Case report of a chest wall cystic hygroma in a teenager

Cystic hygroma or cystic lymphangioma is a congenital malformation of lymphatic origin. Their occurrence on the chest wall is very rare, and they progressively grow with age infiltrating into the local tissues, around muscle fibers and nerves, making them difficult and hazardous to remove. There are various treatment modalities of such lesion. Based on the literature surgical excision is the preferred treatment of choice in cystic hygroma because it gives a better cure rate compared to other modalities. We report a case successful excision of anterolateral chest wall cystic hygroma in a teenager in Hospital Serdang.

Aggressive giant cystic lymphatic malformation in a newborn

Lymphatic malformations are uncommon, benign and congenital malformations of the lymphatic system exhibiting lack of development of communication between the lymphatic and venous circulation. We report the unusual case of rapidly expanding giant lymphatic malformation of the torso, bilateral axillae and left upper extremity of a newborn. As the first-line treatment, aspiration and sclerotherapy with bleomycin were performed. The sclerotherapy failed to cause regression of the mass, and rapid expansion of the malformation necessitated surgery. Partial resection of the mass was performed. Clinical symptoms of respiratory distress resolved in the early postoperative period, and the patient became hemodynamically stable. However, intrathoracic invasion of the mass developed, leading to restriction of thoracic expansion, ending in death. In conclusion, surgical treatment of giant lymphatic malformations remains challenging.

Anesthetic management of a patient undergoing an ex utero intrapartum treatment (EXIT) procedure: a case report

The ex utero intrapartum treatment (EXIT) procedure involves partial delivery of the fetus with the fetal-placental circulation maintained. This allows for management of the obstructed fetal airway via direct laryngoscopy, bronchoscopy, tracheostomy, or surgical intervention. These complex and often challenging procedures have been performed about 100 times in the United States to date. Recent advances in prenatal diagnosis of fetal congenital malformations, in particular, abnormalities involving the fetal airway, have allowed for the development of the EXIT strategy to convert potentially catastrophic situations during fetal delivery to a controlled environment. Indications for the EXIT procedure have expanded to a variety of congenital abnormalities, including fetal neck masses, lung or mediastinal tumors, congenital high airway obstruction syndrome, conjoined twin separation, and acute respiratory distress syndrome requiring transitioning from EXIT to extracorporeal membrane oxygen transitioning. Various considerations must be managed by the anesthesia provider during the EXIT procedure to ensure positive maternal and fetal outcomes. Careful attention to achieving adequate uterine relaxation, maintaining maternal blood pressure, avoiding placental abruption, prioritizing fetal airway establishment, and providing return of uterine tone when indicated are examples of these considerations. In this case report, a parturient presented for an EXIT procedure secondary to fetal cystic hygroma.

Congenital cystic lesions of the head and neck

This article presents clinical characteristics and radiologic features of congenital cervical cystic masses, among them thyroglossal duct cysts, cystic hygromas, branchial cleft cysts, and the some of the rare congenital cysts, such as thymic and cervical bronchogenic cysts. The imaging options and the value of each for particular masses, as well as present clinical and radiologic images for each, are discussed.

A holistic approach to a rare pathology

A case of cystic hygroma (CH), a congenital lymph-filled multicystic hamartoma of the neck, with a holistic approach to patient management is presented. The stigma of the CH imposed by attending physicians, dentists, parents, teachers and peers affected the psychological development of this patient since her diagnosis in childhood. Although surgery relieves the threat of airway obstruction and may improve the esthetic appearance of the CH, the patient may be isolated and traumatized by the ignorance and superstitions of the individuals she encounters on a daily basis.

Fetal mediastinal lymphangiomas

OBJECTIVE

The purpose of this series was to evaluate the prenatal sonographic findings and postnatal outcomes in 2 fetuses with mediastinal lymphangiomas.

METHODS

The fetal images were compared with postnatal imaging and surgical findings.

