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From the Archives of the AFIP

A Comprehensive Review of Fetal Tumors with Pathologic Correlation¹

¹ From the Department of Radiologic Pathology, Armed Forces Institute of Pathology, Bldg 54, Rm M-121, 14th and Alaska Ave NW, Washington, DC 20306-6000 (P.J.W.); Oregon Health Science University, Portland, Ore (R.S.); University of Utah, Salt Lake City (A.K.); and Armed Forces Institute of Pathology, Washington, DC (K.K.K.). Received August 5, 2004; revision requested October 6 and received October 19; accepted October 19. All authors have no financial relationships to disclose. Address correspondence to P.J.W. (e-mail: woodwardp@afip.osd.mil).

View larger version (59K): [in a new window]   Figure 1a.  Gonadal embryology. (a) Drawing of a 6-week embryo depicts migration of the primordial germ cells (red dots) from the yolk sac along the hindgut to the genital ridges. (b) Diagram of a midabdominal cross section shows incorporation of the primordial germ cells (red dots) into the primitive sex cords, which will continue to develop into either a testis or ovary. Unincorporated germ cells have the potential to form teratomas.

View larger version (53K): [in a new window]   Figure 1b.  Gonadal embryology. (a) Drawing of a 6-week embryo depicts migration of the primordial germ cells (red dots) from the yolk sac along the hindgut to the genital ridges. (b) Diagram of a midabdominal cross section shows incorporation of the primordial germ cells (red dots) into the primitive sex cords, which will continue to develop into either a testis or ovary. Unincorporated germ cells have the potential to form teratomas.

View larger version (195K): [in a new window]   Figure 2.  Immature teratoma. Photomicrograph (original magnification, x100; hematoxylin-eosin stain) shows ectodermally derived immature neuroglial tissue. Neuroepithelial rosettes (arrows) are seen in a background of cellular stroma.

View larger version (159K): [in a new window]   Figure 3a.  Classification of sacrococcygeal teratomas. (a) Type I. Coronal US image of a fetal spine shows a small, exophytic, cystic mass (straight white arrow) emanating from the coccyx (curved arrow). No internal component was identified. Black arrow = iliac crest. (b) Type II. Longitudinal US image of a lower fetal spine shows a mixed cystic and solid sacrococcygeal teratoma (straight arrow), which extends into the presacral space (arrowhead). Curved arrow = coccyx. (c) Type III. Sagittal T2-weighted image shows a mass with a cystic external component and extension of a solid portion into the fetal abdomen (white arrow). Arrowhead = umbilical cord insertion. A type IV mass would have no external component.

View larger version (137K): [in a new window]   Figure 3b.  Classification of sacrococcygeal teratomas. (a) Type I. Coronal US image of a fetal spine shows a small, exophytic, cystic mass (straight white arrow) emanating from the coccyx (curved arrow). No internal component was identified. Black arrow = iliac crest. (b) Type II. Longitudinal US image of a lower fetal spine shows a mixed cystic and solid sacrococcygeal teratoma (straight arrow), which extends into the presacral space (arrowhead). Curved arrow = coccyx. (c) Type III. Sagittal T2-weighted image shows a mass with a cystic external component and extension of a solid portion into the fetal abdomen (white arrow). Arrowhead = umbilical cord insertion. A type IV mass would have no external component.

View larger version (194K): [in a new window]   Figure 3c.  Classification of sacrococcygeal teratomas. (a) Type I. Coronal US image of a fetal spine shows a small, exophytic, cystic mass (straight white arrow) emanating from the coccyx (curved arrow). No internal component was identified. Black arrow = iliac crest. (b) Type II. Longitudinal US image of a lower fetal spine shows a mixed cystic and solid sacrococcygeal teratoma (straight arrow), which extends into the presacral space (arrowhead). Curved arrow = coccyx. (c) Type III. Sagittal T2-weighted image shows a mass with a cystic external component and extension of a solid portion into the fetal abdomen (white arrow). Arrowhead = umbilical cord insertion. A type IV mass would have no external component.

View larger version (99K): [in a new window]   Figure 4a.  Type II sacrococcygeal teratoma. (a) Clinical photograph of an infant shows an obvious external mass. Preoperative work-up showed that the tumor extended into the presacral space. (b) Intraoperative photograph shows the internal component being resected.

