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Walasik I, Litwińska-Korcz E, Szpotańska M, Stanirowski P, Księżopolska A, Ludwin A, Litwińska M. Prenatal Manifestation of Transient Abnormal Myelopoiesis: Case Report and Review of the Literature. J Clin Med 2024; 13:4584. [PMID: 39200726 PMCID: PMC11354785 DOI: 10.3390/jcm13164584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2024] [Revised: 07/27/2024] [Accepted: 07/29/2024] [Indexed: 09/02/2024] Open
Abstract
Background: Congenital malignancies are unusual fetal conditions, and therefore, the data on their prenatal manifestation are limited. Transient abnormal myelopoiesis (TAM) is a hematologic disorder characteristic for babies with trisomy 21 and based on the transient appearance of blast cells in peripheral blood. Methods: This paper presents prenatal manifestation of congenital TAM in a newborn with normal karyotype and reviews the literature on prenatal manifestation of this disorder. Results: A pregnant woman in her third pregnancy referred herself to the hospital for reduced fetal movements at 30 weeks of gestation. Admission's ultrasound scan showed an increased middle cerebral artery peak systolic velocity together with hepatomegaly. The patient was admitted to the labor ward for cardiotocography monitoring which showed acute fetal distress with repeated unprovoked decelerations. An emergency cesarean section was conducted and a phenotypically normal female newborn with low Apgar score was delivered. Further examination of the peripheral blood revealed anemia and leukocytosis with high blast proportion. A bone marrow aspirate revealed 70.2% of blasts in a sample with an abnormal karyotype of 47 XX+21. Cytogenetic analysis of the blasts with later microarray comparative genomic hybridization confirmed the presence of GATA1 mutation. However, the buccal smear showed a normal karyotype in the infant. The disease was classified as TAM. Conclusions: Our study demonstrates a rare case of prenatal manifestation of TAM in a neonate with a normal karyotype. Obstetricians should pay attention to symptoms like high MCA PSV and hepatosplenomegaly as possible causes of fetal hematological disorders and differentiate it with infection or isoimmunization.
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Affiliation(s)
| | | | | | | | | | | | - Magdalena Litwińska
- I Department of Obstetrics and Gynecology, Medical University of Warsaw, 02-091 Warsaw, Poland; (I.W.); (E.L.-K.); (M.S.); (P.S.); (A.K.); (A.L.)
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2
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Kobayashi K, Motokura K, Mizuta S, Yoshida S, Ohashi Y, Kawano M, Iwai A, Tanaka K, Maihara T, Iio J, Nishida Y, Wada T, Ueshimo T, Usami I, Heike T. Atypical eosinophils as a biomarker of idiopathic pericardial effusion associated with transient abnormal myelopoiesis in Down syndrome. Pediatr Blood Cancer 2024; 71:e30763. [PMID: 37950509 DOI: 10.1002/pbc.30763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 10/24/2023] [Accepted: 10/26/2023] [Indexed: 11/12/2023]
Affiliation(s)
- Kenichiro Kobayashi
- Department of Pediatrics, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan
- Department of Pediatric Hematology and Oncology, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan
| | - Kouji Motokura
- Department of Neonatology, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan
| | - Shumpei Mizuta
- Department of Clinical Laboratory, Hyogo Prefectural Amagasaki General Medical Cente, Hyogo, Japan
| | - Saya Yoshida
- Department of Clinical Laboratory, Hyogo Prefectural Amagasaki General Medical Cente, Hyogo, Japan
| | - Yuka Ohashi
- Department of Clinical Laboratory, Hyogo Prefectural Amagasaki General Medical Cente, Hyogo, Japan
| | - Marina Kawano
- Department of Clinical Laboratory, Hyogo Prefectural Amagasaki General Medical Cente, Hyogo, Japan
| | - Atsushi Iwai
- Department of Pediatrics, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan
- Department of Pediatric Hematology and Oncology, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan
| | - Kuniaki Tanaka
- Department of Pediatrics, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan
- Department of Pediatric Hematology and Oncology, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan
| | - Toshiro Maihara
- Department of Pediatrics, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan
| | - Jun Iio
- Department of Neonatology, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan
| | - Yoshinobu Nishida
- Department of Neonatology, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan
| | - Takahito Wada
- Department of Pediatrics, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan
- Department of Genomic Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takeshi Ueshimo
- Department of Clinical Laboratory, Hyogo Prefectural Amagasaki General Medical Cente, Hyogo, Japan
| | - Ikuya Usami
- Department of Pediatrics, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan
- Department of Pediatric Hematology and Oncology, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan
| | - Toshio Heike
- Department of Pediatrics, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan
