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Jacob D, Pratap T, Yadav A, Jalal MJA, Mahadevan P, Unnikrishnan R. Case Report of Undifferentiated Hepatic Embryonal Sarcoma with Mesenchymal Hamartoma: A Rare Entity. JOURNAL OF GASTROINTESTINAL AND ABDOMINAL RADIOLOGY 2022. [DOI: 10.1055/s-0042-1758125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
AbstractUndifferentiated embryonal sarcoma (UES) is a highly malignant hepatic neoplasm, which occurs mostly in pediatric population. There is a link between embryonal sarcoma and mesenchymal hamartoma as evidenced by clinicopathological overlap and similar genetic abnormality. Here, we report a case of UES in a young female in a background of mesenchymal hamartoma of liver.
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Affiliation(s)
- Dhanya Jacob
- Department of Radiology, VPS Lakeshore Hospital, Kochi, Kerala, India
| | - Thara Pratap
- Department of Radiology, VPS Lakeshore Hospital, Kochi, Kerala, India
| | - Abhishek Yadav
- Department of Comprehensive Liver Care, VPS Lakeshore Hospital, Kochi, Kerala, India
| | | | - Pushpa Mahadevan
- Department of Pathology, VPS Lakeshore Hospital, Kochi, Kerala, India
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Gang S, Choi Y, Lee S, Hong SY, Suh S, Han ES, Hong SK, Yi NJ, Lee KW, Suh KS. Progression of a persisting mesenchymal hamartoma to intrahepatic cholangiocarcinoma 24 years after the initial diagnosis: A case report. Ann Hepatobiliary Pancreat Surg 2022; 26:407-411. [PMID: 35995570 PMCID: PMC9721246 DOI: 10.14701/ahbps.22-022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 05/13/2022] [Accepted: 05/18/2022] [Indexed: 12/15/2022] Open
Abstract
Mesenchymal hamartoma of the liver (MHL) is a rare benign tumor that often presents in early childhood, and it rarely occurs in adulthood. Aberrant development of the portal tract is a known cause of MHL. Although limited information is available on the natural course of MHL, malignant transformation has been reported in a few cases. Here, we report a case of a 26-year-old female with intrahepatic cholangiocarcinoma secondary to unresected MHL. The patient underwent resection of the hepatic mass, which was diagnosed as MHL at 2 years of age, due to an increase in mass size and a suspicion of malignant transformation during work-up. Histopathology confirmed intrahepatic adenosquamous carcinoma in the background of MHL, with a T2N0M0 pathological stage (stage II). The surgical margin was free from tumor cells. The patient fully recovered postoperatively and started receiving adjuvant chemotherapy. Previous case reports have only reported about the development of undifferentiated embryonal sarcoma or angiosarcoma as malignant transformation of MHL. Cases of other malignancies have not been published; however, it is difficult to rule out the occurrence of various malignancies related to the portal tract when considering the pathogenesis of the disease. To the best of our knowledge, this is the first case report of adenocarcinoma of bile duct origin secondary to MHL. This case report suggests that aggressive surgical management should be considered after the initial diagnosis of MHL.
