Abstract
Objectives The prenatal finding of a cystic suprarenal mass (CSM) presents a wide differential
diagnosis. The aim of this study was to present the natural course and outcome of
antenatally diagnosed CSMs.
Methods We reviewed the medical records of patients with prenatally detected CSMs that were
assessed between January 1998 and December 2011. Retrospective data collection included
the age at the time of diagnosis, the size of the mass, and the sonographic evolution
of the mass. Surgical treatment was indicated in cases of malignant tumors and symptoms
or when size increased.
Results The observation period ranged from 1 month to 10 years. The data of 21 patients were
analyzed. The median length of follow-up was 32 months (ranging from 2 to 131 months).
A total of 13 masses were detected on the left side and 8 on the right side. In 13
patients, the lesions disappeared after a median of 7 months (ranging from 0 to 37
months). Surgery was performed in two neonates: one for a teratoma at 10 days postpartum,
and one for a neuroblastoma at 17 days postpartum. Six patients had an extralobar
pulmonary sequestration (ELPS), and in four patients, surgical resection was performed
at an average of 9.2 months (ranging from 1 to 20 months) postpartum, because of an
infection or increase in ELPS size. Histological examination confirmed the pulmonary
sequestration. An association with congenital cystic adenomatoid malformation (CCAM)
was found in one patient, and ectopic pancreatic tissue was discovered in another
patient. Two patients conservatively managed remain under observation.
Conclusions During the neonatal period, the accurate assessment of CSMs is necessary to exclude
the presence of malignant tumors. Most patients can be conservatively managed, with
close follow-up, including radiological assessment. If the mass persists after 1 year
of age, ELPS should be considered as a probable diagnosis, and minimally invasive
laparoscopic surgery can be performed, as it provides both definitive diagnosis and
treatment.
Keywords
prenatal ultrasonography - extralobar bronchopulmonary sequestration - minimally invasive
surgery
