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Gigola F, Morini F, Libro G, Morabito A, Grimaldi C. Congenital hepatoblastoma: Expanding knowledge, improving outcomes. Pediatr Blood Cancer 2024; 71:e31132. [PMID: 38952263 DOI: 10.1002/pbc.31132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 04/13/2024] [Accepted: 05/19/2024] [Indexed: 07/03/2024]
Abstract
Hepatoblastoma (HB) is a rare liver tumour, and its congenital counterpart (CHB) is even less frequent. CHB has a clinically challenging management and a generally perceived worse outcome. This study aims to review the literature on CHB to better define presentation, diagnosis, available treatments and management options. The analysis of outcomes suggests that a significant portion of mortality is unrelated to the malignant nature of the tumour. Key factors influencing overall outcomes were identified: mortality linked to the 'mass effect' during both the prenatal (22%) and perinatal (32%) stages, as well as 'oncological' mortality encompassing tumour and/or treatment-related factors (46%). Overall, after birth, CHB does not seem to confer a worse oncological prognosis per se, and should be managed similarly to older children, if patients are stable enough to undergo proper staging and treatment. A deeper knowledge and better outcomes would come from a large, homogeneous, collection of data possibly allowing a global protocol, focusing on a comprehensive management of CHB.
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Affiliation(s)
- Francesca Gigola
- School of Pediatric Surgery, University of Florence, Florence, Italy
- Department of Pediatric and Neonatal Surgery, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Francesco Morini
- Department of Pediatric and Neonatal Surgery, Meyer Children's Hospital IRCCS, Florence, Italy
- Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
| | - Giorgia Libro
- School of Pediatric Surgery, University of Florence, Florence, Italy
- Department of Pediatric and Neonatal Surgery, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Antonino Morabito
- Department of Pediatric and Neonatal Surgery, Meyer Children's Hospital IRCCS, Florence, Italy
- Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
| | - Chiara Grimaldi
- Department of Pediatric and Neonatal Surgery, Meyer Children's Hospital IRCCS, Florence, Italy
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Ho RW, Nonnenmacher G, Henkes H, Vokuhl C, Loff S. A multi-step approach to the treatment of giant scalp congenital hemangiomas: a report of two cases. Front Surg 2023; 10:1045285. [PMID: 37292488 PMCID: PMC10244559 DOI: 10.3389/fsurg.2023.1045285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 04/12/2023] [Indexed: 06/10/2023] Open
Abstract
This is a review of two cases of neonatal giant scalp congenital hemangioma. Both patients were treated with propranolol using a similar multi-step approach that included transarterial embolization of the supplying arteries followed by surgical resection of the lesion. In this report, we discuss the treatments, complications, and clinical outcomes of interventions and surgical procedures.
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Affiliation(s)
- Raymond W. Ho
- Department of Pediatric Surgery, Olgahospital, Klinikum Stuttgart, Stuttgart, Germany
| | - Gabriel Nonnenmacher
- Department of Pediatric Surgery, Olgahospital, Klinikum Stuttgart, Stuttgart, Germany
| | - Hans Henkes
- Neuroradiological Clinic, Katherinenhospital, Klinikum Stuttgart, Stuttgart, Germany
| | | | - Steffan Loff
- Department of Pediatric Surgery, Olgahospital, Klinikum Stuttgart, Stuttgart, Germany
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Liu D, Yu J, Yang Y, Ouyang M, Zhang M, Zeng S, Xu G. Unusual presentation of a case of fetal hepatic mass: a case report. BMC Pregnancy Childbirth 2023; 23:290. [PMID: 37101255 PMCID: PMC10131444 DOI: 10.1186/s12884-023-05626-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 04/19/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND Giant hepatic hemangiomas are rare and can cause serious complications that contribute to a high risk of perinatal mortality. The purpose of this article is to review the prenatal imaging features, treatment, pathology, and prognosis of an atypical fetal giant hepatic hemangioma and to discuss the differential diagnosis of fetal hepatic masses. CASE PRESENTATION A gravida 9, para 0 woman at 32 gestational weeks came to our institution for prenatal ultrasound diagnosis. A complex, heterogeneous hepatic mass measuring 5.2 × 4.1 × 3.7 cm was discovered in the fetus using conventional two-dimensional ultrasound. The mass was solid and had both a high peak systolic velocity (PSV) of the feeding artery and intratumoral venous flow. Fetal magnetic resonance imaging (MRI) revealed a clear, hypointense T1-W and hyperintense T2-W solid hepatic mass. Prenatal diagnosis was very difficult due to the overlap of benign and malignant imaging features on prenatal ultrasound and MRI. Even postnatally, neither contrast-enhanced MRI nor contrast-enhanced computed tomography (CT) was useful in accurately diagnosing this hepatic mass. Due to persistently elevated Alpha-fetoprotein (AFP), a laparotomy was performed. Histopathological examination of the mass showed atypical features such as hepatic sinus dilation, hyperemia, and hepatic chordal hyperplasia. The patient was ultimately diagnosed with a giant hemangioma, and the prognosis was satisfactory. CONCLUSIONS When a hepatic vascular mass is found in a third trimester fetus a hemangioma should be considered as a possible diagnosis. However, prenatal diagnosis of fetal hepatic hemangiomas can be challenging due to atypical histopathological findings. Imaging and histopathological assays can provide useful information for the diagnosis and treatment of fetal hepatic masses.