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Affiliation(s)
- Sujin Gang
- Department of Surgery, Seoul National University Hospital, Seoul, Korea,Department of Pediatric Surgery, Asan Medical Center, Seoul, Korea
| | - YoungRok Choi
- Department of Surgery, Seoul National University Hospital, Seoul, Korea,Corresponding author: YoungRok Choi, MD Department of Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea Tel: +82-2072-2511, Fax: +82-766-3975, E-mail: ORCID: https://orcid.org/0000-0001-9776-6325
| | - Sola Lee
- Department of Surgery, Seoul National University Hospital, Seoul, Korea
| | - Su young Hong
- Department of Surgery, Seoul National University Hospital, Seoul, Korea
| | - Sanggyun Suh
- Department of Surgery, Seoul National University Hospital, Seoul, Korea
| | - Eui Soo Han
- Department of Surgery, Seoul National University Hospital, Seoul, Korea
| | - Suk Kyun Hong
- Department of Surgery, Seoul National University Hospital, Seoul, Korea
| | - Nam-Joon Yi
- Department of Surgery, Seoul National University Hospital, Seoul, Korea
| | - Kwang-Woong Lee
- Department of Surgery, Seoul National University Hospital, Seoul, Korea
| | - Kyung-Suk Suh
- Department of Surgery, Seoul National University Hospital, Seoul, Korea
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Idrees M, Chung K, Philipoff A, Jeffrey G, Garas G, Jaques B, Delriviere L, De Boer B, Bhandari M, Mou L. Liver Transplant for Adult Recurrent Hepatic Mesenchymal Hamartoma and a Feasible Treatment Modality: A Case Report and Literature Review. Transplant Proc 2022; 54:1636-1639. [PMID: 35842317 DOI: 10.1016/j.transproceed.2022.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 04/12/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Adult hepatic mesenchymal hamartoma (HMH) is an extremely rare hepatic tumor. Recurrence following complete resection is uncommon. Liver transplantation (LT) is described as a possible treatment option in nonresectable HMH. We conducted a systematic review investigating LT in adult HMH followed by a case report describing evidence of extensive recurrence following complete resection of large right-sided HMH requiring LT. CASE REPORT A 46-year-old woman with symptomatic large right-hepatic HMH underwent right hemi-hepatectomy with histologic evidence of complete resection. Two and a half years postresection, she presented with abdominal pain and distension; imaging revealed large multi-septated hepatic cystic lesions within the liver suggestive of extensive recurrence of disease with concerns of malignant sarcomatous transformation. After a multidisciplinary team discussion, the lesion was deemed unresectable and the patient was referred for LT. Findings on transplantation included giant multiple hepatic cystic lesions occupying the entire abdomen and histopathological analysis confirmed recurrent HMH with no malignancy. The 6-month follow-up was unremarkable with no signs of postoperative complications or rejection. CONCLUSION We identified only 3 reported adult unresectable HMH cases in the English literature requiring LT, with good clinical outcome and no rejection on a 1-year follow-up. To our knowledge, we report the first recurrent HMH that required LT in the English literature. Current evidence suggests possible malignant sarcomatous transformation of those lesions. No guidelines exist on postresection surveillance for HMH; however, given their malignant potential, we suggest a benefit of imaging-based surveillance following HMH resection. Offering LT for nonresectable or recurrent HMH is a feasible treatment modality with a reported good outcome.
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Affiliation(s)
- Marwan Idrees
- Hepatopancreaticobiliary/General Surgery Department, Fiona Stanley Hospital, Western Australia, Australia.
| | - Kimberley Chung
- Department of Anatomical Pathology, PathWest, QE2 Medical Centre and Fiona Stanley Hospital, Hospital Avenue, Western Australia, Australia
| | - Adam Philipoff
- WA Liver and Kidney Transplant Department, Sir Charles Gairdner Hospital, Western Australia, Australia
| | - Gary Jeffrey
- WA Liver and Kidney Transplant Department, Sir Charles Gairdner Hospital, Western Australia, Australia
| | - George Garas
- WA Liver and Kidney Transplant Department, Sir Charles Gairdner Hospital, Western Australia, Australia
| | - Bryon Jaques
- WA Liver and Kidney Transplant Department, Sir Charles Gairdner Hospital, Western Australia, Australia
| | - Luc Delriviere
- WA Liver and Kidney Transplant Department, Sir Charles Gairdner Hospital, Western Australia, Australia
| | - Bastian De Boer
- Department of Anatomical Pathology, PathWest, QE2 Medical Centre and Fiona Stanley Hospital, Hospital Avenue, Western Australia, Australia
| | - Mayank Bhandari
- Hepatopancreaticobiliary/General Surgery Department, Fiona Stanley Hospital, Western Australia, Australia
| | - Lingjun Mou
- WA Liver and Kidney Transplant Department, Sir Charles Gairdner Hospital, Western Australia, Australia; Discipline of Surgery, Medical School, The University of Western Australia, Western Australia, Australia
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4
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18F-FDG PET/CT findings of mesenchymal hamartoma of the liver in an adolescent. Eur J Nucl Med Mol Imaging 2022; 49:4748-4749. [PMID: 35751665 DOI: 10.1007/s00259-022-05874-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 06/09/2022] [Indexed: 11/04/2022]
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Bauzon J, Morris D, St. Hill C, Schanda T, Scheidler M, Chang S. A rapidly growing mesenchymal hamartoma in a neonate with known placental anomalies. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2022.102324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Ma Y, Chen C, Ding X, Zhang X, Ma Y. Hepatic cystic echinococcosis misdiagnosed as hepatic hamartoma: A case report. Asian J Surg 2022; 45:1086-1087. [PMID: 35190232 DOI: 10.1016/j.asjsur.2022.01.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 12/22/2021] [Accepted: 01/28/2022] [Indexed: 11/15/2022] Open
Affiliation(s)
- Yuan Ma
- First Clinical Medical School, Lanzhou University, Lanzhou, Gansu, 730000, China
| | - Congmin Chen
- First Clinical Medical School, Lanzhou University, Lanzhou, Gansu, 730000, China
| | - Xinyun Ding
- First Clinical Medical School, Lanzhou University, Lanzhou, Gansu, 730000, China
| | - Xiaohui Zhang
- First Clinical Medical School, Lanzhou University, Lanzhou, Gansu, 730000, China
| | - Yuqing Ma
- Department of Anesthesiology, First Hospital of Lanzhou University, Lanzhou, 730000, China.
