Umbilical cord cysts: Classification, diagnosis, prognosis, and pregnancy recommendations.

Umbilical cord cysts (UCCs)-cysts located in the umbilical cord that are derived from an abnormal embryonic development process-are typically an incidental discovery during prenatal ultrasound. It can be described as either a pseudocyst or a true UCC, which results from focal edema or degeneration of Wharton jelly or the remnants of embryonic development, respectively. Due to the relative rarity of the UCC, the clinical guidance of UCCs is not yet available. Herein, the aim of this paper is to discuss the classification, diagnosis, prognosis, and clinical management of UCCs through a literature review, in order to improve the understanding of UCCs among clinical obstetricians and pediatricians.

Color Doppler, HDlive, and HDlive Silhouette features of an umbilical cord cyst before 11 weeks of gestation: Diagnostic value.

OBJECTIVE: We describe transvaginal color Doppler, HDlive, and HDlive Silhouette features of an umbilical cord cyst (UCC) before 11 weeks of gestation. METHODS: In this cohort study, 135 transvaginal dating scans were performed at 7 to 10 + 6 weeks of gestation, and 17 UCCs were identified (12.6%). UCC was evaluated using color Doppler, HDlive, and HDlive Silhouette. The clinical characteristics, pregnancy courses, and outcomes were also investigated. RESULTS: UCC location was on the fetal side in six cases, at the free loop in 10 cases, and on the placental side in one case. There were seven single and 10 multiple cysts. Cyst diameters ranged from 3.3 to 11.3 mm (mean, 5.6; standard deviation, ±2.1). Blood flow inside the cyst was noted in three cases (17.6%). HDlive clearly showed the spatial relationships among UCC, the umbilical cord, midgut herniation, yolk sac, and embryo. Location of UCC could be clearly identified with HDlive. HDlive Silhouette showed central cysts inside UCCs in seven cases (41.2%). HDlive Silhouette also clearly demonstrated the sac of midgut herniation in the umbilical cord in 12 cases (70.6%). All UCCs resolved before 15 weeks (mean, 11.1 weeks; standard deviation, ±1.5). All fetuses with UCCs showed good neonatal outcomes. CONCLUSION: The incidence of UCC was high compared with that in previous reports. Color Doppler, HDlive, and HDlive Silhouette may provide information on the nature and origin of UCCs before 11 weeks of gestation. UCC before 11 weeks of gestation may be a common, transient, and benign finding.

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.

A Retrospective Cohort Analysis of the Genetic Assay Results of Foetuses with Isolated and Nonisolated Umbilical Cord Cyst.

Objective: To analyse the risk of clinical chromosomal abnormalities in foetuses with umbilical cord cysts. Methods: Data from all genetic assays that were performed as part of invasive prenatal diagnoses of umbilical cord cysts between October 2014 and June 2021 were retrospectively collected from Guangdong Women and Children Hospital. We compared the differences in genetic assay findings in isolated and nonisolated umbilical cord cyst cohorts. Results: A total of 49 singleton pregnancies and 2 foetuses that were one of the cotwins in monochorionic twin pregnancies were enrolled in the cohort; 20 isolated and 31 nonisolated umbilical cord cysts were identified in the cohort. One foetus (5%, 1/20) in the isolated umbilical cord cyst group showed chromosomal abnormalities and 17p12 microduplication. Twelve cases (38.7%, 12/31) of chromosomal abnormalities, including seven cases of trisomy 18, two cases of trisomy 13 and three cases of microdeletion, were identified in the nonisolated umbilical cord cyst group. The incidences of chromosomal abnormalities between the two groups were significantly different (1/20, 5% vs 13/31, 38.7%, p=0.003). There was no relative pathological medical exome sequencing finding in the three foetuses suffering from nonisolated umbilical cord cysts whose parents chose to undergo chromosomal microarray analysis (CMA) and medical exome sequencing. Conclusion: This retrospective cohort study evaluated the value of CMA in foetuses with umbilical cord cysts and suggested that copy number variants (CNVs) may be the basic genetic aetiological factors that should be considered for diagnostic evaluation. We recommended CMA as a basic genetic evaluation in cases of umbilical cord cysts, especially in nonisolated cases.

