Fetal Tumors - SD

Introduction

Good morning.
I'm Philip Genti. I work at InnoVision Women's Ultrasound
in Nashville, Tennessee.
And this morning I will talk
to you about tumors in the fields.

Good morning. In this presentation, I'm going
to show a lecture that was presented that was prepared,
by my fellow Iranco.
She's a physician from Belarus
and she came to visit our place several years ago
and we have worked on this lecture jointly.
When she started doing this lecture on tumors,
I had no really consideration for
how big this was going to be.
And in this segment here, I will just talk
to you about brain tumors and if I have time, I will go on
and talk about facial tumors.

Brain Tumors

So let's start with brain tumors.
And, brain tumors can arise from essentially three,
type of lesion, intracranial tumors, lipoma
of the corpus call, which is more a
birth defect than a real tumor, and then vascular anomaly.
Overall, if you take any brain mass,
the outcome is not very good.
About only 28% of these babies survive
and the findings are not going to be very precise.
Usually we'll find a mass,
which is either cystic solid or a heterogeneous.
We'll find activation of the shape and size of the brain
or part of the brain.
We'll see a loss of the normal intracranial architecture.
We may see microcephaly or sometime
but less common microcephaly.
And quite commonly there will be alteration of the swelling
of fluid and those baby will develop body hydros.

The associated malformation,
essentially I believe just random, cleft lip
and cleft path have been associated cardiac
anatomy, urine tract.
But I don't believe these are true association.
I believe these are just random,
report in the literature.

Now the outcome is difficult to predict
because we don't have the histology of the lesion.
So we'll try our best to try to guess what of which
of the brain tumor we are looking at.
And the outcome is of course going to depend on size,
location, the histology, the fact
that the tumor can be resected or not,
and the condition of the fetus at the time of diagnosis.
So for the very large tumor in which we don't still have the
histology, very much,
a good reasonably prognosis can be obtained simply
because of the size, location.
And these criteria, neonates that have a plexus, papillo
glioma or low grade astrocytoma are those
that have the best prognosis, whereas those that have Oma
or the primitive neuro dermal tumors that we refer to
as pnet tumors have the worst prognosis.

Brain Neoplasms

So let's start with the brain neoplasm.
And brain neoplasm essentially arises from two main type
of cells, the G gl, and
therefore they will be gliomas such as the astrocytes
and the early good endocyte
or the append cells, which will result in impends.
There are also some primitive neuro dermal cells
that have been left over and somehow developed into tumors.
There are also some pineal, perineum C plexus
and all these are quite common.
And then there will be some neurop epithelial
tumors of uncertain origin.
And then of course there will be mixed tumors.
So essentially a great variation here,
but mostly ggl, and impend tumors.
And these are some of the common tumors,
the OMA intracranial germ cell tumor,
glioblastoma gang neuroma, astrocytoma plexus,
papillo cranial, he angio per cytoma.
And we'll see some of each.
And then the pnet tumor, the neuro dermal tumor
that are presented by this group over here.

Now this may look like a very frightening list of anomaly,
but I one like to make an analogy here with the fetal echo.
I don't know if you remember the situation,
but 15 years ago when we were looking at fetal heart
and something was not normal, the report usually said
complex congenital heart disease.
And I don't think anyone would put
a complex conal heart disease report anymore.
We want to be more precise than that.
And I think that this is probably the level we are at
with a brain neoplasm.
It is not sufficient to say the baby has a brain tumor.
You want to be a bit more precise than that.

This is the frequency distribution
and you see that plexus papillo is the most common,
although they're quite rarely reported.
Teratomas, astrocytoma, Blas stoma, and so on and so forth.

Intracranial Germ Cell Tumors

And let's start with the intracranial germ cell tumors.
This is 0.4 to 3% of all intracranial tumors.
They will present as a mass around the third ventricle.
And these are tissue of germ cell origin
that will in feed this be mostly Oma,
but can be other type
of tumors in older patient including DeRoma, em,
brain cell carcinoma and so on and so forth.
But in fetuses we're talking mostly about Oma.
The complication of these tumors will be compression
obstruction of the, CS CSF, flow,
and this is going to lead to hydrocephalus.
So remember, toum in the brain will cause,
hydrocephalus and
of course the prognosis is quite poor for these tumors.

