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Collier S, Wasilewska EM, Craver R. Novel Autopsy Findings in Premature Infant With Beckwith-Wiedemann Syndrome Uniparental Disomy: Multifocal Developmental Dysplastic Chrondromatous Lesions and Cortical Neuronal Heterotopias. Fetal Pediatr Pathol 2024; 43:257-265. [PMID: 38587479 DOI: 10.1080/15513815.2024.2337639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 03/28/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND Beckwith-Wiedemann syndrome (BWS) is an overgrowth disorder that exhibits etiologic genomic imprinting characterized by molecular heterogeneity and phenotypic variability. Associations with localized developmental dysplastic chondromatous lesions and cortical neuronal heterotopias have not previously been described. CASE PRESENTATION A 33-week gestational age female had an omphalocele and intractable hypoglycemia at birth. The placenta demonstrated placental mesenchymal dysplasia. Detection of hypermethylation of IC1 and hypomethylation of IC2 confirmed Beckwith-Wiedemann syndrome, most likely due to uniparental disomy. Additional findings included right mid-tibial and right 5-8th developmental dysplastic chondromatous lesions, absent corpus callosum and numerous right-sided cortical neuronal heterotopias, right hemihypertrophy, multiple cystic hepatic mesenchymal hamartomas and hepatic infantile hemangiomas, nisidioblastosis and cystic pancreatic lesions. The infant died with multi-organ failure and anasarca at 7 weeks of life. CONCLUSION Beckwith-Wiedemann syndrome anomalies may include multifocal developmental dysplastic chondromatous lesions and cerebral neuronal heterotopias, lateralized, and corpus callosum aplasia.
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Affiliation(s)
- Stephanie Collier
- Department of Pathology, New Orleans Children's Hospital, LA State University Health Science Center and Children's Hospital of New Orleans, New Orleans, LA, USA
| | - Ewa M Wasilewska
- Department of Radiology, Tulane School of Medicine, Children's Hospital of New Orleans. New Orleans Children's Hospital, New Orleans, LA, USA
| | - Randall Craver
- Department of Pathology, New Orleans Children's Hospital, LA State University Health Science Center and Children's Hospital of New Orleans, New Orleans, LA, USA
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Pinelli D, Guerci C, Cammarata F, Cirelli R, Scatigno A, Colledan M. Huge mesenchymal hamartoma in a young adult: a case report. J Surg Case Rep 2024; 2024:rjae184. [PMID: 38572276 PMCID: PMC10984728 DOI: 10.1093/jscr/rjae184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 03/07/2024] [Indexed: 04/05/2024] Open
Abstract
Mesenchymal hamartoma of the liver (MHL) is rare. Less than 50 adult cases have been described. Due to their potential degeneration or recurrence, a complete surgical resection must be performed. We describe a case of a 26-year-old with a palpable solid lesion, which displaced abdominal organs. Percutaneous needle biopsies suggested the diagnosis of MHL. A right hemi-hepatectomy without segment 1 was performed; the post-operative course was uneventful. The mesenchymal component of the tumour was reactive to desmin and smooth muscle actin. Low proliferation index was confirmed (MIB1). Genetic counselling: the sequencing analysis of DICER1 and CDKN1C gene was negative, DNA methylation analysis on the chromosome 11p15 region was normal. After 42 months, there was no recurrence. In conclusion, clinicians should consider MHL in the differential diagnosis. The dimension and the need of radicality impose major liver resections or liver transplantations, which should be performed in referral centres.
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Affiliation(s)
- Domenico Pinelli
- Department of Organ Failure and Transplantation, ASST Papa Giovanni XXIII Hospital, Bergamo 24127, Italy
| | - Claudio Guerci
- Department of Organ Failure and Transplantation, ASST Papa Giovanni XXIII Hospital, Bergamo 24127, Italy
- University of Milan, Via Festa del Perdono 7, Milano 20122, Italy
| | - Francesco Cammarata
- Department of Organ Failure and Transplantation, ASST Papa Giovanni XXIII Hospital, Bergamo 24127, Italy
- University of Milan, Via Festa del Perdono 7, Milano 20122, Italy
| | - Riccardo Cirelli
- Department of Organ Failure and Transplantation, ASST Papa Giovanni XXIII Hospital, Bergamo 24127, Italy
| | - Agnese Scatigno
- Department of Pediatrics, ASST Papa Giovanni XXIII Hospital, Bergamo 24127, Italy
| | - Michele Colledan
- Department of Organ Failure and Transplantation, ASST Papa Giovanni XXIII Hospital, Bergamo 24127, Italy
- School of Medicine and Surgery, Unversity of Milano-Bicocca, Milan 20126, Italy
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Abstract
The most recent advance in the care of children diagnosed with hepatoblastoma and hepatocellular carcinoma is the Pediatric Hepatic International Tumor Trial, which opened to international enrollment in 2018. It is being conducted as a collaborative effort by the pediatric multicenter trial groups in North America, Europe, and the Far East. This international effort was catalyzed by a new unified global risk stratification system for hepatoblastoma, an international histopathologic consensus classification for pediatric liver tumors, and a revised 2017 collaborative update of the PRE-Treatment EXTent of disease radiographic based staging system.
