Mesenchymal hamartoma of the liver. Case report and literature review

Liver transplantation as definitive treatment of an unresectable mesenchymal hamartoma in a child with Beckwith-Wiedemann Syndrome

Mesenchymal liver hamartomas are benign tumors that can cause life-threatening abdominal distension and carry a risk for malignant transformation. In this case report, we describe a 13-month-old male with Beckwith–Wiedemann Syndrome (BWS) who presented with multiple mesenchymal liver hamartomas causing severe intra-abdominal mass effect. Imaging revealed six large multi-locular cystic lesions, ranging from 3.8 to 8.9 cm in diameter. The large size and spread of the tumors necessitated liver transplantation for complete removal. The patient successfully underwent cadaveric piggyback liver transplantation at 25 months of age. He was alive at 16-month follow-up without evidence of tumor recurrence or graft rejection. Histological examination of the hepatic masses revealed mucinous epithelial lining and abundant hepatocytes in varying stages of differentiation, supporting the diagnosis of mesenchymal hamartoma. To the best of our knowledge, this is the first reported case of liver transplantation in a patient with BWS as definitive treatment for unresectable mesenchymal liver hamartoma.

Long-term follow up of mesenchymal hamartoma of liver--single center study

BACKGROUND/AIM

Mesenchymal hamartoma of liver (MHL) is a rare liver tumor of childhood. About 200 cases have been reported till now. Most of the work on MHL is limited to case reports and there are not many long term follow-up studies. We present our 20 years of experience with this uncommon entity. This study aims to highlight clinical features, diagnosis and treatment of MHL.

MATERIALS AND METHODS

All patients with a diagnosis of MHL in last 20 years were included in this retrospective study. The patients were evaluated clinically, radiologically and pathologically.

RESULTS

The total number of patients with a diagnosis of MHL was nine. Mean age of the patients was 19.89 ± 2.75 months. Right lobe was involved in eight patients. The prominent clinical features were distension of abdomen and anorexia. Surgical options used were hepatic lobectomy, wedge resection and enucleation. Histopathology of the specimens showed cysts of variable size with normal hepatocytes, bile ducts and connective tissue stroma. Overall mortality was one (11.11%).

CONCLUSION

MHL is a benign tumor that can present with various clinical features. It should be differentiated carefully from other liver masses especially malignant ones. The diagnosis can be made with the help of radiology and histopathology. Adequate resection is curative in most of the cases and long-term follow up is satisfactory.

Mesenchymal hamartoma of the liver: a systematic review

Mesenchymal hamartoma of the liver is the second commonest benign liver tumor in children, yet its biology and pathogenesis are poorly understood. Cytogenetic studies have suggested that the tumor may be a neoplasm rather than a hamartoma. Typically, it presents as a large benign multicystic liver mass in a child younger than 3 years amenable to complete resection. However, its imaging characteristics are variable, ranging from a few large cysts to a solid mass occupying one or both lobes of the liver. In addition, the tumor occasionally contains angiomatous elements or is multifocal. Most tumors gradually increase in size, some reaching enormous proportions, which can make surgery challenging. Paradoxically, a few undergo incomplete spontaneous regression and, on rare occasions, others have shown malignant transformation to undifferentiated (embryonal) sarcoma. These unusual pathological and biological features must be taken into account when considering the management of affected individuals.

Liver tumors

Liver tumors in children are rare, potentially complex, and encompass a broad spectrum of disease processes. Any age group may be affected, including the fetus. Most present with abdominal distension and/or a mass. Accurate preoperative diagnosis is usually possible using a combination of ultrasound scanning and cross-sectional imaging techniques (CT and/or MR), supplemented by liver biopsy and measurement of tumor markers. The most common benign tumors are hemangiomas, but mesenchymal hamartoma, focal nodular hyperplasia, and adenoma also are found. In Western countries, hepatoblastoma is the most common primary malignant liver tumor; disease-free survival is now possible in more than 80% of affected patients because of advances in combination chemotherapy, improved techniques of surgical resection, and the selective use of liver transplantation. In contrast, there has been less progress in the management of hepatocellular cancer, which still poses many therapeutic challenges.

Ultrasonographic diagnosis of a fetal abdominal mass: a case of a mesenchymal liver hamartoma and a review of the literature

A case of a prenatally recognized hepatic mesenchymal hamartoma is presented and the literature reviewed. These tumors are benign and usually present in early infancy with symptoms that are related to the mass effect on adjacent organs. Radiologic methods used in the past to image this tumor include angiography and ultrasound. However, there is no specific radiologic finding, and, therefore, the diagnosis is usually made during surgery. Once the tumor is removed, the prognosis is generally good. With the increasing use of high resolution ultrasound in prenatal diagnosis, this rare tumor should be considered in the differential diagnosis of any multicystic mass found in the fetal abdomen. The recognition of a mass should then alert the physician to the need for early neonatal intervention.

Cytogenetic analysis of a mesenchymal hamartoma of the liver

Cytogenetic analysis of a mesenchymal hamartoma of the liver in a 3-year-old child revealed a balanced translocation between chromosomes 15 and 19 as the sole chromosome change.

