* Department of Obstetrics and Gynaecology Clinical Centre Vojvodina, Novi Sad, Serbia;
** Diagnostic Imaging Centre, Institute of Oncology, Sremska Kamenica, Serbia.
A 27-year-old nullipara was referred to our unit at 22 weeks of gestation because a tumour located on the fetal head was seen at a routine ultrasound scan. Ultrasonography revealed a 45×41×50 mm tumor originating on the left side of the skull, spreading towards the same side of the neck, behind the ear. It appeared as an echogenic soft tissue mass with the hypoechogenic areas within it. Color Doppler revealed vascularisation in the tumor, mainly on its border and the 4D examination showed the ear was intact. No other abnormalities were detected. Cord blood sampling was done and karyotyping was normal (46,XY).
MRI studies at 26 weeks showed tumor originating from the scalp of the left endocranium in antero-posterior direction from frontoparietal suture with extension along the whole area of frontotemporal squama and left parietal bone (84x45x71 mm) that did not disturb tabula interna and did not extend to the internal endocranium. Edema of the ipsilateral nuchal region was seen. T2 was iso/hyperintense with prominent peripheral flow void and hypointense capsule. Based on these findings, diagnosis of a haemangioma was made. The fetus was followed up and the tumour gradually increased in size. At 38 weeks of gestation, an elective Caesarean section was performed to avoid fetal trauma during vaginal delivery. A 3810 g male baby was delivered, with Apgar scores of 7 and 8, at 1 and 5 minutes, respectively. The infant required no resuscitation or respiratory support. Neonatal examination revealed a bluish purple, well-defined, non-pulsating mass at the left parietal area measuring 80x90 mm.
Since the tumour showed no increase in the size, nor any complications developed, it was followed until the three months of age, when a surgery was done and the tumour excised in total. Pathohystology confirmed the diagnosis of haemangioma.
In conclusion, we suggest that prenatal diagnosis of fetal tumour should include not only detailed ultrasonography, Doppler imaging and 4D, but also MRI examinations in order to help define the extent of the lesion and therefore the prognosis, as well as organize adequate follow up and delivery.
Images 1, 2: 23rd week of pregnancy. Image 1 shows the fetal head with the prominent mass of hemangioma. Image 2 shows the hemangioma of the head in detailed view.