Liver transplantation as definitive treatment of an unresectable mesenchymal hamartoma in a child with Beckwith-Wiedemann Syndrome

A rare case of giant hepatic mesenchymal hamartoma in a pediatric patient: diagnostic and surgical challenges

Hepatic mesenchymal hamartoma is a rare benign liver tumor in pediatric patients, typically presenting within the first two years of life. This case involves a 10-month-old female who initially presented with repeated vomiting and was misdiagnosed with a hepatic hemangioma. Subsequent imaging revealed a large, multicystic hepatic mass, and a biopsy indicated spindle cell proliferation, initially suggesting embryonal rhabdomyosarcoma. Due to uncertainty in the initial histopathological diagnosis, the case was discussed in a multidisciplinary team meeting, and the decision was made to proceed with surgical resection. The final diagnosis of hepatic mesenchymal hamartoma was confirmed postoperatively. The patient underwent successful tumor resection, sparing the liver, with no postoperative complications. This case highlights the diagnostic challenges associated with large pediatric hepatic masses and underscores the importance of a multidisciplinary approach for successful outcomes in similar cases.

Infant With Beckwith-Wiedemann Requiring Transplant for Hepatic Mesenchymal Hamartoma

BACKGROUND

Liver transplantation for unresectable, benign hepatic lesions is rare. Hepatic mesenchymal hamartomas (HMH) are benign, cystic tumors that arise mostly in pediatric populations and can cause compressive symptoms. HMH is rarely associated with placental mesenchymal dysplasia (PMD) and Beckwith-Wiedemann syndrome (BWS). Treatment is complete excision due to the risk of rapid growth, recurrence, and malignant transformation. Very rarely is HMH so diffuse that transplantation is required.

METHODS

We present the first case of a patient with BWS, HMH, and a history of PMD who underwent a transplant. This is also incidentally the third case of a pediatric patient with a myxoid adrenocortical adenoma (MACA).

RESULTS

Our patient with HMH, MACA, chronic respiratory distress secondary to tracheobronchomalacia and abdominal competition from hepatomegaly, and nasojejunal (NJ) tube dependence successfully underwent orthotopic whole liver transplantation at 7 months of age. She had one episode of acute cellular rejection, but otherwise recovered well. Despite negative molecular testing for BWS in peripheral blood, additional analysis on the explanted liver was consistent with a diagnosis of mosaic BWS. At a 14-month follow-up, she continues to do well with improvement in growth.

CONCLUSIONS

Transplantation is an effective treatment option for patients with unresectable HMH. Our case highlights this and introduces a possible underlying association between HMH, PMD, and BWS.

Giant Mesenchymal Hepatic Hamartomas With Adrenal Involvement Precipitating Respiratory Failure: A Myxomatous Mystery in a Three-Month-Old

The combination of placental mesenchymal dysplasia and hepatic mesenchymal hamartomas is an extremely rare finding. We present the case of a three-month-old female born at 35 weeks gestation with a history of placental mesenchymal dysplasia who presented with non-bilious, non-bloody emesis, and episodes of respiratory distress due to multiple enlarging abdominal cystic lesions. The patient's presentation was unique due to both liver and adrenal solid and cystic lesions. After extensive imaging and multiple biopsies, expert interpretation of biopsy tissue revealed hepatic mesenchymal hamartoma within the liver and the adrenal gland. To our knowledge, this is one of the few documented cases of unresectable hepatic mesenchymal hamartomas with adrenal involvement successfully undergoing a whole liver transplant.

Fetal mesenchymal hamartoma of the liver: A case report and literature review

This paper reports the diagnosis and treatment process of a case of fetal mesenchymal hamartoma of the liver (MHL), and reviews the previous literature reports. At 38⁺² weeks of gestation, prenatal ultrasound found a well bound mixed solid and cystic mass, which was located at the lower edge of the right lobe of the liver and in front of the right kidney of the fetus, but the source and nature of the mass were not clear by ultrasound. Due to the approaching due date, the fetus showed no other abnormal symptoms, and no special treatment was given with the consent of the family members. A female fetus was delivered weighing 3,520 g at 39 weeks. An exploratory laparotomy was performed on the eighth day after delivery. During the operation, it was found that the tumor originated from the fifth, sixth and seventh hepatic segment and the corresponding hepatic segments were removed. Recovery was uneventful and the infant was discharged on the 6th day after surgery. Follow-up at 2 years showed a thriving young girl, and there was no tumor recurrence.

Pediatric Primary Hepatic Tumors: Diagnostic Considerations

The liver is the third most common site of abdominal tumors in children. This review article aims to summarize current evidence surrounding identification and diagnosis of primary hepatic tumors in the pediatric population based upon clinical presentation, epidemiology, and risk factors as well as classical imaging, histopathological, and molecular diagnostic findings. Readers will be able to recognize the features and distinguish between benign and malignant hepatic tumors within different age groups.

Hepatic mesenchymal hamartoma and undifferentiated embryonal sarcoma of the liver: a pathologic review

This review highlights two rare entities that are predominantly seen in children: hepatic mesenchymal hamartoma (HMH) and undifferentiated embryonal sarcoma of the liver (UESL). HMH is a benign lesion predominantly seen in the first 2 years of life, while UESL is malignant and usually identified in patients between 6 and 10 years of age. UESL may arise in the background of HMH, and the association has been supported by similar chromosomal aberrations (19q13.4). The diagnosis of both lesions is primarily based on histologic evaluation, as the clinical and radiological features are not always typical. The clinicopathologic characteristics, pathogenesis, differential diagnoses and treatment for both lesions are discussed.

[Mesenchymal abdominal tumors in children]

Mesenchymal tumors in childhood comprise benign and malign entities and differ regarding typical sites of manifestation, age peak and clinical symptoms. In some cases biopsy is mandatory. If nephroblastoma is a possible diagnosis, biopsy must be avoided by all means in order to avoid biopsy tract metastasis. Imaging is used to narrow the differential diagnosis, describe the exact extent of the lesion and deliver complete staging. In pediatric patients sonography and MRI are the most important imaging modalities. Low-dose CT of the thorax serves for assessment of possible pulmonary metastases.