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Affiliation(s)
- Dongmei Liu
- Department of Ultrasound Diagnosis, The Second Xiangya Hospital, Central South University, 139 Renmin Road (M), Changsha, 410011, Hunan, China
- Research Center of Ultrasound Diagnosis, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
- Clinical Research Center for Medical Imaging in Hunan Province, Changsha, 410011, Hunan, China
| | - Jiali Yu
- Department of Ultrasound Diagnosis, The Second Xiangya Hospital, Central South University, 139 Renmin Road (M), Changsha, 410011, Hunan, China
- Research Center of Ultrasound Diagnosis, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
- Clinical Research Center for Medical Imaging in Hunan Province, Changsha, 410011, Hunan, China
| | - Yang Yang
- Department of Ultrasound Diagnosis, The Second Xiangya Hospital, Central South University, 139 Renmin Road (M), Changsha, 410011, Hunan, China
- Research Center of Ultrasound Diagnosis, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
- Clinical Research Center for Medical Imaging in Hunan Province, Changsha, 410011, Hunan, China
| | - Minzhi Ouyang
- Department of Ultrasound Diagnosis, The Second Xiangya Hospital, Central South University, 139 Renmin Road (M), Changsha, 410011, Hunan, China
- Research Center of Ultrasound Diagnosis, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
- Clinical Research Center for Medical Imaging in Hunan Province, Changsha, 410011, Hunan, China
| | - Ming Zhang
- Department of Ultrasound Diagnosis, The Second Xiangya Hospital, Central South University, 139 Renmin Road (M), Changsha, 410011, Hunan, China
- Research Center of Ultrasound Diagnosis, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
- Clinical Research Center for Medical Imaging in Hunan Province, Changsha, 410011, Hunan, China
| | - Shi Zeng
- Department of Ultrasound Diagnosis, The Second Xiangya Hospital, Central South University, 139 Renmin Road (M), Changsha, 410011, Hunan, China
- Research Center of Ultrasound Diagnosis, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
- Clinical Research Center for Medical Imaging in Hunan Province, Changsha, 410011, Hunan, China
| | - Ganqiong Xu
- Department of Ultrasound Diagnosis, The Second Xiangya Hospital, Central South University, 139 Renmin Road (M), Changsha, 410011, Hunan, China.
- Research Center of Ultrasound Diagnosis, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China.
- Clinical Research Center for Medical Imaging in Hunan Province, Changsha, 410011, Hunan, China.
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Bauzon J, Morris D, St. Hill C, Schanda T, Scheidler M, Chang S. A rapidly growing mesenchymal hamartoma in a neonate with known placental anomalies. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2022.102324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Abstract
Hepatoblastoma (HB) is the most common malignancy within the rare cohort of
pediatric primary liver tumors. It may arise sporadically or in association with
germline mutations in specific genetic syndromes. Histogenesis recapitulates
fetal hepatic development, however, this tumor can exhibit a markedly
heterogeneous appearance both macroscopically and under the microscope.
Histologic subtypes are classified based on morphologic appearance, with
additional discrimination based on emerging molecular and immunohistochemical
features. Numerous diagnostic pitfalls exist from clinical presentation through
to ancillary testing; at all stages, the surgical pathologist must be discerning
and open to collaboration with colleagues of different specialties. Problematic
areas include the adequacy of tissue sampling, correlation of histology with
radiologic appearance and alpha feto-protein (AFP) serology, forming a
diagnostic consensus within the pediatric pathology community and choosing a
shrewd immunohistochemical panel. This review discusses the sequence of events
leading up to histologic assessment, and the nuances of microscopic evaluation.
Along the way, pitfalls are highlighted, providing a tool for the surgical
pathologists to support their individual approach.
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Affiliation(s)
| | - Consolato M. Sergi
- Anatomic Pathology Division, Children's Hospital of Eastern Ontario,
Ottawa, ON, Canada
- Consolato M. Sergi, Chief, Anatomic
Pathology Division, Pediatric Pathologist, Children’s Hospital of Eastern
Ontario (CHEO), 401 Smyth Road Ottawa, ON, K1H 8L1, Canada.
