Congenital liver cyst presenting as congenital diaphragmatic hernia

A case of congenital diaphragmatic hernia with a hernia sac attached to the liver: hints for an early embryological insult

We describe here the unusual operative findings in a case of congenital diaphragmatic hernia (CDH). A neonate antenatally diagnosed as having CDH was operated via a left subcostal incision. The operative findings included a large central diaphragmatic defect of 5 x 5 cm, lined by a thick sac. The contents of the hernia included the stomach, spleen, and loops of the small and large intestine. The left side of the liver was thinned out and forming a part of the dome of the sac of the CDH. Vessels of the hepatic tissue were in continuity with the sac. There were scattered liver tissues forming cords in the sac lining. These findings were confirmed by histopathologic examinations. These findings have not been reported earlier in humans and might help to elucidate the embryology of the development of the diaphragm. Our findings suggest that this kind of defect occurs early in development, and we hypothesize that it is associated with a poorer prognosis.

Molecular genetics of congenital diaphragmatic defects

Congenital diaphragmatic hernia (CDH) is a severe birth defect that is accompanied by malformations of the lung, heart, testis, and other organs. Patients with CDH may have any combination of these extradiaphragmatic defects, suggesting that CDH is often a manifestation of a global embryopathy. This review highlights recent advances in human and mouse genetics that have led to the identification of genes involved in CDH. These include genes for transcription factors, molecules involved in cell migration, and extracellular matrix components. The expression patterns of these genes in the developing embryo suggest that mesenchymal cell function is compromised in the diaphragm and other affected organs in patients with CDH. We discuss potential mechanisms underlying the seemingly random combination of diaphragmatic, pulmonary, cardiovascular, and gonadal defects in these patients.

Infants with Bochdalek diaphragmatic hernia: sibling precurrence and monozygotic twin discordance in a hospital-based malformation surveillance program

Congenital diaphragmatic hernia (CDH) is a common and often devastating birth defect. In order to learn more about possible genetic causes, we reviewed and classified 203 cases of the Bochdalek hernia type identified through the Brigham and Women's Hospital (BWH) Active Malformation Surveillance Program over a 28-year period. Phenotypically, 55% of the cases had isolated CDH, and 45% had complex CDH defined as CDH in association with additional major malformations or as part of a syndrome. When classified according to likely etiology, 17% had a Recognized Genetic etiology for their CDH, while the remaining 83% had No Apparent Genetic etiology. Detailed analysis using this largest cohort of consecutively collected cases of CDH showed low precurrence among siblings. Additionally, there was no concordance for CDH among five monozygotic twin pairs. These findings, in conjunction with previous reports of de novo dominant mutations in patients with CDH, suggest that new mutations may be an important mechanism responsible for CDH. The twin data also raise the possibility that epigenetic abnormalities contribute to the development of CDH.

A genetic model for a central (septum transversum) congenital diaphragmatic hernia in mice lacking Slit3

Congenital diaphragmatic hernia (CDH) is a significant cause of pediatric mortality in humans with a heterogeneous and poorly understood etiology. Here we show that mice lacking Slit3 developed a central (septum transversum) CDH. Slit3 encodes a member of the Slit family of guidance molecules and is expressed predominantly in the mesothelium of the diaphragm during embryonic development. In Slit3 null mice, the central tendon region of the diaphragm fails to separate from liver tissue because of abnormalities in morphogenesis. The CDH progresses through continuous growth of the liver into the thoracic cavity. This study establishes the first genetic model for CDH and identifies a previously unsuspected role for Slit3 in regulating the development of the diaphragm.

Accessory liver in an infant with congenital diaphragmatic hernia

Incidence of congenital diaphragmatic hernia (CDH) ranges from 1 in 2,400 to one in 5,000 live births. Associated anomalies in CDH are approximately 30% to 35%. The authors report on an infant with CDH and an accessory supradiaphragmatic liver with separate vascularization from the thoracic aorta. The pathogenesis of this malformation is discussed. The postoperative course and the follow-up of the child over 5 years was completely uneventful.

Multiloculated epidermoid cyst of the liver

Epidermoid cysts of the liver are extremely rare and have been described in both children and adults. Their etiology remains an enigma, and several theories have been suggested as to their origin. Due to their possible malignant potential, early detection and resection are mandatory whether the cysts are unilocular or multilocular.

Solitary nonparasitic cysts of the liver: the Boston Children's Hospital experience

A 3 3/12-year-old female child with abdominal distention, new onset pain, and tenderness is described. The child underwent surgical resection of a multilocular cyst of the right lobe of the liver. We reviewed the autopsy and surgical files of Children's Hospital for the past 63 years to identify other congenital cysts of the liver. We found 30 additional cases including 4 multilocular cysts. The origin of these cysts, a review of the literature, and a discussion of diagnostic parameters for the identification of such cysts in context with other hepatobiliary cystic lesions are presented.

Congenital solitary nonparasitic cyst of the liver in a newborn

Congenital solitary nonparasitic cysts of the liver (CSNCL) are extremely rare causes of abdominal masses in newborns and infants. We describe a cystic abdominal mass virtually all extrahepatic in a newborn that proved to be a CSNCL.