Published online Aug 8, 2016. doi: 10.5409/wjcp.v5.i3.273
Peer-review started: January 19, 2016
First decision: March 24, 2016
Revised: April 6, 2016
Accepted: June 1, 2016
Article in press: June 3, 2016
Published online: August 8, 2016
We aim to provide an up-to-date summary of infantile hepatic hemangioma (IHH) and its misnomers and to dialectically present the differential diagnosis of these rare entities of the liver. Eligible peer-reviewed articles on hepatic infantile hemangiomas, published between 2000 and 2015, were reviewed for this study. IHH is the most common hepatic vascular tumor in children. Once a liver mass is identified in an infant, the differential diagnosis ranges from vascular malformations to benign and malignant tumors including mesenchymal hamartoma, hepatoblastoma, metastatic neuroblastoma, so careful physical examination, imaging studies, and, if indicated, tumor markers and biopsy, are of pivotal importance to ascertain the correct diagnosis. Despite the benign nature of IHHs, some of these lesions may demand medical and/or surgical intervention, especially for multiple and diffuse IHH. Complications can include hepatomegaly, hypothyroidism and cardiac failure. Therefore, a close follow-up is required until complete involution of the lesions. We propose an algorithm to guide the physicians towards the proper management of hepatic lesions.
Core tip: Differential diagnosis of pediatric liver lesions ranges from vascular malformations to benign and malignant tumors. Infantile hepatic hemangioma (IHH) is the most common, benign, hepatic vascular tumor in infants. They are sub-classified in focal, multiple and diffuse lesions, based on degree of unaffected liver parenchyma. Despite the benign nature of IHHs, multiple and diffuse lesions can present with life-threatening complications including severe hypothyroidism and cardiac failure, requiring prompt medical intervention. Therefore, a proper diagnosis is of pivotal importance. Including severe hypothyroidism and cardiac failure, requiring prompt medical intervention, therefore, a proper diagnosis is of pivotal importance.