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2002-09-12-12 Answer to the case of the week #78 © Ochua www.TheFetus.net


Answer to case of the week # 78

August 22-September 12, 2002

Guillermina M. Ochua, MD, Ricardo De Loredo , MD, Roque A. Carpio , MD, Javier B. Gardey, MD, Silvina Fernàndez, MD

Hospital Privado del Sur, Servicio de Ecograf?a, Las Heras 164, Bah?a Blanca, C?digo postal: 8000 Provincia de Buenos Aires, Argentina

This is a 36-year-old patient who had her first ultrasound at 36 weeks.  The examination demonstrated a singleton fetus with normal cardiac activity and fetal movement. The fetal biometry corresponded to the 50th percentile for growth (Hadlock). The placenta was anterior. The amniotic fluid was normal.

Prenatal images. At the superior level of the abdomen, the desplacement of the umbilical vein by a mixed mass. The right superrenal is normal while the left superrenal and the fetal stomach are not seen.

Findings:

The finding was a large mass in the left upper quadrant

The mass itself was solid, probably with some heterogenous/cystic space on its right margin.

 

These findings suggested a hepatic lesion

 

Choriocarcinoma[i],[ii]

Focal nodular hyperplasia[iii]

Hemangioma[iv]

Hemangioendothelioma[v]

Multifocal hemangioendothelioma[vi]

Hepatoblastoma[vii], [viii]

Metastases from a maternal bronchial carcinoma[ix]

Teratoma[x]

The differential diagnosis between these various tumor is not always possible and there are few reported cases to compare to. In this case the lesion was demonstrated postnatally to be a hepatic Hepatic hemangioendothelioma

These are the images from the liver at the first day of life.

The ultrasound demonstrated a mixed mass without calcifications with well-defined edges was seen in left lobe of the liver.

 

In the precontrast computer axial tomography a hypodense heterogeneous lesion was seen in the left lobe of the liver. The lesion takes contrast from the periphery to the center, suggesting the diagnosis of  hemangioendotelioma.

Postnatal examination one and a half months after birth. The corticords treatment began, showing evidence of a shrinking tumor.

Postnatal examination four months after birth. The tumor is reduced with corticord treatment.



[i] Kishkurno S, Ishida A, Takahashi Y, Arai H, Nakajima W, Abe T, Takada G.  A case of neonatal choriocarcinoma. Am J Perinatol. 1997 Feb;14(2):79-82

[ii] Tsukamoto N, Matsumura M, Matsukuma K, Kamura T, Baba K. Choriocarcinoma in mother and fetus. Gynecol Oncol. 1986 May;24(1):113-9

[iii] Petrikovsky BM, Cohen HL, Scimeca P, Bellucci E. Prenatal diagnosis of focal nodular hyperplasia of the liver. Prenat Diagn. 1994 May;14(5):406-9

[iv] Gembruch U, Baschat AA, Gloeckner-Hoffmann K, Gortner L, Germer U. Prenatal diagnosis and management of fetuses with liver hemangiomata. Ultrasound Obstet Gynecol. 2002 May;19(5):454-60

[v] Meirowitz NB, Guzman ER, Underberg-Davis SJ, Pellegrino JE, Vintzileos AM. Hepatic hemangioendothelioma: prenatal sonographic findings and evolution of the lesion. J Clin Ultrasound. 2000 Jun;28(5):258-63.

[vi] Marton T, Silhavy M, Csapo Z, Szende B, Papp Z. Multifocal hemangioendothelioma of the fetus and placenta. Hum Pathol. 1997 Jul;28(7):866-9

[vii] Shih JC, Tsao PN, Huang SF, Yen BL, Lin JH, Lee CN, Hsieh FJ.  Antenatal diagnosis of congenital hepatoblastoma in utero. Ultrasound Obstet Gynecol. 2000 Jul;16(1):94-7.

[viii] Doss BJ, Vicari J, Jacques SM, Qureshi F. Placental involvement in congenital hepatoblastoma. Pediatr Dev Pathol. 1998 Nov-Dec;1(6):538-42

[ix] Kochman AT, Rabczynski JK, Baranowski W, Palczynski B, Kowalski P. Metastases to the products of conception from a maternal bronchial carcinoma. A case report and review of literature. Pol J Pathol. 2001;52(3):137-40.

[x] Robinson RA, Nelson L. Hepatic teratoma in an anencephalic fetus. Arch Pathol Lab Med. 1986 Jul;110(7):655-7

 

 

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