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Affiliation(s)
- Rebecka Meyers
- Division Pediatric Surgery, University of Utah, Primary Children's Hospital, 100 North Mario Capecchi Drive, Suite 3800, Salt Lake City, UT 84113, USA.
| | - Eiso Hiyama
- Department of Pediatric Surgery, Hiroshima University Hospital, 1-2-3, Kasumi, Minami-Ku, Hiroshima 734-8551, Japan
| | - Piotr Czauderna
- Department of Surgery and Urology for Children and Adolescents, Medical University of Gdansk, Marii Skłodowskiej-Curie 3a, 80-210 Gdańsk, Poland
| | - Greg M Tiao
- Division Pediatric Surgery, Cincinnati Children's Hospital and Medical Center, 3333 Burnet Ave, Cincinnati, Ohio 45229, USA
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Lucas B, Ravishankar S, Pateva I. Pediatric Primary Hepatic Tumors: Diagnostic Considerations. Diagnostics (Basel) 2021; 11:333. [PMID: 33670452 PMCID: PMC7922091 DOI: 10.3390/diagnostics11020333] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 02/12/2021] [Accepted: 02/15/2021] [Indexed: 02/06/2023] Open
Abstract
The liver is the third most common site of abdominal tumors in children. This review article aims to summarize current evidence surrounding identification and diagnosis of primary hepatic tumors in the pediatric population based upon clinical presentation, epidemiology, and risk factors as well as classical imaging, histopathological, and molecular diagnostic findings. Readers will be able to recognize the features and distinguish between benign and malignant hepatic tumors within different age groups.
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Affiliation(s)
- Bryony Lucas
- Rainbow Babies and Children’s Hospital—Department of Pediatrics, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA
| | - Sanjita Ravishankar
- Rainbow Babies and Children’s Hospital—Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA
| | - Irina Pateva
- Rainbow Babies and Children’s Hospital—Department of Pediatric Hematology and Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA
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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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Pan ET, Yoeli D, Kueht ML, Galvan NTN, Cotton RT, O'Mahony CA, Rana A, Goss JA. Liver transplantation as definitive treatment of an unresectable mesenchymal hamartoma in a child with Beckwith-Wiedemann Syndrome. J Surg Case Rep 2017; 2017:rjx167. [PMID: 28928922 PMCID: PMC5597790 DOI: 10.1093/jscr/rjx167] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 08/12/2017] [Indexed: 12/12/2022] Open
Abstract
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.
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Affiliation(s)
- Evelyn T Pan
- Michael E DeBakey Department of Surgery, Division of Abdominal Transplantation, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - Dor Yoeli
- Michael E DeBakey Department of Surgery, Division of Abdominal Transplantation, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - Michael L Kueht
- Michael E DeBakey Department of Surgery, Division of Abdominal Transplantation, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - N Thao N Galvan
- Michael E DeBakey Department of Surgery, Division of Abdominal Transplantation, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - Ronald T Cotton
- Michael E DeBakey Department of Surgery, Division of Abdominal Transplantation, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - Christine A O'Mahony
- Michael E DeBakey Department of Surgery, Division of Abdominal Transplantation, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - Abbas Rana
- Michael E DeBakey Department of Surgery, Division of Abdominal Transplantation, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - John A Goss
- Michael E DeBakey Department of Surgery, Division of Abdominal Transplantation, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
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Liao W, Zhang B, Zhang W, Chen L, Zhang W, Zhang B, Chen X. A 4 and a half years old boy with mesenchymal hamartomas in the left lateral lobe of the liver: A case report and literature review. Medicine (Baltimore) 2017; 96:e7281. [PMID: 28767567 PMCID: PMC5626121 DOI: 10.1097/md.0000000000007281] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
RATIONALE Mesenchymal hamartomas of the liver is one type of rare liver tumor. PATIENT CONCERNS Mesenchymal hamartomas of the liver (MHL) is rarely reported in the left lobe of the liver in children who are more than 2 years old. It is difficult to distinguish it from liver lesions such as hepatoblastoma in children, and hepatocellular carcinoma and focal nodular hyperplasia in adults. In addition, it is hard to correctly diagnose it without pathological examination. DIAGNOSES Mesenchymal hamartomas of the liver. INTERVENTIONS This patient underwent an operation assisted by the Da Vinci surgical system and the tumor was completely resected. OUTCOMES No tumor recurrence or metastasis was observed 14 months after operation. LESSONS MHL is a benign tumor that is difficult to diagnose due to the lack of specific clinical symptoms and signs. The management of MHL remains controversial. To achieve a good long-term outcome, complete resection of MHL is recommended.
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