‘Watchful Waiting’ May Be an Appropriate Treatment for ELBW Infant with Hepatic Mesenchymal Hamartoma

Özgül Salihoğlu, MD; Emrah Can*, MD; Sinem Can, MD; Sami Hatipoğlu, MD Department of Pediatrics, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey Received: May 31, 2012; Accepted: Nov 19, 2012, Available Online: Dec 03, 2012 Hepatic mesenchymal hamartoma (HMH) is an uncommon benign tumor of childhood. Typically a patient will present with an enlarged, nontender abdominal mass. No specific panel of laboratory tests is characteristic of HMH. Laboratory studies often reveal normal liver function tests and various tumor markers, including human chorionic gonadotropin, alpha fetoprotein, and vanillylmandelic acid, are usually negative. Abdominal ultrasound can demonstrate either a multicystic or solid mass[1]. Although not required for diagnosis, computed tomography and magnetic resonance imaging are useful for surgical planning. Surgery, consisting of either enucleation or lobectomy, traditionally has been the treatment of choice in the postpartum period; however, less invasive techniques, such as laparoscopic fenestration have also been used successfully[2]. Because the natural course of this tumor is initially rapid increase and subsequently decrease in size, some investigators have opted for ‘‘watchful waiting’’ in asymptomatic patients[3]. At 29 weeks of gestation, a 960g male infant presented with distress and abdominal distention during the postnatal period. There was visible fullness in the right upper quadrant of the abdomen. The liver was palpable, 6 cm below the left subcostal margin in the midclavicular line. Serum bilirubin was 3.91 mg/dl, SGPT 56 U/L, SGOT 8U/L, blood urea 21 mg/dl, Hb 14g. Serum alpha-fetoprotein was in normal range. Bleeding, clotting, and prothrombin time, as well as platelet count and blood gas analysis were normal. X-ray of the chest showed elevated right dome of the diaphragm. US of the abdomen revealed a large, 8.8×7.0×4.7 cm sized anechoic cystic mass occupying almost the entire left lobe and superior segment of right lobe of the liver. There were multiple internal septations and multilobules within the mass. However, no solid component was visible. Other hepatic parenchymal echoes were homogeneous. The right lobe of the liver was enlarged. The portal vein showed normal flow. No portal or retroperitoneal lymphadenopathy was seen and there was minimal perihepatic ascites. On first MRI scan, the lesion was 4.7×5.3×5.6 cm, hyper intense on T2W image and hypo intense on T1W images confirming its cystic nature in the right lobe (Fig 1). Control ultrasound and MRI scan was repeated 3 months later. Anechoic cystic mass size was 10.8×6.4×5.6 cm. MRI scan did not show enlargement of the previously diagnosed cystic lesions but gave rise to multilocular