View larger version (112K): [in a new window]   Figure 4b.  Type II sacrococcygeal teratoma. (a) Clinical photograph of an infant shows an obvious external mass. Preoperative work-up showed that the tumor extended into the presacral space. (b) Intraoperative photograph shows the internal component being resected.

View larger version (165K): [in a new window]   Figure 5a.  Sacrococcygeal teratoma with developing cardiovascular failure. (a) US image of a fetal lower spine (Sp) shows a large complex mass with a substantial soft-tissue component (arrows). (b) Color Doppler US image demonstrates prominent feeding vessels (curved arrow) supplying the mass (straight arrow). (c) On a coronal US image of the fetal abdomen, the inferior vena cava (white arrow), compared with the aorta (black arrow, Ao), appears greatly dilated, a finding indicative of impending cardiovascular compromise. (d) Autopsy photograph shows obvious intratumoral hemorrhage within the teratoma.

View larger version (74K): [in a new window]   Figure 5b.  Sacrococcygeal teratoma with developing cardiovascular failure. (a) US image of a fetal lower spine (Sp) shows a large complex mass with a substantial soft-tissue component (arrows). (b) Color Doppler US image demonstrates prominent feeding vessels (curved arrow) supplying the mass (straight arrow). (c) On a coronal US image of the fetal abdomen, the inferior vena cava (white arrow), compared with the aorta (black arrow, Ao), appears greatly dilated, a finding indicative of impending cardiovascular compromise. (d) Autopsy photograph shows obvious intratumoral hemorrhage within the teratoma.

View larger version (163K): [in a new window]   Figure 5c.  Sacrococcygeal teratoma with developing cardiovascular failure. (a) US image of a fetal lower spine (Sp) shows a large complex mass with a substantial soft-tissue component (arrows). (b) Color Doppler US image demonstrates prominent feeding vessels (curved arrow) supplying the mass (straight arrow). (c) On a coronal US image of the fetal abdomen, the inferior vena cava (white arrow), compared with the aorta (black arrow, Ao), appears greatly dilated, a finding indicative of impending cardiovascular compromise. (d) Autopsy photograph shows obvious intratumoral hemorrhage within the teratoma.

View larger version (75K): [in a new window]   Figure 5d.  Sacrococcygeal teratoma with developing cardiovascular failure. (a) US image of a fetal lower spine (Sp) shows a large complex mass with a substantial soft-tissue component (arrows). (b) Color Doppler US image demonstrates prominent feeding vessels (curved arrow) supplying the mass (straight arrow). (c) On a coronal US image of the fetal abdomen, the inferior vena cava (white arrow), compared with the aorta (black arrow, Ao), appears greatly dilated, a finding indicative of impending cardiovascular compromise. (d) Autopsy photograph shows obvious intratumoral hemorrhage within the teratoma.

View larger version (73K): [in a new window]   Figure 6a.  In utero drainage of a large cystic sacrococcygeal teratoma. (a) US image of a cystic sacrococcygeal teratoma shows a needle being inserted into the sac (straight arrow) under US guidance. Curved arrow = tip of the spine. The contents were aspirated, which facilitated vaginal delivery. (b) Photograph of the infant obtained immediately after delivery shows the collapsed sacrococcygeal teratoma (arrow).

View larger version (60K): [in a new window]   Figure 6b.  In utero drainage of a large cystic sacrococcygeal teratoma. (a) US image of a cystic sacrococcygeal teratoma shows a needle being inserted into the sac (straight arrow) under US guidance. Curved arrow = tip of the spine. The contents were aspirated, which facilitated vaginal delivery. (b) Photograph of the infant obtained immediately after delivery shows the collapsed sacrococcygeal teratoma (arrow).

View larger version (166K): [in a new window]   Figure 7a.  Cervical teratoma. (a) Coronal T2-weighted MR image shows a large mixed-signal-intensity mass (curved arrow) within the soft tissues of the fetal neck. The head (straight arrow) is being deviated to the side. (b) Clinical photograph of the infant shows the mass involving the anterior neck with hyperextension of the head.

