| Abstract [eng] |
Objective. To describe a clinical case of neonatal hepatic hemangioma and placental chorioangioma; review relevant literature and present the prevalence, diagnostic methods, treatment strategies, and associations between these two tumors; and to provide recommendations. Methodology. A clinical case was described and analyzed. The literature search was conducted using PubMed and Google Scholar. Using inclusion and exclusion criteria, 60 relevant publications were selected for the review. Zotero, a bibliography management software, was utilized for article selection, review, and citation. Case report. A 30-year-old woman in her second pregnancy gave birth to monochorionic diamniotic twins. Uneven growth of the twins was observed starting at 27 weeks of gestation, and anemia was suspected in Twin B. At 30 weeks of gestation, an emergency Cesarean section was performed due to the unstable condition of the fetuses. The first twin to be born was a girl weighing 1350 g; the second girl weighed 1100 g. Both newborns scored 8/8 on the Apgar scale. After delivery, a yellowish-brown lesion was macroscopically visible at the edge of the placenta. Histological examination revealed acute chorioamnionitis and chorioangioma. Chorioangioma of the placenta was not diagnosed during pregnancy. The newborns were treated for 12 days in the neonatal intensive care unit due to respiratory failure. Respiratory therapy was administered, and empirical intravenous antibiotic therapy with penicillin and gentamicin was prescribed. Treatment of the newborns, who were stable, continued in the neonatal ward. An abdominal ultrasound was performed at 5 weeks of age. In the first twin, three hypoechoic, vascularized, well-defined lesions measuring 5-10 mm were incidentally found in the liver; multiple hepatic hemangiomas were suspected. The diagnosis was confirmed by contrast-enhanced ultrasound. Propranolol was prescribed orally for the treatment. Over several weeks, three dot-like hemangiomas appeared on the skin. No hemangiomas were observed on the skin, nor did an abdominal ultrasound reveal any abnormalities of the second twin. At 4 months of age, three small hemangiomas appeared on the skin; an abdominal ultrasound revealed multiple hypoechoic lesions measuring 4-14 mm in both lobes of the liver, confirming multiple hepatic hemangiomas. Treatment with propranolol was initiated. Follow-up revealed a positive response, and treatment was discontinued after 6 months. Conclusions. Hepatic hemangiomas in newborns are rare but clinically significant benign tumors, more commonly observed in preterm infants. In clinical practice, abdominal ultrasound is indicated when more than 5 hemangiomas are visible on the skin; however, visceral hemangiomas do not always occur in conjunction with superficial ones, and the exact type of hemangioma is determined by immunohistochemical testing for the GLUT-1 marker. Beta-blockers are the first-line treatment for both superficial and visceral hemangiomas; other treatments should be considered for large, deep lesions that do not respond to conservative management. Although the pathogenesis of hemangiomas is not fully understood, a clinical association with placental chorioangiomas has been observed, which is important for the early diagnosis of asymptomatic hemangiomas in the neonatal period. |
