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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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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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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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Paudice M, Peñuela LA, Torielli F, Spina B, Remorgida V, Buffelli F, Fulcheri E, Arioni C, Vellone VG. Giant Hepatic Hemangioma and Placental Chorangiosis: A Unique Case of Stillbirth? Fetal Pediatr Pathol 2019; 38:175-181. [PMID: 30676122 DOI: 10.1080/15513815.2018.1564159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Hepatic hemangiomas (HH) are benign vascular tumors, and when large, may contribute to fetal morbidity/mortality. Chorangiosis is placental villus capillary hypervascularity, probably linked with fetal hypoxia. CASE REPORT We present a macrosomic stillbirth at 39 + 3 weeks of gestation with congestive heart failure (CHF) and myocardial infarction. A giant right hepatic lobe HH was present, along with placental chorangiosis. CONCLUSION A common pathogenetic pathway between congenital HH and placental chorangiosis has not been reported. Our case suggests that the effects of HH and chorangiosis increase the risk of late fetal loss due to the high-output CHF.
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Affiliation(s)
| | | | - Flaminia Torielli
- c Neonatology Unit , University of Genoa, Azienda Ospedaliera San Martino IRCCS - IST National Institute on Cancer Research , Genoa , Italy
| | - Bruno Spina
- d Pathology Unit , San Martino Hospital , Genoa , Italy
| | - Valentino Remorgida
- e Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health , University of Genoa , Genoa , Italy
| | - Francesca Buffelli
- b Fetal and Placental Pathology Unit , G. Gaslini Institute , Genoa , Italy
| | - Ezio Fulcheri
- a Pathology, DISC , University of Genoa , Genoa , Italy.,b Fetal and Placental Pathology Unit , G. Gaslini Institute , Genoa , Italy
| | - Cesare Arioni
- c Neonatology Unit , University of Genoa, Azienda Ospedaliera San Martino IRCCS - IST National Institute on Cancer Research , Genoa , Italy
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Jiao-Ling L, Xiu-Ping G, Kun-Shan C, Qiu-Ming H, Xiao-Fen L, Bo-Yang Y, Qian F. Huge fetal hepatic Hemangioma: prenatal diagnosis on ultrasound and prognosis. BMC Pregnancy Childbirth 2018; 18:2. [PMID: 29291724 PMCID: PMC5748961 DOI: 10.1186/s12884-017-1635-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 12/15/2017] [Indexed: 12/05/2022] Open
Abstract
Background Although huge fetal hepatic hemangiomas are rare, they can cause fatal complications. The purpose of this study is to describe the imaging features and prognosis of these tumors. Methods Imaging data were collected for 6 patients with huge fetal hepatic hemangiomas treated at our hospital. Imaging modalities included prenatal magnetic resonance imaging and ultrasound and postnatal color Doppler ultrasound and contrast-enhanced computed tomography (CT). Results Among the 93,562 fetuses of 92,126 pregnant women examined at our hospital, 6 had huge hepatic hemangiomas (incidence rate, 0.64/10,000), as confirmed via postnatal color Doppler imaging and contrast-enhanced CT. Five fetuses had solitary lesions, whereas 1 (fetus 2) had multiple lesions. Four fetuses had lesions in the right liver lobe and 1 had a lesion in the left liver lobe, and 1 (fetus 2) had lesions in both lobes. All lesions showed centripetal enhancement on postnatal contrast-enhanced CT, which was more intense peripherally. Following postnatal treatment with oral propranolol, with or without dexamethasone or interventional therapy with the medical sclerosant pingyangmycin, all lesions decreased in size, with calcification plaques appearing 6 months after treatment. Conclusions Huge hepatic hemangiomas have typical ultrasonographic features and can be diagnosed prenatally. Treatment with propranolol, with or without dexamethasone, may result in a favorable prognosis. Electronic supplementary material The online version of this article (10.1186/s12884-017-1635-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Li Jiao-Ling
- Department of Ultrasound, GZ Women & Children Medical Centre, Jinsui Road 9, Guangzhou, 510623, China.