View larger version (129K): [in a new window]   Figure 7b.  Cervical teratoma. (a) Coronal T2-weighted MR image shows a large mixed-signal-intensity mass (curved arrow) within the soft tissues of the fetal neck. The head (straight arrow) is being deviated to the side. (b) Clinical photograph of the infant shows the mass involving the anterior neck with hyperextension of the head.

View larger version (143K): [in a new window]   Figure 8a.  Epignathus. (a) Coronal US image obtained in the plane of the fetal nose (arrowhead) and lips shows a mass with cystic areas (curved arrow) and calcifications (straight arrow). (b) Three-dimensional reformatted image of the fetal head from an in utero CT examination shows the jaw held in an open position with obvious calcifications within the intraoral portion of the mass. (Reprinted, with permission, from reference 31.)

View larger version (123K): [in a new window]   Figure 8b.  Epignathus. (a) Coronal US image obtained in the plane of the fetal nose (arrowhead) and lips shows a mass with cystic areas (curved arrow) and calcifications (straight arrow). (b) Three-dimensional reformatted image of the fetal head from an in utero CT examination shows the jaw held in an open position with obvious calcifications within the intraoral portion of the mass. (Reprinted, with permission, from reference 31.)

View larger version (167K): [in a new window]   Figure 9a.  EXIT procedure. (a) US image of a fetal profile shows a complex cystic and solid mass (arrow) protruding from the mouth (arrowhead = lower jaw). (b, c) Intraoperative photographs show the intubation. The fetus was delivered via cesarean section and placed on the maternal abdomen. The placenta was left intact, and uteroplacental gas exchange was maintained while intubation was performed. (d) Photograph of the cut gross specimen shows the complex nature of the teratoma.

View larger version (131K): [in a new window]   Figure 9b.  EXIT procedure. (a) US image of a fetal profile shows a complex cystic and solid mass (arrow) protruding from the mouth (arrowhead = lower jaw). (b, c) Intraoperative photographs show the intubation. The fetus was delivered via cesarean section and placed on the maternal abdomen. The placenta was left intact, and uteroplacental gas exchange was maintained while intubation was performed. (d) Photograph of the cut gross specimen shows the complex nature of the teratoma.

View larger version (137K): [in a new window]   Figure 9c.  EXIT procedure. (a) US image of a fetal profile shows a complex cystic and solid mass (arrow) protruding from the mouth (arrowhead = lower jaw). (b, c) Intraoperative photographs show the intubation. The fetus was delivered via cesarean section and placed on the maternal abdomen. The placenta was left intact, and uteroplacental gas exchange was maintained while intubation was performed. (d) Photograph of the cut gross specimen shows the complex nature of the teratoma.

View larger version (147K): [in a new window]   Figure 9d.  EXIT procedure. (a) US image of a fetal profile shows a complex cystic and solid mass (arrow) protruding from the mouth (arrowhead = lower jaw). (b, c) Intraoperative photographs show the intubation. The fetus was delivered via cesarean section and placed on the maternal abdomen. The placenta was left intact, and uteroplacental gas exchange was maintained while intubation was performed. (d) Photograph of the cut gross specimen shows the complex nature of the teratoma.

View larger version (144K): [in a new window]   Figure 10a.  Intrapericardial teratoma. (a) Color Doppler US image through a fetal chest shows a large echogenic mass (straight arrow) adjacent to the heart. Note the extensive surrounding pericardial effusion (curved arrows). (b) Coronal T2-weighted image shows a mixed-signal-intensity mass (straight arrow) adjacent to the heart (curved arrow). The mass is surrounded by high-signal-intensity pericardial fluid. No normal lung parenchyma is identified. (c) Autopsy photograph obtained with the pericardium intact shows a massive effusion, with the pericardial sac essentially filling the entire thoracic cavity. (d) Autopsy photograph obtained with the pericardium removed reveals the large teratoma (straight arrow) anterior to the heart (curved arrow).

