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Fu F, Yang X, Li R, Li Y, Zhou H, Cheng K, Huang R, Wang Y, Guo F, Zhang L, Pan M, Han J, Zhen L, Li L, Lei T, Li D, Liao C. Single-cell RNA sequencing reveals cellular and molecular landscape of fetal cystic hygroma. BMC Med Genomics 2024; 17:96. [PMID: 38650036 PMCID: PMC11036587 DOI: 10.1186/s12920-024-01859-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 03/29/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND The molecular mechanism of fetal cystic hygroma (CH) is still unclear, and no study has previously reported the transcriptome changes of single cells in CH. In this study, single-cell transcriptome sequencing (scRNA-seq) was used to investigate the characteristics of cell subsets in the lesion tissues of CH patients. METHODS Lymphoid tissue collected from CH patients and control donors for scRNA-seq analysis. Differentially expressed gene enrichment in major cell subpopulations as well as cell-cell communication were analyzed. At the same time, the expression and interactions of important VEGF signaling pathway molecules were analyzed, and potential transcription factors that could bind to KDR (VEGFR2) were predicted. RESULTS The results of scRNA-seq showed that fibroblasts accounted for the largest proportion in the lymphatic lesions of CH patients. There was a significant increase in the proportion of lymphatic endothelial cell subsets between the cases and controls. The VEGF signaling pathway is enriched in lymphatic endothelial cells and participates in the regulation of cell-cell communication between lymphatic endothelial cells and other cells. The key regulatory gene KDR in the VEGF signaling pathway is highly expressed in CH patients and interacts with other differentially expressed EDN1, TAGLN, and CLDN5 Finally, we found that STAT1 could bind to the KDR promoter region, which may play an important role in promoting KDR up-regulation. CONCLUSION Our comprehensive delineation of the cellular composition in tumor tissues of CH patients using single-cell RNA-sequencing identified the enrichment of lymphatic endothelial cells in CH and highlighted the activation of the VEGF signaling pathway in lymphoid endothelial cells as a potential modulator. The molecular and cellular pathogenesis of fetal cystic hygroma (CH) remains largely unknown. This study examined the distribution and gene expression signature of each cell subpopulation and the possible role of VEGF signaling in lymphatic endothelial cells in regulating the progression of CH by single-cell transcriptome sequencing. The enrichment of lymphatic endothelial cells in CH and the activation of the VEGF signaling pathway in lymphatic endothelial cells provide some clues to the pathogenesis of CH from the perspective of cell subpopulations.
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Affiliation(s)
- Fang Fu
- Department of Prenatal Diagnostic Centre, Guangzhou Women and Children's Medical Centre, Guangzhou Medical University, 510623, Guangzhou, China
| | - Xin Yang
- Department of Prenatal Diagnostic Centre, Guangzhou Women and Children's Medical Centre, Guangzhou Medical University, 510623, Guangzhou, China
| | - Ru Li
- Department of Prenatal Diagnostic Centre, Guangzhou Women and Children's Medical Centre, Guangzhou Medical University, 510623, Guangzhou, China
| | - Yingsi Li
- Department of Prenatal Diagnostic Centre, Guangzhou Women and Children's Medical Centre, Guangzhou Medical University, 510623, Guangzhou, China
| | - Hang Zhou
- Department of Prenatal Diagnostic Centre, Guangzhou Women and Children's Medical Centre, Guangzhou Medical University, 510623, Guangzhou, China
| | - Ken Cheng
- Department of Prenatal Diagnostic Centre, Guangzhou Women and Children's Medical Centre, Guangzhou Medical University, 510623, Guangzhou, China
| | - Ruibin Huang
- Department of Prenatal Diagnostic Centre, Guangzhou Women and Children's Medical Centre, Guangzhou Medical University, 510623, Guangzhou, China
| | - You Wang
- Department of Prenatal Diagnostic Centre, Guangzhou Women and Children's Medical Centre, Guangzhou Medical University, 510623, Guangzhou, China
| | - Fei Guo
- Department of Prenatal Diagnostic Centre, Guangzhou Women and Children's Medical Centre, Guangzhou Medical University, 510623, Guangzhou, China
| | - Lina Zhang
- Department of Prenatal Diagnostic Centre, Guangzhou Women and Children's Medical Centre, Guangzhou Medical University, 510623, Guangzhou, China
| | - Min Pan
- Department of Prenatal Diagnostic Centre, Guangzhou Women and Children's Medical Centre, Guangzhou Medical University, 510623, Guangzhou, China
| | - Jin Han
- Department of Prenatal Diagnostic Centre, Guangzhou Women and Children's Medical Centre, Guangzhou Medical University, 510623, Guangzhou, China
| | - Li Zhen
- Department of Prenatal Diagnostic Centre, Guangzhou Women and Children's Medical Centre, Guangzhou Medical University, 510623, Guangzhou, China
| | - Lushan Li
- Department of Prenatal Diagnostic Centre, Guangzhou Women and Children's Medical Centre, Guangzhou Medical University, 510623, Guangzhou, China
| | - Tingying Lei
- Department of Prenatal Diagnostic Centre, Guangzhou Women and Children's Medical Centre, Guangzhou Medical University, 510623, Guangzhou, China
| | - Dongzhi Li
- Department of Prenatal Diagnostic Centre, Guangzhou Women and Children's Medical Centre, Guangzhou Medical University, 510623, Guangzhou, China
| | - Can Liao
- Department of Prenatal Diagnostic Centre, Guangzhou Women and Children's Medical Centre, Guangzhou Medical University, 510623, Guangzhou, China.
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Puri S, Jafra A, Dogra N, Sen IM, Solanki S. Anesthetic Management of a Massive Cystic Hygroma of the Neck in a Neonate. J Indian Assoc Pediatr Surg 2024; 29:183-185. [PMID: 38616834 PMCID: PMC11014163 DOI: 10.4103/jiaps.jiaps_197_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 12/11/2023] [Accepted: 12/27/2023] [Indexed: 04/16/2024] Open
Abstract
Cystic hygroma of the neck, a congenital benign tumor of the lymphatic system, is a potential cause of neonatal airway obstruction leading to stridor. Meticulous airway evaluation, case appropriate preparation, and use of advanced technology, including videolaryngoscope and ultrasonography, can facilitate the safe management of the difficult airway.
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Affiliation(s)
- Sunaakshi Puri
- Department of Anaesthesia, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anudeep Jafra
- Department of Anaesthesia, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Neeti Dogra
- Department of Anaesthesia, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Indu Mohini Sen
- Department of Anaesthesia, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shailesh Solanki
- Department of Pediatric Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Barma A, Kunwar S, Yadav NK, Karn M. Unusual cystic hygromas: Case report. Int J Surg Case Rep 2024; 116:109368. [PMID: 38342028 PMCID: PMC10943632 DOI: 10.1016/j.ijscr.2024.109368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 02/02/2024] [Accepted: 02/05/2024] [Indexed: 02/13/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Cystic hygromas are congenital lymphangiomas that arise from a developmental anomaly in the lymphatic system. Typically detected in early childhood, their incidence in adolescents and at the chest wall or axillary area is rare. CASE PRESENTATION We report two cases, a 14-year-old male child (Case I) and a 1-year-old male infant (Case II), who presented with swelling in unusual locations, the right axillary region and the right anterolateral chest wall respectively. Local examination findings were indicative of a cystic hygroma in the first case, while in the second case, characteristic transillumination was not seen due to a complication: hemorrhage within the cyst. The diagnoses were established after a correlation of the patient's history, and clinical findings with radiological investigations. Both underwent surgical intervention and had no complications. Histopathology of the post-operative specimens confirmed the diagnoses. DISCUSSION The diagnosis of cystic hygroma is made in the totality of thorough history taking, clinical examination, and radiological and histopathological investigations. Though most cases typically manifest before the age of two years and in the cervicofacial area, unusual locations and delayed presentation can occur. Surgical excision is a safe and effective treatment modality for these lesions. CONCLUSION Although a rare entity, cystic hygroma should be considered a possible differential diagnosis of any swelling in the pediatric population.
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Affiliation(s)
- Aachal Barma
- Gandaki Medical College Teaching Hospital and Research Center, Pokhara 33700, Nepal.
| | - Sarjan Kunwar
- Gandaki Medical College Teaching Hospital and Research Center, Pokhara 33700, Nepal
| | - Nabin Kumar Yadav
- Gandaki Medical College Teaching Hospital and Research Center, Pokhara 33700, Nepal
| | - Mitesh Karn
- Gandaki Medical College Teaching Hospital and Research Center, Pokhara 33700, Nepal
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Sop FYL, Benato A, Izoudine BK, Khouri K, Marangon A, Fraschetti F, Lonjon N, Ferraresi S. Spinal lymphangiomas: Case-based review of a chameleonic disease entity. J Craniovertebr Junction Spine 2024; 15:4-14. [PMID: 38644908 PMCID: PMC11029117 DOI: 10.4103/jcvjs.jcvjs_125_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 12/31/2023] [Indexed: 04/23/2024] Open
Abstract
Purpose Lymphangiomas are benign hamartomas in the spectrum of lymphatic malformations, exhibiting multifaceted clinical features. Spinal involvement is exceedingly rare, with only 35 cases reported to date. Both due to their rarity and chameleonic radiologic features, spinal lymphangiomas (SLs) are usually misdiagnosed; postoperatively, surgeons are thus confronted with an unexpected histopathological diagnosis with sparse pertinent literature and no treatment guidelines available. Methods Here, we report the case of a 67-year-old female who underwent surgery for a T6-T7 epidural SL with transforaminal extension, manifesting with spastic paraparesis. Then, we present the results of the first systematic review of the literature on this subject, delineating the clinical and imaging features and the therapeutic implications of this rare disease entity. Results Our patient was treated with T6-T7 hemilaminectomy and resection of the epidural mass, with complete recovery of her neurological picture. No recurrence was evident at 18 months. In the literature, 35 cases of SL were reported that can be classified as vertebral SL (n = 18), epidural SL (n = 10), intradural SL (n = 3), or intrathoracic lymphangiomas with secondary spinal involvement (n = 4). Specific treatment strategies (both surgical and nonsurgical) were adopted in relation to each of these categories. Conclusion Gathering knowledge about SL is fundamental to promote both correct preoperative identification and appropriate perioperative management of this rare disease entity. By reviewing the literature and discussing an exemplary case, we delineate a framework that can guide surgeons facing such an unfamiliar diagnosis.
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Affiliation(s)
- François Yves Legninda Sop
- Department of Neurosurgery, CHU Montpellier, Montpellier, France
- Department of Neurosurgery, Ospedale Santa Maria Della Misericordia, Rovigo, Italy
| | - Alberto Benato
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Kifah Khouri
- Department of Neurosurgery, CHU Montpellier, Montpellier, France
| | - Anna Marangon
- Department of Anesthesiology and Critical Care Medicine, Ospedale Santa Maria Della Misericordia, Rovigo, Italy
| | - Flavia Fraschetti
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Nicolas Lonjon
- Department of Neurosurgery, CHU Montpellier, Montpellier, France
| | - Stefano Ferraresi
- Department of Neurosurgery, Ospedale Santa Maria Della Misericordia, Rovigo, Italy
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McInerney NJ, O'Keeffe N, Nae A, Morariu J, Timon C. Cystic hygroma in adults: a single-centre experience and review of the literature. Ir J Med Sci 2023; 192:2373-2377. [PMID: 36642745 PMCID: PMC10522499 DOI: 10.1007/s11845-022-03271-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 12/30/2022] [Indexed: 01/17/2023]
Abstract
Cystic hygroma (CH) is a benign congenital lymphatic malformation, occurring predominantly in children, typically as an asymptomatic neck mass. Surgical resection or sclerotherapy is the recommended treatment options. A retrospective review of four cases of adult-onset CH was performed over 2 years by a single surgeon across two institutions. Four patients (two females, median age 31.5 years) who presented with supraclavicular neck masses (range 5-17 cm) are discussed. Ultrasound and MRI demonstrated supraclavicular masses, suggestive of CH. All patients underwent surgical resection. Post-operative courses were uncomplicated, with a mean length of stay of 4 days. All histological samples returned as CH. As of yet, there are no guidelines on the management of CH. Individualised care tailored to each patient, following careful discussion is the most prudent approach. This study demonstrates that surgical resection is a safe and effective treatment for adults in this rarely encountered clinical entity.
