1 Department of gynecology-obstetric, University Hospital Hassan II, Fez 30 000, Morocco
2 Neonatal Intensive Care Unit, University Hospital Hassan II, Fez 30 000, Morocco
3 Department of radiology, University Hospital Hassan II, Fez 30000, Morocco

Introduction

Fetal hepatic hemangioma is a benign vascular tumor and belongs among the most common hepatic tumors of the fetal, neonatal, and childhood period of life [1-4]. Its pathogenesis is poorly known.

Synonyms

Hepatic arteriovenous (AV) malformation; hemangioendothelioma.

Case report

A 40-year-old woman (G5P2) was examined in our department at 36 weeks of her pregnancy. Her previous examinations were reported to be normal.

Our ultrasound examination found a fetus of overall normal biometry, except of abdominal circumference reaching 97th percentile. A hypoechoic round structure with hyperechoic center of 73 mm in its largest diameter was found in the right upper abdomen. Initially we considered the structure to be a mesoblastic nephroma, but magnetic resonance imaging was done later and enabled to localize the structure within hepatic parenchyma.  This finding led us to the diagnosis of hepatic hemangioma.

The male neonate was delivered at term (2700 g, Apgar score 7/10/10) and the postnatal ultrasonographic examination found hypervascular hepatic structure of inhomogeneous echogenicity.

Laboratory tests showed thrombocytopenia (80,000/mm³). During three months the hepatic mass has slowly decreased in size leaving just small hyperechoic region within the liver parenchyma. The laboratory tests have also got to normal levels.

Image 1: 36 weeks of gestational age: the image shows hypoechoic round structure with hyperechoic center of 73 mm in its largest diameter in the right upper right abdomen, representing hepatic hemangioma.

Discussion

Hepatic hemangioma is a benign vascular tumor. It is the second most common liver tumor after hepatoblastoma of the fetal, neonatal, and childhood period of life, and accounts for 12% of pediatric hepatic tumors [1-6]. Its pathogenesis is poorly known. 20% of cases are accompanied with cutaneous and visceral lesions [7]. Hemangioma may grow in size during the first six months of life following by spontaneous regression. The growth phase may be associated with heart failure due to hyperkinetic circulation, Kasabach–Merritt syndrome, jaundice, or very rarely hepatocellular insufficiency [8].

References

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3. Abuhamad AZ, Lewis D, Inati MN, Johnson DR, Copel JA. The use of color flow Doppler in the diagnosis of fetal hepatic hemangioma.J Ultrasound Med 1993; 4: 223-6

4. Sepúlveda WH, Donetch G, Giuliano A. Prenatal sonographic diagnosis of hepatic hemangioma. Eur J Obstet Gynecol Reprod Biol 1993; 48: 73–6

5. Helmberger TK, Ros PR, Mergo PJ et al. Pedriatric liver neoplasms: A radiologic-pathologic correlation. Eur Radiol 1999; 9: 1339– 1347

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7. Schmitz R, Heinig J, Klockenbusch W, Kiesel L, Steinhard J,Antenatal Diagnosis of a Giant. Fetal Hepatic Hemangioma and Treatment with Maternal Corticosteroid Ultraschall in Med 2009; 30

8. S.Franchi-Abella, D. Pariente. Tumeurs hépatique de l'enfant: approche par l'imagerie; EMC radiodiagnostic-appareil digestif 2005.