Postnatal treatment and evolution patterns of giant fetal hepatic hemangioma: a case series of 29 patients
Abstract Objectives To explore the clinical characteristics, postnatal treatment and prognosis of giant fetal hepatic hemangioma (GFHH). Method Retrospective analysis was performed on children with giant fetal hepatic hemangioma (maximum tumor diameter > 40 mm) diagnosed by prenatal ultrasound an...
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| Format: | Article |
| Language: | English |
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BMC
2024-01-01
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| Series: | BMC Pediatrics |
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| Online Access: | https://doi.org/10.1186/s12887-023-04476-2 |
| _version_ | 1797362844978642944 |
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| author | Lu-lu Xie Yan-bing Huang Kui-ran Dong Shao-bo Yang Chun Shen Yang-yang Ma |
| author_facet | Lu-lu Xie Yan-bing Huang Kui-ran Dong Shao-bo Yang Chun Shen Yang-yang Ma |
| author_sort | Lu-lu Xie |
| collection | DOAJ |
| description | Abstract Objectives To explore the clinical characteristics, postnatal treatment and prognosis of giant fetal hepatic hemangioma (GFHH). Method Retrospective analysis was performed on children with giant fetal hepatic hemangioma (maximum tumor diameter > 40 mm) diagnosed by prenatal ultrasound and MRI from December 2016 to December 2020. These patients were observed and treated at the Children’s Hospital of Fudan University after birth. The clinical data were collected to analyze the clinical characteristics, treatment, and prognosis of GFHH using independent sample t tests or Fisher’s exact tests. Results Twenty-nine patients who were detected by routine ultrasound in the second and third trimester of pregnancy with giant fetal hepatic hemangiomas were included. The first prenatal ultrasound diagnosis of gestational age was 34.0 ± 4.3 weeks, ranging from 22 to 39 weeks. Of the patients, 28 had focal GFHHs and 1 had multifocal GFHHs. Surgery was performed, and the diagnosis was confirmed histopathologically in two patients. There were 8 cases with echocardiography-based evidence of pulmonary hypertension, 11 cases had a cardiothoracic ratio > 0.6, and 4 cases had hepatic arteriovenous fistula (AVF). The median follow-up time was 37 months (range: 14–70 months). During the follow-up, 12 patients received medical treatment with propranolol as the first-line therapy. The treatment group had a higher ratio of cardiothoracic ratio > 0.6 (P = 0.022) and lower albumin levels (P = 0.018). Four (14.8%) lesions showed postnatal growth before involuting. Complete response was observed in 13 (13/29) patients, and partial response was observed in 16 (16/29) patients. Conclusions Fetal giant hepatic hemangioma is mainly localized, and its clinical outcome conforms to RICH (rapidly involuting) and PICH (partially involuting), but some fetal giant hepatic hemangiomas will continue to grow after birth and then gradually decrease. For uncomplicated giant fetal hepatic hemangioma, postnatal follow-up is the main concern, while those with complications require aggressive medical treatment. Propranolol may have no effect on the volume change of GFHH. |
| first_indexed | 2024-03-08T16:13:16Z |
| format | Article |
| id | doaj.art-56a11f5f00904237b46829b6843282bc |
| institution | Directory Open Access Journal |
| issn | 1471-2431 |
| language | English |
| last_indexed | 2024-03-08T16:13:16Z |
| publishDate | 2024-01-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Pediatrics |
