Prenatal diagnosis of a large liver cavernous haemangioma associated with polyhydramnios

Giant hepatic hemangioma in the fetus: case reports and updated review of the literature

OBJECTIVES

To describe three cases of giant fetal hepatic hemangioma detected by prenatal ultrasound in the third trimester of pregnancy and further confirmed by fetal magnetic resonance imaging (MRI). An updated review of the literature was also carried out.

RESULTS

In one case, there was an unexpected intrauterine demise at 35 weeks. The other two women delivered liveborn infants at term. The first of these two neonates had a stormy neonatal course and underwent endovascular embolization with limited clinical success. The infant presented multiple medical complications and was discharged home at five months of age. The second infant had an uneventful postnatal course. Subsequent follow-up scans showed progressive shrinkage of the lesion with no associated complications. A review of the English literature revealed a total of 42 cases prenatally diagnosed by ultrasound. The most relevant clinical and ultrasound findings are presented and the diverse perinatal outcomes related to this condition are discussed.

CONCLUSIONS

Fetal hepatic hemangiomas are exceedingly rare vascular tumors; however, they can be associated with several life-threatening conditions. They are usually detected by ultrasound, either incidentally or in the context of nonimmune hydrops secondary to high-output cardiac failure. Our review documents the increasing role of fetal MRI in the prenatal diagnosis and management of these cases. However, the improvement in prenatal diagnostic imaging techniques has not been associated with a better perinatal prognosis in the reported cases.

Fetal oncology

A szerző áttekinti a magzatokban előforduló jó- és rosszindulatú daganatokat. A gyermek- és felnőttkori daganatok szinte minden alakja előfordul méhen belül a magzatokban, illetve világrajövetel után az újszülöttekben. A diagnózis létfontosságú eszköze a szonográfia és a mágneses rezonanciás vizsgálati módszer. Ez a két eljárás nagy előrelépés a kórismézés terén. A kezelések még kísérleti fázisban vannak, és csak néhány központi intézetben végeznek ilyen beavatkozásokat. A választás a műtéti beavatkozás kockázat-haszon arányától függ.

Outcome of prenatally diagnosed solid fetal tumors

BACKGROUND/PURPOSE

In the last 10 years, the ability to diagnose fetal tumors in the prenatal period has improved greatly because of technical advances in imaging. Early diagnosis and determination of tumor may affect prognosis.

METHODS

The authors retrospectively reviewed the records of 1316 fetuses who underwent sonographic evaluation for congenital defects at University of California-San Francisco over a 6-year period. Of these, 16 had fetal tumors and were followed up at our institution. There were solid or predominantely solid with small cystic component masses in one of 3 locations: cervical, mediastinal, or abdominal. Excluded from our study were those fetuses with either sacrococcygeal teratoma, congenital cystic adenomatoid malformation of the lung, or ovarian cyst, because these defects have been extensively reviewed elsewhere. In addition, masses that were primarily cystic also were excluded. Data collected included diagnosis, gestational age at diagnosis and at delivery, mode of delivery, fetal and neonatal survival, and disease confirmation.

RESULTS

Of the 16 fetuses, 4 had mediastinal tumors: 2 with pericardial teratomas (both of whom died in utero) and 2 with cardiac rhabdomyomas (1 died; the other presented tuberous sclerosis and is alive at 2 years of age). Four patients had cervical tumors (3 died; 1 survived and is alive and well), and 8 had abdominal tumors (3 with liver tumors, 4 with a left adrenal mass, and 1 with retroperitoneal teratoma). All eight patients with an abdominal tumor are alive and well.

CONCLUSIONS

Fetal tumors are rare, and the prognosis seems to depend on their location and size. Although easier to detect, cervical and mediastinal tumors have a worse prognosis. Abdominal masses are more difficult to detect but have a better prognosis.

Fetal Hepatic Hemangioma Prenatal Diagnosis

A case of a fetal hepatic hemangioma, complicated by dilated cardiomyopathy, is presented. In cases of large arteriovenous shunting, emergent treatment is often required following delivery due to ensuing renal failure, pulmonary hypertension, congestive heart failure, and coagulopathy. A thorough perinatal sonogram performed at a screening facility detected the anomaly, providing the patient and her physician time to arrange for a delivery at a tertiary-care center that could accommodate such a critically ill patient.

Prenatal diagnosis of focal nodular hyperplasia of the liver

A case of focal nodular hyperplasia of the liver presenting in a 36-week-old fetus is reported. The tumour appeared on antenatal ultrasound as a 4.0 cm x 3.0 cm x 2.7 cm hypoechoic mass at the periphery of the right lobe of the liver. Colour Doppler imaging showed it to have prominent vascularity. Postnatally, sonography confirmed the presence of a vascular mass within the liver. The tumour was removed at laparotomy and was diagnosed as an area of focal nodular hyperplasia on histopathological examination.

Prenatal sonographic diagnosis of fetal hepatic hemangioma

Although hepatic hemangioma represents the most common tumor of the liver during childhood, the prenatal diagnosis of this condition has been rarely reported in the literature. In this report, we describe a case of hepatic hemangioma presenting as a small hyperechogenic mass (1.1 x 0.9 cm) in the fetal liver in which the diagnosis was made at 33 weeks' gestation by ultrasound. Subsequent postnatal evaluation by Doppler ultrasound confirmed the diagnosis and follow-up examinations have documented its spontaneous regression. The prenatal diagnosis of a liver mass allows not only the evaluation of changes in size or pattern of the mass itself during pregnancy but also its prompt evaluation after birth.