- Department of Neonatology, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan
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Hidalgo Sanz J, Fernández Ventureira V, Palanca Arias D, Pérez Pérez P, Jiménez Montañés L, AyerzaCasas A. Isolated fetal pericardial effusion follow-up: Should we worry? ANALES DE PEDIATRÍA (ENGLISH EDITION) 2022; 96:342-348. [DOI: 10.1016/j.anpede.2021.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 02/11/2021] [Indexed: 10/18/2022] Open
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Morin C, Ponzio A, Guirgis M, Benzouid C, Beyler C, Rosenblatt J. Prenatal diagnosis of congenital ventricular aneurysm and diverticulum: prenatal features and perinatal management. Prenat Diagn 2022; 42:428-434. [PMID: 35238062 DOI: 10.1002/pd.6122] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 02/05/2022] [Accepted: 02/14/2022] [Indexed: 11/06/2022]
Abstract
Congenital ventricular diverticulum and aneurysm are rare cardiac developmental anomalies and their pathophysiology is still unclear. They present as an anomaly of the four chambers view, cardiomegaly, arrhythmia, pericardial effusion, or hydrops. They are usually isolated anomalies. Differential diagnosis between diverticulum and aneurysm is challenging during the prenatal period. Management policy is not uniform either conservative or repeated pericardial puncture. OBJECTIVE We wanted to describe prenatal features and post-natal outcomes of fetal cardiac out pouching. METHODS We retrospectively report 6 cases of ventricular diverticulum and aneurysm prenatally managed in our fetal medicine unit between 2010 and 2020. All cases were evaluated from the first or second trimester of pregnancy until postnatal follow-up (3 months to 3 years). RESULTS All 6 cases underwent a monthly ultrasound follow-up with spontaneous regression of pericardial effusion, and normal hemodynamics at birth No pericardial puncture was done and postnatal outcome was favorable in all cases. CONCLUSION Based on our experience and on cases previously published, prenatal counseling should be prudent regarding the final diagnosis. Referral and monthly prenatal ultrasound follow-up, birth in a tertiary center after multidisciplinary evaluation and cardiological evaluation at birth still seem mandatory. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Cecile Morin
- Fetal Medicine Unit, Hopital Universitaire Robert Debré, APHP, Paris, France
| | - Alice Ponzio
- Fetal Medicine Unit, Hopital Universitaire Robert Debré, APHP, Paris, France
| | - Maurice Guirgis
- Pediatric Cardiology Unit, Hopital Universitaire Robert Debré, APHP, Paris, France
| | - Cherine Benzouid
- Pediatric Cardiology Unit, Hopital Universitaire Robert Debré, APHP, Paris, France
| | - Constance Beyler
- Pediatric Cardiology Unit, Hopital Universitaire Robert Debré, APHP, Paris, France
| | - Jonathan Rosenblatt
- Fetal Medicine Unit, Hopital Universitaire Robert Debré, APHP, Paris, France
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5
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Hidalgo Sanz J, Fernández Ventureira V, Palanca Arias D, Pérez Pérez P, Jiménez Montañés L, Ayerza Casas A. [Isolated fetal pericardial effusion follow-up: Should we worry?]. An Pediatr (Barc) 2021; 96:S1695-4033(21)00139-9. [PMID: 33781717 DOI: 10.1016/j.anpedi.2021.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 02/05/2021] [Accepted: 02/11/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES Fetal pericardial effusion appears in different pathologies such as hydrops fetalis, heart structural or rhythm alterations, however, it can be observed in isolation but an increase in its incidence has been observed in relation to the presence of severe pathologies. METHODS Analysis of all cases of IFPE detected in Aragon and assessed in a cardiological consultation for prenatal diagnosis of a tertiary hospital collected over 10years, as well as the evolution of the patients to the present. RESULTS A sample of 38 fetuses was obtained from 37 pregnant women diagnosed with DPFA with spontaneous resolution in 86.8%. Two abortions (voluntary interruptions after prenatal diagnosis of 22q13 deletion and primary infection by cytomegalovirus) and one spontaneous fetal death were recorded. Pathological alterations were observed in 10/38 newborns: 2patients with metabolic disease, 2patients with chromosomopathies, one patient with pulmonary hypoplasia and unilateral hydronephrosis, one patient with hypertrophic cardiomyopathy, and 4patients studied for alterations in psychomotor development and/or congenital ophthalmological or hearing disorders. The overall morbidity rate was 34.2% and death rate 15.7%. The detection of other ultrasound alterations and the alteration in the first trimester screening were significantly associated with the presence of pathology. CONCLUSIONS IFPE has been classically associated with a good prognosis, although it is sometimes related to clinical entities with high morbidity and mortality: more than a third of the patients in our sample are affected. An exhaustive pre- and posnatal follow-up of these cases is recommended in order to perform an early intervention.
