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2010-03-13-10 Answer to the case of the week #273 © Cuillier
Answer to the case of the week #273

July 29, 2010 - August 12, 2010.

Fabrice Cuillier, MD*, Elad T. MD**, Prost F. MD***, Possati P. MD***, Riviere J.P. MD.****

*    Service de Gynécologie-Obstétrique, Hôpital Félix Guyon, Saint-Denis de La Réunion, France.
**   Gynecologist, 97400 Saint- André, Ile de la Reunion, France.
***  Department of radiology, CHR Felix Guyon Hospital, 97400 Saint-Denis, Ile de la Reunion, France.
**** Department of Anatomo-pathology, CHR Felix Guyon Hospital, 97400 Saint-Denis, Ile de la Reunion, France. 

Case report

This is a case of a 30-year-old-woman, G2P1, with unremarkable family or personal history.
The first trimester scan was normal (NT=1 mm), triple test came out negative. The second ultrasound scan at 20 weeks didn't show any abnormalities. The third trimester scan at 32 weeks of gestation did not reveal any anomaly either, there was no sign of ventriculomegaly.

The ultrasound scan performed at 36 weeks of gestation for the estimated fetal weight showed the folowing findings:
  • Bilateral ventriculomegaly - left 17 mm, right 50 mm
  • Tumor inside the right choroid plexus; calcification, possible hemorrhage and cysts within the tumor
  • Corpus callosum and pericallosal artery were absent
The MRI was performed the same day, it confirmed our ultrasound findings. The differential diagnosis included: choroid plexus papilloma, choroid plexus carcinoma,  choroid plexus teratoma or other rare tumors.  

The subsequent ultrasound performed within three days showed the increase of the ventriculomegaly. It measured 55 mm on the right side. The neurosurgeon assumed an adverse prognosis for the fetus due to a rapid growth of the tumor and presence of necrosis and multicystic foci inside the tumor.

Parents opted for the termination of the pregnancy based on the multidisciplinary counselling. Couple hours before the termination, the right lateral ventricle measured 68 mm. There were signs of the hemorrage inside the tumor.

Parents did not wish for an autopsy but agreed on CT stereotaxic brain biopsy. The final histopathology diagnosis was glial cell tumor. This is a neoplasm derived from glial cells and includes astrocytomas, glioblastoma multiforme, oligodendroglioma, ependymoma, chorioid plexus neoplasm or colloid cysts of the third ventricle. The type of the glial cell tumor could not be specified because the brain tissue was partially necrotic at the time of the stereotaxic biopsy.

Have a look at the answer for this case of the week sent by Javier Cortejoso!

Images 1- 4: Axial views of the fetal brain. Note the dilation of the right lateral ventricle (46 mm) and round mass located in the anterior choroid plexus.

Images 5- 8: Detail of the tumor mass, note multicystic foci and calcifications; absence of the corpus callosum was noted on these images.


Image 9: Doppler imaging, there is the absence of pericallosal artery.

Images 10-13: MRI images showing the fetal brain with the tumor located in the anterior part of the right lateral ventricle.

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