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Palaniappan K, Borkar VV, Safwan M, Vij M, Govil S, Shanmugam N, Rela M. Pediatric hepatocellular carcinoma in a developing country: Is the etiology changing? Pediatr Transplant 2016; 20:898-903. [PMID: 27392999 DOI: 10.1111/petr.12754] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/07/2016] [Indexed: 12/26/2022]
Abstract
HCC is the second most common malignant liver tumor of childhood. It typically affects children with a median age of 10-14 yr on background hepatitis B-related liver disease and is often metastatic or locally advanced at diagnosis. Children below the age of five yr typically constitute <10% of all children with HCC. In these children, it occurs on a background of congenital or metabolic liver disease. The records of all children with HCC who presented to our department over a six-yr study period were reviewed. Twelve patients with a median age of 5.9 yr (range 1.6-15.4) were diagnosed to have HCC. All patients underwent liver transplantation, and none were resected. Eleven patients had background congenital or metabolic liver disease. All five of those with hereditary tyrosinemia type 1 who presented to us were found to have HCC. No patient had hepatitis B-related liver (HBV) disease. Eight (66.7%) patients had incidentally discovered HCC on examination of the explant. Incidentally discovered HCC were smaller, well differentiated, and did not show microvascular invasion compared to those diagnosed preoperatively. There was no recurrence with a median follow-up of five months. The patient demographic for pediatric HCC is changing probably as a consequence of successful immunization against HBV. Younger patients with congenital and metabolic liver disease in whom liver transplantation is the ideal treatment are likely to constitute an ever-increasing proportion of patients with pediatric HCC as HBV disease is controlled or eradicated.
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Affiliation(s)
- Kumar Palaniappan
- Institute of Liver Disease and Transplantation, Global Health City, Chennai, India
| | - Vibhor V Borkar
- Institute of Liver Disease and Transplantation, Global Health City, Chennai, India
| | - Mohamed Safwan
- Institute of Liver Disease and Transplantation, Global Health City, Chennai, India
| | - Mukul Vij
- Institute of Liver Disease and Transplantation, Global Health City, Chennai, India
| | - Sanjay Govil
- Institute of Liver Disease and Transplantation, Global Health City, Chennai, India
| | - Naresh Shanmugam
- Institute of Liver Disease and Transplantation, Global Health City, Chennai, India.,National Foundation for Liver Research, Chennai, India
| | - Mohamed Rela
- Institute of Liver Disease and Transplantation, Global Health City, Chennai, India. .,National Foundation for Liver Research, Chennai, India.
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Thyagarajan MS, Sharif K. Space Occupying Lesions in the Liver. Indian J Pediatr 2016; 83:1291-1302. [PMID: 27783314 DOI: 10.1007/s12098-016-2240-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 09/27/2016] [Indexed: 12/19/2022]
Abstract
Space occupying liver lesions usually present with abdominal pain or abnormal physical findings, such as a palpable abdominal mass or distention. Liver lesions identified in children include benign and malignant neoplasms, inflammatory masses, cysts and metastatic lesions. Two-thirds of liver lesions in children are malignant. Hepatoblastoma accounts for two-thirds of malignant liver tumors in children. Benign lesions of the liver in children include vascular lesions, hamartomas, adenomas, and focal nodular hyperplasia. Although benign and malignant liver masses share some clinical manifestations, however treatment and prognosis differ. Evaluation involves physical examination, imaging evaluation and laboratory investigations such as serological markers [alpha-fetoprotein (AFP)] for malignant liver lesions. Ultrasound is the initial imaging modality of choice because it can detect, characterize, and provide the extent of liver lesions. However, CT or MRI are often subsequently performed for further characterization, assessment of precise extent, and detection of associated metastatic disease in cases of malignant hepatic neoplasm. Serological markers (such as alpha fetoprotein) can be useful in narrowing the differential diagnosis when they are markedly elevated but a substantial number of patients unfortunately do not have high levels of these markers at the time of presentation or cautious interpretation is warranted as AFP level is frequently elevated in infants up to 6 mo of age and may be slightly elevated with benign tumors and with hepatic insult or regeneration. Therefore, a tissue diagnosis is often required to guide subsequent management. The histology and anatomy of a pediatric liver tumor guides the treatment and prognosis.