Choroid Plexus Papilloma

This is now the next condition. The CEX is papillo.
This is one of the most common, tumor.
It is a benign tumor of the quad plexus.
It presents with enlarged and irregularly HyperCard plexus.
And you can see here an example.
This is the enlarged quad plexus.
You can see it over here invading into the third ventricle.
And, the treatment will be surgery.
Now notice that this image here is not very striking.
This is a tumor. This is not a normal image,
and we should not have this vascularization at this level.
These are four more images in other cases
also from Gustavo Malinger.
You see what appears to be a cast
of the ventricle over here, a cast over here.
And this, these are the typical form of plexus papillo
and they're easy to miss.
So I would like to alert you to recognize them.
This is a slightly different form with a cystic appearance
of the quad plexus papillo,
but that also is a quad plexus papillo here.
As you can see on the video clip,
the quad plexus look rather normal,
but they are way more bulky than they should be,
and there is extra vascularization inside the, tumor.
So that is really the finding that you may want
to pay attention to this bulky
poly ablated quad plexus.
They look bigger than normal, but
otherwise the texture of it is not very different.

Teratoma

A teratoma, as remember, is a tumor that has all three
germ cell layer.
So it has ectoderm, it has the endoderm,
and it has the mesoderm.
And because of that, we can clearly expect
that these are going to be tumors that are
irregular in texture that will contain some cystic lesion
that will contain some solid lesion,
and they probably will have some classification.
And here is the, most classical appearance of a
cystic tooma of the brain.
You see a complete loss of normal brain architecture.
The, tumor is full with cyst
and those cysts are probably secreting,
C plexus, fluid.
There's some calcification, there's some shadowing.
And essentially nothing of the brain is visible.
And not only that, but the baby has a very severe myran.
If I can read properly, the bi diameter here was 120
and you remember that at birth it should be
around ninety five, ninety seven.
So this is a baby that has to have either a cranio synthesis
or will have to have a season infection.
And the prognosis, of course, for such a lesion is fatal.

The findings will be an heterogeneous mass with loss
of brain architecture
and recognizable midline, midline echo, ventric
and calcification.
This is a case from Geni pillow,
a little bit less severe than the one I just showed you.
There's still a little bit of architecture that is visible,
but essentially the brain has been entirely replaced.
These have a very rapid growth
and sometime there is some bleeding inside the tumor
that cause some, change
that are visible over a couple of days.
Because of the bleeding and
because of the shunting inside the lesion,
they will have high cardiac failure
and this is going to lead to point HIAs
and they will also have, pulmonary hyperplasia.
All these involving premature delivery.
And these are the complication, that may occur.

The tumor tumor are frequently located in third ventricle in
the sub frontal region or in the sub temporal area.
This is a quite different form of tur tumor.
And I would like you to burn this image in your mind
because I'll show you cranial frame in ger in just a second.
And you'll see the cranial germa look very much like this,
but this one has a bit more irregular texture.
And here you can see the trium at this level.
This is another trium.
And you can see the growth of the intracranial tumor
is deforming the face here, this is pushing the eye
and you'll see that rdo mys sarcoma can also look like
that, but the rdo mys sarcoma does not involve the whole
brain, just the eye and the neck and the face.

The complication will be ventricle dietician
with mal formation, obstruction, hydrocephalus,
microcephaly, spontaneous intracranial hemorrhage in up
to 20% of the case and dystocia during delivery.
The differential diagnosis will be craniopharyngioma.
I'll show you when very soon, the plexus papillo.
And we've seen that much less, severe oid cyst,
which would be predominantly cystic
and will be, mostly on the posterior fossa
and the fetus vascular malformation, infarction,
and the hemorrhages.
The prognosis is fatal in all in those cases,
but in rare case, it may depend on the grade of the tritium
or the size, the location of the tumor,
and its consequence on the remaining brain.
So from time to time, some of the small ter can be removed,
but usually death milk occur in Euro, the management is
to decompress the head by doing repeated synthesis
or a termination of pregnancy.

