Findings
- There is clearly a placental mass and it is vascular. Little differential diagnoses here: this is a typical chorioangioma
- The other finding is of a vascular mass inferior to the heart and anterior to the stomach. This is highly characteristic of a liver hemangioendothelioma.
Hemangioendothelioma may present with the following:
- elevated maternal serum alpha-fetoprotein level
- cardiomegaly from high-output cardiac failure
- hepatomegaly
- a hepatic mass
- dilated intrahepatic vessels
The association with chorioangioma 1,2 or other placental lesions has been reported4.
Other primary liver tumors that could have been differential diagnosis include:
- hepatoblastoma,
- infantile hemangioendothelioma,
- mesenchymal hamartoma,
- undifferentiated (embryonal) sarcoma,
- hepatocellular carcinoma,
Treatment of the hemangioendothelioma may involve3:
- medical management (steroids, furosemide and alpha-interferon) or
- interventional modalities (hepatic artery ligation or embolization, resectional surgery, or orthotopic liver transplantation).
So the final diagnoses were chorioangioma and hemangioendothelioma
References:
1) Meirowitz NB, Guzman ER, Underberg-Davis SJ, Pellegrino JE, Vintzileos AMHepatic hemangioendothelioma: prenatal sonographic findings and evolution of the lesion.J Clin Ultrasound 2000 Jun;28(5):258-63
2) Marton T, Silhavy M, Csapo Z, Szende B, Papp Z Multifocal hemangioendothelioma of the fetus and placenta. Hum Pathol 1997 Jul;28(7):866-9
3) Daller JA, Bueno J, Gutierrez J, Dvorchik I, Towbin RB, Dickman PS, Mazariegos G, Reyes J Hepatic hemangioendothelioma: clinical experience and management strategy. J Pediatr Surg 1999 Jan;34(1):98-105
4) Kanai N, Saito K, Homma Y, Makino S Infantile hemangioendothelioma of the liver associated with anomalous dilated and tortuous vessels on the placental surface. Pediatr Surg Int 1998 Mar;13(2-3):175-6