Neonatal Hepatoblastoma: Two Cases Posing a Diagnostic Dilemma, with a Review of the Literature

Abstract

Hepatoblastoma accounts for less than 1% of all pediatric malignancies. However, it remains the most common malignant tumor of the liver in newborns. Less than 10% of hepatoblastoma cases are diagnosed in the neonatal period. The diagnosis can be very difficult due to the wide spectrum of presentation and differences in the size of the lesion at the time of detection either antenatally or during an infant's neonatal course. In this review, we describe the current investigations used to establish the diagnosis of congenital hepatoblastoma and the role of a nuclear red cell scan as an additional strategy in the evaluation of this malignant condition. The report uses two cases of neonatal hepatoblastoma to highlight both the clinical and pathologic findings, and the problems encountered in the evaluation of this disorder.

Fetal and neonatal hepatic tumors

“…Because spontaneous involution occurs, initially hepatic hemangiomas are treated conservatively, especially when the infant is asymptomatic. If the hemangioma is localized, surgical excision is recommended and may be done safely; hepatic arterial ligation or embolization are reserved for intractable cardiac failure and/or refractory consumptive coagulopathy [3,18]. Hepatic mesenchymal hamartoma, a benign lesion of unknown etiology, typically presents as an asymptomatic abdominal mass [2,4,19].…”

“…They comprise approximately 5% of the total neoplasms of various types occurring in the fetus and neonate [1][2][3][4][5][6][7][8][9]. Infantile hemangioma is the leading primary hepatic tumor followed in order by mesenchymal hamartoma and hepatoblastoma [1,4,5,10,11].…”

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

“…3,8,13,21,22,27,29 Traumatic rupture of these tumors as a result of dystocia was reported in equine neonates 22 and have also been reported in humans. 34 Juvenile horses frequently presented with a nonspecific history of lethargy, fever, inappetence, weight loss, diarrhea, and mucous membrane congestion. 3,8,13,21,29 Icterus, dyspnea, and pleural effusion were among the more specific signs noted.…”

“…3,8,13,21,22,27,29 Ultrasonographically, human HB typically appeared as a lobulated, vascular, solid mass with calcification and hypoechoic areas that may have indicated necrosis or hemorrhage. 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.…”

“…6,7,38,40 The causes of HB are largely unknown, but relation to genetic conditions such as abnormal gene imprinting in Beckwith-Wiedemann syndrome or mutated adenomatous polyposis coli tumor suppressor genes has been reported. 34 Hepatocellular carcinoma typically occurs in individuals with preexisting chronic hepatic disease from viral infections or toxin exposure or from metabolic storage disease. 16 Neoplastic hepatocytes may revert to production of proteins not normally produced postnatally, such as a-fetoprotein (AFP).…”