A 4-day-old girl weighing 3500 g was referred to the neonatology ward because of a palpable abdominal tumor.
During the interview, the mother reported no relevant background.
On physical examination, the only positive sign was the globulous abdomen, blade, non-painful, with a hard, irregular and little movable mass, approximately 8 cm in diameter in the left upper quadrant.
No cutaneous hemangiomas or other visible alterations were observed; no clinical evidence of heart failure was found.
Pathological Pathological Pathological Pathological Studies of Income, Normal Hemoglobin, Albumin, Cholesterol, Blood Glucose, Creatinine, Total Bilirubin and Proteins 100 μL, High
The alpha-fetoprotein showed abnormal values (65 IU).
Thyroid function tests were normal.
Simple ultrasound reported a complex image in the liver, predominantly in the left lobe, measuring 80 mm x 70 mm x 36 mm.
Laparoscopy with biopsy of the lesion, procedure after which the child suffered hypovolemic shock and cardiorespiratory arrest.
No patient required mechanical ventilation for three days.
During this period, it worsened clinically and the tumor increased in size.
With the clinical suspicion of infantile hepatic hemangioendothelioma, it was decided to start treatment with intravenous prednisone at a dose of 1 mg/kg/day.
In spite of this, purpuric lesions appeared throughout the body and platelet count.
At that time she was referred to the Department of Hepatobiliary Surgery, where an abdominal Doppler ultrasound was performed, which showed the presence of a complex tumor located in the left lobe of the liver, with arteriovenous flow diagnosis.
Moreover, the celiac trunk was visualized very dilated, a sign very suggestive of this disease.
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Due to the high risk of invasive treatments under critical patient conditions, it was decided to increase the dose of prednisone to 5 mg/ kg/day.
After 72 hours, the child showed an evident clinical and ultrasound improvement.
Fifteen days later, the steroid dose was reduced every 10 days after clinical evaluation and ultrasound.
At 36 days of life, the patient was discharged and 45 days later, a mass size reduction greater than 50% was found.
Prednisone was maintained at a dose of 1 mg/kg/day until 5 months of age.
