Department of Ultrasound Diagnosis, The Second Xiangya Hospital, Central South University, 139 Renmin Road (M), Changsha, 410011, Hunan, China.
Research Center of Ultrasound Diagnosis, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China.
BMC Pregnancy Childbirth. 2023 Apr 26;23(1):290. doi: 10.1186/s12884-023-05626-1.
Giant hepatic hemangiomas are rare and can cause serious complications that contribute to a high risk of perinatal mortality. The purpose of this article is to review the prenatal imaging features, treatment, pathology, and prognosis of an atypical fetal giant hepatic hemangioma and to discuss the differential diagnosis of fetal hepatic masses.
A gravida 9, para 0 woman at 32 gestational weeks came to our institution for prenatal ultrasound diagnosis. A complex, heterogeneous hepatic mass measuring 5.2 × 4.1 × 3.7 cm was discovered in the fetus using conventional two-dimensional ultrasound. The mass was solid and had both a high peak systolic velocity (PSV) of the feeding artery and intratumoral venous flow. Fetal magnetic resonance imaging (MRI) revealed a clear, hypointense T1-W and hyperintense T2-W solid hepatic mass. Prenatal diagnosis was very difficult due to the overlap of benign and malignant imaging features on prenatal ultrasound and MRI. Even postnatally, neither contrast-enhanced MRI nor contrast-enhanced computed tomography (CT) was useful in accurately diagnosing this hepatic mass. Due to persistently elevated Alpha-fetoprotein (AFP), a laparotomy was performed. Histopathological examination of the mass showed atypical features such as hepatic sinus dilation, hyperemia, and hepatic chordal hyperplasia. The patient was ultimately diagnosed with a giant hemangioma, and the prognosis was satisfactory.
When a hepatic vascular mass is found in a third trimester fetus a hemangioma should be considered as a possible diagnosis. However, prenatal diagnosis of fetal hepatic hemangiomas can be challenging due to atypical histopathological findings. Imaging and histopathological assays can provide useful information for the diagnosis and treatment of fetal hepatic masses.
巨大肝血管瘤罕见，可引起严重并发症，导致围产儿死亡率高。本文旨在回顾一例非典型胎儿巨大肝血管瘤的产前影像学特征、治疗、病理学和预后，并讨论胎儿肝肿块的鉴别诊断。
一位 32 孕周的初产妇因产前超声检查来我院就诊。常规二维超声发现胎儿肝内有一复杂、不均匀的肿块，大小为 5.2×4.1×3.7cm。肿块实性，供血动脉收缩期峰值流速（PSV）高，瘤内有静脉血流。胎儿磁共振成像（MRI）显示肝内清晰的低 T1-W 和高 T2-W 实性肿块。由于产前超声和 MRI 的良性和恶性影像学特征重叠，产前诊断非常困难。即使产后，增强 MRI 和增强 CT 也无法准确诊断该肝肿块。由于甲胎蛋白（AFP）持续升高，行剖腹手术。肿块的组织病理学检查显示出不典型特征，如肝窦扩张、充血和肝索状增生。最终诊断为巨大血管瘤，预后良好。
当在妊娠晚期胎儿中发现肝血管肿块时，应考虑肝血管瘤作为可能的诊断。然而，由于不典型的组织病理学发现，胎儿肝血管瘤的产前诊断具有挑战性。影像学和组织病理学检查可为胎儿肝肿块的诊断和治疗提供有用的信息。