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Affiliation(s)
| | - Nick O'Keeffe
- Department of Otolaryngology, Royal Victoria Eye and Ear Hospital, Dublin, Ireland
| | - Andreea Nae
- Department of Otolaryngology, Royal Victoria Eye and Ear Hospital, Dublin, Ireland
| | - Juliana Morariu
- Department of Otolaryngology, Royal Victoria Eye and Ear Hospital, Dublin, Ireland
| | - Con Timon
- Department of Otolaryngology, Royal Victoria Eye and Ear Hospital, Dublin, Ireland
- Department of Otolaryngology, St. James Hospital, Dublin, Ireland
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Zhou H, Yang X, Yi C, Zhong H, Yuan S, Pan M, Li D, Liao C. Prenatal diagnosis and early childhood outcome of fetuses with extremely large nuchal translucency. Mol Cytogenet 2023; 16:22. [PMID: 37660152 PMCID: PMC10475177 DOI: 10.1186/s13039-023-00650-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 07/20/2023] [Indexed: 09/04/2023] Open
Abstract
OBJECTIVE To evaluate the prenatal and perinatal outcome of fetuses with extremely large nuchal translucency (eNT) thickness (≥ 6.5 mm). METHODS 193 (0.61%) singleton fetuses with eNT were retrospectively included. Anomaly scan, echocardiography, and chromosomal and genetic test were included in our antenatal investigation. Postnatal follow-up was offered to all newborns. RESULTS Major congenital anomalies included congenital heart defect (32.6%, 63/193), hydrops fetalis (13.5%, 26/193), omphalocele (9.3%, 18/193), and skeletal dysplasia (7.8%, 15/193) et al. Abnormal karyotype was identified in 81/115 (70.4%) cases including Turner syndrome (n = 47), Trisomy 18 (n = 17), Trisomy 21 (n = 9), and Trisomy 13 (n = 3). Chromosomal microarray analysis provided informative results with 3.6% (1/28) incremental diagnostic yield over conventional karyotyping. The diagnostic yield of exome sequencing is 10.0% (2/20). There was no significant increase [Odds Ratio (OR) = 1.974; 95% confidence interval 0.863-4.516; P = 0.104] in the incidence of chromosomal defects despite the presence of other structural anomalies. Only 13 fetuses were successfully followed up and survived at term, no one was found with developmental delay or mental retardation. CONCLUSIONS Extremely large NT has a high risk of chromosomal abnormality. CMA and ES improve chromosomal genomic and genetic diagnosis of fetal increased NT. When cytogenetic analysis and morphology assessment are both normal, the outcome is good.
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Affiliation(s)
- Hang Zhou
- Prenatal Diagnostic Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Xin Yang
- Prenatal Diagnostic Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
- Department of Medical Genetics and Prenatal Diagnosis, Longgang District Maternity and Child Healthcare Hospital of Shenzhen City (Longgang Maternity and Child Institute of Shantou University Medical College), Shenzhen, Guangdong, China
| | - CuiXing Yi
- Prenatal Diagnostic Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Huizhu Zhong
- Prenatal Diagnostic Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Simin Yuan
- Prenatal Diagnostic Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Min Pan
- Prenatal Diagnostic Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Dongzhi Li
- Prenatal Diagnostic Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Can Liao
- Prenatal Diagnostic Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China.
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Zhou Y, Lu X, Zhang Y, Ge Y, Xu Y, Wu L, Jiang Y. Prenatal Genetic Diagnosis of Fetal Cystic Hygroma: A Retrospective Single-Center Study from China. Cytogenet Genome Res 2023; 162:354-364. [PMID: 36907182 DOI: 10.1159/000528600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 12/07/2022] [Indexed: 03/12/2023] Open
Abstract
Fetal cystic hygroma (CH) is associated with poor prognosis and chromosomal anomalies. Recent studies have suggested that the genetic background of affected fetuses is essential for predicting pregnancy outcomes. However, the detection performance of different genetic approaches for the etiological diagnosis of fetal CH remains unclear. In this study, we aimed to compare the diagnostic efficiency of karyotyping and chromosomal microarray analysis (CMA) in a local fetal CH cohort, and tried to propose an optimized testing strategy that may help improve the cost-effectiveness of disease management. We reviewed all pregnancies that underwent invasive prenatal diagnosis between January 2017 and September 2021 at one of the largest prenatal diagnostic centers in Southeast China. We collected cases identified by the presence of fetal CH. Prenatal phenotypes and laboratory records of these patients were audited, collated, and analyzed. The detection rates of karyotyping and CMA were compared, and the concordance rate of these two methods was calculated. A total of 157 fetal CH cases were screened from 6,059 patients who underwent prenatal diagnosis. Diagnostic genetic variants were identified in 44.6% (70/157) of the cases. Karyotyping, CMA, and whole-exome sequencing (WES) identified pathogenic genetic variants in 63, 68, and 1 case, respectively. The Cohen's κ coefficient between karyotyping and CMA was 0.96, with a concordance of 98.0%. Of the 18 cases in which cryptic copy number variants <5 Mb were detected by CMA, 17 were interpreted as variants of uncertain significance, and the remaining cases were interpreted as pathogenic. Trio exome sequencing revealed a pathogenic homozygous splice site mutation in the PIGN gene in a case undiagnosed by CMA and karyotyping. Our study demonstrated that chromosomal aneuploidy abnormalities are the main genetic cause of fetal CH. Based on this, we recommend karyotyping combined with rapid aneuploidy detection as a first-tier approach for the genetic diagnosis of fetal CH. WES and CMA could improve the diagnostic yield when routine genetic tests fail to determine the cause of fetal CH.
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Affiliation(s)
- Yulin Zhou
- United Diagnostic and Research Center for Clinical Genetics, Women and Children's Hospital, School of Medicine and School of Public Health, Xiamen University, Xiamen, China
| | - Xingxiu Lu
- United Diagnostic and Research Center for Clinical Genetics, Women and Children's Hospital, School of Medicine and School of Public Health, Xiamen University, Xiamen, China
| | - Yanhong Zhang
- Department of Medical Ultrasonics, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, China
| | - Yunsheng Ge
- United Diagnostic and Research Center for Clinical Genetics, Women and Children's Hospital, School of Medicine and School of Public Health, Xiamen University, Xiamen, China
| | - Yasong Xu
- Department of Prenatal Diagnosis, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, China
| | - Lili Wu
- Department of Gynecology, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, China
| | - Yu Jiang
- United Diagnostic and Research Center for Clinical Genetics, Women and Children's Hospital, School of Medicine and School of Public Health, Xiamen University, Xiamen, China
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Jian W, Yuan H, Liu Y, Sun J, Chen F, Li Y, Chen M. Prenatal diagnosis of Noonan syndrome in a set of monozygotic twins- a case report. BMC Pregnancy Childbirth 2023; 23:10. [PMID: 36609239 PMCID: PMC9825018 DOI: 10.1186/s12884-022-05323-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 12/20/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND We report a pair of dichorionic diamniotic (DCDA) twin pregnancy affected by Noonan syndrome (NS) with a novel mutation of LZTR1 determined by genetic analysis. CASE PRESENTATION A pregnant woman with monozygotic twins (DCDA) at 12 + 2 weeks gestation was referred to our center. This was her second pregnancy following a previous delivery of a healthy infant. Nuchal translucency of two fetuses was 11.2 mm (CRL 62.0 mm) and 6.9 mm (CRL 62.1 mm) respectively. Ultrasound examination indicated cystic hygroma and hypoplastic ear. The couple was not consanguineous, and both had normal phenotype. Familial hereditary disease was also excluded. Under ultrasound guidance, 30 mg of chorionic villi was obtained for karyotyping, quantitative fluorescent polymerase chain reaction (QF-PCR), chromosomal microarray analysis(CMA), and Trio-whole-exome sequencing(WES) examination. We used the "target region capture and sequencing" for WES, and the BWA (Burrows Wheeler Aligner) Multi-Vision software package for the data analysis. The results of all these tests were normal except WES detected a c.427 A > G mutation in the exonic region of the LZTR1 gene and a p. Asn143Asp novel heterozygous mutation associated with NS in this pair of twins. In addition, WES suggested that the mutation in the twin fetuses originated from the mother. When the mother got the genetic test report, she came to our fetal medicine department for genetic counseling and she declined the appointment with a clinical geneticist. The couple opted to terminate the pregnancy. Because the patient did not choose to terminate the pregnancy at our hospital, we were unable to take further examination. With the help of colleagues in another hospital, photos of the fetuses were taken. Compared with the prenatal ultrasound results, the appearance of the "cystic hygroma" and "hypoplastic ear" was consistent with the ultrasound. The couple were depressed after knowing this pathogenic result and although we advised the mother to take further investigation, they refused. CONCLUSION The mutant locus might be incompletely dominant, which led to an abnormal fetal phenotype such as cystic hygroma and hypoplastic ear.
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Affiliation(s)
- Wei Jian
- grid.417009.b0000 0004 1758 4591Department of Obstetrics and Gynecology, Department of Fetal Medicine and Prenatal Diagnosis, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Huizhen Yuan
- grid.469571.80000 0004 5910 9561Jiangxi Key Laboratory of Birth Defect Prevention and Control, Jiangxi Maternal and Child Health Hospital, Guangzhou, China
| | - Yu Liu
- grid.417009.b0000 0004 1758 4591Department of Obstetrics and Gynecology, Department of Fetal Medicine and Prenatal Diagnosis, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jimei Sun
- grid.417009.b0000 0004 1758 4591Department of Obstetrics and Gynecology, Department of Fetal Medicine and Prenatal Diagnosis, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Fei Chen
- grid.417009.b0000 0004 1758 4591Department of Obstetrics and Gynecology, Department of Fetal Medicine and Prenatal Diagnosis, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yufan Li
- grid.417009.b0000 0004 1758 4591Department of Obstetrics and Gynecology, Department of Fetal Medicine and Prenatal Diagnosis, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Min Chen
- grid.417009.b0000 0004 1758 4591Department of Obstetrics and Gynecology, Department of Fetal Medicine and Prenatal Diagnosis, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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Biji IK, Mahay SB, Saxena R, Verma I, Kumar B, Puri RD. Antenatal Phenotype of Desbuquois Dysplasia. Indian J Pediatr 2023; 90:83-86. [PMID: 36331722 DOI: 10.1007/s12098-022-04386-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/11/2022] [Accepted: 10/14/2022] [Indexed: 11/06/2022]
Abstract
Desbuquois dysplasia (DBQD) is an uncommon, autosomal recessive disorder with multiple joint dislocations. It is caused by pathogenic variants in CANT1 (calcium-activated nucleotidase 1) [NM_001159773.2]. This study adds to the scant data of nine reported antenatal phenotypes of DBQD. The present paper describes two unrelated consanguineous families with antenatal features of lethal skeletal dysplasia. The defining radiological changes were identified in only one patient who presented in the late second and third trimesters. Solo exome sequencing was performed and two previously reported homozygous variants c.896C>T (p.Pro299Leu) in patient 1 and c.902_906dup (p.Ser303fs*20) in patient 2 were identified. This study highlights the fetal presentations in DBQD and adds to its phenotypic spectrum. A complete clinical workup, including fetal autopsy and radiographs is essential to confirm the diagnosis of lethal skeletal dysplasia. Molecular diagnosis remains the diagnostic modality to define the causative variant. A definitive diagnosis is essential to inform management and offer reproductive care.
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Affiliation(s)
- Ishpreet K Biji
- Institute of Medical Genetics & Genomics, Sir Ganga Ram Hospital, Delhi, 110060, India
- Amity Institute of Biotechnology, Amity University, Noida, Uttar Pradesh, 201313, India
| | - Sunita Bijarnia Mahay
- Institute of Medical Genetics & Genomics, Sir Ganga Ram Hospital, Delhi, 110060, India
| | - Renu Saxena
- Institute of Medical Genetics & Genomics, Sir Ganga Ram Hospital, Delhi, 110060, India
| | - Ishwar Verma
- Institute of Medical Genetics & Genomics, Sir Ganga Ram Hospital, Delhi, 110060, India
| | - Benu Kumar
- Amity Institute of Biotechnology, Amity University, Noida, Uttar Pradesh, 201313, India
| | - Ratna Dua Puri
- Institute of Medical Genetics & Genomics, Sir Ganga Ram Hospital, Delhi, 110060, India.
