Liver tumors: Pediatric population

Abstract

Liver tumors in childhood are rare and are typically not detected clinically until they reach a large size and often spread within the organ or metastasize. This can make surgical resection problematic, and almost all of them require extirpation for cure. With very effective chemotherapy for hepatoblastoma and to some extent for sarcomas, many cancers can be shrunk to permit partial hepatectomy, but for most hepatocarcinomas, some of the other malignancies, and even some benign proliferations, their location at the hilum and multiplicity of masses in multiple lobes make transplantation the treatment of choice. Major advances in diagnostic imaging, especially enhanced computed tomography and magnetic resonance imaging, permit a preoperative choice of resection versus transplantation to be achieved in almost all instances, and for the remainder, intraoperative ultrasonography can further help to determine the most desirable approach. The outcome is very much better in the case of hepatoblastoma when transplantation is a primary modality rather than following unsuccessful attempts at resection. In this review, transplantation for liver tumors in children is considered from all aspects, including the importance of screening for tumors whenever possible to avoid the need for transplantation. Liver Transpl 14: 1545-1556, 2008.

Equine Primary Liver Tumors: A Case Series and Review of the Literature

“…29 The latter finding is inconsistent with those reported for humans, where HB was rarely, if ever, metastatic to abdominal lymph nodes. 12 In the present report, mesenteric lymph node metastasis was present only in the case classified as HCC (horse no. 3).…”

“…Detection of AFP has utility as an immunohistochemical (IHC) tumor marker for diagnosis, and serum concentration is useful in both diagnosis and assessment of response to therapy. 5,10,12,16,38 Primary equine liver tumors are rare, with only 17 cases reported, of which 9 were classified as HB (Table 1). 3,4,8,13,18,19,21,22,24,27,29,32,33,35 Other reports of primary hepatic tumors in fetuses and juvenile horses included mixed hamartoma, 33 mesenchymal hamartoma, 4 and HCC.…”

“…34 Metastases to abdominal lymph nodes are considered rare in HB but not in HCC. 12 Hepatoblastoma features commonly reported in horses included hepatomegaly, single to multifocal masses with heterogeneous echogenicity, encapsulation, and cavitation. 3,8,13 Hepatoblastomas in humans occasionally elaborate cytokines or hormones resulting in polycythemia, hypoglycemia, thrombocytosis, 2,15,25 precocious puberty and virilization, 26 osteoporosis, 1 or opsoclonus-myoclonus syndrome.…”

“…12,37 Commonly used markers include low-molecular-weight cytokeratin, AFP, and a-1-antitrypsin, among others. Hepatocyte paraffin-1 (HepPar-1), though not commonly used in childhood tumor IHC panels, 31 is a sensitive and specific marker of differentiated hepatocytes that reacts with liver cell mitochondria and has been used to identify primary hepatic neoplasms.…”

Infantile Hepatic Hemangioendothelioma (IHHE) – An Unusual Presentation

“…[1] Infantile hepatic hemangioendothelioma (IHHE) is the most common vascular tumour of the liver in children, accounting for 12% of all childhood hepatic tumours with an estimated incidence of about 1/20,000. [2] Almost 85% of patients with IHHE are diagnosed during the first 6 months of life.…”