This is another example in which part
of the brain is still rather well seen,
but there is this large mass that is compressing
and expanding the head.
Another to tumor.
This is the appear of the newborn after birth and the lesion
and the pathology of the lesion.
So a very, large,
fast growing tumor glioblastoma is two to 9%
of al brain tumor.
So not very common.
It will present as a hyper grade mass
around the third ventricle.
And on cardio dolar, they are very vascular.
The differential diagnosis will be the tooma
that appears multicystic vascular malformation, infarction
and hemorrhage, the complication of glioblastomas
that they can cause some spontaneous intracranial
hemorrhage, heart failure and anemia.
And the prognosis is poor due
to the rapid growth of the tumor.

Ganglioneuroma

The next tumor is ganglio neuroma.
These are also called ganglio cytoma,
and these are tumors of mature neuronal elements.
So they will have a more benign outcome.
These are not coming 0.4 to 3.8% of all intracranial tumors,
and they will be either in the spinal cord in about half
of the case, the cerebral hemisphere
and about a third of the case, and then the brainstem
and rarely in the cellar region, we want
to differentiate them with the cranial pH seum
and the pineal gland.
The treatment would be to shun those babies with,
after delivery and provide chemotherapy in, in an effort
to shrink the mass prior to surgery.
The prognosis is, with complete removal of the tumor.
The baby may also have even when the tumor's completely
removed, issue of hormonal hyper secretory syndromes.
And that is going to complicate the
management of those children.

This is an example of a gang neuroma,
that was in the poster fossa
and was associated with fcon is anemia.
So most of what you see on the image aside from the tumor is
large bleed in the ventricle.
But those bleed were not related to the ganglio neuroma.
They were related to a fcon anemia
and some, bleeding in the brain.
Here is the bleed and the tumor.

Astrocytoma

The next lesion is astrocytoma.
And these are not very common.
They are neuro electrodermal, lesions.
They occur in 0.03
to 0.01 per 10,000 delivery.
So I'd likely to recognize many of them.
They represent 13% of all congenital brain brain tumor,
and 20% of all glioma.
They affect boys and girls at the same level.
And here's an example of one.
As you can see, this is a poly lobulated,
very dense echogenic lesion,
but it has some hypoechoic, area inside
and maybe a few specs of calcification.
Pathogenisis is unknown, maybe some physical
x-ray chemical or viral factor.
The associated anomaly will be
obstructive hydrocephalus resulting from compression
of the ventricle system.
And the prognosis will depend on its probability.

Craniopharyngioma

The next screen pharyngeal,
and that is a common disorder
that you are likely to encounter.
These are benign midline cell tumor
that contain fat calcification and cystic component.
And when they're lethal, it is lethal due
to the extension and growth.
They represent about two to 5% of the intracranial tumor
and 50% of the s cell tumor in children
and girls are slightly more commonly affected than boys.
These are supposed to rise from radius pouch,
which is a nectar dermal erum.
Remember, this is the roof of the mouth.
This is nal dermal erum
that is developing towards the brain.
And there are several forms,
but I don't think that we can recognize the different
forms prenatally.

The findings will be quite easy to recognize.
Here we have a potato like poly lobulated, smooth
genicity mass, this located straight over the cellar.
And, very interestingly, this, lesion will have
to develop for a long time
before it start affecting the ventricles.
So the, hydrocephalus may occur,
but it is often a lead development.
Of course, from its position you will see some,
displacement of the circle of Woolies.
And that is one of the criteria that helps look at the,
the lesion.
This is the same baby 12 days later.
You see that the mass is going quite significantly in 12
days and the baby was delivered.
And this is the two month old ct.
And you see the origin here over this Fenway the baby is
facing in this erection.
This is the, brain
that has been flattened, towards the top.
And this baby died a couple of days
after this, exam was obtained.

Another very similar,
image from ette in Belgium.
Here you see the mass with the same control,
the same genicity.
They tend to be quite smooth.
And if you look at the central view here, it is just located
above the sphenoid and displacing the brain upwards.
That's the reason you don't get hydrocephalus rapidly.
It's also the reason that this lesion is quite central,
which helps differentiate from the astrocytoma
that we were looking at in the previous, set of slides.

