title: Medical and ethical challenges in the case of a prenatally undiagnosed massive congenital brain tumor.
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 Diagnosis of an extensive, inoperable tumor was confirmed and support withdrawn.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.
authors: Department of Neonatology, Children's Hospital, Medical University Vienna, Vienna, Austria.
authors: M
authors: M
authors: Olischar
authors: Department of Neonatology, Children's Hospital of Los Angeles and Keck School of Medicine, Los Angeles, CA, USA.
authors: T
authors: T
authors: Stavroudis
authors: Thomas Jefferson University Hospitals, Philadelphia, PA, USA.
authors: J K
authors: JK
authors: Karp
authors: Boston Children's Hospital and Harvard Medical School Boston, MA, USA.
authors: W E
authors: WE
authors: Kaufmann
authors: Murdoch Childrens Research Institute, Melbourne, VIC, Australia.|University of Melbourne, Melbourne, VIC, Australia.|Royal Women's Hospital, Neonatal Services, Melbourne, VIC, Australia.
authors: C
authors: C
authors: Theda
mesh_terms: D001932:Brain Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology; D003933:Diagnosis; D055088:Early Detection of Cancer / Q000941:ethics / Q000379:methods; D005260:Female; D005910:Glioma / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D018447:Medical Futility / Q000941:ethics; D011247:Pregnancy; D011296:Prenatal Diagnosis / Q000941:ethics / Q000379:methods; D015173:Supratentorial Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology; D014463:Ultrasonography