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7
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Cahís Vela N, Loverdos Eseverri I, Beltrán Salazar VP, Brun Lozano N, Ferreres Piñas JC, Hernández CJR. Liver Mesenchymal Hamartoma. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2021. [DOI: 10.1016/j.epsc.2021.101839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Le LT, Phan HT, Nguyen TS, Truong KD, Nguyen DT, Nguyen TB, Pham TTT. Infantile mesenchymal hamartoma of the liver with elevated alpha fetoprotein. BJR Case Rep 2021; 7:20200196. [PMID: 34131505 PMCID: PMC8171140 DOI: 10.1259/bjrcr.20200196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 12/22/2020] [Accepted: 01/18/2021] [Indexed: 11/27/2022] Open
Abstract
Mesenchymal hamartoma of the liver (MHL) is a benign tumour that most commonly occurs in children. In most cases of MHL, the α fetoprotein (AFP) level is within the normal limits, only in a few cases, increased AFP has been described which usually causes misdiagnosis of hepatoblastoma. We report a case of a 3-month-old paediatric patient who was incidentally detected with a very high level of AFP, at 6388.4 ng ml−1. Ultrasound revealed a right liver tumour, segment VI, measuring at 56 × 53 mm. According to images of ultrasound and MRI, the diagnosis was mesenchymal hepatic sarcoma. The paediatric patient had surgery to remove the entire liver segment containing the tumour. Micropathological examination showed that the tumour was a MHL. The serum AFP level fell rapidly to near normal following the surgery. The MHL benign liver tumour with an atypical presentation caused a very high AFP level. This was a rare clinical case, and it was difficult to diagnose.
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Martins-Filho SN, Putra J. Hepatic mesenchymal hamartoma and undifferentiated embryonal sarcoma of the liver: a pathologic review. Hepat Oncol 2020; 7:HEP19. [PMID: 32647564 PMCID: PMC7338921 DOI: 10.2217/hep-2020-0002] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
This review highlights two rare entities that are predominantly seen in children: hepatic mesenchymal hamartoma (HMH) and undifferentiated embryonal sarcoma of the liver (UESL). HMH is a benign lesion predominantly seen in the first 2 years of life, while UESL is malignant and usually identified in patients between 6 and 10 years of age. UESL may arise in the background of HMH, and the association has been supported by similar chromosomal aberrations (19q13.4). The diagnosis of both lesions is primarily based on histologic evaluation, as the clinical and radiological features are not always typical. The clinicopathologic characteristics, pathogenesis, differential diagnoses and treatment for both lesions are discussed.
