Genetic Analysis of Copy Number Variation in Large Chorangiomas

An Investigation of the Etiologies of Non-Immune Hydrops Fetalis in the Era of Next-Generation Sequence-A Single Center Experience

(1) Background: Numerous etiologies may lead to non-immune hydrops fetalis (NIHF). However, the causes remain unclear in half of NIHF cases following current standard assessment. The application of prenatal chromosomal microarray analysis (CMA) and exome sequencing (ES) can improve the identification of the etiologies. This study aimed to investigate the etiologies of NIHF in the era of next-generation sequence (NGS) following a unified prenatal work-up flow for diagnosis. (2) Methods: A retrospective analysis was conducted on NIHF cases that were collected prospectively to explore the underlying etiologies according to a unified prenatal diagnosis work-up flow at Shanghai First Maternity and Infant Hospital between Jan 2016 and Dec 2019. The medical records for all NIHF cases were reviewed, and the causes of NIHF were classified as confirmed (diagnostic), suspected, or unknown. (3) Results: Prenatal and postnatal medical records for a total of 145 NIHF cases were reviewed, 48.3% (70/145) of the cases were identified to be with confirmed etiologies, and 10.3% (15/145) with suspected etiologies. Among 85 cases with confirmed or suspected etiologies, 44.7% were diagnosed with genetic disorders, 20% with chylothorax/chyloascites diagnosed postnatally, 12.9% with fetal structural anomalies, 12.9% with fetal anemia, 7% (6 cases) with fetal arrhythmia, and 2.3% (2 cases) with placenta chorioangioma. In cases with genetic disorders, 8 aneuploidies were detected by CMA, and 30 cases had single-gene disorders identified by ES (29/30) or targeted gene panel (1/30). There were still 41.4% cases (60/145) with unknown causes after this unified prenatal diagnostic work-up flow. (4) Conclusions: In the era of NGS, the causes of NIHF were identified in 58.6% of cases, with genetic disorders being the most common ones. NGS is helpful in determining the genetic etiology of NIHF when CMA results cannot explain NIHF, but 41.4% of cases were still with unknown causes under the unified prenatal diagnostic work-up flow in this single-center study.

Hepatic and Adrenocortical Choristomas in the Placenta

Background Hepatic and adrenocortical choristomas are unusual findings in the placenta. This meta-analysis includes our own case report and 23 previously reported cases. We searched for patterns of associated placental, fetal and maternal aberrations in order to determine whether these choristomas are clinically relevant. Case report: In our case, abortion was induced due to fetal central nervous system and renal malformations. In the placenta a hepatic choristoma (<0.1 cm), thrombangiitis obliterans and a single umbilical artery were found. Results: In the literature, the majority of lesions were ≤1.0 cm (n = 21/24, 87.5%) and two hepatic choristomas manifested within chorangiomas. In a subfraction of cases, we found an association with twin/triple pregnancies (n = 6/24, 25%) and heterogeneous non-hepatic/non-adrenal malformations in fetuses (n = 4/24, 17%). Conclusion: Hepatic and adrenocortical choristomas are benign, could be based on focal epigenetic changes and might be related to chorangiomas but are not associated with a particular disease pattern or risk profile.