Respiratory insufficiency in a newborn with mesenchymal hamartoma of the chest wall occupying the thoracic cavity

Multifocal Mesenchymal Hamartoma of the Newborn: A Case Study

BACKGROUND

A mesenchymal hamartoma is a rare benign tumor of the chest wall seen prenatally or at birth. Typically arising from one or more ribs, this tumor will have a rapid growth between weeks 28 and 36 of gestation, followed by a plateau and a spontaneous regression, usually within the first year of life.

CLINICAL FINDINGS

A 37-week 2-day, 3.48-kg female infant was admitted to the neonatal intensive care unit with a prenatally diagnosed left chest mass with a large pleural effusion and respiratory failure.

PRIMARY DIAGNOSIS

The infant was referred to our institution with multiple chest masses on the left side, resulting in the thorax's marked deformity. Imaging studies confirmed the presence of a multifocal mesenchymal hamartoma.

INTERVENTIONS

At laparotomy, 3 mesenchymal hamartomas were found. The lateral mass, encompassing ribs 5 and 6, resulted in an en bloc resection. The ribs cephalad and caudal were bowed and displaced but not involved in the mesenchymal hamartoma. Complete excision of the lateral mass was done, and histopathological examination confirmed the diagnosis of mesenchymal hamartoma.

OUTCOMES

After resection of the largest mass, the left lung reinflated appropriately, and within a few weeks, the infant was discharged home without supplemental oxygen support.

PRACTICE RECOMMENDATIONS

Symptomatic patients with cardiorespiratory compromise are best treated with surgical resection. In asymptomatic patients, it is best to proceed with serial imaging and conservative management with watchful waiting. Due to the rarity of the condition, data on long-term follow-up and outcomes are needed.

Bilateral Multifocal Hamartoma of the Chest Wall in an Infant

Background

Hamartoma of the thoracic wall is a rare benign tumor that occurs in infancy and can be mistaken for a malignancy due to its clinical and imaging features. Hamartomas are extrapleural soft tissue lesions that cause rib expansion and destruction and appear on imaging as cystic areas with fluid levels and calcification. They can cause scoliosis, pressure on the neighboring lung parenchyma and mediastinal displacement. While conservative treatment is recommended in asymptomatic cases, growing lesions require surgical excision.

Case Report

In this report, we present the imaging findings in a 3-month-old infant that presented with a firm swelling in the chest wall and was histopathologically confirmed to have a bilateral multifocal hamartoma.

Conclusions

Radiological imaging methods are important for accurate diagnosis of this very rare condition that can be confused with a malignancy.

Chest wall tumors: Diagnosis, treatment and reconstruction

The aim of the present study was to determine a suitable procedure for the treatment of chest wall neoplasms with less potential risk and an increased rate of survival. Fifty patients with suspected chest wall malignancies were analyzed using various preliminary investigation tools. Whole-chest scanning was performed in all the patients. The patients were subsequently subjected to biopsies for further confirmation of the neoplasm. All such patients were then treated with a surgical approach and radiation therapy, with a follow-up period lasting up to six years. The majority of the patients showed improved survival rates relative to conventional therapies. The survival rates of patients suffering from osteosarcoma (78%) were higher those of patients with rhabdomyosarcoma (73%) and malignant small round cell tumors (64%). The survival and the mortality rates of the patients with synovial sarcoma and fibrosarcoma were the same. This study, which was conducted on a small group of patients, has provided guidance for further studies on tumors of the chest wall, which may, in turn, increase the longevity of affected patients.

Prenatal and postnatal features of mesenchymal hamartoma of the chest wall: case report and literature review

Mesenchymal hamartoma of the chest wall is a rare, benign chondro-osseous tumor of the bone. Although it most commonly presents at birth or soon after, prenatal detection is rare. We report a case of prenatally detected mesenchymal hamartoma, and provide the rationale, details, and outcomes of our management. The literature is reviewed, with particular attention to prenatal detection and postnatal management options.

Urgent resection of bleeding congenital mesenchymal chest wall hamartoma in an infant

We report a case with prenatally diagnosed large cystic-solid mesenchymal chest wall hamartoma. An attempt of conservative management was made however repeated intralesional hemorrhage led to enlargement and severe anemia which required urgent resection at the age of 8 weeks. The infant had an unimpaired development over a follow-up of 4 years.

Mesenchymal hamartoma: prenatal and postnatal diagnosis by imaging

We present a case of a twin pregnancy in which one fetus developed a rapidly growing unilateral intrathoracic tumor. While a cystic adenomatoid malformation was suspected in the ultrasound scan, the magnetic resonance scan suggested a pulmonary blastoma or a bronchioalveolar carcinoma. Postnatal chest radiography and contrast-enhanced computed tomography of the affected newborn were performed, and it was ruled out the possibility of malignant origin. Finally, the anatomopathologic exam revealed the presence of a mesenchymal hamartoma in the chest wall. Nevertheless, parents refused any treatment for the newborn.

Mesenchymal hamartoma: prenatal diagnosis by MRI

The clinical presentation of thoracic mesenchymal hamartomas varies from an asymptomatic chest wall mass to severe respiratory distress resulting from compression of the airways and lungs. We present the findings on fetal US and MRI of a histologically confirmed case. Following surgical resection, pathological examination corresponded to the cross-sectional imaging features with haemorrhagic, cystic and calcified components. An awareness of the characteristic imaging findings will allow accurate diagnosis of this condition, even prenatally, and thus facilitate appropriate perinatal management and surgical planning.

Perinatal evolution of mesenchymal hamartoma of the chest wall

Mesenchymal hamartoma of the chest wall (MHCW) is a rare condition. Previously, surgical resection has been advocated with considerable post-operative morbidity. Evidence for conservative management is lacking because the natural history of MHCW is unknown. We present serial measurements of an antenatally detected MHCW (8 antenatal ultrasounds and 2 postnatal computed tomographic scans). The study demonstrates that the relative tumor size peaked at birth and then decreased postnatally. Based on this evidence, we believe that MHCW can be managed conservatively in an asymptomatic patient.

Congenital peribronchial myofibroblastic tumor: a case report

We describe a rare occurrence of congenital peribronchial myofibroblastic tumor of the lung presenting in early fetal life. A female patient in the 24th week of gestation who presented with polyhydramnios was admitted for examination. Ultrasound examination revealed a mass compromising the lungs. Because the intrauterine fetal death was revealed by the ultrasound, delivery was induced. Necropsy revealed a pulmonary lesion compromising the left lower pulmonary lobe together with hepatomegaly. Microscopic analysis of the lung showed a lesion with a storiform arrangement of spindle cells with focal peribronchial distribution. Hepatic architecture was diffusely altered by fibrotic tissue. Immunohistochemical analysis on the pulmonary lesion showed high vimentin positivity in the fusocellular components, pointing to the mesenchymal nature of the lesion. Significant differentiation of smooth muscle tissue, as indicated by high HHF35 positivity, was also observed. Electron microscopy on the pulmonary lesion revealed elongated cells with some cytoplasmatic processes, a finding that is also compatible with mesenchymal differentiation.