Multifocal hepatoblastoma: Is there a place for partial hepatectomy?

Dall’Igna, Patrizia; Cecchetto, Giovanni; Toffolutti, Tiziana; Cillo, Umberto; Cecchetto, Attilio; Guglielmi, M; Perilongo, Giorgio; Plaschkes, J.

doi:10.1002/mpo.10107

Cited by 34 publications

(13 citation statements)

References 11 publications

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“…Recommendations for primary transplant in all patients with POST-TEXT IV or centrally located POST-TEXT III disease are based on indirect and hypothetical evidence only. 13,15,18,21 Proponents of this approach cite 1) the universally poor outcomes that have been reported in patients requiring rescue transplant for disease recurrence after resection, 2) the risk of macroscopic residual disease after radical nonanatomic resections, 3) the potential hazards of microscopic residual disease when centrally located tumors are dissected off main hilar structures, and 4) the possibility of viable tumor cells in sections of the liver that appear to have been cleared of disease by preoperative chemotherapy. [13][14][15]18,21 Although the outcomes of rescue transplant for recurrent disease after resection have been poor, with most series reporting 20% to 30% survival, 12,13 it is unknown how often and in what patients this scenario occurs.…”

Section: Discussionmentioning

confidence: 98%

Successful nontransplant resection of POST‐TEXT III and IV hepatoblastoma

Lautz

Ben-Ami

Tantemsapya

et al. 2010

Cancer

101

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Excellent survival (93%) was obtained with aggressive resection in children with POST-TEXT III and IV hepatoblastoma meeting criteria for transplant referral. The 1 death occurred in a patient with unfavorable small cell histology. These children should be managed at institutions experienced in both advanced pediatric hepatobiliary surgery and transplantation. Operative exploration was frequently required to ultimately determine which tumors can be resected and which require transplantation.

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Section: Discussionmentioning

confidence: 98%

Successful nontransplant resection of POST‐TEXT III and IV hepatoblastoma

Lautz

Ben-Ami

Tantemsapya

et al. 2010

Cancer

101

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“…This principle is guided by the high risk of recurrence from small non-detected viable HB cell remnant after chemotherapy. The sites of all currently and previously visible HB lesions should be excised [104].…”

Section: Overviewmentioning

confidence: 99%

Adult hepatoblastoma: Learning from children

Rougemont

Mclin

Toso

et al. 2012

Journal of Hepatology

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Hepatoblastoma is the most common malignant liver tumour in infants and young children. Its occurrence in the adult population is debated and has been questioned. The aim of this paper is to review the histological and clinical features of adult hepatoblastoma as described in the adult literature, and to compare the findings with those of paediatric hepatoblastoma. The developmental and molecular aspects of hepatoblastoma are reviewed and their potential contribution to diagnosis of adult hepatoblastoma discussed. Case reports of adult hepatoblastoma identified by a PubMed search of the English, French, German, Italian, and Spanish literature through March 2011 were reviewed. Forty-five cases of hepatoblastoma were collected. Age at presentation was variable. Survival was uniformly poor, except for the rare patients who presented with the relatively differentiated, foetal type. The common denominator between adult and paediatric cases is the occurrence of embryonal or immature aspect of the tumours. Whether the adult cases of hepatoblastoma represent blastemal tumours, stem cell tumours, or unusual differentiation patterns in otherwise more frequent adult liver tumours remains to be established. Adult tumours labelled as hepatoblastoma are characterised by malignant appearing mesenchymal components. Surgical management is the cornerstone of therapy in children and also appears to confer an improved prognosis in adults. Whether adult hepatoblastoma exists, remains controversial. Indeed, several features described in adult cases are markedly different from hepatoblastoma as it is understood in children, and other differential diagnoses should also be entertained. Nonetheless, hepatoblastoma should be considered in adults presenting with primary liver tumours in the absence of pre-existing liver disease. Adult and paediatric patients with immature hepatoblastoma appear to have worse outcomes, and adults presenting with presumed hepatoblastoma have an overall poorer prognosis than children with hepatoblastoma. In all patients, surgery should be the treatment of choice, neoadjuvant chemotherapy is advisable.

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“…The cases presented here suggest that standard HB (standard age at diagnosis, standard histology, secretion of AFP) with a good response to chemotherapy might represent such a tumor-response profile. However, these factors seem currently insufficient to predict the complete microscopic sterilization of the tumor cells in the hepatic remnant after partial hepatectomy: Dall'Igna et al [32] reported a very similar case of a 6-year-old child, with AFP-secreting PRETEXT IV multinodular HB, without extrahepatic disease, with embryonal and fetal histology, and very good response to chemotherapy. Nodules in the left lobe had completely disappeared on preoperative imaging and were no longer identifiable during laparotomy.…”

Section: Discussionmentioning

confidence: 96%

“…Immunosuppression has been successfully adapted, with low doses and steroid-free regimens, to reduce cumulated chemotherapy- related toxicity [15]. (4) Macroscopically cleared tumor nodules before surgery sometimes display viable tumor cells [32]. Therefore, since 2004 [4], primary total hepatectomy with LT has become the standard surgical treatment of multinodular panhepatic HBs, without extrahepatic disease after chemotherapy, whatever the regression of intrahepatic lesions.…”

Section: Discussionmentioning

confidence: 99%