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Mude P, Pradhan M, Tiwari A, Parida TK, Nayak MK, Sekar AK, Purkait S, Devi U. Congenital brain tumour in a neonate: a therapeutic challenge. BMJ Case Rep 2024; 17:e259646. [PMID: 38490704 PMCID: PMC10946349 DOI: 10.1136/bcr-2024-259646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2024] Open
Abstract
A term neonate with history of ventriculomegaly in the fetal period was diagnosed with a central nervous system tumour after radiological investigations. It was confirmed as an immature teratoma after histopathological examination. He underwent left frontal craniotomy with tumour excision. Intraoperatively, massive haemorrhage (venous bleed) occurred due to the high vascularity of the tumour and led to haemodynamic instability. A massive transfusion protocol was initiated. Despite multiple transfusions and shock management, he succumbed at 2 weeks of life. This case report highlights the importance of antenatal diagnosis and fetal MRI in prognostication and also the possible role of neoadjuvant chemotherapy in reducing tumour vascularity and, hence, bleeding.
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Affiliation(s)
| | | | - Anuj Tiwari
- Neurosurgery, AIIMS Bhubaneswar, Bhubaneswar, India
| | | | | | | | | | - Usha Devi
- Neonatology, AIIMS Bhubaneswar, Bhubaneswar, India
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2
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Azevedo A, Nunes S, Fernandes A, Soares H, Ferreras C. Congenital intracranial teratoma. J Paediatr Child Health 2023; 59:1267-1269. [PMID: 37721439 DOI: 10.1111/jpc.16495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 08/20/2023] [Accepted: 09/08/2023] [Indexed: 09/19/2023]
Affiliation(s)
- Aida Azevedo
- Department of Neonatology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Susana Nunes
- Paediatric Oncology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Ana Fernandes
- Paediatric Oncology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Henrique Soares
- Department of Neonatology, Centro Hospitalar Universitário de São João, Porto, Portugal
- Department of Gynecology-Obstetrics and Pediatrics, University of Porto Medical School, Porto, Portugal
| | - Cristina Ferreras
- Department of Neonatology, Centro Hospitalar Universitário de São João, Porto, Portugal
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Neuroimaging of paediatric pineal, sellar and suprasellar tumours: a guide to differential diagnosis. Childs Nerv Syst 2022; 38:33-50. [PMID: 34529090 DOI: 10.1007/s00381-021-05359-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 09/05/2021] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Pineal, sellar and suprasellar tumours in children comprise a wide range of diseases with different biological behaviours and clinical management. Neuroimaging plays a critical role in the diagnosis, treatment planning and follow up of these patients, but imaging interpretation can prove challenging due to the significant overlap in radiological features. MATERIALS AND METHOD A review of the literature was performed by undertaking a search of the MEDLINE and EMBASE databases for appropriate MeSH terminology. Identified abstracts were screened for inclusion and articles meeting the objectives of the review were included. RESULTS AND CONCLUSION In this article, we review radiological appearances of common and uncommon pineal, sellar and suprasellar tumours occurring in the paediatric population. We discuss the importance of anatomical localization, clinical information and cerebrospinal fluid tumour markers, and propose a practical approach to differential diagnosis. Lastly, we discuss future directions and prospective new imaging strategies to support state-of-the-art patient care.
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Alallah J, Ali AM, Badros RM, Samkari AM, Almehdar A, Qurashi M, Kandil H. A Newborn With a Mass on the Brain. Neoreviews 2021; 22:e689-e692. [PMID: 34599066 DOI: 10.1542/neo.22-10-e689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Jubara Alallah
- Neonatology Section, Pediatric Department, King Abdulaziz Medical City, Ministry of National Guard, Jeddah, Saudi Arabia.,King Abdullah International Medical Research Centre, Jeddah, Saudi Arabia.,King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Aouhoud M Ali
- Department of Obstetrics and Gynecology, Ministry of National Guard-Health Affairs, Jeddah, Saudi Arabia.,King Abdullah International Medical Research Centre, Jeddah, Saudi Arabia
| | - Reema M Badros
- Department of Obstetrics and Gynecology, Ministry of National Guard-Health Affairs, Jeddah, Saudi Arabia.,King Abdullah International Medical Research Centre, Jeddah, Saudi Arabia.,King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Alaa M Samkari
- Department of Pathology and Laboratory Medicine, Ministry of National Guard-Health Affairs, Jeddah, Saudi Arabia.,King Abdullah International Medical Research Centre, Jeddah, Saudi Arabia.,King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Abeer Almehdar
- Department of Radiology, Ministry of National Guard-Health Affairs, Jeddah, Saudi Arabia.,King Abdullah International Medical Research Centre, Jeddah, Saudi Arabia.,King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Mansour Qurashi
