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Yokomine M, Horinouchi T, Yoshizato T, Sumi A, Koganemaru M, Kinoshita M, Ozono S, Ushijima K. Fetal Hepatic Hemangioma Diagnosed in Utero Using Doppler Microvascular Imaging. Kurume Med J 2024; 70:69-72. [PMID: 38763740 DOI: 10.2739/kurumemedj.ms7012008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2024]
Abstract
A 35-year-old pregnant woman was referred to our institution at 33 weeks' gestation for evaluation of a fetal abdominal tumor. B-mode ultrasonography demonstrated a massive lesion. Bidirectional power Doppler mode showed abundant blood flow surrounding the tumor. On superb micro-vascular imaging, various Doppler signal patterns were observed within the tumor, including diffuse fine dotted-like signals, linear flow, and internal shunt flow. Sequential observations of the tumor and cardiac cycles also revealed pulsatile flow beneath the edges of the tumor and continuous fine flow in the central area, resembling a 'centripetal fill-in' appearance on contrast computed tomography. Therefore, we assumed the fetal tumor to be a hepatic hemangioma. Fetal heart failure was detected at 37 weeks' gestation, and a 2,484-g female infant was delivered with 1- and 5-min Apgar scores of 7 and 8, respectively. A postnatal contrast computed tomography examination showed a progressive centripetal fill-in appearance, leading to a diagnosis of hepatic hemangioma. Kasabach-Merritt syndrome was also noted. Intensive treatment was performed, and the infant was discharged at 3 months after birth. In summary, we experienced a case of hepatic hemangioma diagnosed in utero using superb micro-vascular imaging. And basing seamless postnatal treatments on prenatal imaging findings may help to reduce the perinatal mortality.
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Affiliation(s)
- Masato Yokomine
- Department of Obstetrics and Gynecology, Kurume University School of Medicine
| | - Takashi Horinouchi
- Department of Obstetrics and Gynecology, Kurume University School of Medicine
| | - Toshiyuki Yoshizato
- Department of Obstetrics and Gynecology, Kurume University School of Medicine
| | - Akiko Sumi
- Department of Radiology, Kurume University School of Medicine
| | | | | | - Shuichi Ozono
- Department of Pediatrics, Kurume University School of Medicine
| | - Kimio Ushijima
- Department of Obstetrics and Gynecology, Kurume University School of Medicine
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Lee S, Jeon H, Han J, Song IK, Baek SH, Shim S, Eun H, Park MS, Jang H, Shin JE, Ihn K. Management of Neonatal Hepatic Hemangiomas: A Single-Center Experience Focused on Challenging Cases. J Clin Med 2024; 13:2839. [PMID: 38792380 PMCID: PMC11122465 DOI: 10.3390/jcm13102839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 05/07/2024] [Accepted: 05/08/2024] [Indexed: 05/26/2024] Open
Abstract
Background: Management of hepatic hemangioma (HH) in infancy ranges from close monitoring to surgical resection. We analyzed the clinical characteristics and outcomes of HH according to its treatment options, with particular focus on challenging cases. Methods: Data of patients diagnosed with HHs in their first year of life and followed up for at least 1 year were retrospectively reviewed and divided into treatment and observation groups. Serial imaging results, serum alpha-fetoprotein (AFP) levels, medications, and clinical outcomes were compared. The detailed clinical progress in the treatment group was reviewed separately. Results: A total of 87 patients (75 in the observation group and 12 in the treatment group) were included. The median HH size at the initial diagnosis and the maximum size were significantly larger in the treatment group than the observation group (2.2 [0.5-10.3] cm vs. 1.0 [0.4-4.0] cm and 2.1 [0.7-13.2] vs. 1.1 [0.4-4.0], respectively; all p < 0.05]. The median initial and last serum AFP levels were significantly higher in the treatment group than in the observation group (76,818.7 vs. 627.2 and 98.4 vs. 8.7, respectively; all p < 0.05). Serum AFP levels in both groups rapidly declined during the first 3 months of life and were almost undetectable after 6 months. Among the challenging cases, a large (14 × 10 × 6.5 cm sized) focal HH was successfully treated using stepwise medical-to-surgical treatment. Conclusions: Patients with large HH and mild symptoms can be treated using stepwise pharmacotherapy. More aggressive surgical treatment of tumors unresponsive to initial pharmacotherapy may help shorten the treatment period and improve outcomes.
