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Suzuki T, Yamamoto Y, Nakamura H, Sei-Okawa K, Maruyama Y, Takeda J, Makino S, Yamataka A, Itakura A. Fetal umbilical cord cyst may evolve to omphalocele during pregnancy. JOURNAL OF CLINICAL ULTRASOUND : JCU 2020; 48:181-183. [PMID: 31724176 DOI: 10.1002/jcu.22786] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 08/26/2019] [Accepted: 10/02/2019] [Indexed: 06/10/2023]
Abstract
Omphalocele is rarely complicated by umbilical cord cysts. In our case, an umbilical cord cyst and fetal ascites were detected at 26 weeks' gestation in a fetus with trisomy 13. This changed to omphalocele with subsequently absorbed fetal ascites at 35 weeks' gestation. We propose two hypotheses. The abdominal wall may have been physically pierced or an omphalocele might have preexisted, and the intestinal tract in the hernia sac was pushed by fetal ascites.
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Affiliation(s)
- Toshifumi Suzuki
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Yuka Yamamoto
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Hiroki Nakamura
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Kiguna Sei-Okawa
- Department of Obstetrics and Gynecology, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Yojiro Maruyama
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Jun Takeda
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Shintaro Makino
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Atsuyuki Yamataka
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Atsuo Itakura
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
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Ruiz Campo L, Savirón Cornudella R, Gámez Alderete F, Martínez-Payo C, Pérez Pérez P, Garrido Fernández P, Lerma Puertas D. Prenatal diagnosis of umbilical cord cyst: Clinical significance and prognosis. Taiwan J Obstet Gynecol 2018; 56:622-627. [PMID: 29037547 DOI: 10.1016/j.tjog.2017.08.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2016] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE Clarify the prognosis of the prenatal ultrasound diagnosis of umbilical cord cysts at any gestation trimester and to assess the ultrasound findings and chromosomal alterations associated to this entity. MATERIALS AND METHODS Between 2003 and 2015 a multicenter study was carried out, collecting, in five centers in Spain, the associated findings and perinatal outcomes of 27 cases of umbilical cord cysts, regardless of gestational age of diagnosis. A bibliographic review was conducted to identify previous studies in order to compare them with our data. RESULTS In our sample, the prognosis of this finding and the neonatal outcome, when isolated, is favorable, regardless of gestational age at diagnosis, multiple or unique presentation or vanishing or persistent cysts. CONCLUSIONS It is important to properly assess the umbilical cord cyst and when is diagnosed, it is recommended to conduct a meticulous ultrasound examination searching for other associated malformations. In our study the prognosis of this finding seems to be favorable when isolated. Also, there is no relation between prognosis and gestation weeks at diagnosis. On the other hand, when we find this entity with associated anomalies, it is recommended to assess the need to carry out a karyotype.
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Affiliation(s)
- Leyre Ruiz Campo
- Department of Obstetrics and Gynecology, Hospital Universitario Miguel Servet, Zaragoza, Spain.
| | | | - Francisco Gámez Alderete
- Department of Obstetrics and Gynecology, Hospital Universitario Gregorio Marañón, Madrid, Spain.
| | - Cristina Martínez-Payo
- Department of Obstetrics and Gynecology, Hospital Universitario Puerta de Hierro, Madrid, Spain.
| | - Pilar Pérez Pérez
- Department of Obstetrics and Gynecology, Hospital Universitario Miguel Servet, Zaragoza, Spain.
| | - Pilar Garrido Fernández
- Department of Obstetrics and Gynecology, Hospital Universitario Miguel Servet, Zaragoza, Spain.
| | - Diego Lerma Puertas
- Department of Obstetrics and Gynecology, Hospital Universitario Miguel Servet, Zaragoza, Spain.
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Yonemoto H, Itoh S, Nakamura Y, Kinoshita K. Umbilical cord cyst detected in the first trimester by two- and three-dimensional sonography. JOURNAL OF CLINICAL ULTRASOUND : JCU 2006; 34:150-2. [PMID: 16547996 DOI: 10.1002/jcu.20199] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
A case of umbilical cord cyst was identified via 2-dimensional and 3-dimensional sonographic examination at 8 weeks' menstrual age. The cyst was solitary, measuring 18.0 mm, and it was located close to the placental insertion on the umbilical cord. The gestational sac and yolk sac diameters and the fetal heart rate were within normal ranges for menstrual age. Follow-up 3-Dimensional sonographic examination in the second trimester showed complete resolution of the cyst. Amniocentesis revealed a normal karyotype, and a normal infant was delivered at term.