- Neonatology Section, Pediatric Department, King Abdulaziz Medical City, Ministry of National Guard, Jeddah, Saudi Arabia.,King Abdullah International Medical Research Centre, Jeddah, Saudi Arabia.,King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Hammam Kandil
- Neonatology Section, Pediatric Department, King Abdulaziz Medical City, Ministry of National Guard, Jeddah, Saudi Arabia.,King Abdullah International Medical Research Centre, Jeddah, Saudi Arabia.,King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
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Ulm B, Muin D, Scharrer A, Prayer D, Dovjak G, Kasprian G. Prenatal ultrasound and magnetic resonance evaluation and fetal outcome in high-risk fetal tumors: A retrospective single-center cohort study over 20 years. Acta Obstet Gynecol Scand 2020; 99:1534-1545. [PMID: 32525215 PMCID: PMC7689914 DOI: 10.1111/aogs.13933] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 05/23/2020] [Accepted: 06/01/2020] [Indexed: 12/12/2022]
Abstract
Introduction Fetal tumors are rare and usually followed by poor outcome. We describe our single‐center experience with fetal tumors evaluated by ultrasound and magnetic resonance imaging (MRI). Our aims were to evaluate mortality and morbidity including long‐term outcome and to determine which ultrasound and MRI characteristics were helpful for pre‐ and perinatal management. Material and methods We conducted a retrospective analysis on prenatally diagnosed tumors between 1998 and 2018. Poor outcome included fetal or neonatal death and survival with serious illness. MRI addressed tumor morphology (sacrococcygeal teratomas), compromise of surrounding structures (head and neck tumors) and early depiction of brain alterations specific to tuberous sclerosis (rhabdomyomas). Results Of 68 pregnancies, 15 (22%) were terminated and eight children (8/53, 15%) died pre‐ or postnatally. Of the 45 survivors (45/68, 66%), 24 (24/45, 53%) were healthy, eight (8/45, 18%) had a minor illness and 13 (13/45, 29%) a serious illness. Diffusion‐ and T1‐weighted MRI reliably predicted tumor morphology in teratomas. To detect head and neck tumors critical to airway obstruction, MRI was superior to ultrasound in delivery planning. Rhabdomyomas were frequently associated with tuberous sclerosis, regardless of their number or size in ultrasound; MRI could depict specific brain alterations from the early third trimester onwards. For several rare tumors, MRI provided critical differential diagnoses that could not be clearly displayed in ultrasound. Conclusions The rate of survivors with serious long‐term illness among fetuses with prenatal diagnosis of a tumor was high. MRI is specifically helpful for risk stratification in fetal teratomas and delivery planning in head and neck tumors.
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Affiliation(s)
- Barbara Ulm
- Division of Obstetrics and Feto-Maternal Medicine, Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Dana Muin
- Division of Obstetrics and Feto-Maternal Medicine, Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Anke Scharrer
- Clinical Institute of Pathology, Medical University of Vienna, Vienna, Austria
| | - Daniela Prayer
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Radiology, Medical University of Vienna, Vienna, Austria
| | - Gregor Dovjak
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Radiology, Medical University of Vienna, Vienna, Austria
| | - Gregor Kasprian
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Radiology, Medical University of Vienna, Vienna, Austria
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Shelmerdine SC, Sebire NJ, Arthurs OJ. Perinatal post-mortem ultrasound (PMUS): radiological-pathological correlation. Insights Imaging 2019; 10:81. [PMID: 31432284 PMCID: PMC6702254 DOI: 10.1186/s13244-019-0762-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 06/18/2019] [Indexed: 12/16/2022] Open
Abstract
There has been an increasing demand and interest in post-mortem imaging techniques, either as an adjunct or replacement for the conventional invasive autopsy. Post-mortem ultrasound (PMUS) is easily accessible and more affordable than other cross-sectional imaging modalities and allows visualisation of normal anatomical structures of the brain, thorax and abdomen in perinatal cases. The lack of aeration of post-mortem foetal lungs provides a good sonographic window for assessment of the heart and normal pulmonary lobulation, in contrast to live neonates.In a previous article within this journal, we published a practical approach to conducting a comprehensive PMUS examination. This covered the basic principles behind why post-mortem imaging is performed, helpful techniques for obtaining optimal PMUS images, and the expected normal post-mortem changes seen in perinatal deaths. In this article, we build upon this by focusing on commonly encountered pathologies on PMUS and compare these to autopsy and other post-mortem imaging modalities.
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Affiliation(s)
- Susan C Shelmerdine
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK.
