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Nzelu D, Panayotidis I, Smith GD, Pandya P. Fetal Cystic Lymphatic Malformations: Systematic Review on Pregnancy and Neonatal Outcomes. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024. [PMID: 39248487 DOI: 10.1002/jum.16566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Revised: 07/30/2024] [Accepted: 08/19/2024] [Indexed: 09/10/2024]
Abstract
OBJECTIVE Evaluate pregnancy and neonatal outcomes with fetal cystic lymphatic malformations (LMs), excluding those arising from the posterior neck, to facilitate patient counseling. METHOD A systematic review was performed in accordance with PRISMA guidance. Case series and case reports published between 2000 and 2022 were included. RESULTS Sixty-five studies (96 fetuses) met the inclusion criteria. The average gestational age at diagnosis was 25.5 weeks with the commonest location being the anterior neck (28%). All patients were diagnosed with LM using two-dimensional (2D) ultrasound. Prenatal progression in LM size, presence of intralesional bleeding, or fetal hydrops occurred in 70% (41/59), 9% (5/59), and 3% (2/59), respectively. Chromosomal and structural abnormalities were reported in 4% (2/52) and 2% (2/96), respectively. Overall livebirth rate was 94% (79/84); 12/96 resulted in termination and 5/84 in in utero demise. The average gestational age of delivery was 37.7 weeks. Exactly 19% (15/79) had a vaginal birth, of which shoulder dystocia occurred in one infant. Ex utero intrapartum treatment (EXIT) procedure was performed in 13% (10/79). Postnatal treatment commonly involved surgical excision 38% (30/79), sclerotherapy in 21.5% (17/79), or combination of both in 11.4% (9/79). Of those with reported follow-up, 4 died within 1 year, 1 developed heart failure at 2 years of life, and the remaining 44 had normal developmental outcomes. CONCLUSION Fetal cystic LMs, excluding those in the posterior neck, are not commonly associated with chromosomal, or additional structural abnormalities. They usually increase in size before delivery with only a minority developing complications. The good developmental outcome was reported in all survivors.
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Affiliation(s)
- Diane Nzelu
- Women's Health, University College London Hospitals NHS Foundation Trust, London, UK
| | - Ismini Panayotidis
- Women's Health, Barking, Havering and Redbridge University Hospitals NHS Trust, London, UK
| | - Gill D Smith
- Plastic Surgery, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Pranav Pandya
- Women's Health, University College London Hospitals NHS Foundation Trust, London, UK
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Zeng Z, Liao H, Hu F, Zhao F, Liu H, Hu Q, Yu H. Outcome of Sclerotherapy in a Preterm Infant with a Giant Fetal Neck Lymphatic Malformation: A Case Report. Int J Womens Health 2023; 15:1771-1778. [PMID: 38020936 PMCID: PMC10656836 DOI: 10.2147/ijwh.s430858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 11/08/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Lymphatic malformation (LM), most commonly present in the neck area, is benign vascular malformations of the lymphatic system. In an infant, however, LM poses a high risk of adverse outcomes. Case Presentation We present a case with a giant fetal LM. Through ultrasonography, at 23+ weeks of gestation, a septate cystic mass 7.2×6.5×6.3 cm in size was found on the right side of the fetus's neck. After extensive counseling by the multidisciplinary team, the parents chose to continue the pregnancy. Severe fetal tracheal compression was observed at 29 weeks by magnetic resonance imaging (MRI). At 31 weeks and 5 days, owing to suspected fetal distress, an emergency cesarean section was performed and a male baby weighing 1720 g was delivered. The mass was 10×16×8 cm in size and ex utero intrapartum treatment (EXIT) was implemented. Due to progressive growth of the mass secondary to intralesional bleeding, an intralesional injection of bleomycin was administered three days later. This injection was repeated at the age of 1 month and 8 days. The baby was followed up and, by a year after his birth, LM had disappeared. The baby has since been in good health. Conclusion Accurate prenatal diagnosis and regular monitoring of a fetus with LM may improve prognosis. It is essential to have a trained multidisciplinary team to evaluate the condition of the fetus and the neonate and to provide treatment based on the evaluation. Our experience with intralesional bleomycin injection for the treatment of a giant fetal neck LM in a preterm infant had a favorable outcome. Long-term follow-up by a multidisciplinary team is needed in such cases.
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Affiliation(s)
- Zhaomin Zeng
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, People’s Republic of China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, People’s Republic of China
| | - Hua Liao
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, People’s Republic of China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, People’s Republic of China
| | - Fan Hu
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, People’s Republic of China
- Department of Paediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Fumin Zhao
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, People’s Republic of China
- Department of Radiology, West China Second University Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Hongyan Liu
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, People’s Republic of China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, People’s Republic of China
| | - Qing Hu
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, People’s Republic of China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, People’s Republic of China
| | - Haiyan Yu
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, People’s Republic of China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, People’s Republic of China
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Cai M, Guo N, Lin N, Huang H, Xu L. Retrospective analysis of genetic etiology and obstetric outcome of fetal cystic hygroma: A single-center study. Medicine (Baltimore) 2022; 101:e31689. [PMID: 36451403 PMCID: PMC9704949 DOI: 10.1097/md.0000000000031689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 10/17/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Cystic hygroma (CH) is a relatively common observation in prenatal ultrasounds; however, there are few studies about copy number variations (CNVs) of fetuses with CH. METHODS We performed a retrospective analysis on 40 pregnant patients (out of 8000 pregnant patients) whose fetuses had CH from November 2016 to June 2021. Villus, amniotic fluid, or umbilical cord blood samples were collected, based on the corresponding gestational age, for karyotype analysis and single-nucleotide polymorphism array (SNP-array). RESULTS Among the 40 fetuses with CH, 16 (40.0%, 16/40) exhibited isolated CH and 24 (60.0%, 24/40) exhibited CH combined with other ultrasound abnormalities. The most common CH-comorbid ultrasound abnormalities observed in this study were congenital heart disease (25.0%, 6/24), thickened nuchal translucency (20.8%, 5/24), and fetal edema (12.5%, 3/24). Karyotype and SNP-array analysis resulted in an overall detection rate of 30.0% (12/40). Karyotype analysis led to the detection of eight cases of pathogenic CNVs, among which 45, X was the most common. In addition to the above pathogenic CNV, four additional cases were detected by SNP-array. There was no significant difference in the observed pathogenic CNVs between isolated CH and CH combined with other ultrasound (31.3% vs 29.2%, P > .99). Karyotype analysis and SNP-array results influence whether parents terminate the pregnancy. When genetic abnormalities are detected in the fetus, the parents often choose to terminate the pregnancy. CONCLUSIONS Our study emphasizes that genomic examination should be performed on fetuses with CH to confirm the etiology as soon as possible. During genetic counseling, all fetal characteristics should be carefully and comprehensively evaluated.
