Ali Al-Ibrahim

MFM Fellowship Observer

History
• Mrs. SA is a 35 years old lady, G2, P0 + 1 who was
referred to MSH due to a fetal intracranial lesion (?
Tumor, ?Bleeding).
• This is a spontaneous pregnancy. Otherwise
uncomplicated.
• Her previous pregnancy ended in a spontaneous
complete abortion at 7 weeks of gestation.
• Her medical history includes
o Thyroidectomy for thyroid cancer 2006
o Appendectomy 2007
o Cholecyctectomy 2005
o Anxiety Disorder, including hospitalization in 2005
o Depression 1995
o Bronchial Asthma 1991, well controlled.
• Current medications include, Folic acid, CaCo3,
Pulmicort, Ventolin and Synthyroid .175 OD.
• Pregnancy details:
 Dating scan March 17th
 NT measurement March 4
 IPS March 17th
 Wellbeing scan on March 30
 Anatomy scan on April 16 (19 weeks of gestation, normal but
noted low lying placenta)
 July 28th, 33+5 weeks, placenta normal, fetal intracranical brain
mass seen anterior to the CSP.
 August 6th, confirmation ultrasound of an intracranial mass 2.7 X
2.1 X 1.6 cms.
• The patient was seen on Friday 13th of August, she
was 36 weeks.
• Ultrasound showed 2 findings, but otherwise a
normal baby, appropriate growth and normal
doppler studies.
• The findings were:
Pericallosal Lipoma
Pericallosal Lipoma
• Not mentioned in the previous slide because it is
VERY rare constituting only 0.1% of all fetal brain
tumors!
• Intracranial lipomas are more frequent in the
pericallosal and quadrigeminal region of the brain;
most are asymptomatic, generally caught
incidentally; and accompanying intracranial and
extracranial pathologies are less common than
expected.

Yilmaz N, Unal O, Kiymaz N, Yilmaz C, Etlik O. Intracranial lipomas--a clinical study. Clin Neurol Neurosurg. 2006
Jun;108(4):363-8.
• There are around 15 cases of prenatal diagnosis
published. (7 cases in one single series, and 8
individual cases)
• The majority of published literature is for children
and adults, postnatal and mostly incidental
diagnosis.
• There are 2 types (patterns) of pericallosal lipomas
o Tubo-Nodular
o Curvilinear
Korean J Radiol 3(2), June
2002
Korean J Radiol 3(2), June
2002
AJNR Am J Neuroradiol 22:767–772, April
2001
AJNR Am J Neuroradiol 22:767–772, April
2001
AJNR Am J Neuroradiol 22:767–772, April 2001
AJNR Am J Neuroradiol 22:767–772, April 2001
AJNR Am J Neuroradiol 22:767–772, April 2001
• Pericallosal Lipomas have been reported in the
literature with
o Goldenhar Syndrome (8 cases)
o Pai Syndrome (More than 10 cases)
o Congenital Heart Defects (2 cases)
o Trisomy 21 ( 2 cases)
o Isolated Nasal Appendages (3 cases)
o Frontonasal Dysgensis and First Pharyngeal Arch
Anomalies (3 cases)
Neuroradiology (2006) 48: 1–
7
Symptomatology
• The majority of cases are asymptomatic.
• Reported in the literature
o Headache and vomiting
o Seizures
o Failure to thrive
o Local skull swelling
o Symptoms related to corpus callosum dysgenesis
Differential Diagnosis
• Bleeding (MRI can easily differentiate that from a
tumor)
• Dermoids tend to occur adjacent to the midline and
might look the same on MRI and CT (They appear
round or lobulated on CT and usually have slight
mass effect and foci of calcification with no contrast
enhancement or surrounding edema, They have
high signal on T1-weighted MRI due to their lipid
content and heterogeneous signal on T2-weighted
images due to the mixed composition of the tumor)

Neuroradiology (2006) 48: 1–

7
• Epidermoids (epidermoid cysts) represent
approximately 1% of all primary intracranial
neoplasms. Imaging studies of epidermoids reflect
the high levels of cholesterol and keratin within the
tumor. If the lesion shows T1 shortening, it can be
confused with dermoid or lipoma, but an epidermoid
will not demonstrate chemical shift artifact and
signal will not suppress after application of a fat-
saturation pulse
• Neurofibroma, usually has lower signal intensity on
MR imaging than fat but can be confusing.
Neuroradiology (2006) 48: 1–
7
Thank You