Fetal therapy for giant hepatic cysts

Area of Science:

• Pediatric Surgery
• Fetal Medicine
• Pathology

Background:

• Cystic mesenchymal hamartoma is a rare, benign tumor that can grow rapidly to a giant size.
• Giant hepatic cysts pose risks during fetal life and early childhood.
• Management of antenatally diagnosed giant hepatic cysts varies significantly.

Purpose of the Study:

• To present two cases of antenatally diagnosed giant hepatic cysts.
• To compare different management and treatment approaches.
• To explore the potential link between giant hepatic cysts and fetal complications.

Main Methods:

• Case study of two fetuses with giant hepatic cysts.
• In utero treatment (repeated aspirations) in one case.
• Neonatal surgical excision (laparoscopic and open laparotomy) in both cases.
• Pathologic examination of placenta in one case.

Main Results:

• In utero aspiration followed by neonatal excision resulted in a favorable outcome.
• Non-treatment in utero led to nonimmune hydrops fetalis, premature delivery, neurologic injury, and fetal demise.
• Placental pathology suggested umbilical vein compression secondary to the cyst.

Conclusions:

• Giant mesenchymal hamartoma diagnosed in utero may cause umbilical venous obstruction, leading to fetal ischemia.
• In utero decompression of giant hepatic cysts might reverse this obstruction and promote normal fetal development.
• Early intervention for giant hepatic cysts is crucial for improving fetal outcomes.