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2011-11-01-12 Case of the week #310 © Grochal www.TheFetus.net


Answer to the case of the week #310

January 19, 2012 - February 2, 2012



Frantisek Grochal, MD1 Anton Cunderlik, MD, PhD2; Peter Klesken, MD, PhD2; Pavel Szwarc, MD3; Pavel Calda, MD, PhD4; Radovan Vlk, MD, PhD5; Pavol Babjak, MD6; Denisa Margusova, MD7; Veronika Frisova, MD8

1 Femicare, s.r.o., Center of prenatal ultrasonographic diagnostics, Martin, Slovak republic. UVN SNP Ruzomberok, Gynecological and obstetrical department. Catholic University in Ruzomberok, Faculty of Health Care, Ruzomberok, Slovak Republic;
2 1. gynekologicko – pôrodnícka klinika, Lekárska Fakulta, Slovenská zdravotnícka univerzita, Bratislava a Univerzitná nemocnica Bratislava, FNsP akad.L. Dérera, Kramáre;
3 Nemocnice Trinec Sosna, Czech Republic;
4 Charles University in Prague, First Faculty of Medicine, Department of Gynaecology and Obstetrics of the First Faculty of Medicine and General Teaching Hospital, Apolinarska 18, 128 51 Praha 2 Czech Republic;
5 Department of Gynecology and Obstetrics, Charles University, 2nd Faculty of Medicine in Motol, Prague, Czech Republic;
6 Ambulancia pre rizikovu a patologicku tehotnost, Zilina, Slovak republic;
7 GYN, s. r. o., Krasno nad Kysucou, ulica MUDr. Halka 1367, Slovak republic;
8 Department of Imaging Methods, Charles University, 2nd Faculty of Medicine, Prague, Czech Republic.

Case report


A 35-year-old woman (G2P0) from a nonconsanguineous was sent to our facility at 25 weeks of pregnancy due to tumorous mass within fetal neck. The patient had taken chronic hormonal treatment due to hypothyroidism.

Our examination found polyhydramnios (AFI 291) and a tumorous, predominantly cystic structure, with solid components in fetal neck. The structure was poorly vascularized and occupied anterior portion of the neck reaching down to mediastinum up to aortic arch.

Consequent amniocentesis revealed normal karyotype with normal thyroid hormones levels within the amniotic fluid.

Diagnosis of cervical teratoma was postulated. We also thought of lymphangioma in our differential diagnostic process. Goiter was excluded due to normal hormonal levels in amniotic fluid.

By coincidence, the patient was admitted to Department of Gynecology and Obstetrics, Charles University, 2nd Faculty of Medicine in Motol (Prague, Czech Republic) due to preterm uterine contractions and polyhydramnios. The newborn was delivered via cesarean section after premature rupture of amniotic membranes at 33 weeks and 4 days of gestation (boy, 2120 g). The neonate required immediate intubation ad seven days later underwent surgical removal of the tumor. The diagnosis of cervical teratoma was confirmed. Postoperative course was uneventful and the child is doing well.

Images 1, 2, 3, 4, and 5: 25 weeks of gestation; sagittal and transverse scans of the fetal neck showing mixed (cystic and solid)tumorous mass occupying anterior part of the neck. 


 

 



Images 6, 7, 8, and 9: 25 weeks of gestation; sagittal color Doppler and gray scale images of the fetal neck showing mixed (cystic and solid) tumorous mass occupying anterior part of the neck reaching up to the level of aortic arch.

 

 

Image 10 and video 1 : 25 weeks of gestation; the image and video show 3D appearance of the fetal neck with a "swelling" caused by the tumorous mass of the teratoma under the skin. 

 

Images 11-20: 29 weeks of gestation; the images show sagittal and transverse scans of the tumorous mass of the teratoma within the fetal neck.

 

 

 

 

 

Images 21, 22: 29 weeks of gestation; the images show 3D appearance of the fetal neck with a "swelling" caused by the tumorous mass of the teratoma under the skin.

 

Videos 2, 3: 29 weeks of gestation; the videos show  transverse and sagittal (gray scale and color Doppler) sequences at the level of the fetal neck with tumorous mass of the teratoma.

 

Images 23, 24: Prenatal MRI images of the fetus with cervical teratoma.

 

Images 25, 26, 27: Postnatal MRI images of the fetus with cervical teratoma.

 



Images 28, 29: Postnatal image of the newborn before surgical removal of the cervical teratoma (image 28| and pathological specimen showing the cervical teratoma after its surgical removal.

 
 
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