Association of multinodular goiter, cystic renal disease, and digital anomalies.

blastoma at autopsy in a large population of infants at a rate 40 times that expecte d from the general incidence of clinically apparent neuroblastoma. Therefore, it is possible that a significant association of certain congenital anomalies and subclinical neuroblastoma does exist. The cystic nature of the tumor with clusters of malignant cells in the wM1 of the massl as found in our patient, is similar to a finding reported by Tubergen and Heyn l~ of in situ neuroblastoma associated with an adrenal cyst. It is unknown whether such cysts represent a stage of involution of neurobtastoma or are congenital anomalies associated with in situ neuroblastoma. It is impossible to know what the eventual outcome of the neuroblastoma in our patient might have been had it gone undetected. If the tumor was des;tined to undergo maturation and degeneration, a similar investigation in the future might have proved negative, or a fully differentiated ganglion-euroma might have been found. However, i f tlae tumor was to have grown and metastasized, then early detection may have been lifesaving. Therefore, we recommend that all children with congen i ta lACF continue to be evaluated for the presence of other congenital anomalies, with specific attention to the ultrasonographic examination of the suprarenal regions. If further examples of an association between ACF and neuroblastoma are identified, we suggest that urine be screened for catecholamine metabolites at least once per year during the first 3 years of life. We thank Shirley Brown for typing the manuscript.