RESULTS

The 2 fetuses had anechoic mediastinal masses at 25 and 22 weeks, which proved to be lymphangiomas. One, located in the anterior mediastinum, also enveloped the superior vena cava, brachial plexus, phrenic nerve, larynx, and lower parts of the neck vessels and extended into the subcutaneous tissues of the anterior chest wall through an intercostal space. In the second patient, the lymphangioma appeared to be a unilocular cyst, which involved the deep tissues of the neck as well as the posterior and lateral mediastinum. Both required 2 interventions after birth.

CONCLUSIONS

Fetal mediastinal lymphangiomas appeared anechoic and sent extensions into the neck in the first case, around the superior vena cava, through the intercostal spaces to the skin, and around the brachial plexus in the second case, and deviated the trachea in both cases. In 1 case, there was also ectasia of the superior vena cava. This ability to entwine around vital structures can make it difficult to determine the extent of involvement on antenatal sonography and to remove lymphangiomas completely, and recurrence is common.

[A gigant cystic lymphangioma of the neck]

The cystic lymphangiomas are congenital pathology of lymphatic system which concern 90% of children population, adults suffer very seldom. The authors present the case of giant cystic lymphangioma of the neck in the 37-year-old man with symptoms of tumor of the neck. The USG, CT and MRI confirm the presence of polycystic tumour with feature of bleeding into one of the cavities. Surgical treatment was performed. The patient is controlled without any relaps. The authors remind this rare pathology that should be considered in case of neck tumours.

Three fetuses karyotyped as Turner syndrome with cystic hygroma developing hydrops: prognosis and outcome

INTRODUCTION

We present three cases of fetuses diagnosed as Turner syndrome with cystic hygroma (CH) developing hydrops to discuss the prenatal diagnostic and prognostic criteria of CH in ultrasound and outcome of the fetuses.

CASES

The first case was 30-year-old pregnant woman with a nuchal translucency measurement of 8 mm at 12 weeks' gestation. Serial ultrasound examinations revealed non-septated cystic hygroma and hydrops. The pregnancy was terminated at the 18th week of gestation. Diagnosis of CH was made at 14 and 15 weeks of gestation in case 2 and case 3, respectively. Ultrasound revealed large cystic septated sacs in the nuchal area combined with serosal fluid collection and cutaneous edema. Spontaneous fetal demise occured at 21 and 16 weeks of gestation in cases 2 and 3, respectively. All fetuses were diagnosed as Turner syndrome.

Bleomycin sclerotherapy in congenital lymphatic and vascular malformations of head and neck

Bleomycin is an established antineoplastic drug, but recently some attempts were made to inject it locally as a sclerosing agent in cases of congenital lymphatic malformations. We present the outcome of this treatment modality tried on 10 paediatric cases of whom 9 had such malformation in the cervical region and one in the parotid region. Seven of these cases had congenital lymphatic malformation while three had haemodynamically less active congenital vascular malformation. All these children were subjected to percutaneous intralesional administration of bleomycin. The size of swelling reduced by 50% or more in seven patients out of which three showed complete or near complete response. There were no major deleterious side effects.

[Lymphangioma--the care and treatment in neonates and babies--Part two]

Lymphangioma or cystic hygroma (CH) in neonates is a rare congenital malformation (1:12000 live births), its etiology is unknown. It often occurs in head and neck region. Initial diagnosis based on physical examination is next to be confirmed by MR and CT imaging. The authors presented with diagnosis and treatment of two babies with congenital cystic hygromas of face, neck and thorax. Although in cystic hygroma the surgery still remains as the treatment of choice, the OK-432 sclerotherapy seems to be very promising in huge CH lesions.

Lymphatic malformation of the parapharyngeal space

Lymphatic malformations are rare benign congenital lesions. A 28-month-old girl presented with a parapharyngeal lymphatic malformation. A cystic lesion had been diagnosed at 18 weeks' gestation by ultrasonography and she had been followed up conservatively until her referral to our department. We used a transcervical approach to excise the parapharyngeal lesion and 1 year later, there was no sign of recurrence.