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Yadav S, Gulati N, Shetty DC, Juneja S. Embryological Basis of Cystic Hygroma: A Case Report. Int J Clin Pediatr Dent 2022; 15:774-778. [PMID: 36866128 PMCID: PMC9973091 DOI: 10.5005/jp-journals-10005-2472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
Abstract
Aim We intend to present a cystic hygroma (CH) case in a 2-year-old baby in the anterior cervical triangle, which is a rare site, as the most common site for the occurrence of CH is the supraclavicular fossa of the posterior cervical triangle. Background Among developmental abnormalities in the lymphoid system, CH are usually seen in the posterior neck. Lymphatic malformations are generally exhibited either at birth or before the age of 2 years. Lymphatic channels are attenuated endothelium-lined spaces devoid of any cells and smooth muscle layer. Also, morphologically distinguishing normal lymphatic channels from venules or capillaries is a challenge. Case description A 2-year-old female patient reported having a chief complaint of swelling in the left submandibular region for 4 days. The patient underwent surgery for CH 18 days after birth. Swelling was rubbery in texture and firm in consistency. Conclusion A D2-40 immunoexpression was an identifying clue for normal lymphatics in comparison to morphology. Henceforth, this can be concluded that such tumors depict at least partial differentiation of endothelial cells lining lymphatic spaces. Clinical significance The present article helps in illuminating the role of D2-40 in the diagnosis of lymphatic malformations, such as CH, and also highlights the embryological basis of the pathogenetic mechanism of this rare disease, which potentiates the role of various treatment modalities in pediatric cases for management considerations. How to cite this article Yadav S, Gulati N, Shetty DC, et al. Embryological Basis of Cystic Hygroma: A Case Report. Int J Clin Pediatr Dent 2022;15(6):774-778.
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Affiliation(s)
- Shefali Yadav
- Department of Oral and Maxillofacial Pathology, ITS - Centre for Dental Studies and Research, Ghaziabad, Uttar Pradesh, India
| | - Nikita Gulati
- Department of Oral and Maxillofacial Pathology, ITS - Centre for Dental Studies and Research, Ghaziabad, Uttar Pradesh, India
| | - Devi Charan Shetty
- Department of Oral and Maxillofacial Pathology, ITS - Centre for Dental Studies and Research, Ghaziabad, Uttar Pradesh, India
| | - Saurabh Juneja
- Department of Oral and Maxillofacial Pathology, ITS - Centre for Dental Studies and Research, Ghaziabad, Uttar Pradesh, India
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Demir SS, Cagliyan E, Öztürk D, Özmen S, Altunyurt S, Çankaya T, Bora E. Prenatal diagnosis of cystic hygroma cases in a tertiary centre and retrospective analysis of pregnancy results. J OBSTET GYNAECOL 2022; 42:2899-2904. [PMID: 36006022 DOI: 10.1080/01443615.2022.2112023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The aim of this study is to retrospectively examine invasive diagnostic methods, structural anomalies accompanying cystic hygroma, and pregnancy outcomes in cystic hygroma cases admitted to a tertiary centre. The population of the study consisted of 29 live foetuses with cystic hygroma in the foetal neck only in the first or second trimester. In the study, pregnant women who applied to our centre were included. Amniocentesis or chorionic villus sampling was performed for genetic analysis according to the weeks of the pregnant women who were diagnosed with cystic hygroma by ultrasound examination by two clinicians experienced in foetal anomaly. Of the pregnant women included in the study, 10 had normal karyotype, 12 had abnormal karyotype and 13 had structural abnormality. It is very important to provide genetic counselling to the families of foetuses with cystic hygroma with a multidisciplinary team approach consisting of neonatologists, paediatric surgeons and experienced sonographers. Implications for rehabilitationWhat is already known on this subject? Cystic hygroma, also known as cystic lymphangioma, is a congenital cystic malformation often seen in the first trimester, which occurs in the foetal neck due to the failure of the connections between the cervical lymphatic vessels and the jugular venous system to develop normally. Cystic hygroma may be isolated, but highly associated with foetal aneuploidy, hydrops fetalis, abnormal foetal nuchal translucency.What do the results of this study add? Invasive prenatal diagnostic tests (CVS or amniocentesis) should be performed in all patients with cystic hygroma, as cystic hygromas can be diagnosed by first trimester foetal genetic sonogram screening and are largely accompanied by chromosomal abnormalities.What are the implications of these findings for clinical practice and/or further research? In foetuses with cystic hygroma, foetal karyotyping, detailed sonography and their documentation, genetic counselling is important to families of cystic hygroma foetuses with a multidisciplinary team approach consisting of neonatologists, paediatric surgeons and maternal foetal medicine specialists, since there is a high risk for aneuploidy and foetal malformation.
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Affiliation(s)
- Sureyya Saridas Demir
- Department of Obstetrics and Gynecology, Division of Perinatology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Erkan Cagliyan
- Department of Obstetrics and Gynecology, Division of Perinatology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Derya Öztürk
- Department of Obstetrics and Gynecology, Division of Perinatology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Samican Özmen
- Department of Obstetrics and Gynecology, Division of Perinatology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Sabahattin Altunyurt
- Department of Obstetrics and Gynecology, Division of Perinatology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Tufan Çankaya
- Department of Medical Genetics, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Elcin Bora
- Department of Medical Genetics, Dokuz Eylul University School of Medicine, Izmir, Turkey
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Kurumety S, Morris M, Aydi ZB. New-onset axillary lymphangioma: a case report. J Med Case Rep 2022; 16:242. [PMID: 35717390 PMCID: PMC9206747 DOI: 10.1186/s13256-022-03461-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 05/16/2022] [Indexed: 11/10/2022] Open
Abstract
Background Lymphangioma is a rare diagnosis in adult patients and typically presents in early infancy. These tumors are a result of malformation of the lymphatic vessels and usually involve the head, neck, and axilla. Case presentation We report the case of a 28-year-old African female who recently immigrated from East Africa and presented to our surgical breast clinic with a large and rapidly growing left axillary mass. Initial history and evaluation were concerning for hydatid cyst; however, on surgical excision, gross appearance was consistent with cystic lymphangioma. Diagnosis was confirmed on pathology review. Conclusions Although lymphangiomas are typically found in young children, adults may develop these tumors in response to unknown triggers. Surgical excision is the preferred treatment.
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Affiliation(s)
- Sasha Kurumety
- Department of Internal Medicine, University of Arizona College of Medicine-Phoenix, 1111 East McDowell Rd., Phoenix, AZ, 85006, USA
| | - Michael Morris
- Department of Radiology, Banner University Medical Center-Phoenix, 1111 East McDowell Rd., Phoenix, AZ, 85006, USA
| | - Zeynep Bostanci Aydi
- Department of Surgery, Banner MD Anderson Cancer Center-Phoenix, University of Arizona College of Medicine-Phoenix, 925 East McDowell Rd., Phoenix, AZ, 85006, USA.
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13
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Pichler Sekulic S, Sekulic M. Primary cardiac and pericardial lymphangiomas: clinical, radiologic, and pathologic characterization derived from an institutional series and review of the literature. Virchows Arch 2022; 480:1211-1221. [PMID: 35013774 DOI: 10.1007/s00428-022-03269-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 12/30/2021] [Accepted: 01/03/2022] [Indexed: 11/24/2022]
Abstract
Lymphangiomas are comprised of aggregates of lymphatic vessels, considered to represent either aberrant embryogenic remnants or developing secondary to obstruction. Lymphangiomas primary to the heart and pericardial are exceedingly rare, and to date sparingly reported in individual case reports. In this study, the histopathologic, clinical, and radiologic features of 35 cases of cardiac/pericardial lymphangiomas described in the literature to date together with four cases from our own institution (39 cases in total) are examined to provide clinicopathologic characterization. Cardiac/pericardial lymphangiomas were identified in both children and adults, with two cases initially discovered in utero. If presenting with symptoms, patients most commonly exhibited respiratory distress/dyspnea. By X-ray, a widened cardiac silhouette could be noted, and echocardiogram generally showed an echogenic mass with cystic and septal components. On computed tomography (CT) and magnetic resonance imaging (MRI), cystic and septal components were again observed, with CT showing an absence of calcifications or macroscopic fat. Most lymphangiomas were pericardial (specifically visceral) based, and frequently situated in the right atrioventricular groove. A majority of cases proceeded to surgical resection, with no evidence of recurrence post-operatively. Grossly, lesions had a median size of 6 cm and in almost all cases were multicystic/multilocular. Microscopically, the lymphangiomas were composed of lymphatic spaces lined by endothelial cells that specifically express podoplanin (D2-40) with immunoperoxidase staining. Further investigation with a larger and more uniformly organized cohort is required to better characterize the clinicopathologic features of lymphangiomas of this unusual anatomic location.
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Affiliation(s)
- Simona Pichler Sekulic
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, 630 West 168th Street, VC14-238C, New York, NY, 10032, USA
| | - Miroslav Sekulic
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, 630 West 168th Street, VC14-238C, New York, NY, 10032, USA.
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14
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Santha N, Dhamotharan P, Osmani SG. Anesthetic management of a patient presenting with huge neck lymphatic cyst. Ann Afr Med 2021; 20:313-315. [PMID: 34893573 PMCID: PMC8693739 DOI: 10.4103/aam.aam_52_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Lymphatic cyst in the cervical region presents a great challenge to the anesthesiologist. The anesthetic difficulties are because of the extension of the cyst, difficult airway, postoperative respiratory obstruction, and coexisting anomalies. The management of such patients depends on direct communication between the surgeon and anesthesiologist. We hereby present a case of a 53-year-old male presenting with lymphatic cyst of the cervicothoracic region with dysphagia and dyspnea, posted for direct laryngoscopy and biopsy under general anesthesia. Awake fiberoptic intubation was done in this patient successfully in spite of totally distorted airway anatomy.
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Affiliation(s)
- Neeta Santha
- Department of Anaesthesia, Kasturba Medical College, Mangalore Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Preethi Dhamotharan
- Department of Anaesthesia, Kasturba Medical College, Mangalore Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Sheikh Gulam Osmani
- Department of Anaesthesia, Kasturba Medical College, Mangalore Manipal Academy of Higher Education, Manipal, Karnataka, India
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15
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Malone CM, Mullers S, Kelliher N, Dalrymple J, O'Beirnes J, Flood K, Malone F. Euploid First-Trimester Cystic Hygroma: A More Benign Entity than Previously Thought? Fetal Diagn Ther 2021; 48:667-671. [PMID: 34569548 DOI: 10.1159/000519056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 08/16/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Studies summarizing the outcome of first-trimester septated cystic hygroma are generally based on small studies or from multiple centers with limited ascertainment. We reviewed the natural history of a large cohort of such cases from a single tertiary referral center, with the aim being to establish contemporary outcome data, particularly in the setting of normal karyotype. METHODS A retrospective cohort study from 2007 to 2017 was conducted at a single tertiary referral prenatal diagnosis center. Data were analyzed from a prospectively collated fetal anomaly database. Search terms were "increased nuchal translucency (NT)," "cystic hygroma," and "septated cystic hygroma." All cases were confirmed to have NT >3 mm with septations. Cases of simple increased NT without septations were excluded. RESULTS During the study period, over 110,000 pregnancies were delivered at our center, resulting in 410 cases of septated cystic hygroma diagnosed prior to 14 weeks' gestation. Pregnancy outcome was obtained in 99% (405/410) of cases, with detailed pathology outcome available in 92% (378/410). A total of 87% (351/405) underwent invasive prenatal testing, and postnatal chromosome status was established in further 27 cases. A total of 61% (230/378) had abnormal chromosomal status. Of the 39% (148/378) with normal chromosomal status, only 13% (19/148) had a significant structural fetal abnormality, which included 7 cardiac and 12 noncardiac abnormalities. Overall, the perinatal loss was 62% (253/405). The total survival rate in the setting of euploid cystic hygroma without structural abnormality was 84% (108/129). CONCLUSIONS Counseling regarding outcomes in the setting of first-trimester septated cystic hygroma initially focuses on the strong likelihood of an abnormal karyotype, which occurs in 61% of cases. However, once fetal chromosomal abnormality is excluded, our results demonstrate only a 13% incidence of major structural fetal abnormality, which appears significantly less than previously reported. Normal fetuses have a 77% survival rate. These data represent the largest single-center study of first-trimester cystic hygroma with complete outcome data and therefore will be useful for contemporary patient counseling. Such counseling can be more positive than previously expected, once chromosomal abnormality is first excluded.