| | - Geng Xiu-Ping
- Department of Ultrasound, GZ Women & Children Medical Centre, Jinsui Road 9, Guangzhou, 510623, China
| | - Chen Kun-Shan
- Department of Invasive Technology, GZ Women & Children Medical Centre, Guangzhou, 510623, China
| | - He Qiu-Ming
- Neonatal Intensive Care Unit, GZ Women & Children Medical Centre, Guangzhou, 510623, China
| | - Li Xiao-Fen
- Department of Ultrasound, GZ Women & Children Medical Centre, Jinsui Road 9, Guangzhou, 510623, China
| | - Yang Bo-Yang
- Department of Ultrasound, GZ Women & Children Medical Centre, Jinsui Road 9, Guangzhou, 510623, China
| | - Fang Qian
- Department of Ultrasound, GZ Women & Children Medical Centre, Jinsui Road 9, Guangzhou, 510623, China
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Bashaw M, Triplett S. Coagulopathy In and Outside the Intensive Care Unit. Crit Care Nurs Clin North Am 2017; 29:353-362. [DOI: 10.1016/j.cnc.2017.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Li K, Wang Z, Liu Y, Yao W, Gong Y, Xiao X. Fine clinical differences between patients with multifocal and diffuse hepatic hemangiomas. J Pediatr Surg 2016; 51:2086-2090. [PMID: 27686480 DOI: 10.1016/j.jpedsurg.2016.09.045] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Accepted: 09/12/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND It has been reported that multifocal and diffuse hepatic hemangiomas are true infantile hemangiomas for which a continuum probably exists. We determined the similarities and fine differences between the two types of hemangioma and identified the multifocal subgroup of type, which needs timely treatment. MATERIAL AND METHODS Twenty-four patients (4 males and 20 females; age 114±142days) with multifocal or diffuse hepatic hemangiomas who were treated between January 2000 and June 2015 were studied. For the multifocal type, patients were divided into countable (MC) and uncountable (MU) subgroups. The medical data were analyzed retrospectively. RESULTS The clinical presentations included hepatomegaly (n=11), dyspnea (n=7), heart failure (n=9), hypothyroidism (n=6), and anemia (n=1). There were 19 and 5 patients with multifocal and diffuse types, and 6 and 13 patients in the MC and MU groups, respectively. There were significant differences between the multifocal and diffuse types with respect to hepatomegaly, heart failure, dyspnea, and hypothyroidism. However, there was no difference between the MU group and the diffuse type except for hypothyroidism. Observation was commonly recommended for patients with the multifocal type, and their survival rate was clearly higher than for patients with the diffuse type. Both the MU and diffuse-type groups needed treatment, unlike MC patients. The complete remission rate was higher in the MC group than in the MU and diffuse-type groups. Patients with the diffuse type were more likely to die. CONCLUSIONS Patients with diffuse-type hepatic hemangioma are at high risk and need active treatment. The MU group for the multifocal type is unique and has high similarities to the diffuse type with respect to clinical presentation and treatment, which suggests that a continuum of the disease phenotypes exists. LEVEL OF EVIDENCE Case-control study, level III.
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Affiliation(s)
- Kai Li
- Department of Pediatric Surgery, Children's Hospital of Fudan University, 201102, Shanghai, China.
| | - Zuopeng Wang
- Department of Pediatric Surgery, Children's Hospital of Fudan University, 201102, Shanghai, China
| | - Yinhua Liu
- Department of Pediatric Surgery, Children's Hospital of Fudan University, 201102, Shanghai, China
| | - Wei Yao
- Department of Pediatric Surgery, Children's Hospital of Fudan University, 201102, Shanghai, China
| | - Yin Gong
- Department of Radiology, Children's Hospital of Fudan University, 201102, Shanghai, China
| | - Xianmin Xiao
- Department of Pediatric Surgery, Children's Hospital of Fudan University, 201102, Shanghai, China
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