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Affiliation(s)
- Hisashi Yonemoto
- Department of Obstetrics and Gynecology, Juntendo University School of Medicine, Tokyo, Japan
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Emura T, Kanamori Y, Ito M, Tanaka Y, Hashizume K, Marumo G, Goishi K. Omphalocele associated with a large multilobular umbilical cord pseudocyst. Pediatr Surg Int 2004; 20:636-9. [PMID: 15449087 DOI: 10.1007/s00383-004-1247-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/08/2003] [Indexed: 10/26/2022]
Abstract
The prevalence of umbilical cord cysts at 7-13 weeks' gestation is approximately 3%. More than 20% of such cases are complicated by structural defects and/or chromosomal abnormalities such as trisomy 18. These cysts usually have a single cavity and are <5 cm in size. Therefore, when an umbilical cord cyst is detected in the 2nd trimester, the examination of fetal karyotype is recommended. Omphaloceles are also well known to be complicated by many anomalies, especially trisomy 18. We report a case of an omphalocele associated with a large multilobular umbilical pseudocyst (diameter >5 cm) in a patient with a normal karyotype, 46XY. These anomalies were diagnosed by fetal ultrasonography. However, the cyst was difficult to diagnose as an umbilical cord pseudocyst because it was very large and multilobulated. At 38.5 weeks of gestation, the patient was delivered by Cesarean section. The cyst was resected, and the omphalocele was closed by staged surgeries. Pathologic diagnosis of the cyst was the degeneration of Wharton's jelly. This diagnosis was made by the absence of epithelial lining inside the cyst wall, since the existence of epithelial cells correlates with true cysts.
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Affiliation(s)
- Takaki Emura
- Department of Pediatric Surgery, University of Tokyo Hospital, 7-3-1 Hongo Bunkyo-ku, 113-8655, Tokyo, Japan
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Ghezzi F, Raio L, Di Naro E, Franchi M, Cromi A, Dürig P. Single and multiple umbilical cord cysts in early gestation: two different entities. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2003; 21:215-219. [PMID: 12666213 DOI: 10.1002/uog.68] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVE To investigate the prevalence of single and multiple umbilical cord cysts in the first trimester and to assess whether there is a difference in the pregnancy outcome between them. METHODS A targeted sonographic morphological and morphometric evaluation of the umbilical cord was performed in consecutive patients between 7 and 14 weeks of gestation. Crown-rump length and umbilical cord diameter were measured in all cases. Nuchal translucency thickness was measured between 11 and 14 weeks' gestation. In pregnancies at very early gestational ages (7-10 weeks) an additional scan was performed between 11 and 14 weeks. RESULTS A total of 1159 patients was screened. The prevalence of umbilical cord cysts was 2.1% (24/1159). The cysts were single and multiple in 18 and six cases, respectively. The median (range) largest umbilical cord cyst diameter was no different between multiple and single umbilical cord cysts (3.8 (2.1-18) mm vs. 3.05 (2.0-7.8) mm; P = 0.386). All women with a single umbilical cord cyst delivered an infant without structural abnormalities and without features suggestive of chromosomal abnormalities. Among the women with multiple umbilical cord cysts, four had a missed miscarriage and one had a fetus with obstructive uropathy. CONCLUSION Single and multiple umbilical cord cysts in the first trimester of gestation represent two different entities. While single cysts in the first trimester are associated with a favorable pregnancy outcome, the presence of multiple umbilical cord cysts is associated with an increased risk of miscarriage and aneuploidy.
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Affiliation(s)
- F Ghezzi
- Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy.
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Abstract
This article begins with a presentation of the embryology of the anterior abdominal wall and umbilical cord. Abnormal embryology and resulting anomalies are presented in tabular form and later reviewed in chronologic order of embryologic development. Techniques involved in the prenatal diagnosis of these abnormalities are also described.
