101
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Fresneau B, Oberlin O, Brugières L, Valteau-Couanet D, Patte C. [Malignant primary cardiac tumors in childhood and adolescence]. Arch Pediatr 2010; 17:495-501. [PMID: 20338733 DOI: 10.1016/j.arcped.2010.02.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2008] [Revised: 03/10/2009] [Accepted: 02/11/2010] [Indexed: 11/19/2022]
Abstract
Primary heart tumors are uncommon in children. The majority of them are benign, with only 10% malignant. Among malignant cardiac tumors, sarcoma (rhabdomyosarcoma, angiosarcoma, synovial sarcoma) and lymphoma (Burkitt's lymphoma, large B-cell lymphoma, lymphoblastic lymphoma) predominate. There are few published pediatric series on malignant primary cardiac tumors. We report here 3 observations of primary malignant cardiac tumors, 2 cases of sarcoma (angiosarcoma and synovial sarcoma) and 1 case of Burkitt's lymphoma. A precise pathological diagnosis is necessary for the proper management of these patients. For sarcoma, treatment associates surgery and chemotherapy. Surgery should be as complete as possible because of the lack of chemotherapy sensitivity of some sarcomas, mainly angiosarcoma and synovial sarcoma. Therefore, the prognosis of cardiac sarcoma remains poor. For primary cardiac lymphoma, management should not be different from lymphoma in other locations. Chemotherapy is the main treatment, and surgery has to be used only when complications occur. Prognosis depends on histology and not lymphoma location, and so is better than the prognosis for sarcoma.
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MESH Headings
- Adolescent
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Burkitt Lymphoma/diagnosis
- Burkitt Lymphoma/drug therapy
- Burkitt Lymphoma/pathology
- Burkitt Lymphoma/surgery
- Chemotherapy, Adjuvant
- Combined Modality Therapy
- Cough/etiology
- Diagnosis, Differential
- Dyspnea/etiology
- Echocardiography
- Fatal Outcome
- Female
- Heart Atria/pathology
- Heart Atria/surgery
- Heart Neoplasms/diagnosis
- Heart Neoplasms/drug therapy
- Heart Neoplasms/pathology
- Heart Neoplasms/surgery
- Hemangiosarcoma/diagnosis
- Hemangiosarcoma/drug therapy
- Hemangiosarcoma/pathology
- Hemangiosarcoma/surgery
- Humans
- Male
- Neoplasm Recurrence, Local/diagnosis
- Neoplasm Recurrence, Local/pathology
- Neoplasm, Residual/diagnosis
- Neoplasm, Residual/pathology
- Pulmonary Heart Disease/diagnosis
- Pulmonary Heart Disease/etiology
- Sarcoma, Synovial/diagnosis
- Sarcoma, Synovial/drug therapy
- Sarcoma, Synovial/pathology
- Sarcoma, Synovial/surgery
- Superior Vena Cava Syndrome/diagnosis
- Superior Vena Cava Syndrome/etiology
- Tomography, X-Ray Computed
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Affiliation(s)
- B Fresneau
- Service d'oncologie pédiatrique, institut Gustave-Roussy, rue Camille-Desmoulins, 94800 Villejuif, France.
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102
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Considerations for prenatal counselling of patients with cardiac rhabdomyomas based on their cardiac and neurologic outcomes. Cardiol Young 2010; 20:18-24. [PMID: 20092673 DOI: 10.1017/s1047951109992046] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Cardiac rhabdomyomas are benign cardiac tumours with few cardiac complications, but with a known association to tuberous sclerosis that affects the neurologic outcome of the patients. We have analysed the long-term cardiac and neurological outcomes of patients with cardiac rhabdomyomas in order to allow comprehensive prenatal counselling, basing our findings on the records of all patients seen prenatally and postnatally with an echocardiographic diagnosis of cardiac rhabdomyoma encountered from August, 1982, to September, 2007. We analysed factors such as the number and the location of the tumours to establish their association with a diagnosis of tuberous sclerosis, predicting the cardiac and neurologic outcomes for the patients.Cardiac complications include arrhythmias, obstruction of the ventricular outflow tracts, and secondary cardiogenic shock. Arrhythmias were encountered most often during the neonatal period, with supraventricular tachycardia being the commonest rhythm disturbance identified. No specific dimension or location of the cardiac rhabdomyomas predicted the disturbances of rhythm.The importance of the diagnosis of tuberous sclerosis is exemplified by the neurodevelopmental complications, with four-fifths of the patients showing epilepsy, and two-thirds having delayed development. The presence of multiple cardiac tumours suggested a higher risk of being affected by tuberous sclerosis. The tumours generally regress after birth, and cardiac-related problems are rare after the perinatal period. Tuberous sclerosis and the associated neurodevelopmental complications dominate the clinical picture, and should form an important aspect of the prenatal counselling of parents.
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103
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Gedikbasi A, Oztarhan K, Yararbas K, Arslan O, Yildirim D, Oztek I, Ceylan Y. Prenatal diagnsis of intracardiac hamartoma and Turner syndrome. Fetal Pediatr Pathol 2010; 29:330-7. [PMID: 20704479 DOI: 10.3109/15513815.2010.494699] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Turner syndrome is associated with a higher frequency of heart defects detected prenatally when compared to postnatal reports. The most common heart defects detected prenatally are hypoplastic left heart syndrome and coarctation of the aorta. We report a case involving a fetus at 16 gestational weeks with a septated cystic hygroma located on the neck and head, an interventricular septal mass, a hypoplastic left ventricle due to aortic stenosis, mitral stenosis, and a hypoplastic aortic arch with a karyotype of mos 45, X, [47 cells]/47, XXX [3 cells]. The autopsy findings confirmed our prenatal diagnosis with a final diagnosis of Turner syndrome and congenital cardiac vascular malformation.
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Affiliation(s)
- Ali Gedikbasi
- Department of Obstetrics and Gynecology, Istanbul Bakirkoy Maternity and Children Diseases Hospital, Turkey.
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104
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Saada J, Hadj Rabia S, Fermont L, Le Bidois J, Bernardes LS, Martinovic J, Sonigo P, Dumez Y, Bonnet D, Benachi A. Prenatal diagnosis of cardiac rhabdomyomas: incidence of associated cerebral lesions of tuberous sclerosis complex. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2009; 34:155-159. [PMID: 19606448 DOI: 10.1002/uog.6367] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVES To determine the prevalence of specific cerebral lesions of tuberous sclerosis complex (TSC) and neurological outcome in cases diagnosed prenatally with cardiac rhabdomyomas. METHODS We reviewed all fetuses diagnosed prenatally with cardiac rhabdomyomas which had undergone detailed ultrasound evaluation and cerebral magnetic resonance imaging (MRI) and which were recorded in the database of a single institution covering the period January 1992 to December 2005. RESULTS Fifty-one fetuses were included in the study. MRI was performed at a mean +/- SD gestational age of 30 +/- 3 gestational weeks and showed specific lesions of TSC in 49% of cases. Termination of pregnancy was chosen by the parents in 26 cases. Neurological development was studied in 20 cases, follow-up lasting 4.8 +/- 2.9 years. Neurodevelopmental events occurred during the follow-up period in 45% of cases. Neurological complications occurred in 67% of patients who had cerebral lesions at MRI and in 33% of patients with normal MRI results. There was no significant difference between the two groups of patients (P = 0.2). CONCLUSION In fetuses with cardiac rhabdomyomas detailed ultrasound examination and third-trimester cerebral MRI are able to diagnose most TSC cerebral lesions, but fail to determine neurological outcome.
