Giant Hepatic Hemolymphangioma With Peritoneal Effusion in Children: A Case Report and Literature Review

Abstract

Hemolymphangioma is a congenital malformation of blood vessels and lymphatic vessels, commonly found in the head, neck, and subcutaneous, rarely in the viscera and extremely rarely in the liver. In this case, a 6-year-old boy was found to have abdominal distension for more than 2 months with no other obvious symptoms. Physical examination revealed a large abdominal mass that was hard and not mobile. Laboratory tests found no obvious abnormity. Preoperative ultrasound and CT showed a huge cystic and solid-cystic tumor in the abdomen with close relationship to the right lower margin of the liver and fluid accumulation in the abdominopelvic cavity. The preliminary diagnoses were a malignant tumor of embryonic origin and undifferentiated sarcoma. Liver tumor resection was performed in our hospital, and the postoperative pathology was diagnosed as hepatic hemolymphangioma. The patient recovered well after surgery. It is easy to diagnose a large abdominal mass in a child as a malignant tumor of the liver and delay the treatment-no obvious symptoms, no obvious abnormalities in laboratory tests, and imaging shows a multiocular cystic lesion with clear borders and no invasion of blood vessels, indicating that the possibility of this disease should be considered. The tumor has an abnormal rich blood supply, and preoperative imaging evaluation clearly shows the vascular pathway and blood supply status to help optimize the surgical plan.

Keywords: case report; child; hemolymphangioma; liver; peritoneal effusion.

Figure 1

Enhanced CT of the arterial phase of a giant solid-cystic lesion in the right lower abdomen with abundant tumor vascularity.

Figure 2

Enhanced CT of progressive enhancement of the solid part of the lesion in the portal venous phase, the lesion closely related to the liver, and the abdominopelvic fluid accumulation.

Figure 3

Enhanced CT of three-dimensional reconstruction. The adjacent right branch of the proper hepatic artery, abdominal aorta, right common iliac artery, and mesenteric vein was displaced by compression, and the distal branches of the hepatic artery were penetrated within the tumor.

Figure 4

Pathological HE staining. The tumor consists of abnormally dilated multicystic-like lymphatic vessels and blood vessels, in which hepatocytes and small bile ducts were seen.