Bilateral chest wall mesenchymal hamartomas treated with sclerotherapy and cryoablation

Abstract

Abstract Mesenchymal hamartoma of the chest wall is a rare disorder, traditionally treated with mutilating radical excision. We report a case of an infant with bilateral mesenchymal hamartomas (MH) complicated with aneurysmal bone cyst (ABC) features. We subsequently describe a novel technique combining sclerotherapy and cryoablation to achieve non-operative tumor burden reduction in an effort to minimize disfigurement making the MH amenable to less morbid resection. A 3.5-month-old male presented with bilateral, complex, mixed cystic and solid, chest wall masses consistent with a chest wall mesenchymal hamartoma. Under ultrasound and fluoroscopic guidance, the aneurysmal bone cyst components were aspirated and contrast studies performed to exclude venous drainage. Doxycycline sclerotherapy was performed using dwelling volumes approximately 50–60% of the estimated cyst cavity size. Repeat sclerotherapy was performed on days 85, 147, 229 and 267, with interval imaging guiding timing and location of therapy. The ABC components responded well to sclerotherapy with significant size decrease of the cystic components. Overall lesion size decreased significantly, with new bone formation noted in response to treatment. The first treatment of computer tomographic (CT)-guided cryoablation was then performed on day 329 to attempt further reduce the size of the solid components. Multiple cryoablation probes were advanced into the mass under CT fluoroscopy. Deep components were treated initially with a series of freeze/thaw cycles. Cryoprobes were then retracted to treat the more superficial portions of the lesion. CT guided cryoablation was repeated on day 601.