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.

Quistes de cuerda vocal: experiencia en 44 pacientes del Centro de Voz del Departamento de Otorrinolaringología de la Pontificia Universidad Católica de Chile / Vocal Cord Cysts: experience in 44 patients from the Voice Center of the Department of Otorhinolaryngology Pontificia Universidad Católica de Chile

Introducción: Los quistes de cuerda vocal son una causa relativamente frecuente de disfonía. Su origen es aún controversial, y su diagnóstico y manejo continúan siendo un desafío clínico. Objetivo: Exponer y analizar las características clínicas de los quistes de cuerda vocal en nuestra serie de pacientes. Material y método: Estudio retrospectivo descriptivo de los pacientes con diagnóstico de quiste de cuerda vocal atendidos en nuestro centro entre junio de 2012 y diciembre de 2015. Resultados: Se atendieron 44 pacientes con diagnóstico de quiste de cuerda vocal, lo que representa el 4,32% de las consultas en nuestro Centro de Voz. La mayoría de los pacientes fueron adultos, y de ellos el 68,29% correspondió a mujeres. El 34,1% de los pacientes fueron sometidos a tratamíento quirúrgico con técnica de microfonocirugía. El 75% de los pacientes operados presentó mejoría en patrón de onda mucosa videolaringoestroboscópica. Todos los pacientes en los que se disponía de encuestas de valoración subjetiva de la voz pre y posoperatorias demostraron mejoría vocal significativa. Conclusión: Los quistes de cuerda vocal son lesiones que afectan a niños y adultos. La videolaringoestroboscopía es clave en el diagnóstico de estas lesiones, y el tratamiento quirúrgico con microfonocirugía es efectiva en cuanto a resultados vocales desde el punto de vista anatómico y funcional.

Introduction: Vocal cord cysts are a relatively frequent cause of dysphonia. Their origin is still controversial, and their diagnosis and management continue to be a clinical challenge. Aim: To describe and analyze the clinical characteristics of vocal cord cysts in our series of patients. Material and method: Descriptive retrospective study of patients with diagnosis of vocal cord cyst attended in our center between June 2012 and December 2015. Results: 44 patients had the diagnosis of vocal cord cyst, which represents 4.32% of the patients that attended our Voice Center during that period. Most of the patients were adults, and among them 68.29% corresponded to women. 34.1% of the patients were submitted to surgical treatment with microphonosurgery technique. 75% of the surgical patients presented an improvement in the pattern of the videolaryngostroboscopic mucosal wave. All the patients in which pre and postsurgical subjective voice assessment polls were available, showed a significant voice improvement. Conclusion: Vocal cord cysts are lesions that affect both children and adults. The videolaryngostroboscopy evaluation is key in the diagnosis of these lesions, and the surgical treatment with microphonosurgery is effective in terms of anatomical and functional vocal results.

Pseudoquistes del cordón umbilical: reporte de un caso clínico y revisión de la literatura / Umbilical cord pseudo-cysts: clinical case report and review of the literature

Introducción: los quistes del cordón umbilical se clasifican en pseudoquistes y quistes verdaderos, la diferencia radica en la presencia de epitelio al interior del quiste en la revisión histológica. El objetivo de este documento es reportar un caso de pseudoquiste de cordón umbilical en Colombia y hacer una revisión de la literatura respecto a su origen, las diferencias diagnósticas y su posible asociación con alteraciones congénitas. Materiales y métodos: se presenta el caso de una paciente de veinte años remitida al Hospital Universitario del Valle, Cali, institución de tercer nivel de complejidad, a quien se le encuentran en ultrasonido en la parte proximal del cordón umbilical múltiples imágenes hipoecoicas, a la semana 16. A las 32 semanas se realiza cesárea por trabajo de parto pretérmino, podálico, con recién nacido de sexo femenino, sin defectos congénitos, cariotipo 46, XX. El cordón umbilical tenía apariencia hidrópica, en la observación microscópica se advirtieron los 3 vasos, edema de la gelatina de Wharton con cambios mixoides, sin epitelio, se concluye con diagnóstico de pseudoquistes del cordón umbilical. Se realizó una búsqueda bibliográfica en las bases de datos Medline, Ovid, ScienceDirect y Cochrane Reviews con los términos cordón umbilical, pseudoquiste y quiste del cordón umbilical. Conclusión: los pseudoquistes y quistes verdaderos del cordón umbilical son de buen pronóstico cuando son el único hallazgo anormal en el feto, pero los quistes tienen una importante asociación con otros defectos anatómicos y con alteraciones cromosómicas

Introduction: Umbilical cord cysts are classified as pseudo-cysts and true cysts, the difference being the presence of epithelium inside the cyst on hystology. The objective of this paper is to report a case of umbilical cord pseudocyst in Colombia, and a review of the literature regarding its origin, diagnostic difference, and potential association with congenital abnormalities. Materials and methods: 20 year-old female patient referred to the Valle University Hospital in Cali, a tertiary level institution. On ultrasound, multiple hypoechoic images were found in the proximal portion of the umbilical cord at 16 weeks. At 32 weeks, she was undergone to C-section due to pre-term labor and podalic presentation of a female newborn with no congenital abnormalities and 46, XX karyotype. The umbilical cord showed a hydropic appearance and, under the microscopic examination, 3 vessels were seen, accompanied by edema of Wharton’s jelly, mixoid changes and no epythelium. The final diagnosis was umbilical cord pseudocyst. A search of the literature was conducted in Medline, Ovid, ScienceDirect and Cochrane Reviews using the terms umbilical cord, pseudocyst, and umbilical cord cyst. Conclusion: Umbilical cord pseudocysts and true cysts are of good prognosis when they are the only abnormal finding in the fetus, but there is an important association between cysts and other anatomical defects and chromosomal abnormalities

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.