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Affiliation(s)
- Sumin Lee
- Division of Neonatology, Department of Pediatrics, Severance Children’s Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (S.L.); (J.H.); (I.-K.S.); (S.H.B.); (S.S.); (H.E.); (M.S.P.)
| | - Hojong Jeon
- Division of Pediatric Surgery, Department of Surgery, National Health Insurance Service Ilsan Hospital, Goyang-si 10444, Republic of Korea;
| | - Jungho Han
- Division of Neonatology, Department of Pediatrics, Severance Children’s Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (S.L.); (J.H.); (I.-K.S.); (S.H.B.); (S.S.); (H.E.); (M.S.P.)
| | - In-Kyu Song
- Division of Neonatology, Department of Pediatrics, Severance Children’s Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (S.L.); (J.H.); (I.-K.S.); (S.H.B.); (S.S.); (H.E.); (M.S.P.)
| | - Seung Hwan Baek
- Division of Neonatology, Department of Pediatrics, Severance Children’s Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (S.L.); (J.H.); (I.-K.S.); (S.H.B.); (S.S.); (H.E.); (M.S.P.)
| | - Sungbo Shim
- Division of Neonatology, Department of Pediatrics, Severance Children’s Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (S.L.); (J.H.); (I.-K.S.); (S.H.B.); (S.S.); (H.E.); (M.S.P.)
| | - Hoseon Eun
- Division of Neonatology, Department of Pediatrics, Severance Children’s Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (S.L.); (J.H.); (I.-K.S.); (S.H.B.); (S.S.); (H.E.); (M.S.P.)
| | - Min Soo Park
- Division of Neonatology, Department of Pediatrics, Severance Children’s Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (S.L.); (J.H.); (I.-K.S.); (S.H.B.); (S.S.); (H.E.); (M.S.P.)
| | - Hyeonguk Jang
- Department of Pathology, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Jeong Eun Shin
- Division of Neonatology, Department of Pediatrics, Severance Children’s Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (S.L.); (J.H.); (I.-K.S.); (S.H.B.); (S.S.); (H.E.); (M.S.P.)
| | - Kyong Ihn
- Division of Pediatric Surgery, Department of Surgery, Severance Children’s Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
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Liang L, Wang Y, Zhang Y. Abnormal coronary hyperperfusion due to a giant hemangioendothelioma in fetal distress: A case report. Pediatr Blood Cancer 2024; 71:e30902. [PMID: 38337171 DOI: 10.1002/pbc.30902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/12/2024] [Accepted: 01/20/2024] [Indexed: 02/12/2024]
Affiliation(s)
- Lulu Liang
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Yu Wang
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Ying Zhang
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
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Xie LL, Huang YB, Dong KR, Yang SB, Shen C, Ma YY. Postnatal treatment and evolution patterns of giant fetal hepatic hemangioma: a case series of 29 patients. BMC Pediatr 2024; 24:8. [PMID: 38172842 PMCID: PMC10765870 DOI: 10.1186/s12887-023-04476-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 12/08/2023] [Indexed: 01/05/2024] Open
Abstract
OBJECTIVES To explore the clinical characteristics, postnatal treatment and prognosis of giant fetal hepatic hemangioma (GFHH). METHOD Retrospective analysis was performed on children with giant fetal hepatic hemangioma (maximum tumor diameter > 40 mm) diagnosed by prenatal ultrasound and MRI from December 2016 to December 2020. These patients were observed and treated at the Children's Hospital of Fudan University after birth. The clinical data were collected to analyze the clinical characteristics, treatment, and prognosis of GFHH using independent sample t tests or Fisher's exact tests. RESULTS Twenty-nine patients who were detected by routine ultrasound in the second and third trimester of pregnancy with giant fetal hepatic hemangiomas were included. The first prenatal ultrasound diagnosis of gestational age was 34.0 ± 4.3 weeks, ranging from 22 to 39 weeks. Of the patients, 28 had focal GFHHs and 1 had multifocal GFHHs. Surgery was performed, and the diagnosis was confirmed histopathologically in two patients. There were 8 cases with echocardiography-based evidence of pulmonary hypertension, 11 cases had a cardiothoracic ratio > 0.6, and 4 cases had hepatic arteriovenous fistula (AVF). The median follow-up time was 37 months (range: 14-70 months). During the follow-up, 12 patients received medical treatment with propranolol as the first-line therapy. The treatment group had a higher ratio of cardiothoracic ratio > 0.6 (P = 0.022) and lower albumin levels (P = 0.018). Four (14.8%) lesions showed postnatal growth before involuting. Complete response was observed in 13 (13/29) patients, and partial response was observed in 16 (16/29) patients. CONCLUSIONS Fetal giant hepatic hemangioma is mainly localized, and its clinical outcome conforms to RICH (rapidly involuting) and PICH (partially involuting), but some fetal giant hepatic hemangiomas will continue to grow after birth and then gradually decrease. For uncomplicated giant fetal hepatic hemangioma, postnatal follow-up is the main concern, while those with complications require aggressive medical treatment. Propranolol may have no effect on the volume change of GFHH.