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Affiliation(s)
- J N Robinson
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Columbia Presbyterian Medical Center, New York, New York, USA
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Sherer DM, Anyaegbunam A. Prenatal ultrasonographic morphologic assessment of the umbilical cord: a review. Part II. Obstet Gynecol Surv 1997; 52:515-23. [PMID: 9267869 DOI: 10.1097/00006254-199708000-00023] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Ultrasonographic assessment, although not always possible throughout the entire length of the umbilical cord, may assist in the diagnosis of congenital and functional anomalies of this structure. In such fashion, prenatal ultrasound may outline normal anatomy or alternatively depict various congenital abnormalities of the umbilical cord including: cysts; pseudocysts umbilical vein varix; persistent right umbilical vein; angiomyxomas; aneurysm (arterial or venous); single, hypoplastic or fused umbilical artery; hematomas (spontaneous or iatrogenic); velamentous insertion; vasa previa. The umbilical cord coiling index, an additional ultrasonographic morphologic feature, may identify patients at risk for adverse perinatal outcome. Conditions of potential fetal compromise due to umbilical cord compression including nuchal cords, true knots, occult prolapse, cord presentation, fetal grasping, and cord entanglement in monoamniotic twins, may be detected prenatally; and impaired umbilical flow can be confirmed with Doppler flow velocimetry. Ultrasound has been widely used to guide invasive diagnostic and therapeutic procedures involving access to umbilical circulation. We conclude that the review of current literature supports that precise prenatal ultrasonographic depiction of the morphology of the umbilical cord may enhance perinatal management.
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Affiliation(s)
- D M Sherer
- Department of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine, Bronx, New York 10461-2373, USA
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Sherer DM, Anyaegbunam A. Prenatal ultrasonographic morphologic assessment of the umbilical cord: a review. Part I. Obstet Gynecol Surv 1997; 52:506-14. [PMID: 9267868 DOI: 10.1097/00006254-199708000-00022] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Our objective was to review current data pertaining to prenatal ultrasonographic morphology of the umbilical cord. To this goal we identified studies published in the English language regarding prenatal ultrasonographic morphology of this structure. The studies were obtained from a MEDLINE search from 1966 through May 1997; additional sources were identified through cross-referencing. All published reports, case studies, and articles regarding ultrasonographic morphology of the umbilical cord were reviewed. Data pertaining to Doppler flow velocimetry in association with umbilical cord structural anomalies and umbilical cord compression, were also included. Review of the literature supports that prenatal ultrasound may outline normal anatomy or alternatively depict various congenital abnormalities of the umbilical cord including: cysts; pseudocysts; umbilical vein varix; persistent right umbilical vein; hemangiomas; umbilical vessel aneurysm (arterial or venous); single, hypoplastic, or fused umbilical artery; hematomas (spontaneous or iatrogenic); velamentous insertion; and vasa previa. The umbilical cord coiling index, an additional ultrasonographic morphologic feature may identify patients at risk for adverse perinatal outcome. Conditions of potential fetal compromise due to umbilical cord compression including nuchal cords, true knots, occult prolapse, cord presentation, fetal grasping, and cord entanglement in monoamniotic twins, may be detected prenatally and impaired umbilical flow confirmed with Doppler flow velocimetry. Ultrasound has been widely applied to guide invasive diagnostic and therapeutic procedures involving access to umbilical circulation. In conclusion, precise prenatal ultrasonographic depiction of the morphology of the umbilical cord may enhance perinatal management.
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Affiliation(s)
- D M Sherer
- Department of Obstetrics & Gynecology and Women's Health, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York 10461-2373, USA
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Smith GN, Walker M, Johnston S, Ash K. The sonographic finding of persistent umbilical cord cystic masses is associated with lethal aneuploidy and/or congenital anomalies. Prenat Diagn 1996; 16:1141-7. [PMID: 8994251 DOI: 10.1002/(sici)1097-0223(199612)16:12<1141::aid-pd2>3.0.co;2-4] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Advancements in sonographic technology have led to improved prenatal detection of fetal anomalies. Umbilical cord cystic masses are being detected prenatally and several case reports have appeared in the literature. We report three new cases in which umbilical cord cystic masses were detected prenatally; two cases in the later half of pregnancy and one case in the first trimester. The literature was reviewed and summaries of the 23 reported cases of persistent second- and third-trimester umbilical cord cystic masses and their implications are discussed. There is a high association (18 of 23 cases) with lethal chromosomal anomalies and/or congenital malformations suggesting that the finding of an isolated umbilical cord cystic mass should lead to further detailed sonographic evaluation.
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Affiliation(s)
- G N Smith
- Department of Obstetrics and Gynaecology, Queen's University, Kingston, Ontario, Canada
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