Sudden quadriparesis after non-overdose local anesthesia.

BACKGROUND: A well-known anesthetic, lidocaine is the most widely used local anesthetic. Local anesthetic systemic toxicity (LAST) is a life-threatening event with common and prominent presentations of central nervous system (CNS) toxicity and cardiovascular toxicity. The most frequent and prominent early warning signs and symptoms of LAST are central nervous system symptoms. While rare, cases quadriparesis after the administration of lidocaine has been reported. CASE PRESENTATION: In this paper, we report a very rare case of quadriparesis after local anesthesia administration for vocal cord cyst-removal surgery, which dramatically improved after treatment. LAST can occur during various routes of lidocaine administration, such as local spray. A possible mechanism of our case could be the local diffusion of lidocaine to the spinal cord, which caused the symptoms to mimic anterior cord syndrome. CONCLUSIONS: Our case presented a favorable outcome following the administration of intravenous lipid emulsion (ILE) for non-over dose local anesthetic drug induced spinal cord inhibition symptoms. These findings highlight the need for further research on the use of ILE to reverse LAST and other adverse effects of local anesthetics.

Partial molar pregnancy with a normal live fetus and umbilical cord abnormalities: A novel association with long-term follow-up: A case report.

A euploid fetus in a partial molar pregnancy can develop umbilical cord abnormalities as pregnancy goes on. So, careful examination of the umbilical cord can determine fetuses at risk for ominous adverse effects.

Patent urachus or bladder exstrophy occulta? A case of prenatally disappeared umbilical cord cyst.

We are reporting an umbilical cyst detected at early trimester which mimicking bladder exstrophy occulta. A 3-cm umbilical cord cyst and a slight ventrally located urinary bladder beneath the cord insertion site was detected at 14th gestational weeks, which decreased in size and disappeared at 28th week. A term female neonate born with a 2-cm defect over the base of the umbilical cord, revealed a patent urachal fistula, and a part of the herniated urinary bladder. Detection of a vanished umbilical cord cyst has to keep aware of, making an immediate definite diagnosis and management of urachal anomaly.

Intradural cyst: intramedullary or extramedullary? Illustrative case.

BACKGROUND: Intradural spinal cord cysts are uncommon and generally benign. It can be difficult to determine whether the cyst is intramedullary or extramedullary on preoperative imaging, and the location of the cyst may be determined intraoperatively. This patient presented with intractable back pain associated with imbalance and was found to have a cystic lesion of the ventriculus terminalis (VT). OBSERVATIONS: The patient was found to have a cystic lesion of the VT that was intramedullary rather than extramedullary, as initially expected based on preoperative imaging. LESSONS: VT is a rare cystic expansion of the conus medullaris that can appear extramedullary on preoperative imaging. Intraoperatively, this lesion was found to be intramedullary and was successfully treated with fenestration.

Clinical Image of a Spinal Ependymoma Discovered 8 Years after Initial Misdiagnosis as an Idiopathic Syringomyelia.

With the increasing frequency of neuroimaging, incidental intramedullary cavities are diagnosed more frequently. We present a case of asymptomatic incidental intramedullary cervical cavity diagnosed as an idiopathic syringomyelia as initial magnetic resonance imaging (MRI) showed an isolated cystic image without contrasted component. The patient had no subsequent MRI follow-up, but eventually showed symptoms 8 years later. By this stage of the disease, the MRI appearance had changed, showing a solid and enhanced component. The patient underwent surgical resection and histopathology concluded a papillary ependymoma (grade 2). This case illustrates how asymptomatic intramedullary cavities may hide an underlying tumoral process and why these cavities should not be considered as idiopathic syringomyelia by default, except after prolonged MRI follow-up.

Fetal cloacal dysgenesis sequence presented with first trimester megacystis and associated umbilical cord abnormalities.