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Affiliation(s)
- J Saada
- Maternité, Université Paris-Descartes, Faculté de Médecine, AP-HP, Hôpital Necker-Enfants Malades, Paris, France.
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105
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Abstract
Although cardiac tumours are rare, such tumours are increasingly being diagnosed with increasing frequency and great accuracy by antenatal ultrasound. Cardiac haemangiomas account for less than one-twentieth of all primary cardiac tumours, with most being diagnosed in the neonatal period. We report 3 instances of successful neonatal resection of cardiac haemangioma subsequent to prenatal diagnosis. Such diagnosis is important in perinatal management, since early surgical intervention provides a good prognosis.
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106
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Gazit AZ, Singh GK, Shumway J, Johnson MC, Ludomirsky A. Fetal cardiac rhabdomyoma: A sheep or a wolf? J Matern Fetal Neonatal Med 2009; 20:343-8. [PMID: 17437243 DOI: 10.1080/14767050601158297] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Rhabdomyoma is the most common primary cardiac tumor identified in utero and in infancy. Usually it has a benign course, which has prompted an expectant approach to its management. We report herein the cases of three patients who presented prenatally with cardiac rhabdomyomas. Only one of them had a benign course. The other two patients provided recognizable characteristics of rhabdomyomas with an unfavorable course and demonstrated that fetal rhabdomyomas can have a fatal outcome.
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Affiliation(s)
- Avihu Z Gazit
- Department of Pediatrics, Division of Pediatric Cardiology, Washington University School of Medicine, St Louis, MO, USA
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107
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Early complete regression of multiple cardiac tumors suggestive of cardiac rhabdomyomas. Rev Esp Cardiol 2009; 62:708-9. [PMID: 19480772 DOI: 10.1016/s1885-5857(09)72241-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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108
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Guimarães Filho HA, Araujo Junior E, Pires CR, Costa LLDD, Nardozza LMM, Mattar R. Diagnóstico pré-natal de rabdomioma cardíaco fetal pela ultrassonografia: relato de caso. Radiol Bras 2009. [DOI: 10.1590/s0100-39842009000300015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Os tumores cardíacos constituem condição rara, com incidência entre 0,17 e 28/10.000 na população geral. Os rabdomiomas são os tumores mais frequentes no período pré-natal. Este trabalho tem como objetivo relatar o caso de um feto com 31 semanas de gestação que apresentava tumoração intracardíaca de grandes dimensões, com graves repercussões clínicas.
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109
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Remisión completa precoz de tumoraciones cardiacas múltiples sugestivas de rabdomiomas cardiacos. Rev Esp Cardiol 2009. [DOI: 10.1016/s0300-8932(09)71344-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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110
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Abstract
Rhabdomyomas are the most common cardiac tumours in children. They sometimes cause significant obstruction of the ventricular out flow tracts. We report a series of 3 neonates diagnosed antenatally with multiple rhabdomyomas, who developed significant obstruction of the ventricular outflow tracts following birth. They underwent surgical resection in the neonatal period with good outcome. Antenatal diagnosis of obstructive cardiac tumours allows for planning for appropriate early intervention.
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111
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Günther T, Schreiber C, Noebauer C, Eicken A, Lange R. Treatment strategies for pediatric patients with primary cardiac and pericardial tumors: a 30-year review. Pediatr Cardiol 2008; 29:1071-6. [PMID: 18600370 DOI: 10.1007/s00246-008-9256-6] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2008] [Revised: 04/19/2008] [Accepted: 06/04/2008] [Indexed: 11/24/2022]
Abstract
This study reviewed different types of primary cardiac and mediastinal tumors in infants and children as well as their clinical presentation and management. Altogether, 34 consecutive patients followed from 1976 through December 2005 were analyzed. Of these 34 patients, 14 (41%) underwent surgery and 20 (59%) with rhabdomyomas were managed conservatively. Histologic examination of the surgically resected tumors showed teratoma in four patients, rhabdomyoma in four patients, and hemangioma in two patients. Myxoma, myofibroma, neuroblastoma, and malignant fibrous histiocytoma were encountered in one patient each. Follow-up evaluation was completed for 97% of the patients and extended up to 30 years. Half of the nonsurgical patients with rhabdomyoma showed partial or complete spontaneous regression. One patient died after resection of a malignant histiocytoma, and one patient required a tumor-related reoperation. Freedom from tumor-related reoperation after 10 years was 91% +/- 8.7%. Of the survivors, 85% were New York Heart Association (NYHA) class 1, and 100% had sinus rhythm. Spontaneous tumor regression is common in rhabdomyoma and surgery, and is indicated only for symptomatic patients with hemodynamically significant intracardiac obstruction. For all other benign primary cardiac tumors, complete resection usually can be accomplished with good results. Patients with giant tumor masses compressing or infiltrating the heart frequently cannot undergo complete resection. For these patients, restoration/preservation of sufficient heart function is the primary goal. Malignant tumors are extremely rare in pediatric patients and have a very poor prognosis.
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Affiliation(s)
- Thomas Günther
- Department of Cardiovascular Surgery, German Heart Center at the Technical University, Lazarettstrasse, Munich, Germany
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112
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Descartes M, Romp R, Franklin J, Biggio JR, Zehnbauer B. Constitutional H19 hypermethylation in a patient with isolated cardiac tumor. Am J Med Genet A 2008; 146A:2126-9. [DOI: 10.1002/ajmg.a.32421] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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113
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Burke A, Virmani R. Pediatric heart tumors. Cardiovasc Pathol 2008; 17:193-8. [PMID: 18402818 DOI: 10.1016/j.carpath.2007.08.008] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2007] [Revised: 08/27/2007] [Accepted: 08/28/2007] [Indexed: 01/28/2023] Open
Affiliation(s)
- Allen Burke
- CVPath Institute, Gaithersburg, MD 20878, USA.
