Elevated alpha-fetoprotein levels in the 45,x (Turner syndrome) fetus with cystic hygroma. Case reports

A 45,X fetus with cystic hygroma, associated with an elevated amniotic alpha-fetoprotein (AFP) level (greater than 80 microgram/ml). Is described, as are macroscopic and microscopic characteristics of this fetus and two other female fetuses with cystic hygroma. The ultrasonographic diagnosis of fetal cystic hygroma is discussed. The association of a high amniotic AFP level with cystic hygroma is considered. The relationship between cystic hygroma and pterygium colli in liveborn infants with Turner syndrome, and the evolution of neck webbing, as seen in the adult with turner syndrome, is also discussed.     

Unilocular Cystic Lymphangioma of Thigh—An Extremely Rare Clinical Entity

Majority of cystic lymphangiomas are multilocular and occur in neck and axilla. The cystic lymphangioma is also known as cystic hygroma. Unilocular cystic hygroma of neck and breast have been reported in literature and have been termed hydrocele of neck and breast respectively. However unilocular cystic hygroma of thigh is probably being reported for the first time.     

Giant cystic hygroma associated with venous aneurysm.

Complete excision of giant cystic hygroma requires meticulous dissection of the multilocular lymphatic cysts from the adjacent vascular and neural structures. The association of venous aneurysms with cystic hygroma is extremely rare. We report two infants with cystic hygroma in whom preoperative diagnosis of venous aneurysm was helpful in planning complete excision of the lymphatic lesions.     

Scrotal cystic hygroma in a 13-year-old boy

We describe a patient with cystic hygroma, in a rare location (scrotum). The hygroma was diagnosed incidentally after injury to the scrotum in a 13-year-old boy. The diagnostic methods used, the characteristics of this type of tumor, its treatment and its clinical course are described. We suggest that cystic hygroma be taken into account in the differential diagnosis of other more frequent causes of scrotal masses.     

Cystic hygroma in the quadriceps muscle: a sanguine diagnosis for knee pain

Reported here is a 28-year-old female who presented with severe right knee pain and swelling nearby the joint. Ultrasonography, magnetic resonance imaging and eventually surgery were performed. She was diagnosed to have a cystic hygroma in the vastus lateralis muscle. This is the first patient of a cystic hygroma in the quadriceps muscle.     

A case of cystic hygroma of the chest wall

Hygroma is generally regarded as a benign tumor occurring favoritely in the cervical region of a child. Recently we have experienced a case of hygroma which was initially detected as a right chest wall tumor in a 16-year-old man, then was surgically diagnosed as cystic hygroma; chest roentgenography on a check up examination in his senior high school pointed out some anomaly, leading to his hospitalization. On admission, he had no subjective symptom, but chest roentgenography and CT confirmed an abnormal shadow in the right pulmonary area and a tumor with calcification on the right chest wall, respectively, so he was operated on for excisional biopsy. The tumor was extirpated together with the 7th intercostal muscle adhered to the tumor, and postoperative pathohistological examination led to diagnosis as cystic hygroma. Cystic hygroma of the chest wall is so rare that we would like to report this case, together with some addition consideration of related literature.     

Spontaneous chylopericardium in an adult due to mediastinal cystic hygroma

Chylopericardium is a rare and benign condition. Apart from common causes like non-surgical trauma, tuberculosis, malignancy, radiation, and postoperative, mediastinal cystic hygroma presenting as chylopericardium is an extremely rare entity. Primary or idiopathic chylopericardium is diagnosed when the precise cause is not known. It is a diagnosis of exclusion. We report a 27-year-old lady with mediastinal cystic hygroma, presenting as spontaneous chylopericardium, who was managed surgically with no recurrence on 18 months follow-up. She was evaluated for complaints of discomfort in the upper abdomen region and breathing difficulty in left lateral position for 4 days, and was found to have a large pericardial effusion with impending tamponade. She underwent pericardiocentesis, and on fluid analysis, it was confirmed as chylous pericardial effusion. She was evaluated thoroughly and was taken up for right video-assisted thoracoscopy. The thoracic duct was clipped and a window was created in the pericardium, the cystic hygroma was excised, and pleurodesis was done. The postoperative period was uneventful. Histopathology of the pericardial window showed chronic inflammatory pathology and cystic lesion was confirmed as a chylous cyst.     