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Affiliation(s)
- Juan Hidalgo Sanz
- Servicio de Pediatría, Hospital Infantil Universitario Miguel Servet, Zaragoza, España.
| | | | - Daniel Palanca Arias
- Unidad de Cardiología Pediátrica, Servicio de Pediatría, Hospital Infantil Universitario Miguel Servet, Zaragoza, España
| | - Pilar Pérez Pérez
- Unidad de Diagnóstico Prenatal, Servicio de Obstetricia y Ginecología, Hospital Universitario Miguel Servet, Zaragoza, España
| | - Lorenzo Jiménez Montañés
- Unidad de Cardiología Pediátrica, Servicio de Pediatría, Hospital Infantil Universitario Miguel Servet, Zaragoza, España
| | - Ariadna Ayerza Casas
- Unidad de Cardiología Pediátrica, Servicio de Pediatría, Hospital Infantil Universitario Miguel Servet, Zaragoza, España
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6
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Pharande P, Balegar Virupakshappa KK, Mehta B, Badawi N. Fetal/Neonatal Pericardial Effusion in Down's Syndrome: Case Report and Review of Literature. AJP Rep 2018; 8:e301-e306. [PMID: 30377554 PMCID: PMC6205858 DOI: 10.1055/s-0038-1675337] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 09/05/2018] [Indexed: 11/05/2022] Open
Abstract
We report a preterm (35 4/7 weeks) male neonate with Down's syndrome (DS) diagnosed with isolated pericardial effusion (PE) at 20 weeks of gestation. He was born by precipitous delivery, needed no resuscitation and presented within first 24 hours of life with respiratory distress, anemia due to feto-maternal bleed, hypotension, hepatomegaly, and coagulopathy. Postnatal echocardiography confirmed a 5 mm rim of PE without tamponade, normal cardiac structure, and function. He was stabilized with ventilation, packed red cell, fresh frozen plasma, inotropes (dopamine, dobutamine, and adrenaline), and steroid (hydrocortisone). Subsequent evaluation confirmed hypothyroidism, transient myeloproliferative disorder (TMD), hepatic failure due to fibrosis/cirrhosis with portal hypertension, and steroid sensitive hypotension on two occasions possibly due to adrenal insufficiency. PE completely resolved over 2 weeks. In view of progressively worsening liver failure with ascites and portal hypertension, the family opted for palliation. Literature review has been discussed regarding perinatal onset of PE in DS.
