sonogram, one can assume that there is at least ______ functioning fetal kidney present.

Answer 19

oligohydramnios; one

Question 20

no amniotic fluid

Answer 20

anhydramnios

Question 21

The most worrisome consequence of oligohydramnios is ________, or underdevelopment of the lungs.

Answer 21

pulmonary hypoplasia

Question 22

With fetal renal disease, keep in mind that while _______ conditions carry a better prognosis, _____ disease often leads to oligohydramnios and is thus related to a poor outcome, in most cases, as a result of ________.

Answer 22

unilateral; bilateral; pulmonary hypoplasia

Question 23

Failure of a kidney to form is referred to as ________. Can be unilateral or bilateral.

Answer 23

renal agenesis

Question 24

There are two sonographic findings that are helpful in making the sonographic diagnosis of renal agenesis. First, when the kidney is absent in the abdomen, the adrenal gland can be noted in a parallel, flattened position, a sonographic finding known as the “________” adrenal sign. Second, _______ can be employed over the _______branches of the abdominal aorta. When there is absence of the kidney, there will be no identifiable renal artery branches

Answer 24

lying down; color Doppler; renal artery branches

Question 25

Bilateral renal agenesis, which results in _______ or Potter sequence, is a fatal condition. Potter sequence is caused by any condition in which there is a significant ______ of amniotic fluid around the fetus as it develops.

Answer 25

Potter syndrome; lack

Question 26

physical features of a fetus as a result of oligohydramnios; characterized by bilateral renal agenesis, abnormal facies, pulmonary hypoplasia, and limb abnormalities; also referred to as Potter sequence

Answer 26

Potter syndrome

Question 27

The absence of both the fetal kidneys can be difficult to detect sonographically, secondary to the _____ of amniotic fluid surrounding the fetus. Therefore, it is extremely beneficial to utilize _________ to investigate the renal area. Nonvisualization of the urinary_______ and ________, with associated severe __________, is considered to be a trustworthy finding consistent with bilateral renal agenesis.

Answer 27

lack; color Doppler; bladder and kidneys; oligohydramnios

Question 28

Bilateral renal agenesis may be seen in conjunction with _________and various cardiovascular malformations.

Answer 28

sirenomelia

Question 29

a fetal abnormality characterized by fusion of the lower extremities, renal agenesis, and oligohydramnios; may also be referred to as mermaid syndrome

Answer 29

sirenomelia

Question 30

enlargement of an organ secondary to an increased workload; often seen when part of an organ has been destroyed or when there is absence or decreased function of paired organs

Answer 30

compensatory hypertrophy

Question 31

facial features seen with severe oligohydramnios, including low-set ears, flattened nose, wrinkled skin, and micrognathia

Answer 31

Potter facies

Question 32

Before making the conclusion of unilateral renal agenesis, the sonographer should always analyze the fetal ______for a __________, because this is the most common location of an ectopic kidney. In the presence of unilateral renal agenesis, the contralateral kidney will enlarge, a condition known as __________

Answer 32

pelvis; pelvic kidney; compensatory hypertrophy

Question 33

Any abnormality that brings about oligohydramnios, especially severe, can start the sequence referred to as ________, which ultimately can result in fetal growth restriction, pulmonary hypoplasia, Potter facies, and limb abnormalities.

Answer 33

Potter sequence

Question 34

Most often, with _______ renal agenesis, there is an average amount of amniotic fluid, and the prognosis is good.

Answer 34

unilateral

Question 35

Features of ________ Bilateral renal agenesis Abnormal facial features (Potter facies) Pulmonary hypoplasia (small chest) Limb abnormalities (e.g., clubfeet) Intrauterine growth restriction Low-set ears Oligohydramnios

Answer 35

Potter syndrome or Potter sequence

Question 36

Sonographic Findings of _________ 1.Absent kidneys 2.Absent urinary bladder 3.Severe oligohydramnios or anhydramnios 4.Bilateral lying-down adrenal signs 5.Undetectable renal artery branches with color Doppler (bilateral)

Answer 36

Bilateral Renal Agenesis

Question 37

Sonographic Findings of __________ 1.Absent kidney 2.Compensatory hypertrophy of the contralateral kidney 3.Visible urinary bladder 4.Normal amniotic fluid volume 5.Unilateral lying-down adrenal sign 6.Undetectable renal artery branch with color Doppler (unilateral)

Answer 37

Unilateral Renal Agenesis

Question 38

In order for an _______ disease to be passed to the fetus, both parents must be carriers of the disease. Each offspring of parents, who are both carriers of an autosomal recessive disorder, has a 25% chance of being affected and a 50% chance of being a carrier.