View larger version (174K): [in a new window]   Figure 10b.  Intrapericardial teratoma. (a) Color Doppler US image through a fetal chest shows a large echogenic mass (straight arrow) adjacent to the heart. Note the extensive surrounding pericardial effusion (curved arrows). (b) Coronal T2-weighted image shows a mixed-signal-intensity mass (straight arrow) adjacent to the heart (curved arrow). The mass is surrounded by high-signal-intensity pericardial fluid. No normal lung parenchyma is identified. (c) Autopsy photograph obtained with the pericardium intact shows a massive effusion, with the pericardial sac essentially filling the entire thoracic cavity. (d) Autopsy photograph obtained with the pericardium removed reveals the large teratoma (straight arrow) anterior to the heart (curved arrow).

View larger version (122K): [in a new window]   Figure 10c.  Intrapericardial teratoma. (a) Color Doppler US image through a fetal chest shows a large echogenic mass (straight arrow) adjacent to the heart. Note the extensive surrounding pericardial effusion (curved arrows). (b) Coronal T2-weighted image shows a mixed-signal-intensity mass (straight arrow) adjacent to the heart (curved arrow). The mass is surrounded by high-signal-intensity pericardial fluid. No normal lung parenchyma is identified. (c) Autopsy photograph obtained with the pericardium intact shows a massive effusion, with the pericardial sac essentially filling the entire thoracic cavity. (d) Autopsy photograph obtained with the pericardium removed reveals the large teratoma (straight arrow) anterior to the heart (curved arrow).

View larger version (117K): [in a new window]   Figure 10d.  Intrapericardial teratoma. (a) Color Doppler US image through a fetal chest shows a large echogenic mass (straight arrow) adjacent to the heart. Note the extensive surrounding pericardial effusion (curved arrows). (b) Coronal T2-weighted image shows a mixed-signal-intensity mass (straight arrow) adjacent to the heart (curved arrow). The mass is surrounded by high-signal-intensity pericardial fluid. No normal lung parenchyma is identified. (c) Autopsy photograph obtained with the pericardium intact shows a massive effusion, with the pericardial sac essentially filling the entire thoracic cavity. (d) Autopsy photograph obtained with the pericardium removed reveals the large teratoma (straight arrow) anterior to the heart (curved arrow).

View larger version (135K): [in a new window]   Figure 11a.  Fetus in fetu. (a) Transverse US image through a fetal abdomen shows a markedly complex mass containing both cystic and solid components and areas of calcification (arrow). (b) Photograph of the gross specimen shows a highly differentiated mass with extremity development. Note the pedicle, which forms the vascular attachment (arrow).

View larger version (72K): [in a new window]   Figure 11b.  Fetus in fetu. (a) Transverse US image through a fetal abdomen shows a markedly complex mass containing both cystic and solid components and areas of calcification (arrow). (b) Photograph of the gross specimen shows a highly differentiated mass with extremity development. Note the pedicle, which forms the vascular attachment (arrow).

View larger version (120K): [in a new window]   Figure 12a.  Fetus in fetu. (a) Axial contrast material-enhanced CT image of an infant shows a large abdominal mass containing fat, fluid, and calcifications resembling vertebrae (arrow). (b) Photograph of the cut surface of the gross specimen shows a well-developed spine, which contained elements of a spinal cord. Other tissues identified were portions of a gastrointestinal tract, cartilage, bone, and bone marrow. All elements were histologically mature.

View larger version (117K): [in a new window]   Figure 12b.  Fetus in fetu. (a) Axial contrast material-enhanced CT image of an infant shows a large abdominal mass containing fat, fluid, and calcifications resembling vertebrae (arrow). (b) Photograph of the cut surface of the gross specimen shows a well-developed spine, which contained elements of a spinal cord. Other tissues identified were portions of a gastrointestinal tract, cartilage, bone, and bone marrow. All elements were histologically mature.

View larger version (143K): [in a new window]   Figure 13a.  Intracranial teratoma. (a) Transverse US image of a fetal brain shows a predominantly solid, echogenic midline mass (arrow), which is causing obstructive hydrocephalus. (b) Photograph of the gross specimen demonstrates a variegated, lobular mass (straight arrow) with marked thinning of the remaining cerebral tissue (curved arrow).

