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Prenatal imaging findings of a rapidly involuting congenital hemangioma (RICH) over right flank in a fetus with a favorable outcome
Taiwanese Journal of Obstetrics & Gynecology 55 (2016) 745e747
Contents lists available at ScienceDirect
Taiwanese Journal of Obstetrics & Gynecology journal homepage: www.tjog-online.com
Research Letter
Prenatal imaging findings of a rapidly involuting congenital hemangioma (RICH) over right flank in a fetus with a favorable outcome Chih-Ping Chen a, b, c, d, e, f, *, Chen-Yu Chen a, g, h, Tung-Yao Chang i, Hsiu-Yu Yang j, Yen-Ni Chen a, Shin-Wen Chen a, Wayseen Wang b, k a
Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan Department of Biotechnology, Asia University, Taichung, Taiwan d School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan e Institute of Clinical and Community Health Nursing, National Yang-Ming University, Taipei, Taiwan f Department of Obstetrics and Gynecology, School of Medicine, National Yang-Ming University, Taipei, Taiwan g Department of Medicine, MacKay Medical College, New Taipei City, Taiwan h MacKay Junior College of Medicine, Nursing and Management, Taipei, Taiwan i Taiji Fetal Medicine Center, Taipei, Taiwan j Department of Physiology, MacKay Memorial Hospital, Taipei, Taiwan k Department of Bioengineering, Tatung University, Taipei, Taiwan b c
a r t i c l e i n f o Article history: Accepted 30 July 2016
Dear Editor, A 31-year-old, gravida 3, para 0, woman was referred for genetic counseling at 21 weeks of gestation because of a fetal extracorporeal mass detected by prenatal ultrasound at 17 weeks of gestation. Her husband was 30 years of age, and there was no family history of congenital malformations. Amniocentesis revealed a karyotype of 46,XY, and array comparative genomic hybridization (aCGH) revealed no genomic imbalance. The ultrasound findings of internal organs, placenta and amniotic fluid were unremarkable. At 17 weeks of gestation, a 3 cm 2 cm extracorporeal right flank mass with a central cyst and peripheral color Doppler blood flow was first noted (Figures 1A and 1B). The mass increased to 3.96 cm 3.55 cm and became more echogenic at 24 weeks of gestation (Figure 1C). The mass became a 4.8 cm 4.36 cm echogenic mass and contained peripheral color Doppler blood flow at 28 weeks of gestation (Figure 1D), but decreased to 4.42 cm 1.85 cm in size at 31 weeks of gestation
* Corresponding author. Department of Obstetrics and Gynecology, MacKay Memorial Hospital, 92, Section 2, Chung-Shan North Road, Taipei 10449, Taiwan. E-mail address: [email protected] (C.-P. Chen).
(Figure 1E), to 5.06 cm 1.46 cm in size at 33 weeks of gestation (Figure 1F), to 5.06 cm 1.26 cm in size at 35 weeks of gestation (Figure 1G), to 4.89 cm 1.40 cm in size at 36 weeks of gestation (Figure 1H), and to 4.72 cm 1.29 cm in size at 38 weeks of gestation (Figure 1I). A rapidly involuting congenital hemangioma (RICH) was diagnosed. At 38 weeks of gestation, a 2894-g male baby was delivered by vaginal route uneventfully. There was an erythematous hemangioma over the skin and the subcutaneous tissue of right flank. The baby was in good health without anemia or thrombocytopenia. The mass was involuted to a 3.5 cm 3.5 cm moveable mass with an erythematous center at the age of 2 months. Congenital hemangioma is a vascular anomaly that can be divided into RICH and noninvoluting congenital hemangioma (NICH). RICH is more frequent than NICH and is usually involuted spontaneously during the first 2 years of life, and NICH does not regress and may result in cardiac failure that requires surgical intervention [1e11]. Congenital hemangioma has been reported to be more common in the head, neck, and limbs [10]. RICH is characterized by its nature of spontaneous regression. Complete involution of RICH before term has been observed by Ozcan [9]. Prenatal diagnosis of hemangioma should include a differential diagnosis of soft tumors such as rhabdomyosarcoma, primitive neuroectodermal tumor, neuroblastoma, hamartoma, malignant fibrous histiocytoma, hemangiopericytoma, fibrosarcoma, leiomyoma, embryonal rhabdomyosarcoma, leiomyosarcoma, neuroblastoma, and neurofibromatosis, which tend to show peripheral vascularity [9]. In most cases, RICH does not need treatment. However, large RICH may occasionally require treatment because of ulceration, hemorrhage, obstruction,
http://dx.doi.org/10.1016/j.tjog.2016.07.008 1028-4559/Copyright © 2016, Taiwan Association of Obstetrics & Gynecology. Published by Elsevier Taiwan LLC. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
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C.-P. Chen et al. / Taiwanese Journal of Obstetrics & Gynecology 55 (2016) 745e747
Figure 1. The prenatal ultrasound findings of the hemangioma at (A, B) 17 weeks, (C) 24 weeks, (D) 28 weeks, (E) 31 weeks, (F) 33 weeks, (G) 35 weeks, (H) 36 weeks, and (I) 38 weeks of gestation.