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Affiliation(s)
- Sebastiao N Martins-Filho
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Department of Laboratory Medicine & Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Juan Putra
- Department of Laboratory Medicine & Pathobiology, University of Toronto, Toronto, Ontario, Canada.,Division of Pathology, Department of Paediatric Laboratory Medicine, the Hospital for Sick Children, Toronto, Ontario, Canada
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10
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Mesenchymal Hamartoma of the Liver in Older Children: An Adult Variant or a Different Entity? Report of a Case With Review of the Literature. Appl Immunohistochem Mol Morphol 2016; 23:667-73. [PMID: 22935827 DOI: 10.1097/pai.0b013e31826b56ae] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Mesenchymal hamartoma of the liver (MHL) is an uncommon benign hepatic tumor typically affecting children under 2 years of age. Only 5% of MHL occur after 5 years and are very rarely observed in adults. According to age, MHL may differ in their morphologic features. We report a case of an 11-year-old boy with MHL, resembling a malignant lesion from a clinical point of view, characterized by unusual histologic features: a prominent myxoid stroma, with a minimal ductular component, and absent cystic spaces. The present case and others reported in older children or adults demonstrate that these lesions may represent a potential diagnostic pitfall when occurring outside their classic clinical context especially because of their peculiar histologic findings. Moreover, it may be hypothesized that variation in morphology might be related to different evolutive stages of the cell of origin. To support this hypothesis, we therefore studied the presence of components of the Notch pathway inside and outside the lesion. Their absence inside the tumor and, in contrast, the expression of Notch2 and HES1 evident in overrepresented bile ducts present at the periphery might explain not only the lack of bile ducts, but also indicate a more adult phenotype compared with classic pediatric MHL, which show more bile ducts and liver trabeculae embedded in the mesenchymal matrix.
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11
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Affiliation(s)
- P V Usiakiĭ
- A.V. Vishnevsky Institute of Surgery, Ministry of Health of Russian Federation, Moscow
| | - V A Kubyshkin
- A.V. Vishnevsky Institute of Surgery, Ministry of Health of Russian Federation, Moscow
| | - Iu A Kovalenko
- A.V. Vishnevsky Institute of Surgery, Ministry of Health of Russian Federation, Moscow
| | - D V Kalinin
- A.V. Vishnevsky Institute of Surgery, Ministry of Health of Russian Federation, Moscow
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12
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Li J, Cai JZ, Guo QJ, Li JJ, Sun XY, Hu ZD, Cooper DKC, Shen ZY. Liver transplantation for a giant mesenchymal hamartoma of the liver in an adult: Case report and review of the literature. World J Gastroenterol 2015; 21:6409-16. [PMID: 26034379 PMCID: PMC4445121 DOI: 10.3748/wjg.v21.i20.6409] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Revised: 01/26/2015] [Accepted: 02/11/2015] [Indexed: 02/06/2023] Open
Abstract
Mesenchymal hamartomas of the liver (MHLs) in adults are rare and potentially premalignant lesions, which present as solid/cystic neoplasms. We report a rare case of orthotopic liver transplantation in a patient with a giant MHL. In 2013, a 34-year-old female sought medical advice after a 2-year history of progressive abdominal distention and respiratory distress. Physical examination revealed an extensive mass in the abdomen. Computed tomography (CT) of her abdomen revealed multiple liver cysts, with the diameter of largest cyst being 16 cm × 14 cm. The liver hilar structures were not clearly displayed. The adjacent organs were compressed and displaced. Initial laboratory tests, including biochemical investigations and coagulation profile, were unremarkable. Tumor markers, including levels of AFP, CEA and CA19-9, were within the normal ranges. The patient underwent orthotopic liver transplantation in November 2013, the liver being procured from a 40-year-old man after cardiac death following traumatic brain injury. Warm ischemic time was 7.5 min and cold ischemic time was 3 h. The recipient underwent classical orthotopic liver transplantation. The recipient operative procedure took 8.5 h, the anhepatic phase lasting for 1 h without the use of venovenous bypass. The immunosuppressive regimen included intraoperative induction with basiliximab and high-dose methylprednisolone, and postoperative maintenance with tacrolimus, mycophenolate mofetil, and prednisone. The recipient's diseased liver weighed 21 kg (dry weight) and measured 41 cm × 32 cm × 31 cm. Histopathological examination confirmed the diagnosis of an MHL. The patient did not experience any acute rejection episode or other complication. All the laboratory tests returned to normal within one month after surgery. Three months after transplantation, the immunosuppressive therapy was reduced to tacrolimus monotherapy, and the T-tube was removed after cholangiography showed no abnormalities. Twelve months after transplantation, the patient remains well and is fulfilling all normal activities. Adult giant MHL is extremely rare. Symptoms, physical signs, laboratory results, and radiographic imaging are nonspecific and inconclusive. Surgical excision of the lesion is imperative to make a definite diagnosis and as a cure. Liver transplantation should be considered as an option in the treatment of a non-resectable MHL.