View larger version (91K): [in a new window]   Figure 13b.  Intracranial teratoma. (a) Transverse US image of a fetal brain shows a predominantly solid, echogenic midline mass (arrow), which is causing obstructive hydrocephalus. (b) Photograph of the gross specimen demonstrates a variegated, lobular mass (straight arrow) with marked thinning of the remaining cerebral tissue (curved arrow).

View larger version (92K): [in a new window]   Figure 14a.  Intracranial teratoma. (a) Transverse US image of a fetal brain shows a large, heterogeneous mass within the cranial vault (cursors) completely destroying normal anatomic landmarks. Measurements showed marked macrocephaly. (b) Postmortem coronal T1-weighted image demonstrates complete replacement of brain tissue by a complex mixed-signal-intensity mass. Immature teratoma (with primitive neural tissue, cartilage, bone, intestinal mucosa, smooth muscle, and hemorrhage) was identified at autopsy.

View larger version (131K): [in a new window]   Figure 14b.  Intracranial teratoma. (a) Transverse US image of a fetal brain shows a large, heterogeneous mass within the cranial vault (cursors) completely destroying normal anatomic landmarks. Measurements showed marked macrocephaly. (b) Postmortem coronal T1-weighted image demonstrates complete replacement of brain tissue by a complex mixed-signal-intensity mass. Immature teratoma (with primitive neural tissue, cartilage, bone, intestinal mucosa, smooth muscle, and hemorrhage) was identified at autopsy.

View larger version (142K): [in a new window]   Figure 15a.  Choroid plexus papilloma. (a, b) Transverse (a) and parasagittal (b) US images of a fetal head show a well-defined, lobular, hyperechoic mass (arrow) within the atrium of the right lateral ventricle. Hydrocephalus is also present. (c) Axial contrast-enhanced CT image of the brain demonstrates substantial enhancement of the mass (arrow). There is severe hydrocephalus with transependymal edema (arrowheads). (d) Photograph of the resected tumor shows the characteristic lobular contour.

View larger version (143K): [in a new window]   Figure 15b.  Choroid plexus papilloma. (a, b) Transverse (a) and parasagittal (b) US images of a fetal head show a well-defined, lobular, hyperechoic mass (arrow) within the atrium of the right lateral ventricle. Hydrocephalus is also present. (c) Axial contrast-enhanced CT image of the brain demonstrates substantial enhancement of the mass (arrow). There is severe hydrocephalus with transependymal edema (arrowheads). (d) Photograph of the resected tumor shows the characteristic lobular contour.

View larger version (123K): [in a new window]   Figure 15c.  Choroid plexus papilloma. (a, b) Transverse (a) and parasagittal (b) US images of a fetal head show a well-defined, lobular, hyperechoic mass (arrow) within the atrium of the right lateral ventricle. Hydrocephalus is also present. (c) Axial contrast-enhanced CT image of the brain demonstrates substantial enhancement of the mass (arrow). There is severe hydrocephalus with transependymal edema (arrowheads). (d) Photograph of the resected tumor shows the characteristic lobular contour.

View larger version (104K): [in a new window]   Figure 15d.  Choroid plexus papilloma. (a, b) Transverse (a) and parasagittal (b) US images of a fetal head show a well-defined, lobular, hyperechoic mass (arrow) within the atrium of the right lateral ventricle. Hydrocephalus is also present. (c) Axial contrast-enhanced CT image of the brain demonstrates substantial enhancement of the mass (arrow). There is severe hydrocephalus with transependymal edema (arrowheads). (d) Photograph of the resected tumor shows the characteristic lobular contour.

View larger version (169K): [in a new window]   Figure 16a.  Choroid plexus papilloma. (a) Axial US image of a fetal brain shows an echogenic mass filling and expanding the third ventricle (arrow). There is severe hydrocephalus with dangling choroid plexuses (arrowheads). (b) Coronal US image of the brain obtained after delivery demonstrates that the mass is within the third ventricle (arrow).

View larger version (126K): [in a new window]   Figure 16b.  Choroid plexus papilloma. (a) Axial US image of a fetal brain shows an echogenic mass filling and expanding the third ventricle (arrow). There is severe hydrocephalus with dangling choroid plexuses (arrowheads). (b) Coronal US image of the brain obtained after delivery demonstrates that the mass is within the third ventricle (arrow).