Pathological analysis of congenital cervical cysts in children: 20 years of experience at Chang Gung Memorial Hospital

BACKGROUND

Congenital cervical cysts are frequently encountered in pediatric populations, and constitute one of the most intriguing areas of pediatric pathology. This report analyzes cervical cysts in Taiwanese children diagnosed at Chang Gung Memorial Hospital (CGMH) over the past 20 years. The pathologic and clinical findings are reviewed.

METHODS

Files on 331 patients under the age of 18 years, with a diagnosis of congenital cervical cyst at CGMH from January 1, 1983 to June 30, 2002, were retrieved from the Department of Pathology. There were 204 boys and 127 girls. We reviewed the histology of all cases and correlated it with clinical information in the medical records.

RESULTS

Thyroglossal duct cysts, the most common congenital neck cyst, accounted for 54.68% of all cases, followed by cystic hygromas (25.08%), branchial cleft cysts (16.31%), bronchogenic cysts (0.91%), and thymic cysts (0.30%). Nine cases (2.72%) remained unclassified.

CONCLUSIONS

This is the largest series regarding pediatric cervical cysts in the literature to date. Thyroglossal duct cysts were the most common congenital cervical cyst encountered. Our experience indicates that each type of cyst has its unique location in the neck and is highly associated with its embryonic origin. Complete and precise clinical information is a prerequisite in order for pathologists to make accurate diagnoses of congenital cervical cysts.

EXIT procedure: a case report

The EXIT (Ex-Utero Intrapartum Treatment) procedure is an extremely valuable tool in providing time to secure the airway in infants with large fetal neck masses and abnormalities of the upper airway which impede resuscitation. The fetus is partially delivered while maintaining utero-placental-fetal circulation. We report the use of this technique in a case of huge cystic hygromas of the neck and chest due to a nuchal bleb-lethal dysplasia. Although severe pulmonary hypoplasia precluded an optimal outcome, this report shows that this procedure is technically feasible. We believe this to be the first case performed and reported in Louisiana.

Prenatal diagnosis from cystic hygroma fluid: the value of fluorescence in situ hybridization

OBJECTIVE

We sought to determine the optimal approach to the prenatal chromosome analysis of cystic hygroma fluid using traditional cytogenetic analysis and fluorescence in situ hybridization.

STUDY DESIGN

A retrospective evaluation of our experience with traditional cytogenetic and fluorescence in situ hybridization analysis on cystic hygroma fluid was performed through a systematic review of the Genzyme Genetics database from January 1995 to July 2000. Information on gestational age, sample volume, clinical ultrasound findings (including fetal viability), cytogenetic results, fluorescence in situ hybridization results, and turn-around-time were queried.

RESULTS

Eighty-three specimens were included in the investigation. The mean gestational age was 18.1 weeks (range, 13-27 weeks), and the mean sample volume was 20.7 mL (range, 0.1-101 mL). Of the 72 samples in which > 5 mL of cystic hygroma fluid was available, the success rate for cytogenetic analysis was 76% (55/72 samples). In 11 specimens of < or = 5 mL of cystic hygroma fluid, cytogenetic analysis was successful in only 1 case (9%). Fluorescence in situ hybridization was attempted on 23 samples, 18 of which were successful (78%), including 6 of 9 cases of cell culture failure (67%). Both traditional cytogenetic analysis and fluorescence in situ hybridization were performed in 21 instances when a sample of > 5 mL was available. A successful result was obtained by either cytogenetic testing or fluorescence in situ hybridization analysis or both in 19 of 21 of these cases (90%). Samples of > 5 mL from viable fetuses had a higher cytogenetic success rate (80%) and fluorescence in situ hybridization success rate (89%) than samples from fetuses with intrauterine death (38% and 50% cytogenetic and fluorescence in situ hybridization success rates, respectively.) The mean turn-around time was 8.2 days (range, 4-17 days). Results were available in < or = 12 days in 91% of cases. There was a 91% aneuploidy rate identified, with 45,X occurring in 86% of the samples.

