A Case of Infantile Hepatic Hemangioendothelioma Incidentally Detected during the Evaluation of Galactosemia

선천성 갈락토스혈증으로 오인된 신생아 간 내 혈관내피종 1례

  • Lim, Ryoung-Kyoung (Department of Pediatrics, Pusan National University Children’s Hospital Pusan National University School of Medicine) ;
  • Byun, Shin-Yun (Department of Pediatrics, Pusan National University Children’s Hospital Pusan National University School of Medicine) ;
  • Park, Seong-Shik (Department of Pediatrics, Pusan National University Children’s Hospital Pusan National University School of Medicine) ;
  • Kim, Young-Don (Department of Pediatrics, Jeju National University Hospital University of Jeju School of Medicine)
  • 임령경 (부산대학교 의학전문대학원 부산대학교어린이병원 소아청소년과) ;
  • 변신연 (부산대학교 의학전문대학원 부산대학교어린이병원 소아청소년과) ;
  • 박성식 (부산대학교 의학전문대학원 부산대학교어린이병원 소아청소년과) ;
  • 김영돈 (제주대학교 의학전문대학원 제주대학교병원 소아청소년과)
  • Published : 2010.05.31

Abstract

Galactosemia is a group of inherited enzyme deficiencies characterized by increase in the blood galactose levels. This condition may be associated with deficiencies of galactose-1-phosphate uridyl transferase, galactokinase, or uridine diphosphate galactose-4-epimerase. However, the elevated galactose identified by neonatal screening tests has several other possible etiologies, including hepatic hemangioendothelioma, hepatic hemangioma, and patent ductus venosus with hypoplasia of the portal vein. We report a 13-day-old Korean male with hepatic hemangioendothelioma, which was incidentally detected during the evaluation for suspected galactosemia. Laboratory studies revealed that mildly elevated levels of galactose, galactose-1-phosphate and alpha- fetoprotein, at the time of admission, were graduallydecreased to the normal range over the 6 months of observation. Ultrasonography showed a well-defined heterogeneous hypoechoic mass in the liver, and magnetic resonance imaging study showed multiple enhanced mass lesions, which was compatible with the diagnosis of a hepatic hemangioendothelioma. Thus, hepatic imaging, especially ultrasonography, should be performed if neonatal screening suggests galactosemia.

신생아 선천성 대사이상 선별검사에서 갈락토스혈증이 의심되는 경우, 혈관내피종과 같은 간 실질 내 종양을 동반할 수 있으므로 갈락토스혈증 관련 효소검사와 함께 간초음파 검사와 같은 영상학적 진단법, 총담즙산, AFP등의 측정을 병행하여야 원인감별에 도움이 된다. 저자들은 신생아 선천성 대사이상 질환 선별검사에서 갈락토스혈증이 의심되었던 생후 13일된 영아에 대하여 원인을 조사하던 중 복부초음파 검사에서 간 내 혈관내피종을 발견된 1례를 경험하였기에 이에 보고하는 바이다.

Keywords

References

  1. Nishimura Y, Tajima G, Dwi Bahagia A, Sakamoto A, Ono H, Sakura N, et al. Differential diagnosis of neonatal mild hypergalactosaemia detected by mass screening: clinical significance of portal vein imaging. J Inherit Metab Dis 2004;27:11-8. https://doi.org/10.1023/B:BOLI.0000016621.29854.d6
  2. Uchida Y, Takeda K, Tada K, Nakamura M, Kanekura T. Multifocal haemangioma with extracutaneous involvement associated with hypergalac tosaemia. Clin Exp Dermatol 2009;34:e617-9. https://doi.org/10.1111/j.1365-2230.2009.03309.x
  3. Isselbacher KJ, Anderson EP, Kurahashi K, Kalckar HM. Congenital galactosemia, a single enzymatic block in galactose metabolism. Science 1956;123:635-6. https://doi.org/10.1126/science.123.3198.635
  4. Ono H, Mawatari H, Mizoguchi N, Eguchi T, Sakura N. Clinical features and outcome of eight infants with intrahepatic porto-venous shunts detected in neonatal screening for galactosaemia. Acta Paediatr 1998;87:631-4. https://doi.org/10.1111/j.1651-2227.1998.tb01521.x
  5. Matsumoto T, Okano R, Sakura N, Kawaguchi Y, Tanaka Y, Ueda K, et al. Hypergalactosaemia in a patient with portal-hepatic venous and hepatic arterio-venous shunts detected by neonatal screening. Eur J Pediatr 1993;152:990-2. https://doi.org/10.1007/BF01957222
  6. Ingram JD, Yerushalmi B, Connell J, Karrer FM, Tyson RW, Sokol RJ. Hepatoblastoma in a neonate: a hypervascular presentation mimicking hemangioendothelioma. Pediatr Radiol 2000;30:794-7. https://doi.org/10.1007/s002470000320
  7. Zenge JP, Fenton L, Lovell MA, Grover TR. Case report: infantile hemangioendothelioma. Curr Opin Pediatr 2002;14:99-102. https://doi.org/10.1097/00008480-200202000-00018
  8. Mortele KJ, Vanzieleghem B, Mortele B, Benoit Y, Ros PR. Solitary hepatic infantile hemangioendothelioma: dynamic gadolinium-enhanced MR imaging findings. Eur Radiol 2002;12:862-5. https://doi.org/10.1007/s003300101004
  9. Sty JR, Starshak RJ, Gregg DC. The hepatobiliary system. In: Sty JR, Starshak RJ, Gregg DC, editors. Diagnostic imaging of infants and children. Gaithersburg: Aspen, 1992: 247-93.
  10. Buonomo C, Taylor GA, Share JC, Kirks DR. Abnormalities of the hepatobiliary system. In: Kirks DR, Griscom NT, editors. Practical pediatric imaging: diagnostic radiology of infants and children. 3rd ed. Philadelphia: Lippincott-Raven, 1998:954-79.
  11. Swischuk L. Abnormalities of the liver. In: Swischuk L, editor. Imaging of the newborn, infant and young child. 4th ed. Baltimore: Williams & Wilkins, 1997:501-21.
  12. Keslar PJ, Buck JL, Selby DM. From the archives of the AFIP. Infantile hemangioendothelioma of the liver revisited. Radiographics 1993;13:657-70. https://doi.org/10.1148/radiographics.13.3.8316672
  13. Parker B. The hepatobiliary system. In: Silverman FN, Kuhn, JP, editors. Caffey's pediatric X-ray diagnosis: an integrated imaging approach. 9th ed. St. Louis: Mosby, 1993:915-69.
  14. Horton KM, Bluemke DA, Hruban RH, Soyer P, Fishman EK. CT and MR imaging of benign hepatic and biliary tumors. Radiographics 1999;19:431-51. https://doi.org/10.1148/radiographics.19.2.g99mr04431