Congenital Intracranial Teratoma

Abstract

Received January 6, 2010, from the Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota USA. Revision requested February 8, 2010. Revised manuscript accepted for publication February 25, 2010. Address correspondence to Zaraq Khan, MBBS, Department of Obstetrics and Gynecology, Mayo Clinic, 200 First St SW, Rochester, MN 55905 USA. E-mail: khan.zaraq@mayo.edu Abbreviations MRI, magnetic resonance imaging 32-year-old patient, gravida 2, para 0010, was noted to have a discrepancy in uterine size with dates. At 24 weeks’ gestation, her fundal height measured 28 cm. She had previously had a normal pregnancy course and a normal anatomy scan at 19 weeks (Figures 1 and 2). On imaging at 24 weeks’ gestation, the fetal brain had an irregular shape, and the midline was deviated to the left side (Figures 3–7). A biparietal diameter of 9.9 cm and head circumference of 35.9 cm were both greater than the 99th percentile. The differential diagnosis was a fetal cranial neoplasm versus an intracranial bleed. Results of platelet antibody tests, obtained to rule out neonatal alloimmune thrombocytopenia, were negative. Options for pregnancy termination including cephalocentesis were discussed, and the patient chose to proceed with the pregnancy expectantly. At 27 weeks, fetal magnetic resonance imaging (MRI) showed a cranium of 14 × 11 cm filled with amorphous soft tissue containing multiple cysts. No identifiable brain tissue could be seen (Figure 8), consistent with a teratoma. The patient came to labor and delivery with spontaneous onset of preterm labor at 29 weeks. She was admitted at 7 cm dilation. A cephalic presentation was noted. Intrauterine fetal death was noted by abdominal sonography. Cephalocentesis was again offered to allow vaginal delivery, but the patient refused. She spontaneously dilated to 9 cm, and then artificial rupture of membranes was performed. Soon after, vaginal bleeding was noted, and fetal brain tissue began to pass from the vagina, consistent with cranial rupture. Soon thereafter, she had a vaginal delivery of the fetal body. On postmortem examination congenital intracranial teratoma was identified; no other congenital abnormalities were noted.