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From the archives of the AFIP: Pediatric liver masses: radiologic-pathologic correlation part 1. Benign tumors
Ellen M Chung1, Regino Cube, Rachel B Lewis
1Department of Radiology and Radiological Sciences, Edward F. Hebert School of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814, USA. echung@usuhs.mil
Insights
Pediatric benign liver tumors, including infantile hemangioendothelioma and mesenchymal hamartoma, present unique imaging features. Differentiating these from adult-type tumors like focal nodular hyperplasia requires understanding their distinct pathology and imaging characteristics.
Area of Science:
- Pediatric Radiology
- Gastrointestinal Pathology
- Medical Imaging
Background:
- Benign hepatic tumors in children encompass both pediatric-specific lesions and adult tumors occurring in younger patients.
- Infantile hemangioendothelioma and mesenchymal hamartoma are common pediatric liver tumors with distinct pathological and imaging findings.
- Adult-type benign epithelial tumors like focal nodular hyperplasia (FNH) and hepatocellular adenoma can also occur in children.
Purpose of the Study:
- To elucidate the characteristic imaging appearances of various benign hepatic tumors in children.
- To highlight the pathological features that influence the imaging presentation of these lesions.
- To aid radiologists in differentiating pediatric benign liver tumors and guiding appropriate management.
Main Methods:
- Review of imaging characteristics of infantile hemangioendothelioma, mesenchymal hamartoma, FNH, hepatocellular adenoma, and nodular regenerative hyperplasia.
- Correlation of pathological findings with specific imaging features such as enhancement patterns and lesion composition.
- Analysis of imaging modalities including dynamic contrast-enhanced CT/MRI and scintigraphy.
Main Results:
- Infantile hemangioendothelioma shows characteristic vascularity and peripheral nodular enhancement.
- Mesenchymal hamartoma's imaging appearance depends on the predominance of its mesenchymal or cystic components.
- FNH and hepatic adenoma exhibit arterial phase enhancement; FNH contains Kupffer cells, while adenoma may show intracellular fat and hemorrhage.
Conclusions:
- Understanding the interplay between pathology and imaging is crucial for diagnosing benign pediatric liver tumors.
- Distinct imaging features aid in differentiating infantile hemangioendothelioma and mesenchymal hamartoma from adult-type tumors.
- Accurate radiological assessment facilitates appropriate differential diagnosis and patient management.
Abstract:
Benign hepatic tumors in children include lesions that are unique to the pediatric age group and others that are more common in adults. Infantile hemangioendothelioma, or infantile hepatic hemangioma, is a benign vascular tumor that may cause serious clinical complications. It is composed of vascular channels lined by endothelial cells. At imaging, large feeding arteries and draining veins and early, intense, peripheral nodular enhancement with centripetal filling on delayed images are characteristic features. Mesenchymal hamartoma of the liver occurs in young children and is characterized pathologically by mesenchymal proliferation with fluid-containing cysts of varying size and number. The mesenchymal component or cystic component may predominate; this predominance determines the imaging appearance of the tumor. Benign epithelial tumors that are common in adults may infrequently occur in childhood. These include focal nodular hyperplasia (FNH), hepatocellular adenoma, and nodular regenerative hyperplasia. All are composed of hyperplastic hepatocytes similar to surrounding liver parenchyma and may be difficult to discern at imaging. Preferential hepatic arterial phase enhancement helps distinguish FNH and hepatic adenoma from uninvolved liver. Hepatic adenoma often has intracellular fat and a propensity for intratumoral hemorrhage, neither of which are seen in FNH. Unlike adenoma, FNH often contains enough Kupffer cells to show uptake at sulfur colloid scintigraphy. Nodular regenerative hyperplasia is often associated with portal hypertension, which may be evident at imaging. Knowledge of how the pathologic features of these tumors affect their imaging appearances helps radiologists offer an appropriate differential diagnosis and management plan.
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