Rapid growth of congenital diffuse brain tumor considered to be teratoma: case report

Prenatal ultrasonography of a 17-year-old pregnant female detected ventriculomegaly of the fetus at 31 weeks of gestation. Her medical and family histories were unremarkable. Fetal magnetic resonance imaging taken at 33 weeks of gestation showed a tumorous lesion with ventriculomegaly. A male baby was delivered by cesarean section at 36 weeks of gestation. The Apgar scores were 9 and 9 at 1 and 5 minutes after the delivery, respectively. The head circumference at birth was 41.5 cm with bulging anterior fontanel, but no other congenital anomaly. He showed relatively good activity with satisfactory feeding. Computed tomography performed on postnatal day 5 revealed a massive brain tumor of mixed density, with multiple lobulation and cystic and calcified components. The tumor had rapidly grown with diffuse appearance. The patient underwent endoscopic biopsy with installation of an Ommaya reservoir to control the hydrocephalus on postnatal day 6. The tumor appeared hypervascular and bled profusely on resection maneuver, so the endoscopic procedure for histological verification was abandoned. Cerebrospinal fluid taken intraoperatively revealed marked elevation of the alpha-fetoprotein level and mild increase of the human chorionic gonadotropin level, strongly suggestive of teratoma. Neuroimaging performed on postnatal day 11 indicated significant additional tumor growth which occupied nearly the whole cranial cavity. His activity began to deteriorate on postnatal day 13 and he died of respiratory distress on the 15th day of life.