Prenatal ultrasound diagnosis of congenital infantile fibrosarcoma and congenital hemangioma: Three case reports

Figure 1 Prenatal imaging of congenital infantile fibrosarcoma in Case 1. A: Color Doppler flow imaging of the axillary mass in the fetus at 34+5 wk of gestation, showing abundant blood flow within the mass. Yellow arrow, the mass; B: Two-dimensional ultrasound showing the longitudinal section of the fetus at 34+5 wk of gestation, revealing a heterogeneous mass in the left axilla. Yellow arrow, the mass; C: Magnetic resonance imaging (MRI) at 28+6 wk of gestation documenting a solid mass in the left axilla. White arrow, the fetal mass on MRI.

Figure 2 Postnatal imaging of the congenital infantile fibrosarcoma in Case 1. A: One-day postnatal two-dimensional ultrasound using a linear array transducer with a frequency of 5-12 MHz, revealing a well-defined mass in the left axilla consisting mainly of isoechoic parenchymal components (*) with a few anechoic areas (white triangle) within the mass. Yellow arrow, the boundary of the mass; B: One-day postnatal pulse Doppler ultrasound revealing a rich blood flow and low resistance blood flow spectrum in the mass; C: Postnatal X-ray of the newborn showed a soft tissue density shadow protruding from the left axilla and lateral chest wall, resulting in compression of the adjacent ribs (blue arrow). White arrow, the mass on X-ray.

Figure 3 Prenatal ultrasonic imaging of the congenital hemangioma in Case 2. A: Prenatal two-dimensional ultrasound image revealing a well-defined, heterogeneous mass at the root of the right thigh of the fetus at 23+1 wk of gestation. White arrow, the mass; R-femur, the right femur of the fetus; B: CDFI of the mass at the root of the right thigh of the fetus at 23+1 wk of gestation showing sparse punctate blood flow around the mass. White arrow, the mass.

Figure 4 Prenatal ultrasonic imaging of the congenital hemangioma of the affected twin fetus in Case 3 at 30+0 wk of gestation. A: Two-dimensional ultrasound of the abdominal horizontal cross-section of the mass of the affected fetus revealing a heterogeneous hypoechoic mass with a clear boundary, protruding outward from the abdominal wall; B: CDFI in the horizontal cross-section of the fetal abdomen revealed abundant blood flow within the mass. R: Right; M: Mass; white arrow, the mass.

Figure 5 Prenatal ultrasonic imaging of the congenital hemangioma of the affected twin fetus in Case 3 at 33+0 wk of gestation. A: Two-dimensional ultrasound of the abdominal horizontal cross-section of the mass of the affected fetus revealing that the mass was enlarged and heterogeneous; B: CDFI of an abdominal horizontal cross-section of the mass showing no blood flow signal within the mass. M: Mass; R: Right; white arrow, the mass; C: A two-dimensional ultrasound image of the fetal head showing subcutaneous edema (blue arrow); D: A two-dimensional transverse section of the fetal chest showing intrapericardial fluid collection (yellow arrow). H, heart; M, mass; E: A two-dimensional thoracic horizontal cross-section of the affected fetus showing fetal pleural effusion (orange arrow). L: Lung; M: Mass; R: Right; white arrow, the mass; F: Two amniotic cavities on two-dimensional ultrasound showing that the amniotic fluid of the affected fetus (R-AF) was not clear. R-AF: Right amniotic fluid. LAF left amniotic fluid.

Figure 6 Pathological findings of the congenital infantile fibrosarcoma in Case 1. A: H&E staining image. The tumor cells showing eosinophilic, diffuse sheets of monotonous round cells with fine chromatin, and indistinct nucleoli; B-D: Immunochemistry demonstrated the expression of smooth muscle actin, CD34, and CD31 in the tumor cells; E: The immunochemical study showed that the Ki-67 proliferation index was approximately 20%; F: Using fluorescence in situ hybridization, the tumor cells showed NTRK3 gene rearrangement, with break-apart green (telomeric) and red (centromeric) signals (white arrows).