Neonatal giant hepatic hemangioma: A case report

Abstract

Rationale: Hepatic hemangioma is the third most common pediatric tumor, and it is rare in the neonatal period. This case study presents a rare case of hepatic hemangioma found in a neonate.

Patient concerns: A girl who was 18 days of age with the emergence of jaundice and an abdominal mass was admitted for physical examination in the local department.

Diagnoses: An ultrasound showed that the hepatic left lobe was about 9 cm × 7 cm × 7 cm in size. A CT scan indicated a giant hemangioma in the hepatic left lobe. MRI detected a lesion measuring about 92 mm × 71 mm × 68 mm.

Interventions: The patient was treated with propranolol 3.5 mg PO bid (body weight 3.8 kg) after 1 week of admission for 4 weeks, but the mass did not appear to regress. Surgery was then performed successfully.

Outcomes: The patient recovered well without recurrence beyond one year.

Lessons: Imaging strategies and prenatal diagnosis are vital for the diagnosis of infantile hepatic hemangioma. Propranolol is effective in both cutaneous and hepatic multifocal and diffuse hemangioma. Adequate treatment time is necessary to cure the disease. The role of propranolol in massive hepatic hemangioma remains uncertain and needs further investigation.

Figure 1

CT scan of the liver prior to the initiation of treatment. (A) CTA volume reconstruction images showing a spherical mass in the left abdomen; the density of the outer layer of the mass is high, and no thick artery is obvious. (B, C) Multiplanar reconstruction. The outer part of the tumor is significantly enhanced, there is large nonenhanced area in the mass, and part of the surrounding tissue and blood vessels are oppressed by the tumor. CT = computed tomography.

Figure 2

MRI of the patient with IHE. (A, D) (coronal and transverse) T2-weighted image of the liver shows hyperintense lesions relative to the normal liver parenchyma with a smooth border and surrounding oppressed tissue. (B) T2-weighted image with fat saturation of the liver demonstrates multiple hyperintense lesions scattered throughout. (C) Axial T1-weighted image of the liver shows spherical hypointense mass. IHE = infantile hepatic hemangioma.

Figure 3

Pathological results of the patient with IHE. (A) Small bile ducts are observed in the tumor. (B) The tumor tissue is composed of different sizes of vascular lacunar-like structure, and the vasculature is surrounded with loose fiber interstitial filling. IHE = infantile hepatic hemangioma.

Figure 4

(A, B) Enhanced CT images were reviewed 15 days after the operation, and no recurrence of IHE was observed in the liver. CT = computed tomography, IHE = infantile hepatic hemangioma.