Successful intrauterine treatment of cystic hygroma colli using OK-432. A case report.
Department of Perinatology, National Cardiovascular Center, Osaka, Japan. Fetal Diagnosis and Therapy
(Impact Factor: 2.94). 18(6):391-6.
A 36-year-old multiparous woman was referred at 25 weeks of gestation with suspected cystic hygroma. Ultrasonographic examination demonstrated large multiple cysts around the fetal neck. We treated them by injection of OK-432 at 29 and 32 weeks of gestation. The cysts decreased in size after the intrauterine treatment. A female baby was delivered at 38 weeks of gestation. She was healthy, and there was only a small swelling of the skin in the nuchal area at birth. One month later, the slight swelling of the skin had completely disappeared. Intrauterine injection of OK-432 was a safe and effective therapy for fetal cystic hygroma.
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- "When the cyst is aspirated with an injector, it may lead to the rapid fluid accumulation and it isn't suggested as it may cause infection.12 For the treatment of CH, the new modality is the use of sclerosing agents.36 For the first time in 1986, by Ogita et al. proposed treatment of intralesional injection of OK-432.37 OK432 is a sclerosing agents obtained from derivative of low virulence Streptococcus pyogenes.38 "
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ABSTRACT: Cystic hygroma (CH) is a lymphatic malformation occurring different parts of fetal body, typically in the region of the fetal neck and axillary, abdominal wall, mediastinal, inguinal and retroperitoneal areas. CH has been associated with fetal aneuploidy, hydrops fetalis, structural malformations and intrauterine fetal death.
A 24-year-old gravida 1, para 1 was admitted to our hospital at 28 weeks of gestation. Ultrasonographic examination determined 28 weeks of gestation, singleton, alive fetus who had a mass derived from the right axillary region which was extending to the anterior and posterior thoracic wall with fluid-filled cavities about 12 cm in size. There was no evidence of intrathorasic or intraabdominal extension of mass. Cordocentesis was performed and karyotype examination was normal 46 XY. The fetal demise was found after the first visit. The patient was delivered vaginally after labor induction with oxytocin infusion. The fetal autopsy confirmed the diagnosis of CH.
The fetal CH carries high risk of aneuploidy and fetal malformations. Patients that have been diagnosed with CH in antenatal follow-ups should be assessed in terms of other anomalies. Fetal karyotyping should be done and the patient should be monitored for fetal hydrops. The birth should be planned in a multidisciplinary hospital and as neonatal resuscitation could be needed, pediatricians should be consulted.
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