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Affiliation(s)
- Ciara M Malone
- Department of Obstetrics and Gynaecology, Royal College of Surgeons in Ireland, Dublin, Ireland.,Rotunda Hospital Dublin, Dublin, Ireland
| | - Sieglinde Mullers
- Department of Obstetrics and Gynaecology, Royal College of Surgeons in Ireland, Dublin, Ireland.,Rotunda Hospital Dublin, Dublin, Ireland
| | | | | | | | - Karen Flood
- Department of Obstetrics and Gynaecology, Royal College of Surgeons in Ireland, Dublin, Ireland.,Rotunda Hospital Dublin, Dublin, Ireland
| | - Fergal Malone
- Department of Obstetrics and Gynaecology, Royal College of Surgeons in Ireland, Dublin, Ireland.,Rotunda Hospital Dublin, Dublin, Ireland
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16
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Kagawa K, Takahashi H, Nagayama S, Horie K, Takahashi K, Baba Y, Ogoyama M, Suzuki H, Usui R, Ohkuchi A, Matsubara S. Long-term outcome of fetus with ameliorated cystic hygroma. Taiwan J Obstet Gynecol 2021; 60:874-877. [PMID: 34507664 DOI: 10.1016/j.tjog.2021.07.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2020] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE Cystic hygroma often ameliorates or disappears with pregnancy progression. Fetuses/neonates with amelioration, when without chromosomal or major structural abnormality, generally show a favorable outcome at birth. The present study was aimed to clarify the short/long-term outcomes of fetuses/neonates with the amelioration of cystic hygroma during pregnancy. MATERIAL AND METHODS This was a retrospective observational study. We focused on fetuses with cystic hygroma managed in our institute between January 2006 and June 2019. The infants were followed by pediatricians (neonatologist, pediatric cardiologist, and pediatric neurologist) and pediatric outcomes were retrieved from the medical records up to 3 years old. RESULTS One hundred and seven fetuses with cystic hygroma were included. Of the 107, cystic hygromas ameliorated in 31 fetuses (31/107: 29%). Of the 31, there were 26 livebirths. Half (n = 13) of the 26 fetuses had a good outcome, whereas the remaining half (n = 13) had abnormalities. Various abnormalities were detected in their infancies. A nuchal thickness (diameter of hygroma) of ≥5 mm was significantly correlated with abnormalities (P = 0.047). CONCLUSION Physicians should pay attention to fetuses/neonates with ameliorated cystic hygroma. Of those, special attention should be paid to fetuses/neonates with a nuchal thickness at diagnosis ≥5 mm.
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Affiliation(s)
- Keiko Kagawa
- Department of Obstetrics and Gynecology, Jichi Medical University, 3311-1 Shimotsuke, Tochigi 329-0498, Japan
| | - Hironori Takahashi
- Department of Obstetrics and Gynecology, Jichi Medical University, 3311-1 Shimotsuke, Tochigi 329-0498, Japan.
| | - Shiho Nagayama
- Department of Obstetrics and Gynecology, Jichi Medical University, 3311-1 Shimotsuke, Tochigi 329-0498, Japan
| | - Kenji Horie
- Department of Obstetrics and Gynecology, Jichi Medical University, 3311-1 Shimotsuke, Tochigi 329-0498, Japan
| | - Kayo Takahashi
- Department of Obstetrics and Gynecology, Jichi Medical University, 3311-1 Shimotsuke, Tochigi 329-0498, Japan
| | - Yosuke Baba
- Department of Obstetrics and Gynecology, Jichi Medical University, 3311-1 Shimotsuke, Tochigi 329-0498, Japan
| | - Manabu Ogoyama
- Department of Obstetrics and Gynecology, Jichi Medical University, 3311-1 Shimotsuke, Tochigi 329-0498, Japan
| | - Hirotada Suzuki
- Department of Obstetrics and Gynecology, Jichi Medical University, 3311-1 Shimotsuke, Tochigi 329-0498, Japan
| | - Rie Usui
- Department of Obstetrics and Gynecology, Jichi Medical University, 3311-1 Shimotsuke, Tochigi 329-0498, Japan
| | - Akihide Ohkuchi
- Department of Obstetrics and Gynecology, Jichi Medical University, 3311-1 Shimotsuke, Tochigi 329-0498, Japan
| | - Shigeki Matsubara
- Department of Obstetrics and Gynecology, Jichi Medical University, 3311-1 Shimotsuke, Tochigi 329-0498, Japan
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Chen CP, Shaw SW, Chern SR, Chen SW, Wu FT, Wang W. Prenatal diagnosis and management of monozygotic twins discordant for severe fetal abnormalities. Taiwan J Obstet Gynecol 2021; 59:945-947. [PMID: 33218418 DOI: 10.1016/j.tjog.2020.09.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2020] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE We present prenatal diagnosis and management of monozygotic (MZ) twins discordant for severe fetal abnormalities. CASE REPORT A 36-year-old woman underwent amniocentesis at 18 weeks of gestation because of advanced maternal age, and hydrops fetalis, a giant cystic hygroma of 5 × 3.5 cm and left hydronephrosis in a co-twin. The other co-twin was structurally normal. Amniocentesis revealed a karyotype of 46,XY in both co-twins. Simultaneous polymorphic DNA marker analysis using the DNAs extracted from maternal blood and uncultured amniocytes confirmed MZ twinning. The woman underwent a successful selective fetal reduction by radiofrequency ablation at 22 weeks of gestation. At 28 weeks of gestation, premature rupture of membranes occurred, and a 1280-g normal male baby and a 275-g dead malformed co-twin were delivered. The normal co-twin was phenotypically normal and was doing well at age seven weeks. CONCLUSIONS Prenatal diagnosis of MZ twins discordant for structural abnormalities should include a differential diagnosis of MZ twinning, and a zygosity test is necessary under such a circumstance.
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Affiliation(s)
- Chih-Ping Chen
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan; Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan; School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan; Institute of Clinical and Community Health Nursing, National Yang-Ming University, Taipei, Taiwan; Department of Obstetrics and Gynecology, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
| | - Steven W Shaw
- Department of Obstetrics and Gynecology, Taipei Chang Gung Memorial Hospital, Taipei, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan; Prenatal Cell and Gene Therapy Group, Institute for Women's Health, University College London, London, UK
| | - Schu-Rern Chern
- Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan
| | - Shin-Wen Chen
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Fang-Tzu Wu
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Wayseen Wang
- Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan
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Aslan F, Güvenç İ, Aslan A, Günaydın E. Cystic Hygroma with Multiple Benign Bone Lymphangiomas in an Adult Patient: A Rare Entity in the Differential Diagnosis of Multiple Osseous Lesions in Oncology Practice. Curr Med Imaging 2021; 17:439-442. [PMID: 33327921 DOI: 10.2174/1573405616666201216100301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 09/26/2020] [Accepted: 10/14/2020] [Indexed: 11/22/2022]
Abstract
Cystic lymphangioma presenting with multiple bone lesions in an adult patient is a rare occurrence, with a limited number of reported cases in the literature. In this case report, we describe a 32-year old female patient with chronic neck and pelvic pain, and multiple lytic bone lesions on radiological imaging, which were eventually discovered to originate from cystic hygroma and widespread bone lymphangiomas that were present for more than 10 years. It should be kept in mind that there may be multiple benign causes of differential diagnosis in patients presenting with findings suggestive of diffuse bone metastasis. Misdiagnosis may cause the patient to receive unnecessary treatments, especially radiotherapy. In this case, we reached the diagnosis of benign disease, diffuse bone lymphangiomatosis. For this purpose, we also examine the long and stable medical history of the patient with the findings of BT, ultrasound, and bone scintigraphy. We think that as long as there are no stable and serious results ofclinical and radiological findings of the patient, the patient should be approached with medical follow-up without treatment.
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Affiliation(s)
- Ferit Aslan
- Department of Medical Oncology, Yüksek İhtisas University Medicalpark Ankara Batıkent Hospital, Ankara, Turkey
| | - İnanç Güvenç
- Department of Radiology, Yuksek Ihtisas University Medicalpark Ankara Batikent Hospital, Ankara, Turkey
| | - Aydın Aslan
- Department of Radiology, Yuksek Ihtisas University Medicalpark Ankara Batikent Hospital, Ankara, Turkey
| | - Elif Günaydın
- Department of Radiology, Yuksek Ihtisas University Medicalpark Ankara Batikent Hospital, Ankara, Turkey
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Hammed S, Al Assaf A, Hammed A, Saker Z, Dway A. A rare case report of giant de novo cervical cystic hygroma in an elderly patient: Case report. Ann Med Surg (Lond) 2021; 64:102210. [PMID: 33747502 DOI: 10.1016/j.amsu.2021.102210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 02/27/2021] [Accepted: 03/01/2021] [Indexed: 11/22/2022] Open
Abstract
Introduction and importance Cystic hygroma is an aberrant proliferation of lymphatic vessels resulting from abnormal development of the lymphatic system. Cervical lymphangioma is an uncommon entity, usually reported in children, rarely in adult. Case presentation Our case presents a 65-year-old man with an extremely huge right-sided painless cervical swelling since 8 years with no symptoms. Clinical discussion Computer tomography (CT) showed a cystic lesion with thin walls of 150 × 100mm, medial to right sternocleidomastoid muscle (SCM). The lesion was completely resected along with the entire capsule. Post-operatively, the patient recovered well with no signs of any neurological dysfunction and he was discharged from hospital after 2 days. Conclusion The etiology in the adult population is controversial. Diagnosis in adults is considered to present a greater challenge than in children, and final diagnosis is usually based on postoperative histology. Cystic hygroma should be considered as a differential diagnosis of cervical masses in adults.
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Di Gregorio DM, Martin D, Mansilla L. First Trimester Cystic Hygroma: Herald to Early Diagnosis of Congenital Diaphragmatic Hernia. P R Health Sci J 2021; 40:53-55. [PMID: 33876920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The early diagnosis of in utero congenital diaphragmatic hernia (CDH) allows a thorough evaluation for other morbidities that may be associated with CDH. Our patient was referred to us with a fetus at 13 weeks gestational age with a thick nuchal translucency. Our team performed a transvaginal ultrasound that revealed a large ystic hygroma, a heart displaced to the right, and a heterogeneous mass with peristalsis in the left chest. The fetus was diagnosed with CDH. The patient received genetic counseling after which she requested and underwent chorionic villus sampling. The early diagnosis of CDH allows for a timely intervention with the improved management of pre-natal and post-natal care. Better neonatal management is pivotal in providing a multidisciplinary consultation approach in order to furnish accurate counseling and prognostic information for the patient.
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Affiliation(s)
| | - Dibe Martin
- Maternal- Fetal Medicine Specialists of South Florida, LLC; Herbert Wertheim College of Medicine, Florida International University. Miami, Florida
| | - Luis Mansilla
- Maternal- Fetal Medicine Specialists of South Florida, LLC; Herbert Wertheim College of Medicine, Florida International University. Miami, Florida
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21
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Phupong V, Erjongmanee S, Tanbirojn P, Lertkhachonsuk R. Fetal cystic hygroma in the first trimester led to diagnosis of partial trisomy 22. SAGE Open Med Case Rep 2021; 9:2050313X21991000. [PMID: 33796308 PMCID: PMC7970674 DOI: 10.1177/2050313x21991000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 01/07/2021] [Indexed: 11/17/2022] Open
Abstract
Partial trisomy 22 is a rare condition that is found in live birth. In most cases, diagnosis of partial trisomy 22 was made after birth. Herein, we report a prenatal diagnosis of fetal partial trisomy 22 in a 28-year-old pregnant woman presented with fetal cystic hygroma. Structural abnormalities were detected at 16 weeks of gestation: left cleft lip and ventricular septal defect. The G-banding karyotype analysis and fluorescence in situ hybridization showed partial trisomy 22. It is recommended that pregnant women with fetal anomalies should have prenatal genetic diagnosis to ascertain whether the fetus has partial trisomy 22 or other rare chromosomal abnormalities.