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Affiliation(s)
- Meiying Cai
- Medical Genetic Diagnosis and Therapy Center, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fujian Key Laboratory for Prenatal Diagnosis and Birth Defect, Fuzhou, China
| | - Nan Guo
- Medical Genetic Diagnosis and Therapy Center, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fujian Key Laboratory for Prenatal Diagnosis and Birth Defect, Fuzhou, China
| | - Na Lin
- Medical Genetic Diagnosis and Therapy Center, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fujian Key Laboratory for Prenatal Diagnosis and Birth Defect, Fuzhou, China
| | - Hailong Huang
- Medical Genetic Diagnosis and Therapy Center, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fujian Key Laboratory for Prenatal Diagnosis and Birth Defect, Fuzhou, China
| | - Liangpu Xu
- Medical Genetic Diagnosis and Therapy Center, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fujian Key Laboratory for Prenatal Diagnosis and Birth Defect, Fuzhou, China
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Sherer DM, Hsieh V, Hall A, Gerren A, Walters E, Dalloul M. Current Perspectives of Prenatal Cell-free DNA Screening in Clinical Management of First-Trimester Septated Cystic Hygroma. Int J Womens Health 2022; 14:1499-1518. [PMID: 36325393 PMCID: PMC9621220 DOI: 10.2147/ijwh.s328201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 08/08/2022] [Indexed: 11/07/2022] Open
Abstract
First-trimester septated cystic hygroma occurs in approximately 1 in 268 pregnancies and has long been associated with a markedly increased risk of fetal aneuploidy and, among euploid fetuses, an increased risk of structural anomalies primarily affecting the cardiac and skeletal systems. Invasive prenatal diagnosis – chorionic villus sampling and/or amniocentesis – encompasses the time-honored clinical tools for the next step in management following prenatal sonographic diagnosis of first-trimester septated cystic hygroma. Currently, prenatal cell-free DNA (cfDNA) screening for fetal aneuploidy with select microdeletions is gradually replacing the considerably less sensitive, and labor-intensive combined first-trimester screening. These new technologies have opened potential new venues in the clinical management of this ominous late first-trimester sonographic diagnosis. Advances in cfDNA technologies are now permitting detection of chromosomal copy number variants (CNV) larger than 7Mb across genome and select serious single-gene disorders (mainly impacting skeletal and neurological development), affecting quality of life and may benefit from medical and/or surgical management. This commentary will address the available non-invasive prenatal screening technologies, which clearly enhance immediate genetic analysis modalities applicable in the presence of the complex sonographic finding of first-trimester septated cystic hygroma.
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Affiliation(s)
- David M Sherer
- The Division of Maternal Fetal Medicine, the Department of Obstetrics and Gynecology, State University of New York (SUNY), Downstate Health Sciences University, Brooklyn, New York, USA,Correspondence: David M Sherer, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, State University of New York (SUNY), Downstate Health Sciences University, 450 Clarkson Avenue, Box 24, Brooklyn, NY, 11203, USA, Tel +001-718-270-2081, Fax +001-718-270-4122, Email
| | - Vicky Hsieh
- The Division of Maternal Fetal Medicine, the Department of Obstetrics and Gynecology, State University of New York (SUNY), Downstate Health Sciences University, Brooklyn, New York, USA
| | - Anika Hall
- The Division of Maternal Fetal Medicine, the Department of Obstetrics and Gynecology, State University of New York (SUNY), Downstate Health Sciences University, Brooklyn, New York, USA
| | - Allison Gerren
- The Division of Maternal Fetal Medicine, the Department of Obstetrics and Gynecology, State University of New York (SUNY), Downstate Health Sciences University, Brooklyn, New York, USA
| | - Erin Walters
- The Division of Maternal Fetal Medicine, the Department of Obstetrics and Gynecology, State University of New York (SUNY), Downstate Health Sciences University, Brooklyn, New York, USA
| | - Mudar Dalloul
- The Division of Maternal Fetal Medicine, the Department of Obstetrics and Gynecology, State University of New York (SUNY), Downstate Health Sciences University, Brooklyn, New York, USA
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Gkalonaki I, Anastasakis M, Patoulias I. Atypical locations for cystic lymphangiomas. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2022.102323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Berrada O, Beghdad M, El krimi Z, Oukessou Y, Rouadi S, LarbiAbada R, Roubal M, Mahtar M. Cervicofacial cystic lymphangiomas in 17 childrens: A case series. Ann Med Surg (Lond) 2022; 78:103835. [PMID: 35734738 PMCID: PMC9206928 DOI: 10.1016/j.amsu.2022.103835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 05/16/2022] [Accepted: 05/17/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction Cystic lymphangiomas are rare dysembrioplasias that occur mostly in children. Although benign, these tumors remain potentially life-threatening, due to the possible compression of the upper airway. The management of cystic lymphangiomas is still somewhat controversial, with surgery generally being the first-line treatment. Patients and methods 17 patients were included in this retrospective study, all aged less than 18 years old and treated for head and neck cystic lymphangiomas at our department between 2007 and 2017. All these patients had received surgical treatment alone. The relevant data were analyzed with SPSS software. Results 17 patients were included, with a sex ratio M/F of 1,4, and an average age of 4 years old. Complete resection of the tumor could only be completed in 12 patients. No postoperative complications were observed in our series. All the patients were followed for a minimum of 2 years after treatment. Conclusion Cystic lymphangiomas are rare tumors of mysterious origins. The main symptom is swelling of the affected area. In our series, the results of the surgery were promising and consistent with results reported in the literature. A follow-up study with a larger population could be interesting, to further examine potential prognostic factors.
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Affiliation(s)
- Omar Berrada
- ENT Head and Neck Surgery Department, Ibn Rochd University Hospital, Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
| | - Mohamed Beghdad
- ENT Head and Neck Surgery Department, Ibn Rochd University Hospital, Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
| | - Zineb El krimi
- ENT Head and Neck Surgery Department, Ibn Rochd University Hospital, Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
| | - Youssef Oukessou
- ENT Head and Neck Surgery Department, Ibn Rochd University Hospital, Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
| | - Sami Rouadi
- ENT Head and Neck Surgery Department, Ibn Rochd University Hospital, Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
| | - Redalah LarbiAbada
- ENT Head and Neck Surgery Department, Ibn Rochd University Hospital, Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
| | - Mohamed Roubal
- ENT Head and Neck Surgery Department, Ibn Rochd University Hospital, Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
| | - Mohamed Mahtar
- ENT Head and Neck Surgery Department, Ibn Rochd University Hospital, Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
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The Value of Fetal Heart Evaluation in Fetuses with Rare Congenital Lymphangiomas: A Cohort Study from a Single Tertiary Center across Two Decades (Years 1999-2020). J Clin Med 2022; 11:jcm11041035. [PMID: 35207307 PMCID: PMC8874571 DOI: 10.3390/jcm11041035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/13/2022] [Accepted: 02/15/2022] [Indexed: 12/10/2022] Open
Abstract
Lymphangiomas are uncommon, benign (from a histopathology viewpoint) malformations of the lymphatic system with thin-walled vessels; however, these tumors may be dangerous for fetal or neonatal life. They are observed in 1:6000 newborns at birth and in 1:750 spontaneous abortions. We aimed to investigate the role of fetal echocardiography in the prognosis of lymphangioma. Selected data of 19,836 pregnant women studied between 1999 and 2020 were retrospectively analyzed. In total, 32 cases of lymphangioma meeting the following criteria were further analyzed: (1) ultrasound availability from the 1st trimester of pregnancy and (2) nuchal translucency ≤ 2.5 mm. Echocardiographic findings, karyotype, size, and location of the possible lesion were juxtaposed with the clinical follow-up. The statistical analysis was performed using Statistica 13.1 software (StatSoft, Tulsa, OK, USA). Lymphangioma in the analyzed material coexisted with abnormalities in fetal echo in 78% (n = 25) of cases, especially: heart defect in 50% (n = 16) and with normal heart structure with functional changes in 28% (n = 9). Karyotype was available in 50% of the analyzed cases (n = 16). Normal cytogenetic results were observed in 62.5% (n = 10) of cases. In the remaining cases, the following were observed: Turner Syndrome: 25% (n = 4) and Down Syndrome 12.5% (n = 2). The rate of alive newborns was significantly higher among fetuses with isolated lymphangioma in comparison to those with lymphangioma associated with abnormal ECHO examination: 38.46% (n = 5) vs. 15.38% (n = 2; p = 0.037). Abnormal ECHO exam was a poor prognostic sign for fetuses with lymphangioma; therefore, we think it is important to refer these cases for detailed echocardiography in tertiary centers. Moreover, it should be highlighted that in all lymphangioma cases there was an indication to perform the karyotype assessment, as there was a high risk of aneuploidy.