Cloacal dysgenesis sequence occurs as a result of complete developmental failure of the urorectal septum. Typically, the sequence is featured by a smooth perineum, without any urethral, genital or anal openings. Its clinical manifestation differs throughout gestation. We report an interesting case of first trimester megacystis with associated umbilical cord abnormalities in a female fetus having cloacal dysgenesis sequence. This rare association reflecting high urinary pressure should first suggest urethral atresia. Our case highlights the importance of routine inspection of umbilical cord in the workup of early megacystis in terms of both etiology and fetal diagnosis.

Fetal umbilical cord cyst may evolve to omphalocele during pregnancy.

Omphalocele is rarely complicated by umbilical cord cysts. In our case, an umbilical cord cyst and fetal ascites were detected at 26 weeks' gestation in a fetus with trisomy 13. This changed to omphalocele with subsequently absorbed fetal ascites at 35 weeks' gestation. We propose two hypotheses. The abdominal wall may have been physically pierced or an omphalocele might have preexisted, and the intestinal tract in the hernia sac was pushed by fetal ascites.

[Analysis of CO2 laser and conventional laryngomicrosurgery treatments for vocal cord cyst: an evaluation of short-term voice acoustics outcomes].

Objective: To compare the short-term outcomes of CO2 laser and conventional laryngeal microsurgery for vocal cord cyst. Method: Patients with vocal cord cyst were divided randomly into two groups. One group was treated with CO2 laser (laser group) and the other underwent Micro-flap surgery(Micro-flap group). For the objective assessment, Amulti-dimensional voice program module for voice spectrum analysis was used. Result: In the laser group, there were no significant differences between the preoperative and 1 week postoperative parameters of Jitter, Shimmer and HNR(P>0.05). However，the parameters of G and VHI-10 were significantly different between the laser group and Micro-flap group(P<0.05). The objective data of the laser group pre-and post-surgery showed that the voice recovery of the laser group was significantly better than that of the Micro-flap group after 1 to 3 months of follow-up(P<0.05). But no significant differences of the parameters of G and VHI-10 was noted between the laser group and Micro-flap group(P>0.05). Conclusion: CO2 laser laryngeal microsurgery for vocal cord cyst can significantly improve pronunciation quality.

Prenatally diagnosed patent urachus with umbilical cord cyst and early surgical intervention.

OBJECTIVE: Description of rare diagnosis of patent urachus. DESIGN: Case report. SETTING: Department of Obstetrics and Gynecology, 2nd Faculty of Medicine and Faculty Hospital Motol Prague. CASE REPORT: Patent urachus is a rare diagnosis, which in this case was detected prenatally by ultrasound. Involution of the urachus is not fully completed upon birth, therefore in cases of small persisting communication between the urinary bladder and the umbilicus conservative approach and waiting for spontaneous closure is usually chosen. In our case surgery treatment has chosen as a prevention of urinary infection because of patent urachus manifested as a wide communication. CONCLUSION: This congenital defect usually manifests itself early after birth as a visible structural anomaly of the umbilicus and/or as urine leakage in the umbilicus opening area. It is important to keep in mind that urachus irregularities may be accompanied by other urinary system defects. Every child presenting with such an anomaly should therefore be thoroughly examined. If the procedure is performed by an experienced surgical team postoperative complications are uncommon and overall long-term prognosis for patients is excellent.

[Pathologies of peritoneo-vaginal canal in pediatric surgery at the teaching hospital Gabriel Touré]. / Les Pathologies du Canal Peritoneo-Vaginal en Chirurgie Pediatrique du CHU Gabriel Toure.

The closure anomalies of the peritoneal-vaginal canal include several clinical entities, which are at the origin of various symptomatology. OBJECTIVE: To study the anatomo-clinical and therapeutic aspects of pathologies of the peritoneal-vaginal canal. MATERIALS AND METHOD: This was a prospective study from January 1st to December 31st, 2015 carried out in the pediatric surgery department of University Hospital Gabriel Touré. It covered all children aged 0-15 years old with a pathology of the peritoneal-vaginal canal operating in the department during the study period. This study did not include cases that were not operated on or not seen during the study period. RESULTS: During the study period, 2,699 children were treated in pediatric surgery, of which 150 cases of pathology of the peritoneal-vaginal canal had a hospital frequency of 5.5%. The average age was 3.25 ± 9.63 years. The sex ratio was 14. The reason for consultation was intermittent or permanent inguinal or inguino-scrotal swelling in all children. The pathology was discovered by the parents during the pushing efforts in 46.7%. Inguino-scrotal swelling was found on physical examination in 40% of cases. The right side was reached in 60% of the cases. Hernia accounted for 80.6% of these pathologies. We recorded 31 cases of strangulation and 11 cases of craze. Immediate operative follow-up was simple in 92% of patients. This rate was 96% after 6 months. CONCLUSION: Pathologies of the peritoneal-vaginal canal are very common in pediatric surgical practice. The first place of these pathologies is occupied by hernia. They preferentially affect male infants.