Answer 38

autosomal recessive disease

Question 39

In the case of an __________ disease, at least one of the parents has to be the carrier of the disease, and the gene must be dominant. That means, the dominant gene is capable of overriding the normal gene from the parent who is not a carrier.Each offspring of a parent who is a carrier of an autosomal dominant disease has a _____ chance of receiving the gene from their parents. It is important to note that dominant disorders tend to be ______ severe than recessive disorders

Answer 39

autosomal dominant disease; 50%; less

Question 40

_______ may also be referred to as autosomal recessive polycystic renal disease or infantile polycystic kidney disease. The typical sonographic findings of a fetus affected by ARPKD are bilateral, enlarged, ______ kidneys, nondetectable urinary bladder, and _________

Answer 40

ARPKD; echogenic; oligohydramnios

Question 41

Sonographic Findings of __________ 1.Bilateral, enlarged echogenic kidneys 2.Absent urinary bladder 3.Oligohydramnios

Answer 41

Autosomal Recessive (Infantile) Polycystic Kidney Disease

Question 42

One condition associated with ARPKD is ____________, which is a fatal disorder that includes renal cystic disease, occipital encephalocele, and polydactyly

Answer 42

Meckel–Gruber syndrome

Question 43

fetal syndrome associated with microcephaly, occipital encephalocele, polydactyly, and polycystic kidneys

Answer 43

Meckel–Gruber syndrome

Question 44

protrusion of the brain and meninges through a defect in the skull

Answer 44

encephalocele

Question 45

having more than the normal number of fingers or toes

Answer 45

polydactyly

Question 46

Referring to this condition (ARPKD), a renal cystic disease can be puzzling to a sonographer because cysts are not always perceptible with sonography. This is secondary to the size of the cysts because the cysts with ARPKD are often _________and not macroscopic.

Answer 46

microscopic

Question 47

Sonographic Findings of ________ 1.Normal-appearing or bilateral, enlarged echogenic kidneys 2.Visible urinary bladder 3.Normal amniotic fluid volume 4.Cysts often do not manifest until approximately the fifth decade of life

Answer 47

Autosomal Dominant (Adult) Polycystic Kidney Disease

Question 48

The sonographic appearance of fetal kidneys with ADPKD is similar to that of ______ in that both kidneys will appear enlarged and echogenic, although the kidneys may appear completely ______. If the kidneys do appear enlarged and echogenic, a distinguishing difference between the two diseases is that in the fetus with ADPKD, the urinary bladder is often _______ and there is a _______ amniotic fluid volume, whereas with ARPKD, the bladder is absent and there is oligohydramnios.

Answer 48

ARPKD; normal; present; normal

Question 49

ADPKD does not typically manifest until approximately the _____ or _____decade of life, at which time the adult will develop renal cysts and may die from end-stage renal failure. Adult renal cystic disease is also associated with the development of ______ within the liver, pancreas, and spleen. Fetuses with trisomy 13 and trisomy 18 may also have polycystic kidney disease.

Answer 49

fourth or fifth; cysts

Question 50

Multicystic dysplastic renal disease may also be referred to as _________and multicystic renal dysplasia. MCDK disease is thought to be caused by an early, first-trimester obstruction of the _____.

Answer 50

multicystic dysplastic kidney (MCDK) disease; ureter

Question 51

Sonographic Findings of ____________ 1.Bilateral, smooth-walled, noncommunicating cysts of varying sizes located within the renal fossae 2.Absent urinary bladder 3.Oligohydramnios

Answer 51

Bilateral Multicystic Dysplastic Renal Disease

Question 52

Sonographic Findings of Unilateral _________ 1.Unilateral, smooth-walled, noncommunicating cysts of varying sizes located within the renal fossae 2.Compensatory hypertrophy of the contralateral kidney 3.Visible urinary bladder 4.Normal amniotic fluid volume

Answer 52

Unilateral Multicystic Dysplastic Renal Disease

Question 53

There is typically no normal functioning renal tissue present in the kidney affected by MCDK disease. Therefore, MCDK disease is fatal if ________, with the consistent associated findings of oligohydramnios and absent bladder.