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Affiliation(s)
- Vorapong Phupong
- Placental Related Diseases Research Unit, Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Suchada Erjongmanee
- Placental Related Diseases Research Unit, Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Patau Tanbirojn
- Placental Related Diseases Research Unit, Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Ruangsak Lertkhachonsuk
- Placental Related Diseases Research Unit, Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Hassan HM, Omar AS, Mohammed AA. Mature cystic teratoma of the neck misdiagnosed at cystic hygroma; Case report. Int J Surg Case Rep 2020; 78:321-325. [PMID: 33388510 PMCID: PMC7787949 DOI: 10.1016/j.ijscr.2020.12.062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 12/20/2020] [Accepted: 12/20/2020] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Teratomas arise from primordial germ cells which arrest during its migration from the hindgut allantois the gonads during the first weeks of gestational life, they may occur in both gonadal and extra-gonadal locations. They occur in 1/40,000 live births. The most common anatomical locations are the sacro-coccygeal region and the ovary, neck teratomas constituted about 1.5%. Malignant transformation has been reported. CASE PRESENTATION A 2-year-old boy presented with a gradually enlarging mass in the left side of the neck causing stridor and difficulties in respiration especially during sleep, the parents noticed difficulties during swallowing. The mass was misdiagnosed as cystic hygroma and the patient underwent 2 sessions of sclerotherapy with no improvement. Clinical examination showed a large mass in the left side of the neck which was multilobulated causing tracheal shift to the opposite side. There were no signs of inflammations over the mass. CT-scan showed evidence of enhancing multi-cystic lesion with multiple flecks of calcification. Complete surgical resection was done successfully and the histopathological study of the mass showed mature elements of ectodermal, mesodermal, and ectodermal germinal layers which was consistent with mature cystic teratoma. The follow up showed no postoperative complications. CONCLUSION Mature cystic teratoma of the neck is very rare and may be difficult to be differentiated both clinically and radiologically from other neck masses. The accurate diagnosis must be made before any kind of treatment is started. Complete surgical resection is the main management option and required to decrease the recurrence.
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Affiliation(s)
- Hassan Muhsen Hassan
- Department of Surgery, College of Medicine, University of Duhok, Kurdistan Region, Iraq
| | - Asaad Shareef Omar
- Department of Surgery, College of Medicine, University of Duhok, Kurdistan Region, Iraq
| | - Ayad Ahmad Mohammed
- Department of Surgery, College of Medicine, University of Duhok, Kurdistan Region, Iraq.
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Tiwari P, Pandey V, Bera RN, Sharma SP, Chauhan N. Bleomycin sclerotherapy in lymphangiomas of the head and neck region: a prospective study. Int J Oral Maxillofac Surg 2021; 50:619-26. [PMID: 33059994 DOI: 10.1016/j.ijom.2020.09.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 07/30/2020] [Accepted: 09/14/2020] [Indexed: 11/23/2022]
Abstract
Intralesional sclerotherapy for lymphatic malformations (LMs) has become a modality of choice because of the high morbidity and recurrence rates with surgical excision. Traditionally, the macrocystic variant has shown good results with sclerotherapy. This prospective study was performed to evaluate the role of bleomycin sclerotherapy in the management of different radiological variants of LM. A total of 142 patients were included in this study. The lesions were classified as macrocystic, microcystic, or mixed LMs on the basis of ultrasonography. All patients were managed by intralesional injection of bleomycin and were recalled after 4 weeks for evaluation. Colour photographs of the patients were taken before the onset of treatment and at each monthly visit, and were utilized to assess the response. Following the second, third, and fourth doses, the response was better in patients with the macrocystic variant than in those with the other two variants. However, after the completion of six doses, 80.3% of patients with the macrocystic variant, 67.4% with the microcystic variant, and 71.4% with the mixed type had a complete response. There was no difference in the overall response between the three types (P=0.28). Oedema, erythema, and local induration with fever were the most common adverse effects and were more common in younger children.
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El Sayed M, Touny M, Ibrahim N, Kasb I, Al-Azzawi Z. A rare case of cystic hygroma in neck and extending into thoracic cavity. Int J Surg Case Rep 2020; 76:174-177. [PMID: 33038842 PMCID: PMC7550823 DOI: 10.1016/j.ijscr.2020.09.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 09/13/2020] [Accepted: 09/13/2020] [Indexed: 12/02/2022] Open
Abstract
Cystic Hygroma in Neck and Thorax. Multi disciplinary team approach in the treatment of neck and thorax cystic hygroma. Surgical management of huge cystic hygroma.
Introduction Cystic hygroma is a benign swelling of the neck among the pediatric population. It is a fluid-filled sac resulting from blockage in the lymphatic system and is commonly located in the cervical region and axilla. Case presentation We present a rare case of a large cystic hygroma in the neck and the thorax in a 12 year’s old male. The lesion was diagnosed with the help of MRI which showed a cystic lesion extending from the carotid sheath to the mediastinum. And confirmed by fine-needle aspiration cytology (FNAC). The lesion was treated by surgical excision along with a cardiothoracic team. Discussion We will explore in our discussion the diagnostic modalities for such lesions and the different treatments available for Cystic Hygromas. Conclusion We concluded from this case that accurate diagnosis and careful planning with multidisciplinary team approach and choosing the right treatment as indicated has a great impact on the results for such difficult cases.
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Affiliation(s)
- Mohamed El Sayed
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, Benha University, Benha, Egypt; Department of Oral and Maxillofacial Surgery Nasser Institute Hospital, Cairo, Egypt
| | - Mohamed Touny
- Department of Oral and Maxillofacial Surgery Nasser Institute Hospital, Cairo, Egypt.
| | | | - Ibrahim Kasb
- Department of Cardiothoracic Surgery, Faculty of Medicine, Benha University, Benha, Egypt
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Mukakala AK, Banza MI, Musapudi EM, Lubosha NA, Kasanga TK, Nafatalewa DK, Yumba SN, Ngabunda PM, Mwenibamba RM. [ Cystic hygroma of the neck in a young adult: about a case and literature review]. Pan Afr Med J 2020; 36:54. [PMID: 32774629 PMCID: PMC7388595 DOI: 10.11604/pamj.2020.36.54.21758] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 02/14/2020] [Indexed: 11/11/2022] Open
Abstract
Cystic hygromas are congenital malformations affecting the lymphatic system. These are rare benign dyssembryoplastic lesions mainly affecting the head and neck, in particular the posterior triangle of the neck. They usually occur during childhood and exceptionally in adults. We here report a clinical case of cystic hygroma of the neck in a 22-year old subject.
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Affiliation(s)
- Augustin Kibonge Mukakala
- Département de Chirurgie, Cliniques Universitaires de Bukavu, Faculté de Médecine, Université Officielle de Bukavu, République Démocratique du Congo
- Département de Chirurgie, Cliniques Universitaires de Lubumbashi, Faculté de Médecine, Université de Lubumbashi, République Démocratique du Congo
| | - Manix Ilunga Banza
- Département de Chirurgie, Cliniques Universitaires de Lubumbashi, Faculté de Médecine, Université de Lubumbashi, République Démocratique du Congo
| | - Eric Mbuya Musapudi
- Département de Chirurgie, Cliniques Universitaires de Lubumbashi, Faculté de Médecine, Université de Lubumbashi, République Démocratique du Congo
| | - Nasser Amisi Lubosha
- Département de Chirurgie, Cliniques Universitaires de Lubumbashi, Faculté de Médecine, Université de Lubumbashi, République Démocratique du Congo
| | - Trésor Kibangula Kasanga
- Département de Chirurgie, Cliniques Universitaires de Lubumbashi, Faculté de Médecine, Université de Lubumbashi, République Démocratique du Congo
| | - Dimitri Kanyanda Nafatalewa
- Département de Chirurgie, Cliniques Universitaires de Lubumbashi, Faculté de Médecine, Université de Lubumbashi, République Démocratique du Congo
| | - Serge Ngoie Yumba
- Département de Chirurgie, Cliniques Universitaires de Lubumbashi, Faculté de Médecine, Université de Lubumbashi, République Démocratique du Congo
| | - Papy Mukimba Ngabunda
- Département de Chirurgie, Cliniques Universitaires de Lubumbashi, Faculté de Médecine, Université de Lubumbashi, République Démocratique du Congo
| | - Rodrigue Mupenda Mwenibamba
- Département de Chirurgie, Cliniques Universitaires de Bukavu, Faculté de Médecine, Université Officielle de Bukavu, République Démocratique du Congo
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Abstract
Nonimmune hydrops fetalis (NIHF) historically has been considered a lethal fetal condition. Understanding NIHF to be a symptom or an end-stage status of a variety of fetal conditions, along with improved fetal diagnostics and interventions, has changed the landscape for at least some fetuses. Understanding the pathophysiologic mechanisms has led to the development of diagnostic algorithms, improved understanding of cause, and therefore fetal or neonatal treatments. Multidisciplinary counseling and shared decision making are critical to supporting families through pregnancy decisions, potential fetal therapeutic interventions, neonatal management decisions, and at times accepting or transitioning to palliative care.
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Affiliation(s)
- Corinne Swearingen
- Department of Pediatrics, Medical College of Wisconsin, 999 North 92nd Street, Suite C410, Wauwatosa, WI 53226, USA
| | - Zachary A Colvin
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI 53226, USA
| | - Steven R Leuthner
- Department of Pediatrics, Medical College of Wisconsin, 999 North 92nd Street, Suite C410, Wauwatosa, WI 53226, USA.
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Beal J, Jedraszak G, Saliou AH, Copin H, Sergent F, Gondry J, Merviel P, Muszynski C. [Contribution of array CGH in the management of fetal nuchal translucency]. ACTA ACUST UNITED AC 2020; 48:174-80. [PMID: 31634590 DOI: 10.1016/j.gofs.2019.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Increased nuchal translucency and cystic hygroma have a neonatal prognosis, when the karyotype is normal, which depends on the findings during the medical follow-up. Array comparative genomic hybridization (aCGH) has been systematically included in this follow-up by prenatal diagnosis teams. There are no guidelines and little information on the advantages of carrying out this test systematically. The aim of our study is to evaluate the contribution of the aCGH in the medical follow-up. METHODS Fifty-one patients were included during 18 months and followed till the end of their pregnancy in prenatal diagnosis centers in Brest and Amiens. Inclusion criterion was a nuchal translucency above 3,5mm on the first trimester ultrasound. A fetal DNA ChromoQuant and aCGH analysis on chorionic villi sampling, and an ultrasound at 18 weeks of gestation were performed during the follow-up. RESULTS The aCGH was decisive in only 2 cases. The ultrasound at 18 weeks gestation seemed to be more sensible in the detection of an abnormality. When the aCGH relieved an abnormality, the ultrasound permitted already to detect the presence of a deformity. In 10 cases, the aCGH could not be interpreted on the chorionic villi sampling. In 9 cases, an amniocentesis was performed in order to obtain this result. CONCLUSION Given the results of this study, the aCGH was rarely determinant or decisive on the realization of a therapeutic abortion. These elements make us reflect on the necessity of maintaining this test before 14 weeks of gestation or propose it as a second-line test after the ultrasound shows signs at 18weeks of gestation.
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Upadhyaya VD, Bhatnagar A, Kumar B, Neyaz Z, Kishore JS, Sthapak E. Is multiple session of intralesional bleomycin mandatory for complete resolution of macrocystic lymphatic malformation? Indian J Plast Surg 2019; 51:60-65. [PMID: 29928081 PMCID: PMC5992947 DOI: 10.4103/ijps.ijps_154_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background Intralesional bleomycin scelro-therapy has become a favored line of treatment for macrocystic lymphatic malformations. However the need for multiple sessions is a drawback associated with this treatment modality. Our aim is to document whether multiple session of intra- lesional sclero-therapy is necessary for complete resolution of cystic lymphatic malformation. Method Intralesional bleomycin under Ultrasound guidance was used for macrocystic lymphangioma at concentration of 3mg/ml but not exceeding the total dose (1mg/kg) body weight for single session or cumulative dose of 5mg/kg. In all cases intralesional sclerosant (ILS) was installed under proper aseptic precaution in operation theatre in general anesthesia or sedation depending on the site or size of lesion and age of the patient. Age of patients at the time of enrolment in study ranged from 3 months to 18 years. Clinical examination was the main stay of diagnosis which was supplemented by USG and/or computed tomography. Compression of the lesion site was done for few hours wherever it was possible after the ILS session. Result A total of 21 patients included in our study. The age ranged from 3 months to 18 years. Male to female ratio was 8:13. The most common site of involvement was neck and axilla followed by anterior chest wall and nape of the neck. Complete resolution after single session was observed in 90.5% cases where as surgery was required in 9.5% case. Major complication was observed in one patient, who had intralesional bleeding which was managed conservatively. Transient pain and fever was observed in 23.8% of cases. Only two patient required surgical intervention where one had persistent subcutaneous fibrotic nodule and other one did not respond to ILS. Conclusion Intralesional bleomycin is an effective treatment for macrocystic lesion, and complete resolution may be achieved by single session of ILS if proper principle are followed.
