A 23-year-old primigravida presented to her local hospital with reduced fetal movements at 31 week of gestation. An admission cardiotocograph showed sinusoidal pattern. An ultrasound (US) revealed a brain abnormality with a mass. An US at the regional Fetal Medicine unit confirmed a hydropic fetus, with an intracranial mass measuring 6.6×7 cm in the right lateral ventricle (possibly haemorrhagic), ventriculomegaly and loss of anatomical landmarks in the brain. Antenatal MRI scan confirmed a 7 cm mass with appearances suggestive of an intraventricular tumour, possibly choroid plexus papilloma or carcinoma. Following counselling by the multidisciplinary fetal medicine team the couple opted for termination of pregnancy and a vaginal delivery, the first such report in the literature. Cephalocentesis was performed following fetocide to reduce the hydrocephalus. Postmortem, histology, cytology and immunohistochemistry confirmed a Glioblastoma (WHO Grade IV).
The incidence of brain tumours in first year of life is approximately 1.1 per 100 000. Only 2–9% of congenital brain tumours are Glioblastomas. The prognosis of Glioblastoma is universally poor.
The management of fetal intracranial fetal tumours diagnosed antenatally can present clinical and ethical dilemmas for professionals and parents particularly with late diagnosis. Multidisciplinary management with fetal medicine specialists, neonatologists, paediatric radiologists and neurosurgeons ensures that the parents are offered appropriate counselling to make informed choices. When the prognosis is poor the parents should be offered the option of late termination of pregnancy.
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