Congenital metastatic neuroblastoma with placental involvement as a rare cause of non-immune fetal hydrops.

Non-immune hydrops fetalis represents the end-stage status of a variety of diseases, including metastatic tumors. We report a case of non-immune hydrops fetalis associated with multiple disseminated echogenic nodular lesions detected by ultrasound and confirmed by magnetic resonance. Cordocentesis demonstrated anemia and thrombopenia. Differential diagnosis included histiocytosis X, acute leukemia or metastatic disease. A stillbirth was diagnosed at week 25 + 6. The autopsy revealed hydrops fetalis, a right adrenal gland mass, multiple disseminated nodules histologically composed of small round blue cells positive for synaptophysin, and placental involvement, concordant findings with congenital undifferentiated neuroblastoma Stage M. No chromosomal abnormalities were associated, nor amplification abnormalities in MYCN and ALK genes. Metastatic neuroblastoma should be considered in the differential diagnosis of non-immune hydrops fetalis associated with multiple nodular lesions.

Abordaje no quirúrgico de los miomas sintomáticos. Métodos físicos. Embolización selectiva / Non-surgical approach for symptomatic fibroids. Physical methods: selective embolization

El abordaje de los miomas uterinos sintomáticos ha presentado una franca evolución en los últimos años gracias a la aparición de técnicas mínimamente invasivas que permiten la conservación uterina. La embolización selectiva de arterias uterinas (EAU) consiste en la oclusión completa de las 2 arterias uterinas con partículas embolizantes con el objetivo de producir una necrosis isquémica de los miomas sin afectar de forma permanente al tejido uterino normal. Esta técnica mejora significativamente la cantidad de sangrado y produce una reducción del volumen uterino a los 3 meses posprocedimiento, que se mantiene a lo largo del tiempo, permitiendo que un 70% de las pacientes evite la cirugía. Por otro lado, la EAU conlleva un menor tiempo quirúrgico, una reducción en la estancia hospitalaria y un menor número de días necesarios para la reincorporación a la vida laboral si lo comparamos con las técnicas quirúrgicas clásicas (histerectomía y miomectomía), sin presentar diferencias en las escalas de calidad de vida a 5 años. Por lo tanto creemos que debe incluirse la EAU en las opciones terapéuticas que ofrecer a las pacientes con útero miomatoso sintomático (AU)

The approach to symptomatic uterine fibroids has seen a marked evolution in recent years thanks to the emergence of minimally invasive techniques that allow for uterine preservation. Selective uterine artery embolization (UAE) consists of the complete occlusion of the 2 uterine arteries with embolic particles in order to produce ischemic necrosis of the fibroids without permanently affecting the normal uterine tissue. This technique significantly reduces the amount of bleeding and causes a reduction in uterine volume at 3 months postprocedure, which is maintained over time, allowing for 70% of patients to avoid surgery. Moreover, UAE entails shorter surgical times, reduced hospital stays and fewer days needed to return to work when compared with traditional surgical techniques (hysterectomy and fibroidectomy), without any differences in the quality-of-life scales at 5 years. UAE should therefore be included in the therapeutic options offered to patients with symptomatic fibroid uteri (AU)