Fetal Adrenal Mass on Ultrasound: A Rare Prenatal Challenge

Congenital neuroblastoma is a rare fetal malignancy arising from neural crest cells, most commonly from the adrenal gland. We report a case of a primigravida in whom a left suprarenal mass was incidentally detected on routine third-trimester ultrasonography at 35 weeks’ gestation in an uncomplicated pregnancy, and conservative antenatal management with close fetal surveillance with multidisciplinary care was adopted. The patient delivered a live male neonate at term by cesarean section for failed induction. Postnatal computed tomography demonstrated a solid left adrenal mass with internal calcifications and retroperitoneal extension, without evidence of metastasis. The diagnosis of neuroblastoma was confirmed by ultrasonography-guided fine-needle aspiration cytology. The infant was treated with combination chemotherapy and tolerated the treatment uneventfully and remained well on follow-up. This case highlights the value of antenatal diagnosis, which facilitates early surveillance and management through a multidisciplinary approach, thereby optimizing outcomes in congenital neuroblastoma.