Mesenchymal hamartoma of the liver in an adult: radiologic diagnosis

A case of mesenchymal hamartoma of the liver in a 30-year-old female is reported. Ultrasonography, computed tomography, and hepatic angiography demonstrated the presence of a large, mixed cystic and solid mass within the liver, suggesting the diagnosis of a mesenchymal hamartoma. At surgery, the tumor proved to be unresectable.

Giant hamartoma of liver mimicking malignancy

Two infants with mesenchymal hamartoma of the liver are reported. This lesion clinically simulates a malignant neoplasm very closely and awareness is essential to avoid unnecessary major hepatic resections. The cases were successfully treated with simple enucleation.

Benign tumors of the liver in children: analysis of a series of 20 cases

Twenty children were treated for a benign hepatic tumor during a 17-year period. One child was not operated upon but followed since birth for 2 years by ultrasonogram. Mesenchymal hamartoma was found in 8 cases, a solitary cyst in 4, and 3 other cases of hamartomas were without cystic components. Two girls had lesions corresponding to focal nodular hyperplasia; two children had a solitary adenoma. Radical surgical treatment was possible in all 19 operated cases, except one case of focal nodular hyperplasia where a right lobectomy would have been necessary. Ultrasonography and angiography are the main explorations to be undertaken before treatment; preoperative embolization of the main arteries to the tumor was done in five cases, with unquestionable advantage in four of them. No mortality was recorded and results were good with a mean follow-up of 19 months.

Hepatic lymphangiomatosis. Report of a case and review of the literature

Hepatic lymphangioma is an extremely rare benign tumor, which usually occurs as part of a multiorgan lymphangiomatous involvement. We describe an adult patient with a huge hepatomegaly caused by a diffuse lymphangiomatous infiltration of the liver, which has never been reported before. Extrahepatic localizations could not be demonstrated. On ultrasonography and computed abdominal tomography, the liver lesions were not distinguishable from necrotic metastases. However, the endoscopic and histologic picture as well as the benign clinical evolution during a 2-yr follow-up allowed us to diagnose this rare benign disorder.

Hepatic mensenchymal hamartoma of an infant

An 8-month-old boy was found to have a solitary hepatic mesenchymal hamartoma. Histologically, the lesion appeared as a large island of loose mesenchymal tissue with few cystic bile ducts and liver cells. Electronmicroscopy showed microvilli on the surface of tumor cells and desmosomes between the cells. Immunohistochemical studies showed that alpha-fetoprotein was localized in the proliferating liver cells and bile ductal epithelium of this neoplasm. This case is the 17th case of hepatic mesenchymal hamartoma reported in Japan.

Mesenchymal hamartoma of the liver

Mesenchymal hamartoma is a benign, cystic lesion that arises from connective tissues of the portal tracts. It is most common in children under 5 years of age. The diagnosis can be suspected when a relatively asymptomatic child has a large, smooth mass in the liver. Radionuclide scans demonstrate a solitary lesion, and on ultrasound there are cystic spaces and septa. These are perfectly benign lesions and may be simply enucleated.

Mesenchymal hamartoma of the liver: report of 30 cases and review of the literature

Thirty cases of mesenchymal hamartoma of the liver are presented and compared with 42 previously published cases. The patients, 69% male, range in age from newborn to 10 years (average age 15 months, median age 10 months). Except for occasional cases in which the lesion is an incidental finding at autopsy, most present with progressive abdominal enlargement over a period of days to months. Physical and radiologic examinations are nonspecific except for the demonstration of a mass within or attached to the liver. The masses are large, averaging 1311 g, and frequently contain cysts filled with clear fluid or gelatinous material. Histologic examination shows a mixture of loose mesenchymal tissue, bile ducts, connective tissue, and hepatocytes along with cysts formed either from degenerative areas of mesenchyme or from dilated bile ducts and lympathics. Treatment is partial or total excision of the lesion. Mortality (7-17%) is related to intraoperative or postoperative complications. Recurrence or malignant transformation has not been noted.

Multicystic hepatic mesenchymal hamartoma of childhood. Computerized tomography and ultrasound characteristics

A case of massive mesenchymal hamartoma of the liver is described in a 13-month-old infant. A complex multicystic mass was demonstrated by ultrasound and computed tomography (CT). The appearances suggested the preoperative diagnosis.

Mesenchymal hamartoma of the liver in infants

Mesenchymal hamartoma of the liver is a rare benign tumor of childhood which has been confused with various other benign liver lesions, particularly vascular hamartomas which are mesodermal but not mesenchymal. The mass, frequently cystic, is characterized by an admixture of epithelial structures in a loose connective tissue stroma with fluid accumulation suggestive of lymphangiomatous channels. Four patients are presented and reviewed with 25 previously reported cases. The patients, usually asymptomatic, present during the first two years of life with progressive abdominal distention, which may be rapid because of increasing fluid content in the connective tissue stroma and cysts. Exploration and biopsy may be necessary before definitive excision. The present cases include a newborn, the youngest known, and a case in which radiation resulted in hyalinization of the mesenchyme, decrease in fluid content, and easlier resection. Respiratory distress and signs of vena caval obstruction due to intra-abdominal pressure were noted. Prognosis after extirpation is very good.

Hepatic mesenchymal hamartoma causing heart failure in the neonate

This is the first report of an hepatic mesenchymal hamartoma causing congestive heart failure in an infant. These benign tumors usually present as a bulky abdominal mass but rarely can present with congestive failure when the angiomatous component is prominent.