C.-P. Chen et al. / Taiwanese Journal of Obstetrics & Gynecology 55 (2016) 745e747
747
Figure 1. (continued).
arteriovenous shunting, high-output heart failure, coagulopathy, and thrombocytopenia [2,5,12]. Prenatal diagnosis of a RICH over the flank is very uncommon. In this report, we present the prenatal imaging findings of a RICH over right flank in a fetus with prenatal involution and a favorable outcome. Conflicts of interest The authors have no conflicts of interest relevant to this article. Acknowledgments This work was supported by research grants MOST-103-2314-B195-010, MOST-104-2314-B-195-009 and MOST-105-2314-B-195012 from the Ministry of Science and Technology and MMH-E-10504 from Mackay Memorial Hospital, Taipei, Taiwan. References [1] Rogers M, Lam A, Fischer G. Sonographic findings in a series of rapidly involuting congenital hemangiomas (RICH). Pediatr Dermatol 2002;19:5e11. [2] Berenguer B, Mulliken JB, Enjolras O, Boon LM, Wassef M, Josset P, et al. Rapidly involuting congenital hemangioma: Clinical and histopathologic features. Pediatr Dev Pathol 2003;6:495e510.
[3] Gorincour G, Kokta V, Rypens F, Garel L, Powell J, Dubois J. Imaging characteristics of two subtypes of congenital hemangiomas: Rapidly involuting congenital hemangiomas and noninvoluting congenital hemangiomas. Pediatr Radiol 2005;35:1178e85. [4] Krol A, MacArthur C. Congenital hemangiomas: rapidly involuting and noninvoluting congenital hemangiomas. Arch Facial Plast Surg 2005;7: 307e11. [5] Baselga E, Cordisco M, Garzon M, Lee MT, Alomar A, Blei F. Rapidly involuting congenital haemangioma associated with transient thrombocytopenia and coagulopathy: a case series. Br J Dermatol 2008;158:1363e70. [6] Elia D, Garel C, Enjolras O, Vermouneix L, Soupre V, Oury JF, et al. Prenatal imaging findings in rapidly involuting congenital hemangioma of the skull. Ultrasound Obstet Gynecol 2008;31:572e5. [7] Goh SG, Calonje E. Cutaneous vascular tumours: an update. Histopathology 2008;52:661e73. nifla JL, Jouannic JM. Prenatal [8] Richard F, Garel C, Cynober E, Soupre V, Be diagnosis of a rapidly involuting congenital hemangioma (RICH) of the skull. Prenat Diagn 2009;29:533e5. [9] Ozcan UA. Rapidly involuting congenital hemangioma: a case of complete prenatal involution. J Clin Ultrasound 2010;38:85e8. [10] Fadell 2nd MF, Jones BV, Adams DM. Prenatal diagnosis and postnatal followup of rapidly involuting congenital hemangioma (RICH). Pediatr Radiol 2011;41:1057e60. [11] Jo EJ, Choi SJ, Oh SY, Park BK, Roh CR, Kim JH. Complete involution of prenatally-diagnosed fetal scalp hemangioma. Taiwan J Obstet Gynecol 2014;53:86e9. [12] Browning JC, Metry DW. Rapidly involuting congenital hemangioma: case report and review of the literature. Dermatol Online J 2008;14:11.
