P37.08: Case report: prenatal diagnosis and postnatal course of a fetus with choroid plexus papilloma

Abstract

In the 30th week of gestation a targeted-ultrasound scan revealed an echogenic, slightly perfused mass of about 1 cm in diameter within the posterior horn of the right lateral fetal ventricle without any further sonographic findings raising the suspicion of a fetal tumor. Fetal blood sampling revealed normal blood values and a normal karyotype. Serial follow-up scans showed a marked increase in tumor size within two weeks the lesion having now 6 cm of diameter and a beginning macrocephaly with midline deviation of the cerebral structures. Colour Doppler and power Doppler confirmed increasing vascularization within the tumor with low pulsatility indices. These findings were highly suggestive of a choroid plexus tumor and elective Cesarean section was performed with completed 35 weeks of gestation. Confirming the prenatal data the newborn, an otherwise healthy girl, had a macrocephaly and a diastasis of the sagittal suture. A cranial MRI and a MR angiography of the neonate on the first day of life revealed a contrast enhancing tumor in the lateral right ventricle of 8 cm in diameter with blood supply by the posterior choroid artery with a diameter of approximatley 1 mm. A successful embolization of the feeding vessel was conducted at the fifth day of age. The following day a right temporal craniotomy was perfomed and the tumor was removed in a complication-free intervention. Histological examination showed a highly differentiated choroid plexus tumor without nuclear atypia, WHO Grade II. One year follow-up showed a normal neurologic development. Prenatal ultrasonography is a useful tool to identify any intracranial space-occupying lesion larger than 10 mm. The location, the size and the growth patterns of intracranial tumors have to be considered in obstetric decision making. This case demonstrates the technical feasibility and the clinical benefit of prenatal diagnosis and emphasizes intracranial tumor embolisation even in the newborn child.