CONCLUSION

We conclude that the optimal approach for the prenatal diagnosis of chromosome abnormalities from cystic hygroma samples is to perform both traditional cytogenetic studies and interphase prenatal fluorescence in situ hybridization evaluation for the most common aneuploidies that involve chromosomes 13, 18, 21, X, and Y. With this combined approach, our data indicate that, in viable pregnancies with a fluid sample of >5 mL, a 90% diagnostic success rate can be achieved.

Concurrent cysts of the mediastinum, pleura and neck

A 14-year-old male was found to have a mediastinal mass on chest radiograph. Chest computed tomography scans showed a cystic lesion behind the left main bronchus. Magnetic resonance imaging revealed additional cystic lesions in the left chest and root of the neck. He underwent excision of mediastinal mass and a pleural cyst. The neck lesion was presumed to be a cystic hygroma. Histological examination of the two lesions resected showed them to be a foregut cyst and a benign mesothelial cyst. We know of no other report of concurrent multicystic lesions in the chest and neck and hypothesize that these cysts may have a common embryonic origin.

Increased nuchal translucency, hydrops fetalis or hygroma colli. A new test strategy for early fetal aneuploidy detection

OBJECTIVES

Nuchal translucency measurement of 3 mm or more (> or = 95th centile for gestation age), hydrops fetalis or hygroma colli between the 11th and 14th weeks of gestation is associated with a higher risk of fetal Down syndrome and other aneuploidies. So far, chromosome preparation of chorionic villi samplings (CVS) after short-term (or direct) culture is the only valid, reliable and rapid method of choice for the early detection of chromosomal aberrations. However, because of the placental mosaicisms detected after short-term culture, CVS has to be confirmed by a second method. Moreover, short-term villi preparation does not always provide a sufficient quantity and quality of metaphases to enable cytogenetic analysis. Unfortunately, a predicative cytogenetic result will be available only after long-term cultivation (usually after 1-2 weeks). An alternative rapid method, inexpensive and suitable for diagnosing autosomal trisomies, is the quantitative fluorescence polymerase reaction (QF-PCR) using different polymorphic small tandem repeats (STRs) on CVS-DNA. Therefore, it was the aim of the study to evaluate whether a new CVS test strategy could be employed in early pregnancies at high risk after the rapid detection of fetal chromosomal abnormalities by QF-PCR for chromosomes 13, 18 or 21 and sexing in conjunction with short-term chromosome analysis.

MATERIALS

Nineteen CVS were chosen for QF-PCR detection of trisomy 21, 18 or 13 after an increased nuchal translucency measurement (> or = 95th centile for gestation age), a hydrops fetalis or a hygroma colli. The amelogenin locus of chromosomes X and Y (AMXY) were used for sexing. The QF-PCR results were compared with routine karyotyping after short- and/or long-term cultivation of CVS cells.

RESULTS

An informative result was demonstrated in all analysed specimens. Nine CVS were diagnosed as a QF-PCR trisomy either for chromosome 21, 18 and 13. The pathological samples also included 4 cases of mosaicism where the normal cell line was not identified by QF-PCR. In 1 additional case with a normal QF-PCR result, short-term CVS chromosome analysis showed a mosaic trisomy 13, whereas longterm CVS culture revealed a normal karyotype. The malformed aborted fetus showed no clinical signs of trisomy 13, confirming the normal results obtained by QF-PCR and long-term CVS chromosome analysis. One pregnancy with a Turner syndrome was not identified by molecular analysis.

CONCLUSIONS

This study showed that all early pregnancies with a clinically relevant autosomal trisomy could be detected prenatally in routine practice by QF-PCR. The combined use of both rapid methods - QF-PCR and short-term chromosome analysis - optimise the results by minimising the possibility of false-positive or false-negative findings. We believe that after verification of a pathological result obtained by two independent methods (QF-PCR and short-term CVS chromosome analysis), long-term villi cultivation is no longer necessary. However, in all cases with discrepancies, especially in samples with mosaic findings at short-term CVS cultivation, further studies are still necessary.