| spelling | doaj.art-56a11f5f00904237b46829b6843282bc2024-01-07T12:47:18ZengBMCBMC Pediatrics1471-24312024-01-0124111010.1186/s12887-023-04476-2Postnatal treatment and evolution patterns of giant fetal hepatic hemangioma: a case series of 29 patientsLu-lu Xie0Yan-bing Huang1Kui-ran Dong2Shao-bo Yang3Chun Shen4Yang-yang Ma5Shanghai Institute of Infectious Disease and BiosecurityCollege of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Children’s Hospital, Fujian Medical UniversityDepartment of Pediatric Surgery, Shanghai Key Laboratory of Birth Defect, Key Laboratory of Neonatal Disease, Ministry of Health, Children’s Hospital of Fudan UniversityDepartment of Pediatric Surgery, Shanghai Key Laboratory of Birth Defect, Key Laboratory of Neonatal Disease, Ministry of Health, Children’s Hospital of Fudan UniversityDepartment of Pediatric Surgery, Shanghai Key Laboratory of Birth Defect, Key Laboratory of Neonatal Disease, Ministry of Health, Children’s Hospital of Fudan UniversityDepartment of Pathology, Children’s Hospital of Fudan UniversityAbstract Objectives To explore the clinical characteristics, postnatal treatment and prognosis of giant fetal hepatic hemangioma (GFHH). Method Retrospective analysis was performed on children with giant fetal hepatic hemangioma (maximum tumor diameter > 40 mm) diagnosed by prenatal ultrasound and MRI from December 2016 to December 2020. These patients were observed and treated at the Children’s Hospital of Fudan University after birth. The clinical data were collected to analyze the clinical characteristics, treatment, and prognosis of GFHH using independent sample t tests or Fisher’s exact tests. Results Twenty-nine patients who were detected by routine ultrasound in the second and third trimester of pregnancy with giant fetal hepatic hemangiomas were included. The first prenatal ultrasound diagnosis of gestational age was 34.0 ± 4.3 weeks, ranging from 22 to 39 weeks. Of the patients, 28 had focal GFHHs and 1 had multifocal GFHHs. Surgery was performed, and the diagnosis was confirmed histopathologically in two patients. There were 8 cases with echocardiography-based evidence of pulmonary hypertension, 11 cases had a cardiothoracic ratio > 0.6, and 4 cases had hepatic arteriovenous fistula (AVF). The median follow-up time was 37 months (range: 14–70 months). During the follow-up, 12 patients received medical treatment with propranolol as the first-line therapy. The treatment group had a higher ratio of cardiothoracic ratio > 0.6 (P = 0.022) and lower albumin levels (P = 0.018). Four (14.8%) lesions showed postnatal growth before involuting. Complete response was observed in 13 (13/29) patients, and partial response was observed in 16 (16/29) patients. Conclusions Fetal giant hepatic hemangioma is mainly localized, and its clinical outcome conforms to RICH (rapidly involuting) and PICH (partially involuting), but some fetal giant hepatic hemangiomas will continue to grow after birth and then gradually decrease. For uncomplicated giant fetal hepatic hemangioma, postnatal follow-up is the main concern, while those with complications require aggressive medical treatment. Propranolol may have no effect on the volume change of GFHH.https://doi.org/10.1186/s12887-023-04476-2Congenital hepatic hemangiomaPrenatal diagnosisPrenatal diagnosisUltrasound |
| spellingShingle | Lu-lu Xie Yan-bing Huang Kui-ran Dong Shao-bo Yang Chun Shen Yang-yang Ma Postnatal treatment and evolution patterns of giant fetal hepatic hemangioma: a case series of 29 patients BMC Pediatrics Congenital hepatic hemangioma Prenatal diagnosis Prenatal diagnosis Ultrasound |
| title | Postnatal treatment and evolution patterns of giant fetal hepatic hemangioma: a case series of 29 patients |
| title_full | Postnatal treatment and evolution patterns of giant fetal hepatic hemangioma: a case series of 29 patients |
| title_fullStr | Postnatal treatment and evolution patterns of giant fetal hepatic hemangioma: a case series of 29 patients |
| title_full_unstemmed | Postnatal treatment and evolution patterns of giant fetal hepatic hemangioma: a case series of 29 patients |
| title_short | Postnatal treatment and evolution patterns of giant fetal hepatic hemangioma: a case series of 29 patients |
| title_sort | postnatal treatment and evolution patterns of giant fetal hepatic hemangioma a case series of 29 patients |
| topic | Congenital hepatic hemangioma Prenatal diagnosis Prenatal diagnosis Ultrasound |
| url | https://doi.org/10.1186/s12887-023-04476-2 |
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