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Tica OS, Gug C, Tica AA, Busuioc CJ, Amiri S, Tica I, Bică Brăiloiu G, Tica VI. A unique case of recurrent fetal cystic hygroma: first fetus with an inherited heteromorphism of chromosome 1 (1qh+) and the second fetus with 69XXX triploidy. ROMANIAN JOURNAL OF MORPHOLOGY AND EMBRYOLOGY 2021; 61:935-940. [PMID: 33817737 PMCID: PMC8112748 DOI: 10.47162/rjme.61.3.34] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The authors report a unique recurrent septated cystic hygroma (CH), on two successive pregnancies, at five years interval. The chromosome analysis of the first fetus showed an increase in length of heterochromatin on the long arm of chromosome 1 – 1qh+, a chromosomal polymorphism inherited from mother, 46XX,1qh+,14ps+,21ps+. The karyotype of the second CH, with more severe ultrasound (US) imaging, showed a 69XXX triploidy. The patient took no risk and underwent each time a termination of pregnancy (TOP). The first karyotype is generally considered “normal”, although there are few reports linking 1qh+ with low fertility, but this was not the case, the patient having, from a previous marriage, a healthy boy and two TOPs. So, this “particular”, but “healthy” karyotype was not a cause for the first CH. The second karyotype highlights a possible causality between the 69XXX triploidy, usually associated with partial hydatidiform mole, and a more severe septated CH in the last fetus. Neither the CHs’ appearance nor their recurrence seemed to be family linked, as the two CHs had distinct genetic profiles. We recommend that, once CH is diagnosed, a careful US examination is compulsory for the determination of subcutaneous edema, ascites, pleural and pericardial effusions and cardiac or renal abnormalities; an early genetic work-up is mandatory, by chorionic villus sampling or amniocentesis. However, a “healthy” karyotype does not exclude a severe form, as in our first case of CH. Due to the very poor outcome of fetuses with CH, the patient must be thoroughly informed about the short and the long-term fetal prognosis.
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Affiliation(s)
- Oana Sorina Tica
- Department of Pharmacology, University of Medicine and Pharmacy of Craiova, Romania; ; Department of Internal Medicine, Faculty of Medicine, Ovidius University of Constanţa, Romania;
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Sparks TN, Lianoglou BR, Adami RR, Pluym ID, Holliman K, Duffy J, Downum SL, Patel S, Faubel A, Boe NM, Field NT, Murphy A, Laurent LC, Jolley J, Uy C, Slavotinek AM, Devine P, Hodoglugil U, Van Ziffle J, Sanders SJ, MacKenzie TC, Norton ME. Exome Sequencing for Prenatal Diagnosis in Nonimmune Hydrops Fetalis. N Engl J Med 2020; 383:1746-1756. [PMID: 33027564 PMCID: PMC7650529 DOI: 10.1056/nejmoa2023643] [Citation(s) in RCA: 100] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND The cause of most fetal anomalies is not determined prenatally. Exome sequencing has transformed genetic diagnosis after birth, but its usefulness for prenatal diagnosis is still emerging. Nonimmune hydrops fetalis (NIHF), a fetal abnormality that is often lethal, has numerous genetic causes; the extent to which exome sequencing can aid in its diagnosis is unclear. METHODS We evaluated a series of 127 consecutive unexplained cases of NIHF that were defined by the presence of fetal ascites, pleural or pericardial effusions, skin edema, cystic hygroma, increased nuchal translucency, or a combination of these conditions. The primary outcome was the diagnostic yield of exome sequencing for detecting genetic variants that were classified as either pathogenic or likely pathogenic according to the criteria of the American College of Medical Genetics and Genomics. Secondary outcomes were the percentage of cases associated with specific genetic disorders and the proportion of variants that were inherited. RESULTS In 37 of the 127 cases (29%), we identified diagnostic genetic variants, including those for disorders affecting the RAS-MAPK cell-signaling pathway (known as RASopathies) (30% of the genetic diagnoses); inborn errors of metabolism and musculoskeletal disorders (11% each); lymphatic, neurodevelopmental, cardiovascular, and hematologic disorders (8% each); and others. Prognoses ranged from a relatively mild outcome to death during the perinatal period. Overall, 68% of the cases (25 of 37) with diagnostic variants were autosomal dominant (of which 12% were inherited and 88% were de novo), 27% (10 of 37) were autosomal recessive (of which 95% were inherited and 5% were de novo), 1 was inherited X-linked recessive, and 1 was of uncertain inheritance. We identified potentially diagnostic variants in an additional 12 cases. CONCLUSIONS In this large case series of 127 fetuses with unexplained NIHF, we identified a diagnostic genetic variant in approximately one third of the cases. (Funded by the UCSF Center for Maternal-Fetal Precision Medicine and others; ClinicalTrials.gov number, NCT03412760.).
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Affiliation(s)
- Teresa N Sparks
- From the University of California, San Francisco (T.N.S., B.R.L., S.L.D., S.P., A.F., A.M.S., P.D., U.H., J.V.Z., S.J.S., T.C.M., M.E.N.), the University of California, San Diego (R.R.A., L.C.L.), the University of California, Los Angeles (I.D., K.H., A.M.), the University of California, Irvine (J.D., J.J., C.U.), and the University of California, Davis (N.M.B., N.T.F.)
| | - Billie R Lianoglou
- From the University of California, San Francisco (T.N.S., B.R.L., S.L.D., S.P., A.F., A.M.S., P.D., U.H., J.V.Z., S.J.S., T.C.M., M.E.N.), the University of California, San Diego (R.R.A., L.C.L.), the University of California, Los Angeles (I.D., K.H., A.M.), the University of California, Irvine (J.D., J.J., C.U.), and the University of California, Davis (N.M.B., N.T.F.)
| | - Rebecca R Adami
- From the University of California, San Francisco (T.N.S., B.R.L., S.L.D., S.P., A.F., A.M.S., P.D., U.H., J.V.Z., S.J.S., T.C.M., M.E.N.), the University of California, San Diego (R.R.A., L.C.L.), the University of California, Los Angeles (I.D., K.H., A.M.), the University of California, Irvine (J.D., J.J., C.U.), and the University of California, Davis (N.M.B., N.T.F.)
