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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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Yoo GHY, Mugarab-Samedi V, Hansen G, Miller G, Givelichian L, Kalaniti K, Daspal S. Rare cause of emergency in the first week of life: congenital hepatoblastoma (case report). Oxf Med Case Reports 2020; 2020:omaa002. [PMID: 32123567 PMCID: PMC7037083 DOI: 10.1093/omcr/omaa002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 01/04/2020] [Accepted: 01/14/2020] [Indexed: 12/02/2022] Open
Abstract
During the first week of life, a sudden deterioration in a newborn commonly includes investigations to rule out infections, lung pathologies, cardiac lesions, neurological insults, metabolic disorders or gastrointestinal emergencies. It is unusual, however, to consider malignancy as the primary causative factor. In this case report, we describe a rare and unusual presentation of congenital hepatoblastoma, its complications and management in a neonate with multi-organ dysfunction. A term infant presented with sudden deterioration, hemodynamic instability and an acute abdomen on his 4th day of life. Surgical exploration revealed a ruptured neoplasm that pathology diagnosed as a congenital hepatoblastoma. After the patient was stabilized, chemotherapy was initiated. At present, the patient is 8 months old and under continuous follow-up of oncology service. This case highlights the importance of considering rare diagnoses including congenital malignancy when investigating and managing a sick newborn with multi-organ dysfunction.
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Affiliation(s)
- Gloria Ha Young Yoo
- Faculty of Pediatrics, University of Saskatchewan, Saskatoon, SK S7N 5E5, Canada.,Pediatric Department, Jim Pattison Children' Hospital, Royal University Hospital, Saskatoon, SK S7N 0W8, Canada
| | - Veronica Mugarab-Samedi
- Faculty of Pediatrics, University of Saskatchewan, Saskatoon, SK S7N 5E5, Canada.,Pediatric Department, Jim Pattison Children' Hospital, Royal University Hospital, Saskatoon, SK S7N 0W8, Canada
| | - Gregory Hansen
- Faculty of Pediatrics, University of Saskatchewan, Saskatoon, SK S7N 5E5, Canada.,Pediatric Department, Jim Pattison Children' Hospital, Royal University Hospital, Saskatoon, SK S7N 0W8, Canada
| | - Grant Miller
- Faculty of Pediatrics, University of Saskatchewan, Saskatoon, SK S7N 5E5, Canada.,Pediatric Department, Jim Pattison Children' Hospital, Royal University Hospital, Saskatoon, SK S7N 0W8, Canada
| | - Laurence Givelichian
- Faculty of Pediatrics, University of Saskatchewan, Saskatoon, SK S7N 5E5, Canada.,Pediatric Department, Jim Pattison Children' Hospital, Royal University Hospital, Saskatoon, SK S7N 0W8, Canada
| | - Kaarthigeyan Kalaniti
- Faculty of Pediatrics, University of Saskatchewan, Saskatoon, SK S7N 5E5, Canada.,Pediatric Department, Jim Pattison Children' Hospital, Royal University Hospital, Saskatoon, SK S7N 0W8, Canada
| | - Sibasis Daspal
- Faculty of Pediatrics, University of Saskatchewan, Saskatoon, SK S7N 5E5, Canada.,Pediatric Department, Jim Pattison Children' Hospital, Royal University Hospital, Saskatoon, SK S7N 0W8, Canada
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Banerjee A, Almel S, Shah SR. Nine-Year Follow-up in a Child with Antenatally Diagnosed Hepatoblastoma. J Gastrointest Cancer 2016; 49:67-70. [PMID: 27277663 DOI: 10.1007/s12029-016-9848-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Abhirup Banerjee
- Division of Gastro-Intestinal Surgery, P.D. Hinduja National Hospital and Medical Research Centre, Veer Savarkar Marg, Mahim, Mumbai, India, 400016.
