Cystic Hygroma of the Neck: Prognostic Factors and Therapeutic Implications

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. Page 2 of 4 Citation: Ridha F, Ines M, Houssem R, Sabra H, Wassim S (2015) Cystic Hygroma of the Neck: Prognostic Factors and Therapeutic Implications. Gynecol Obstet (Sunnyvale) 5: 345. doi:10.4172/2161-0932.1000345 Volume 5 • Issue 12 • 1000345 Gynecol Obstet (Sunnyvale) ISSN: 2161-0932 Gynecology, an open access journal Contrasting with chromosomal abnormalities, older women are not at a higher risk of CH. In our series, 78% of the patients were young (under 35 years old). By the way, no risk features for CH have been identified in literature. CH of the neck results from developing abnormalities in the lymphatic system. This system develops from five primitive cistern resulting from budding of the venous system [6]. These cisterns are made of: • Two bags flanking the internal jugular vein. • A retroperitoneal bag on the bases of the mesenteric vein. • Two iliac bags behind the sciatic vein. These primitive bags connect with eleven other cisterns and undergo budding centrifugal lymphatic system to the device. These lymphatic cisterns are drained by the adjacent venous system. The only constant connection is the lymphatic-jugular one. The CH occurs by partitioning of these cisterns or lack of communication with the adjacent venous system, in this case the internal jugular. Dilated jugular cisterns lead to fluid cavities. When the blockage is total, CH gradually increases in volume and can lead to compression of the foetal venous return, causing foetal hydrops. At the contrary, when the blockage is partial or if a secondary connection is established with the lymphatic system, the anomaly may regress (Figure 3). We aim to analyse the elements of the diagnosis and the prognosis of the CH of the neck in order to propose a practical attitude to have facing a CH of the neck.