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Affiliation(s)
| | - Ankur Bhatnagar
- Department of Plastic Surgery, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Basant Kumar
- Department of Pediatric Surgery, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Zafar Neyaz
- Department of Radio Diagnosis, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - J S Kishore
- Department of Pediatric Surgery, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Eti Sthapak
- Department of Anatomy, RML, PGIMER, Lucknow, Uttar Pradesh, India
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Yakıştıran B, Altınboğa O, Canpolat E, Çakar EŞ, Çelen Ş, Çağlar AT, Engin Üstün Y. Analysis of cystic hygroma diagnosed in the first trimester: Single-center experience. J Turk Ger Gynecol Assoc 2019; 21:107-110. [PMID: 31298510 PMCID: PMC7294829 DOI: 10.4274/jtgga.galenos.2019.2019.0032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objective: To evaluate the obstetric outcomes of fetuses with cystic hygroma other than karyotype abnormalities and structural malformations. Material and Methods: We conducted a retrospective study based on the review of medical records of pregnant women in whom ultrasonographic diagnosis of fetal cystic hygroma was established in the first trimester from January 2014 to October 2018. All patients were offered genetic counselling and prenatal invasive diagnostic procedures to obtain fetal karyotype. For ongoing pregnancies fetal echocardiography and detailed second trimester sonographic anomaly screening was performed by a perinatologist/pediatric cardiologist. The demographic characteristics of the women and the results of the karyotype analysis were obtained from the database of our hospital and correlated with the obstetric outcomes. Results: Within a five-year period, there were 106 cases of fetal cystic hygroma. Of those, fetal cardiac malformations were detected in four and micrognathia in one fetus. Eighty-five women underwent fetal invasive procedures and karyotype abnormalities were detected in 52 of the cases. Fetal outcomes of 33 cases with normal karyotype and 21 cases in whom karyotyping analysis were not performed due to patient refusal were enrolled into the study. Obstetric outcomes of 21 women who refused karyotyping consisted of 13 livebirths, seven missed abortions, and one fetal death, whereas those of 33 women with normal karyotype were; 12 livebirths, 12 missed abortions, two hydrops fetalis, and five fetal deaths. Nineteen of 33 fetuses with a normal karyotype and eight of 21 fetuses in whom karyotyping was not performed were terminated. Conclusion: The presence of cystic hygroma carries a high risk for fetal karyotype abnormalities and cardiac malformations. The postnatal outcomes of the fetuses with cystic hygroma appeared to be correlated with the absence of structural malformations and karyotype abnormalities.
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Affiliation(s)
- Betül Yakıştıran
- Department of Obstetrics and Gynecology, University of Health Sciences, Ankara Zekai Tahir Burak Women’s Health Training and Research Hospital, Ankara, Turkey
| | - Orhan Altınboğa
- Department of Obstetrics and Gynecology, University of Health Sciences, Ankara Zekai Tahir Burak Women’s Health Training and Research Hospital, Ankara, Turkey
| | - Emre Canpolat
- Department of Pediatrics, University of Health Sciences, Ankara Zekai Tahir Burak Women’s Health Training and Research Hospital, Ankara, Turkey
| | - Esra Şükran Çakar
- Department of Genetic, University of Health Sciences, Ankara Zekai Tahir Burak Women’s Health Training and Research Hospital, Ankara, Turkey
| | - Şevki Çelen
- Department of Obstetrics and Gynecology, University of Health Sciences, Ankara Zekai Tahir Burak Women’s Health Training and Research Hospital, Ankara, Turkey
| | - Ali Turhan Çağlar
- Department of Obstetrics and Gynecology, University of Health Sciences, Ankara Zekai Tahir Burak Women’s Health Training and Research Hospital, Ankara, Turkey
| | - Yaprak Engin Üstün
- Department of Obstetrics and Gynecology, University of Health Sciences Turkey, Ankara Etlik Zubeyde Hanım Women`s Health and Research Center, Ankara, Turkey
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Vičić A, Hafner T, Bekavac Vlatković I, Korać P, Habek D, Stipoljev F. Prenatal diagnosis of Down syndrome: A 13-year retrospective study. Taiwan J Obstet Gynecol 2018; 56:731-735. [PMID: 29241910 DOI: 10.1016/j.tjog.2017.10.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2017] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE The aim of this study is to summarize the experience on prenatal diagnosis of Down syndrome. MATERIALS AND METHODS The study includes a retrospective data analysis of 157 prenatally detected cases of Down syndrome, routinely diagnosed among 6448 prenatal investigations performed during a 13-year period (2002-2014) in a single tertiary center. RESULTS The prevalence of diagnosed Down syndrome cases was 2.4%. Maternal age alone was indication for prenatal diagnosis in 47 cases (45.2%), increased first-/second-trimester biochemical screening test in 34 cases (21.7%), abnormal ultrasound examination in 69 cases (43.9%), positive familial history for chromosomal abnormalities in four cases, and high risk for trisomy 21 revealed by cell-free DNA testing in three cases. Ultrasound anomalies were present in total of 94 fetuses (59.8%). The most common abnormality was cystic hygroma found in 46 cases (29.3%). A regular form of Down syndrome (trisomy 21) was found in 147 cases (93.6%), Robertsonian translocation in six cases (3.8%), and mosaic form in four cases (2.6%). CONCLUSION In prenatal diagnosis of Down syndrome noninvasive screening methods are important for estimation of individual risks, in both, young population of woman and older mothers, while conventional and molecular cytogenetic methods are essential for definite diagnosis and proper genetic counseling.
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Affiliation(s)
- Ana Vičić
- Department of Obstetrics and Gynecology, Clinical Hospital "Sveti Duh", Zagreb, Croatia.
| | - Tomislav Hafner
- Department of Obstetrics and Gynecology, Clinical Hospital "Sveti Duh", Zagreb, Croatia
| | | | - Petra Korać
- Division of Molecular Biology, Department of Biology, Faculty of Science, University of Zagreb, Zagreb, Croatia
| | - Dubravko Habek
- Department of Obstetrics and Gynecology, Clinical Hospital "Sveti Duh", Zagreb, Croatia
| | - Feodora Stipoljev
- Department of Obstetrics and Gynecology, Clinical Hospital "Sveti Duh", Zagreb, Croatia; Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
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Abstract
Cystic hygroma is a benign, painless loculated lymphatic proliferation, which occur due to a combination of sequestration from developing lymphatic system, abnormal budding of the lymphatic system or lack of development of the normal connections between venous and lymphatic drainage. We report a case of giant cervico-thoracic cystic hygroma in a preterm neonate with management options and a brief review of literature.
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Affiliation(s)
- Rahul Mansing Kadam
- Lotus Hospitals for Women and Children, Lakdikapul, Hyderabad, Telangana, India
| | - A Narendra Kumar
- Lotus Hospitals for Women and Children, Lakdikapul, Hyderabad, Telangana, India
| | - Vsv Prasad
- Lotus Hospitals for Women and Children, Lakdikapul, Hyderabad, Telangana, India
| | - Sudha Boda
- Lotus Hospitals for Women and Children, Lakdikapul, Hyderabad, Telangana, India
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Orgul G, Ozyuncu O, Oktem A, Beksac MS. Management and outcomes of cystic hygromas: experience of a tertiary center. J Ultrasound 2017; 20:127-131. [PMID: 28593002 DOI: 10.1007/s40477-017-0251-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 04/06/2017] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Cystic hygroma (CH) is a fetal sonographic finding with an incidence of 1%. Chromosomal abnormalities and structural malformations are commonly related with CH. We aimed to describe our experience and determine the association between diagnosis of CH and adverse pregnancy outcome. METHODS We retrospectively reviewed data of prenatal CH diagnoses over a ten-year period. Cases were evaluated for maternal age, gestational week at CH diagnosis, invasive procedure, karyotype result, associated abnormality and perinatal outcome. We categorized cases into two groups to understand the impact of maternal age on perinatal outcomes, and the cut-off was 35 years old. RESULTS Totally 28 individuals were enrolled in the study. The median maternal age at birth was 27.5 years old, and 7 patients were over 35 years old. Karyotype results were available for all individuals, and 15 had an abnormal chromosome (53.5%). Five fetuses had structural abnormalities, and they were all observed within patients under 35 years old. Healthy fetuses (without any problem at antenatal screening and birth) were found to be only 14.3% in advanced maternal age (AMA) group and 33.3% in young mothers. CONCLUSIONS Women with AMA and CH had a higher risk of having a baby with a chromosomal abnormality, as compared with younger women.
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Affiliation(s)
- Gokcen Orgul
- Division of Perinatology, Department of Obstetrics and Gynecology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Ozgur Ozyuncu
- Division of Perinatology, Department of Obstetrics and Gynecology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Ahmet Oktem
- Department of Neonatology, Hacettepe University School of Medicine, Ankara, Turkey
| | - M Sinan Beksac
- Division of Perinatology, Department of Obstetrics and Gynecology, Hacettepe University School of Medicine, Ankara, Turkey
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Abstract
Airway management of an infant with a giant cervical lump may be a difficult task. The anesthesiologist must be prepared to face associated challenges during securing the airway in such patients. We report our experience with One year old infant who presented with huge cystic hygroma in the cervical region leading to recurrent episodes of respiratory tract infection and distress. Surgical removal was needed as sclerotherapy proved ineffective in reducing its size. Proseal laryngeal mask airway was used as a conduit after inhalational induction since airway could not be maintained with bag and mask. The child was tracheostomized postoperatively and also had a prolonged Intensive Care Unit stay. Difficulties encountered in intubation and postoperative management of this child are discussed in this report.
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Affiliation(s)
- Suman Saini
- Department of Anaesthesia, Vardhman Mahaveer Medical College and Safdarjung Hospital, New Delhi, India
| | - Madhu Dayal
- Department of Anaesthesia, Vardhman Mahaveer Medical College and Safdarjung Hospital, New Delhi, India
| | - Amita Gupta
- Department of Anaesthesia, Vardhman Mahaveer Medical College and Safdarjung Hospital, New Delhi, India
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Igoumenakis D, Logothetis I, Barmpagadaki A, Ieromonachou P, Mastorakis G. Temporal Space Lymphatic Malformation in a 15-Year-Old Adolescent: An Extraordinary Case. J Maxillofac Oral Surg 2016; 15:274-8. [PMID: 27408452 DOI: 10.1007/s12663-015-0789-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2014] [Accepted: 03/23/2015] [Indexed: 11/29/2022] Open
Abstract
Lymphatic malformations-previously called lymphangiomas or cystic hygromas-are regarded as non-malignant primary disorders of the lymphatic system. They appear predominantly in infants and children, with 90 % of cases being diagnosed by the age of 2 years. Also, they constitute an infrequent entity, accounting for 5 % of all benign tumors in infants and children. In adults they are extremely rare. In the present article we present an extraordinary case of a lymphatic malformation that ensued in the temporal area of a 15-year old adolescent.
