Hepatic mesenchymal hamartoma

Marius Bogdan Muresan, MD. *, Maria Cezara Muresan, MD.**

*  Medical Center of Dr.Muresan, Timisoara, Romania.
** Department of Obstetrics and Gynecology, V. Babes medical University, Timisoara, Rumania.


Case report

A 39-year-old G3P0 was referred to our department at 24 weeks of gestation. Patient's personal and family history were unremarkable. The ultrasound examination revealed a tumoral mass in the liver. The mass was well vascularized and was mostly of a cystic structure. There were now other abnormal findings detected during this ultrasound examination. There was a normal amount of the amniotic fluid. Cardiac examination showed a normal 4-chamber view and no signs of cardiac failure.
Our differential diagnosis based on the ultrasound findings included hemangioma and hemangioendothelioma.

The subsequent ultrasound examination was performed within 14 days showed an enlargement of the highly vascularized hepatic lesion. Doppler of the ductus venosus was normal, middle cerebral artery Doppler showed high peak systolic velocity (76 cm/s) indicating possible fetal anemia. 4-chamber view did not show any heart enlargement, there was no sign of fetal hydrops.

Patient delivered at 38 weeks of gestation via cesarean section. The neonate showed signs of incipient cardiac failure, heart dilatation, cardiac valve insufficiency. The surgery was performed 24 hours after delivery. The tumor involved almost the whole right hepatic lobe. The tumor had a cystic structure and macroscopically resembled lymphangioma. A partial liver resection was performed and the tumor removed. Unfortunately, the neonate died 24 hours after the surgery due to disseminated coagulopathy.

The final diagnosis was hepatic mesenchymal hamartoma.

Images 1,2: 24 weeks, transverse view of the fetal abdomen. Arrow on image 1 indicates tumor. Image 2 shows a Doppler imaging and tumor vascularization.

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Images 3,4: Vascularization of the tumor.

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Images 5,6
: Transverse view of the abdomen, arrow indicates tumor.

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Images 7,8
: 26 weeks, image 7 shows a tumor and its location next to the inferior vena cava (IVC) and aorta (Ao).

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Images 9,10,11: Doppler imaging of the tumor.

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Images 12,13
: Image 11 shows a Doppler imaging of the middle cerebral artery, peak systolic velocity is very high indicating fetal anemia. Image 12 shows a normal 4-chamber view with normal size of the heart.

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