Cystic Hygroma of the Neck: Prognostic Factors and Therapeutic Implications

Abstract

The cystic hygroma (CH) of the neck is a rare congenital malformation that is due to an abnormal development of lymphatic system. Its gravity is due to the high frequency of chromosomic anomaly and/ or fetal malformations whom are associated to it. Objective of the study: To precise the prognostic features, as well as to bring forward therapeutic strategy. Study design: It is a retrospective study taking place in Kairouan’s hospital at gynecologic department lasting two years, from January 2011 to December 2012. During this period we collected nine cases of CH of the neck diagnosed in antenatality thanks to the obstetrical ultrasonography performed in the second trimester and the diagnosis of which is confirmed by the foetopathological examination. Results: Thanks to ultrasonography, the antenatal diagnosis of CH became easy and possible since the tenth week of pregnancy at 22% of cases. The CH is associated with foetal hydrops in 34% of cases and with a malformative syndrome in 22%. Three fetuses were already dead in uteru when diagnosing the CH. Karyotype was realized only in six cases in which 66% had chromosomal abnormalities. On the therapeutic plan, an uterine evacuation was performed to three patients who present already an in utero fetal death. The medical interruption of the pregnancy was indicated for the other cases. A fetopathological xam was systematicly performed and had confirmed the diagnosis . Besides, this exam showed a fetal hydrops in 3 cases and a polymalformatif syndrom in two cases. Conclusion: Cystic hygroma is an early suggestive sign of chromosomal aberration or malformative abnormalities. Prognostic features are well established: hydrops, malformative syndrome and karyotype abnormalities. Once one or several bad prognosis factors are identified, this justify a medical interruption of pregnancy.