BACKGROUND: Mesenchymal hamartoma (MH) of the liver constitutes the third o
r fourth most common tumor of the liver in childhood and occurs most common
ly in the first two years of life. MHs of the liver are seldom aspirated, a
nd reports on the role of fine needle aspiration (FNA) in the diagnosis of
MH are scarce. Clinically, cytologically and evert histologically, MH can b
e mistaken for a number of reactive and neoplastic hepatic lesions that may
occur in children tinder 2 years of age.
CASE: A 10-month-old Pakistani female presented with a history of a right-s
ided, nonpainful abdominal swelling. Abdominal computed tomography showed a
large, partly solid and partly cystic, heterogeneous hepatic mass. FNA cyt
ology showed clusters of both epithelial and mesenchymal/spindle-shaped cel
ls with pieces of loose connective tissue. A cytologic differential diagnos
is of mesenchymal hepatic hamartoma and hepatoblastoma of the possible mixe
d mesenchymal/epithelial subtype was rendered. The histopathologic diagnosi
s of the resected tumor mass was benign mesenchymal hamartoma of the liver.
CONCLUSION: In children under 2 years of age who present with partly solid
and partly cystic hepatic masses, the possibility of MH gf the liver should
be considered. FNA has a role in the diagnosis of MH. The cytopathologist
should be aware of the patient's age, radiologic features and cytologic app
earances oft his rare, benign neoplasm. Histologic examination of tru-cut b
iopsies and immunohistochemical stains can help to exclude other pediatric
neoplasms that may show cytologic features similar to or mimicking those of
MH.