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Abstract
Mesenchymal hamartoma is a benign hamartomatous lesion with unknown histogenesis. It generally occurs in pediatric population and has been rarely reported in adults. We report an unusual case of a cystic mesenchymal hamartoma of liver in an 81-year-old elderly male. A provisional diagnosis of liver abscess was made and definitive histopathology confirmed the diagnosis. This case has been reported because of its rarity.
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Affiliation(s)
- Madhawi Sharma
- Department of Laboratory Medicine, Fortis Escorts Hospital, SRL Ltd., Jaipur, Rajasthan, India
| | - Preeti Bansal
- Department of Laboratory Medicine, Fortis Escorts Hospital, SRL Ltd., Jaipur, Rajasthan, India
| | - Neeraj Krishna Goyal
- Department of Laboratory Medicine, Fortis Escorts Hospital, SRL Ltd., Jaipur, Rajasthan, India
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14
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Wildhaber BE, Montaruli E, Guérin F, Branchereau S, Martelli H, Gauthier F. Mesenchymal hamartoma or embryonal sarcoma of the liver in childhood: a difficult diagnosis before complete surgical excision. J Pediatr Surg 2014; 49:1372-7. [PMID: 25148740 DOI: 10.1016/j.jpedsurg.2014.04.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Revised: 03/03/2014] [Accepted: 04/11/2014] [Indexed: 12/21/2022]
Abstract
BACKGROUND Clinical experience shows that the primary diagnosis of mesenchymal hamartoma (MHL) and embryonal sarcoma of the liver (ESL) recurrently is mistaken, leading to inadequate managements. We evaluated the accuracy of the primary diagnosis of those liver tumors, compared with the final histological diagnosis. METHODS Records of 25 children (0-16 years, treated 01/1989-01/2013) with final diagnosis of MHL or ESL were analyzed. RESULTS Final diagnosis was MHL in 18/25 children (10 solid-cystic, 2 cystic, 6 solid) and ESL in 7/25 (4 solid-cystic, 1 cystic, 2 solid). Only 3/7 ESL patients and 15/18 MHL patients fell into the "typical" age group. In 13/25 children primary diagnosis was based on imaging only. Overall, primary diagnosis was concordant with the final diagnosis in 17/25 patients. Of 99/25 biopsied cases, 4/9 biopsy results exposed the wrong final diagnosis; of cystic-solid masses 4/14 were mistaken, of cystic masses 1/3, of solid masses 3/8. CONCLUSION Preoperative diagnosis of MHL and ESL is challenging because of atypical clinical presentation, misleading "typical" radiological findings, and difficult interpretation of biopsies. If feasible, complete surgical resection of, in particular, solid-cystic liver masses in the pediatric age group must be aimed for, to get a definitive, final diagnosis, followed by an adequate treatment strategy.
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Affiliation(s)
- Barbara E Wildhaber
- Hôpitaux Universitaires de Genève, Department of Pediatrics, Division of Pediatric Surgery, 6 Rue Willy Donzé, 1205 Geneva, Switzerland.