Contents lists available at ScienceDirect
Taiwanese Journal of Obstetrics & Gynecology journal homepage: www.tjog-online.com
Research Letter
Prenatal imaging findings of a rapidly involuting congenital hemangioma (RICH) over right flank in a fetus with a favorable outcome Chih-Ping Chen a, b, c, d, e, f, *, Chen-Yu Chen a, g, h, Tung-Yao Chang i, Hsiu-Yu Yang j, Yen-Ni Chen a, Shin-Wen Chen a, Wayseen Wang b, k a
Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan Department of Biotechnology, Asia University, Taichung, Taiwan d School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan e Institute of Clinical and Community Health Nursing, National Yang-Ming University, Taipei, Taiwan f Department of Obstetrics and Gynecology, School of Medicine, National Yang-Ming University, Taipei, Taiwan g Department of Medicine, MacKay Medical College, New Taipei City, Taiwan h MacKay Junior College of Medicine, Nursing and Management, Taipei, Taiwan i Taiji Fetal Medicine Center, Taipei, Taiwan j Department of Physiology, MacKay Memorial Hospital, Taipei, Taiwan k Department of Bioengineering, Tatung University, Taipei, Taiwan b c
a r t i c l e i n f o Article history: Accepted 30 July 2016
Dear Editor, A 31-year-old, gravida 3, para 0, woman was referred for genetic counseling at 21 weeks of gestation because of a fetal extracorporeal mass detected by prenatal ultrasound at 17 weeks of gestation. Her husband was 30 years of age, and there was no family history of congenital malformations. Amniocentesis revealed a karyotype of 46,XY, and array comparative genomic hybridization (aCGH) revealed no genomic imbalance. The ultrasound findings of internal organs, placenta and amniotic fluid were unremarkable. At 17 weeks of gestation, a 3 cm 2 cm extracorporeal right flank mass with a central cyst and peripheral color Doppler blood flow was first noted (Figures 1A and 1B). The mass increased to 3.96 cm 3.55 cm and became more echogenic at 24 weeks of gestation (Figure 1C). The mass became a 4.8 cm 4.36 cm echogenic mass and contained peripheral color Doppler blood flow at 28 weeks of gestation (Figure 1D), but decreased to 4.42 cm 1.85 cm in size at 31 weeks of gestation
* Corresponding author. Department of Obstetrics and Gynecology, MacKay Memorial Hospital, 92, Section 2, Chung-Shan North Road, Taipei 10449, Taiwan. E-mail address: [email protected] (C.-P. Chen).
(Figure 1E), to 5.06 cm 1.46 cm in size at 33 weeks of gestation (Figure 1F), to 5.06 cm 1.26 cm in size at 35 weeks of gestation (Figure 1G), to 4.89 cm 1.40 cm in size at 36 weeks of gestation (Figure 1H), and to 4.72 cm 1.29 cm in size at 38 weeks of gestation (Figure 1I). A rapidly involuting congenital hemangioma (RICH) was diagnosed. At 38 weeks of gestation, a 2894-g male baby was delivered by vaginal route uneventfully. There was an erythematous hemangioma over the skin and the subcutaneous tissue of right flank. The baby was in good health without anemia or thrombocytopenia. The mass was involuted to a 3.5 cm 3.5 cm moveable mass with an erythematous center at the age of 2 months. Congenital hemangioma is a vascular anomaly that can be divided into RICH and noninvoluting congenital hemangioma (NICH). RICH is more frequent than NICH and is usually involuted spontaneously during the first 2 years of life, and NICH does not regress and may result in cardiac failure that requires surgical intervention [1e11]. Congenital hemangioma has been reported to be more common in the head, neck, and limbs [10]. RICH is characterized by its nature of spontaneous regression. Complete involution of RICH before term has been observed by Ozcan [9]. Prenatal diagnosis of hemangioma should include a differential diagnosis of soft tumors such as rhabdomyosarcoma, primitive neuroectodermal tumor, neuroblastoma, hamartoma, malignant fibrous histiocytoma, hemangiopericytoma, fibrosarcoma, leiomyoma, embryonal rhabdomyosarcoma, leiomyosarcoma, neuroblastoma, and neurofibromatosis, which tend to show peripheral vascularity [9]. In most cases, RICH does not need treatment. However, large RICH may occasionally require treatment because of ulceration, hemorrhage, obstruction,
http://dx.doi.org/10.1016/j.tjog.2016.07.008 1028-4559/Copyright © 2016, Taiwan Association of Obstetrics & Gynecology. Published by Elsevier Taiwan LLC. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
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C.-P. Chen et al. / Taiwanese Journal of Obstetrics & Gynecology 55 (2016) 745e747
Figure 1. The prenatal ultrasound findings of the hemangioma at (A, B) 17 weeks, (C) 24 weeks, (D) 28 weeks, (E) 31 weeks, (F) 33 weeks, (G) 35 weeks, (H) 36 weeks, and (I) 38 weeks of gestation.
