Mesenchymal Hamartoma of the Liver: Complete Excision Always Necessary

Abstract

Mesenchymal hamartoma (MH) is not an uncommon tumor of the liver in the age group of 2–10 years. It is the second most common benign liver tumor in children. Previously considered a developmental anomaly, newer insights into other theories of origin including toxic-metabolic, ischemic, and a true neoplastic process are in progress. Previous understanding of a purely benign nature of the tumor is being overridden by a real malignant transformation. Complete excision of the tumor with clear margins is recommended to achieve a long term cure. A thorough understanding of the natural history of these tumors and skillful surgical treatment are indispensable elements of care.

Giant solid mesenchymal hamartoma of the liver in a neonate: case report

“…The majority (75%) of mesenchymal hamartomas develop in the right lobe of the liver, with the remainder found in the left lobe or involving both lobes. Up to 20% of these lesions are pedunculated, arising from the inferior surface of the liver [6]. In this study, the tumor was attached to the inferior surface of the right lobe of the liver with a broad thick peduncle making its complete excision easy after dividing that peduncle.…”

“…Histologically, the tumor is made up of loose or mucoid connective tissue containing different amounts of blood vessels, cystic lymphatic spaces, bile ducts, and normal hepatocytes [4]. Developmental theories include exposure of otherwise normal hepatic parenchyma to regional ischemia or toxic injury during its development [6]. The term "mesenchymal hamartoma" was first used by Edmondson in 1956 who distinguished the pathology from other cystic and tumor-like lesions of the liver [2,7].…”

Hepatic mesenchymal hamartoma: The role of radiology in diagnosis and management

“…Approximately 75% of HMH cases develop in the right lobe of the liver [7] . On imaging, the appearance of HMH may be variable, appearing as a multiseptated cystic tumor, a mixed cystic and solid tumor, or solid tumor, depending on the HMH components [1] .…”

Hepatic mesenchymal hamartoma: An uncommon but important paediatric diagnosis

“…Whilst well-circumscribed, this mass is unencapsulated. 5 , 6 Serum AFP levels can be within the normal limits, but can also be elevated because of the proliferation of hepatocytes in the neoplasm. 5 , 7 Elevated GGT, but otherwise normal liver function tests, is also reported.…”

“…1,2,3,4 These neoplasms may undergo malignant transformation, and, as a result, complete surgical excision, with clear margins, remains the mainstay of treatment. 6 There is a strong association with undifferentiated embryonal sarcomas, which are especially aggressive and have a poor prognosis. 12,13 Longterm follow-up is necessary post-resection.…”