a fetal intracranial tumor

8/8/2019 A Fetal Intracranial Tumor

http://slidepdf.com/reader/full/a-fetal-intracranial-tumor 1/48

Ali Al-IbrahimMFM Fellowship Observer



History Mrs. SA is a 35 years old lady, G2, P0 + 1 who was

referred to MSH due to a fetal intracranial lesion (?Tumor, ?Bleeding).

This is a spontaneous pregnancy. Otherwiseuncomplicated.

Her previous pregnancy ended in a spontaneouscomplete abortion at 7 weeks of gestation.

H

er medical history includeso Thyroidectomy for thyroid cancer 2006o Appendectomy 2007o Cholecyctectomy 2005o Anxiety Disorder, including hospitalization in 2005o Depression 1995o Bronchial Asthma 1991, well controlled.



Current medications include, Folic acid, CaCo3,Pulmicort, Ventolin and Synthyroid .175 OD.

Pregnancy details: Dating scan March 17th NT measurement March 4 IPS March 17th Wellbeing scan on March 30 Anatomy scan on April 16 (19 weeks of gestation, normal but

noted low lying placenta) July 28th, 33+5 weeks, placenta normal, fetal intracranical brain

mass seen anterior to the CSP. August 6th, confirmation ultrasound of an intracranial mass 2.7 X

2.1 X 1.6 cms.



The patient was seen on Friday 13th of August, shewas 36 weeks.

Ultrasound showed 2 findings, but otherwise anormal baby, appropriate growth and normal doppler studies.

The findings were:



Pericallosal Lipoma



Pericallosal Lipoma Not mentioned in the previous slide because it is

VERY rare constituting only 0.1% of all fetal braintumors!

Intracranial lipomas are more frequent in thepericallosal and quadrigeminal region of the brain;most are asymptomatic, generally caughtincidentally; and accompanying intracranial and

extracranial pathologies are less common thanexpected.

Yilmaz N, Unal O, Kiymaz N, Yilmaz C, Etlik O. Intracranial lipomas--a clinical study. Clin Neurol Neurosurg. 2006Jun;108(4):363-8.



There are around 15 cases of prenatal diagnosispublished. (7 cases in one single series, and 8individual cases)

The majority of published literature is for childrenand adults, postnatal and mostly incidentaldiagnosis.

There are 2 types (patterns) of pericallosal lipomas

o Tubo-Nodular o Curvilinear



Korean J Radiol 3(2), June2002



AJNR Am J Neuroradiol 22:767±772, April2001



AJNR Am J Neuroradiol 22:767±772, April 2001



Pericallosal Lipomas have been reported in theliterature witho Goldenhar Syndrome (8 cases)o Pai Syndrome (More than 10 cases)o Congenital Heart Defects (2 cases)o Trisomy 21 ( 2 cases)o Isolated Nasal Appendages (3 cases)o Frontonasal Dysgensis and First Pharyngeal Arch Anomalies (3 cases)



Neuroradiology (2006) 48: 1±7



Symptomatology The majority of cases are asymptomatic. Reported in the literature

o Headache and vomitingo Seizureso Failure to thriveo Local skull swellingo Symptoms related to corpus callosum dysgenesis



Differential Diagnosis Bleeding (MRI can easily differentiate that from a

tumor) Dermoids tend to occur adjacent to the midline and

might look the same on MRI and CT (They appear round or lobulated on CT and usually have slightmass effect and foci of calcification with no contrastenhancement or surrounding edema, They have

high signal on T1-weighted MRI due to their lipidcontent and heterogeneous signal on T2-weightedimages due to the mixed composition of the tumor)




Epidermoids (epidermoid cysts) representapproximately 1% of all primary intracranialneoplasms. Imaging studies of epidermoids reflectthe high levels of cholesterol and keratin within thetumor. If the lesion shows T1 shortening, it can beconfused with dermoid or lipoma, but an epidermoidwill not demonstrate chemical shift artifact and signal

will not suppress after application of a fat-saturationpulse

Neurofibroma, usually has lower signal intensity onMR imaging than fat but can be confusing.




Thank You

a fetal intracranial tumor

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