| | - Ilina D Pluym
- From the University of California, San Francisco (T.N.S., B.R.L., S.L.D., S.P., A.F., A.M.S., P.D., U.H., J.V.Z., S.J.S., T.C.M., M.E.N.), the University of California, San Diego (R.R.A., L.C.L.), the University of California, Los Angeles (I.D., K.H., A.M.), the University of California, Irvine (J.D., J.J., C.U.), and the University of California, Davis (N.M.B., N.T.F.)
| | - Kerry Holliman
- From the University of California, San Francisco (T.N.S., B.R.L., S.L.D., S.P., A.F., A.M.S., P.D., U.H., J.V.Z., S.J.S., T.C.M., M.E.N.), the University of California, San Diego (R.R.A., L.C.L.), the University of California, Los Angeles (I.D., K.H., A.M.), the University of California, Irvine (J.D., J.J., C.U.), and the University of California, Davis (N.M.B., N.T.F.)
| | - Jennifer Duffy
- From the University of California, San Francisco (T.N.S., B.R.L., S.L.D., S.P., A.F., A.M.S., P.D., U.H., J.V.Z., S.J.S., T.C.M., M.E.N.), the University of California, San Diego (R.R.A., L.C.L.), the University of California, Los Angeles (I.D., K.H., A.M.), the University of California, Irvine (J.D., J.J., C.U.), and the University of California, Davis (N.M.B., N.T.F.)
| | - Sarah L Downum
- From the University of California, San Francisco (T.N.S., B.R.L., S.L.D., S.P., A.F., A.M.S., P.D., U.H., J.V.Z., S.J.S., T.C.M., M.E.N.), the University of California, San Diego (R.R.A., L.C.L.), the University of California, Los Angeles (I.D., K.H., A.M.), the University of California, Irvine (J.D., J.J., C.U.), and the University of California, Davis (N.M.B., N.T.F.)
| | - Sachi Patel
- From the University of California, San Francisco (T.N.S., B.R.L., S.L.D., S.P., A.F., A.M.S., P.D., U.H., J.V.Z., S.J.S., T.C.M., M.E.N.), the University of California, San Diego (R.R.A., L.C.L.), the University of California, Los Angeles (I.D., K.H., A.M.), the University of California, Irvine (J.D., J.J., C.U.), and the University of California, Davis (N.M.B., N.T.F.)
| | - Amanda Faubel
- From the University of California, San Francisco (T.N.S., B.R.L., S.L.D., S.P., A.F., A.M.S., P.D., U.H., J.V.Z., S.J.S., T.C.M., M.E.N.), the University of California, San Diego (R.R.A., L.C.L.), the University of California, Los Angeles (I.D., K.H., A.M.), the University of California, Irvine (J.D., J.J., C.U.), and the University of California, Davis (N.M.B., N.T.F.)
| | - Nina M Boe
- From the University of California, San Francisco (T.N.S., B.R.L., S.L.D., S.P., A.F., A.M.S., P.D., U.H., J.V.Z., S.J.S., T.C.M., M.E.N.), the University of California, San Diego (R.R.A., L.C.L.), the University of California, Los Angeles (I.D., K.H., A.M.), the University of California, Irvine (J.D., J.J., C.U.), and the University of California, Davis (N.M.B., N.T.F.)
| | - Nancy T Field
- From the University of California, San Francisco (T.N.S., B.R.L., S.L.D., S.P., A.F., A.M.S., P.D., U.H., J.V.Z., S.J.S., T.C.M., M.E.N.), the University of California, San Diego (R.R.A., L.C.L.), the University of California, Los Angeles (I.D., K.H., A.M.), the University of California, Irvine (J.D., J.J., C.U.), and the University of California, Davis (N.M.B., N.T.F.)
| | - Aisling Murphy
- From the University of California, San Francisco (T.N.S., B.R.L., S.L.D., S.P., A.F., A.M.S., P.D., U.H., J.V.Z., S.J.S., T.C.M., M.E.N.), the University of California, San Diego (R.R.A., L.C.L.), the University of California, Los Angeles (I.D., K.H., A.M.), the University of California, Irvine (J.D., J.J., C.U.), and the University of California, Davis (N.M.B., N.T.F.)
| | - Louise C Laurent
- From the University of California, San Francisco (T.N.S., B.R.L., S.L.D., S.P., A.F., A.M.S., P.D., U.H., J.V.Z., S.J.S., T.C.M., M.E.N.), the University of California, San Diego (R.R.A., L.C.L.), the University of California, Los Angeles (I.D., K.H., A.M.), the University of California, Irvine (J.D., J.J., C.U.), and the University of California, Davis (N.M.B., N.T.F.)
| | - Jennifer Jolley
- From the University of California, San Francisco (T.N.S., B.R.L., S.L.D., S.P., A.F., A.M.S., P.D., U.H., J.V.Z., S.J.S., T.C.M., M.E.N.), the University of California, San Diego (R.R.A., L.C.L.), the University of California, Los Angeles (I.D., K.H., A.M.), the University of California, Irvine (J.D., J.J., C.U.), and the University of California, Davis (N.M.B., N.T.F.)
| | - Cherry Uy
- From the University of California, San Francisco (T.N.S., B.R.L., S.L.D., S.P., A.F., A.M.S., P.D., U.H., J.V.Z., S.J.S., T.C.M., M.E.N.), the University of California, San Diego (R.R.A., L.C.L.), the University of California, Los Angeles (I.D., K.H., A.M.), the University of California, Irvine (J.D., J.J., C.U.), and the University of California, Davis (N.M.B., N.T.F.)
| | - Anne M Slavotinek
- From the University of California, San Francisco (T.N.S., B.R.L., S.L.D., S.P., A.F., A.M.S., P.D., U.H., J.V.Z., S.J.S., T.C.M., M.E.N.), the University of California, San Diego (R.R.A., L.C.L.), the University of California, Los Angeles (I.D., K.H., A.M.), the University of California, Irvine (J.D., J.J., C.U.), and the University of California, Davis (N.M.B., N.T.F.)
| | - Patrick Devine
- From the University of California, San Francisco (T.N.S., B.R.L., S.L.D., S.P., A.F., A.M.S., P.D., U.H., J.V.Z., S.J.S., T.C.M., M.E.N.), the University of California, San Diego (R.R.A., L.C.L.), the University of California, Los Angeles (I.D., K.H., A.M.), the University of California, Irvine (J.D., J.J., C.U.), and the University of California, Davis (N.M.B., N.T.F.)
| | - Ugur Hodoglugil
- From the University of California, San Francisco (T.N.S., B.R.L., S.L.D., S.P., A.F., A.M.S., P.D., U.H., J.V.Z., S.J.S., T.C.M., M.E.N.), the University of California, San Diego (R.R.A., L.C.L.), the University of California, Los Angeles (I.D., K.H., A.M.), the University of California, Irvine (J.D., J.J., C.U.), and the University of California, Davis (N.M.B., N.T.F.)
