Mesenchymal hepatic hamartoma associated with elevated alpha fetoprotein mimicking a hepatoblastoma: A rare case and a literature review

Abstract

Introduction: A mesenchymal hepatic hamartoma is a heterogeneous and a rare congenital benign neoplasm whose presentation may be cystic, solid or mixed and the mass may demonstrate varying degrees of vascularity. Treating mesenchymal hepatic hamartomas conservatively is not encouraged because these lesions have the potential to grow rapidly and may degenerate to a malignant undifferentiated embryonal sarcoma. The standard treatment of mesenchymal hepatic hamartoma is surgical resection. However, marsupialization is also indicated in surgically unresectable cases. Case Report: We report a case of one-year-old girl who presented with a one-month history of abdominal distention. The patient was born through a normal vaginal delivery at term. Apgar score 9/10-10/10, birth weight 2.8 kg. Head circumference 36 cm. The patient is retro-viral disease negative. She has normal developmental milestones and the immunizations are up to date. Ultrasound of the abdomen was performed and it showed right liver lobe large masses. Computed tomography (CT) scan was subsequently performed to further characterize the liver lesions. Ultrasound guided biopsy was performed and it confirmed the diagnosis of mesenchymal hepatic hamartoma. The alpha-fetoprotein was markedly elevated. Conclusion: It is of utmost importance to note that as much as the mesenchymal hepatic hamartoma typically shows a normal alpha-fetoprotein, a rare presentation of this benign tumor may be associated with markedly elevated alpha fetoprotein.