Surgical management of parapharyngeal cystic hygroma causing sudden airway obstruction

Parapharyngeal cystic hygroma is a rare tumor of the neck. This report describes two cases in which surgical resection was necessary to overcome sudden airway obstruction and details the surgical technique. These cases were considered "near misses" for sudden infant death syndrome (SIDS) and were revealed by computed tomography (CT) and echography to be parapharyngeal cystic hygroma. The location of this malformation could have produced sudden airway collapse and be erroneously diagnosed as SIDS. The postoperative follow-up was satisfactory and no recurrence was detected. We believe CT and echography should be included in the evaluation of such cases.     

Cavernous lymphangioma arising in the chest wall 19 years after excision of a cystic hygroma

Lymphangioma is a congenital malformation of the lymphatic system and is thought to result from the failure of the lymphatic system to connect with the venous system. Lymphangioma of the chest wall is a very rare disease entity, and only a few cases have ever been documented in the literature. To the best of our knowledge, there have been few cases of recurrent cavernous lymphangioma after surgical excision of a cystic hygroma on the same side of the chest wall. Here, we report a case of a cavernous lymphangioma of the chest wall in a patient who had undergone surgical excision of a cystic hygroma 19 years earlier.     

Massive symptomatic cystic hygroma confined to the thorax in early childhood

A case of massive symptomatic cystic hygroma confined to the left hemithorax and mediastinum in a 21-month-old boy is reported. The symptoms were of increasing respiratory distress and cough with fever. The mass surrounded all of the major vascular and nervous structures of the mediastinum and left hemithorax and was attached to the pericardium. It was excised, and the postoperative course was complicated by prolonged chylothorax and malfunction of the left hemidiaphragm. Seven other reported symptomatic cases of cystic hygroma confined to the thorax in early childhood are reviewed. The hygromas tend to be large and their care typically is complex and complicated. Hemorrhage into the cysts is a frequent finding and likely contributes to the acute and progressive symptoms.     

Pedunculated cystic lymphangioma of the splenocolic ligament in a child

An unusual case is presented of a large symptomatic pedunculated cystic intra-abdominal mass arising from the area of the splenocolic ligament in a three and a half year old girl. The child was managed successfully by resection of the mass, which proved on gross and microscopic examination to be a benign cystic lymphangioma. To our knowledge intra-abdominal cystic hygroma in this locale or with this configuration has not been previously reported.     

Acute airway obstruction in children with benign head and neck tumours. Case reports

Infants presenting with acute airway obstruction secondary to cystic hygroma and neurofibroma are presented. Early surgical correction of large benign tumours of the head and neck is recommended to prevent life-threatening complications.     

Report of a case: the anesthetic management for fetal tracheal intubation with intact uteroplacental circulation during cesarean section

We experienced a case of cesarean section in a patient with a fetus having a prenatally diagnosed huge cervical mass, which could cause airway obstruction immediately after delivery. The fetal cervical mass was confirmed at 19 gestational weeks, and amniocentesis was performed at 33 weeks. At 35 weeks, MRI showed the large mass that could disturb the airway patency after birth, and elective cesarean section was scheduled at 37 weeks. In the anesthetic management, anesthesia was maintained with isoflurane in oxygen, and ritodorine and nitroglycerin were used for obtaining uterine relaxation and keeping uteroplacental circulation. Fetal head was exposed from the uterine incision site and tracheal intubation was successfully performed. After confirming the neonatal oxygenation under manual ventilation, the baby was delivered. After delivery, the mass was diagnosed as cystic hygroma and he was maintained under mechanical ventilation in NICU. Five months later subtotal excision of the cervical cystic hygroma and tracheostomy were performed.     