The differential diagnosis includes oma, cytoma optic,
chima glioma, hypothalamic glioma, peanut lipoma,
the corpus cosm, but they're usually higher in the brain
and intracranial bleed.
None of this tumor except
for astrocytoma really look very much like Caryn.
So that differential diagnosis is a very wide
differential diagnosis.
The prognosis is very poor because they grow very rapidly.
It's only the very small one that can, be operated
and the management is to, terminate the pregnancy.
When they are discovered even with complete resection,
there is a risk of recurrence that is 7%.
So this is a tumor that comes back
and remember it was a benign lesion originally.

Another example of corn.
pH germa a very midline lesion that is well centered.
It is located just above, the, pineal region,
with displacement of the flow
and not very many vessels inside.
That is quite typical of cornal

Meningioma and Hemangiopericytoma

Image of, cytoma.
This is a tumor of the arachnoid membranes, and
because of that, you can expect that this is going
to be a tumor that grows from the periphery
towards the center of the brain.
And so it would be an asymmetrical tumor.
That tumor usually has very poor prognosis.
This is the Doppler, flow of this, lesion,
which is vascular and displacing the adjacent vessel
and the, MRI that shows the compression of the brain,
displacement of the brain.
This is the lesion under the brain,
you see part of the membranes.
And this is the cut section with the histology of the,
hema para cytoma NeuroDerm tumors.

Neurodermal Tumors

These are, tumors that are central
or peripheral, nervous system.
You can have the two types.
These are soft tissue sarcoma that arises from primitive
and undifferentiated nerve cells that have been left over
during the development of the nervous system.
The synonyms are the pnet, which is probably the easiest
to pronounce, peripheral neuro epithelium,
peripheral neuroblastoma asking tumor
and the old, extra os even sarcoma.
The prevalence, this is a rare tumor,
but they represent 30% of all sod brain tumor.
Overall they affect 0.05 to 10,000 children.
There's a slightly higher incidence in Caucasian than in
black, and there's a slightly higher preponderance
among boys than girls 1.8 over one.

The pnet can be divided into two form the central peanut
and the peripheral peanut.
The central peanuts are themselves divided into a super
tentorial and, for instance,
the pineoblastoma is a sal form
or the infratentorial such as the medulloblastoma.
And here is a list of the most common,
neuro dermal tumors that you're likely to encounter.

This is one from Brian Bromley.
This is one that was originating in the,
pons in the Seum and caused some four ventricle,
hemorrhage and also bilateral germinate hemorrhage.
So here the tumor is not very big,
but has caused some bleeding that, enlarged effect.
The treatment would be surgery,
radiation therapy and chemotherapy.
And some of those, can be, taken care of

Ependymoma

Appendamoma, a glad tumor
that originate in the ventricle space,
all from residual intraparenchymal, ependymal cells.
And they are divided into two third in the posterior fossa
and one third in the superal region.
And that one third instal region is divided almost evenly
among the lesion in the parenchyma
and the lesion in the vent system.
And here we have the, image of this append here.
The criteria is that this will be asymmetrical lesion,
but that tend to, arise into the ventricle.
And so there will be some connection with the ventricle
to the tumor here or see the poly lobulated appearance,
rather homogeneous,
but it has some speckles
of calcification in some little cystic area.
Inside them, The prevalence is six to 9%
of the primary central nervous system neoplasm, six 9%
of all neuro epithelial tumor, 60 12%
of brain tumor in children
and a oma may recur even after surgery.

Lipoma of the Corpus Callosum

Lipoma of the corpus, a lipoma
of the corpus sch is actually not a tumor.
It is mostly a brain malformation.
And as you can see, it occurs mostly at the level of the gen
of the corus schism.
However, this is a great mimicker
because it can involve the lateral ventricle
and then it will look very much like a co plexus papilloma.
This is not a common finding, 0.04
to 0.4 per 10,000 autopsy.
They are hyper coic and homogeneous
and the offering in the genu of the corpus colors.
And, here's another example.
This is the most typical form, a bright mass located
straight at the level of the genu of the corpus call.
When it is limited to this,
the diagnosis is not very difficult,
but sometimes it involves also the lateral ventricle.
And here it is a bit harder to recognize as being a lipoma
of the corpus collo.
Here's another example. You can see the inversion
that looks very much like the plexus papillo,
but here on the pathology segment
you can see the origin here in the du,
the extension in the ventricle.
And very clearly when you do the path even I can see
that this is a lipoma
and you see all the fat lobules that have been dissolved
during the processing.