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114
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Chao AS, Chao A, Wang TH, Chang YC, Chang YL, Hsieh CC, Lien R, Su WJ. Outcome of antenatally diagnosed cardiac rhabdomyoma: case series and a meta-analysis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2008; 31:289-295. [PMID: 18307215 DOI: 10.1002/uog.5264] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVES Rhabdomyoma, the most common primary fetal cardiac tumor, is often associated with tuberous sclerosis (TS). We aimed to evaluate outcome in cases diagnosed with fetal cardiac rhabdomyoma. METHODS This study presents 11 cases with fetal cardiac rhabdomyoma. In addition, all relevant published cases of antenatally diagnosed cardiac rhabdomyoma since 1982 were identified from MEDLINE. We evaluated the following risk factors associated with clinical impact and perinatal outcome: family history of TS, gestational age at diagnosis, tumor size, site and number of tumors, tumor progression, and associated intracardiac and extracardiac anomalies. RESULTS In this meta-analysis, 138 cases, including nine newly added by us, were categorized into Group A (107 live babies) and Group B (16 neonatal deaths and 15 intrauterine fetal deaths). Univariate analysis showed that large cardiac tumors (P < 0.0001), fetal dysrhythmia (P < 0.0001) and hydrops (P < 0.0001) were strong predictors of neonatal outcome. Tumor size >or= 20 mm (relative risk (RR), 20.6; 95% CI, 2.2-195.9; P = 0.009) and fetal dysrhythmia (RR, 13.6; 95% CI, 2.9-62.3; P = 0.001) were significantly associated with neonatal morbidity. TS, present in 85/133 (63.9%) cases, was significantly associated with multiple cardiac tumors (P < 0.0001) and family history of TS (P = 0.02). CONCLUSIONS Large tumor size and hydrops are significantly associated with poor neonatal outcome, whereas family history of TS and multiple fetal cardiac tumors are associated with TS. Any sonographic detection of a fetal cardiac tumor should warrant further investigation for the possible presence of associated disorders.
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Affiliation(s)
- A S Chao
- Department of Obstetrics and Gynecology, Chang-Gung Memorial Hospital and Chang Gung University, Tao-Yuan, Taiwan.
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115
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Tanrikulu MA, Ozben B, Cincin AA, Baskan O, Agirbasli M. A pedunculated left ventricular hemangioma initially misdiagnosed as thrombus in a woman with atypical chest pain. J Thromb Thrombolysis 2008; 27:227-32. [PMID: 18246465 DOI: 10.1007/s11239-008-0201-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2008] [Accepted: 01/21/2008] [Indexed: 10/22/2022]
Abstract
The incidence of cardiac masses increased as echocardiography is becoming increasingly popular. Benign tumors of the heart constitute about 72% of all primary cardiac neoplasms and hemangioma accounts for 5-10% of benign cardiac tumors. Cardiac hemangiomas are generally asymptomatic and diagnosed incidentally during echocardiography or magnetic resonance imaging (MRI). We reported a 52-year-old woman presented with atypical chest pain and exertional dyspnea. The echocardiographic examination revealed a hyperechoic round mass in the left ventricle. With an initial diagnosis of left ventricular thrombus, the patient underwent cardiac MRI. The mass was found compatible with cardiac hemangioma. It was removed surgically and histopathologic evaluation identified a cardiac hemangioma. As reports of cardiac hemangioma are extremely rare and cardiac masses are mostly thought to be thrombi or myxomas (being the most common primary cardiac tumor), such hemangioma cases warrant attention as possibility of hemangioma should also be kept in mind.
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Affiliation(s)
- M Azra Tanrikulu
- Department of Cardiology, Faculty of Medicine, Marmara University, Yildiz Caddesi Konak Apartmani No. 43/24, 34353 Besiktas, Istanbul, Turkey
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116
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Fetal cardiac rhabdomyoma with maternal tuberous sclerosis complicating pregnancy. Arch Gynecol Obstet 2008; 278:169-70. [DOI: 10.1007/s00404-008-0559-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2007] [Accepted: 01/03/2008] [Indexed: 10/22/2022]
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117
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Schwartz RA, Fernández G, Kotulska K, Jóźwiak S. Tuberous sclerosis complex: advances in diagnosis, genetics, and management. J Am Acad Dermatol 2007; 57:189-202. [PMID: 17637444 DOI: 10.1016/j.jaad.2007.05.004] [Citation(s) in RCA: 260] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2006] [Revised: 04/30/2007] [Accepted: 05/10/2007] [Indexed: 12/22/2022]
Abstract
UNLABELLED Tuberous sclerosis complex (TSC) is an autosomal dominant multisystem neurocutaneous syndrome characterized by the development of multiple hamartomas distributed throughout the body, skin, brain, heart, kidneys, liver, and lungs. Two-thirds of patients represent sporadic mutations. The classic triad is seizures, mental retardation, and cutaneous angiofibromas. However, the full triad occurs in only 29% of patients; 6% of them lack all three of them. Two tumor suppressor genes responsible for TSC have been identified: TSC1 gene on chromosome 9 and TSC2 on chromosome 16. This article highlights the most recent significant advances in the diagnosis and genetics of TSC, along with a discussion on the limitations and the usefulness of the revised 1998 clinical criteria for the tuberous sclerosis complex. The "ash leaf" macule often comes in other shapes, such as round; most are polygonal, usually 0.5 cm to 2.0 cm in diameter, resembling a thumbprint. Since the death of its describer, Thomas Fitzpatrick, we call each a "Fitzpatrick patch." Special attention is paid in this work to TSC treatment options, including therapeutic trials with rapamycin, also known as sirolimus. LEARNING OBJECTIVE After completing this learning activity, participants should familiar with tuberous sclerosis complex, its cutaneous signs and systemic findings stratified by patient age, its genetics, and the potential for meaningful therapeutic intervention.
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Affiliation(s)
- Robert A Schwartz
- Department of Dermatology, New Jersey Medical School, Newark, NJ 07103, USA.
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118
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Mühler MR, Rake A, Schwabe M, Schmidt S, Kivelitz D, Chaoui R, Hamm B. Value of fetal cerebral MRI in sonographically proven cardiac rhabdomyoma. Pediatr Radiol 2007; 37:467-74. [PMID: 17357805 DOI: 10.1007/s00247-007-0436-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2007] [Revised: 02/16/2007] [Accepted: 02/18/2007] [Indexed: 11/26/2022]
Abstract
BACKGROUND Tuberous sclerosis complex (TSC) is an autosomal dominant phakomatosis associated with intracardiac rhabdomyomas. OBJECTIVE The aim of our study was to examine the value of cerebral MRI in diagnosing TSC in fetuses with intracardiac rhabdomyomas, applying the TSC Consensus Conference (TSCCC) criteria. MATERIALS AND METHODS In a prospective manner six consecutive fetuses with cardiac rhabdomyomas (21-34 weeks' gestation) underwent cerebral MRI. The MRI results were correlated with clinical follow-up at 10-34 months after birth, histology, and genetic data. RESULTS In five of the six fetuses the diagnosis of TSC was established. In two of five fetuses MRI demonstrated cerebral manifestations of TSC that correlated well with severe epilepsy manifesting during the follow-up period. In another two of five fetuses MRI as well as clinical follow-up were normal. One of five pregnancies was terminated and histology demonstrated microscopically small subependymal nodules not demonstrated by MRI. CONCLUSION The results of our study agree with the available literature that fetal MRI is sufficient for the detection of cerebral lesions in TSC and should be better promoted. The TSCCC criteria can also be applied to fetal MRI.