Answer 53

bilateral

Question 54

Fetuses with _______ disease can also have additional related anomalies, such as abnormalities of the gastrointestinal tract and central nervous system, limb anomalies, and further renal abnormalities.

Answer 54

MCDK

Question 55

MCDK disease is fatal if _______, but fortunately, most cases of MCDK are unilateral.

Answer 55

bilateral

Question 56

______, like MCDK disease, is caused by an early renal _______. It can be unilateral or bilateral.

Answer 56

Obstructive cystic dysplasia; obstruction

Question 57

A ________, or a severe bladder outlet obstruction, early in gestation, can lead to bilateral obstructive cystic dysplasia, in which case ________ will be present.

Answer 57

ureterocele; oligohydramnios

Question 58

an abnormality in which the distal ureter projects into the urinary bladder *appears as a thin-walled cyst inside the bladder

Answer 58

ureterocele

Question 59

the junction of the ureter and the renal pelvis

Answer 59

pelviureteral junction

Question 60

Unilateral obstructive cystic dysplasia is most often caused by a ______ or vesicoureteral junction obstruction. Bilateral cystic dysplasia may be associated with ________ or posterior urethral valves.

Answer 60

pelviureteral junction; urethral atresia

Question 61

Sonographic Findings of __________ 1.Small, echogenic kidneys 2.Peripheral renal cysts 3.Bilateral hydronephrosis 4.Thick-walled urinary bladder 5.Oligohydramnios

Answer 61

Bilateral Obstructive Cystic Dysplasia

Question 62

irregular thin membranes of tissue located within the male posterior urethra that does not allow urine to exit the urethra

Answer 62

posterior urethral valves

Question 63

the dilation of the renal collecting system resulting from the obstruction of the flow of urine from the kidney(s) to the bladder; also referred to as pelvocaliectasis or pelvicaliectasis

Answer 63

hydronephrosis

Question 64

the funnel-shaped collecting system in the central portion of the kidney that allows urine to flow from the kidney to the ureter

Answer 64

renal pelvis

Question 65

the junction of the ureter and the urinary bladder

Answer 65

ureterovesical junction (UVJ)

Question 66

the junction of the ureter and the renal pelvis

Answer 66

ureteropelvic junction (UPJ)

Question 67

the part of the collecting system that encompasses the apex of the renal pyramids

Answer 67

renal calices

Question 68

An obstruction of the fetal urinary tract can lead to _______ of the urethra, bladder, ureters, and renal collecting system, depending upon the level of obstruction.

Answer 68

distension

Question 69

The sonographer must understand the creation and flow of urine through the urinary tract in order to determine the ______ of a urinary tract obstruction.

Answer 69

origin

Question 70

Urine is produced by the kidney; exits the kidney by means of the _______; travels down the ureter, into the bladder; and exits the body via the ______.

Answer 70

renal pelvis; urethra

Question 71

if there is an obstruction at the region where the ureter meets the bladder, the ______, then those structures that are positioned _______ to the obstruction will be dilated. That means, the entire ureter, the renal pelvis, and the renal calices will be eventually dilated and filled with urine. Conversely, if the obstruction level lies at the point at which the renal pelvis meets the ureter, the ________, then the ipsilateral renal pelvis and renal calices will be dilated, whereas the ureter and bladder will most likely remain normal, provided that contralateral urine flow is not obstructed in any way

Answer 71

ureterovesical junction (UVJ); proximal; ureteropelvic junction (UPJ)

Question 72

________is the most common fetal abnormality noted during an obstetric sonogram.

Answer 72

Hydronephrosis

Question 73

________, or pelvocaliectasis, may be described as pelviectasis (pyelectasis) or caliectasis, depending on which _____ of the collecting system is dilated.

Answer 73

Hydronephrosis; part

Question 74

Enlargement of the bladder is called ______, whereas dilation of the ureter may be referred to as _______ or hydroureter.

