With the advent of routine prenatal ultrasonography, the diagnosis of fetal (Ho et al. 1993; Toma et al. 1994; Jennings et al. 1993) or congenital (Granata et al. 2000; Forman et al. 1990) neuroblastoma has become more common. The tumor may be solid or cystic (Atkinson et al. 1986; Hamada et al. 1999) and may be localized (stage 1) or associated with liver metastases (stage 4S; Toma et al. 1994). Subcutaneous nodules are frequently present. At birth, these findings can be confirmed by ultrasonography. In addition to NB,the differential diagnosis of an adrenal mass detected prenatally or at birth includes extralobar pulmonary sequestration (Curtis et al. 1997) and adrenal hemorrhage (Strouse et al. 1995; Burbige 1993). Many adrenal hemorrhages show shrinkage within 2 weeks after birth; however, shrinkage of an adrenal hemorrhage may sometimes take weeks to months. These masses therefore may be confused with tumor. On the other hand, regressing NB in a neonate can also mimic adrenal hemorrhage (Croitoru et al. 1992). In the absence of large tumor masses and organ compromise, observation rather than surgery is acceptable in an asymptomatic infant with a small adrenal mass (see Chap. 11). Follow-up ultrasonography is important, especially if there is liver involvement. If clinically indicated, the distinction between NB and adrenal hemorrhage can usually be made with MIBG scintigraphy.
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