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Affiliation(s)
- Matthias R Mühler
- Department of Radiology, Charité Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117, Berlin, Germany.
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119
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Uzun O, Wilson DG, Vujanic GM, Parsons JM, De Giovanni JV. Cardiac tumours in children. Orphanet J Rare Dis 2007; 2:11. [PMID: 17331235 PMCID: PMC3225855 DOI: 10.1186/1750-1172-2-11] [Citation(s) in RCA: 159] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2006] [Accepted: 03/01/2007] [Indexed: 01/12/2023] Open
Abstract
Cardiac tumours are benign or malignant neoplasms arising primarily in the inner lining, muscle layer, or the surrounding pericardium of the heart. They can be primary or metastatic. Primary cardiac tumours are rare in paediatric practice with a prevalence of 0.0017 to 0.28 in autopsy series. In contrast, the incidence of cardiac tumours during foetal life has been reported to be approximately 0.14%. The vast majority of primary cardiac tumours in children are benign, whilst approximately 10% are malignant. Secondary malignant tumours are 10-20 times more prevalent than primary malignant tumours. Rhabdomyoma is the most common cardiac tumour during foetal life and childhood. It accounts for more than 60% of all primary cardiac tumours. The frequency and type of cardiac tumours in adults differ from those in children with 75% being benign and 25% being malignant. Myxomas are the most common primary tumours in adults constituting 40% of benign tumours. Sarcomas make up 75% of malignant cardiac masses. Echocardiography, Computing Tomography (CT) and Magnetic Resonance Imaging (MRI) of the heart are the main non-invasive diagnostic tools. Cardiac catheterisation is seldom necessary. Tumour biopsy with histological assessment remains the gold standard for confirmation of the diagnosis. Surgical resection of primary cardiac tumours should be considered to relieve symptoms and mechanical obstruction to blood flow. The outcome of surgical resection in symptomatic, non-myxomatous benign cardiac tumours is favourable. Patients with primary cardiac malignancies may benefit from palliative surgery but this approach should not be recommended for patients with metastatic cardiac tumours. Surgery, chemotherapy and radiotherapy may prolong survival. The prognosis for malignant primary cardiac tumours is generally extremely poor.
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Affiliation(s)
- Orhan Uzun
- Consultant Paediatric Cardiologist, Department of Paediatric Cardiology, University Hospital Of Wales, Heath Park Cardiff, CF14 4XW, Wales, UK
| | - Dirk G Wilson
- Consultant Paediatric Cardiologist, Department of Paediatric Cardiology, University Hospital Of Wales, Heath Park Cardiff, CF14 4XW, Wales, UK
| | - Gordon M Vujanic
- Consultant Senior Lecturer in Paediatric Pathology, School of Medicine, Cardiff University, Heath Park, Cardiff CF14 4XW, Wales, UK
| | - Jonathan M Parsons
- Consultant Paediatric Cardiologist, Yorkshire Heart Centre, Department Of Paediatric Cardiology, Leeds, UK
| | - Joseph V De Giovanni
- Consultant Paediatric Cardiologist. Birmingham Children's Hospital, Birmingham, UK
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120
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Hou CF, Chao A, Wang CJ, Chao AS, Hsueh C. Atrial hemangioma: A rare cause of hydrops fetalis and intrauterine fetal death. Eur J Obstet Gynecol Reprod Biol 2007; 130:271-2. [PMID: 16621228 DOI: 10.1016/j.ejogrb.2006.02.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2005] [Revised: 01/12/2006] [Accepted: 02/08/2006] [Indexed: 11/29/2022]
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121
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Stainback RF, Hamirani YS, Cooley DA, Buja LM. Tumors of the Heart. CARDIOVASCULAR MEDICINE 2007. [DOI: 10.1007/978-1-84628-715-2_110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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122
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Abstract
We present our experience in the management of fetuses diagnosed with huge cardiac tumors. These cases illustrate that the size of the tumor likely does not impact on survival as much as the location of the tumor and how it compromises blood flow into and out of the ventricles. We speculate that obstruction of right-sided inflow and/or simultaneous obstruction to outflow from both ventricles may lead to diminished cardiac output, atrial and caval hypertension, and hydrops fetalis. Obstruction can occur at any point in gestation and depends on both the size and the location of the tumor in relation to all cardiac structures. We therefore suggest serial assessment of these fetuses throughout gestation, particularly after the point of postnatal viability, to assess the hemodynamic effects that the tumor has on the heart. If obstruction to blood flow and/or early fetal compromise is noted, then the decision of whether to deliver early can be made. At the time of birth, if obstruction to blood flow persists, surgery can be considered, keeping in mind that the natural history of these tumors is to shrink and become clinically less important over time.
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Affiliation(s)
- S R Lacey
- Virginia Commonwealth University Health System, 1200 East Broad Street, Box 980026, Richmond, VA 23298, USA
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123
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Ilina MV, Jaeggi ET, Lee KJ. Neonatal rhabdomyoma causing right ventricular inflow obstruction with duct-dependent pulmonary blood flow: Successful stenting of PDA. Catheter Cardiovasc Interv 2007; 69:881-5. [PMID: 17436271 DOI: 10.1002/ccd.21064] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
We describe an infant with the antenatal diagnosis of a large intracardiac rhabdomyoma causing tricuspid inflow obstruction. Postnatal cyanosis and arterial hypoxemia prompted commencement of intravenous prostaglandin E1 with immediate improvement in saturations. Clinical and genetic testing confirmed diagnosis of tuberous sclerosis. To secure ductal patency, two tandem coronary stents were implanted via an antegrade approach. Several episodes of long RP atrio-ventricular re-entrant tachycardia were observed. At 7(1/2) months of age, the tumor was no longer obstructive to tricuspid inflow, ductal flow was highly restrictive and there was no recurrence of supraventricular tachycardia.
