AN UNUSUAL CASE OF A GIANT FETAL FACIAL TUMOUR 1 Start ,
1,2 Ryan ,
2 Cathart ,
3 Colleran ,
3 Adams ,
4 Vassaveur ,
2 Walsh
AO GA B G N C J 1UCD Perinatal Research Centre, School of Medicine, University College Dublin, National 2 3 4 Maternity Hospital, Dublin. Fetal Medicine Unit,. Paediatric Radiology, Neonatology, National Maternity Hospital, Dublin, Ireland.
BACKGROUND
The prevalence of congenital tumours is quite rare with Feygin et al 2020 suggesting it was between 1.7 and 13.5 per 100,000 live births. Even more rare however is the presence of a fetal facial tumour.
AIMS
To explore the diagnosis and management of a giant fetal facial tumour.
Antenatal ultrasound
Antenatal ultrasound
Antenatal MRI
CASE PRESENTATION
We present the case of a healthy 32-year-old who at 22 week anatomy scan a facial lesion noted in the left temporal region 4 x 3.5 x 3 cm with no flow on colour Doppler and with a single solid component measuring 1.02 x 1.03 cm. A fetal MRI confirmed a large periauricular tumour. The primary differential diagnosis included a lymphatic malformation, cystic teratoma, a branchial cyst/cleft remnant. By 28+3 weeks the tumour began to increase in size to 8.5 x 7.7 x 7.5 cm. At 33+3 weeks drainage of the fetal tumour was performed using a 22G needle draining 640ml of clear fluid.
CONCLUSION
Antenatal MRI
Postnatal MRI
Postnatal CT
CASE PRESENTATION
A good clinical result was obtained with collapse of the cystic structure. However the next day it has refilled. At 38 weeks an elective lower segment caesarean section was performed. Immediately prior to the uterine incision a further 960mls of cystic fluid was drained to facilitate delivery. Almost immediately after birth the cyst had refilled and the baby was transferred for further surgical management. Postnatal histology revealed cystic teratoma, the cyst has been fully resected and the baby is well at home. The plan is to await for the skull to remodel before considering further surgical options.
This case report highlights the challenges associated with a giant fetal facial tumour and underpins how useful MRI is as an adjunct to aid in management of complex fetal tumours.