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  • Perinatal/Neonatal Case Presentation
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Perinatal/Neonatal Case Presentation

Medical and ethical challenges in the case of a prenatally undiagnosed massive congenital brain tumor

Journal of Perinatology volume 35, pages 773–775 (2015)Cite this article

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Abstract

Fetal and neonatal brain tumors are rare. Prenatal ultrasound aids early tumor detection. Nonetheless, we encountered a preterm neonate born at 32 weeks gestation with a massive supratentorial glioma, which was undetected on ultrasound at 19-6/7 weeks gestation. The patient presented at birth with unanticipated massive macrocephaly. Resuscitation and stabilization were difficult, but the medical team felt that futility of care was not established and opted to transfer the baby to an academic center for further imaging and specialist consultations. Diagnosis of an extensive, inoperable tumor was confirmed and support withdrawn. Postmortem histologic examination and immunohistochemical stains identified the majority of tumor cells as glial in origin. This case report illustrates well how a severe and potentially fatal anomaly, which remained undetected prenatally, presented the medical team and family with multiple medical, ethical and emotional challenges at birth; decisions regarding futility of care in the neonatal transport setting are difficult.

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Acknowledgements

We acknowledge the staff of the referring hospital, transport team and receiving hospital (who are not further named to deidentify the patient). We thank Dr Judith Rossiter for review of the deidentified prenatal US findings.

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Authors and Affiliations

  1. Department of Neonatology, Children’s Hospital, Medical University Vienna, Vienna, Austria

    M Olischar

  2. Department of Neonatology, Children's Hospital of Los Angeles and Keck School of Medicine, Los Angeles, CA, USA

    T Stavroudis

  3. Thomas Jefferson University Hospitals, Philadelphia, PA, USA

    J K Karp

  4. Boston Children’s Hospital and Harvard Medical School Boston, MA, USA

    W E Kaufmann

  5. Murdoch Childrens Research Institute, Melbourne, VIC, Australia

    C Theda

  6. University of Melbourne, Melbourne, VIC, Australia

    C Theda

  7. Royal Women’s Hospital, Neonatal Services, Melbourne, VIC, Australia

    C Theda

Authors
  1. M Olischar
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  2. T Stavroudis
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  3. J K Karp
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  4. W E Kaufmann
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  5. C Theda
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Corresponding author

Correspondence to C Theda.

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The authors have not received any support for the work in the form of grants and/or equipment or drugs. The authors declare no conflict of interest.

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Olischar, M., Stavroudis, T., Karp, J. et al. Medical and ethical challenges in the case of a prenatally undiagnosed massive congenital brain tumor. J Perinatol 35, 773–775 (2015). https://doi.org/10.1038/jp.2015.80

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  • DOI: https://doi.org/10.1038/jp.2015.80

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