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Affiliation(s)
- Maria V Ilina
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto School of Medicine, Toronto, Ontario, Canada
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124
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Motto A, Ballo P, Bocelli A, Gramenzi S, de Martino M. Echocardiographic History of an Asymptomatic Congenital Cardiac Tumor. Circulation 2006; 114:e591-3. [PMID: 17116773 DOI: 10.1161/circulationaha.106.637116] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Andrea Motto
- Cardiology Operative Unit, S. Andrea Hospital, La Spezia, Italy
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125
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Atallah J, Robertson M, Rebeyka IM, Dyck J, Noga ML. Antenatal diagnosis and successful surgical removal of a large right ventricular fibroma. Pediatr Cardiol 2006; 27:493-6. [PMID: 16835803 DOI: 10.1007/s00246-006-1260-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2005] [Accepted: 03/13/2006] [Indexed: 11/26/2022]
Abstract
Congenital cardiac tumors are very rare and fibromas are the second most common type. Fibromas are benign tumors, but they have potentially serious complications. Their antenatal diagnosis is infrequently reported in the literature, and the management of these tumors is a source of controversy. We report the case of a rare form of right ventricular free wall fibroma. Antenatal diagnosis was made at 36 weeks of gestation, with subsequent successful resection at 2 weeks of age. A brief review of the literature focuses on the diagnostic approach and the clinical and surgical management of congenital cardiac fibromas.
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Affiliation(s)
- Joseph Atallah
- Division of Pediatric Cardiology, University of Alberta Hospitals, Stollery Children's Hospital, Edmonton, Alberta, Canada T6G 2B7.
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126
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Chen CP, Liu YP, Huang JK, Chang TY, Chen MR, Chiu NC, Wang W. Contribution of ultrafast magnetic resonance imaging in prenatal diagnosis of sonographically undetected cerebral tuberous sclerosis associated with cardiac rhabdomyomas. Prenat Diagn 2005; 25:523-4. [PMID: 15966047 DOI: 10.1002/pd.1182] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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127
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Ikemba CM, Eidem BW, Dimas VV, O'Day MP, Fraser CD. Fetal Rhabdomyoma Causing Postnatal Critical Left Ventricular Outflow Tract Obstruction. Ann Thorac Surg 2005; 80:1529. [PMID: 16181915 DOI: 10.1016/j.athoracsur.2003.10.095] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/28/2003] [Indexed: 11/25/2022]
Affiliation(s)
- Catherine M Ikemba
- Division of Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA.
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128
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Gandy KL, Burtelow MA, Reddy VM, Silverman NH. Myofibroblastic tumor of the heart: A rare intracardiac tumor. J Thorac Cardiovasc Surg 2005; 130:888-9. [PMID: 16153948 DOI: 10.1016/j.jtcvs.2005.02.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2005] [Accepted: 02/08/2005] [Indexed: 10/25/2022]
Affiliation(s)
- Kimberly L Gandy
- Division of Pediatric Cardiac Surgery, Stanford University School of Medicine, Stanford, Calif, USA.
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129
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Hirakubo Y, Ichihashi K, Shiraishi H, Momoi MY. Ventricular tachycardia in a neonate with prenatally diagnosed cardiac tumors: a case with tuberous sclerosis. Pediatr Cardiol 2005; 26:655-7. [PMID: 16132312 DOI: 10.1007/s00246-004-0714-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
We report a patient with prenatally diagnosed tuberous sclerosis. Fetal ultrasonography demonstrated multiple cardiac tumors and arrhythmia. After birth, because of frequent supraventricular extrasystoles, the infant was admitted to the neonatal intensive care unit. Findings on 24-hour ambulatory electrocardiogram (ECG) showed frequent supraventricular tachycardia and ventricular tachycardia with four beats as the longest run. At the age of 12 days, he developed cardiopulmonary arrest after crying out. A monitored ECG showed ventricular tachycardia. Twenty minutes after onset, a 12-lead ECG showed ventricular fibrillation, which returned to normal sinus rhythm with repeated DC cardioversion. Oral antiarrhythmic therapy with carteolol hydrochloride was effective. The patient showed no further symptoms after oral medication was initiated and the tumors regressed spontaneously.
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Affiliation(s)
- Y Hirakubo
- Department of Pediatrics, Jichi Medical School, Minamikawachi, Tochigi 329-0498, Japan.
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130
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Mackie AS, Kozakewich HPW, Geva T, Perez-Atayde AR, Mulliken JB. Vascular tumors of the heart in infants and children: case series and review of the literature. Pediatr Cardiol 2005; 26:344-9. [PMID: 15549621 DOI: 10.1007/s00246-004-0717-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Primary tumors of the heart are rare in children, of which vascular tumors comprise a small subgroup. We present the clinical, histopathologic, and imaging findings in six children with vascular tumors of the heart and review the findings of 36 previously published cases. We observed three intramuscular hemangiomas of the small-vessel type in older children, two congenital hemangiomas in infants, and one malignant polymorphous hemangioendothelioma. Intramuscular hemangiomas did not respond to corticosteroid and were biologically distinct from the congenital hemangiomas, both of which exhibited regression with pharmacotherapy. Age at diagnosis appears to predict histologic type, tumor location, and clinical presentation.
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Affiliation(s)
- A S Mackie
- Department of Cardiology, Children's Hospital Boston, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
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131
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Padalino MA, Basso C, Milanesi O, Vida VL, Moreolo GS, Thiene G, Stellin G. Surgically treated primary cardiac tumors in early infancy and childhood. J Thorac Cardiovasc Surg 2005; 129:1358-63. [PMID: 15942578 DOI: 10.1016/j.jtcvs.2004.10.020] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Primary heart tumors in childhood are rare and mostly benign. Surgical treatment is advocated when symptoms or hemodynamic impairment is present. MATERIALS AND METHODS Between 1986 and 2003, 8 children (3 males and 5 females, age ranging 5 days to 6.7 years, median 78 days) with a clinical diagnosis of cardiac mass were treated with surgery. Diagnosis was made by prenatal echocardiography in 3 patients and by 2-dimensional Doppler echocardiography in 5 patients. RESULTS Complete surgical excision of the cardiac mass was feasible in all but 1 patient who underwent orthotopic heart transplantation. Surgical pathology examination revealed myxoma in 2 patients, fibroma in 2 patients, rhabdomyoma in 2 patients (multiple in 1), hamartoma in 1 patient, and teratoma in 1 patient. One patient died of cerebral malignancy 38 months after cardiac transplantation. At a mean follow-up of 69.2 months (range 3-190 months), all the remaining patients are asymptomatic, with good ventricular function on 2-dimensional echocardiography and no signs of residual or recurrent tumor. CONCLUSION Surgical excision of obstructive cardiac tumors in childhood is safely feasible. Heart transplantation may represent the only therapeutic option when the tumor extensively invades the ventricular walls. Although 2-dimensional echocardiography remains a reliable diagnostic tool, a definite diagnosis of tumor histotype requires a thorough histopathologic characterization.