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Affiliation(s)
- Lu-Lu Xie
- Shanghai Institute of Infectious Disease and Biosecurity, Shanghai, 200032, China
- Department of Pediatric Surgery, Shanghai Key Laboratory of Birth Defect, Key Laboratory of Neonatal Disease, Ministry of Health, Children's Hospital of Fudan University, 399 Wan Yuan Road, Shanghai, 201102, China
| | - Yan-Bing Huang
- College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Children's Hospital, Fujian Medical University, Fuzhou, 350001, China
| | - Kui-Ran Dong
- Department of Pediatric Surgery, Shanghai Key Laboratory of Birth Defect, Key Laboratory of Neonatal Disease, Ministry of Health, Children's Hospital of Fudan University, 399 Wan Yuan Road, Shanghai, 201102, China
| | - Shao-Bo Yang
- Department of Pediatric Surgery, Shanghai Key Laboratory of Birth Defect, Key Laboratory of Neonatal Disease, Ministry of Health, Children's Hospital of Fudan University, 399 Wan Yuan Road, Shanghai, 201102, China.
| | - Chun Shen
- Department of Pediatric Surgery, Shanghai Key Laboratory of Birth Defect, Key Laboratory of Neonatal Disease, Ministry of Health, Children's Hospital of Fudan University, 399 Wan Yuan Road, Shanghai, 201102, China.
| | - Yang-Yang Ma
- Department of Pathology, Children's Hospital of Fudan University, Shanghai, China
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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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Wen R, Zhou ZZ, Chen WJ. Clinical and Pathological Features of Congenital Hepatic Hemangioma in Children: A Retrospective Analysis. Fetal Pediatr Pathol 2023; 42:198-206. [PMID: 36036082 DOI: 10.1080/15513815.2022.2114300] [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: 11/04/2022]
Abstract
Objective: We reviewed our experience with congenital hepatic hemangiomas (CHH) to assess the effectiveness of our treatment strategies. Methods: Clinical and pathologic features of children with CHH were reviewed. Results: Twenty-two cases of CHH were collected, 17 were resected and 5 were followed until resolution. In 17 with alpha-feto-protein (AFP) levels, 9 were elevated with 5 decreasing to normal before surgery. In six with tumors under 3 cm, five regressed between 1 and 13 months, one required removal 5 years after initial diagnosis. Postoperative histopathology of 17 cases showed abnormal vascular hyperplasia without lobular architecture. CD34 was expressed in all tumors, glucose transporter 1(Glut1) was negative. Conclusion: If the tumor is less than 3 cm, AFP is normal and there are no obvious complications, the lesion can be followed with regular assessment imaging. Surgical resection is an option in tumors less than 3 cm which have not regressed over time.