| | - Ernesto Montaruli
- Hôpitaux Universitaires de Genève, Department of Pediatrics, Division of Pediatric Surgery, 6 Rue Willy Donzé, 1205 Geneva, Switzerland
| | - Florent Guérin
- Hôpitaux Universitaires Paris Sud-Bicêtre, Department of Pediatric Surgery, 78 Rue du Général Leclerc, 94275 Le Kremlin Bicêtre, France
| | - Sophie Branchereau
- Hôpitaux Universitaires Paris Sud-Bicêtre, Department of Pediatric Surgery, 78 Rue du Général Leclerc, 94275 Le Kremlin Bicêtre, France
| | - Hélène Martelli
- Hôpitaux Universitaires Paris Sud-Bicêtre, Department of Pediatric Surgery, 78 Rue du Général Leclerc, 94275 Le Kremlin Bicêtre, France
| | - Frédéric Gauthier
- Hôpitaux Universitaires Paris Sud-Bicêtre, Department of Pediatric Surgery, 78 Rue du Général Leclerc, 94275 Le Kremlin Bicêtre, France
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Scheele J, Lemke J, Barth TFE, Juchems M, Wittau M, Kornmann M, Henne-Bruns D. Chondroid hamartoma of the liver. GMS INTERDISCIPLINARY PLASTIC AND RECONSTRUCTIVE SURGERY DGPW 2014; 3:Doc16. [PMID: 26504727 PMCID: PMC4582503 DOI: 10.3205/iprs000057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A 60-year-old patient presented with a solitary mass within the right hepatic lobe. Diagnostic imaging revealed a solid tumor on the diameter of 3 cm. In absence of any extrahepatic manifestation and based on FNAC findings the lesion was classisfied a primary hepatic chondroid sarcoma. However, after right hemihepatectomy histologic assessment resulted the final diagnosis of a benign chondroid hamartoma. Our findings add another variant to the versatile phenotype of liver hamartoma.
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Affiliation(s)
- Jan Scheele
- Clinic of General and Visceral Surgery, University of Ulm, Ulm, Germany
| | - Johannes Lemke
- Clinic of General and Visceral Surgery, University of Ulm, Ulm, Germany
| | | | - Markus Juchems
- Clinic of Diagnostic and Interventional Radiology, University of Ulm, Ulm, Germany
| | - Mathias Wittau
- Clinic of General and Visceral Surgery, University of Ulm, Ulm, Germany
| | - Marko Kornmann
- Clinic of General and Visceral Surgery, University of Ulm, Ulm, Germany
| | - Doris Henne-Bruns
- Clinic of General and Visceral Surgery, University of Ulm, Ulm, Germany
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Mathews J, Duncavage EJ, Pfeifer JD. Characterization of translocations in mesenchymal hamartoma and undifferentiated embryonal sarcoma of the liver. Exp Mol Pathol 2013; 95:319-24. [PMID: 24120702 DOI: 10.1016/j.yexmp.2013.09.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Accepted: 09/27/2013] [Indexed: 01/28/2023]
Abstract
BACKGROUND Mesenchymal hamartoma of the liver (MHL) is an uncommon benign primary liver tumor that typically occurs in the pediatric population, although cases have been described in adults. MHL is sometimes associated with the highly malignant undifferentiated embryonal sarcoma (UES), and the synchronous or metachronous occurrence of MHL and UES suggests they share a common genetic link. Although the exact mechanism of tumorigenesis has not been identified, MHL cases harbor recurring chromosomal rearrangements involving 19q13. DESIGN In order to provide more details on the genetic events of MHL tumorigenesis, capture-based next generation sequencing (NGS) targeted to loci recently shown to be involved in a translocation in a case of UES arising in MHL (specifically, the MALAT1 gene on chromosome 11 and a gene poor region termed MHLB1 on chromosome 19) was performed on formalin fixed paraffin embedded tissue from seven cases of MHL. RESULTS Chromosome rearrangements involving the MHLB1 locus were identified in three of the seven cases, including the translocation t(11,19)(q13.1;q13.42) involving the MALAT1 gene; the translocation t(2,19)(q31.1;q13.42) involving AK023515, an uncharacterized noncoding gene; and the inversion inv(19,19)(q13.42;q13.43) involving the PEG3 gene encoding a Kruppel-type zinc-finger protein. Rearrangements were exclusively identified in pediatric tumors. In each case, the presence of the rearrangement was confirmed by PCR and interphase FISH. Interphase FISH also demonstrated that the arrangements occur within the spindle cell component but not within the epithelial components of the tumor. CONCLUSIONS Since the MHLB1 locus contains a CpG-rich region whose methylation regulates C19MC miRNA genes, rearrangements that disrupt this region may contribute to MHL development through alteration of miRNA expression. The demonstration that the loose stromal cells harbor the rearrangements indicates that (some cases of) MHL are a neoplastic process due to a somatic genetic change and not a germline abnormality.
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Affiliation(s)
- James Mathews
- Lauren V. Ackerman Laboratory of Surgical Pathology, Department of Pathology, Washington University School of Medicine, St. Louis, MO, USA.
