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Grossi AP, Astori AF, Nakatani ET, Jure R, Salazar D, Tonni G, Sepulveda W. Prenatal Diagnosis of Umbilical Cord Angiomyxoma: Case Studies and Literature Review of 45 Cases. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024; 43:1769-1784. [PMID: 38884130 DOI: 10.1002/jum.16506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 05/20/2024] [Accepted: 05/23/2024] [Indexed: 06/18/2024]
Abstract
We describe two cases of umbilical cord (UC) angiomyxoma diagnosed prenatally by sonography in the second trimester of pregnancy. In both cases, a complex mass was detected at the placental insertion site, characterized by an echoic nodule surrounding the umbilical vessels and distal edematous Wharton's jelly. Follow-up scans showed that the mass grew mainly at the expense of its edematous component, with normal uteroplacental Dopplers throughout the remaining of the pregnancy. However, late-onset fetal growth restriction complicated the progress of pregnancy, requiring delivery by Cesarean section at 37 weeks' gestation in both cases. Neonatal courses were unremarkable. An extensive review of the English literature was also performed, collecting 45 similar cases including ours. Our experience as well as the review of the literature confirms that UC angiomyxoma is an uncommon, sporadic condition that is usually detected incidentally during prenatal sonography and presents as an isolated finding. Nevertheless, it represents a high-risk condition for pregnancy complications including prematurity, fetal growth restriction, and fetal demise.
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Affiliation(s)
- Alexandra Pires Grossi
- Department of Obstetrics and Gynecology, Nossa Senhora do Rocio Hospital, Campo Largo, Brazil
| | | | | | | | - Deyana Salazar
- Department of Pathology, Hospital Dr. Franco Ravera Zunino, Rancagua, Chile
| | - Gabriele Tonni
- Department of Obstetrics and Gynecology, Azienda USL - Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Reggio Emilia, Italy
| | - Waldo Sepulveda
- FETALMED-Maternal-Fetal Diagnostic Center, Fetal Imaging Unit, Santiago, Chile
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Ferreira EO, Stefanovici C, Kostadinov S, Duncan V. Umbilical Cord Hemangiomas: A Multi-Institutional Case Series With Literature Review. Pediatr Dev Pathol 2024:10935266241264161. [PMID: 39056566 DOI: 10.1177/10935266241264161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/28/2024]
Abstract
Umbilical cord hemangiomas are rare lesions, for which data on pregnancy outcome is lacking. This study combines a multi-institution 4-case series with a systematic literature search (n = 52) to determine possible pathologic lesion parameters which may have an effect on pregnancy outcome. Of all 56 pregnancies, lesion size ranged from 0.2 to 23.0 cm with pregnancy outcomes ranging from healthy liveborns (58.9%), liveborns with severe complications largely due to prematurity and/or fluid overload (12.5%), intrauterine/neonatal demise (25.0%), and pregnancy termination (3.6%). Of the 52 cases included for statistical analysis, there was no significant association between fetal outcome and vascular lesion location (P = .12) or fetal outcome and single umbilical artery involvement versus involvement of other vasculature (P = .29). The mean length of vascular lesions that resulted in healthy liveborns did not significantly differ from those resulting in severe fetal complications and/or demise (P = .72). Cases resulting in severe complications and/or demise were significantly earlier at delivery than those resulting in healthy liveborns (P < .001). Combined findings suggest that functional lesion characteristics, such as the degree of turbulent flow generated, have more significance than size, especially in early gestation losses. Moving forward, standardized reporting of pathologic lesion characteristics is paramount to better predict pregnancy prognosis.
