Prognosis of fetal umbilical cord cyst with structural abnormalities indicated by prenatal ultrasound: analysis of 109 cases / 中华围产医学杂志

Objective:To explore the prognosis of umbilical cord cysts in fetuses with structural abnormalities diagnosed by prenatal ultrasonography.Methods:This retrospective study involved 109 cases of umbilical cord cysts diagnosed by ultrasound at Beijing Obstetrics and Gynecology Hospital from January 2016 to December 2020. According to the ultrasound findings, these cases were divided into the isolated umbilical cord cyst, umbilical cord cyst with soft ultrasound markers, and umbilical cord cyst with fetal malformation groups. Chi-square was performed for statistical analysis to compare the prognosis. Results:(1) Among 109 cases of umbilical cord cysts, 55 cases (50.5%) were isolated, 20 (18.3%) were complicated by soft ultrasound markers, and 34 (31.2%) cases were complicated by fetal malformation. After excluding two cases of multiple cysts at different locations, the incidence of umbilical cord cysts at the placental end, free segment, and fetal terminal with other ultrasound abnormalities in the remaining 107 cases increased sequentially [27.5% (14/51), 10/17, and 76.9% (30/39), χ2=22.20, P<0.001]. The incidence of umbilical cord cysts with other ultrasound abnormalities at the fetal end was higher than at the placental end ( χ2=21.65, P<0.001). (2) A total of 60 fetal malformations were detected, dominated by fetal ventricular septal defect, omphalocele, giant bladder, fetal edema, and nuchal cystic hygroma, et al., mainly involving the cardiovascular system, urogenital system, anterior abdominal wall, and skeletal system. (3) Eighty-nine cases were followed up to the end of the pregnancy, and 21 (23.6%) of them had adverse outcomes. The prognoses of isolated umbilical cord cyst cases were all good. Two pregnancies (2/18) were terminated in the umbilical cord cyst with ultrasound soft markers group. In the group of umbilical cord cyst with fetal malformation, 19 pregnancies (19/26, 73.1%) had adverse outcomes, including pregnancy termination, intrauterine fetal demise, and perinatal death. Conclusions:The prognosis of isolated umbilical cord cysts is generally good. The umbilical cord cyst complicated by soft ultrasound marker and fetal malformation can have adverse outcomes, while conditions might be worse in those with fetal malformation. When an umbilical cord cyst is revealed, a systematical examination is recommended to identify whether it is combined with other ultrasound abnormalities.

Unusual umbilical cord finding in a neonate

Umbilical cord cyst refers to any cystic lesion that are associated with the umbilical cord. They are classified as true cysts or pseudocysts. True cysts are small remnants of the allantois, whereas false cysts originate from liquefaction of Wharton Jelly. In present case, cyst was diagnosed at birth without any associated congenital anomalies and resolved spontaneously within a few days requiring nil surgical intervention. Umbilical cord cysts deserve special attention since 20% of them, regardless of type, are associated with structural or chromosomal anomalies. Because of this, fetal karyotyping and amniocentesis should be considered when cysts persist beyond the first trimester.

Umbilical cord cyst: a diagnostic dilemma

Umbilical cord cyst refers to any cystic lesion associated with the umbilical cord. Cord cysts can be defined as true or false cysts and may occur in any location along the cord. They are irregular in shape and are located between the cord vessels. Authors are reporting the case of an infant with an umbilical cord tumor which had twice been misdiagnosed previously as a hemangioma, based on ultrasound image of its cystic and solid component with good vascular supply. The ultrasound image most likely suggestive of a hemangioma as a differential diagnosis led to caesarean section in our patient (based on large size of the lesion and fear of rupture of same during process of labour). The definitive diagnosis was made only after birth of the baby. Final diagnosis of true umbilical cord cyst was made after histopathological examination. Thus, there can be confusion in the diagnosis between umbilical cord hemangiomas and umbilical cord cysts based on ultrasound.

Falsely diagnosed umbilical edema due to necrotizing funisitis during prenatal ultrasound examination as an umbilical cord cyst corrected by postpartum histological test / 대한산부인과학회지

Umbilical cord cyst is correlated with the fetal chromosomal defects or its structural abnormality; therefore, the follow-up evaluations on fetal growth, lesion size, and concomitant congenital malformation are essential. Thus, when a prenatal ultrasonogram suspects an umbilical cord cyst, karyotyping is strongly recommended to rule out any chromosomal abnormality. The pathologic findings of necrotizing funisitis are paraumbilical exudates due to inflammatory changes, the secondary calcification change of the exudates, thrombosis, and sometimes edema of the umbilical cord. Even though incidence of umbilical cord cyst is rare, it must be differentiated from a cord edema caused by necrotizing funisitis. We have encountered a patient with a suspicious umbilical cord cyst in the third trimester of her pregnancy but the postpartum diagnosis turned out to be an umbilical cord edema by necrotizing funisitis, so we investigated the case with brief comparison to other literature.

Falsely diagnosed umbilical edema due to necrotizing funisitis during prenatal ultrasound examination as an umbilical cord cyst corrected by postpartum histological test / 대한산부인과학회지

Umbilical cord cyst is correlated with the fetal chromosomal defects or its structural abnormality; therefore, the follow-up evaluations on fetal growth, lesion size, and concomitant congenital malformation are essential. Thus, when a prenatal ultrasonogram suspects an umbilical cord cyst, karyotyping is strongly recommended to rule out any chromosomal abnormality. The pathologic findings of necrotizing funisitis are paraumbilical exudates due to inflammatory changes, the secondary calcification change of the exudates, thrombosis, and sometimes edema of the umbilical cord. Even though incidence of umbilical cord cyst is rare, it must be differentiated from a cord edema caused by necrotizing funisitis. We have encountered a patient with a suspicious umbilical cord cyst in the third trimester of her pregnancy but the postpartum diagnosis turned out to be an umbilical cord edema by necrotizing funisitis, so we investigated the case with brief comparison to other literature.

A Case of Multiple Umbilical Cord Cyst Associated with Intrauterine Fetal Death / 대한산부인과학회잡지

Cystic masses are among the most common sonographically detectable abnormalities of the umbilical cord. Umbilical cord cysts have been described in association with fetal anomalies, with chromosomal or structural defects being found in over 20% of cases. We present a case of umbilical cord cyst associated with fetal death at 29 weeks of gestation with a brief review of literatures.