Aspiration of Giant Hepatic Cyst in the Fetus in utero

Abstract

A large hepatic cyst was diagnosed in a fetus at 29 weeks of gestation by puncture and aspiration performed under ultrasonographic guidance. This procedure was repeated five times at about 2-week intervals, with a total of 1,446 ml of cystic fluid aspirated. A healthy female infant was delivered vaginally at 40 weeks of gestation. Her Apgar score was 9 at 1 min, and she weighed 2,790 g. On the 14th postnatal day, the hepatic cyst was punctured percutaneously under ultrasonographic guidance, and 119 ml of yellow fluid was aspirated. The cyst was subsequently not visible on computed tomography at 9 months. Surgery was not indicated in this infant, and the cyst was also not detected at the age of 21 month. Thus, treatment in utero appeared to have obviated the need for surgery.

Mesenchymal Hamartoma of the Liver: A Benign Tumor with Deceptive Prognosis in the Perinatal Period

“…From the current literature, the impression is created that prenatal cyst drainage is an accepted innovative treatment modality which improves the outcome. This is only based on 4 reports where invasive therapy was performed and a case where fetal demise occurred just before a planned intervention [7,8,11,12,27] .…”

“…One of these cases concerns a repeated drainage of a cystic liver mass with good outcome [27] . However, it is uncertain whether this lesion was a HMH, as pathology was not performed.…”

“…Of note is also the fact that diagnosis could never be established based on the cytology of the cystic aspirate as such invasive testing has no role in aiding differential diagnosis [1,7,11,12,20,27] .…”

Large Hepatic Mesenchymal Hamartoma Leading to Mid-Trimester Fetal Demise

“…Although catheter drainage did not decompress the cysts completely in the case reported by Bejvan et al [9] and might have contributed to the PROM, the child had a favorable outcome after delivery by cesarean section at 30 weeks of gestation and surgery at 3 weeks of life. Repeated needle drainage has also been reported in one fetus with a large simple liver cyst [14], which is different from MHL. In that case the lesion regressed after 6 fetal and 1 postnatal aspirations.…”

Two‐ and three‐dimensional prenatal sonographic diagnosis of hepatic cysts

“…Although prenatal needle aspiration of bile from isolated cysts may be diagnostic, this approach is of uncertain clinical value. 4,7 Moreover, the procedural risks are unknown. Diffuse hepatic cystic involvement may occur with congenital hepatic fibrosis and congenital intrahepatic bile duct dilation (Caroli's disease).…”