View larger version (152K): [in a new window]   Figure 17a.  Lipoma with agenesis of the corpus callosum. (a) Coronal US image of a fetal head shows a midline, echogenic mass in the region of the corpus callosum (arrow). This appearance is characteristic of a lipoma, and the rest of the brain should be carefully evaluated for agenesis of the corpus callosum. (b) Photograph of the brain (infant died of other causes) demonstrates a lipoma (arrow), which corresponds to the mass seen at US. Note absence of the corpus callosum, which would normally be seen as a band of tissue connecting the two cerebral hemispheres.

View larger version (159K): [in a new window]   Figure 17b.  Lipoma with agenesis of the corpus callosum. (a) Coronal US image of a fetal head shows a midline, echogenic mass in the region of the corpus callosum (arrow). This appearance is characteristic of a lipoma, and the rest of the brain should be carefully evaluated for agenesis of the corpus callosum. (b) Photograph of the brain (infant died of other causes) demonstrates a lipoma (arrow), which corresponds to the mass seen at US. Note absence of the corpus callosum, which would normally be seen as a band of tissue connecting the two cerebral hemispheres.

View larger version (141K): [in a new window]   Figure 18a.  Neuroblastoma. (a) Coronal US image of a fetal body shows a well-defined echogenic mass (cursors) above the right kidney (RK). (b) Longitudinal US image obtained after delivery demonstrates the solid suprarenal mass (cursors). (c) Photograph of the resected tumor and right kidney. The tumor was confined to the adrenal gland. (Reprinted, with permission, from reference 53.)

View larger version (135K): [in a new window]   Figure 18b.  Neuroblastoma. (a) Coronal US image of a fetal body shows a well-defined echogenic mass (cursors) above the right kidney (RK). (b) Longitudinal US image obtained after delivery demonstrates the solid suprarenal mass (cursors). (c) Photograph of the resected tumor and right kidney. The tumor was confined to the adrenal gland. (Reprinted, with permission, from reference 53.)

View larger version (90K): [in a new window]   Figure 18c.  Neuroblastoma. (a) Coronal US image of a fetal body shows a well-defined echogenic mass (cursors) above the right kidney (RK). (b) Longitudinal US image obtained after delivery demonstrates the solid suprarenal mass (cursors). (c) Photograph of the resected tumor and right kidney. The tumor was confined to the adrenal gland. (Reprinted, with permission, from reference 53.)

View larger version (159K): [in a new window]   Figure 19.  Cystic neuroblastoma. Longitudinal US image of a fetal abdomen shows a large, complex cystic mass (straight arrow) above the right kidney (RK).

View larger version (184K): [in a new window]   Figure 20a.  Stage IV neuroblastoma. (a) Transverse US image of a fetal abdomen shows a large, solid adrenal mass (curved arrow). The liver is heterogeneous with several discrete metastases (arrowheads). Ascites is also present (straight arrow). (b, c) Autopsy photographs show the large solid mass above the kidney (b) and diffuse liver metastases (c). Metastases were also present in the bone and placenta.

View larger version (70K): [in a new window]   Figure 20b.  Stage IV neuroblastoma. (a) Transverse US image of a fetal abdomen shows a large, solid adrenal mass (curved arrow). The liver is heterogeneous with several discrete metastases (arrowheads). Ascites is also present (straight arrow). (b, c) Autopsy photographs show the large solid mass above the kidney (b) and diffuse liver metastases (c). Metastases were also present in the bone and placenta.

View larger version (102K): [in a new window]   Figure 20c.  Stage IV neuroblastoma. (a) Transverse US image of a fetal abdomen shows a large, solid adrenal mass (curved arrow). The liver is heterogeneous with several discrete metastases (arrowheads). Ascites is also present (straight arrow). (b, c) Autopsy photographs show the large solid mass above the kidney (b) and diffuse liver metastases (c). Metastases were also present in the bone and placenta.

View larger version (175K): [in a new window]   Figure 21a.  Fibrosarcoma. (a) US image of the upper legs of a fetus shows dramatic thickening of the soft tissues around the distal left thigh and knee (arrow). (b) Gross photograph shows the left leg soft-tissue mass. (Reprinted, with permission, from reference 64.)