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Liu X, Tian S, Zhu Z, Peng F, Yuan Q, Duan X, Yan X. Fetal mesenchymal hamartoma of the liver: A case report and literature review. Front Pediatr 2022; 10:1016260. [PMID: 36507148 PMCID: PMC9727103 DOI: 10.3389/fped.2022.1016260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 11/07/2022] [Indexed: 11/24/2022] Open
Abstract
This paper reports the diagnosis and treatment process of a case of fetal mesenchymal hamartoma of the liver (MHL), and reviews the previous literature reports. At 38+2 weeks of gestation, prenatal ultrasound found a well bound mixed solid and cystic mass, which was located at the lower edge of the right lobe of the liver and in front of the right kidney of the fetus, but the source and nature of the mass were not clear by ultrasound. Due to the approaching due date, the fetus showed no other abnormal symptoms, and no special treatment was given with the consent of the family members. A female fetus was delivered weighing 3,520 g at 39 weeks. An exploratory laparotomy was performed on the eighth day after delivery. During the operation, it was found that the tumor originated from the fifth, sixth and seventh hepatic segment and the corresponding hepatic segments were removed. Recovery was uneventful and the infant was discharged on the 6th day after surgery. Follow-up at 2 years showed a thriving young girl, and there was no tumor recurrence.
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Affiliation(s)
- Xin Liu
- Department of Pediatric Surgery, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Sha Tian
- Department of Ultrasound, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Zhenchuang Zhu
- Department of Pediatric Surgery, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Fei Peng
- Department of Pediatric Surgery, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Qiang Yuan
- Department of Pediatric Surgery, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Xufei Duan
- Department of Pediatric Surgery, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Xueqiang Yan
- Department of Pediatric Surgery, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
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Jin Y, Li L, Yang F. Infantile hepatic hemangioma misdiagnosed by prenatal ultrasonography: A case report. Medicine (Baltimore) 2021; 100:e24242. [PMID: 33466207 PMCID: PMC7808497 DOI: 10.1097/md.0000000000024242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 12/17/2020] [Indexed: 02/05/2023] Open
Abstract
RATIONALE The drastic differences in treatment and prognosis of infantile hepatic hemangioma (IHH) and hepatoblastoma (HBL) make accurate prenatal diagnosis imperative. The retrospective comparisons of ultrasonic features between fetal IHH and HBL have been reported before, but clinically, the differential diagnosis in utero is very difficult and can lead to prenatal misdiagnosis. PATIENT CONCERNS A 27-year-old woman at 30 gestational weeks underwent the routine prenatal examination. A heterogeneous solid mass of the fetus, with close relationship to the liver, was recognized by ultrasound. DIAGNOSIS A diagnosis of HBL was highly considered. INTERVENTIONS The fetus was aborted and the autopsy was performed. OUTCOMES The histological outcome was IHH. LESSONS The prognosis of fetal IHH and HBL is very different, so an accurate diagnosis prenatally is crucial and indispensable. The radiologist and clinician should differentiate between IHH and HBL, especially since the fetus can have serious complications.
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Affiliation(s)
- Ya Jin
- Department of Ultrasound
- Key Laboratory of Obstetrics and Gynecology and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second Hospital of Sichuan University
| | - Lin Li
- Department of Pathology, West China Hospital of Sichuan University
| | - Fan Yang
- Department of Ultrasound
- Key Laboratory of Obstetrics and Gynecology and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second Hospital of Sichuan University
- Chengdu Chenghua District Maternal and Child Health Hospital, Chengdu, Sichuan, China
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Abstract
Following the discovery of a fetal hepatic tumor, labor was induced at 38 weeks, and a phenotypically normal female was delivered vaginally. A serum alpha-fetoprotein level at birth was 373,170 ng/mL. Postnatal magnetic resonance imaging confirmed a mass in the right lobe of the liver, and a percutaneous core biopsy revealed an epithelial type hepatoblastoma with predominantly embryonal histology. Methylation testing revealed hypomethylation at imprinting center 2, consistent with a diagnosis of Beckwith-Wiedemann syndrome. This case suggests that Beckwith-Wiedemann syndrome testing should be considered in all patients with hepatoblastoma, even in the absence of other phenotypic stigmata.
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Abstract
Vascular liver tumors in the pediatric population can present a diagnostic dilemma. The most common hepatic vascular tumors are hepatic hemangiomas; however the differential diagnosis can also include other benign lesions and malignant masses. Management is unique to the type and nature of the specific lesion. Thus, correct diagnosis and timely intervention is critical. The work up, diagnosis, and management of the different hepatic lesions are discussed in this paper.