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Affiliation(s)
- Pramod Pharande
- Department of Neonatology, Nepean Hospital, Kingswood, New South Wales, Australia.,School of Women's and Children's Health, Sydney Medical School Nepean, University of Sydney, Kingswood, New South Wales, Australia.,Monash Newborn, Monash Children's Hospital, Melbourne, Victoria, Australia
| | - Kiran Kumar Balegar Virupakshappa
- Department of Neonatology, Nepean Hospital, Kingswood, New South Wales, Australia.,School of Women's and Children's Health, Sydney Medical School Nepean, University of Sydney, Kingswood, New South Wales, Australia
| | - Bhavesh Mehta
- Grace Centre for Newborn Care, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.,School of Women's and Children's Health, University of Sydney, New South Wales, Australia
| | - Nadia Badawi
- Grace Centre for Newborn Care, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.,School of Women's and Children's Health, University of Sydney, New South Wales, Australia
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7
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Tamblyn JA, Norton A, Spurgeon L, Donovan V, Bedford Russell A, Bonnici J, Perkins K, Vyas P, Roberts I, Kilby MD. Prenatal therapy in transient abnormal myelopoiesis: a systematic review. Arch Dis Child Fetal Neonatal Ed 2016; 101:F67-71. [PMID: 25956670 DOI: 10.1136/archdischild-2014-308004] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Accepted: 04/15/2015] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To systematically review current evidence regarding prenatal diagnosis and management of transient abnormal myelopoiesis (TAM) in fetuses with trisomy 21. A novel case of GATA1-positive TAM, in which following serial in utero blood transfusion clinical improvement and postnatal remission were observed, is included. SEARCH STRATEGY AND DATA COLLECTION A systematic search of electronic databases (inception to October 2014) and reference lists, hand-searching of journals and expert contact. All confirmed cases of prenatal TAM were included for analysis. Data on study characteristics, design and quality were obtained. RESULTS Of 73 potentially relevant citations identified, 22 studies were included, describing 39 fetuses. All studies included comprised single case or small cohort studies; overall quality was 'very low'. Fetal/neonatal outcome was poor; 12 stillbirths (30.8%), 4 neonatal deaths (10.2%) and 7 infant deaths (17.9%). In two cases, the pregnancy was terminated (5.1%). TAM was primarily detected in the third trimester (79.4%), and in 14 a retrospective diagnosis was made postpartum. Ultrasound features indicative of TAM included hepatomegaly±splenomegaly (79.5%), hydrops fetalis (30.8%), pericardial effusion (23.1%) and aberrant liquor volume (15.4%). When performed, liver function tests were abnormal in 91.6% of cases. CONCLUSIONS Prenatal TAM presents a challenging diagnosis, and prognosis is poor, with consistently high mortality. A low threshold to measure haematological and biochemical markers is advised when clinical features typical of TAM are detected in the context of trisomy 21. Larger prospective studies are warranted to accurately ascertain the role of GATA1 analysis and potential value of prenatal therapy.
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Affiliation(s)
- J A Tamblyn
- Centre for Women's & Children's Health, College of Medical & Dental Sciences, University of Birmingham, Birmingham, UK
| | - A Norton
- Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - L Spurgeon
- Centre for Women's & Children's Health, College of Medical & Dental Sciences, University of Birmingham, Birmingham, UK
| | - V Donovan
- Fetal Medicine Centre, Birmingham Women's Foundation Trust, Edgbaston, Birmingham, UK
| | - A Bedford Russell
- Department of Neonatal Paediatrics, Birmingham Women's Foundation Trust, Edgbaston, Birmingham, UK
| | - J Bonnici
- Department of Paediatrics, Children's Hospital and Molecular Haematology Unit, Weatherall Institute of Molecular Medicine, Oxford University and John Radcliffe Hospital, Oxford, UK
| | - K Perkins
- Department of Paediatrics, Children's Hospital and Molecular Haematology Unit, Weatherall Institute of Molecular Medicine, Oxford University and John Radcliffe Hospital, Oxford, UK
| | - P Vyas
- Department of Paediatrics, Children's Hospital and Molecular Haematology Unit, Weatherall Institute of Molecular Medicine, Oxford University and John Radcliffe Hospital, Oxford, UK
| | - I Roberts
- Department of Paediatrics, Children's Hospital and Molecular Haematology Unit, Weatherall Institute of Molecular Medicine, Oxford University and John Radcliffe Hospital, Oxford, UK
| | - M D Kilby
- Centre for Women's & Children's Health, College of Medical & Dental Sciences, University of Birmingham, Birmingham, UK Fetal Medicine Centre, Birmingham Women's Foundation Trust, Edgbaston, Birmingham, UK
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8
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Traficante G, Biagiotti R, Andreucci E, Di Tommaso M, Provenzano A, Cariati E, Giglio S. Prenatal diagnosis of X-linked adrenoleukodystrophy associated with isolated pericardial effusion. Clin Case Rep 2015; 3:643-5. [PMID: 26273461 PMCID: PMC4527815 DOI: 10.1002/ccr3.283] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 03/10/2015] [Accepted: 03/19/2015] [Indexed: 12/03/2022] Open
Abstract
This is the first reported case of fetal pericardial effusion in association with X-linked adrenoleukodystrophy and hypocortisolism from a nonautoimmune cause. Our hypothesis is that in experienced hands and after accurate genetic counseling, isolated pericardial effusion can constitute an indication for a severe metabolic disease.