View larger version (91K): [in a new window]   Figure 21b.  Fibrosarcoma. (a) US image of the upper legs of a fetus shows dramatic thickening of the soft tissues around the distal left thigh and knee (arrow). (b) Gross photograph shows the left leg soft-tissue mass. (Reprinted, with permission, from reference 64.)

View larger version (170K): [in a new window]   Figure 22.  Rhabdosarcoma. Axial T2-weighted image obtained through the level of the fetal orbits shows a fungating soft-tissue mass (straight arrow) emanating from the left orbit. The right eye (curved arrow) is normal.

View larger version (155K): [in a new window]   Figure 23a.  Hemangiopericytoma. (a) Transverse US image of a fetal chest shows asymmetric thickening of the lateral chest wall (arrow). (b) Axial unenhanced CT image, obtained with a metallic marker over the area of palpable abnormality, demonstrates increased soft tissue compared with the opposite side. (c) Intraoperative photograph obtained during excision shows the lobular mass. Histologic findings confirmed the diagnosis of hemangiopericytoma.

View larger version (89K): [in a new window]   Figure 23b.  Hemangiopericytoma. (a) Transverse US image of a fetal chest shows asymmetric thickening of the lateral chest wall (arrow). (b) Axial unenhanced CT image, obtained with a metallic marker over the area of palpable abnormality, demonstrates increased soft tissue compared with the opposite side. (c) Intraoperative photograph obtained during excision shows the lobular mass. Histologic findings confirmed the diagnosis of hemangiopericytoma.

View larger version (125K): [in a new window]   Figure 23c.  Hemangiopericytoma. (a) Transverse US image of a fetal chest shows asymmetric thickening of the lateral chest wall (arrow). (b) Axial unenhanced CT image, obtained with a metallic marker over the area of palpable abnormality, demonstrates increased soft tissue compared with the opposite side. (c) Intraoperative photograph obtained during excision shows the lobular mass. Histologic findings confirmed the diagnosis of hemangiopericytoma.

View larger version (150K): [in a new window]   Figure 24a.  Mesoblastic nephroma. (a) Oblique coronal US image of a fetal kidney shows a markedly enlarged lower pole, which is extending into the pelvis and abutting the bladder (B). The upper pole has a normal appearance (white arrows), whereas the lower pole is replaced by a large solid mass (black arrows). (b) Photograph of the resected kidney shows a well-defined, fleshy, lower pole mass with a dense stromal architecture. Scale is in centimeters.

View larger version (104K): [in a new window]   Figure 24b.  Mesoblastic nephroma. (a) Oblique coronal US image of a fetal kidney shows a markedly enlarged lower pole, which is extending into the pelvis and abutting the bladder (B). The upper pole has a normal appearance (white arrows), whereas the lower pole is replaced by a large solid mass (black arrows). (b) Photograph of the resected kidney shows a well-defined, fleshy, lower pole mass with a dense stromal architecture. Scale is in centimeters.

View larger version (134K): [in a new window]   Figure 25a.  Mesoblastic nephroma. (a) Axial US image through a fetal abdomen is most striking for associated severe polyhydramnios. There is a large solid mass in the region of the right kidney (straight arrow). The left kidney is normal (curved arrow). (b) Axial contrast-enhanced CT scan obtained after delivery shows dramatic enlargement of the right kidney with essentially complete replacement by the tumor.

View larger version (92K): [in a new window]   Figure 25b.  Mesoblastic nephroma. (a) Axial US image through a fetal abdomen is most striking for associated severe polyhydramnios. There is a large solid mass in the region of the right kidney (straight arrow). The left kidney is normal (curved arrow). (b) Axial contrast-enhanced CT scan obtained after delivery shows dramatic enlargement of the right kidney with essentially complete replacement by the tumor.

View larger version (176K): [in a new window]   Figure 26a.  Hemangioendothelioma. (a) Transverse US image through a fetal abdomen shows a large, irregular, heterogeneous mass (arrows) essentially replacing the liver. (b) Frontal radiograph of the chest and abdomen obtained after delivery shows obvious congestive heart failure with cardiac enlargement and soft-tissue edema. Also note the fullness in the right upper quadrant and displacement of bowel loops by the liver mass. (c) Autopsy photograph of the liver demonstrates the large, irregular mass with areas of fibrosis and hemorrhage. (d) Photograph of the foot shows a coexistent cutaneous hemangioma.