C.-P. Chen et al. / Taiwanese Journal of Obstetrics & Gynecology 55 (2016) 745e747
747
Figure 1. (continued).
arteriovenous shunting, high-output heart failure, coagulopathy, and thrombocytopenia [2,5,12]. Prenatal diagnosis of a RICH over the flank is very uncommon. In this report, we present the prenatal imaging findings of a RICH over right flank in a fetus with prenatal involution and a favorable outcome. Conflicts of interest The authors have no conflicts of interest relevant to this article. Acknowledgments This work was supported by research grants MOST-103-2314-B195-010, MOST-104-2314-B-195-009 and MOST-105-2314-B-195012 from the Ministry of Science and Technology and MMH-E-10504 from Mackay Memorial Hospital, Taipei, Taiwan. References [1] Rogers M, Lam A, Fischer G. Sonographic findings in a series of rapidly involuting congenital hemangiomas (RICH). Pediatr Dermatol 2002;19:5e11. [2] Berenguer B, Mulliken JB, Enjolras O, Boon LM, Wassef M, Josset P, et al. Rapidly involuting congenital hemangioma: Clinical and histopathologic features. Pediatr Dev Pathol 2003;6:495e510.
[3] Gorincour G, Kokta V, Rypens F, Garel L, Powell J, Dubois J. Imaging characteristics of two subtypes of congenital hemangiomas: Rapidly involuting congenital hemangiomas and noninvoluting congenital hemangiomas. Pediatr Radiol 2005;35:1178e85. [4] Krol A, MacArthur C. Congenital hemangiomas: rapidly involuting and noninvoluting congenital hemangiomas. Arch Facial Plast Surg 2005;7: 307e11. [5] Baselga E, Cordisco M, Garzon M, Lee MT, Alomar A, Blei F. Rapidly involuting congenital haemangioma associated with transient thrombocytopenia and coagulopathy: a case series. Br J Dermatol 2008;158:1363e70. [6] Elia D, Garel C, Enjolras O, Vermouneix L, Soupre V, Oury JF, et al. Prenatal imaging findings in rapidly involuting congenital hemangioma of the skull. Ultrasound Obstet Gynecol 2008;31:572e5. [7] Goh SG, Calonje E. Cutaneous vascular tumours: an update. Histopathology 2008;52:661e73. nifla JL, Jouannic JM. Prenatal [8] Richard F, Garel C, Cynober E, Soupre V, Be diagnosis of a rapidly involuting congenital hemangioma (RICH) of the skull. Prenat Diagn 2009;29:533e5. [9] Ozcan UA. Rapidly involuting congenital hemangioma: a case of complete prenatal involution. J Clin Ultrasound 2010;38:85e8. [10] Fadell 2nd MF, Jones BV, Adams DM. Prenatal diagnosis and postnatal followup of rapidly involuting congenital hemangioma (RICH). Pediatr Radiol 2011;41:1057e60. [11] Jo EJ, Choi SJ, Oh SY, Park BK, Roh CR, Kim JH. Complete involution of prenatally-diagnosed fetal scalp hemangioma. Taiwan J Obstet Gynecol 2014;53:86e9. [12] Browning JC, Metry DW. Rapidly involuting congenital hemangioma: case report and review of the literature. Dermatol Online J 2008;14:11.