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Shaughnessy MP, Spencer-Manzon M, Cowles RA. Antenatally detected liver and biliary pathology. Semin Pediatr Surg 2020; 29:150939. [PMID: 32861443 DOI: 10.1016/j.sempedsurg.2020.150939] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Liver and biliary pathology in the neonate are rare and include a broad range of structural, neoplastic, infectious, genetic, and metabolic diseases. While most conditions present postnatally, antenatal detection is increasing given recent advances in antenatal imaging capabilities. In certain structural or obstructive liver diseases, antenatal detection now proves essential to help guide treatment and prevent morbidity. We review the epidemiology, pathophysiology, common antenatal diagnostic findings, and recommendations for surgical liver and biliary pathology in the neonate.
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Affiliation(s)
- Matthew P Shaughnessy
- Department of Surgery, Division of Pediatric Surgery, Yale University School of Medicine, 333 Cedar St., FMB 131, New Haven, CT 06510, USA
| | | | - Robert A Cowles
- Department of Surgery, Division of Pediatric Surgery, Yale University School of Medicine, 333 Cedar St., FMB 131, New Haven, CT 06510, USA.
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Feasibility of free-breathing T1-weighted 3D radial VIBE for fetal MRI in various anomalies. Magn Reson Imaging 2020; 69:57-64. [PMID: 32171775 DOI: 10.1016/j.mri.2020.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 03/06/2020] [Accepted: 03/10/2020] [Indexed: 11/21/2022]
Abstract
RATIONALE AND OBJECTIVES In magnetic resonance (MR) fetal imaging, the image quality acquired by the traditional Cartesian-sampled breath-hold T1-weighted (T1W) sequence may be degraded by motion artifacts arising from both mother and fetus. The radial VIBE sequence is reported to be a viable alternative to conventional Cartesian acquisition for both pediatric and adult MR, yielding better image quality. This study evaluated the role of radial VIBE in fetal MR imaging and compared its image quality and motion artifacts with those of the Cartesian T1W sequence. MATERIALS AND METHODS We included 246 pregnant women with 50 lesions on 1.5-T MR imaging. Image quality and lesion conspicuity were evaluated by two radiologists, blinded to the acquisition schemes used, using a five-point scale, where a higher score indicated a better trajectory method. Mixed-model analysis of variance and interobserver variability assessment were performed. RESULTS The radial VIBE sequence showed a significantly better performance than conventional T1W imaging in the head and neck, fetal body, and placenta region: 3.92 ± 0.88 vs 3 ± 0.74, p < 0.001, 3.8 ± 0.94 vs 3.15 ± 0.87, p < 0.001, and 4.17 ± 0.63 vs 3.12 ± 0.72, p < 0.001, respectively. Additionally, fewer motion artifacts were observed in all regions with the radial VIBE sequence (p < 0.01). Of 50 lesions, 49 presented better lesion conspicuity on radial VIBE images than on T1W images (4.34 ± 0.91 vs 3.48 ± 1.46, p < 0.001). CONCLUSION For fetal imaging, the radial VIBE sequences yielded better image quality and lesion conspicuity, with fewer motion artifacts, than conventional breath-hold Cartesian-sampled T1W sequences.
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Masmejan S, Baud D, Ryan G, Van Mieghem T. Management of fetal tumors. Best Pract Res Clin Obstet Gynaecol 2019; 58:107-120. [PMID: 30770283 DOI: 10.1016/j.bpobgyn.2019.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 01/07/2019] [Accepted: 01/08/2019] [Indexed: 12/28/2022]
Abstract
In this review article, we discuss the most common fetal tumors, their prenatal management, and outcomes. Overall, the most important outcome predictors are tumor histology, size, vascularity, and location. Very large lesions, lesions causing cardiac failure, and hydrops and lesions obstructing the fetal airway have the poorest outcome, as they may cause fetal death or complications at the time of delivery. Fetal therapy has been developed to improve outcomes for the most severe cases and can consist of transplacental therapy (sirolimus for rhabdomyomas or steroids for hemangiomas and microcystic lung lesions) or surgical intervention (shunting of cystic masses, tumor ablation, occlusion of blood flow or airway exploration, and protection). Given the rarity of fetal tumors, patients should be referred to expert centers where care can be optimized and individualized to allow the best possible outcomes.
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Affiliation(s)
- Sophie Masmejan
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, Mount Sinai Hospital and University of Toronto, Toronto, Canada; Obstetrics Unit, Mother-Child Department, University Hospital Lausanne, Switzerland
| | - David Baud
- Obstetrics Unit, Mother-Child Department, University Hospital Lausanne, Switzerland
| | - Greg Ryan
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, Mount Sinai Hospital and University of Toronto, Toronto, Canada
| | - Tim Van Mieghem
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, Mount Sinai Hospital and University of Toronto, Toronto, Canada.
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