Cutis marmorata telangiectatica congenita associated with an elevated maternal serum human chorionic gonadotrophin level and transitory isolated fetal ascites

Cutis marmorata telangiectatica congenita: a focus on its diagnosis, ophthalmic anomalies, and possible etiologic factors

Purpose: Cutis marmorata telangiectatica congenita (CMTC) is a rare congenital disorder typified by localized or generalized cutaneous vascular anomalies, which dissipate over time. We review the diagnostic approach to CMTC and present a comprehensive examination of its ocular manifestations. Additionally, we offer recommendations for the ophthalmologic workup for patients with CMTC. Finally, we examine the possible causes of CMTC and summarize the current efforts to establish an etiologic mechanism for this disease.Methods: Thirty-three published cases of CMTC with ocular anomalies are examined in detail.Results: CMTC is diagnosed based on a specific set of congenital cutaneous symptoms, principally congenital reticular erythema that is unresponsive to local warming and absence of venectasia within the skin lesions. Ocular findings are not currently employed in this diagnostic process, likely due to an incomplete understanding into their presentation, frequency, and natural history. We show that the majority of ophthalmic manifestations are congenital, with glaucoma and posterior segment anomalies, consisting of retinal perfusion defects and vascular abnormalities, as the most frequently reported findings. Typical ophthalmic medical and surgical interventions appear to be effective for management of these CMTC-related pathology. Unfortunately, the etiology and pathophysiology of CMTC remains unknown, which obfuscates efforts to identify, examine, and initiate treatment in patients.Conclusions: While the ophthalmic community has traditionally viewed glaucoma as the classic ocular anomaly of CMTC, this dataset advocates for the prompt investigation of posterior segment abnormalities as well. However, our understanding of CMTC's ocular anomalies is complicated by a lack of reporting and/or incomplete (or nonexistent) ophthalmic examinations, and we strongly encourage comprehensive ophthalmic examinations for all CMTC patients at the time of diagnosis, followed by appropriate screening and surveillance throughout life. We believe these recommendations will spur additional data and disease insights that may be useful for future refinements to CMTC diagnostic algorithms.

The outcome of isolated fetal ascites

OBJECTIVE

To describe the outcome of pregnancies complicated by isolated fetal ascites.

STUDY DESIGN

This is a review of 12 cases of isolated fetal ascites managed at the fetal medicine unit at the Royal Victoria Infirmary in Newcastle. The work-up for ascites included detailed ultrasound examination, checking maternal blood group and testing for the presence of antibodies, as well as maternal infection screening and fetal karyotyping.

RESULTS

Ten out of the 12 pregnancies had a viable fetal outcome, with two babies (20%) requiring further bowel surgery. Ascites resolved spontaneously in three pregnancies (30%) antenatally and in two babies (20%) few weeks after delivery.

CONCLUSION

Isolated fetal ascites with normal karyotype and negative infection screen carries a good prognosis, with spontaneous resolution in most of the cases. However the parents should be counselled as regards the possibility of need for surgery or the presence of underlying syndromes.

[Cutis marmorata telangiectatica congenita--case report]

Cutis marmorata telangiectatica congenita is a rare, usually congenital, localized or generalized cutaneous vascular abnormality characterized by a persistent cutis marmorata pattern, spider naevus-like telangiectasia and ulceration or atrophy of the involved skin, which frequently improves with age. Approximately 300 cases have been reported worldwide. The authors present a case of cutis marmorata telangiectatica congenita with typical clinical findings: phlebectasia of the scalp with ulceration, almost generalized persistent cutis marmorata, telangiectasia. No associated anomalies were detected. The relevant literature is also reviewed.

Macrocephaly-cutis marmorata telangiectatica congenita: report of six new patients and a review

We report on six additional patients with macrocephaly-cutis marmorata telangiectatica congenita (M-CMTC; MIM 602501) and review the literature. This syndrome is a multiple congenital anomalies/mental retardation and overgrowth disorder comprising macrocephaly, cutis marmorata, vascular marks of lip and/or philtrum, syndactyly, hemihypertrophy, CNS anomalies, and developmental delay. Based on the findings in our 6 patients and on 69 patients previously reported we listed the very frequent (observed in >75%), frequent (25-75%), and less frequent (>25%) components of the syndrome.

Cutis marmorata telangiectatica congenita with hemangiomatous histopathologic features

Cutis marmorata telangiectatica congenita (CMTC) is a congenital cutaneous vascular malformation that is diagnosed on the typical clinical findings of persistent cutis marmorata, telangiectasia, phlebectasia, occasional ulceration and atrophy, and tendency for clinical improvement. Histopathologic findings seldom have been reported. We report a case of CMTC with atypical histopathologic findings of proliferation of vasculature in addition to dilated capillaries in the dermis. We have reviewed all cases of CMTC with histopathologic findings published in the English-language literature. The most common and prominent finding was dilation of capillaries and veins in the dermis (13/15 cases). Two cases, including our own, demonstrated proliferation of vascular channels. The implications of vascular proliferation on the clinical course of CMTC are unclear.