Prenatal diagnosis and postnatal management of perinatal thoracoabdominopelvic tumors: multicenter experience.
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OBJECTIVES: The primary objective was to assess the accuracy of prenatal examination in detecting and characterizing perinatal solid tumors of the thoracoabdominopelvic region. Secondary objectives were to describe the epidemiology, clinical characteristics and outcome of these tumors. METHODS: This was a retrospective multicenter study of all patients with a thoracic, abdominal or pelvic tumor diagnosed prenatally or within the first 3 months after birth in the Île-de-France area between January 2010 and May 2021. The gestational age at which a mass was detected on prenatal imaging, or the postnatal age at which the first tumor-related sign or symptom was noted, in addition to the timing of postnatal diagnostic confirmation (clinicoradiological or pathological), were extracted from patient medical files. RESULTS: Overall, 153 tumors were identified. An associated congenital malformation was identified in 14 (9%) infants and four (3%) had a known germline pathogenic variant. The main tumor locations were adrenal gland (43%), extra-adrenal and extrarenal retroperitoneum (12%) and kidney (12%). The most common diagnoses were neuroblastoma (93/153 (61%)) (including 65 adrenal, 20 extra-adrenal retroperitoneal and eight thoracic/mediastinal), hepatoblastoma (10/153 (7%)), teratoma (10/153 (7%)), nephroblastoma (8/153 (5%)) and congenital mesoblastic nephroma (7/153 (5%)). In 35% (53/153) of cases, a mass was detected prenatally (mainly during the third trimester (62%)) and the diagnosis was confirmed at a median of 9 (interquartile range (IQR), 2-20) days after birth. Tumor detection was postnatal in 65% (100/153) of cases, mainly on the basis of tumor mass syndrome (39%) or tumor palpation by parents or during a routine medical visit (36%), and occurred at a median of 73 (IQR, 39-104) days after birth. Distant metastasis was noted in 4% (2/53) of cases with a prenatal mass and in 36% (36/100) of cases detected postnatally. Five medical terminations of pregnancy for a compressive tumor were reported, in addition to one in-utero fetal demise. Five (3%) neonates required early supportive intensive care due to respiratory distress, arterial hypertension, intestinal perforation or intestinal obstruction. At a median follow-up of 5 (range, 0-14) years, 136 (89%) patients remained alive. CONCLUSIONS: Only 35% of perinatal thoracic, abdominal and pelvic tumors were detected before birth. Although mainly malignant, their prognosis was largely favorable. Improving early detection may assist postnatal multidisciplinary management and parental guidance. © 2025 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.