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Gupta R, Gupta R, Bansal K, Mohta A. Aspiration cytology of mesenchymal hamartoma of the liver: report of a case and review of literature. Diagn Cytopathol 2012; 41:434-6. [PMID: 22298335 DOI: 10.1002/dc.22824] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2011] [Accepted: 11/19/2011] [Indexed: 11/07/2022]
Affiliation(s)
- Ruchika Gupta
- Department of Pathology, Chacha Nehru Bal Chikitsalaya Affiliated to Maulana Azad Medical College, Delhi, India.
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Tucker SM, Cooper K, Brownschidle S, Wilcox R. Embryonal (undifferentiated) sarcoma of the liver with peripheral angiosarcoma differentiation arising in a mesenchymal hamartoma in an adult patient. Int J Surg Pathol 2011; 20:297-300. [PMID: 22134632 DOI: 10.1177/1066896911424899] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Embryonal (undifferentiated) sarcoma of the liver (ESL) is a rare malignant neoplasm composed of undifferentiated sarcomatous tissue. We are presenting a case of a 74-year-old woman diagnosed with an ESL arising from a mesenchymal hamartoma of the liver (MHL). Both lesions occur typically in childhood, with only rare reported cases in adults. Histologically, the mass consisted primarily of loose myxoid stroma admixed with bland spindle cells and extensive, cystic (lymphangioma-like) degeneration. However, also present peripherally were markedly atypical cells (including multi-nucleated forms) and hyaline globules. Additionally, atypical cells with a sinusoid tectorial growth pattern were identified, which were positive for CD31, CD34 and Factor VIII. The tumor cells of ESL are classically described as being negative for tissue-specific immunohistochemical markers. However our case demonstrated focal positivity for vascular markers CD31, CD34 and Factor VIII and this along with the sinusoidal tectorial growth pattern, mimicked an angiosarcoma.
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Affiliation(s)
- Suzanne M Tucker
- Fletcher Allen Health Care, 300 Colchester Avenue, Burlington, VT 05401, USA.
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Levy M, Trivedi A, Zhang J, Miles L, Mattis AN, Kim GE, Lassman C, Anders RA, Misdraji J, Yerian LM, Xu H, Dhall D, Wang HL. Expression of glypican-3 in undifferentiated embryonal sarcoma and mesenchymal hamartoma of the liver. Hum Pathol 2011; 43:695-701. [PMID: 21937079 DOI: 10.1016/j.humpath.2011.06.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2011] [Revised: 06/06/2011] [Accepted: 06/08/2011] [Indexed: 12/25/2022]
Abstract
Glypican-3 (GPC3) is an oncofetal protein that has been demonstrated to be a useful diagnostic immunomarker for hepatocellular carcinoma and hepatoblastoma. Its expression in mesenchymal tumors of the liver, particularly undifferentiated embryonal sarcoma (UES) and mesenchymal hamartoma (MH), has not been investigated. In this study, a total of 24 UESs and 18 MHs were immunohistochemically stained for GPC3 expression. The results showed cytoplasmic staining for GPC3 in 14 (58%) UESs, of which 6 exhibited diffuse immunoreactivity and the remaining 8 showed focal positivity. The patients with GPC3-positive UES tended to be younger (mean 18 years; median 11 years) than those with GPC3-negative tumors (mean 39.4 years; median 27 years), although the difference did not reach statistical significance (P = .06). Eight MHs also exhibited GPC3 immunoreactivity (44%; 4 diffuse and 4 focal). Positive staining in all 8 cases was primarily seen in entrapped nonlesional hepatocytes with a canalicular and cytoplasmic staining pattern. In only 4 cases (22%) was GPC3 immunoreactivity also observed in the mesenchymal component. The patients with positive staining also tended to be younger (mean 2.6 years; median 1.1 years) compared with those with negative staining (mean 16.3 years; median 4.5 years), but the difference was not statistically significant (P = .15). Our data demonstrate that GPC3 is expressed in a subset of UES and MH of the liver. Caution should thus be exercised when evaluating a GPC3-expressing hepatic neoplasm, particularly on a needle biopsy when the differential diagnosis includes poorly differentiated hepatocellular carcinoma or hepatoblastoma.
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Affiliation(s)
- Mary Levy
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
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