Answer 74

megacystis; megaureter

Question 75

dilation of the renal pelvis; may also be referred to as pyelectasis

Answer 75

pelviectasis (pyelectasis)

Question 76

dilation of the calices

Answer 76

caliectasis

Question 77

Fetal pelviectasis, or dilation of the renal pelvis, can be established and measured with sonography by taking a ________. The measurement of the renal pelvis is made in the _______ plane and should not exceed ______ before 20 weeks’ or _____ after 20 weeks’ gestation. However, it is important to note that ________ hydronephrosis should be reported because of the possible gradual evolution of this disorder and because of possible chromosomal associations

Answer 77

renal pelvic diameter; anteroposterior; 7mm; 10mm; borderline

Question 78

It is also important to note that ______ common causes of hydronephrosis in the fetus include ureterocele, ectopic ureter, vesicoureteral reflux, and urethral atresia

Answer 78

less

Question 79

the retrograde flow of urine from the urinary bladder into the ureter

Answer 79

vesicoureteral reflux

Question 80

the congenital absence of the urethra

Answer 80

urethral atresia

Question 81

_______, or _____ obstruction, is the most common cause of hydronephrosis in the neonate and the most common form of fetal renal obstruction.

Answer 81

Ureteropelvic junction obstruction; UPJ

Question 82

The _____ is located at the junction of the renal pelvis and the ureter. The cause of this abnormality may be due to irregular development of the smooth muscle in the area of the _____ (UPJ obstruction). Some authors suspect ureteral stenosis or kinks, adhesions, crossing vessels, or abnormal outlet shapes. The disease is usually _______ and more common in ________.

Answer 82

UPJ; UPJ; unilateral; males

Question 83

It is important to note that fetal pyelectasis can be a sonographic marker for _________.

Answer 83

Down syndrome

Question 84

Sonographic Findings of _____________ 1.Hydronephrosis (dilated renal pelvis and calices) 2.Normal ureters (nonvisualization) 3.Normal bladder

Answer 84

Ureteropelvic Junction Obstruction

Question 85

Renal pelvis diameter measurements indicative of fetal hydronephrosis -Gestational Weeks: 20 weeks -Renal Pelvis Diameter Measurement: ≥7 mm (borderline between ___ and ___) -Gestational Weeks: After 20 weeks -Renal Pelvis Diameter Measurement: ≥10 mm (borderline between ___ and ___)

Answer 85

4 and 6 mm; 5 and 9 mm

Question 86

Sonographic Findings of _______ 1.“Keyhole” sign (dilated bladder and urethra) 2.Bilateral hydroureter 3.Bilateral hydronephrosis 4.Oligohydramnios 5.Thickened bladder wall

Answer 86

Posterior Urethral Valves

Question 87

A __________describes the condition in which there is a blockage of the flow of urine out of the urinary bladder.

Answer 87

bladder outlet obstruction

Question 88

It is especially significant to determine the _____of the fetus once a renal obstruction is identified. For example, posterior urethral valves are a common cause of bladder outlet obstructions in ____ fetuses. These thin membranes of tissue located within the posterior urethra do not allow urine to exit the ______.

Answer 88

sex; male; urethra

Question 89

The “keyhole” sign is seen when there is dilation of the _______and ________.

Answer 89

urinary bladder; posterior urethra

Question 90

_____________ result in dilation of the bladder, ureters, and renal collecting system. Oligohydramnios and bladder wall thickening will be observed as well.

Answer 90

Posterior urethral valves

Question 91

Prune belly syndrome is typically caused by ________, a massively dilated urinary bladder. This syndrome is seen mostly in ____ fetuses and is the result of a _______ abnormality, which, in turn, leads to a bladder outlet obstruction.

Answer 91

megacystis; male; urethral

Question 92

_________ describes the result of the abdominal wall musculature being stretched by the extremely enlarged urinary bladder. The sonographic finding of the “_______” sign is also seen with prune belly syndrome. Dilatation of the _____ and the ________ systems will occur

Answer 92

Prune belly; keyhole; prune belly syndrome; ureters; renal collecting

Question 93

The triad of absent _________, undescended _____, and _______ abnormalities is consistent with the diagnosis of prune belly syndrome.

Answer 93

absent abdominal musculature; testis; urinary tract

Question 94

Sonographic Findings of ________ 1.Dilated bladder and, possibly, urethra (“keyhole” sign) 2.Absent abdominal musculature 3.Undescended testis 4.Urinary tract abnormalities (megacystis and hydronephrosis)

Answer 94

Prune Belly Syndrome

Question 95

________, or UVJ obstruction, is the least common cause of hydronephrosis in the fetus.

Answer 95

Ureterovesical junction obstruction

Question 96

The _________system and ______ will be dilated with a UVJ obstruction. Whereas unilateral UVJ obstructions lead to ______amounts of amniotic fluid, bilateral obstructions lead to ___________.

