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Nonimmune Hydrops Fetalis
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Chelsea DeBolt, Katherine Connolly, Mary E. Norton, Joanne Stone
The worst prognosis is expected in cases diagnosed before 24 weeks gestation, cases in which a cystic hygroma is present, or cases with chromosomal abnormalities. Half of cases diagnosed prior to 24 weeks are associated with aneuploidy and have very poor survival. Even in those cases diagnosed prior to 24 weeks without aneuploidy, survival is less than 50% [48]. Counseling should include the option of termination depending on patient preferences. After 24 weeks of gestation, the survival rate in euploid fetuses is nearly 50% when effective treatments are performed. Fetal anemia and fetal arrhythmia are two of the etiologies of NIH associated with >70–90% survival rate, if appropriate treatment is instituted (1). Consideration should also be given to transferring the patient to a tertiary care center for management and delivery where possible.
Neonatal and General paediatric Surgery
Published in Stephan Strobel, Lewis Spitz, Stephen D. Marks, Great Ormond Street Handbook of Paediatrics, 2019
Spontaneous regression of the cystic hygroma is excessively rare. Injection sclerotherapy is now the main treatment of choice (e.g. hypertonic saline, bleomycin, doxycycline, OK-432). Surgical excision is reserved for persistent disease or recurrence and may prove difficult due to ‘infiltration’ of the cysts between vital structures (e.g. carotid artery, internal jugular vein, phrenic nerve, cranial nerves). It is important NOT to sacrifice vital structures but to accept that recurrences will occur, which can then be treated on their merits.
Soft Tissues
Published in Joseph Kovi, Hung Dinh Duong, Frozen Section In Surgical Pathology: An Atlas, 2019
DIFFERENTIAL DIAGNOSIS: ClinicalThe so-called “cystic hygroma” of the neck is the best known example of the tumor. The lesion can be easily differentiated from cervical lymphadenopathy by palpation.MicroscopicLymphangioma is composed of narrow or dilated, thick-walled lymphatic channels containing lymph. In various forms of hemangioma there are red blood cells present in the vessels. The lymphatic channels of lymphangioma are generally associated with collections of lymphocytes. This feature is not noted in hemangioma.
Prenatal diagnosis of cystic hygroma cases in a tertiary centre and retrospective analysis of pregnancy results
Published in Journal of Obstetrics and Gynaecology, 2022
Sureyya Saridas Demir, Erkan Cagliyan, Derya Öztürk, Samican Özmen, Sabahattin Altunyurt, Tufan Çankaya, Elcin Bora
The aim of this study is to retrospectively examine 29 pregnancies admitted to a tertiary centre and diagnosed with prenatal cystic hygroma. ‘Cystic hygroma’ is a malpharmacy of the lymphatic system, which is most commonly seen in the prenatal period and has increased detection rate since the routine implementation of foetal nuchal thickness measurement in the first trimester of pregnancy and is associated with congenital anomalies, aneuploidy (abnormal karyotypes) and developmental disorders (Noia et al. 2018; Almonacid et al. 2020). Due to its frequency, its relation with anomalies and various syndromes, it is of great importance for early antenatal diagnosis, determining the prognosis, planning the mode of delivery and postnatal management (Behera et al. 2020). When cystic hygroma is detected in early pregnancy, it is usually found with chromosomal or structural abnormalities, and in cases where pregnancy is not terminated, it results in 63% hydrops, intrauterine foetal death or spontaneous abortion. When the diagnosis is made close to the birth, there is a single lymphangioma and there is no other anomaly accompanying the disease, i.e. the disease progresses (Özcan et al. 2017; Tanay Tayyar et al. 2017; Erkayiran et al. 2018; Lore et al. 2018). The probability of a foetus with antenatally diagnosed cystic hygroma to be born as a healthy newborn at full term is 5% or less (Sahni et al. 2017; Tanay Tayyar et al. 2017). Cystic hygroma cases can be diagnosed in the intrauterine period by obstetric ultrasonography (Almonacid et al. 2020; Lodhia et al. 2020; Yener et al. 2020).
Early prenatal diagnosis of 49,XXXXY: two case reports
Published in Journal of Obstetrics and Gynaecology, 2019
Yue-Cheng Lu, Lv-Yin Huang, Yan-Dong Yang, Dong-Zhi Li
A 27-year-old G1P0 woman was given a routine first-trimester scan at 12 weeks of gestation. An isolated cystic hygroma was noticed (Figure 1(C)). Considering the presence of a structural anomaly, a direct diagnostic testing was done with CVS for a chromosomal investigation. A direct analysis and the cell culture showed a homogeneous 49,XXXXY karyotype (Figure 1(D)). The pregnancy was terminated by the request of parents using the vaginal misoprostol. The parents declined the necropsy. The karyotype was normal in both parents.