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Affiliation(s)
- Elizabeth O Ferreira
- Department of Pathology, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Camelia Stefanovici
- Department of Pathology, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Stefan Kostadinov
- Department of Laboratory Medicine and Pathology, Brown University, Providence, RI, USA
| | - Virginia Duncan
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA
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Kaur N, Heerema-McKenney A, Kollikonda S, Karnati S. Changing Course of an Umbilical Cord Mass - Chasing the Diagnosis of Angiomyxoma. Pediatr Dev Pathol 2022; 25:558-561. [PMID: 35658744 DOI: 10.1177/10935266221106910] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Angiomyxoma of the umbilical cord is a rare benign vascular malformation with potential for fetal morbidity and mortality. Gross and histologic features of this lesion are identical to those described as "hemangioma," however "angiomyxoma" is a preferable term as current practice restricts the term "hemangioma" to infantile capillary proliferations that express glucose transporter 1. Here we describe the case of an umbilical cord angiomyxoma with associated pseudocysts diagnosed after delivery at 33 weeks. It presented as a heterogeneous-appearing mass near the fetal cord insertion and mimicked serious fetal anomalies throughout gestation. We found fetal MRI helpful for monitoring this lesion, narrowing the differential, and informing management. Proximity to the fetal end of the cord and uncertainty about diagnosis also required surgical resection of the mass after delivery with umbilicoplasty.
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Affiliation(s)
- Navkiranjot Kaur
- 161821Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - Amy Heerema-McKenney
- Pathology and Laboratory Medicine Institute, 2569Cleveland Clinic, Cleveland, OH, USA
| | - Swapna Kollikonda
- Department of Obstetrics and Gynecology, Women's Health Institute, 2569Cleveland Clinic, Cleveland, OH, USA
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Buechel J, Bruder E, Manegold-Brauer G. Three-dimensional imaging of rare mesenchymal tumor of umbilical cord. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2020; 55:279-280. [PMID: 31115104 DOI: 10.1002/uog.20349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 05/01/2019] [Accepted: 05/10/2019] [Indexed: 06/09/2023]
Affiliation(s)
- J Buechel
- Department of Obstetrics and Gynecology,Division of Gynecologic and Prenatal Ultrasound, University Hospital Basel, Basel, Switzerland
| | - E Bruder
- Institute for Medical Genetics and Pathology, University Hospital Basel, Basel, Switzerland
| | - G Manegold-Brauer
- Department of Obstetrics and Gynecology,Division of Gynecologic and Prenatal Ultrasound, University Hospital Basel, Basel, Switzerland
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Iglesias-Deus A, Pérez-Muñuzuri A, Urisarri A, Bautista-Casasnovas A, Couce ML. Umbilical cord and visceral hemangiomas diagnosed in the neonatal period: A case report and a review of the literature. Medicine (Baltimore) 2016; 95:e5196. [PMID: 27759656 PMCID: PMC5079340 DOI: 10.1097/md.0000000000005196] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Umbilical cord hemangioma is very rare and may not be detected prenatally. However, it should be considered in differential diagnosis with other umbilical masses because it can cause significant morbidity. METHODS We report the case of a newborn referred with suspected omphalitis and umbilical hernia. RESULTS Physical examination showed an irreducible umbilical tumor, the size of olive, with dubious secretion. The initial suspected diagnosis was urachal or omphalomesenteric duct remnants. Abdominal ultrasound and magnetic resonance imaging showed an umbilical and a mesenteric mass. Tumor markers were negative. A definitive diagnosis of umbilical cord and intestinal hemangioma was established after surgical excision and histologic examination of the umbilical mass. Propranolol was prescribed due to the extent of the intestinal lesion. CONCLUSION This report highlights the diagnostic challenges of hemangiomas in unusual locations. Apart from the rarity of these tumors, few tests are available to guide diagnosis, and surgery and histologic examination are generally required for a definitive diagnosis. Finally, it is essential to rule out associated malformations and hemangiomas in other locations.
