Prenatal course and diagnostics
A 28-year-old III G I P gravida in the 28th week of pregnancy was referred to our prenatal diagnostic center due to the suspicion of a fetal neck tumor detected by prenatal ultrasound. The course of pregnancy was uneventful until the 28th week of pregnancy. The mother reported one prior spontaneous abortion and had no regular medication. The parents were of Caucasian origin and nonconsanguineous and the family history was otherwise unremarkable.
A detailed fetal anatomic ultrasound survey confirmed a fetal neck tumor with a dimension of 45 x 46 x 39 mm located at the anterior neck, presenting morphological features of a cystic-caverneous lymphhemangioma. The tumor extended from the right submandibular region across the front of the neck to the opposite side, with weak vascularization. The tumor was supposed to infiltrate the base of the mouth. Additionally, the mass could not be separated from the upper thoracic aperture (Fig. 1 a, b). With the exception of a polyhydramnios, no further sonomorphological abnormalitiy of the fetus was detected. The fetus showed an appropriate growth with an estimated fetal weight of 1,020 g corresponded to the 28th percentile. The parents decided against an amniocentesis. Subsequent ultrasound examinations within two to three months showed the growth of the tumor (73 x 68 x 41 mm), which was already strongly vascularized and now affecting the floor of mouth, but without identifying its entity beyond any doubt (Fig. 1 c, d). The parents were interdisciplinary counselled together with neonatologists and pediatric surgeons. Magnetic resonance imaging (MRI) was performed, confirming the inhomogeneity as well as the extent of the tumor but were also unable to clarify the definite tumor entity.