| | - Jessica Van Ziffle
- From the University of California, San Francisco (T.N.S., B.R.L., S.L.D., S.P., A.F., A.M.S., P.D., U.H., J.V.Z., S.J.S., T.C.M., M.E.N.), the University of California, San Diego (R.R.A., L.C.L.), the University of California, Los Angeles (I.D., K.H., A.M.), the University of California, Irvine (J.D., J.J., C.U.), and the University of California, Davis (N.M.B., N.T.F.)
| | - Stephan J Sanders
- From the University of California, San Francisco (T.N.S., B.R.L., S.L.D., S.P., A.F., A.M.S., P.D., U.H., J.V.Z., S.J.S., T.C.M., M.E.N.), the University of California, San Diego (R.R.A., L.C.L.), the University of California, Los Angeles (I.D., K.H., A.M.), the University of California, Irvine (J.D., J.J., C.U.), and the University of California, Davis (N.M.B., N.T.F.)
| | - Tippi C MacKenzie
- From the University of California, San Francisco (T.N.S., B.R.L., S.L.D., S.P., A.F., A.M.S., P.D., U.H., J.V.Z., S.J.S., T.C.M., M.E.N.), the University of California, San Diego (R.R.A., L.C.L.), the University of California, Los Angeles (I.D., K.H., A.M.), the University of California, Irvine (J.D., J.J., C.U.), and the University of California, Davis (N.M.B., N.T.F.)
| | - Mary E Norton
- From the University of California, San Francisco (T.N.S., B.R.L., S.L.D., S.P., A.F., A.M.S., P.D., U.H., J.V.Z., S.J.S., T.C.M., M.E.N.), the University of California, San Diego (R.R.A., L.C.L.), the University of California, Los Angeles (I.D., K.H., A.M.), the University of California, Irvine (J.D., J.J., C.U.), and the University of California, Davis (N.M.B., N.T.F.)
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10
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Morotti A, Busso M, Consiglio Barozzino M, Cinardo P, Angelino V, Familiari U, Veltri A, Guerrasio A. Detection and management of retroperitoneal cystic lesions: A case report and review of the literature. Oncol Lett 2017; 14:1602-1608. [PMID: 28789385 DOI: 10.3892/ol.2017.6323] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 11/04/2016] [Indexed: 12/25/2022] Open
Abstract
The identification of cystic lesions within the retroperitoneal space is a rare event that poses clinicians the challenge of a difficult diagnosis and disease management. Retroperitoneal cystic lesions account for a group of lesions that range from common benign lesions (e.g., lymphoceles developing as a surgical complication) to rare aggressive malignant neoplasms. Currently, in the majority of cases, image-guided procedures allow for a pathological diagnosis to be achieved in these challenging lesions, thus offering the chance of an appropriate treatment; however, the overall clinical assessment of retroperitoneal cysts is highly demanding. The present study reports the management of a representative clinical case, presenting with a voluminous cystic mass able to dislocate cave vein, whose diagnosis was preceded by a deep vein thrombosis. Computed tomography-scan and ultrasound guided percutaneous drainage were performed to achieve the diagnosis. Following the discussion of the current case report, a review of the pathological and radiological characteristics of retroperitoneal cystic lesions is presented.
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Affiliation(s)
- Alessandro Morotti
- Division of Internal Medicine, University of Turin, Orbassano, I-10043 Turin, Italy.,Department of Clinical and Biological Sciences, University of Turin, Orbassano, I-10043 Turin, Italy
| | - Marco Busso
- Department of Oncology, University of Turin and San Luigi Hospital, Orbassano, I-10043 Turin, Italy
| | - Maria Consiglio Barozzino
- Department of Clinical and Biological Sciences, University of Turin, Orbassano, I-10043 Turin, Italy
| | - Paola Cinardo
- Department of Clinical and Biological Sciences, University of Turin, Orbassano, I-10043 Turin, Italy
| | - Valeria Angelino
- Department of Oncology, University of Turin and San Luigi Hospital, Orbassano, I-10043 Turin, Italy
| | - Ubaldo Familiari
- Department of Pathology, San Luigi Hospital, Orbassano, I-10043 Turin, Italy
| | - Andrea Veltri
- Department of Oncology, University of Turin and San Luigi Hospital, Orbassano, I-10043 Turin, Italy
| | - Angelo Guerrasio
- Division of Internal Medicine, University of Turin, Orbassano, I-10043 Turin, Italy.,Department of Clinical and Biological Sciences, University of Turin, Orbassano, I-10043 Turin, Italy
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11
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Durukan H, Gözükara İ, Cevikoglu M, Dilek TUK. Isolated fetal lymphatic malformation of the thigh: prenatal diagnosis and follow-up. AUTOPSY AND CASE REPORTS 2017; 7:49-53. [PMID: 28536688 PMCID: PMC5436922 DOI: 10.4322/acr.2017.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 02/17/2017] [Indexed: 01/04/2023] Open
Abstract
Fetal lymphatic malformation can be found in different parts of the fetal body. It occurs most frequently in the nuchal and axillary region and less frequently in the abdomen or inguinal areas. Lymphatic malformation has been associated with fetal aneuploidy, hydrops fetalis, structural malformations, and intrauterine fetal death. A 31-year-old gravida 3, para 2 woman was admitted to our hospital at 22 weeks of gestation (confirmed by ultrasonographic examination). The fetus was alive, and had a mass derived from the left inguinal region extending to the anterior left leg with fluid-filled cavities about 3–5 cm in size. There was no evidence of intra-abdominal extension of the mass. Amniocentesis was performed. Fetal magnetic resonance imaging revealed a left inguinal cystic mass, which extended to the left thigh. Antenatal follow-up was uneventful. The mother gave birth at term with a cesarean section. Postnatal clinical examination and imaging examination confirmed the diagnosis of lymphatic malformation. Fetal lymphatic malformation carries a high risk of aneuploidy and fetal malformations. Patients diagnosed with lymphatic malformation in antenatal follow-up should be assessed in terms of coexistent anomalies. Fetal karyotyping should be done and the fetus should be monitored for fetal hydrops.
