case_images: PMC10851418_01
case_images: Prenatal ultrasound of fetal intracranial medulloepithelioma. (A) CDFI through the transabdominal approach; (B,C) sagittal view of the tumor through the transvaginal approach without (B) and with (C) CDFI; (D) ultrasound of the tumor at 23 weeks of gestation (axial view).
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case_images: fig1
case_images: Meanwhile, color Doppler flow imaging (CDFI) through the transabdominal approach revealed no blood flow signal (Figure 1A). However, abundant blood flow signals within the mass on CDFI were observed by transvaginal ultrasound (Figures 1B,C). A review of her medical record and previous ultrasonography exams showed a mass (0.7 x 0.7 cm) with homogenous hyperechogenicity and well-circumscribed margins at 23 weeks of gestation (Figure 1D).
case_images: Prenatal MRI of fetal intracranial medulloepithelioma. MRI of the fetal brain: axial view of T1WI (A), coronal (B), axial (C), and sagittal (D) view of T2WI; white arrow indicates the tumor.
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case_images: fig2
case_images: Tesla mode at 26 weeks of gestation, which revealed abnormal echogenicity with unclear margins between the bilateral thalamus. The mass was hyperintense on both T1-weighted magnetic resonance imaging (T1WI) and T2-weighted magnetic resonance imaging (T2WI) as compared to the surrounding brain tissue (Figures 2A-D).
case_images: Pathological examinations of fetal intracranial mass. (A) Gross examinations; (B) histology of the resected tumor (200 x magnification); and (C) immunohistochemistry analysis of synaptophysin; the white arrow indicates stromal vessels.
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case_images: fig3
case_images: According to a gross examination following an autopsy, the tumor was situated beneath the arachnoid between the bilateral cerebral hemispheres, separated from brain tissue (Figure 3A). The tumor cells displayed a papillary, glandular tubular arrangement and formed a pseudostratified epithelium that resembled the structure of the primitive neural tube with multilayered rosettes and abundant stromal vessels within the tumor (Figure 3B). Figure 3C), Ki67 (regional, 60%), CD99, AFP, and CK (regional), but it revealed no immunoreactivity to NSE, EMA, GFAP, CK19, or CD30. Finally, an intracranial medulloepithelioma (WHO GRADE 4) diagnosis was made, which is highly malignant according to the 2021 WHO criteria.