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Affiliation(s)
- Rong Wen
- Department of Pathology, Hunan Children's Hospital, Changsha, China
| | - Zheng-Zhen Zhou
- Department of Pathology, Hunan Children's Hospital, Changsha, China
| | - Wei-Jian Chen
- Department of Pathology, Hunan Children's Hospital, Changsha, China
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Rutten C, Ladarre D, Ackermann O, Gonzales E, Guettier C, Franchi-Abella S. Spontaneous evolution patterns of focal congenital hepatic hemangiomas: a case series of 25 patients. Pediatr Radiol 2022; 52:1048-1060. [PMID: 35229180 DOI: 10.1007/s00247-021-05277-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 11/10/2021] [Accepted: 12/22/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Hepatic hemangiomas are the most common benign liver tumors of infancy. They are termed congenital if fully developed at birth or infantile if they appear in the first weeks of life. Previous studies suggested that most focal hepatic hemangiomas are congenital in nature, exhibit no postnatal growth and have an evolution that parallels their cutaneous counterparts. They are subdivided by pattern of involution, whether rapidly involuting (RICH), partially involuting (PICH) or non-involuting (NICH) congenital hemangiomas. In our experience, some focal hepatic hemangiomas show postnatal growth, behaving like infantile forms. OBJECTIVES To analyze the spontaneous evolution of focal congenital hepatic hemangiomas with quantification of tumor volume changes over time and to identify initial postnatal ultrasound (US) imaging biomarkers predictive of their evolution pattern. MATERIALS AND METHODS A retrospective review of clinical, imaging and pathology data of children diagnosed with focal congenital hepatic hemangioma (prenatal diagnosis or age at diagnosis <7 days and/or glucose transporter protein 1 [GLUT1]-negative tumor) diagnosed between 2000 and 2018 was performed with analysis of tumor volume changes over time. Exclusion criteria were treatment inducing a tumor volume change (hepatic artery embolization, propranolol, or corticosteroids), imaging follow-up less than 1 month or fewer than two US examinations. Volumetric analysis was based on US and cross-sectional imaging. Lesion volumes were estimated using the standard ellipsoid formula. A 35% margin of error was assumed for tumor volume variation to account for variability in measurements. Imaging studies, including US, computed tomography, and magnetic resonance imaging, were reviewed and initial postnatal US features were correlated with evolution pattern. RESULTS Twenty-five patients with focal congenital hepatic hemangiomas were included. The median follow-up time was 46.5 months (range: 4-144 months). Eight (32%) lesions showed postnatal growth before involuting, without signs of intralesional hemorrhage, as do cutaneous infantile hemangiomas. The other 17 (68%) lesions exhibited a strict decrease in volume with age, of which 15 underwent complete involution (8 before age 18 months and 7 after age 18 months) and 2 underwent partial involution. The different evolution patterns of focal congenital hepatic hemangiomas showed overlapping imaging features and we found no initial US feature to be significantly associated with postnatal growth. However, large vascular spaces with marked vascularity at US were noted in three of the eight rapidly involuting lesions. CONCLUSION Focal congenital hepatic hemangiomas are not the equivalent of cutaneous RICH, as some may increase in size and tumor regression may be rapid or slow. The different evolution patterns of focal congenital hepatic hemangiomas show overlapping US features.
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Affiliation(s)
- Caroline Rutten
- Department of Pediatric Radiology, Bicêtre Hospital, 78 Rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France
| | - Delphine Ladarre
- Department of Pediatric Hepatology and Liver Transplantation, Bicêtre Hospital, AP-HP, Le Kremlin-Bicêtre, France.,Reference Centre for Vascular Diseases of the Liver, FSMR FILFOIE, ERN RARE LIVER, Bicêtre Hospital, AP-HP, FHU Hépatinov, Paris-Saclay University, Le Kremlin-Bicêtre, France
| | - Oanez Ackermann
- Department of Pediatric Hepatology and Liver Transplantation, Bicêtre Hospital, AP-HP, Le Kremlin-Bicêtre, France.,Reference Centre for Vascular Diseases of the Liver, FSMR FILFOIE, ERN RARE LIVER, Bicêtre Hospital, AP-HP, FHU Hépatinov, Paris-Saclay University, Le Kremlin-Bicêtre, France
| | - Emmanuel Gonzales
- Department of Pediatric Hepatology and Liver Transplantation, Bicêtre Hospital, AP-HP, Le Kremlin-Bicêtre, France.,Reference Centre for Vascular Diseases of the Liver, FSMR FILFOIE, ERN RARE LIVER, Bicêtre Hospital, AP-HP, FHU Hépatinov, Paris-Saclay University, Le Kremlin-Bicêtre, France.,INSERM UMRS 1193, Paris-Saclay University, FHU Hépatinov, Orsay, France
| | - Catherine Guettier
- Reference Centre for Vascular Diseases of the Liver, FSMR FILFOIE, ERN RARE LIVER, Bicêtre Hospital, AP-HP, FHU Hépatinov, Paris-Saclay University, Le Kremlin-Bicêtre, France.,INSERM UMRS 1193, Paris-Saclay University, FHU Hépatinov, Orsay, France.,Department of Pathology, Bicêtre Hospital, AP-HP, Le Kremlin-Bicêtre, France
| | - Stéphanie Franchi-Abella
- Department of Pediatric Radiology, Bicêtre Hospital, 78 Rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France. .,Reference Centre for Vascular Diseases of the Liver, FSMR FILFOIE, ERN RARE LIVER, Bicêtre Hospital, AP-HP, FHU Hépatinov, Paris-Saclay University, Le Kremlin-Bicêtre, France. .,DMU Smart Imaging, BIOMAPS UMR 9011 CNRS - INSERM - CEA, Le Kremlin-Bicêtre, France.