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Affiliation(s)
- Giovanna Traficante
- Medical Genetics Unit, Department of Clinical and Experimental Biomedical Sciences "Mario Serio", University of Florence Florence, Italy
| | - Roberto Biagiotti
- Medical and Surgical Feto-Neonatal Department, Meyer Children's University Hospital Florence, Italy
| | - Elena Andreucci
- Medical Genetics Unit, Meyer Children's University Hospital Florence, Italy
| | | | - Aldesia Provenzano
- Medical Genetics Unit, Department of Clinical and Experimental Biomedical Sciences "Mario Serio", University of Florence Florence, Italy
| | - Ettore Cariati
- Medical and Surgical Feto-Neonatal Department, Meyer Children's University Hospital Florence, Italy
| | - Sabrina Giglio
- Medical Genetics Unit, Department of Clinical and Experimental Biomedical Sciences "Mario Serio", University of Florence Florence, Italy ; Medical Genetics Unit, Meyer Children's University Hospital Florence, Italy
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9
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Oh LZB, Ng PMY, Quah TC. A dysmorphic newborn with petechiae and a 'Big Heart'. BMJ Case Rep 2014; 2014:bcr-2014-204195. [PMID: 24706711 DOI: 10.1136/bcr-2014-204195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A male fetus was noted to have an isolated pericardial effusion. At birth, he had dysmorphic features of Down syndrome and extensive petechiae. He was diagnosed to have transient myeloproliferative disorder. The large pericardial effusion and TMD spontaneously resolved. At 4 years of age, he was diagnosed with acute megakaryoblastic leukaemia, underwent chemotherapy and achieved complete remission.
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Affiliation(s)
- Ling Zhi Bernice Oh
- Department of Paediatrics, National University Hospital, Singapore, Singapore
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10
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Buyukkale G, Cetinkaya M, Akcay A, Payaslı M, Oztarhan K, Ozbek AS, Kavuncuoglu S. Transient leukemia-associated pericardial tamponade in a neonate with Down syndrome. Pediatr Hematol Oncol 2012; 29:386-8. [PMID: 22568804 DOI: 10.3109/08880018.2012.680683] [Citation(s) in RCA: 3] [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
Approximately 10% of neonates with Down syndrome may develop a form of megakaryoblastic leukemia that usually disappear spontaneously during the first months of the life. Although it seems to have a benign course, it may also be lethal and severe in some cases, especially in the form of hydrops and/or cardiopulmonary failure. Herein, we report a male infant with Down syndrome who was admitted with respiratory distress due to severe pericardial effusion leading to pericardial tamponade in the first 2 weeks of life. Pericardiosentesis and pericardial tube replacement in combination with steroid therapy was performed. He responded well to these therapies and his leukemia resolved on the fourth month of life. This case suggests that severe pericardial effusion and pericardial tamponade may be life-threatening complications of transient leukemia of Down syndrome and also it may be managed successfully with appropriate treatments.
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Affiliation(s)
- Gokhan Buyukkale
- Division of Neonatology, Department of Pediatrics, Kanuni Sultan Suleyman Training and Research Hospital, İstanbul, Turkey.
