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Published on: August 31, 2022
Hepatic mesenchymal hamartoma mimicking hemangioma on multiple-phase gadolinium-enhanced MRI
Savvas Andronikou1, Susanne Soin, Omar Nafoos
1Department of Radiology, Stellenbosch University, John Radcliffe Hospital, Oxford. docsav@mweb.co.za
Abstract:
Mesenchymal Hamartoma [MH] is a cystic benign liver mass occurring in children. Diagnostic confusion with hepatoblastoma may arise when alpha-feto-protein is elevated, and with hemangioendothelioma when imaging shows centripetal filling. We demonstrate one such case with progressive centripetal enhancement of a liver mass with Gadolinium enhanced multiple phase gradient-echo MRI, in a child with raised alpha-feto protein.
Insights
Mesenchymal hamartoma (MH) can mimic other pediatric liver tumors. This case highlights MRI findings that aid in distinguishing MH, especially with elevated alpha-fetoprotein.
Area of Science:
- Pediatric Radiology
- Hepatobiliary Imaging
- Pediatric Oncology
Background:
- Mesenchymal hamartoma (MH) is a rare, benign pediatric liver tumor.
- Diagnostic challenges arise due to overlapping clinical and imaging features with malignant neoplasms like hepatoblastoma and hemangioendothelioma.
- Elevated alpha-fetoprotein (AFP) and centripetal enhancement on imaging can cause diagnostic confusion.
Observation:
- A pediatric case presented with a liver mass and elevated AFP.
- Imaging revealed progressive centripetal enhancement, a pattern often associated with other liver lesions.
- Gadolinium-enhanced multiple-phase gradient-echo MRI was utilized for detailed visualization.
Findings:
- The MRI findings, particularly the progressive centripetal enhancement pattern, were crucial in the diagnostic workup.
- While AFP was elevated, the specific enhancement characteristics on MRI helped differentiate MH from other pediatric liver masses.
- This case underscores the importance of advanced MRI techniques in diagnosing pediatric liver lesions.
Implications:
- Accurate differentiation of MH is vital to avoid unnecessary aggressive treatment for benign conditions.
- Advanced MRI protocols can improve diagnostic confidence in complex pediatric liver mass cases.
- Understanding imaging nuances is key for pediatric radiologists and oncologists managing liver tumors in children.