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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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Crivelli L, Millischer AE, Sonigo P, Grévent D, Hanquinet S, Vial Y, Alamo L. Contribution of magnetic resonance imaging to the prenatal diagnosis of common congenital vascular anomalies. Pediatr Radiol 2021; 51:1626-1636. [PMID: 33891148 PMCID: PMC8363547 DOI: 10.1007/s00247-021-05031-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 09/08/2020] [Accepted: 02/21/2021] [Indexed: 10/29/2022]
Abstract
BACKGROUND Screening ultrasound (US) has increased the detection of congenital vascular anomalies in utero. Complementary magnetic resonance imaging (MRI) may improve the diagnosis, but its real utility is still not well established. OBJECTIVES We aimed to describe the imaging findings on prenatal US and MRI of the most frequent congenital vascular anomalies (lymphatic malformations and congenital hemangiomas) to assess the accuracy of prenatal US and MRI exams for diagnosis and to evaluate the relevance of the additional information obtained by complementary fetal MRI. MATERIALS AND METHODS All confirmed postnatal congenital vascular anomalies detected in the last 10 years at 3 university hospitals were retrospectively identified. The prenatal diagnosis was compared with the final diagnosis for both methods and the clinical relevance of additional MRI information was evaluated. A second MRI in advanced pregnancy was performed in fetuses with lesions in a sensitive anatomical location and the clinical relevance of the additional information was evaluated. RESULTS Twenty-four cases were included in the study, 20 lymphatic malformations and 4 hemangiomas. MRI slightly improved the diagnosis of lymphatic malformation, 85% vs. 80% at US, especially for abdominal lesions. Both methods had a low identification rate (25%) for tumors. MRI performed late in five fetuses with lymphatic malformation allowed optimized management at birth. CONCLUSION MRI improves the diagnosis of congenital lymphatic malformations whereas hemangiomas remain difficult to identify in utero. The main role of MRI is to provide high-defined anatomical data to guide management at birth.
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Affiliation(s)
- Laurence Crivelli
- Department of Diagnostic and Interventional Radiology, CHUV - Centre Hospitalier Universitaire Vaudois, Rue du Bugnon 21, 1011, Lausanne, Switzerland.
