Mesenchymal and Biliary Hamartomas of the Liver: A Systematic Review and Management Algorithm

Mesenchymal hamartomas are rare benign liver tumors located in the embryonic mesenchymal tissue, most frequently affecting male infants and young children. While clinical presentation is typically asymptomatic, rupture, hemorrhage, infection, and malignant transformation are possible. Biliary hamartomas are benign lesions most frequently in patients >35 years. Imaging for both entities is typically nonspecific; a broad differential between solid and cystic lesions of the liver makes histologic evaluation critical. Both hamartomas are treated by liver resection, with most patients recovering fully with no further treatment. Here, we report a rare case of a mesenchymal hamartoma in an adult and provide a systematic review of mesenchymal and biliary hamartomas utilizing PRISMA guidelines; this review highlights the reported diagnostic and treatment paradigms and utilizes these to develop a diagnostic algorithm to assist in the definitive identification of these benign lesions with the potential to avoid surgical resection in appropriately selected patients.