Les anomalies de fermeture du canal péritonéo-vaginal (CPV) regroupent plusieurs entités cliniques qui sont à l'origine d'une symptomatologie variée. OBJECTIF: étudier les aspects anatomo-cliniques et thérapeutiques des pathologies du canal péritonéo-vaginal. MATÉRIELS ET MÉTHODE: il s'agissait d'une étude prospective du 1er Janvier au 31 Décembre 2015 réalisée dans le service de chirurgie pédiatrique du CHU Gabriel Touré. Elle a porté sur tous les enfants de 0-15 ans présentant une pathologie du canal péritonéo-vaginal opérés dans le service pendant la période d'étude. N'ont pas fait partie de cette étude, les cas non opérés et ou non vus pendant la période d'études. RÉSULTATS: Durant la période d'étude 2699 enfants ont été pris en charge en chirurgie pédiatrique dont 150 cas de pathologies du canal péritonéo-vaginal soit une fréquence hospitalière de 5,5%. L'âge moyen était de 3,25± 9,63 ans. Le sexe ratio était de 14. Le motif de consultation était la tuméfaction inguinale ou inguino-scrotale intermittente ou permanente chez tous les enfants. La pathologie a été découverte par les parents lors des efforts de poussées dans 46,7%. La tuméfaction inguino-scrotale a été retrouvée à l'examen physique dans 40% des cas. Le côté droit était atteint dans 60% des cas. La hernie a représenté 80,6% de ces pathologies. Nous avons enregistré 31 cas d'étranglement et 11 cas d'engouement. Les suites opératoires immédiates ont été simples chez 92% des patients. Ce taux était de 96% après 6 mois. CONCLUSION: Les pathologies du CPV sont très fréquentes dans la pratique chirurgicale pédiatrique. La première place de ces pathologies est occupée par la hernie. Elles touchent préférentiellement les nourrissons de sexe masculin.

Three-dimensional HDlive imaging of an umbilical cord cyst.

Umbilical cord cysts (UCC) are a rare congenital malformation. Previous reports have suggested that the second- and third-trimester UCC may be associated with other structural anomalies or chromosomal abnormalities. Therefore, high-quality imaging is clinically important for the antenatal diagnosis of UCC and to conduct a precise anatomical survey of intrauterine abnormalities. There have been few reports of antenatal diagnosis of UCC with the conventional two- and three-dimensional ultrasonography. In this report, we demonstrate the novel visual depiction of UCC in utero with three-dimensional HDlive imaging, which helps substantially with prenatal diagnosis. A case with an abnormal placental mass at 16 weeks and 5 days of gestation was observed in detail using HDlive. HDlive revealed very realistic images of the intrauterine abnormality: the oval lesion was smooth with regular contours and a homogenous wall at the site of cord insertion on the placenta. In addition, we confirmed the absent of umbilical cord, placental, and fetal structural anomalies. Here, we report a case wherein HDlive may have provided clinically valuable information for prenatal diagnosis of UCC and offered a potential advantage relative to the conventional US.

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.

[Prenatal diagnosis and evolution of patent urachus]. / Diagnostic et évolution prénatale de l'ouraque perméable: à propos d'un cas.

Prenatal ultrasonographic features of patent urachus consist in anechoic proximal cord cyst communicating with the bladder associated with large umbilicus. Distinction should be made with omphalocele and bladder extrophy. Spontaneous evolution leads to rupture during mid-trimester and bladder protrusion. Karyotyping is not mandatory in isolated typical cases. Early postnatal surgery is usually required.

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