| | - Anne-Elodie Millischer
- grid.412134.10000 0004 0593 9113Department of Pediatric Radiology, Hôpital Universitaire Necker - Enfants Malades, Paris, France
| | - Pascale Sonigo
- grid.412134.10000 0004 0593 9113Department of Pediatric Radiology, Hôpital Universitaire Necker - Enfants Malades, Paris, France
| | - David Grévent
- grid.412134.10000 0004 0593 9113Department of Pediatric Radiology, Hôpital Universitaire Necker - Enfants Malades, Paris, France
| | - Sylviane Hanquinet
- grid.150338.c0000 0001 0721 9812Department of Radiology, HUG – Hôpitaux Universitaires de Genève, Genève, Switzerland
| | - Yvan Vial
- grid.8515.90000 0001 0423 4662Department of Gynecology and Obstetrics, CHUV – Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Leonor Alamo
- grid.8515.90000 0001 0423 4662Department of Diagnostic and Interventional Radiology, CHUV – Centre Hospitalier Universitaire Vaudois, Rue du Bugnon 21, 1011 Lausanne, Switzerland
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Ica R, Simulescu A, Sarbu M, Munteanu CVA, Vukelić Ž, Zamfir AD. High resolution mass spectrometry provides novel insights into the ganglioside pattern of brain cavernous hemangioma. Anal Biochem 2020; 609:113976. [PMID: 32987010 DOI: 10.1016/j.ab.2020.113976] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 09/19/2020] [Accepted: 09/21/2020] [Indexed: 12/27/2022]
Abstract
In this study we have optimized nanoelectrospray ionization (nanoESI) high resolution mass spectrometry (HR MS) performed on Orbitrap instrument in the negative ion mode for the determination of the composition and structure of gangliosides extracted from human brain cavernous hemangioma. The optimized HR MS platform, allowed the discrimination of 62 ions, corresponding to 52 different ganglioside species, which represents roughly twice the number of species existing in the current inventory of human brain hemangioma-associated gangliosides. The experiments revealed a ganglioside pattern dominated by GD-type of structures as well as an elevated incidence of species characterized by a low degree of sialylation and short glycan chains, including asialo GA1 (d18:1/18:0), which offer a new perspective upon the ganglioside composition in this benign tumor. Many of the structures are characteristic for this type of tumor only and are to be considered in further investigations for their potential use in early brain hemangioma diagnosis based on molecular markers. The detailed fragmentation analysis performed by collision-induced dissociation (CID) tandem MS provided information of structural elements related to the glycan core and ceramide moiety, which confirmed the molecular configuration of GD3 (d18:1/24:1) and GD3 (d18:1/24:2) species with potential biomarker role.
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Affiliation(s)
- Raluca Ica
- National Institute for Research and Development in Electrochemistry and Condensed Matter, Timisoara, Romania; Faculty of Physics, West University of Timisoara, Romania
| | - Anca Simulescu
- "Victor Babes" University of Medicine and Pharmacy Timisoara, Romania
| | - Mirela Sarbu
- National Institute for Research and Development in Electrochemistry and Condensed Matter, Timisoara, Romania
| | | | - Željka Vukelić
- Department of Chemistry and Biochemistry, University of Zagreb Medical School, Zagreb, Croatia
| | - Alina D Zamfir
- National Institute for Research and Development in Electrochemistry and Condensed Matter, Timisoara, Romania; "Aurel Vlaicu" University of Arad, Arad, Romania.
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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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12
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Demirci O, Celayir A. Prenatal diagnosis and treatment of intrahepatic arteriovenous fistulas: case reports and the literature review. J Matern Fetal Neonatal Med 2020; 35:837-845. [PMID: 32241194 DOI: 10.1080/14767058.2020.1731466] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Background: Congenital arteriovenous intrahepatic fistulas, which are hepatic hemangiomas and arteriovenous malformations (AVMs) are rare and they confused with each other. Knowledge of prenatal medical treatment of AVMs is insufficient.Objectives: First is to emphasize the distinction between hepatic hemangioma and AVMs. Second is discussion of the first case of hepatic AVM that responded well to steroid-propranolol treatment in the prenatal period.Methods: Color Doppler ultrasonography, fetal and postnatal MR were used for diagnosis.Results: The first case is a giant hepatic hemangioma diagnosed and progressively growing in the prenatal period and gradually shrinking in the postnatal period. The second case was hepatic AVM with no signs of heart failure during the prenatal period and postnatal right extended hepatectomy was performed as the anastomosis was enlarged and intraportal collateral vessels were developed. The third case is the first hepatic AVM which reaches a term that was prenatally diagnosed and responded to treatment with marked reduction.Conclusion: Color flow and pulse Doppler imaging have a key role in the prenatal diagnosis of arteriovenous fistulas. Intrahepatic AVM are abnormal intrahepatic vascular network formation primarily fed by the hepatic artery or its branches and drained by the hepatic venous system. This vascular region looks like a mass, but it does not contain a solid area, which allows the separation of hepatic AVMs from hepatic hemangiomas. Steroid and propranolol therapy should be considered in management.
