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Mesenchymal hamartoma of the liver: a case report
C Y Tzen1, B F Chen, P Y Chang
1Department of Pathology, Mackay Memorial Hospital, Taipei, Taiwan, ROC.
Abstract:
Mesenchymal hamartoma of the liver (MHL) is a rare lesion occurring mainly in infants and children. It is often misdiagnosed clinically as a malignant tumor because of its rapid increase in size within a short period of time, or as a hepatic cyst or abscess because of its cystic appearance. Although a benign lesion, MHL may cause heart failure, due to arteriovenous shunts, or death if untreated, as a result of respiratory complications. A typical case of MHL was recently encountered in a 15-month-old boy. The patient presented with progressive abdominal distension; surgery revealed a large mass arising from the right lobe of the liver. The mass was predominantly solid, but collections of fluid were also present. Loose mesenchymal tissue and branched, tortuous bile ducts were the key diagnostic features. When predominantly cystic, MHL may mimic a lymphangioma both grossly and microscopically. Prudent examination of the cystic structures can establish a correct diagnosis.
Insights
Mesenchymal hamartoma of the liver (MHL) is a rare pediatric liver tumor. Accurate diagnosis is crucial as MHL can mimic malignant tumors or cysts, and untreated cases can lead to severe complications.
Area of Science:
- Pediatric pathology
- Hepatology
- Surgical oncology
Background:
- Mesenchymal hamartoma of the liver (MHL) is a rare benign liver tumor primarily affecting infants and children.
- Clinical presentation can be misleading, often leading to misdiagnosis as malignant tumors, hepatic cysts, or abscesses due to rapid growth or cystic appearance.
Observation:
- A case of MHL in a 15-month-old boy presented with progressive abdominal distension.
- Surgical exploration revealed a large, predominantly solid liver mass with fluid collections.
- Histopathological examination showed characteristic loose mesenchymal tissue and branched, tortuous bile ducts.
Findings:
- MHL can be predominantly solid or cystic.
- Predominantly cystic MHL may be mistaken for lymphangioma on gross and microscopic examination.
- Key diagnostic features include mesenchymal tissue and abnormal bile duct structures.
Implications:
- Despite being benign, untreated MHL can cause significant morbidity, including heart failure from arteriovenous shunts and respiratory compromise.
- Careful examination of cystic components is essential for accurate diagnosis and appropriate management.
- Early and correct diagnosis of MHL is vital to prevent life-threatening complications in pediatric patients.