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Affiliation(s)
- Alicia Iglesias-Deus
- Neonatal Unit, Department of Pediatrics. Santiago de Compostela University Hospital, IDIS (Health Research Institute of Santiago de Compostela)
| | - Alejandro Pérez-Muñuzuri
- Neonatal Unit, Department of Pediatrics. Santiago de Compostela University Hospital, IDIS (Health Research Institute of Santiago de Compostela)
| | - Adela Urisarri
- Neonatal Unit, Department of Pediatrics. Santiago de Compostela University Hospital, IDIS (Health Research Institute of Santiago de Compostela)
| | | | - Maria-Luz Couce
- Neonatal Unit, Department of Pediatrics. Santiago de Compostela University Hospital, IDIS (Health Research Institute of Santiago de Compostela)
- Correspondence: María-Luz Couce, Neonatal Unit, Department of Pediatrics, Santiago de Compostela University Hospital, Travesía Choupana, s/n, Santiago de Compostela, Galicia, España (e-mail: )
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Hara K, Fukumura Y, Saito T, Arakawa A, Okabe H, Takeda S, Yao T. A giant cord hemangioma with extramedullary hematopoiesis and elevated maternal serum human chorionic gonadotropin: a case report and review of the literature. Diagn Pathol 2015; 10:154. [PMID: 26337640 PMCID: PMC4559187 DOI: 10.1186/s13000-015-0385-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 08/25/2015] [Indexed: 02/07/2023] Open
Abstract
A case of prenatally diagnosed, giant cord hemangioma is reported, which was accompanied by the elevation of maternal serum alpha-fetoprotein (MS-AFP) and human chorionic gonadotropin (MS-hCG) levels. A 30-year-old woman without a previous history of gravida or para, presented with intermittent abdominal pain at 26 weeks of gestation. Doppler studies showed the fetus developing heart failure as the tumor grew larger. Caesarian section was performed at 29 weeks of gestation. Macroscopic examination of the placenta revealed a 17.0 × 10.0 × 7.0 cm tumor localized at the placental end of the umbilical cord. Microscopically, the tumor was composed of small arborizing vessels proliferating in the myxoid background, and the tumor cells were positive for AFP by immunohistochemistry. Extramedullary hematopoiesis was seen in the tumor vascular channels. The present case is one of the largest umbilical cord hemangiomas reported in the literature, and the first hemangioma case with MS-hCG elevation, extramedullary hematopoiesis, and positive AFP staining in the cord hemangioma. Its clinical course and detailed pathological findings are presented along with a review of the related literature.
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Affiliation(s)
- Kieko Hara
- Department of Human Pathology, Juntendo University School of Medicine, Motomachi Bldg. 3F, Hongo 1-1-19, Bunkyo-ku, Tokyo, 113-0033, Japan.
| | - Yuki Fukumura
- Department of Human Pathology, Juntendo University School of Medicine, Motomachi Bldg. 3F, Hongo 1-1-19, Bunkyo-ku, Tokyo, 113-0033, Japan.
| | - Tsuyoshi Saito
- Department of Human Pathology, Juntendo University School of Medicine, Motomachi Bldg. 3F, Hongo 1-1-19, Bunkyo-ku, Tokyo, 113-0033, Japan.
| | - Atsushi Arakawa
- Department of Human Pathology, Juntendo University School of Medicine, Motomachi Bldg. 3F, Hongo 1-1-19, Bunkyo-ku, Tokyo, 113-0033, Japan.
| | - Hitomi Okabe
- Department of Obstetrics & Gynecology, Juntendo University School of Medicine, Tokyo, Japan.
| | - Satoru Takeda
- Department of Obstetrics & Gynecology, Juntendo University School of Medicine, Tokyo, Japan
| | - Takashi Yao
- Department of Human Pathology, Juntendo University School of Medicine, Motomachi Bldg. 3F, Hongo 1-1-19, Bunkyo-ku, Tokyo, 113-0033, Japan.
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Papadopoulos VG, Kourea HP, Adonakis GL, Decavalas GO. A case of umbilical cord hemangioma: Doppler studies and review of the literature. Eur J Obstet Gynecol Reprod Biol 2009; 144:8-14. [DOI: 10.1016/j.ejogrb.2009.01.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2008] [Revised: 01/15/2009] [Accepted: 01/19/2009] [Indexed: 12/17/2022]
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