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Affiliation(s)
- Dimosthenis Igoumenakis
- Department of Oral and Maxillofacial Surgery, General Hospital of Attica "KAT", 2 Nikis Street, 14561 Kifisia, Athens, Greece
| | - Ioannis Logothetis
- Department of Oral and Maxillofacial Surgery, Venizeleio-Pananeio General Hospital of Heraklion, Knossos Avenue, P.O. Box 44, Heraklion, Crete, Greece
| | | | - Panayotis Ieromonachou
- Department of Pathology, Venizeleio-Pananeio General Hospital of Heraklion, Knossos Avenue, P.O. Box 44, Heraklion, Crete, Greece
| | - George Mastorakis
- Department of Oral and Maxillofacial Surgery, Venizeleio-Pananeio General Hospital of Heraklion, Knossos Avenue, P.O. Box 44, Heraklion, Crete, Greece
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35
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Ali E, Karim N, Hicham A, Mohamed Z. [Cystic lymphangioma on the floor of the oral cavity extending to the submandibular region in adult patients]. Pan Afr Med J 2016; 24:202. [PMID: 27795797 PMCID: PMC5072845 DOI: 10.11604/pamj.2016.24.202.8395] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 06/02/2016] [Indexed: 11/16/2022] Open
Abstract
Les lymphangiomes kystiques sont des lésions congénitales bénignes prédominantes nettement au niveau de la région de la tête et du cou plus particulièrement dans le triangle cervical postérieur. Ces malformations des vaisseaux lymphatiques sont fréquemment diagnostiquées chez l'enfant. Nous rapportons le cas clinique d'un lymphangiome kystique du plancher buccal ayant survenu chez un adulte de 28 ans et qui s'est étendu progressivement vers la région sous mandibulaire gauche. La tumeur suspecté cliniquement a été bien exploré à la tomodensitométrie. Le traitement a consisté en une exérèse complète par voie endobuccale avec étude histologique qui a confirmé le diagnostic d'un lymphangiome kystique macroscopique. Le suivi à quatre ans n'a montré aucune récidive.
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Affiliation(s)
- Elboukhari Ali
- Service d'Otorhinolaryngologie et de Chirurgie Cervico-faciale, Hopital Militaire Moulay Ismail, Meknès, Maroc
| | - Nador Karim
- Service d'Otorhinolaryngologie et de Chirurgie Cervico-faciale, Hopital Militaire Moulay Ismail, Meknès, Maroc
| | - Attifi Hicham
- Service d'Otorhinolaryngologie et de Chirurgie Cervico-faciale, Hopital Militaire Moulay Ismail, Meknès, Maroc
| | - Zalagh Mohamed
- Service d'Otorhinolaryngologie et de Chirurgie Cervico-faciale, Hopital Militaire Moulay Ismail, Meknès, Maroc
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Lin FCF, Yang TL, Tung MC, Tsai SCS. Robot-assisted excision of cervical cystic hygroma through a retroauricular hairline approach: a case report. J Med Case Rep 2016; 10:154. [PMID: 27276912 PMCID: PMC4899928 DOI: 10.1186/s13256-016-0929-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 05/04/2016] [Indexed: 11/10/2022] Open
Abstract
Background Cystic hygroma is a rare benign abnormality of the lymphatic system generally occurring in young children less than 2 years old. The standard transcervical surgical treatment of cystic hygroma may often leave a permanent scar in the neck region. Case presentation We report a case of cystic hygroma in a 19-month-old Asian baby girl successfully treated with robot-assisted excision through a hairline neck-lift approach. We present the use of the Yang’s retractor as an instrumental advancement to this surgical approach. Conclusions Treatment options for cystic hygroma may be surgical or nonsurgical. We report a case of cystic hygroma in a 19-month-old child successfully treated with robot-assisted excision through a small concealed retroauricular hairline approach. This is the first report in the medical literature of treating cystic hygroma with a minimally invasive robot-assisted excision via a small, concealed, hairline incision. Electronic supplementary material The online version of this article (doi:10.1186/s13256-016-0929-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Frank Cheau-Feng Lin
- Department of Surgery, Chung Shan Medical University Hospital, Taichung, Taiwan, ROC
| | - Tsung-Lin Yang
- Department of Otolaryngology, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan, ROC
| | - Min-Che Tung
- Department of Surgery, Tungs' Taichung MetroHarbor Hospital, Taichung, Taiwan, ROC
| | - Stella Chin-Shaw Tsai
- Department of Otolaryngology, Tungs' Taichung MetroHarbor Hospital, 699, Sec.8, Taiwan Boulevard, Taichung, 43503, Taiwan, ROC.
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Gezdirici A, Ekiz A, Güleç EY, Kaya B, Sezer S, Atış Aydın A. How necessary is to analyze PTPN11 gene in fetuses with first trimester cystic hygroma and normal karyotype? J Matern Fetal Neonatal Med 2016; 30:938-941. [PMID: 27193571 DOI: 10.1080/14767058.2016.1191463] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Cystic hygroma (CH) is a vascular-lymphatic malformation and can occur either as an isolated finding or as a part of a syndrome. The incidence of CH is about 1:1000-1:6000 births. Ultrasonographic diagnosis of CH is usually obtained in the first trimester, and the lesion can appear in septated or non-septated forms. Increased nuchal translucency and CH have been associated with a wide range of structural and genetic abnormalities. Most of CHs are associated with a number of chromosomal abnormalities especially Trisomy 21, 13, 18 and Turner syndrome. Besides, the associations between CH and non-chromosomal syndromes were also reported and Noonan Syndrome (NS) is one of the leading causes. Approximately 50% of NS cases are caused by mutations in the PTPN11 gene. A novel PTPN11 mutation defined in two separate fetuses with CH and associated with NS phenotype is being reported here.
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Affiliation(s)
- Alper Gezdirici
- a Department of Medical Genetics , Kanuni Sultan Suleyman Training and Research Hospital , Istanbul , Turkey and
| | - Ali Ekiz
- b Department of Maternal Fetal Medicine , Kanuni Sultan Suleyman Training and Research Hospital , Istanbul , Turkey
| | - Elif Yılmaz Güleç
- a Department of Medical Genetics , Kanuni Sultan Suleyman Training and Research Hospital , Istanbul , Turkey and
| | - Başak Kaya
- b Department of Maternal Fetal Medicine , Kanuni Sultan Suleyman Training and Research Hospital , Istanbul , Turkey
| | - Salim Sezer
- b Department of Maternal Fetal Medicine , Kanuni Sultan Suleyman Training and Research Hospital , Istanbul , Turkey
| | - Alev Atış Aydın
- b Department of Maternal Fetal Medicine , Kanuni Sultan Suleyman Training and Research Hospital , Istanbul , Turkey
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Abstract
Cystic hygroma is a benign congenital malformation of the lymphatic system that occurs in infant or children younger than 2 years of age. Although cystic hygroma is well recognized in pediatric practice, it seldom presents de novo in adulthood. These are commonly present in head and neck but can be present anywhere. Cystic hygroma is very rare in adults, but it should be considered in the differential diagnosis of adult neck swellings. Patients presenting with a painless, soft, fluctuant, and enlarging neck mass should have a careful history and physical examination along with radiological imaging to assist with diagnosis. Surgical intervention is the treatment of choice for this rare condition. Here, we are reporting a case of cystic hygroma in a 32-year-old male patient in the neck region. The objectives of this case report are to discuss the clinical presentation, diagnosis, histopathological findings and management of this malformation.
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Affiliation(s)
- Sumit Bahl
- Department of Oral and Maxillofacial Pathology, K.M Shah Dental College, Sumandeep Vidyapeeth University, Vadodara, India
| | - Vandana Shah
- Department of Oral and Maxillofacial Pathology, K.M Shah Dental College, Sumandeep Vidyapeeth University, Vadodara, India
| | - Sonal Anchlia
- Department of Oral and Maxillofacial Surgery, Government Dental College and Hospital, Ahmedabad, Gujarat, India
| | - Siddharth Vyas
- Department of Oral and Maxillofacial Surgery, Government Dental College and Hospital, Ahmedabad, Gujarat, India
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Lisan Q, Villepelet A, Parodi M, Garabedian EN, Blouin MJ, Couloigner V, Leboulanger N. Value of radiofrequency ablation in the management of retropharyngeal lymphatic malformation. Int J Pediatr Otorhinolaryngol 2016; 83:37-40. [PMID: 26968050 DOI: 10.1016/j.ijporl.2016.01.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Revised: 01/11/2016] [Accepted: 01/15/2016] [Indexed: 11/26/2022]
Abstract
Lymphatic malformations are benign malformations frequently occurring in the head and neck. Retropharyngeal location is rare, can be life threating and its management is particularly challenging. Over a three-year period, three patients presented with symptomatic (dyspnea and/or dysphagia) retropharyngeal lymphatic malformation. All were treated using a radiofrequency ablation of lymphatic malformation through a trans-oral approach. No major complications occurred following the surgery. During the follow-up, no recurrence was noted and all patients were asymptomatic. Radiofrequency ablation in the management of retropharyngeal lymphatic malformations is a simple technique with very good results and allows a fast recovery with minimum morbidity and a short hospital stay.
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Affiliation(s)
- Quentin Lisan
- Department of Otolaryngology, Head and Neck Surgery, Necker Children's Hospital, 149, rue de Sèvres, 75015 Paris, France.
| | - Aude Villepelet
- Department of Otolaryngology, Head and Neck Surgery, Necker Children's Hospital, 149, rue de Sèvres, 75015 Paris, France
| | - Marine Parodi
- Department of Otolaryngology, Head and Neck Surgery, Necker Children's Hospital, 149, rue de Sèvres, 75015 Paris, France
| | - Eréa-Noël Garabedian
- Department of Otolaryngology, Head and Neck Surgery, Necker Children's Hospital, 149, rue de Sèvres, 75015 Paris, France
| | - Marie Julie Blouin
- Department of Otolaryngology, Head and Neck Surgery, Necker Children's Hospital, 149, rue de Sèvres, 75015 Paris, France
| | - Vincent Couloigner
- Department of Otolaryngology, Head and Neck Surgery, Necker Children's Hospital, 149, rue de Sèvres, 75015 Paris, France
| | - Nicolas Leboulanger
- Department of Otolaryngology, Head and Neck Surgery, Necker Children's Hospital, 149, rue de Sèvres, 75015 Paris, France
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Abstract
OBJECTIVE This is a systematic review of the literature describing doxycycline sclerotherapy (DS) to treat pediatric head and neck lymphatic malformations and examine patient factors associated with treatment success. DATA SOURCES PubMed, EMBASE, and Ovid. REVIEW METHODS A query of PubMed, EMBASE, and Ovid search engines (1995-2014) for studies examining outcomes for doxycycline sclerotherapy (DS) as primary treatment strategy for children with head and neck lymphatic malformations was undertaken. Successful outcome was defined as clinical resolution of symptoms or greater than 50% reduction in radiographic involvement. RESULTS Five studies met the inclusion criteria for review. All were retrospective case series reports with high risk of bias. The dose of doxycycline used in all but one of the studies was 10mg/mL, and the highest concentration administered was 20mg/mL. Thirty-eight children met the inclusion criteria for analysis. Thirty-two (84.2%) children were successfully treated with DS, with 23 (60.5%) utilizing only one treatment session. Average follow-up was 9.7months. Age, gender, de Serres stage 1, and type of lymphatic malformation were not related to successful treatment outcome (p=0.23, 1, 1, and 0.13, respectively). CONCLUSIONS DS is very effective for treatment of macrocystic and mixed head and neck lymphatic malformations in children. Overall success with DS treatment in children with lymphatic malformation of the head and neck was 84.2%. DS has distinct advantages over other sclerotherapy agents including that it is inexpensive and widely available, and has minimal side effects. No associated patient characteristics were found to predict improved success.
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Affiliation(s)
- Jeffrey Cheng
- Division of Pediatric Otolaryngology, Cohen Children's Medical Center, New Hyde Park, NY, USA; Department of Otolaryngology-Head and Neck Surgery, Hofstra North Shore-LIJ School of Medicine, Hempstead, NY, USA.