Cystic lymphangioma: its orofacial manifestations

A patient age five years, nine months with cystic lymphangioma was studied to determine the causes of malocclusion and the optimum time for its treatment. The main findings were unilateral anterior and posterior crossbite and displacement of the mandibular midline due to maxillary deformity and mandibular rotation. The force of the cystic lymphangioma mass caused deformity of the maxilla and rotation of the mandible. The patient had no functional impairment of speech or mastication. A decision was made to defer treatment of malocclusion until complete surgical excision of the cystic lymphangioma can be undertaken, thereby minimizing the chance of malocclusion re-occurrence.

A huge cystic hygroma of the neck associated with intraventricular haemorrhage in a term neonate

We report on a female term neonate who presented with a huge cystic hygroma of the right neck associated with intraventricular haemorrhage as demonstrated by computerized tomography and magnetic resonance imaging studies. She underwent extraventricular drainage and excision of the neck mass with stable postoperative condition. Psychomotor retardation was found thereafter. To our knowledge, the association of a large cystic hygroma of the neck with intracranial haemorrhage has not been reported previously. The possible mechanism of the occurrence of the haemorrhage is discussed.

[Cystic lymphangioma of the neck and mediastinum: are there acquired forms? Report of 37 cases]

BACKGROUND

In 9 out of 10 cases, lymphangiomas are observed during the first years of life, generally located in the neck. Rare lymphangiomas have been reported in adults, usually in an intrathoracic localization, raising the hypothesis of an acquired origin.

PATIENTS AND METHODS

A retrospective analysis of patients undergoing surgery for lymphanioma of the neck or mediastinum was conducted. Pathology reports, clinical data and medical imaging (CT) were reviewed and operative and post-operative findings were analyzed in order to determine whether the cases could be divided into congenital and non-congenital forms.

RESULTS

Data were obtained on 37 patients (23 men and 14 women, mean age 45 years, range 8-77). Four lesions (11%) were located in the neck: 3 in children and one in an elderly subject (77 yrs). Thirty-three tumors (89%) were located in the mediastinum. In 5 cases, the tumor was located in the phrenic nodes of the anterior mediastinum. These lymphangiomas occurred in young adults, had a CT density less than liquid with enhancement after contrast injection, and had a malformative vascular component proven anatomically and histologically (hemolymphangioma). These elements favored a congenital orgin. In 28 cases (76.6%) the tumor involved nodes in the posterior or middle mediastinum. They occurred in older adults and were purely liquid with no vascular component. These lymphangiomas were undoubtedly acquired.

CONCLUSION

In children, adolescents and young adults, lymphagiomas are found in the neck or anterior mediastinum and have a tissular component. These tumors should be considered as congenital lymphangiomas. In older adults, lymphangiomas are found in the posterior or middle mediastinum and are purely liquid cysts suggesting an acquired origin.

Cystic lymphangioma of the scrotum

A 7-year-old boy who presented with a painful left hemiscrotal mass was diagnosed with acquired lymphangioma of the scrotum. Chronic friction from a cast for Perthes' disease might have been the cause of sudden enlargement of a congenital lymphangioma of the scrotum. Magnetic resonance imaging (MRI) was useful for preoperative diagnosis and determining the extent of the scrotal lesions. Total excision of the mass leaving the overlying skin was successfully performed. The clinical significance of MRI for preoperative diagnosis and planning surgical resection of this lesion is discussed.

[Congenital cervical deformities]

The paper deals with the survey of 66 congenital neck malformations (27 thyroglossal cysts and 32 branchial plus 7 lymphatic anomalies) surgically treated in the last 5 years term. Thyroglossal cysts presented in children and young people, in the middle line, and 92.6% of them were infrahyoid. Recidivation appeared in 7.4% of all cases, always in connection with previous infections. Branchial malformations presented on the neck's side of middle age persons were related to the 2nd. cleft (97%). Lymphatic anomalies presented in children under 3 years, in these instances the dissection sheaths were not spared and the neighboring structures altered.