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Affiliation(s)
- Oya Demirci
- Perinatology Unit, Zeynep Kamil Gynecologic and Pediatric Training Research Hospital, Health Sciences University, Istanbul, Turkey
| | - Aysenur Celayir
- Pediatric Surgery Unit, Zeynep Kamil Gynecologic and Pediatric Training Research Hospital, Health Sciences University, Istanbul, Turkey
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13
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Sepulveda W, Sepulveda F, Corral E, Gutierrez J. Giant hepatic hemangioma in the fetus: case reports and updated review of the literature. J Matern Fetal Neonatal Med 2019; 34:2554-2566. [PMID: 31530056 DOI: 10.1080/14767058.2019.1669555] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To describe three cases of giant fetal hepatic hemangioma detected by prenatal ultrasound in the third trimester of pregnancy and further confirmed by fetal magnetic resonance imaging (MRI). An updated review of the literature was also carried out. RESULTS In one case, there was an unexpected intrauterine demise at 35 weeks. The other two women delivered liveborn infants at term. The first of these two neonates had a stormy neonatal course and underwent endovascular embolization with limited clinical success. The infant presented multiple medical complications and was discharged home at five months of age. The second infant had an uneventful postnatal course. Subsequent follow-up scans showed progressive shrinkage of the lesion with no associated complications. A review of the English literature revealed a total of 42 cases prenatally diagnosed by ultrasound. The most relevant clinical and ultrasound findings are presented and the diverse perinatal outcomes related to this condition are discussed. CONCLUSIONS Fetal hepatic hemangiomas are exceedingly rare vascular tumors; however, they can be associated with several life-threatening conditions. They are usually detected by ultrasound, either incidentally or in the context of nonimmune hydrops secondary to high-output cardiac failure. Our review documents the increasing role of fetal MRI in the prenatal diagnosis and management of these cases. However, the improvement in prenatal diagnostic imaging techniques has not been associated with a better perinatal prognosis in the reported cases.
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Affiliation(s)
- Waldo Sepulveda
- Fetal Imaging Unit, FETALMED - Maternal Fetal Diagnostic Center, Santiago, Chile
| | - Francisco Sepulveda
- Fetal Imaging Unit, FETALMED - Maternal Fetal Diagnostic Center, Santiago, Chile
| | - Edgardo Corral
- Ultrasound Unit, Department of Obstetrics and Gynecology, Regional Hospital, University Diego Portales School of Medicine, Rancagua, Chile
| | - Jorge Gutierrez
- Ultrasound Unit, Department of Obstetrics and Gynecology, Clinica Indisa, Santiago, Chile
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14
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ZHANG D, WANG J. [Prenatal diagnosis and management of fetal hepatic hemangioma]. Zhejiang Da Xue Xue Bao Yi Xue Ban 2019; 48:439-445. [PMID: 31901050 PMCID: PMC8800699 DOI: 10.3785/j.issn.1008-9292.2019.08.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 05/30/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To review the application of medical imaging in diagnosis and management of fetal hepatic hemangioma. METHODS Clinical data and imaging findings of 14 cases of fetal hepatic hemangioma, who were diagnosed prenatally and followed up in Women's Hospital of Zhejiang University School of Medicine from February 2014 to September 2018 were retrospective reviewed. RESULTS The fetal hepatic hemangiomas were single lesions in all 14 cases, and most of them were located in the right lobe of the liver (13/14). Ultrasound images were mainly hypoechoic with heterogeneity, the honeycomb-like or grid-like anechoic regions were presented in 9 lesions and circumferential blood flow was observed with low to moderate blood flow resistance index. MRI findings showed well-defined lesions with low signal intensity on T1WI, and high or slightly high signal intensity on T2WI. Among 14 cases, there were 8 cases of induced labor and 6 cases of continuing pregnancy. In 6 cases of successful delivery, 2 were treated with propranolol, 4 cases were followed-up without treatment. The growth and development of 6 children were normal. The lesions of hepatic hemangioma showed no significant changes in 3 children and were reduced in the other 3 children, of whom the lesion was complete disappeared in 1 case. CONCLUSIONS Fetal hepatic hemangiomas present relatively typical imaging characteristics, and prenatal diagnosis can be made with ultrasound and MRI. If there are no complications, the fetus with hepatic hemangioma can be delivered at full term with a good outcome.
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Affiliation(s)
| | - Junmei WANG
- 王军梅(1973—), 女, 博士, 主任医师, 主要从事妇产科超声诊断及胎儿出生缺陷筛查研究; E-mail:
;
https://orcid.org/0000-0002-9150-4540
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