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11
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Rougemont AL, Makrythanasis P, Finci V, Billieux MH, Epiney M, McKee TA, Nizetic D, Fokstuen S. Myeloid proliferation without GATA1 mutations in a fetus with Down syndrome presenting in utero as a pericardial effusion. Pediatr Dev Pathol 2010; 13:423-6. [PMID: 20429643 DOI: 10.2350/09-11-0743-cr.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
An isolated pericardial effusion was observed during a routine prenatal ultrasound in a fetus of 30 and 3/7 weeks gestation. Amniocentesis was performed and revealed a trisomy 21. After prenatal counseling, the parents opted for termination of the pregnancy at 32 weeks. Postmortem examination confirmed the presence of a pericardial effusion, without structural cardiac anomalies, and showed the development of ascites and subcutaneous edema. Histological examination showed an infiltrate of megakaryoblasts and irregular, dysplastic megakaryocytes confined to the epicardium, the pericardial lymph nodes, and the pancreas, consistent with a myeloid proliferation related to Down syndrome. Sequencing of exons 2 and 3 of the GATA1 gene from the umbilical cord blood and from megakaryoblast infiltrate showed no mutation. A high incidence of chromosomal abnormalities, in particular trisomy 21, has been described in fetuses with pericardial effusion. However, myeloid proliferation related to Down syndrome without GATA1 mutations is extremely rare. To our knowledge, only one such case has been reported to date. We present here a 2nd case, which further supports the hypothesis that hyperproliferation of megakaryocytes in a subset of Down syndrome patients may be initiated by events other than GATA1 mutations.
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Affiliation(s)
- Anne-Laure Rougemont
- Division of Clinical Pathology, Geneva University Hospitals, 1211 Geneva, Switzerland.
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12
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Devore GR. Genetic sonography: the historical and clinical role of fetal echocardiography. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2010; 35:509-521. [PMID: 20443195 DOI: 10.1002/uog.7652] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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13
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Nasrallah FK, Baho H, Sallout A, Qurashi M. Prenatal diagnosis of idiopathic infantile arterial calcification with hydrops fetalis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2009; 34:601-604. [PMID: 19813208 DOI: 10.1002/uog.7438] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Idiopathic infantile arterial calcification (IIAC) is a rare and nearly always fatal disorder. To date, prenatal diagnosis has been reported in fewer than 10 cases. We describe a series of three cases in which the diagnosis of IIAC was made at 23, 25 and 29 weeks' gestation. All three cases presented with a normal anatomy scan at 20 weeks' gestation with an echogenic intracardiac focus. Follow-up scans showed generalized hyperechogenicity and calcification of the walls of the large arteries, particularly the aorta and the iliac arteries. All cases developed hydrops fetalis with cardiomegaly and polyhydramnios later in gestation, resulting in intrauterine fetal death in two cases and neonatal death immediately following delivery in the third. This is the largest case series and the earliest gestational age of prenatal diagnosis of IIAC reported to date. When surveying for the disease, serial scans are important, perhaps from 20 weeks' gestation, with close examination of the iliac and aortic arteries. Detection of echogenic intracardiac focus could be an early marker in patients with a family history of the disease.
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Affiliation(s)
- F K Nasrallah
- Department of Obstetrics and Gynecology, King Abdulaziz Medical City, Jeddah, Saudi Arabia.
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14
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Chong CR, Hutchins GM. Idiopathic infantile arterial calcification: the spectrum of clinical presentations. Pediatr Dev Pathol 2008; 11:405-15. [PMID: 17990935 DOI: 10.2350/07-06-0297.1] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2007] [Accepted: 08/20/2007] [Indexed: 12/19/2022]
Abstract
Idiopathic infantile arterial calcification (IIAC) is a rare disorder characterized by extensive calcification of medium and large arteries. We report the case of a 32-week-old infant with hydrops fetalis and heart failure who died at 4 days of age. At autopsy the infant was found to have cardiomegaly, myocardial infarctions and multifocal calcifications of the aorta and arteries in the lungs, heart, thyroid, spleen, and testis. Calcification extended from the internal elastic lamina into the intima and media and was associated with a giant-cell reaction and smooth muscle proliferation. A search of the English language medical literature identified 161 IIAC case reports. Of these, 48% of cases presented in utero or at birth with hydrops fetalis, maternal hydramnios, heart failure, or respiratory distress and 52% present later, at a median age of 3 months, with sudden onset of fever, vomiting, irritability, or respiratory distress in a previously healthy infant. Significantly, 19 of 22 IIAC survivors presented at less than 2 weeks of age, and 15 survivors were treated with diphosphonates.
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Affiliation(s)
- Curtis R Chong
- Department of Pharmacology and Medical Scientist Training Program, The John Hopkins University School of Medicine, Baltimore, MD 21287, USA.