Unusual autosomal recessive lymphatic anomalies in two unrelated Amish families

We report on two unrelated Amish families with familial occurrence of unusual lymphatic anomalies. The first family had two children, a boy and a girl, with congenital chylothorax both of whom died as a consequence of this condition (one prenatally and one neonatally). The second family has two brothers with isolated cystic hygroma. Neither family has any other individuals affected with any type of lymphatic anomaly. Differential diagnosis and presumed autosomal recessive inheritance pattern will be discussed. Familial cystic hygroma not associated with hydrops fetalis and neonatal death has not been reported previously.

Cystic hygromas of the head and neck

Cystic hygroma is a congenital lymphatic malformation with a predilection for the head and neck and that usually presents in the pediatric population. This is a benign lesion but is often challenging to deal with. This paper reviews some of the characteristic features of this lesion including its presentation, pathophysiology, evaluation, and treatment.

Developmental analysis of cardiovascular system of 45,X fetuses with cystic hygroma

There have been few pathological investigations of 45,X embryos and fetuses from a developmental point of view. Since most 45,X embryos and fetuses are lost prenatally, it is important to investigate them morphologically in order to elucidate the pathogenesis of the abnormalities. In this study, 13 45,X fetuses with cervical cystic hygroma were examined between 12 and 23 weeks of pregnancy. Every case had a hypoplastic thymus. The aortic valve was bicuspid in 11 cases and unicuspid in 2 cases. The aortic arch showed tubular hypoplasia between the left carotid artery and the left subclavian artery in 12 cases and type B interruption in one case. Smooth muscle cells and elastic fibers were reduced in number in the hypoplastic aortic arch. These results suggest hypoplastic development of the fourth branchial arch. Combined abnormalities between the aortic arch and aortic valve are not infrequently observed in DiGeorge anomaly. A similar developmental mechanism apparently underlies the pathogenesis of 45,X embryos. Possible genes causing the abnormalities are discussed.

The surgical management of giant cervicofacial lymphatic malformations

Giant cervicofacial lymphatic malformation, a potentially life-threatening congenital malformation, historically has been removed in staged resections. However, complete surgical extirpation is desirable and can be achieved with the aid of a multidisciplinary team. The authors present the case of a 12-year-old girl who had an extensively enlarged cervicofacial lymphatic malformation. Effective treatment involved aggressive surgical excision, facilitated by mandibular osteotomies to provide access to the floor of the mouth, the tongue, and the pharyngeal wall. In addition, total removal of involved facial and neck skin was performed. The remaining soft tissue defect was reconstructed primarily with an abdominal musculocutaneous free flap. In the 5 years since the procedure, there has been no recurrence. Based on this experience, excision of involved skin and mandibular access osteotomies are important techniques to help completely remove cervicofacial lymphatic malformations with oral involvement, thus potentially reducing the number of recurrences. In addition, these cases require the best efforts of a multidisciplinary team to achieve a successful result so that complete and radical excision can be performed with the hope of avoiding the pitfalls of multiple resections.

[Therapy of cystic lymphangioma in childhood. Report of 4 cases with manifestations in the area of the head-neck]

BACKGROUND

Lymphangiomas are localized in the head and neck area in about 75% of cases. About 75% of these cases are children less than one year old. Treating lymphangiomas with installation therapy to obliterate the cysts has been discussed, but surgery remains the treatment of choice.

PATIENTS

Two lymphangiomas in newborns required resection due to the size of the lesions. The surgery involved monitoring of the facial and hypoglossal nerves. A third child had a large lesion with infiltration into the supraglottic space and the tongue requiring a tracheotomy. In a four-and-one-half-year-old child, a parapharyngeal lymphangioma caused stridor and had to be incised before it could be completely excised through an intraoral and extraoral approach.

RESULTS

Lymphangiomas can be excised safely even in newborns.

CONCLUSIONS

The use of neurologic monitoring is recommended for surgery of lymphangiomas in children since these lesions conceal neurovascular structures making them difficult to identify.

Congenital fibrosarcoma masquerading as lymphatic malformation: report of two cases

Two infants presented with a congenital cervicothoracic mass; both were initially diagnosed as having lymphatic malformation. A biopsy specimen for one child and excision for the other showed that both lesions were congenital fibrosarcomas. Postoperative chemotherapy was administered to both children. One died within 6 months of incisional biopsy from widespread metastatic disease; the other is still being treated. Congenital fibrosarcoma can be confused in its clinical presentation, radiographic findings, and histopathology with lymphatic malformation (cystic hygroma).