| | - Sachin Almel
- Division of Medical Oncology, P.D. Hinduja National Hospital and Medical Research Centre, Veer Savarkar Marg, Mahim, Mumbai, India, 400016
| | - Sudeep R Shah
- Division of Gastro-Intestinal Surgery, P.D. Hinduja National Hospital and Medical Research Centre, Veer Savarkar Marg, Mahim, Mumbai, India, 400016
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Trobaugh-Lotrario AD, Chaiyachati BH, Meyers RL, Häberle B, Tomlinson GE, Katzenstein HM, Malogolowkin MH, von Schweinitz D, Krailo M, Feusner JH. Outcomes for patients with congenital hepatoblastoma. Pediatr Blood Cancer 2013; 60:1817-25. [PMID: 23798361 DOI: 10.1002/pbc.24655] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Accepted: 05/20/2013] [Indexed: 12/17/2022]
Abstract
BACKGROUND Congenital hepatoblastoma, diagnosed in the first month of life, has been reported to have a poor prognosis; however, a comprehensive evaluation of this entity is lacking. PROCEDURE We retrospectively reviewed two patients from the senior authors' personal series and 25 cases identified in the databases of several multicenter group studies (INT-0098, P9645, 881, P9346, HB 89, HB94, and HB 99). We compared this series with cases of congenital hepatoblastoma previously published in the literature. RESULTS The 3-year survival in our case series was 86% (18/21) with a follow-up of 44-230 months (median 85.5 months). Presentation and treatment were not substantially different from hepatoblastoma cohorts unselected for age. Survival was comparable to the reported disease free survival for a similar cohort of hepatoblastoma patients unselected for age between 1986 and 2002 (82.5%) [von Schweinitz et al., Eur J Cancer 1997; 33:1243-1249]. The 2-year survival of cases reported in the literature was 0% (0/9) and 42% (10/24) for patients reported before and after 1990, respectively. CONCLUSIONS Congenital hepatoblastoma does not appear to confer a worse prognosis. The improved survival of our current series of patients, collected from the past 20 years of German and American multicenter trials and personal series, suggests that the outcome of hepatoblastoma at this young age is much better than has been historically reported. More rigorous analysis should be conducted in future multicenter trials. It is possible that congenital hepatoblastoma should be treated like all other patients with hepatoblastoma provided that the child is stable enough to proceed with surgery and chemotherapy.
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Opioid growth factor (OGF) for hepatoblastoma: a novel non-toxic treatment. Invest New Drugs 2012; 31:1066-70. [DOI: 10.1007/s10637-012-9918-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Accepted: 12/17/2012] [Indexed: 10/27/2022]
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Lai M, Burjonrappa S. Perinatal hemorrhage complicating neonatal hepatoblastoma: case report. J Pediatr Surg 2012; 47:e29-32. [PMID: 23084227 DOI: 10.1016/j.jpedsurg.2012.05.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Revised: 05/02/2012] [Accepted: 05/25/2012] [Indexed: 11/29/2022]
Abstract
Hepatoblastoma is the most common malignant liver tumor of infancy and presents most frequently at a median age of 18 months. Presentation in the neonatal period is rare, and there are very few reports of an antenatal diagnosis of hepatoblastoma. We recently encountered a neonate who presented with hemoperitoneum after rupture of a congenital hepatoblastoma during vaginal delivery. After successful right hepatectomy and adjuvant cis-platinum-based chemotherapy, the child is doing well. We draw attention to rarity of this condition and difficulty in definitively establishing a diagnosis both in the antenatal and neonatal periods and discuss the management dilemmas in congenital presentations of hepatoblastoma.
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Affiliation(s)
- May Lai
- Touro College of Osteopathic Medicine, NY, USA
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Huang LC, Ho M, Chang WC, Chen HY, Hung YC, Chiu TH. Prenatal diagnosis of fetal hepatoblastoma with a good neonatal outcome: case report and narrative literature review. Pediatr Hematol Oncol 2011; 28:150-4. [PMID: 21299342 DOI: 10.3109/08880018.2010.536299] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The authors report a case of congenital hepatoblastoma that was diagnosed in the antenatal period at 39 weeks' gestation. The infant was delivered vaginally without rupture of the tumor. The neonate then received chemotherapy and underwent surgical excision of the tumor. After 1 year, no tumor recurrence has been noted.
