1404 SERUM TOTAL AND H.D.L. CHOLESTEROL IN RELATION TO
syndrome: characteristic dysmorphic facies, retardation, dysplastic kidneys, and abnormalipsychomotor the fetal alcohol
ALCOHOL CONSUMPTION
(MOSTLY WINE)
ties of the palmar creases. His mother had used both alcohol and illegal drugs heavily throughout pregnancy. At 7 months, the patient received a cadaveric renal transplant and was maintained on azathioprine and prednisone to prevent rejection. At 27 months, a rapidly growing right-upper-quadrant abdominal mass was diagnosed histologically as hepatoblastoma. Eleven days after complete surgical removal of tumour, the infant died of candida sepsis. Review of the liver-biopsy specimen did not reveal any of the histological abnormalities reported previously in four patients with the fetal alcohol syn-
drome.2,33
*
alcohol could have promoted liver cancer in this infant or increased hepatic susceptibility to other carcinogenic substances. Although diethylstilbcestrol is the only agent yet shown to be a transplacental carcinogen in humans, recent reports have also implicated ethanol and hydantoin: adrenocortical carcinoma was diagnosed in a patient with fetal alcohol syndrome,4neuroblastoma in two patients with fetal hydantoin syndrome",’2 and ganglioneuroblastoma in a patient with features of both syndromes.S Immunosuppressive therapy was another potential xtiological factor. Liver cancer has developed in at least two other children"-’" and in adultsl5 receiving immunosuppressants after transplant. Our patient is the youngest to have a malig-
Transplacental
exposure
to
nancy following transplant. Additional cases may clarify the suspected increased risk of malignancy in the fetal alcohol and hydantoin syndromes. In any child with cancer and birth defects, prenatal exposures
p
syndrome: characteristic dysmorphic facies, retardation, dysplastic kidneys, and abnormalipsychomotor the fetal alcohol
ALCOHOL CONSUMPTION
(MOSTLY WINE)
ties of the palmar creases. His mother had used both alcohol and illegal drugs heavily throughout pregnancy. At 7 months, the patient received a cadaveric renal transplant and was maintained on azathioprine and prednisone to prevent rejection. At 27 months, a rapidly growing right-upper-quadrant abdominal mass was diagnosed histologically as hepatoblastoma. Eleven days after complete surgical removal of tumour, the infant died of candida sepsis. Review of the liver-biopsy specimen did not reveal any of the histological abnormalities reported previously in four patients with the fetal alcohol syn-
drome.2,33
*
alcohol could have promoted liver cancer in this infant or increased hepatic susceptibility to other carcinogenic substances. Although diethylstilbcestrol is the only agent yet shown to be a transplacental carcinogen in humans, recent reports have also implicated ethanol and hydantoin: adrenocortical carcinoma was diagnosed in a patient with fetal alcohol syndrome,4neuroblastoma in two patients with fetal hydantoin syndrome",’2 and ganglioneuroblastoma in a patient with features of both syndromes.S Immunosuppressive therapy was another potential xtiological factor. Liver cancer has developed in at least two other children"-’" and in adultsl5 receiving immunosuppressants after transplant. Our patient is the youngest to have a malig-
Transplacental
exposure
to
nancy following transplant. Additional cases may clarify the suspected increased risk of malignancy in the fetal alcohol and hydantoin syndromes. In any child with cancer and birth defects, prenatal exposures
p
