ALTHOUGH primary malignant tumours of the liver occur rarely in early life, there are quite a number of cases in the literature from different parts of the world. These cases have been reviewed from time to time and additional cases have been recorded (Steiner, 1938;Drummond and Tollman, 1939;Edmondson, 1956;Clatworthy and Boles, 1961;Kasai, 1963; Fish, McCarey and Galveston, 1966;Misugi et al., 1966). Reviewing the literature, there are no reports of these tumours in several parts of Africa, particularly in those areas where the incidence of adult hepatomas is relatively high and pregnant women who are poorly nourished are known to drink or eat locally produced medicinal preparations. Some of these are infusions of plants which have been shown to contain hepatotoxic alkaloids or similar carcinogenic compounds (Mattocks et al., 1961; Schoental, 1963; Ogan, 1966, personal communication). Malignant liver cell tumours do not appear to be very common in our autopsies of infants and children but they are not uncommon in young adults. This paper deals with four cases of primary malignant liver cell tumours in Nigerian children seen in the University College Hospital, Ibadan, over a period of three years, 1963-1966. Two were diagnosed on open surgical biopsy specimens and the remaining two were diagnosed at autopsy. CASE
REPORTS
Case IThe patient, a moderately well developed 4-month-old male baby, weighing 4365 g., was first seen at the outpatients department of the University College Hospital at the age of 6 weeks. The mother had noticed gradual swelling of the abdomen, which progressively had got bigger since the child was about one month old. The child was suspected of having " worms " and constipation at that time and was treated with antihelminthics. He showed little or no improvement and the parents gave him local medicinal infusions orally for 3 weeks which they claimed were of some value. He then developed a skin rash, and was brought back to hospital when he was treated symptomatically. Two months later the presenting complaints were dyspnoea, anorexia, constipation and his mother had noticed a lump moving in his abdomen while the child fed. There had been no other significant illnesses. Examination at this stage revealed a grossly emaciated, dehydrated, afebrile child with no clinical evidence of jaundice, peripheral oedema or superficial lymphadenopathy. The mucous membranes were extremely pale and the abdomen was swollen. The child was dyspnoeic and some accessory muscles of respiration were being used. Pulse was 142/minute, regular
