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2019-07-21  Case of the week # 503  © Fabien Ho  www.TheFetus.net

Answer to the case of the week # 503
August 29 - September 12

Dr Ho F.1, Dr Cuillier F.2, Dr Balu M.1, Dr Fernandez C.3

1. Radiologist, private sector, 97400 Saint-Denis, Reunion Island, France. 
2. Department of Obstetrics, Felix Guyon Hospital, Reunion Island, France.
3. Department of Pathology, Felix Guyon Hospital, 97400 Saint-Denis, Reunion Island, France. 



Case report 

This patient had been referred to our hospital after at 25 weeks of pregnancy due polyhydramnios. Previous personal, familial and obstetrical history is non relevant. 


Image 1: Our US examination from 25 weeks and 27 weeks revealed an unusual oropharyngeal mass with unusual echoic spots that do not look like facial bones.


 


Videos 1 and 2: Our US examination from 25 weeks and 27 weeks revealed an unusual oropharyngeal mass with unusual echoic spots that do not look like facial bones.

  



Image 2: US follow up at 31 weeks of pregnancy revealed mass grew up rapidly and was now protruding out of the oral cavity, pushing down and out the tongue. It was a solid mass with some internal echos, most likely calcifications or ossifications.

 


Video 3, 4 and 5: US follow up at 31 weeks of pregnancy revealed mass grew up rapidly and was now protruding out of the oral cavity, pushing down and out the tongue. It was a solid mass with some internal echos, most likely calcifications or ossifications.

  




Images 3-8:  then we performed an MRI examination at 31 weeks of pregnancy which showed the extension of the mass, filling both the oropharynx and nasopharynx, and also protruding through the base of the skull next to the pituitary fossa, probably through foramens around the sphenoid bone, such as ovale foramen or round foramen. 

    
  


The foetus then died in utero at 32 weeks of pregnancy. Placental examination revealed a massive retroplacenteal hematoma, probably the cause of intrauterine death.

Images 9-12: foetopathology examination revealed a tumor arising from the nasopharynx/cavum, protruding through the oropharynx and oral cavity, and also invading the central base of the skull around the pituitary fossa. The foetus itself had normal morphology otherwise, and a mild IUGR (-2 WG). Histology of the tumor showed a mix of epithelial, bone, chondroid and inmature nervous tissues. 


Our final diagnosis was nasopharyngeal immature teratoma, also called epignathus teratoma.

    


References:

1. https://sonoworld.com/Client/TheFetus/page.aspx?id=207

2. https://sonoworld.com/TheFetus/Case.aspx?CaseId=633&answer=1
















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