Mature teratoma splitting the brainstem in a newborn: case report

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Mature teratomas (MTs) of the posterior fossa are extremely rare. The authors present a case of a prenatal diagnosis of an MT splitting the brainstem. Representative images as well as the clinical and surgical course are presented. Literature regarding “split brainstem” and MT of the posterior fossa is discussed.

ABBREVIATIONS MT = mature teratoma; SCM = split cord malformation.

Article Information

Correspondence Jonathan Roth: Dana Children’s Hospital, Tel-Aviv Medical Center, Tel-Aviv, Israel. jonaroth@gmail.com.

INCLUDE WHEN CITING Published online July 26, 2019; DOI: 10.3171/2019.5.PEDS19142.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.

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Figures

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    Fetal axial ultrasound showing a heterogeneous mass within the posterior fossa, splaying the cerebellar hemispheres.

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    Brain MRI. A and B: T2-weighted coronal and sagittal MRI. C: T1-weighted sagittal MRI. D–H: Axial T2-weighted MRI. MRI demonstrates severe ventriculomegaly, and a heterogeneous irregular mass extending from the clivus anteriorly to the center of a massively enlarged posterior fossa posteriorly. There was low signal intensity on T2 sequences, which was suspected to represent calcific or bony changes, as well as fat signal changes and enhancing components. Associated splaying of the midbrain, pons, and medulla was also present, giving a butterfly configuration. Fusion of the two halves of the medulla was seen only at the level of the craniocervical junction.

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    Head CT scans obtained at the age of 5 days (A) and 28 months (B). There were growing bony elements, showing extensive osseous changes within the infratentorial midline mass, with teeth-like structures. Axial T2-weighted MRI obtained at the age of 28 months (C–G). The soft tissue and bony element grew significantly, causing brainstem compression and edema.

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    Pathological specimen showing components from all 3 germ layers: squamous epithelium (ectoderm), glandular epithelium (endoderm), and fatty tissue (mesoderm). Findings were compatible with MT. H & E, original magnification ×40. Figure is available in color online only.

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    Axial T2-weighted MRI obtained 11 months after tumor resection showing a stable residual tumor.

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