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Virtual Pediatric Hospital: Correlapaedia - a Correlative Encyclopedia of Pediatric Imaging, Surgery, and Pathology: Case 44

Correlapaedia - a Correlative Encyclopedia of Pediatric Imaging, Surgery, and Pathology

Case 44

Michael P. D'Alessandro, M.D.,
Steven J. Fishman, M.D.,
Deborah E. Schofield, M.D.

Peer Review Status: Internally Peer Reviewed
Chief Complaint:
Eighteen month old male diagnosed 9 months ago with a liver tumor.

Clinical History:
The patient was a 18 month old male diagnosed at an outside hospital at 9 months of age with a massive liver tumor.

Clinical Physical Exam:
Multiple abdominal scars, with the liver edge being 10 cm.

Clinical Labs:

Clinical Differential Diagnosis:
Hemangioma, hemangioendothelioma, mesenchymal hamartoma

Imaging Findings:
An outside MRI exam performed 6 months after the initial diagnosis showed a heterogenous mass involving the left and right lobes of the liver. An ultrasound from one month later confirmed these finding. An angiogram performed 3 months after the MRI showed the mass to have an avascular center and a hypervascular rim.

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Imaging Differential Diagnosis:
Mesenchymal hamartoma

Operative Findings:
The mass was initially biopsied on the outside and found to be a mesenchymal hamartoma. The patient underwent an attempt at resection on the outside which was terminated due to bleeding. The patient was tried on interferon therapy to shrink the tumor, without success. Nine months after the initial diagnosis, the patient had a second exploratory laparotomy via a bilateral subcostal incision. The left lateral segment and the right lobe of the liver appeared normal and this was confirmed by intraoperative ultrasound. The patient underwent a left medial segment hepatectomy.

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Pathological Findings:
Examination of the resected liver mass showed it measured 16 x 12 x 5 cm in size and contained cystic spaces. It had findings characteristic for a cystic mesenchymal hamartoma.

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Final Diagnosis:
Mesenchymal Hamartoma

Follow-up and Prognosis:
The patient went on to develop a persistent bile leak post operatively.

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