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Affiliation(s)
- Huseyin Durukan
- Department of Obstetrics and Gynecology - Faculty of Medicine - Mersin University, Mersin - Turkey
| | - İlay Gözükara
- Department of Obstetrics and Gynecology - Faculty of Medicine - Mustafa Kemal University, Hatay - Turkey
| | - Murside Cevikoglu
- Department of Obstetrics and Gynecology - Faculty of Medicine - Mersin University, Mersin - Turkey
| | - Talat Umut Kutlu Dilek
- Department of Obstetrics and Gynecology - Faculty of Medicine - Acıbadem Atakent University Hospital, Istanbul - Turkey
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12
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Tonni G, Granese R, Martins Santana EF, Parise Filho JP, Bottura I, Borges Peixoto A, Giacobbe A, Azzerboni A, Araujo Júnior E. Prenatally diagnosed fetal tumors of the head and neck: a systematic review with antenatal and postnatal outcomes over the past 20 years. J Perinat Med 2017; 45:149-165. [PMID: 27508950 DOI: 10.1515/jpm-2016-0074] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 06/19/2016] [Indexed: 12/19/2022]
Abstract
AIM The aim of this study was to review prenatally diagnosed tumors of the head and neck in the fetus and to report antenatal and postnatal outcomes. METHODS PubMed/Medline, EMBASE/SCOPUS, Cochrane database and Google Scholar were reviewed over the last 20 years. No language or article type restriction was used. RESULTS A total of 1940 record were retrieved. Of the 713 records screened, 566 full-text articles were assessed for eligibility. After 445 articles were excluded for specified reasons, 111 studies met the research criteria and were included for qualitative analysis. Overall, 306 cases of fetal tumors of the head and neck were reviewed. Maternal age was an independent factor. The mean maternal age was 28.2 years and gestational age at prenatal diagnosis was 27.1 weeks. Conventional 2D ultrasound was the standard diagnostic procedure in 27.9% of cases and was implemented in 27.3% of cases by 3D ultrasound and fetal magnetic resonance imaging (MRI). Diagnostic evaluation of intracranial spreading and high-airway obstructions was greatly enhanced by fetal MRI. The more common type of fetal tumor was hemangioma/lymphangioms (42.1%), followed by teratomas (29.7%), tumors of the gingiva (10.1%) and lymphatic venous malformations (9.1%), respectively. Fetal karyotyping was performed only in 9.8% of cases; within fetuses undergoing karyotype, chromosomal abnormalities accounted for 20% of cases. The most common pregnancy complication was polyhydramnios (26.3%). Ex utero intrapartum treatment (EXIT) procedure was performed in 30.1% of cases while surgical excision was used in 22.9% during postnatal life. The survival rate was 35.35%. CONCLUSION Fetal tumors of the head and neck are rare congenital malformations. Two-dimensional ultrasound is diagnostic in almost all cases; however, MRI may be an important diagnostic adjunct in targeted cases and help patient selection for immediate intubation at the time of delivery. EXIT procedure and surgical removal of the tumor was associated with good prognosis.
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13
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An Interesting Association of Cystic Hygroma of the Neck and Lymphangioma Causing a Paediatric Swollen Tongue. Case Rep Pediatr 2016; 2016:7930945. [PMID: 27069707 PMCID: PMC4812285 DOI: 10.1155/2016/7930945] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 01/27/2016] [Accepted: 02/08/2016] [Indexed: 11/17/2022] Open
Abstract
Up to 75% of lymphatic malformations occur in the head and neck region. Of these, cystic hygromas and lymphangiomas have been widely reported; however they rarely occur in the same patient. We report the case of a 5-year-old girl who presented to the Department of Paediatrics of a district general hospital with a short history of recurrent, painful swelling of the anterior one-third of her tongue. She was reviewed under the joint care of the Oral and Maxillofacial Surgery and Otolaryngology Teams. Relevant past medical history included a previously excised cystic hygroma from her right neck when she was aged 2 years. Diagnosis of lymphangioma was made and of the potential management options available active monitoring was favoured due to the patient's age. To our knowledge the occurrence of both tongue lymphangioma and cystic hygroma has not been previously reported in a paediatric patient. This case report therefore shows a rare association between a cystic hygroma of the neck and lymphangioma of the tongue.
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14
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Ersoy AO, Oztas E, Saridogan E, Ozler S, Danisman N. An Unusual Origin of Fetal Lymphangioma Filling Right Axilla. J Clin Diagn Res 2016; 10:QD09-11. [PMID: 27134953 PMCID: PMC4843338 DOI: 10.7860/jcdr/2016/18516.7513] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 01/27/2016] [Indexed: 01/30/2023]
Abstract
Fetal lymphangioma is a hamartomatous congenital anomaly of the lymphatic system, which is embracing the fetal skin (sometimes mucous membranes) and the subcutaneous tissue. The general consensus is that it occurs as a result of failure in lymphatic drainage. A 36-year-old pregnant woman was referred to our perinatology clinic at 22 weeks' gestation, because of a fetal right-sided axillary mass revealed by ultrasonography. The mass measuring 5x7x7cm in three dimensions had a multilocular structure without colour Doppler flow and well-circumscribed borders. Amniocentesis revealed a normal constitutional karyotyping. Lymphangioma was considered as prediagnosis. A healthy female baby weighing 3470 grams was delivered at term. Neonatal examination and the postnatal MRI confirmed the diagnosis. The baby is still on follow-up with the medical treatment of Sirolimus an anti-proliferative drug, and the mass got smaller significantly in 8 months after delivery.
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Affiliation(s)
- Ali Ozgur Ersoy
- Medical Doctor, Department of Obstetrics and Gynecology, Zekai Tahir Burak Women’s Healthcare, Training and Research Hospital, Ankara, Turkey
| | - Efser Oztas
- Medical Doctor, Department of Obstetrics and Gynecology, Zekai Tahir Burak Women’s Healthcare, Training and Research Hospital, Ankara, Turkey
| | - Erdinc Saridogan
- Medical Doctor, Department of Obstetrics and Gynecology, Zekai Tahir Burak Women’s Healthcare, Training and Research Hospital, Ankara, Turkey
| | - Sibel Ozler
- Medical Doctor, Department of Obstetrics and Gynecology, Zekai Tahir Burak Women’s Healthcare, Training and Research Hospital, Ankara, Turkey
| | - Nuri Danisman
- Medical Doctor, Department of Obstetrics and Gynecology, Zekai Tahir Burak Women’s Healthcare, Training and Research Hospital, Ankara, Turkey
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15
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Lu D, Wang Y, Zeng W, Peng B. Giant fetal lymphangioma at chest wall and prognosis: case report and literature review. Taiwan J Obstet Gynecol 2015; 54:62-5. [PMID: 25675922 DOI: 10.1016/j.tjog.2014.11.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/26/2013] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE To report a rare liveborn case with a giant, septated, chest wall lymphangioma that underwent prenatal expectation treatment. CASE REPORT A case of giant fetal chest wall cystic lymphangioma was diagnosed prenatally at 19 weeks gestation. Expectation treatment was performed, carefully after prenatal counseling, ruling out other structural abnormalities. At 38 weeks gestation, ultrasound showed a multilocular, subcutaneous cystic mass of 12.3 cm × 9.2 cm × 11.0 cm located on the left chest wall and left upper arm. The tumor was surgically removed 4 days after birth, and no recurrence was observed in the following 18 months. CONCLUSION Our experience suggests that a large, septated fetal lymphangioma may still merit prenatal expectation treatment if there is no evidence for chromosomal and structural abnormality.
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Affiliation(s)
- Donghao Lu
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China; Department of Medical Epidemiology & Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Yuhe Wang
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Weiyue Zeng
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Bing Peng
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China.
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16
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Appraisal of efficacy and safety of intralesional injection of high concentration of bleomycin A5 for treatment of huge macrocystic lymphatic malformations in cervical region. J Craniofac Surg 2015; 25:1707-9. [PMID: 25119414 DOI: 10.1097/scs.0000000000000900] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The objective of this study was to investigate the therapeutic effects and safety of intralesional injection of high concentration of bleomycin A5 for huge (more than 5 cm in diameter) macrocystic lymphatic malformations (LMs) in the cervical region. Thirty-two patients with huge macrocystic LMs were treated with percutaneous injection of bleomycin A5 in our department between 2006 and 2011. Among them, 13 patients had unilateral submandibular lesions, and 19 patients had lesions in anterior cervical regions. The age of patients ranged from 10 months to 29 years (mean age, 11.4 y). The concentration of the drug was as high as 2.7 mg/mL (8 mg/3 mL) with an addition of dexamethasone. The mean sessions of injection were 1.6 (1-3 sessions). Repeated injection interval was 4 to 6 weeks. The follow-up period was 6 months to 4 years after the last treatment, and the mean follow-up time was 18 months. The results were evaluated based on clinical examination and Doppler ultrasonography scan. The clinical follow-up showed excellent response in 28 of the 32 patients, whereas 4 of the 32 patients also had a satisfactory response. No serious complications were encountered. Intralesional injection of high concentration of bleomycin A5 was an effective and safe treatment of huge macrocystic LMs in the cervical region and can obtain satisfactory results esthetically and functionally without surgery.
