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Case Reports
. 2021 Jan 28;7(3):20200196.
doi: 10.1259/bjrcr.20200196. eCollection 2021 May 1.

Infantile mesenchymal hamartoma of the liver with elevated alpha fetoprotein

Liem Thanh Le  1 , Hai Thanh Phan  1 , Trung Sao Nguyen  1 , Khai Dinh Truong  2 , Dang Thanh Nguyen  1 , Toan Bao Nguyen  1 , Thuy Thi Thu Pham  1
Affiliations
Case Reports

Infantile mesenchymal hamartoma of the liver with elevated alpha fetoprotein

Liem Thanh Le et al. BJR Case Rep. .

Abstract

Mesenchymal hamartoma of the liver (MHL) is a benign tumour that most commonly occurs in children. In most cases of MHL, the α fetoprotein (AFP) level is within the normal limits, only in a few cases, increased AFP has been described which usually causes misdiagnosis of hepatoblastoma. We report a case of a 3-month-old paediatric patient who was incidentally detected with a very high level of AFP, at 6388.4 ng ml-1. Ultrasound revealed a right liver tumour, segment VI, measuring at 56 × 53 mm. According to images of ultrasound and MRI, the diagnosis was mesenchymal hepatic sarcoma. The paediatric patient had surgery to remove the entire liver segment containing the tumour. Micropathological examination showed that the tumour was a MHL. The serum AFP level fell rapidly to near normal following the surgery. The MHL benign liver tumour with an atypical presentation caused a very high AFP level. This was a rare clinical case, and it was difficult to diagnose.

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Figures

Figure 1.
Figure 1.
Abdominal ultrasound revealed a right hepatic lesion with mixed echo, multi curvilinear, (a, b) Mode ultrasound section showed right hepatic lesion, segment VI with many echogenic septae inside, b&c: Doppler ultrasound showed solid content with vessels, d: Real-time 2D shearwave elastography (SSI) showed solid content with low stiffness around 6.6 kPa.
Figure 2.
Figure 2.
Contrast-enhanced MRI detected a right hepatic lesion in the segment VI. (a and b) The lesion had heterogeneous high signal intensity in axial and coronal T2W. c: The lesion has heterogeneous low signal intensity in T1W and T1 pre gadolinium. d: Heterogeneous gadolinium contrast opacification, peripheral enhancement of the arterial phase. (e and f) Contrast opacification progressive centripetally in the venous phase (T1 portal venous phase) and late phase (T1 delay phase) and without filling the whole lesion.
Figure 3.
Figure 3.
(a) and (b): Macropathology. (c) and (d): Micropathology.
Figure 4.
Figure 4.
Pictures of the paediatric patient and abdominal ultrasound after the surgery.
See this image and copyright information in PMC

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