Intrathoracic extra-mediastinal cystic hygroma in infancy

An infant with intrathoracic extra-mediastinal cystic hygroma is described. Fluid collection within the fetal chest was noted on routine antenatal ultrasound scan and this was subsequently drained. Postnatally, echocardiogram and thoracic CT scan demonstrated a cystic space between the pericardium and right mediastinal pleura. Thoracotomy performed at six weeks of age showed a multiloculated cystic mass adherent to the right pericardium and to the medial aspect of the diaphragm. Histology revealed the tumour to be a cystic hygroma (lymphangioma). Intrathoracic cystic hygroma occurring outside the mediastinum is extremely rare and has never been diagnosed previously in infancy.

Congenital cystic hygroma involving the larynx presenting as an airway emergency

Cystic hygroma is a benign, painless, soft, compressible malformation of the lymphatic system. The head and neck region is the most common place of presentation. These lesions most commonly present shortly after birth with 40% presenting in the newborn period. With the increased use of prenatal ultrasonography, cystic hygromas are being diagnosed in the antenatal period; thus, appropriate measures to secure the airway of the infant can be prearranged prior to birth. This article reports a case where a multispecialty approach was undertaken to assure the survival of an infant born with a large cervical cystic hygroma with laryngeal and base tongue involvement by the tumor. This article also reviews the incidence of laryngeal involvement of cystic hygromas and airway management in the acute period and long term.

Role of the autopsy in congenital cystic hygroma

Sixteen cases of congenital cystic hygroma were identified through a retrospective review of surgical pathology and autopsy records. Tissue sections of the cystic hygromas were available in 10 cases and were examined histopathologically and for reactivity to factor VIII antiserum. Of 13 cases with ultrasound examinations, cystic hygroma was diagnosed prenatally in 9. In 11 cases with successful karyotyping, six were 45, X. Histopathologic observations of lymphatic vascular architecture were apparent in 10 cases, and immunoreactivity of the endothelium to factor VIII antiserum was preserved regardless of the degree of autolysis.

Absent aortic and pulmonary valves: investigation of three fetal cases with cystic hygroma and review of the literature

Absent semilunar valve was found in three fetal cases with cystic hygroma. Two cases which simultaneously showed absent aortic and pulmonary valves (AAV and APV, respectively) had double-outlet right ventricle. The third case, which lacked only the aortic valve, had atrioventricular septal defect and anomalous origin of the right subclavian artery. Two of the three cases had a markedly hypoplastic thymus. Fifteen AAV and 179 APV cases, including the above-mentioned cases and others reported elsewhere, were discussed with special reference to the pathogenesis of absent semilunar valve. Of the 15 AAV cases, hypoplasia of the left heart was observed in 11 cases (73.3%), double-outlet right ventricle in 5 (33.3%), and aortic arch malformations in 6 (40.0%). In the 179 APV cases, there were 111 tetralogy of Fallot (62.0%) and 44 right-sided aortic arch (24.6%). DiGeorge anomaly was found in one AAV and eight APV cases. These results indicate a pathogenesis that is possibly related to hemodynamic abnormalities or abnormal neural crest cells. Further investigation will be needed to elucidate a more definite pathogenesis of absent semilunar valve.

Mediastinal cystic hygroma: prenatal decompression with neonatal resection and recurrence at 19 months of age

A case of an anterior mediastinal cystic hygroma detected prenatally at 22 weeks' gestation is reported. Because of progressive nonimmune hydrops, cardiac compromise, and mediastinal shift compressing the lungs, in utero decompression was successfully performed at 24 weeks. This newborn infant was delivered at 37 weeks' gestation with no respiratory distress. Operative excision of a large thoracic cystic hygroma was performed shortly after birth. At 19 months of age, this patient appeared with unilateral wheezing and fever. Operative findings confirmed recurrence of a cystic hygroma.