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15
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Anuk D, Tarcan A, Alioglu B, Avci Z, Haberal N, Ozyurek E, Ozbek N. Hydrops fetalis in a neonate with down syndrome, transient myeloproliferative disorder and hepatic fibrosis. Fetal Pediatr Pathol 2007; 26:223-8. [PMID: 18363154 DOI: 10.1080/15513810701818379] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Transient myeloproliferative disorder is a self limiting disorder characterized by leukocytosis with the presence of megakaryoblasts in the peripheral blood and bone marrow, anemia, thrombocytopenia, and organomegaly. It occurs in approximately 10% of newborn infants with Down syndrome. Hepatic fibrosis is seen in the severe form of transient myeloproliferative disorder with Down syndrome that is characterized by diffuse intralobular sinusoidal fibrosis and extramedullary hematopoesis. We describe a patient with hydrops fetalis, Down syndrome, and transient myeloproliferative disorder. We suggest that patients with the severe form of transient myeloproliferative disorder should be examined for hepatic fibrosis.
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Affiliation(s)
- Deniz Anuk
- Department of Pediatrics, Baskent University Faculty of Medicine, Ankara, Turkey.
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16
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Benoit B, Murta MM, Leite J, Jeanty P. Intrathoracic fluid may be a normal finding at around 8 gestational weeks. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2007; 30:188-91. [PMID: 17582229 DOI: 10.1002/uog.3976] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
OBJECTIVE To describe the observation of embryonic thoracic fluid at around 8 weeks' gestation and to discuss the likely etiology. METHODS This was a retrospective study of patients referred between August 2005 and May 2006 to our units in France and in the USA for a dating scan between 6 and 10 weeks. Included in our series were all embryos presenting with an ultrasound finding suggestive of an early pericardial fluid collection, i.e. a large anechoic fluid collection surrounding the heart. The gestational age, fetal heart rate and maternal age at this first scan were recorded, along with nuchal translucency thickness as measured at the 12-week scan and the second-trimester anomaly scan results. RESULTS Five cases were included in this study. In all five patients, the anechoic fluid collection was visualized at 8 weeks, and by the time of the nuchal scan it had disappeared completely. The nuchal translucency thickness was normal in all cases and all five embryos had normal cardiac examinations during the second trimester and were normal at birth. CONCLUSIONS The observation on ultrasound at 8 weeks' gestation of a large anechoic fluid collection surrounding the heart that disappears by week 12 is suggestive of a transient pericardial collection.
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Affiliation(s)
- B Benoit
- Obstetrics and Gynecology, Princess Grace Hospital, Monaco, France
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17
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Kikuchi A, Tamura N, Ishii K, Takakuwa K, Matsunaga M, Sudo N, Tanaka K. Four cases of fetal hypoechoic hepatomegaly associated with Trisomy 21 and transient abnormal myelopoiesis. Prenat Diagn 2007; 27:665-9. [PMID: 17437323 DOI: 10.1002/pd.1738] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Our objective was to determine the clinical significance of fetal hypoechoic hepatomegaly and serial change of liver sizes. METHODS The liver sizes of four fetuses with hypoechoic hepatomegaly were serially estimated by liver length, as measured from the dome of the right hemidiaphragm to the tip of the right lobe. RESULTS All cases were associated with trisomy 21 or transient abnormal myelopoiesis (TAM). Two cases were trisomy 21 with TAM, one case was a phenotypically normal newborn, who had developed TAM during the fetal period, and the last case was trisomy 21 without TAM. In the last case, it is speculated that TAM had developed and regressed completely before birth. Two cases, whose hepatomegaly had improved before birth, showed good prognosis and the other two cases, in whom improvement had not been observed, resulted in death after birth by liver failure. CONCLUSION These experiences show that one of the differential diagnoses of hypoechoic hepatosplenomegaly is TAM and that the change of live size is a predictor of prognosis.
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Affiliation(s)
- Akira Kikuchi
- Department of Obstetrics and Gynecology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
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18
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Agapitou P, Lazaris AC, Agapitos E, Patsouris ES. Abruptio placentae and idiopathic arterial calcification in a stillborn. J Matern Fetal Neonatal Med 2006; 19:583-5. [PMID: 16966129 DOI: 10.1080/14767050600736457] [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: 10/24/2022]
Abstract
We report a case of idiopathic arterial calcification in a stillborn of 22 weeks gestational age. The pregnancy was complicated by abruptio placentae and the postmortem examination showed widespread arterial calcification in the placenta, as well as in the pulmonary, renal, cerebellar, and brain arteries.
