Olischar M, Stavroudis T, Karp J K, Kaufmann W E, Theda C
Department of Neonatology, Children's Hospital, Medical University Vienna, Vienna, Austria.
Department of Neonatology, Children's Hospital of Los Angeles and Keck School of Medicine, Los Angeles, CA, USA.
J Perinatol. 2015 Sep;35(9):773-5. doi: 10.1038/jp.2015.80.
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 Diagnosis of an extensive, inoperable tumor was confirmed and support withdrawn.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.
胎儿和新生儿脑肿瘤较为罕见。产前超声有助于早期肿瘤检测。尽管如此，我们遇到了一名孕32周出生的早产儿，患有巨大的幕上胶质瘤，在孕19 - 6/7周时超声未检测到。该患者出生时出现意外的巨大头围。复苏和稳定病情很困难，但医疗团队认为未确定治疗无效，于是选择将婴儿转至学术中心进行进一步成像和专家会诊。确诊为广泛的、无法手术的肿瘤后，停止了支持治疗。尸检组织学检查和免疫组化染色确定大多数肿瘤细胞起源于神经胶质细胞。本病例报告很好地说明了一种严重且可能致命的异常情况，产前未被发现，在出生时给医疗团队和家庭带来了多重医疗、伦理和情感挑战；在新生儿转运过程中关于治疗无效的决策很困难。
