Martin et al have recently reported on a newborn with an increasing number
of haemangiomas on her body and liver.1 This phemomenon, once it is very
diffuse may cause cardiovascular decompensation and mortality. We had a
similar case, which we followed in utero because of chorioangioma and
increased ammniotic fluid.2
Among the prenatal findings were also abnormal triple-test results. This
included AFP levels of 14.9 MoM, hCG of 3.42, MoM and uE3 of 1.01 MoM. The
pregnancy was followed uneventfully until 35 weeks of gestation, when
polyhydramnios and severe fetal cardiomegaly developed. Labor was
therefore induced.
An euploid female, who had multiple diffuse cutaneous and liver
angiomatosis was born (Figure 1). Although treatment with steroids was
started, she died at the age of one month because of cardiac failure and
infection.
An interesting question is how angiomas of the liver, skin and the
placenta, could be connected by a single developmental event being
responsible for this multicentre disorganised growth of capillaries. The
vascular precursor cells (placental
angioblasts) might embolise to receptive fetal tissues during gestation
through right to left shunts that characterise the fetal circulation.3 In
this respect, it is of relevance that immunohistochemical studies have
demonstrated a fundamental similarity
between the vasculature of infantile haemangioma and that of the
placenta.3
In our case report we raised several questions in which maybe the authors
and the readers could find out in their cases as well:
1. Were there abnormal maternal serum triple test serum markers been
found? They may indicate fetal liver haemangiomatosis.
2. Any abnormal findings within the placenta? This also may be secondary
to the above.
3. In both cases the newborn's gender was female. Are female infants more
at risk to develop such complications?
References
1. BMJ 2011 342:d3495; doi:10.1136/bmj.d3495
2. Maymon R, Hermann G, Reish O, Herman A, Strauss S, Sherman D, et al.
Chorioangioma and its severe infantile sequelae: case report. Prenat Diagn
2003;23:976-80.
3. North PE, Waner M, Brodsky MC. Are infantile hemangioma of placental
origin? Ophthalmology 2002;109:223-4.
Figure 1: Newborn with multiple diffuse haemangiomatosis
Patient consent obtained.
Ron Maymon, MD*
*All correspondence: Department of Obstetrics and Gynecology, Assaf
Harofe Medical Center, Zerifin 70300, Israel. E mail: maymonrb@bezeqin.net
Rapid Response:
Diffuse haemangionas and infantile sequelae
Dear Sir,
Martin et al have recently reported on a newborn with an increasing number
of haemangiomas on her body and liver.1 This phemomenon, once it is very
diffuse may cause cardiovascular decompensation and mortality. We had a
similar case, which we followed in utero because of chorioangioma and
increased ammniotic fluid.2
Among the prenatal findings were also abnormal triple-test results. This
included AFP levels of 14.9 MoM, hCG of 3.42, MoM and uE3 of 1.01 MoM. The
pregnancy was followed uneventfully until 35 weeks of gestation, when
polyhydramnios and severe fetal cardiomegaly developed. Labor was
therefore induced.
An euploid female, who had multiple diffuse cutaneous and liver
angiomatosis was born (Figure 1). Although treatment with steroids was
started, she died at the age of one month because of cardiac failure and
infection.
An interesting question is how angiomas of the liver, skin and the
placenta, could be connected by a single developmental event being
responsible for this multicentre disorganised growth of capillaries. The
vascular precursor cells (placental
angioblasts) might embolise to receptive fetal tissues during gestation
through right to left shunts that characterise the fetal circulation.3 In
this respect, it is of relevance that immunohistochemical studies have
demonstrated a fundamental similarity
between the vasculature of infantile haemangioma and that of the
placenta.3
In our case report we raised several questions in which maybe the authors
and the readers could find out in their cases as well:
1. Were there abnormal maternal serum triple test serum markers been
found? They may indicate fetal liver haemangiomatosis.
2. Any abnormal findings within the placenta? This also may be secondary
to the above.
3. In both cases the newborn's gender was female. Are female infants more
at risk to develop such complications?
References
1. BMJ 2011 342:d3495; doi:10.1136/bmj.d3495
2. Maymon R, Hermann G, Reish O, Herman A, Strauss S, Sherman D, et al.
Chorioangioma and its severe infantile sequelae: case report. Prenat Diagn
2003;23:976-80.
3. North PE, Waner M, Brodsky MC. Are infantile hemangioma of placental
origin? Ophthalmology 2002;109:223-4.
Figure 1: Newborn with multiple diffuse haemangiomatosis
Patient consent obtained.
Ron Maymon, MD*
*All correspondence: Department of Obstetrics and Gynecology, Assaf
Harofe Medical Center, Zerifin 70300, Israel. E mail: maymonrb@bezeqin.net
Competing interests: No competing interests