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Mesenchymal Hamartoma in Children: A Diagnostic Challenge
Muhammad Rehan Khan1, Larry A Binkovitz2, Thomas C Smyrk3
1Division of Pediatric Gastroenterology & Hepatology, Department of Pediatrics, Mayo Clinic, Rochester, Minnesota, USA.
Insights
Mesenchymal hamartoma is a rare liver tumor in children over two. This case highlights the importance of considering this benign tumor in older children with vague abdominal symptoms.
Area of Science:
- Hepatology
- Pediatric Oncology
- Surgical Pathology
Background:
- Mesenchymal hamartoma is a rare, benign liver tumor with unknown causes.
- It is infrequently seen in children older than two years.
- Diagnosis can be challenging due to nonspecific symptoms.
Observation:
- A 5-year-old male presented with abdominal pain, fatigue, and fever, initially treated for pneumonia.
- Computed tomography (CT) revealed a hepatic mass, and magnetic resonance imaging (MRI) showed features suggestive of Caroli syndrome.
- Clinical examination and biochemistry, including liver function tests and alpha-fetoprotein, were normal.
Findings:
- Multidisciplinary review of imaging suggested mesenchymal hamartoma.
- Surgical resection of the liver mass was performed.
- Pathological examination confirmed the diagnosis of mesenchymal hamartoma.
Implications:
- This case underscores the need for a high index of suspicion for mesenchymal hamartoma in older children with nonspecific abdominal complaints.
- Accurate diagnosis through advanced imaging and expert consultation is crucial.
- Prompt surgical intervention can lead to favorable outcomes for this benign liver tumor.
Abstract:
Mesenchymal hamartoma is a benign tumor of the liver with a poorly understood pathogenesis. It is uncommon in older children, especially after 2 years of age. The signs and symptoms may be nonspecific; therefore, a high index of suspicion is required for diagnosis and treatment. We report a 5-year-old previously healthy male who presented with acute abdominal pain, fatigue, and fever. He was diagnosed with pneumonia initially and treated with antibiotics. A computed tomography (CT) scan done for evaluation of his persistent abdominal pain demonstrated a hepatic mass. Follow-up magnetic resonance imaging (MRI) of the liver demonstrated multiple serpiginous tubular-type structures, read as possible Caroli syndrome. He had a normal abdominal examination and normal biochemistries including alanine aminotransferase, aspartate aminotransferase, gamma-glutamyl transferase, alkaline phosphatase, and alpha-fetoprotein. He was referred to our institution for second opinion. On further review of his imaging studies, the lesion was thought to be a mesenchymal hamartoma. He subsequently underwent resection of the mass. Pathology confirmed the diagnosis of mesenchymal hamartoma.