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Affiliation(s)
- Pagona Agapitou
- Department of Pathology, School of Medicine, First National and Kapodistrian University of Athens, Athens, Greece
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19
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Brink DS. Transient leukemia (transient myeloproliferative disorder, transient abnormal myelopoiesis) of Down syndrome. Adv Anat Pathol 2006; 13:256-62. [PMID: 16998319 DOI: 10.1097/01.pap.0000213039.93328.44] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Transient leukemia of Down syndrome (DS-TL), also known as transient myeloproliferative disorder of Down syndrome (DS) and transient abnormal myelopoiesis of DS, occurs in approximately 10% of DS neonates and in phenotypically normal neonates with trisomy 21 mosaicism. In DS-TL, peripheral blood analysis shows variable numbers of blasts and, usually, thrombocytopenia; other cytopenias are uncommon. Bone marrow characteristics of DS-TL are, likewise, variable, though (in contrast to other leukemias) the bone marrow blast differential can be lower than the peripheral blood blast differential. The blasts of DS-TL typically show light microscopic, ultrastructural, and flow cytometric evidence of megakaryocyte differentiation. DS-TL neonates have a approximately 15% risk of developing potentially fatal liver disease and show <10% incidence of hydrops fetalis. Additional manifestations of DS-TL include cutaneous involvement, hyperviscosity, myelofibrosis, cardiopulmonary failure, splenomegaly, and spleen necrosis. Despite its typical transient nature, 20% to 30% of DS-TL patients develop overt (nontransient) acute leukemia, usually within 3 years and typically of the M7 phenotype (acute megakaryoblastic leukemia). The pathogenesis of DS-TL (and of subsequent acute leukemia) involves mutation of GATA1 (on chromosome X), which normally encodes a transcription factor integral to normal development of erythroid, megakaryocytic, and basophilic/mast cell lines. The pathogenetic role of trisomy 21 in DS-TL is unclear. Though indications for chemotherapy in DS-TL have not been firmly established, the blasts of DS-TL are sensitive to low-dose cytosine arabinoside.
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Affiliation(s)
- David S Brink
- Department of Pathology, Saint Louis University School of Medicine, Saint Louis, MO 63104-1003, USA.
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20
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Glatz AC, Pawel BR, Hsu DT, Weinberg P, Chrisant MRK. Idiopathic infantile arterial calcification: two case reports, a review of the literature and a role for cardiac transplantation. Pediatr Transplant 2006; 10:225-33. [PMID: 16573612 DOI: 10.1111/j.1399-3046.2005.00414.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Idiopathic infantile arterial calcification (IIAC) is a rare, but important, cause of rapidly progressive ischemic heart disease in children. In this paper, we report two recent cases of IIAC seen at tertiary referral hospitals. Both cases presented in infancy with signs of heart failure and, ultimately, died with the diagnosis of IIAC confirmed at postmortem examination. A thorough review of the literature reveals approximately 160 reported cases of IIAC. The clinical outcomes, radiographic findings and pathologic details are summarized. Proposed etiologic mechanisms are reviewed, including promising research into the role of inorganic pyrophosphate as a regulatory factor in the development of IIAC. Because of the typically fatal outcome of IIAC and the lack of proven therapies, the potential role for cardiac transplantation is discussed.
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Affiliation(s)
- Andrew C Glatz
- Division of Cardiology, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA.
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21
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Yezewski KA, Ferroni KM. Very Large Isolated Fetal Pericardial Effusion With Spontaneous Resolution. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2004. [DOI: 10.1177/8756479303262868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This case study describes a fetus with a very large isolated pericardial effusion of unknown etiology. This resolved spontaneously. The authors’ review of the literature suggests that this is an unusual presentation. Sonography is an invaluable tool in the detection and monitoring of a fetal pericardial effusion.
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22
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Current awareness in prenatal diagnosis. Prenat Diagn 2003; 23:435-41. [PMID: 12778892 DOI: 10.1002/pd.529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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