Prenatal sonographic findings associated with malignant astrocytoma following normal early third-trimester ultrasonography

We present an unusual case in which sonographic assessment at 33 weeks' ges tation, 5 weeks following a normal fetal anatomical survey and biometry, de monstrated a large, irregular-shaped, echogenic, suprasellar midline intrac ranial mass occupying the anterior and middle fossas. Associated severe obs tructive hydrocephalus with "dangling" choroid plexus bilaterally was noted with a markedly thin cortical mantle and increased cranial biometry. Elect ive cesarean delivery was performed due to the associated craniomegaly at 3 7 weeks' gestation. Although breathing spontaneously at delivery, the infan t subsequently required mechanical ventilation and developed neonatal seizu res. A ventriculoperitoneal shunt was placed on Day 3 of life. Transcranial needle biopsy demonstrated malignant astrocytoma (glioblastoma multiforme) . This case suggests the rapid development of an intracranial malignant ast rocytoma over a relatively short period of time. The significant ultrasonog raphic finding of an intracranial, destructive fetal deformation, following a normal examination 5 weeks previously, demonstrates the limitations of s creening ultrasonography in predicting perinatal outcome.