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Affiliation(s)
- Li-Chia Huang
- Department of Obstetrics and Gynecology, China Medical University Hospital, Taiching, Taiwan.
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Affiliation(s)
- Logan G Spector
- Division of Epidemiology/Clinical Research, Department of Pediatrics, University of Minnesota, MN, USA
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Sebire NJ, Jauniaux E. Fetal and placental malignancies: prenatal diagnosis and management. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2009; 33:235-244. [PMID: 19009536 DOI: 10.1002/uog.6246] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Fetal and placental malignancies are rare complications during pregnancy, but when they occur they may present significant challenges for the perinatology team. Owing to their rarity, there is limited information on many of these entities, with much data derived from individual case reports or small case series. Prenatal diagnosis of these entities is rare and inconsistent, usually in the form of isolated case reports. In the majority of fetal tumors, prenatal features are those of a mass lesion, with or without other non-specific features of fetal compromise such as polyhydramnios, fetal hydrops or intrauterine death, the final diagnosis in most cases being based on postnatal pathological examination.Expectant management is almost always indicated antenatally, with serial ultrasound examinations performed to detect rapid enlargement, metastasis or secondary fetal complications, such as non-immune hydrops, which may require intervention. Delivery should be planned in a specialist center in conjunction with pediatric surgeons and oncologists to allow appropriate neonatal management. Placental malignancy is most commonly in the form of gestatational trophoblastic disease, which requires assessment and management in specialist centers.
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Affiliation(s)
- N J Sebire
- Department of Paediatric Pathology, Great Ormond Street Hospital, London, UK
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Catanzarite V, Hilfiker M, Daneshmand S, Willert J. Prenatal diagnosis of fetal hepatoblastoma: case report and review of the literature. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2008; 27:1095-1098. [PMID: 18577676 DOI: 10.7863/jum.2008.27.7.1095] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Hepatoblastoma is the most common liver malignancy in childhood. The reported incidence is 11.2 cases per 1 million during the first year of life. Genetic predispositions include Beckwith-Wiedemann syndrome and familial polyposis. The prognosis depends on the extent of tumor spreading at the time of initial treatment, which typically includes chemotherapy and surgery. Imaging of hepatoblastoma has only rarely been reported prenatally. Here we report a recent case with a successful outcome and discuss issues of differential diagnosis and treatment.
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Affiliation(s)
- Val Catanzarite
- Department of Maternal-Fetal Medicine, Sharp Mary Birch Hospital for Women, and San Diego Perinatal Center, San Diego, California 92123, USA.
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Spector LG, Hooten AJ, Ross JA. Ontogeny of Gene Expression: A Changing Environment for Malignancy: Figure 1. Cancer Epidemiol Biomarkers Prev 2008; 17:1021-3. [PMID: 18483321 DOI: 10.1158/1055-9965.epi-08-0275] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Abstract
OBJECTIVE To review the diagnosis, management, and treatment options of tumors presenting during fetal development. METHODS Recognized textbooks and peer-reviewed literature (from the years 1985-2006) were summarized for the most common information on fetal tumors. RESULTS Fetal tumors are rare, with a usual prevalence of less than 1 in 10,000 live births. The list of fetal tumors reviewed includes tumors involving multiple sites, such as teratoma, lymphangioma, and hemangioma, and tumors located specifically in organs such the liver, adrenal gland, kidney, and placenta. CONCLUSIONS Prenatal diagnosis, surveillance, and treatment of fetal tumors is limited to case reports, small series, and single-institution experience.
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Affiliation(s)
- R Douglas Wilson
- The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Pennsylvania, USA.
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Current awareness in prenatal diagnosis. Prenat Diagn 2006; 26:94-9. [PMID: 16475249 DOI: 10.1002/pd.1027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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