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17
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Nassar F, DeFranco E. Turner syndrome presenting with echogenic fetal lungs on first-trimester sonography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2015; 34:356-357. [PMID: 25614412 DOI: 10.7863/ultra.34.2.355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Fatema Nassar
- University of Cincinnati, Cincinnati, Ohio USA (F.N.), Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio USA (E.D.)
| | - Emily DeFranco
- University of Cincinnati, Cincinnati, Ohio USA (F.N.), Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio USA (E.D.)
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18
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Ben Hamouda H, Gasmi O, Wannes S, Korbi A, Belguith M, Jerbi S, Soua H, Souissi MM, Hamza H, Nouri A, Sfar MT. [Prenatal diagnosis of a giant cystic lymphangioma in the axillothoracic wall]. Arch Pediatr 2014; 21:1011-5. [PMID: 25089042 DOI: 10.1016/j.arcped.2014.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2013] [Revised: 02/20/2014] [Accepted: 06/11/2014] [Indexed: 11/30/2022]
Abstract
Cystic lymphangiomas are benign malformative tumors of the lymphatic vessels, rare but potentially serious and usually located in the cervical region. The diagnosis is usually easy, but the treatment is sometimes difficult because of their location and extension into the surrounding tissue. We report a case of giant cystic lymphangioma of the right axillary-thoracic wall diagnosed by prenatal ultrasound at 20 weeks gestation. The male infant was born at 37 weeks gestation with a large, swelling, lateral parietal right chest. Ultrasound soft tissue and chest CT scan confirmed the diagnosis of giant cystic lymphangioma of the right axillary-thoracic wall. Surgical excision was performed on the 21st day after birth and the mass was excised incompletely. The postoperative course was uncomplicated. Ultrasound soft tissue follow-up showed the persistence of multiple cystic structures in the axilla. Prenatal diagnosis of these tumors is essential for planning multidisciplinary management in early postnatal care.
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Affiliation(s)
- H Ben Hamouda
- Service de pédiatrie et de néonatologie, CHU Tahar Sfar, 5111 Mahdia, Tunisie.
| | - O Gasmi
- Service de pédiatrie et de néonatologie, CHU Tahar Sfar, 5111 Mahdia, Tunisie
| | - S Wannes
- Service de pédiatrie et de néonatologie, CHU Tahar Sfar, 5111 Mahdia, Tunisie
| | - A Korbi
- Service de gynéco-obstétrique, CHU Tahar Sfar, 5111 Mahdia, Tunisie
| | - M Belguith
- Service de chirurgie pédiatrique, CHU Fattouma Bourghuiba, 5000 Monastir, Tunisie
| | - S Jerbi
- Service de radiologie, CHU Tahar Sfar, 5111 Mahdia, Tunisie
| | - H Soua
- Service de pédiatrie et de néonatologie, CHU Tahar Sfar, 5111 Mahdia, Tunisie
| | - M M Souissi
- Service de gynéco-obstétrique, CHU Tahar Sfar, 5111 Mahdia, Tunisie
| | - H Hamza
- Service de radiologie, CHU Tahar Sfar, 5111 Mahdia, Tunisie
| | - A Nouri
- Service de chirurgie pédiatrique, CHU Fattouma Bourghuiba, 5000 Monastir, Tunisie
| | - M T Sfar
- Service de pédiatrie et de néonatologie, CHU Tahar Sfar, 5111 Mahdia, Tunisie
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19
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Lymphatic malformations of the head and neck—current concepts in management. Br J Oral Maxillofac Surg 2013; 51:98-102. [DOI: 10.1016/j.bjoms.2011.12.016] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Accepted: 12/14/2011] [Indexed: 11/21/2022]
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Abstract
BACKGROUND Cystic hygroma (CH) is a congenital malformation of the lymphatic system. It most commonly presents in the neck, and aetiological factors include environmental and genetic factors. CASE REPORT A 13-year-old female presented with spontaneous dental pain affecting the maxillary left first and second permanent molar teeth. Medical history revealed a history of left sided cervico-facial-thoracic CH. She was diagnosed with periapical peridontitis and required extraction of both teeth. Clinical management was compromised by the CH involving the left face, neck, ear, tongue, larynx, oropharynx and mediastinum and circling the trachea and great vessels. TREATMENT Initial management included the placement of obtundant dressings for teeth number 26 and 27 with resolution of dental pain. Intensive prevention was instigated, and teeth number 16 and 17 were restored with composite resin under local analgesia (LA) without incident. Extraction of teeth number 26 and 27 was complicated by significant trismus and the unacceptably high risk associated with general anaesthesia, due to intubation difficulties. It proved impossible to achieve satisfactory local analgesia. Due to her difficult airway, it was decided to treat the patient with inhalational sedation, but administered in an operating theatre by a consultant anaesthetist, and teeth were extracted using articaine LA. FOLLOW-UP The patient coped well with this treatment, and was discharged home on the same day. Two year follow-up with intensive prevention showed improved oral health, with no new carious lesions detected. CONCLUSION This is the first report to our knowledge describing dental extractions in the immediate vicinity of a cystic hygroma. A potential management strategy and the difficulties of conventional methods in such patients are discussed.
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Affiliation(s)
- S Barry
- Department of Paediatric Dentistry, Leeds Dental Institute, Leeds, UK.
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Colby CE, Carey WA, Blumenfeld YJ, Hintz SR. Infants with prenatally diagnosed anomalies: special approaches to preparation and resuscitation. Clin Perinatol 2012; 39:871-87. [PMID: 23164184 DOI: 10.1016/j.clp.2012.09.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
When a fetal anomaly is suspected, a multidisciplinary approach to diagnosis, counseling, pregnancy management, surveillance, delivery planning, and neonatal care is critical to creating a comprehensive management plan. This article provides a basic framework for integrating prenatal diagnostic and maternal-fetal care considerations, delivery planning, special resuscitation needs, and immediate and later neonatal care and evaluation into developing a thoughtful management plan for infants with prenatally diagnosed complex anomalies including congenital heart disease, intrathoracic masses, fetal airway obstruction, neural tube defects, abdominal wall defects, and skeletal dysplasia.
