Tumors

Question 1

What abnormalities are associated with Tumors in pregnancy?

Answer 1

2
Lymphangioma
Neuroblastoma

Question 2

Lymphangioma

Answer 2

Prevalence: 1 in 6,000 births.

Ultrasound: Multiseptated, multicystic irregular mass, which is usually located on the neck (75%), axillary region (20%), chest wall, abdominal wall and extremities (5%); in <1% of cases the tumor is in the mesentery or retroperitoneum.
In case of cervical and thoracic lymphangioma, there is an increased risk of central venous compression leading to hydrops and esophageal compression resulting in polyhydramnios.

Assoc Abnorms: The incidence of chromosomal abnormalities and genetic syndromes is not increased.

Follow-Up: Ultrasound scans every 2-3 weeks to monitor the size of the tumor and assess amniotic fluid volume. Amniodrainage may be necessary if there is polyhydramnios and cervical shortening.

Prognosis: Prognosis is favourable, unless there is associated cardiac failure, hydrops or high airway compression.
Some mesenchymal lesions may partially regress spontaneously after birth. The treatment of choice is surgical excision.

Recurrence: No increased risk of recurrence.

Question 3

Neuroblastoma

Answer 3

Prevalence: 1 in 20,000 births.
Arises from undifferentiated neural tissue of the adrenal medulla (90%) or sympathetic ganglia in the abdomen, thorax, pelvis, or head and neck (10%).

Ultrasound: Cystic, solid, or complex mass in the region of the adrenal gland, usually in the third trimester. Occasionally, calcifications are present.
Tumors arising from the sympathetic ganglia may appear in the abdomen, thorax or neck.
The tumor can metastasize in utero to the placenta, umbilical cord or liver.
There may be associated polyhydramnios and fetal hydrops.

Assoc Abnorms: No increased risk of chromosomal abnormalities or genetic syndromes.

Follow-Up: Ultrasound scans every 4 weeks to monitor the size of the tumor and development of development of hepatomegaly, placentomegaly, heart failure and polyhydramnios.

Prognosis: Survival is >90% if the diagnosis is made in utero or in the first year of life, but <20% for those diagnosed after the first year. Treatment requires surgical excision of the tumor and chemotherapy.

Recurrence: No increased risk of recurrence.