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| LETTER TO THE EDITOR |
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| Year : 2016 | Volume
: 12
| Issue : 1 | Page : 430-431 |
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Infantile rhabdoid tumor mimicking hepatic hemangioendothelioma
Serhan Kupeli1, Ahmet Yöntem1, Nejat Narli2, Figen Doran3, Süreyya Soyupak4
1 Department of Pediatric Oncology and Pediatric, Bone Marrow Transplantation Unit, Çukurova University, Adana, Turkey
2 Department of Neonatology, Faculty of Medicine, Çukurova University, Adana, Turkey
3 Department of Pathology, Faculty of Medicine, Çukurova University, Adana, Turkey
4 Department of Radiology, Faculty of Medicine, Çukurova University, Adana, Turkey
| Date of Web Publication | 13-Apr-2016 |
Correspondence Address:
Serhan Kupeli
Department of Pediatric Oncology and Pediatric, Bone Marrow Transplantation Unit, Faculty of Medicine, Çukurova University, Adana
Turkey
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0973-1482.172138
How to cite this article:
Kupeli S, Yöntem A, Narli N, Doran F, Soyupak S. Infantile rhabdoid tumor mimicking hepatic hemangioendothelioma. J Can Res Ther 2016;12:430-1 |
Sir,
Malignant rhabdoid tumors are aggressive and often fatal malignancies of childhood, mainly occurring in the kidney and brain.[1] They are high-grade neoplasms of the central nervous system (CNS), kidneys, and soft tissue.[2] Rhabdoid tumor of the kidney (RTK) is unique among childhood renal neoplasms in its frequent association with primary or metastatic CNS lesions.[3] Infantile hepatic hemangioendothelioma (IHH) is among the most common hepatic tumors in children.[4] Here, we report a newborn with an infantile rhabdoid tumor, mimicking hepatic hemangioendothelioma radiologically and causing diagnostic challenge.
A male infant of 38 weeks' gestational age was born to a 35-year-old primigravid woman by cesarean section. The abdomen was distended, and liver was palpated 6 cm subcostally at the midclavicular line with an extension to the left part of the abdomen. Ultrasonography of abdomen showed heterogeneous, predominantly cystic mass in the left lobe of the liver which was compatible with cavernous hemangioma or hemangioendothelioma. Propranolol 1 mg/kg/day in two doses was started for hemangiomatous lesions on day 8 postnatally. Progressive enlargement of the mass, an extension to the pelvis, and new lesions in the right lobe of the liver was noticed in follow-up. Contrast-enhanced computed tomography (CT) determined hepatic, perihepatic, and retroperitoneal spread without bone involvement on day 16 [Figure 1]a. The patient was evaluated to be unsuitable for surgery. Other system examinations were normal. Cranial magnetic resonance imaging showed a solid mass measured 22 mm × 16 mm in posterior fossa [Figure 1]b. There was a deterioration in follow-up. A Tru-Cut biopsy was performed, and pathologic diagnosis was consistent with rhabdoid tumor [Figure 2]. Immunohistochemical studies showed CK19, Pancreatin, EMA, S100, and Desmin positivity with INI-1 negativity. On the 40th day of hospitalization, chemotherapy protocol consisting of vincristine, actinomycin-D, and cyclophosphamide was started. Four days after the first cycle of chemotherapy, the patient died due to sepsis and multiorgan failure. | Figure 1: Hepatic, perihepatic, and retroperitoneal involvement in abdominal computerized tomography (a). Solid mass in posterior fossa in T2 weighted axial magnetic resonance imaging (b)
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 | Figure 2: Pathologic appearance of the tumor taken from liver by Tru-Cut biopsy
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IHH is the third most common hepatic tumor in children, the most common benign vascular tumor of the liver in infancy, and the most common symptomatic liver tumor during the first 6 months of life.[4] Because the prevalence of RTK is relatively low, and because the CT findings are not pathognomonic, a renal mass seen on CT in a child is unlikely to represent RTK regardless of its CT features. It has been proposed that if CT could accurately predict the correct diagnosis of RTK preoperatively, then imaging protocols should include imaging of the brain.[3]
Corticosteroids have long been the mainstay treatment for hemangiomatous lesions, but after successful use of propranolol on severe hemangiomas in 2008, propranolol has been the preferred choice of treatment in many centers.[5] Propranolol, a beta-blocking agent, was started with an intension to treat the giant lesion in liver, but no regression was seen on propranolol treatment. Only after biopsy and pathologic examination, the correct diagnosis could be made. In case of progressive hepatic mass in the perinatal period, clinicians must be aware of possible rhabdoid tumors and abdominal and cranial imaging should be done to prevent delay in diagnosis.
Financial support and sponsorship
Nil
Conflicts of interest
There are no conflicts of interest.
| > References | |  |
| 1. | Isaacs H Jr. Fetal and neonatal rhabdoid tumor. J Pediatr Surg 2010;45:619-26.  |
| 2. | Sultan I, Qaddoumi I, Rodríguez-Galindo C, Nassan AA, Ghandour K, Al-Hussaini M. Age, stage, and radiotherapy, but not primary tumor site, affects the outcome of patients with malignant rhabdoid tumors. Pediatr Blood Cancer 2010;54:35-40. |
| 3. | Agrons GA, Kingsman KD, Wagner BJ, Sotelo-Avila C. Rhabdoid tumor of the kidney in children: A comparative study of 21 cases. AJR Am J Roentgenol 1997;168:447-51. |
| 4. | Avagyan S, Klein M, Kerkar N, Demattia A, Blei F, Lee S, et al. Propranolol as a first-line treatment for diffuse infantile hepatic hemangioendothelioma. J Pediatr Gastroenterol Nutr 2013;56:e17-20. |
| 5. | Küpeli S. Use of propranolol for infantile hemangiomas. Pediatr Hematol Oncol 2012;29:293-8. |
[Figure 1], [Figure 2]
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