- UCL Great Ormond Street Institute of Child Health, London, UK.
| | - Neil J Sebire
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Owen J Arthurs
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK
- UCL Great Ormond Street Institute of Child Health, London, UK
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Gkasdaris G, Chourmouzi D. Congenital intracranial mature teratoma: the role of fetal MRI over ultrasound in the prenatal diagnosis and the perinatal management. BMJ Case Rep 2019; 12:12/5/e229774. [PMID: 31064792 PMCID: PMC6506130 DOI: 10.1136/bcr-2019-229774] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Grigorios Gkasdaris
- Fourth Surgical Department, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.,European Interbalkan Medical Center, Thessaloniki, Greece
| | - Danai Chourmouzi
- Department of Diagnostic Radiology, Interbalcan Medical Centre, Thessaloniki, Greece
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Maghrabi Y, Kurdi ME, Baeesa SS. Infratentorial immature teratoma of congenital origin can be associated with a 20-year survival outcome: a case report and review of literature. World J Surg Oncol 2019; 17:22. [PMID: 30660187 PMCID: PMC6339688 DOI: 10.1186/s12957-019-1564-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 01/09/2019] [Indexed: 12/02/2022] Open
Abstract
Background Congenital intracranial tumors are very rare and account for less than 2% of all childhood brain tumors. Teratomas constitute about one third to one half of these, predominantly located midline in the supratentorial region. Posterior fossa location rarely occurs and, based on the cases reported in the literature, commonly has a poor prognosis. Case presentation A newborn female, diagnosed prenatally with hydrocephalus, is presented at birth with increasing head circumference and Parinaud’s syndrome. Magnetic resonance imaging scans demonstrated a huge posterior fossa tumor with obstructive hydrocephalus. At surgery, through a suboccipital craniotomy, complete excision was achieved of a histological-proven immature teratoma. The infant received adjuvant chemotherapy for 1 year. She had normal neurological development and remained tumor-free through her 20-year follow-up. Conclusion The authors report this rare case of congenital posterior fossa teratoma with long-term outcome, and the literature is reviewed.
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Affiliation(s)
- Yazid Maghrabi
- Division of Neurological Surgery, Department of Surgery, King Abdulaziz University Hospital, P.O. Box 80215, Jeddah, 21589, Kingdom of Saudi Arabia
| | - Maher E Kurdi
- Department of Pathology, King Abdulaziz University Hospital, P.O. Box 9946, Jeddah, 21423, Kingdom of Saudi Arabia
| | - Saleh S Baeesa
- Division of Neurological Surgery, Department of Surgery, King Abdulaziz University Hospital, P.O. Box 80215, Jeddah, 21589, Kingdom of Saudi Arabia.
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Jiang Y, Mao X, Zhao Y, Fan C. Intracranial immature teratoma invading the nasal cavity mimicking olfactory neuroblastoma: A case report. Medicine (Baltimore) 2018; 97:e11527. [PMID: 29995824 PMCID: PMC6076187 DOI: 10.1097/md.0000000000011527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Primary intracranial immature teratoma accounts for majority of congenital central nervous system germ-cell tumors, but it is extremely rare in patients older than 15 years. PATIENT CONCERNS A 27-year-old woman was referred to our hospital for headache, nasal congestion, and decreased olfactory sensation. Imaging showed a mass measuring approximately 5 cm × 4 cm in the right frontal lobe, which also filled the right nasal cavity. Histopathologically, the intracranial tumor tissues were composed of both mature tissues, including glands and squamous epithelial cells and immature neuroectodermal components. However, the tumor tissues in the nasal cavity were mainly immature neuroectodermal components that mimicked olfactory neuroblastoma. The cells stained positively for neuron-specific enolase, Alpha Thalassemia/Mental Retardation Syndrome X-Linked, and Oligodendrocyte transcription factor on immunostaining, proving a neuroectodermal differentiation. DIAGNOSES According to these findings, the tumor was diagnosed as a primary intracranial immature teratoma that also involved the nasal cavity after excluding the metastatic tumors. INTERVENTIONS The patient underwent 2 surgeries. The first surgery was via the subfrontal approach, followed by a second endoscopic sinus surgery performed 22 days later. OUTCOMES The patient had no recurrence within a 6-month follow-up after the last surgery. LESSONS When an intracranial immature teratoma involves the nasal cavity, the lesions in the nasal cavity may mimic other tumors including olfactory neuroblastoma. We suggest that thorough examination of tumor tissues and identification of variable components are critical for the appropriate diagnosis of intracranial immature teratoma, a rare tumor.
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Affiliation(s)
- Yuefeng Jiang
- Department of Pathology, First Affiliated Hospital and College of Basic Medical Sciences of China Medical University
| | - Xiaoyun Mao
- Department of Breast Surgery, Department of Surgical Oncology, Research Unit of General Surgery, First Affiliated Hospital of China Medical University
| | - Yang Zhao
- Department of Hepatobiliary and Spleenary Surgery, The Affiliated Shengjing Hospital, China Medical University, Shenyang, China
| | - Chuifeng Fan
- Department of Pathology, First Affiliated Hospital and College of Basic Medical Sciences of China Medical University
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