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Affiliation(s)
- Massimo A Padalino
- Division of Pediatric Cardiovascular Surgery, University of Padova Medical School, Padova, Italy
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132
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Vettraino IM, Hoprasart NJ, Bronsteen RA, Comstock CH. Clinical implications of the prenatal sonographic finding of fetal myocardial echogenic foci. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2005; 24:195-199. [PMID: 15661950 DOI: 10.7863/jum.2005.24.2.195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVE The purpose of this study was to investigate the clinical implications of fetal echogenic foci limited to the myocardium of the ventricular wall (EMF) or intraventricular septum detected during prenatal sonography. METHODS A retrospective review of fetuses found to have EMF during prenatal sonography from April 1990 through December 2003 was undertaken. Videotapes and reports were reviewed to determine the indication for sonography, gestational age, location, sonographic characteristics of the masses, and additional fetal findings. Sources of outcome data included neonatal and pediatric records and echocardiographic reports. RESULTS Five fetuses were identified. Indications for sonographic evaluation included fetal growth (n = 4) and follow-up twin-twin transfusion syndrome (n = 1). Mean gestational age +/- SD at diagnosis was 23.7 +/- 8.0 weeks (range, 17.1-36.4 weeks). The EMF identified were within the right ventricular myocardium (n = 2), intraventricular septum (n = 1), left ventricular myocardium (n = 1), and myocardium of the cardiac apex (n = 1). All foci appeared sonographically "bright as bone." The foci ranged in size from 0.1 x 0.1 to 1.2 x 0.9 cm. Neonatal echocardiographic findings were reported as normal for each of the cases. Follow-up examinations available for up to 2.5 years of age showed normal cardiac function. CONCLUSIONS The prenatal identification of EMF is unlikely to lead to notable short-term pathologic conditions because the fetuses in this investigation had unremarkable neonatal and pediatric echocardiograms and normal cardiac function.
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Affiliation(s)
- Ivana M Vettraino
- Department of Obstetrics and Gynecology, Division of Fetal Imaging, William Beaumont Hospital, 3601 W Thirteen Mile Rd, Royal Oak, MI 48073-6769, USA.
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133
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Tallarico D, Chiavari PA, Critelli G, Carbone I, Passariello R. Visualization of right atrial tumor mass with transesophageal echocardiography through nasal way (TEENW). J Am Soc Echocardiogr 2005; 18:69-70. [PMID: 15637492 DOI: 10.1016/j.echo.2004.08.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Demetrio Tallarico
- Second Division of Cardiology, Institute of the Heart and Great Vessels, University La Sapienza, Rome Italy.
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134
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Milunsky A, Shim SH, Ito M, Jaekle RK, Bassett LL, Brumund MR, Milunsky JM. Precise prenatal diagnosis of tuberous sclerosis by sequencing the TSC2 gene. Prenat Diagn 2005; 25:582-5. [PMID: 16032769 DOI: 10.1002/pd.1197] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The presumptive prenatal diagnosis of tuberous sclerosis (TSC) previously depended upon fetal imaging. Cloning of the two TSC genes (TSC1 and TSC2) now enables precise molecular diagnosis by gene sequencing. We used this approach for the prenatal diagnosis of a fetus showing multiple intracardiac tumors. METHODS DNA extracted from cultivated amniotic fluid cells underwent sequencing of all coding regions and exon-intron boundaries of the TSC1 and TSC2 genes. RESULTS A mutation (R611Q) was found in exon 16 of the TSC2 gene. Thus far, neither clinically unaffected parents has provided blood samples for mutation analysis. CONCLUSION For the first time, mutation analysis of a TSC gene enabled a precise prenatal diagnosis.
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Affiliation(s)
- Aubrey Milunsky
- Center for Human Genetics, Boston University School of Medicine, Boston, MA 02118, USA.
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135
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Tongsong T, Sirichotiyakul S, Sittiwangkul R, Wanapirak C. Prenatal sonographic diagnosis of cardiac hemangioma with postnatal spontaneous regression. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2004; 24:207-208. [PMID: 15287062 DOI: 10.1002/uog.1102] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
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136
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Kauffmann E, Randrianaivo H, Boumahni B, Roman H, Laffitte A, Dumas H, Barau G, Fourmaintraux A. [Post mortem brain MRI: an alternative for pathology examination in Bourneville tuberous sclerosis of the fetus?]. ACTA ACUST UNITED AC 2004; 33:245-7. [PMID: 15170440 DOI: 10.1016/s0368-2315(04)96446-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Antenatal discovery of cardiac rhabdomyomes evokes the diagnosis of Bourneville's disease. Antenatal brain exploration with ultrasonography and magnetic resonance imaging (MRI) can highlight cerebral localizations. In the event of termination of pregnancy, confirmation of the cerebral lesions can be achieved with post mortem MRI as well as pathology examination. MRI can be usefully employed in the event pathology examination is not feasible.
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Affiliation(s)
- E Kauffmann
- Centre Pluridisciplinaire de Diagnostic Prénatal du Groupe Hospitalier Sud Réunion, BP 350, 97448 Saint-Pierre Cedex, La Réunion, France.
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137
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Abstract
Primary tumors of the heart are uncommon in the fetus and neonate. Nevertheless, the widespread use of new imaging techniques has contributed significantly to earlier diagnosis, treatment, and thus improved survival. The clinical findings, imaging studies, pathology, and outcome of 224 fetuses and neonates with cardiac tumors collected from the literature are evaluated and discussed. Most tumors are benign, and of these rhabdomyoma is the most common, followed by teratoma, fibroma, oncocytic cardiomyopathy, vascular tumors, and myxoma. Malignant and metastatic tumors are described but are rare. Murmurs, arrhythmias, cyanosis, respiratory distress, and cardiac failure are the main presenting signs of cardiac tumors in the perinatal period. Disturbances in hemodynamic function are correlated with the size and location of the tumor. Cardiac vascular tumors have the best outcome, whereas malignant tumors have the worst. The purpose of this review is to concentrate on the fetus and neonate in an attempt to determine the various ways cardiac tumors differ clinically and morphologically in this age group from those occurring in older children and adults and to show that certain types of tumors have a better prognosis than others.
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Affiliation(s)
- H Isaacs
- Department of Pathology, Children's Hospital San Diego, 3020 Children's Way, MC 5007, San Diego, CA 92123, USA.
