Fetal neck is the site of important pathological changes, related to genetic, cardiovascular, lymphatic, endocrine systems.Among the main neck pathology are fetal hygroma, goiter, teratoma/sarcoma, hemangioma/lymphangioma. Posterior anomalies of the fetal neural tube, such as occipital myelomeningocele or iniencephaly may also be included in this area.Fetal hygroma is the main pathology, probably related to abnormal development of the lymphatic drainage system. There is a large spectrum of the disease, from enlarged nuchal translucency to generalized edema. Enlarged nuchal translucency is often associated with aneuploidy, particularly trisomy 21 and Turner syndrome (monosomy X). However, the pathophysiology is different for the two aneuploidies. On the diagnostic side, cystic hygromas consist of large single or multilocular fluid-filled cavities, which are usually easily identified during first trimester ultrasound examination. About one-third of euploid fetuses with first trimester septated cystic hygromas have major structural anomalies. In contrast, structural anomalies are detected in only 4 to 10% of euploid fetuses with enlarged nuchal translucency.Enlargement of fetal thyroid gland is accompanied by increased or decreased level of thyroid hormones (hyper or hypothyroidism), but the thyroid function may also be normal. The physiopathology of fetal and neonatal goiter is complex. Causes of fetal goiter include inborn errors of thyroid hormone production, transplacental passage of maternal antibodies, maternal ingestion of antithyroid drugs and other goitrogens, thyroid tumors. Detection of the fetal goiter is facilitated by the associated maternal history, present in most of the cases. By definition, goiter means enlargement of the thyroid gland above the 95th centile of the normal range. Reliable and objective data about fetal thyroid function involves an invasive testing.Teratomas are large mixed tumors arising from the neck region. Teratomas are cystic, semicystic or solid tumors. They develop from all three germ cell layers. Cervical teratomas are detected antenatally in most cases, as they are large size tumors.Hemangiomas and lymphangiomas are tumors derived from the endothelial tissue of blood vessels or lymphatic vessels. They may develop anywhere in the body, but in the antenatal life and the first years they show a predisposition for the head, neck and axillar area.Regarding the occipital encephalocele and iniencephaly, even though they represent major anomalies that affect he cervical and cephalic area, from a developmental point of view they are part of the neural tube defects spectrum and should be considered as such especially from a prognosis point of view.

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Primary ovarian fibrosarcoma is one of the rarest ovarian tumors. It is an aggressive malignant condition and there are no clinical guidelines for the management of patients. In the published reports, these ovarian malignancies present a great heterogeneity of clinical and pathological features, and no specific sonographic features have been reported. We present two cases of primary ovarian fibrosarcoma referred to our tertiary center in Rome. These two cases are unique in several aspects: i) both patients did not complain of any particular symptom and the diagnosis was made at a routine ultrasound scan; in the vast majority of previously reported cases, the patients were symptomatic, with abdominal and pelvic pain or progressive abdominal enlargement ii) the malignant nature of the ovarian tumor was suspected at the preoperative sonographic examination: in both cases a monolateral inhomogeneous roundish solid ovarian mass, with irregular borders and the largest diameter of 110 and 80 mm, respectively, was diagnosed. A small amount of free fluid in the pouch of Douglas was detected in both cases. At color Doppler examination, a main vessel penetrating into the mass (''lead vessel'') was observed in one case (color score = 3), whereas only a few vascular spots were detected (color score = 2) in the other case. In both cases an aggressive strategy was applied, and after radical surgery, the patients underwent six courses of adjuvant chemotherapy with Adriamicin and Ifosfamide. Both patients are now free of disease and the survival period of 50 months, for the first patient, is one of the longest reported in the literature. In both cases the ovarian fibrosarcomas showed an inhomogeneous solid morphology with irregular borders. These sonographic features, together with the absence of regular stripes, allowed us to exclude the hypothesis of ovarian fibromas. However, no specific sonographic features to discriminate fibrosarcomas from ovarian carcinomas, were identified. Objectives: To construct new models based on ultrasound and clinical data to predict malignancy in ovarian tumors. Methods: All women (n = 415, 222 postmenopausal) were examined prior to surgery using 2D gray-scale sonography with pulsed and color Doppler and with 3D sonoangiography (GE Voluson 730 EXPERT, Zipf, Austria). Analyzed variables included: age, menopausal status, BMI, serum CA-125, uni-or bilaterality, tumor diameter and volume, locularity, solid parts, papillary projections, blood vessels localization, color score, PSV, TAMX, PI, RI and 3D power Doppler indices: VI, FI, VFI. The data were randomly divided into train set (n = 355) and test set (n = 60). The outcome (benign vs. malignant) was predicted using least squares SVM with either linear or radial basis function (RBF) kernel. Results: Malignant tumors were found in 170 women (41%) and benign masses were confirmed in 245 patients. Of 18 parameters, CA-125 had the best individual performance with sensitivity of 80% and specificity of 78%. PPV, NPV and accuracy were 73%, 84% and 79%, res...