Fetal axillary hemangiolymphangioma with secondary intralesional bleeding: serial ultrasound findings.

A case of fetal axillary hemangiolymphangioma coexisting with intralesional hemorrhage is presented. At 27 weeks' gestation, the fetus was found to have a 52 x 43-mm left axillary multilocular cystic mass which showed no signals on color Doppler. The mass was composed mostly of sonolucent spaces. At 29 weeks' gestation, an arterial flow signal (15 cm/s) was detected within the mass. In addition, two low-density echogenic cystic spaces with bidirectional flow waveforms were found, which raised the suspicion of intratumoral bleeding. Two weeks later, a fine-needle aspiration of the mass revealed both straw-colored and chocolate-colored fluid. The tumor size increased from 52 x 43 mm at 27 weeks to 100 x 79 mm at 37 weeks. Blood clots developed gradually in the hemorrhagic spaces. The pregnancy proceeded smoothly to term and at 38 weeks an elective Cesarean section was performed. After a surgical excision of the mass at the age of 4 days, a mixed cavernous hemangioma and cystic lymphangioma with secondary intralesional hemorrhage was confirmed histopathologically.