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138
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Zhou QC, Fan P, Peng QH, Zhang M, Fu Z, Wang CH. Prenatal echocardiographic differential diagnosis of fetal cardiac tumors. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2004; 23:165-171. [PMID: 14770398 DOI: 10.1002/uog.979] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVES To present data on echocardiographic findings of fetal cardiac tumors and discuss their differential diagnoses. METHODS We retrospectively reviewed 14 cases of fetal echogenic cardiac mass diagnosed between 1990 and 2003; 12 were confirmed to be cardiac tumors and two were false-positive diagnoses. The echocardiographic characteristics examined included number, size, location and associated complications. RESULTS Eight fetuses had a single tumor and four fetuses had multiple tumors. The left ventricle was most often affected. Parents of eight fetuses opted for termination of pregnancy, one fetus died in utero and three affected fetuses survived. Histopathological examination revealed cardiac rhabdomyoma in six fetuses, fibroma in two, teratoma in two, lipoma in one and hemangioma in one. The pitfalls associated with prenatal echocardiographic diagnosis of cardiac tumors include: they may be too small to be visualized, intracardiac echogenic foci may mimic tumors, and echogenicity resulting from extracardiac structures or neoplasms near the heart may falsely appear as tumors. CONCLUSION Fetal cardiac tumors can be detected by echocardiography. However, differential diagnosis is important as this will affect prognosis and subsequent management.
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Affiliation(s)
- Q C Zhou
- Department of Ultrasonography, Department of Obstetrics and Gynecology, Second Xiangya Hospital, Central South University, Changsha, P.R. China.
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139
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Prenatal Ultrasonographic Findings of a Cardiac Myxoma. Obstet Gynecol 2003. [DOI: 10.1097/00006250-200311001-00019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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140
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Bader RS, Chitayat D, Kelly E, Ryan G, Smallhorn JF, Toi A, Hornberger LK. Fetal rhabdomyoma: prenatal diagnosis, clinical outcome, and incidence of associated tuberous sclerosis complex. J Pediatr 2003; 143:620-4. [PMID: 14615733 DOI: 10.1067/s0022-3476(03)00494-3] [Citation(s) in RCA: 147] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES We reviewed our institution's experience with fetal cardiac rhabdomyoma to document the clinical outcome and incidence of associated tuberous sclerosis complex (TSC) and compared our findings with those of patients diagnosed with cardiac rhabdomyoma after birth. STUDY DESIGN We reviewed the medical records of all cases diagnosed prenatally and postnatally with cardiac rhabdomyoma between January 1990 and June 2002. RESULTS Twenty fetuses with cardiac rhabdomyoma were diagnosed at 28.4+/-6.0 weeks' gestational age. Of 19 continued pregnancies, there was one spontaneous intrauterine death, and 18 were delivered at term. Although none had prenatal hemodynamic complications, after birth seven had cardiac symptoms requiring medical (n=4) or surgical intervention (n=3). On follow-up, 15 of 19 with available outcome had TSC (79%), including six with neurodevelopmental disease. Over the same period, 26 patients were diagnosed with cardiac rhabdomyoma postnatally. Most (77%) were referred for cardiac assessment after findings suggesting TSC. On follow-up, TSC was confirmed in 25 (96%), including 22 with neurodevelopmental disease. The incidence of cardiac symptoms and TSC was not statistically different between the prenatal and postnatal diagnosis groups. CONCLUSIONS Cardiac rhabdomyomas are benign from the cardiovascular standpoint in most affected fetuses. As observed in postnatally diagnosed cardiac rhabdomyoma, TSC is diagnosed in most cases of fetal cardiac rhabdomyoma.
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Affiliation(s)
- Rima S Bader
- Department of Pediatrics, Division of Cardiology, Fetal Cardiac Program, the Hospital for Sick Children, Toronto, Ontario, Canada
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141
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Tworetzky W, McElhinney DB, Margossian R, Moon-Grady AJ, Sallee D, Goldmuntz E, van der Velde ME, Silverman NH, Allan LD. Association between cardiac tumors and tuberous sclerosis in the fetus and neonate. Am J Cardiol 2003; 92:487-9. [PMID: 12914889 DOI: 10.1016/s0002-9149(03)00677-5] [Citation(s) in RCA: 124] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A retrospective review was performed in 94 patients with > or =1 cardiac tumors seen on prenatal or neonatal echocardiography at 5 major referral centers. Tuberous sclerosis was present in 68 patients diagnosed with a cardiac tumor in utero or during the neonatal period, including 61 of 64 with multiple tumors.
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Affiliation(s)
- Wayne Tworetzky
- Department of Cardiology, Children's Hospital, Boston, Massachusetts 02115, USA.
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142
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Verhaaren HA, Vanakker O, De Wolf D, Suys B, François K, Matthys D. Left ventricular outflow obstruction in rhabdomyoma of infancy: meta-analysis of the literature. J Pediatr 2003; 143:258-63. [PMID: 12970643 DOI: 10.1067/s0022-3476(03)00250-6] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Primary heart tumors are exceptional in infants and children. Most common is the rhabdomyoma, often associated with tuberous sclerosis (Bourneville's disease). This tumor is generally believed to have no hemodynamic effects in the majority of cases. Recently, severe obstruction of the left ventricular outflow tract by a solitary tumor was diagnosed during pregnancy and emergency surgery was needed soon after birth.
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Affiliation(s)
- Henri A Verhaaren
- Departments of Pediatrics and Cardiac Surgery, University and University Hospital of Ghent, De Pintelaan 185, B-9000 Ghent, Belgium.
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143
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Perez T, Christiaens L, Bonneau D, Nassimi A, Oriot D. [Cardiac hamartomas in Bourneville's tuberous sclerosis. Perinatal echographic diagnosis and spontaneous evolution]. Arch Pediatr 2003; 10:126-9. [PMID: 12829353 DOI: 10.1016/s0929-693x(03)00308-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
UNLABELLED Cardiac hamartomas are frequently the earliest revelation of Bourneville's tuberous sclerosis. They sometimes allow to consider the diagnosis during the antenatal period, and to plan therefore genetic and CNS investigations. After the neonatal period, the evolution of hamartomas is frequently favourable, characterised with at least partial involution. OBSERVATION Antenatal equivocal cardiac echographic images did not allow the diagnosis in a fetus whose father had Bourneville's disease. Other antenatal investigations (genetics, central nervous system MRI) were not helpful. The diagnosis was carried out at birth as cardiac ultrasound reliably showed two cardiac hamartomas. CONCLUSION Even when suspected, the antenatal diagnosis of Bourneville's disease is difficult. The presence of cardiac hamartomas at birth is a reliable mean to make the diagnosis.
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Affiliation(s)
- T Perez
- Service de médecine néonatale, hôpital Gatien-de-Clocheville, 49, boulevard Béranger, 37044 Tours cedex, France.
