Second-trimester diagnosis of intracranial teratoma

Second-trimester diagnosis of intracranial teratoma

Murat Cagan
 on 09/14/2022
 on Wednesday, September 14th, 2022
It is inappropriate to give the answer as "teratoma" instead of "fetal brain tumor". It is not possible to reach a pathological diagnosis with imaging findings. Although the most common type is teratoma, the definitive diagnosis is only confirmed after birth by histology. Therefore, "fetal brain tumor" should also be accepted as the correct answer.
#1 - 
Cerine Jeanty said Dear Dr Cagan,

Thank you so much for your input regarding Case of the Week #566 (intracranial teratoma). While I do agree with you that a histologic diagnosis cannot be made on imaging, I believe that the idea behind providing 3 guesses is to offer your top three most specific differential diagnosis for the case, which is often necessary in a true clinical scenario.

I discussed your concern with Dr Cortejoso and here was his response below:

"Even recognizing that the diagnosis of this case can only be histological, I believe that there are enough findings to think of an intracranial teratoma: supratentorial large, complex, mixed cystic and solid mass with foci of calcification. It is true that although ultrasound can detect fetal intracranial tumors, it does not allow a specific diagnosis of the histologic variety. But this happens with all the pathology that we diagnose with imaging tests, including the gynecological pathology. There have been several cases of intracranial teratomas throughout the history of TheFetus and I don't know if the images were always much more demonstrative than those of the present case. Of course intracranial tumor is correct, but I think we are used to being asked to be more specific, especially if three possible answers can be given."

There have been instances in the past year and a half since I have taken over the website after my father's death that we have presented cases with genetic diagnosis. It is from feedback such as the one that you have given, that I am now more careful to avoid cases where the diagnosis cannot be made on imaging and clinical history (and 3 guesses).

Please continue to provide us with your feedback. If you would like other cases presented as the Case of the Week, I encourage you to submit some of your own!

#2 - 
Oskar Sylwestrzak said I agree with prof. Cerine Jeanty. There are diagnoses based on the ultrasound images that actually do not need histopathological examination. Histopahthology is usually also made on 'images'. Images of the cells under microscope and we see also images but of the whole pathology and its signs and symptomes. Lets consider multiple fetal heart tumor. Rahbdomyoma is nearly 100% clear diagnosis without additional histopathology. gather specialists all around the world and some of us are MASTERS. That is why we need to learn and if we are good enoguh we can diagnose parhologies looking on fetal ultrasound. You have to know what You are looking for- that is something, that prof. P. Jeanty taught us. Regards :)

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