Tongsong Theera, Palangmonthip Watchareepohn, Chankhunaphas Wisit, Luewan Suchaya
Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand.
Department of Pathology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand.
Diagnostics (Basel). 2022 Aug 12;12(8):1951. doi: 10.3390/diagnostics12081951.
Congenital mesoblastic nephroma (CMN) is the most common renal tumor among fetuses and infants before the age of 6 months. It usually behaves as a benign tumor. The prenatal features and outcomes of pregnancies with fetal CMN have never been systematically reviewed and analyzed, whereas neonatal or pediatric series have been published several times. The aims of this study are to (1) describe the prenatal natural course and prenatal sonographic char-acteristics of CMN; (2) determine the outcomes of pregnancies with fetal CMN; and (3) demonstrate typical sonographic images together with video clips of prenatal CMN, as an educational example based on our index case presented here. Studies focused on fetal CMN, including those consecutively published on PubMed from 1980 to June 2022 as well as the index case presented here, were identified and validated to perform a systematic review. The data of fetal imaging and the prenatal course of pregnancies were extracted for analysis. The findings derived from 41 cases of review are as follows: (1) No single case has been diagnosed in the first half of pregnancy. No cases were detected during routine anomaly screening at mid-pregnancy. All cases were de-tected in the third trimester or late second trimester. (2) Polyhydramnios is very common and is the first clinical manifestation in most cases, leading to detailed ultrasound in the second half of pregnancy. (3) Preterm birth and low birth weight are the most common adverse pregnancy out-comes, resulting in neonatal morbidity. (4) Hydrops fetalis, though relatively rare, can be associated with CMN and is a grave sign. (5) Prenatal diagnosis is essential since it is critical for the antenatal plan, comprising either referral to a tertiary care center or proper surveillance to prevent serious obstetric complications, especially preterm birth. (6) Ultrasound is the primary tool for prenatal diagnosis of CMN, whereas MRI can be used as an adjunct if some other tumors are suspicious or sonographic features are not typical for CMN. In contrast to CMN in neonates, fetal CMN is much more serious since it significantly impacts adverse pregnancy outcomes and perinatal morbidity and mortality. The typical prenatal course and the sonographic features of CMN are described.
先天性中胚层肾瘤（CMN）是6个月龄前胎儿和婴儿中最常见的肾肿瘤。它通常表现为良性肿瘤。胎儿CMN妊娠的产前特征和结局从未得到系统回顾和分析，而新生儿或儿科系列研究已多次发表。本研究的目的是：（1）描述CMN的产前自然病程和产前超声特征；（2）确定胎儿CMN妊娠的结局；（3）展示产前CMN的典型超声图像及视频片段，作为基于本文所呈现的索引病例的教学示例。我们检索并验证了聚焦于胎儿CMN的研究，包括1980年至2022年6月在PubMed上连续发表的研究以及本文所呈现的索引病例，以进行系统回顾。提取胎儿影像学数据和妊娠的产前病程进行分析。41例回顾性研究的结果如下：（1）妊娠前半期无一例诊断。孕中期常规畸形筛查未发现病例。所有病例均在妊娠晚期或妊娠中期晚期被检测到。（2）羊水过多非常常见，且在大多数情况下是首发临床表现，导致妊娠后半期进行详细超声检查。（3）早产和低出生体重是最常见的不良妊娠结局，会导致新生儿发病。（4）胎儿水肿虽然相对罕见，但可与CMN相关，是一个严重征象。（5）产前诊断至关重要，因为它对产前计划至关重要，包括转诊至三级医疗中心或进行适当监测以预防严重产科并发症，尤其是早产。（6）超声是CMN产前诊断的主要工具，而如果怀疑有其他肿瘤或超声特征不典型时，MRI可作为辅助手段。与新生儿CMN相比，胎儿CMN更为严重，因为它会显著影响不良妊娠结局以及围产期发病率和死亡率。本文描述了CMN典型的产前病程和超声特征。
