Congenital glioblastoma - prenatal diagnosis becoming a diagnostic challenge after birth: a case report

Abstract

Objectives: The incidence of congenital brain tumors is estimated at 1.1-3.6 per 100.000 live births, accounting for 0.5-2 % of all cancers in the pediatric population. Congenital gliomas account for 3.1-8.9 % of all congenital brain tumors and are cancers with a poor prognosis. The rate of stillbirth and death on the first day of life reaches 29 %; 38 % die within the first week, and 56 % die within the first two months. The average length of survival is two years.

Case presentation: In the 29th week of pregnancy, a female fetus was diagnosed with intracranial hemorrhage complicated by hydrocephalus. Postnatal brain MRI imaging showed a solid proliferative lesion of the left hemisphere with dilatation of the ventricular system. Brown cerebrospinal fluid was collected during the puncture of the left lateral ventricle to reduce hydrocephalus. No tumor cells were detected by cytology. Due to increasing hydrocephalus, the patient was qualified for Rickham reservoir implantation. On day 27th, a craniotomy was performed to determine the etiology of recurrent prenatal intraventricular bleeding. During surgery, the bleeding mass raised the suspicion of neoplasm-histopathological examination of the retrieved tissue diagnosed WHO stage IV malignant glioma. The patient died at 8 months of age.

Conclusions: Prenatal diagnosis of an abnormal structure in the fetal brain remains a diagnostic challenge in neonates. Glioblastoma is a rare neoplasm with a poor prognosis.

Keywords: central nervous system; congenital; glioblastoma; intraventricular hemorrhage; newborn; tumor.

Figure 1:

Newborn head MRI at 2nd day of life (A–C). In the image B an arrow marks the brain tissue. The tumor mass is marked with an arrow in image C.

Figure 2:

Trans-temporal ultrasound of a newborn with glioblastoma on the lateral plane. Visible lack of flow within the tumor on Doppler examination.