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Affiliation(s)
- Christopher E Colby
- Department of Pediatrics, Neonatal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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Iskender C, Tarım E, Çok T, Yalcinkaya C, Kalaycı H, Sahin F. Fetal axillary cystic hygroma: A novel association with triple X syndrome. ACTA ACUST UNITED AC 2012; 94:955-7. [DOI: 10.1002/bdra.23083] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2012] [Revised: 08/21/2012] [Accepted: 08/28/2012] [Indexed: 11/10/2022]
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Temizkan O, Abike F, Ayvaci H, Demirag E, Görücü Y, Isik E. Fetal axillary cystic hygroma: a case report and review. Rare Tumors 2011; 3:e39. [PMID: 22355494 PMCID: PMC3282444 DOI: 10.4081/rt.2011.e39] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2011] [Accepted: 07/27/2011] [Indexed: 12/05/2022] Open
Abstract
Cystic hygroma (CH) is a lymphatic malformation occurring different parts of fetal body, typically in the region of the fetal neck and axillary, abdominal wall, mediastinal, inguinal and retroperitoneal areas. CH has been associated with fetal aneuploidy, hydrops fetalis, structural malformations and intrauterine fetal death. A 24-year-old gravida 1, para 1 was admitted to our hospital at 28 weeks of gestation. Ultrasonographic examination determined 28 weeks of gestation, singleton, alive fetus who had a mass derived from the right axillary region which was extending to the anterior and posterior thoracic wall with fluid-filled cavities about 12 cm in size. There was no evidence of intrathorasic or intraabdominal extension of mass. Cordocentesis was performed and karyotype examination was normal 46 XY. The fetal demise was found after the first visit. The patient was delivered vaginally after labor induction with oxytocin infusion. The fetal autopsy confirmed the diagnosis of CH. The fetal CH carries high risk of aneuploidy and fetal malformations. Patients that have been diagnosed with CH in antenatal follow-ups should be assessed in terms of other anomalies. Fetal karyotyping should be done and the patient should be monitored for fetal hydrops. The birth should be planned in a multidisciplinary hospital and as neonatal resuscitation could be needed, pediatricians should be consulted.
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Affiliation(s)
- Osman Temizkan
- Department of Obstetrics Gynecology, Sisli Etfal Education and Research Hospital, Istanbul
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Fetal tumors: imaging features. Pediatr Radiol 2010; 40:1263-73; quiz 1321-2. [PMID: 20309537 DOI: 10.1007/s00247-010-1571-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2009] [Revised: 12/29/2009] [Accepted: 01/22/2010] [Indexed: 10/19/2022]
Abstract
Although fetal tumors are rare, the prognostic and decision-making implications are substantial. The purpose of this pictorial essay is to highlight the most common tumors encountered during fetal imaging and to discuss the respective typical imaging findings. When appropriate, limited additional information regarding further considerations for patient care will be included.
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Perkins JA, Manning SC, Tempero RM, Cunningham MJ, Edmonds JL, Hoffer FA, Egbert MA. Lymphatic malformations: Current cellular and clinical investigations. Otolaryngol Head Neck Surg 2010; 142:789-94. [DOI: 10.1016/j.otohns.2010.02.025] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2009] [Revised: 02/18/2010] [Accepted: 02/18/2010] [Indexed: 10/19/2022]
Abstract
Objective: Summarize current knowledge of lymphatic malformation development, biology, and clinical outcome measures. Methods: Panel presentation of lymphatic malformation biology and measurement of head and neck malformation treatment outcomes. Results: Characterization of lymphatic malformation endothelial and stromal cells may lead to biologically based treatment. Traditionally, lymphatic malformation treatment outcomes have been measured according to reduction of malformation size. Currently, methods to measure functional outcomes following lymphatic malformation treatment are lacking. This is particularly apparent when the malformation directly involves the upper aerodigestive tract. Conclusions: The etiology and pathogenesis of head and neck lymphatic malformations are poorly understood, but understanding is improving through ongoing investigation. Reduction of lymphatic malformation size is generally possible, but further work is necessary to optimize methods for measuring therapeutic outcomes in problematic areas.
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Affiliation(s)
- Jonathan A. Perkins
- Division of Pediatric Otolaryngology–Head and Neck Surgery, Seattle Children's Hospital, Seattle, WA
- Department of Otolaryngology–Head and Neck Surgery, University of Washington, Seattle, WA
| | - Scott C. Manning
- Division of Pediatric Otolaryngology–Head and Neck Surgery, Seattle Children's Hospital, Seattle, WA
- Department of Otolaryngology–Head and Neck Surgery, University of Washington, Seattle, WA
| | | | - Michael J. Cunningham
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, and Department of Otology and Laryngology, Harvard Medical School, Boston, MA
| | - Joseph L. Edmonds
- Children's ENT of Houston, Houston, TX
- Department of Otolaryngology and Division of Plastic Surgery, Baylor College of Medicine, Houston, TX
- Department of Otolaryngology, Weill Cornell College of Medicine, New York, NY
- Department of Otolaryngology, University of Texas School of Medicine, Houston, TX
| | - Fredric A. Hoffer
- Department of Radiology, Seattle Children's Hospital, University of Washington, Seattle WA
| | - Mark A. Egbert
- Department of Oral and Maxillofacial Surgery, Dental Medicine, Seattle Children's Hospital, University of Washington, Seattle WA
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Case report of fetal axillo-thoraco-abdominal cystic hygroma. Arch Gynecol Obstet 2009; 281:111-5. [DOI: 10.1007/s00404-009-1068-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2008] [Accepted: 03/24/2009] [Indexed: 10/20/2022]
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Itakura E, Yamamoto H, Oda Y, Furue M, Tsuneyoshi M. VEGF-C and VEGFR-3 in a series of lymphangiomas: is superficial lymphangioma a true lymphangioma? Virchows Arch 2009; 454:317-25. [PMID: 19151999 DOI: 10.1007/s00428-008-0720-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2008] [Revised: 11/24/2008] [Accepted: 12/10/2008] [Indexed: 11/24/2022]
Abstract
Lymphangiomas are commonly regarded as vascular malformations during embryonic development rather than as true neoplasms. VEGF-C and VEGFR-3 are known to be active in the formation of lymphangiomas. However, the significance of the disorders seems to be obscured by confusing different entities. In 114 lymphangiomas, we investigated the clinicopathological features and the expression of VEGF-C and VEGFR-3. The age of patients with lymphangioma circumscriptum or intraabdominal lymphangioma was significantly higher than in patients with cavernous lymphangioma and in patients with cystic hygroma. In cavernous lymphangioma, the age of female patients was significantly higher than in male patients. Five adult cystic hygromas were identified. VEGF-C was detected in 21 of 58 (36%) cavernous lymphangiomas, ten of 28 (36%) cystic hygromas, 0 of 12 (0%) lymphangioma circumscriptum, and four of ten (40%) intraabdominal lymphangiomas. VEGFR-3 was detected in 43 of 58 (72%) cavernous lymphangiomas, 20 of 28 (71%) cystic hygromas, six of 12 (50%) lymphangiomas circumscriptum, and seven of ten (70%) intraabdominal lymphangiomas. VEGF-C was absent from superficial lymphangiomas associated with cavernous lymphangiomas. In typical cases of cavernous lymphangioma, VEGF-C was strongly expressed, suggesting that these cases possessed proliferative activity. In cystic hygroma and intraabdominal lymphangioma, VEGF-C was limited in its distribution. Superficial lymphangiomas more likely represent from peripheral lymphatic dilatation rather than due to growth factor.
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Affiliation(s)
- Eijun Itakura
- Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, 3-1-1Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
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