Answer 96

renal collecting system; ureter; normal; oligohydramnios

Question 97

Sonographic Findings of __________Obstruction 1.Hydronephrosis 2.Dilated ureter 3.Normal bladder 4.Normal amniotic fluid (if unilateral)

Answer 97

Ureterovesical Junction Obstruction

Question 98

________ is an anomaly wherein the bladder is located outside of the fetal pelvis.

Answer 98

Bladder exstrophy

Question 99

After an extended amount of investigation, nonvisualization of the bladder in the presence of a normal amniotic fluid volume and normal kidneys should warrant a search for ________.

Answer 99

bladder exstrophy

Question 100

the embryonic structure that develops into the normal rectum and urogenital sinus

Answer 100

cloaca

Question 101

Sonographic Findings of _______ 1.Lower abdominal wall mass inferior to the umbilicus 2.Absent urinary bladder 3.Normal kidneys

Answer 101

Bladder Exstrophy

Question 102

the region between the external genitalia and the anus

Answer 102

perineum

Question 103

The ______ is the embryonic structure that develops into the rectum and urogenital sinus. The cloaca can be persistent and result in the ________ of the urinary, genitals, and intestinal tract, emptying into a common orifice located on the perineum.

Answer 103

cloaca; combination

Question 104

With cloacal exstrophy, also referred to OEIS complex, there is an ______, _______, _______, and ________.

Answer 104

omphalocele; bladder exstrophy, imperforate anus, and spina bifida.

Question 105

the most common sold fetal renal mass

Answer 105

mesoblastic nephroma

Question 106

The most common solid fetal renal mass is the _______, which is essentially a hamartoma of the kidney. This tumor will typically appear as a solid, _______mass within the renal fossa and may completely replace the kidney. However, it may contain ______ components.

Answer 106

mesoblastic nephroma; homogeneous; cystic

Question 107

Sonographic Findings of The _________ 1.Solid, homogeneous mass within the renal fossa and may completely replace the kidney.

Answer 107

Mesoblastic Nephroma

Question 108

The sex of the embryo depends upon the ______ gamete. The sperm carries either an X or a Y chromosome, whereas the ovary always contributes an ____ chromosome. An X chromosome from the sperm will yield XX, which is _______ offspring. The combination of a Y chromosome will yield XY, which is a ______ offspring.

Answer 108

male; X; female; male

Question 109

The external genitalia can be visualized and differentiated in the _______ trimester. Determining the _____ of the fetus can offer important diagnostic information. When a urinary tract obstruction is noted, the sonographer should determine the _____of the fetus, because there may be different causes of obstructions specific for each sex. For example, posterior urethral valves are a common cause of urinary obstruction in only the ________ fetus.

Answer 109

second; sex; sex; male

Question 110

____________ is a birth defect in which the sex of the fetus cannot be determined. Findings of abnormal external genitalia in the ______ are micropenis, hypospadias, hypospadias with chordee, epispadias, and undescended testicles.

Answer 110

Ambiguous genitalia; male

Question 111

a fluid collection within the scrotum between the two layers of the tunica vaginalis

Answer 111

hydroceles

Question 112

_________ is the abnormal ventral curvature of the penis as a result of a shortened urethra that exits on the ventral penile shaft.

Answer 112

Hypospadias

Question 113

enlargement of the clitoris

Answer 113

clitoromegaly

Question 114

Fetal ____ cysts may be noted in the fetal pelvis, secondary to maternal hormone stimulation. These cysts are most often benign and resolve ________, although if they continue to grow, they can lead to hemorrhage and, possibly, ovarian torsion.

Answer 114

ovarian cysts; spontaneously

Question 115

an abnormally small penis

Answer 115

micropenis

Question 116

abnormal ventral curvature of the penis as a result of a shortened urethra that exits on the ventral penile shaft

Answer 116

hypospadias

Question 117

the head of the penis curves upward or downward

Answer 117

chordee

Question 118

in males, the urethral opening is located on the upper aspect of the penis

Answer 118

epispadias

Question 119

The most common malignant abdominal mass in neonates is the _________, located primarily within the ________.

Answer 119

neuroblastoma; adrenal gland