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' gestation, 5 weeks following a normal fetal anatomical survey and biometry, demonstrated a large, irregular-shaped, echogenic, suprasellar midline intracranial mass occupying the anterior and middle fossas. Associated severe obstructive hydrocephalus with 'dangling' choroid plexus bilaterally was noted with a markedly thin cortical mantle and increased cranial biometry. Elective cesarean delivery was performed due to the associated craniomegaly at 37 weeks' gestation. Although breathing spontaneously at delivery, the infant subsequently required mechanical ventilation and developed neonatal seizures. 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 astrocytoma over a relatively short period of time. The significant ultrasonographic finding of an intracranial, destructive fetal deformation, following a normal examination 5 weeks previously, demonstrates the limitations of screening ultrasonography in predicting perinatal outcome.