Vascular Anomalies

Let's go on.
We have seen the intracranial tumor in the lipoma.
Now let's go into the vascular anomaly
and we talk about the hemorrhages,
the arteriovenous anomalies and the vein of gi varix.

Intracranial Hemorrhages

Now intracranial hemorrhage are uncommon.
They are divided very clearly in newborns
and we have just used the same, division
and same terminology into a grade one through four grade one
representing pre ventricle hemorrhage, confined
to both ventricle, both germinal matrix in grade two
and three of the hemorrhage as extended into the ventricle.
And in grade three it has caused a dation of the ventricle.
And in grade four there is extension
to the adjacent white matter.
This is a very large grade four.
He emerged with a large invasion of the white matter.
This was a baby that had a bleed
after a 23 transfusion syndrome.
This is a large cystic mass.
This is a great big arterial venous, malformation.
This is not the event of GI varix
that we'll see in just a second.
This is just a large pool of blood with one feeding artery
and draining artery.
And babies that have
that typically will have a local mass effect.
They will have hemodynamic effect,
in particular ventricular hypertrophy
and poor contractility.
They will have atrial ventricular regurgitation,
umbilical venous procession that radiate to the placenta
and there will be, cardiac output
and hydro, cardiac output issues and hydro.

The differential diagnosis will be hemangioma cap.
He angio othel angio plast angiosarcoma general.
He angio cytoma that we saw earlier.
And arterio venous fistula
and doppler here helps narrow the diagnosis
because you can see this particularly large amount
of vessel inside the tumor.
There will be some maternal complication including the
mirror syndrome, the tine syndrome with maternal oli uia,
mild elevation of the blood pressure
and minimal proteinuria with elevation
of the uric acid level.
And the other syndrome that can occur is the caac,
merit syndrome with disseminate intravascular coagulation.

Vein of Galen Varix

The next condition is the vein of gill and varix.
This is not a tumor, this is just a space OCU lesion
and this is the cystic appearance that we typically,
see with this.
Of course, this could represent a ACHs,
but as soon as we put doppler,
the differential diagnosis is established.

Okay, this is what I wanted to show you about the brain.
Let me show you a few tumor of the face.
And these are the lesion that we're going
to be, covering.

Facial Tumors

Epulis

The pulis is a rather common lesion.
It is a pedunculated tumor of the anterior ging gva.
It's also called granular cell myoblast stoma.
And this is although a rare condition, it is something easy
to recognize prenatal, so they tend to be seen fairly well.
It occurs in the second trimester.
You see the nice smooth border, you see that it attach
to the upper gums.
The finding will be a solid intraoral mass protruding out.
It is well circumscribed, it is homogeneous.
There may be calcification assisted component,
but that is not very prevalent
and it will increase in size as gestation develop,
but still keep the well conscribed,
appearance on cardio doer.
There is no particular feature,
but it's useful to differentiate from heger.
It may have a single, feeding vessel.
And there's some interesting, intriguing idea
of using cardio doctor to assess the patency
of the nose during breathing.
You know that you can see flow
through the nostrils in the mouth when babies are breathing
and it is interesting to see whether the PUIs is,
causing some, trouble with that.
And 3D ultrasound is useful to see the overall appearance
and to, reassure the parents about what it looks like.

However, notice that on this,
3D there is the sensation
that this lesion is actually cystic.
That is an artifact of the 3D rendering.
This is, this lesion is not cystic, it is solid
and you can see on the 2D of the same baby
that this is really a solid lesion.
If you are cystic, of course you're thinking about ULA
and we'll talk about ULA in just a second.
If you have access to MRI, you can confirm the presence
of the upper airways
and confirm that the upper airways are not obstructed
when the baby is born.
The complication would be pretty ous.
Respiratory obstruction, postnatally as fixture
to do airway obstruction.
If you see an intracranial extension thing mostly
of ignitis When the baby is born, what you do is,
an exit procedure is, is suspicion
of breathing problem.
But otherwise you just surgically resect the lesion
as soon as the baby arrives.
And this is how that is done. The baby is placed here.
There's some local anesthesia.
A clamp is placed, the masses ligated
and the baby can go on to the nursery.
And this is the solid mass and the appearance in pathology.