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Farnoosh S, Don D, Koempel J, Panossian A, Anselmo D, Stanley P. Efficacy of doxycycline and sodium tetradecyl sulfate sclerotherapy in pediatric head and neck lymphatic malformations. Int J Pediatr Otorhinolaryngol 2015; 79:883-887. [PMID: 25887132 DOI: 10.1016/j.ijporl.2015.03.024] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Revised: 03/24/2015] [Accepted: 03/26/2015] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Lymphatic malformations are congenital vascular anomalies that occur from abnormal development of the lymphatic channels. Studies have shown that sclerotherapy can be a reliable alternative to surgery. The purpose of this retrospective study is to evaluate the safety and efficacy of percutaneous sclerotherapy with doxycycline and 3% Sotradecol as primary treatment for pediatric head and neck LMs, and to assess outcomes based on lesion classification, location and sclerosant used. STUDY DESIGN This study was a single center, retrospective, case series study. MATERIALS AND METHODS The medical records of 38 children who underwent percutaneous sclerotherapy of LMs in the head and neck region at our tertiary care center between 1/1/2006 and 1/31/2011 were reviewed. A mean average of 2.9 (range 1-10) sclerotherapy sessions per child were performed. LMs involved primarily the face (61.3%), posterior neck (48.4%), submental area (45.2%), and anterior neck (35.5%). RESULTS Twenty-nine subjects had adequate follow-up data, with 51.7% demonstrating complete resolution, 27.6% moderate improvement, and 20.7% no response. There was no significant difference in the outcome based on the sclerosant agent used or location of the lesion. Lesion type did affect outcome and macrocystic lesions were found to have a significantly higher resolution rate (95.2%) than microcystic or mixed lesions (p < 0.05). The total number of complications was similar between agents and all were minor. CONCLUSION Our results indicate that percutaneous therapy with doxycycline and Sotradecol is safe and effective for children with LMs of the head and neck. Better outcomes were observed with macrocystic LMs. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Soroush Farnoosh
- University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY, USA.
| | - Debra Don
- Children's Hospital at Los Angeles, Department of Otolaryngology - Head and Neck Surgery, Los Angeles, CA, USA
| | - Jeffery Koempel
- Children's Hospital at Los Angeles, Department of Otolaryngology - Head and Neck Surgery, Los Angeles, CA, USA
| | - Andre Panossian
- Children's Hospital at Los Angeles, Department of Plastic Surgery, Los Angeles, CA, USA
| | - Dean Anselmo
- Children's Hospital at Los Angeles, Department of Plastic Surgery, Los Angeles, CA, USA
| | - Philip Stanley
- Children's Hospital at Los Angeles, Department of Radiology, Los Angeles, CA, USA
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Abstract
A 58-year-old man presented with sudden-onset axillary swelling. Workup revealed the mass to be a cystic hygroma of adult-onset. Surgical resection was preferred over sclerotherapy. There is scant reporting of this pediatric mass in adults.
INTRODUCTION Lymphatic malformations are commonly recognized as relatively benign congenital masses affecting infants and children in the perinatal period. In children, these masses are most commonly found in the neck, and are occasionally seen in other areas of the body. PRESENTATION OF CASE A 58-year-old man presented with an acute axillary swelling measuring approximately 20 cm in length, 12 cm in AP width, and 7 cm in depth. Biopsy and cytology analysis demonstrated this mass to be a cystic hygroma of adult-onset. DISCUSSION Given its multi-loculated nature and size, it was surgically excised and one year later the patient is without evidence of recurrence. CONCLUSION As the incidence of adult-onset cystic hygroma is rare, the nature and reporting of their management is limited. This case report contributes to the body of literature which serves to elucidate the optimal management of this perinatal condition in adults.
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Abstract
Vascular malformations consist of a spectrum of lesions involving all parts of the body. They have different terminologies like vascular tumors, vascular malformations, vascular anomalies, and so on, which create a lot of confusion in understanding and treating these pathologies. Of late, classification on the basis of cellular kinetics and clinical behavior has been devised. Hemangioma is the most common vascular tumor. Vascular malformations are of either lymphatic or capillary and venous origin. Sometimes they are of a mixed origin. Lymphangiomas are common in the face and neck area. They are also not unusual in the mediastinum. We present a case where a huge lymphangioma occupied the right supraclavicular area of the neck, extending to nearly the entire right thoracic cavity, compressing the whole lung. The patient had occasional symptoms of cough. Ultrasonography (US) and computed tomography (CT) images clearly described the lesion as cystic, occupying both the supraclavicular and thoracic cavity compressing the lung parenchyma. Surgical excision was planned and we approached the lesion via both cervical and thoracotomy incisions. Complete excision was done, and the lung expended fully after the surgery.
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Affiliation(s)
- Shailendra Kumar
- Department of Surgery, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Sanjeev Kumar
- Department of Surgery, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Surender Kumar
- Department of Surgery, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Ved Prakash
- Department of Pulmonary Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Vijay Kumar
- Department of Plastic Surgery, King George's Medical University, Lucknow, Uttar Pradesh, India
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Torres-Palomino G, Juárez-Domínguez G, Guerrero-Hernández M, Méndez-Sánchez L. [Airway obstruction due to cystic hygroma in a newborn]. Bol Med Hosp Infant Mex 2014; 71:233-237. [PMID: 29421256 DOI: 10.1016/j.bmhimx.2014.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 07/29/2014] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Cystic hygroma is a diffuse dilatation of the lymphatic system, which can be prenatally diagnosed by ultrasound. The incidence is 1/6,000 live births and 1/750 spontaneous abortions. This malformation can occur at the cervical level located in the inferior lateral part of the neck where it appears with large single or multilocular cavities. It is generally caused by a lack of connection with jugular lymphatic channels or with the venous drainage system lymph sacs. CASE REPORT In order to emphasize these diseases and non-surgical treatment options, we present a patient with a cervical cystic hygroma that compromises the airway and digestive tract due to tumor extension and treatment with pure ethanol with clinical improvement. CONCLUSIONS Depending on the characteristics of the lesion, treatment options are surgery, pharmacological or mixed. When the extension involves vital organs, the best option is to reduce the size of the lesion and the compromise of the adjacent organ. This is done by sclerotherapy and, if necessary, surgery.
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Affiliation(s)
| | | | | | - Lucía Méndez-Sánchez
- Maestra en Ciencias de la Salud, Campo Epidemiología Clínica, Área de Investigación Epidemiología Clínica, Hospital Infantil de México Federico Gómez, México D.F., México.
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45
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Abstract
Lymphangiomas are benign lesions with a marked predilection for the head and neck region. Giant lymphangiomas of head and neck may occur and they may present with life threatening complications. The author is presenting here, a three month-old boy who presented with a giant cystic lymphangioma on left side of neck, which extended to the head as well. His clinical diagnosis of a cystic lymphangioma was confirmed on a Ultrasonography (USG) examination. Complete surgical excision of the lesion was achieved, without damaging any vital structures. His post-operative recovery was uneventful. A follow-up at two months after his surgery showed a cosmetically acceptable scar and no recurrence was noted.
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Affiliation(s)
- Rajendra K Ghritlaharey
- Associate Professor, Department of Paediatric Surgery, Gandhi Medical College and Associated, Kamla Nehru and Hamidia Hospitals , Bhopal, Madhya Pradesh-462 001, India
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46
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Abstract
Cystic hygroma or cystic lymphangioma is a congenital malformation of the lymphatic system that manifests itself as a soft, benign, and painless mass. It is widely accepted that they arise from the remnants of embryonic lymphatic tissue which retains the potential for proliferation. They grow in the fashion of sprouting and are capable of transgressing anatomical boundaries. They can occur almost at any anatomical site. However, 75-80% cystic hygromas are located in the head and neck region. In the neck, they are typically located within the posterior cervical triangle. The majority of cases (80-90%) are diagnosed under the age of two. We present a case of cervical cystic hygroma in a 6 year old male child which was surgically treated.
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Affiliation(s)
- Yadavalli Guruprasad
- Department of Oral & Maxillofacial Surgery, AME'S Dental College Hospital & Research Centre, Raichur, 584103 Karnataka India
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Lajeunesse C, Stadler A, Trombert B, Varlet MN, Patural H, Prieur F, Chêne G. [First-trimester cystic hygroma: prenatal diagnosis and fetal outcome]. ACTA ACUST UNITED AC 2013; 43:455-62. [PMID: 23747217 DOI: 10.1016/j.jgyn.2013.04.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Revised: 04/13/2013] [Accepted: 04/26/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To describe the ultrasonographic (US) and fetal karyotyping data of fetuses with cystic hygroma diagnosed in the first trimester. PATIENTS & METHODS Maternal and fetal data of 69 consecutive fetal cystic hygroma were analysed between 2002 and 2009. RESULTS The mean size of the cystic hygroma was 6.3 mm ± 2.4 mm. US abnormalities were present in 54% of cases (37/69) (essentially hydrops fetalis in 45%), with an unfavourable prognosis (P=0.006). Chromosomal abnormalities were present in 53% of cases (36/68) (including 44% of Down syndrome). The rate of unfavourable outcome of pregnancy was 71% of cases (49/69) and was associated with the oldest mothers (P=0.011). In the chromosomally normal pregnancies, there were 59% (19/32) fetus with no apparently abnormalities. Among these 19 children, 13 have been followed up until an average age of 5 years and a half, the infant development was strictly normal. DISCUSSION AND CONCLUSION The current results suggest to look for the poor prognosis data: nuchal thickness superior to 6 to 6,5 mm, presence of a hydrops fetalis and/or US abnormalities, fetal karyotyping and/or US evolution of cystic hygroma.
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Affiliation(s)
- C Lajeunesse
- Département de gynécologie-obstétrique & médecine de la reproduction, université de Saint-Étienne, Jean-Monnet, CHU de Saint-Étienne, avenue Albert-Raimond, 42023 Saint-Étienne, France
| | - A Stadler
- Département de gynécologie-obstétrique & médecine de la reproduction, université de Saint-Étienne, Jean-Monnet, CHU de Saint-Étienne, avenue Albert-Raimond, 42023 Saint-Étienne, France
| | - B Trombert
- Département de santé publique, université de Saint-Étienne, Jean-Monnet, CHU de Saint-Étienne, 42023 Saint-Étienne, France
| | - M N Varlet
- Département de gynécologie-obstétrique & médecine de la reproduction, université de Saint-Étienne, Jean-Monnet, CHU de Saint-Étienne, avenue Albert-Raimond, 42023 Saint-Étienne, France
| | - H Patural
- Département de pédiatrie, université de Saint-Étienne, Jean-Monnet, CHU de Saint-Étienne, 42023 Saint-Étienne, France
| | - F Prieur
- Département de génétique, université de Saint-Étienne, Jean-Monnet, CHU de Saint-Étienne, 42023 Saint-Étienne, France
| | - G Chêne
- Département de gynécologie-obstétrique & médecine de la reproduction, université de Saint-Étienne, Jean-Monnet, CHU de Saint-Étienne, avenue Albert-Raimond, 42023 Saint-Étienne, France.
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Abstract
Respiratory distress is one of the commonest cause of admission into a Neonatal Intensive Care Unit, be it surgical or medical in nature. Adequate and prompt resuscitation as well as intubation can be life saving. Emergency or early tracheostomy may be necessary if airway intervention is needed. The authors present the case of a term neonate who was born with a large cervical cystic hygroma causing compression of the airway, together with a concurrent grade III subglottic stenosis, in respiratory distress within few minutes of life. Nine months post tracheostomy and sclero-therapy treatment twice, the child shows marked improvement. The succesful management of this unusual case of severe extrinsic compression with concurrent internal airway obstruction is presented.
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Affiliation(s)
- Anusha Balasubramanian
- Department of Otorhinolaryngology-Head & Neck Surgery, School of Medical Sciences, University Sains Malaysia, Kota Bharu, Kelantan, Malaysia
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49
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Abstract
Benign cystic lesions such as cystic hygroma commonly manifest as progressively increasing swelling in the neck with or without compression effects. Rarely, they present with sudden respiratory distress in instances such as infection or haematoma resulting in a sudden increase in the size of the tumour. We present a seven month old child with sudden onset respiratory distress without any obvious neck swelling. The chest X ray findings correlated with the history and were suggestive of right upper lobe pneumonia that leads to a wrong diagnosis of aspiration pneumonia. However, presence of a deviated trachea in the neck raised a suspicion of possible mass. Computed tomogram showed a large cystic mass in the right upper mediastinum with tracheal collapse. We caution intensivists and paediatricians that sudden respiratory distress in infants in the absence of obvious neck swelling does not rule out possibility of intrathoracic tumour.
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Affiliation(s)
- Umesh Goneppanavar
- Department of Anaesthesiology, Kasturba Medical College, Manipal, Karnataka, India
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50
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Hata T, Hanaoka U, Tenkumo C, Ito M, Uketa E, Mori N, Kanenishi K, Tanaka H, Ishimura M. Three-dimensional HDlive rendering image of cystic hygroma. J Med Ultrason (2001) 2013; 40:297-9. [PMID: 27277254 DOI: 10.1007/s10396-012-0419-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2012] [Accepted: 10/25/2012] [Indexed: 10/27/2022]
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