View larger version (130K): [in a new window]   Figure 26b.  Hemangioendothelioma. (a) Transverse US image through a fetal abdomen shows a large, irregular, heterogeneous mass (arrows) essentially replacing the liver. (b) Frontal radiograph of the chest and abdomen obtained after delivery shows obvious congestive heart failure with cardiac enlargement and soft-tissue edema. Also note the fullness in the right upper quadrant and displacement of bowel loops by the liver mass. (c) Autopsy photograph of the liver demonstrates the large, irregular mass with areas of fibrosis and hemorrhage. (d) Photograph of the foot shows a coexistent cutaneous hemangioma.

View larger version (125K): [in a new window]   Figure 26c.  Hemangioendothelioma. (a) Transverse US image through a fetal abdomen shows a large, irregular, heterogeneous mass (arrows) essentially replacing the liver. (b) Frontal radiograph of the chest and abdomen obtained after delivery shows obvious congestive heart failure with cardiac enlargement and soft-tissue edema. Also note the fullness in the right upper quadrant and displacement of bowel loops by the liver mass. (c) Autopsy photograph of the liver demonstrates the large, irregular mass with areas of fibrosis and hemorrhage. (d) Photograph of the foot shows a coexistent cutaneous hemangioma.

View larger version (91K): [in a new window]   Figure 26d.  Hemangioendothelioma. (a) Transverse US image through a fetal abdomen shows a large, irregular, heterogeneous mass (arrows) essentially replacing the liver. (b) Frontal radiograph of the chest and abdomen obtained after delivery shows obvious congestive heart failure with cardiac enlargement and soft-tissue edema. Also note the fullness in the right upper quadrant and displacement of bowel loops by the liver mass. (c) Autopsy photograph of the liver demonstrates the large, irregular mass with areas of fibrosis and hemorrhage. (d) Photograph of the foot shows a coexistent cutaneous hemangioma.

View larger version (141K): [in a new window]   Figure 27a.  Mesenchymal hamartoma. (a) Transverse US image of a fetal abdomen shows a predominantly cystic mass associated with the liver (arrow). (b) Photograph of the resected specimen demonstrates the typical large cystic spaces in a background of disorganized mesenchymal tissue.

View larger version (119K): [in a new window]   Figure 27b.  Mesenchymal hamartoma. (a) Transverse US image of a fetal abdomen shows a predominantly cystic mass associated with the liver (arrow). (b) Photograph of the resected specimen demonstrates the typical large cystic spaces in a background of disorganized mesenchymal tissue.

View larger version (173K): [in a new window]   Figure 28a.  Hepatoblastoma. (a) Transverse US image obtained at the level of the fetal liver shows a large, well-demarcated solid mass (arrow). Note the areas of alternating echogenicity, giving the mass a "spoked-wheel" appearance. (b) Autopsy photograph of the liver shows the well-defined mass with prominent fibrous bands extending to the pseudocapsule.

View larger version (118K): [in a new window]   Figure 28b.  Hepatoblastoma. (a) Transverse US image obtained at the level of the fetal liver shows a large, well-demarcated solid mass (arrow). Note the areas of alternating echogenicity, giving the mass a "spoked-wheel" appearance. (b) Autopsy photograph of the liver shows the well-defined mass with prominent fibrous bands extending to the pseudocapsule.

View larger version (148K): [in a new window]   Figure 29a.  Congenital leukemia. (a) Longitudinal US image of a fetus (spine up) shows a massively enlarged liver causing a protuberant abdomen (arrows). Compare the abdomen to the size of the chest (arrowhead). (b) Autopsy photograph shows hepatomegaly. The spleen was also enlarged.

View larger version (134K): [in a new window]   Figure 29b.  Congenital leukemia. (a) Longitudinal US image of a fetus (spine up) shows a massively enlarged liver causing a protuberant abdomen (arrows). Compare the abdomen to the size of the chest (arrowhead). (b) Autopsy photograph shows hepatomegaly. The spleen was also enlarged.