Another example here from Serbia, from Dr. Ov.
You can see this mass here exactly the same
as on the previous exam.
The same here on the MRI
and the same appearance on the 3D ultrasound.
The baby is born, the mass is ligated and resected
and the outcome is quite good.

There's a long differential diagnosis here
and that differential diagnosis, a bit academic,
I would say a hemangioma mechy sarcoma,
cystic hydroma don't really look like this.
Cphi seals gran cell neoblastoma,
that is the same condition.
This is just a different name
nor tumor OSA duct cyst, bunch of clef cyst.
Both are very cystic anterior remaining seal
that is quite different.
We'll see them later on rdo myoma nectar, we'll see some,
they look more like the ignitis fibroma ignitis
il that looks like PUIs, but they're cystic
and the disto genetic cyst.
So that long list is probably a bit longer than it
really ought to be.

The big differential diagnosis of course, is with Apttus.
And here we have this baby that has this very large mass
and you see from the onset
that it is much larger than it has irregular surface.
It has irregular contours
and the texture is not as smooth
as the previous one.
And then of course it is due to the fact that these are
te tumor due to all three germ layers.
So you can have any kind of tissue inside that.

Epignathus

Now the aptus is a ger tumor
that originated from the facial bones,
in particularly the heart pat, the sphenoid and the ethmoid.
And that is an important clue
because by originating from these three bones,
what you will see is not only an invasion of the mouth,
but there is a potential for an invasion into the brain.
And of course that severely affects the prognosis.
Again, a rare condition but easy to recognize.
Prenatally the finding will be a solid tumor arising from
the oral cavity with calcification
and cystic component that are present.
And there may be an intracranial extension
and there will be poly hydrous duty pharyngeal obstruction.

Here's an example. The baby's head is over here
and there is a ill-defined poly lobulated,
heterogeneous mass.
Notice that this in this baby,
the heart pad is well preserved
and there's no extension into the brain.
Big mass over here.
Quite different from the PUIs
that we were looking at a second ago
on this other baby here.
This mass could look like an PUIs,
although it is quite large for an PUIs.
But you see on other section from the same baby
that the mass is irregular.
It has some low level echoes,
it has some little cystic area, it has some,
calcification and a fair amount
of vascularization vascularization.
So this is most likely an apttus.
And the 3D rendering is the typical bro
or cauliflower image
with this big poly lobulated mass in
front of the baby's face.
Same as in apttus.

The lesion is, resected as soon as the baby is born
and the outcome is, tend to be fav favorable
when it does not involve the brain.
Here you can see the mass and the cross section of the mass.
You see that it is not as smooth
as the one we saw when we're talking about the purist.
The prognosis is going to depend on the size, the degree
of airway obstruction, death, milk cure
after birth due to his fixture
because of airway obstruction and the rest.
Surgical resection, may, allow a normal post of
of operative course.
In some cases. The differential diagnosis is that same list
as we saw for PUIs,
but you see the texture is a bit different
and so it will, have some,
slight difference in the way the differential diagnosis
are taken into account.

The complication is that they may grow into the oral
and nasal cavity or intracranial,
and they will be poly MOUs, which is associated
with poor prognosis.

This is another aptus of the mandible.
This time you see the same type of lesion,
but look at the face over here
and mostly visible on the 3D rendering.
This is not arising from the top of the mouth.
This is rising from the bottom of the mouth.
This is from the mandible and this is confirmed after birth.
This the baby is being intubated.
Over here you see this big lesion
and when the lesion was resected, part
of the mandible had to be resected.
So this baby has a gap
that will require some repair later on.

Now if the,
OMA is not originating from the mouth,
then it is just a regular facial oma.
And here's an example arising from the zygomatic arch.
You see this big facial, it ous mass with calcification
and it arises from the side of the baby's, face.
And here you can see the appearance when the baby is born.
This is the same type
of lesion simply arising from a different bone.
This is a benign condition. This is a hamma of the mandible.
When you see this baby has this appearance of a large beard
or large, potato shape, lesion arising
underneath the, the mandible.
And this is the appearance of the baby after birth.
You can see this large lesion
and the reconstruction several months later.
Aula is a benign condition.