Ultrasonography's role in prenatal diagnosis: The nuchal fold

Two cases of nuchal fold abnormalities diagnosed by transvaginal ultrasonography are presented: nuchal edema at 10 weeks (fold = 5.5 mm) of normal size at 13 weeks (fold = 2.6 mm) and cystic hygroma colli associated with omphalocel in a women with a 24-week arrested pregnancy terminated by spontaneous abortion. Genetic tests done in the second case showed a karyotype 45XO. The etiopathogenesis of nuchal skin fold abnormalities--edema and cystic hygroma colli is discussed. The importance of ultrasound screening during pregnancy is emphasized, the detection rate of genetic abnormalities depending on both the quality of the ultrasound equipment and examiners skills. Ultrasound examination at 10 and 20 weeks--ultrasound marker (nuchal fold, LF ratio and DBP/FL ratio)--together with the triple test (AFP, HCG and E3) in the mathematical model used for detecting the risk of genetic defects may represent an alternative to amniocentesis and trophoblast biopsy when this is impracticable or rejected by the patient.     

Unilateral leg edema caused by abdominoscrotal hydrocele: elegant diagnosis by MRI.

A 5-month-old boy presented with bilateral hydroceles since birth and right leg edema. An ultrasound of the pelvis showed a 4-cm cystic mass that was diagnosed as a teratoma or cystic hygroma. Magnetic resonance imaging was performed, which showed a dumbbell shaped contiguous, fluid filled mass extending intraabdominally through the inguinal canal from the scrotum. The cystic portion in the right iliac fossa was lying on the right iliac vessels, which were patent. A bilateral hydrocelectomy was performed, and the intraperitoneal sac was completely excised through the inguinal incision. The edema of the right leg disappeared a few days after surgery.     

Concurrent cysts of the mediastinum, pleura and neck.

A 14-year-old male was found to have a mediastinal mass on chest radiograph. Chest computed tomography scans showed a cystic lesion behind the left main bronchus. Magnetic resonance imaging revealed additional cystic lesions in the left chest and root of the neck. He underwent excision of mediastinal mass and a pleural cyst. The neck lesion was presumed to be a cystic hygroma. Histological examination of the two lesions resected showed them to be a foregut cyst and a benign mesothelial cyst. We know of no other report of concurrent multicystic lesions in the chest and neck and hypothesize that these cysts may have a common embryonic origin.     

Giant cystic hygroma of the posterior mediastinum

The case of a 5-year-old girl with a giant cystic hygroma of the posterior mediastinum is reported. Although the tumor was bilateral, it was excised by unilateral thoractomy. The unique anatomical features of this tumor suggested an embryologic origin from the cisterna chyli or the primitive paired thoracic ducts.     

Unilateral lower limb swelling secondary to cavernous lymphangioma.

INTRODUCTION: We report an unusual case of unilateral leg swelling secondary to cavernous lymphangioma (cystic hygroma), which normally affects the head and neck regions. CASE REPORT: A 25 year gentleman presented to our department with a 13-year history of gradually increasing unilateral leg swelling and recurrent infections. Investigations showed appearances consistent with cavernous lymphangioma, and partial excision of the lesion led to resolution of symptoms. DISCUSSION: The most common sites for cystic hygroma are the head and neck areas, but the extremities can be affected as demonstrated. Complete surgical excision is often difficult, and there is a tendency for recurrence. This case acts as an illustration of an uncommon yet important cause for unilateral leg swelling.     

Laryngeal cystic hygroma

An unusual case of cervical cystic hygroma with laryngeal extension is reported. A patient with acute upper airway obstruction due to a laryngeal lesion was seen 18 years after the original cervical surgery. Maintenance of an adequate airway has required a partial laryngectomy in addition to repeated endoscopic procedures for removal of recurrent disease. The rationale for this therapy is discussed in light of the current literature.     

Huge cervico-thoracic thymic cyst

We present a case of a 6 year-old boy who presented with a huge mass in the right side of the neck and changes its size with respiration and with straining. Computed tomography of the chest and neck showed a huge mass that was thought to be cystic hygroma. It was excised by both median sternotomy and a right cervical incision. Pathology revealed a thymic cyst.