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144
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D'Addario V, Pinto V, Di Naro E, Del Bianco A, Di Cagno L, Volpe P. Prenatal diagnosis and postnatal outcome of cardiac rhabdomyomas. J Perinat Med 2002; 30:170-5. [PMID: 12012639 DOI: 10.1515/jpm.2002.022] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIMS To evaluate the sonographic appearance of suspected fetal cardiac rhabdomyomas and their evolution until delivery and in the postnatal period. METHODS The study group consisted of 6 patients at 23-37 weeks of gestation referred to our Ultrasonic Unit, between March 1992 and December 1998, for suspected fetal cardiac rhabdomyomas. RESULTS The cardiac tumors were single in three cases and multiple in the other cases. The size ranged from 11 to 47 mm. In two cases the tumors arose from the right ventricle, in one case from the interventricular septum and in three cases from the left ventricle. Five infants are alive and in satisfactory hemodynamic compensation, but three of them developed tuberous sclerosis. In two infants a regression in the maximum diameter of the tumor masses has been observed. One child underwent surgical treatment at the age of six months and the baby died after surgery. CONCLUSIONS Two-dimensional and Doppler echocardiography are useful non invasive methods to diagnose fetal cardiac rhabdomyomas and to monitor their influence on the fetal cardiac function. However they do not allow us to recognize which fetuses presenting with features compatible with rhabdomyomas will develop tuberous sclerosis.
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Affiliation(s)
- Vincenzo D'Addario
- IV Unit of Obstetrics and Gynecology, University Medical School of Bari, Italy.
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145
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Gamzu R, Achiron R, Hegesh J, Weiner E, Tepper R, Nir A, Rabinowitz R, Auslander R, Yagel S, Zalel Y, Zimmer E. Evaluating the risk of tuberous sclerosis in cases with prenatal diagnosis of cardiac rhabdomyoma. Prenat Diagn 2002; 22:1044-7. [PMID: 12424773 DOI: 10.1002/pd.464] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To evaluate the prenatal parameters that increase the risk of tuberous sclerosis in prenatal management of fetal cardiac tumors suspected as rhabdomyoma. METHODS The study was a retrospective survey of 18 documented cases in which cardiac rhabdomyoma was suspected during pregnancy. The following parameters were evaluated as possible risk factors associated with tuberous sclerosis: tumor size, isolated or multiple, and family history of tuberous sclerosis. RESULTS Eighteen documented cases in which cardiac rhabdomyoma was found during pregnancy were evaluated. Of these cases, seven (39%) had proven tuberous sclerosis and 11 were found to be non-associated tuberous sclerosis tumors. When combining the present data with previous series, cases with diagnosis of tuberous sclerosis had equal mean tumor size to those with normal outcome. Family history of tuberous sclerosis in the presence of cardiac rhabdomyoma almost invariably ended with tuberous sclerosis (86%). All other cases with diagnosis of tuberous sclerosis and no family history had all multiple cardiac tumors. CONCLUSION The present data suggest that 39% of in utero suspected cardiac rhabdomyoma would have tuberous sclerosis. Family history and multifocality remain the strongest predictors of tuberous sclerosis, whereas size of the cardiac tumor can not reliably be used to predict tuberous sclerosis in prenatal counseling.
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Affiliation(s)
- Ronni Gamzu
- Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel Hashomer, Israel
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146
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Eirich C, Longo S, Palmgren M, Finnan JH, Ross-Ascuitto N. Unusual sonographic appearance of a large fetal cardiac rhabdomyoma: antenatal diagnosis and treatment. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2002; 21:681-685. [PMID: 12054307 DOI: 10.7863/jum.2002.21.6.681] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Affiliation(s)
- Christian Eirich
- Tulane University Health Sciences Center, New Orleans, Louisiana 70112, USA
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147
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Kim TH, Kim YM, Han MY, Kim WH, Oh MH, Han KS. Perinatal sonographic diagnosis of cardiac fibroma with MR imaging correlation. AJR Am J Roentgenol 2002; 178:727-9. [PMID: 11856706 DOI: 10.2214/ajr.178.3.1780727] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Tae Hoon Kim
- Department of Radiology, Sejong General Hospital, 91-121 Sosa-dong, Sosa-gu, Pucheon, Kyunggi-do 422-711, South Korea
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148
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Lee SH, Cho JY, Song MJ, Min JY, Han BH, Lee YH, Cho BJ, Kim SH. Prenatal ultrasound findings of fetal neoplasms. Korean J Radiol 2002; 3:64-73. [PMID: 11919481 PMCID: PMC2713989 DOI: 10.3348/kjr.2002.3.1.64] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
A variety of neoplasms can develop in each fetal organ. Most fetal neoplasms can be detected by careful prenatal ultrasonographic examination. Some neoplasms show specific ultrasonographic findings suggesting the differential diagnosis, but others do not. Knowledge of the presence of a neoplasm in the fetus may alter the prenatal management of a pregnancy and the mode of delivery, and facilitates immediate postnatal treatment. During the last five years, we experienced 32 cases of fetal neoplasms in a variety of organs. We describe their typical ultrasonographic findings with correlating postnatal CT, MRI, and pathologic findings.
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Affiliation(s)
- Soo-Hyun Lee
- Department of Radiology, Samsung Cheil Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong Yeon Cho
- Department of Radiology, Samsung Cheil Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Mi Jin Song
- Department of Radiology, Samsung Cheil Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jee-Yeon Min
- Department of Radiology, Samsung Cheil Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byoung Hee Han
- Department of Radiology, Samsung Cheil Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Ho Lee
- Department of Radiology, Samsung Cheil Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byung Jae Cho
- Department of Radiology, Samsung Cheil Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung Hyup Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
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149
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Bonnamy L, Perrotin F, Megier P, Haddad G, Body G, Lansac J. Fetal intracardiac tumor(s): prenatal diagnosis and management. Three case reports. Eur J Obstet Gynecol Reprod Biol 2001; 99:112-7. [PMID: 11604198 DOI: 10.1016/s0301-2115(01)00337-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- L Bonnamy
- Département de Gynécologie Obstétrique, Reproduction humaine et médecine foetale, Hopital Bretonneau, Chu Tours, 2 Boulevard Tonnellé 37044 Cedex 1, France.
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150
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Park RJ, Bolton PF. Pervasive developmental disorder and obstetric complications in children and adolescents with tuberous sclerosis. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2001; 5:237-48. [PMID: 11708584 DOI: 10.1177/1362361301005003002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Children with autism have an increased risk for obstetric complications but it is not known whether these are of primary aetiological significance. It is also unclear whether obstetric complications play a secondary role in shaping phenotypic expression in individuals at genetic risk for autism. We investigated this question by studying the role of obstetric complications in determining phenotypic manifestations in tuberous sclerosis, a single gene disorder frequently associated with autism spectrum disorders. Obstetric histories of 43 children with non-familial TS and 40 unaffected siblings were obtained using a structured parent interview. ADI-R, ADOS-G and IQ evaluations were undertaken. Children with TS experienced more obstetric complications than their unaffected siblings, but these were related to mild rather than severe adversities. No differences in obstetric complications were found in children with and without autism spectrum disorders and there was no positive correlation between obstetric adversities and severity of autism spectrum disorders or intellectual impairments.
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Affiliation(s)
- R J Park
- The Autism and Related Conditions Research Centre, Department of Psychiatry, University of Cambridge, UK.
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