Ranula

This is a cystic malformation of the oral cavity due
to obstruction of the sublingual
or minor salivary gland is also called a retention cyst,
a mucus seal or an oral pseudo cyst.
And the finding here will be like the baby blowing a
gigantic bubble gum full of fluid instead of full of air
and it will not have vascularization.
And that is the big criteria
that differentiated from the other mass
we have seen up to now.
Prognosis is very good.

Rhabdomyosarcoma

Roma sarcoma,
briefly mentioned this earlier when we're talking about the,
thoma of the face.
This is a common and highly malignant sarcoma
of the primitive muscle cells.
And they can be located different lesion region of the body.
They can be around the head
and neck around the eyes, in particular in 35 to 40%,
20% into the genital urinary tract, 20% in the extremities,
and then 10 to 15% in the chest and lung region.
So the eye is the common lesion and there are four type
and we don't need to worry about that.
The only, version we can see prenatally is the ural form
of ribs sarcoma, which is the most common in occurs,
also in the head, neck and gene to urinary tract.
And this is the AP appearance.
You see this is very similar to what we saw
with the Oma early on, a big mass
that is pushing the ocular globe in front
and giving this odd appearance
to this poor little child.
You can see here the, the video clip
with the mass pushing the eye forward.
And since this is a very malignant lesion,
the prognosis is fatal.

Cephalocele

Now of course the feather seals are usually easy
to trace back to the brain, but sometimes the ethmoidal
and the sphenoidal cef seals, may present
as facial tumors.
And then you want to look for a science of hydrocephalus
and microcephaly in order to help in the diagnosis.
Here, for instance, we have an ill-defined mass in the,
midface and there is the appearance of a cystic lesion
inside the mouth of the baby
with something protruding over here.
When you look at the video clip, it appears
that the baby has a great big cyst there,
but that cyst, this is the eye.
That cyst is not the mouth that is open.
See, that appears to be an open mouth,
but it's actually a cystic lesion inside the mouth.
And this is the appearance of that ant S seal,

Another baby that has clearly a lipoma of the corpus collos,
but it also has some frontal busing,
which we have seen before.
And you see the head is protruding over here.
And on the 3D reconstruction you see that part
of the brain is pushed forward.
This is the typical form of an,

this is a more complicated, more complicated lesion.
There is a mass here between the eyes
and the nose that is pushing here.
That mass is solid, it is not cystic,
as we will see in the deck.
Cysto seed in just a second.
And you see this mass is protruding above the nose
and in front of the eyes.
That is another form of ele.
You can see it over here after delivery of the child.

The differential diagnosis for that, if it was cystic
and not solid, would be a dura cystocele
and DCU cysto c obstruction
of the la criminal duct at the level of valve
of has over here.
Remember that baby opened their eyes around the 28th week,
and from then on they blinking
and when they blink, they push some
of the americ fluid down the lacrimal duct
and that keeps it patent.
But if the patency has not been established over here,
then there is no, outlet for these, tears of am fluid.
And they accumulate in this region.
And the, soft tissue in front of the D
are very, compliant.
And so there is a progressive formation
of a little cyst, in this region.
And this is the appearance of it. This is the two eyes.
This is the decker cyto seal, another image of that.
This is here a bilateral decker cyto seal.
And this is a decker cyto seal that is not only bilateral
but contains some low level echo with some debris
or some poly formation.
This is the 3D rendering of it, the other 3D rendering.
And on, the video clip,
you can see the lesion right next to the eye
and the bilateral lesion on both sides of the nose.
Here, here we can see the newborn.
The lesion is over here, the lesion is over there.
And the treatment for that is very simple.
It is just a matter of pressing with the thumb
and squeezing the fluid down to the nose
and rupturing the valve of asner.

Conclusion

So this is what I want you to show you in this, two segments.
I hope that I have rekindled your interest in,
tumors and that in the future we'll try to,
be more precise than just saying large brain tumor
or large facial tumor
and be able to put a correct diagnosis on the issue.
Thank you very much.