Liver involvement in pediatric Hodgkin lymphoma: A systematic review by an international collaboration on Staging Evaluation and Response Criteria Harmonization (SEARCH) for Children, Adolescent, and Young Adult Hodgkin Lymphoma (CAYAHL)

Hagleitner, Melanie M.; Metzger, Monika L.; Flerlage, Jamie E.; Kelly, Kara M.; Voss, Stephan D.; Kluge, Regine; Kurch, Lars; Cho, Steve; Mauz-Koerholz, Christine; Beishuizen, Auke

doi:10.1002/pbc.28365

Cited by 7 publications

(3 citation statements)

References 53 publications

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“…Around 5% of HD children have liver involvement at presentation, usually as hepatomegaly. 10 However, despite infiltration, liver size may be normal. Rather than large masses, smaller lesions are usually seen in the liver.…”

Section: Hepatobiliary Involvement In Hdmentioning

confidence: 99%

Hepatobiliary Involvement of Hematolymphoid Malignancies in Children: From a Pediatric Gastroenterologist\'s Perspective

Sarma¹,

Reddy²,

Mathiyazhagan³

2023

Annals of Pediatric Gastroenterology and Hepatology ISPGHAN

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may be seen at initial contact or during the treatment course. Leukemic cells can infiltrate the hepatic sinusoids and portal tracts in the liver. Infiltration can lead to hepatocellular necrosis and elevated transaminases. In a pediatric study of 147 patients with ALL, elevated transaminases were reported in 34% at presentation. 2 Along with abnormal liver enzymes, 3.4% had IntroductIonLeukemias, lymphomas, and LCH constitute the common hematolymphoid malignancies in children. The reticuloendothelial system includes the liver, which is frequently involved either at the time of presentation or during the disease course. The mechanisms causing various hepatobiliary manifestations are a multitude, including infiltration, drug toxicity, immunodeficiency, etc. (Table 1). They may be subtle in the form of asymptomatic hepatomegaly and/or mildly elevated transaminases to a fulminant presentation like liver failure, often posing a challenge to pediatric gastroenterologists/hepatologists. Their presentation frequently overlaps with chronic infectious and inflammatory conditions causing a delay in diagnosis and impacting survival. In this review, we briefly discuss the aspects of hepatic involvement, focusing on their presentation and approach in clinical practice. Leukemias in ChildrenAmong the pediatric malignancies seen in the <15 years of age-group, one-third are constituted by acute leukemias. 1 Acute leukemias often infiltrate the lymphoreticular organs, like the lymph nodes, liver, and spleen.

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Section: Hepatobiliary Involvement In Hdmentioning

confidence: 99%

Hepatobiliary Involvement of Hematolymphoid Malignancies in Children: From a Pediatric Gastroenterologist\'s Perspective

Sarma¹,

Reddy²,

Mathiyazhagan³

2023

Annals of Pediatric Gastroenterology and Hepatology ISPGHAN

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“…Hepatobiliary involvement in HD: Liver involvement is less frequent in HD than in NHL. Five percent of patients with HD have liver involvement at the time of diagnosis[ 43 ]. Usually, hepatomegaly is present when the liver is involved.…”

Section: Lymphomas In Childrenmentioning

confidence: 99%

“…HD of the liver is almost invariably associated with disease of the spleen. The more extensive the splenic disease, the greater the likelihood of hepatic involvement[ 43 ]. In HD, lymphomatous cells may infiltrate the liver in up to 15% of patients with hepatomegaly and 45% in the later stages of the disease.…”

Section: Lymphomas In Childrenmentioning

confidence: 99%

Gut and liver involvement in pediatric hematolymphoid malignancies

Devarapalli¹,

Sarma²,

Mathiyazhagan³

2022

WJGO

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Hematolymphoid malignancies are common neoplasms in childhood. The involvement of the gastrointestinal (GI) tract, liver, biliary system, pancreas, and peritoneum are closely interlinked and commonly encountered. In leukemias, lymphomas, and Langerhans cell histiocytosis (LCH), the manifestations result from infiltration, compression, overwhelmed immune system, and chemotherapy-induced drug toxicities. In acute leukemias, major manifestations are infiltrative hepatitis, drug induced gastritis, neutropenic typhlitis and chemotherapy related pancreatitis. Chronic leukemias are rare. Additional presentation in lymphomas is cholestasis due to infiltration or biliary obstruction by lymph nodal masses. Presence of ascites needs a thorough workup for the underlying pathophysiology that may modify the therapy and affect the outcome. Uncommon hematolymphoid malignancies are primary hepatic, hepatosplenic, and GI lymphomas which have strict definitions. In advanced diseases with extensive spread, it may be impossible to distinguish these diseases from the primary site of origin. LCH produces biliary strictures that mimic as sclerosing cholangitis. Liver infiltration is associated with poor liver recovery even after chemotherapy. The heterogeneity of gut and liver manifestations in hematolymphoid malignancies has a clinical impact on their management. Though chemotherapy is the mainstay of therapy in all hematolymphoid malignancies, debulking surgery and radiotherapy have an adjuvant role in specific clinical scenarios. Rare situations presenting as liver failure or end-stage liver disease require liver transplantation. At their initial presentation to a primary care physician, given the ambiguity in clinical manifestations and the prognostic difference with time-bound management, it is vital to recognize them early for optimal outcomes. Pooled data from robust registries across the world is required for better understanding of these complications.

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