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Affiliation(s)
| | - Khalid Sharif
- Department of Pediatric Hepatobiliary Surgery and Transplantation, NHS Foundation Trust, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B46NH, UK
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Dong R, Zheng S, Dong K. Distinguishing Among Pediatric Hepatoblastomas, Transitional Liver Cell Tumors, and Hepatocellular Carcinomas and Using Appropriate Chemotherapy Regimens. J Clin Oncol 2016; 35:115-116. [PMID: 28034077 DOI: 10.1200/jco.2016.66.9689] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Rui Dong
- Rui Dong, Shan Zheng, and Kuiran Dong, Children's Hospital of Fudan University, and Key Laboratory of Neonatal Disease, Ministry of Health, Shanghai, People's Republic of China
| | - Shan Zheng
- Rui Dong, Shan Zheng, and Kuiran Dong, Children's Hospital of Fudan University, and Key Laboratory of Neonatal Disease, Ministry of Health, Shanghai, People's Republic of China
| | - Kuiran Dong
- Rui Dong, Shan Zheng, and Kuiran Dong, Children's Hospital of Fudan University, and Key Laboratory of Neonatal Disease, Ministry of Health, Shanghai, People's Republic of China
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54
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Zhuang L, Ni C, Din W, Zhang F, Zhuang Y, Sun Y, Xi D. Huge focal nodular hyperplasia presenting in a 6-year-old child: A case presentation. Int J Surg Case Rep 2016; 29:76-79. [PMID: 27825058 PMCID: PMC5099262 DOI: 10.1016/j.ijscr.2016.10.053] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 10/23/2016] [Accepted: 10/23/2016] [Indexed: 11/28/2022] Open
Abstract
FNH is a benign lesion of the liver which is rare in children. We report the case of a 6-year-old child (male) with a huge FNH which size is more than 10 cm. This could be the biggest FNH among all children’s FNH cases ever reported. When pediatric FNH patients accord with (1) clinical symptoms; (2) indefinite diagnosis or hepatitis B virus carriage; (3) tumor size >5 cm, surgical treatment could be considered.
Introduction Focal nodular hyperplasia (FNH) is a benign lesion of the liver which is usually found in healthy adults, however, FNH is rare in children, and comprises only 2% of all pediatric liver tumors. Herein, we report the case of a 6-year-old child (male) with a huge FNH which size is more than 10 cm. This could be the biggest FNH among all children’s FNH cases ever reported. Case presentation A 6-year-old boy was found a hepatic space-occupying lesion two years ago. As the time went by, the lesion became bigger gradually. The last CT examination showed the size of the tumor to be 10.5 × 9.9 cm in the right hepatic lobe. This child underwent surgical resection of the tumor which was confirmed as FNH (11 × 8 × 7 cm) by pathology. Conclusion FNH is a benign lesion of the liver, and it is characterized by hepatocyte hyperplasia and a central stellate scar. It is uncommon for FNH to be diagnosed in children. Such huge FNH (about 11 cm) is extremely rare. Surgical operation may be the effective method to cure huge FNH.
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Affiliation(s)
- Lin Zhuang
- Department of General Surgery, Wujin Affiliated Hospital of Jiangsu University, Changzhou, 213161, China
| | - Chuangye Ni
- Department of Liver Surgery, First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Wenbing Din
- Department of Liver Surgery, First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Feng Zhang
- Department of Liver Surgery, First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Yi Zhuang
- Department of Emergency, Wujin Affiliated Hospital of Jiangsu University, Changzhou, 213161, China
| | - Yawei Sun
- Department of General Surgery, Wujin Affiliated Hospital of Jiangsu University, Changzhou, 213161, China
| | - Dong Xi
- Department of General Surgery, Wujin Affiliated Hospital of Jiangsu University, Changzhou, 213161, China.
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Abstract
18F-fluorodeoxyglucose positron emission tomography (FDG-PET) is a well-established imaging modality in adult oncological practice. Its role in childhood malignancies needs to be discussed as paediatric malignancies differ from adults in tumor subtypes and they have different tumor biology and FDG uptake patterns. This is also compounded by smaller body mass, dosimetric restrictions, and physiological factors that can affect the FDG uptake. It calls for careful planning of the PET study, preparing the child, the parents, and expertise of nuclear physicians in reporting pediatric positron emission tomography/computed tomography (PET/CT) studies. In a broad perspective, FDG-PET/CT has been used in staging, assessment of therapy response, identifying metastases and as a follow-up tool in a wide variety of pediatric malignancies. This review outlines the role of PET/CT in childhood malignancies other than hematological malignancies such as lymphoma and leukemia.
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Affiliation(s)
- Subramanyam Padma
- Department of Nuclear Medicine and PET/CT, Amrita Institute of Medical Sciences, Cochin, Kerala, India
| | | | - Anshu Tewari
- Department of Nuclear Medicine and PET/CT, Amrita Institute of Medical Sciences, Cochin, Kerala, India
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Geller J, Kasahara M, Martinez M, Soresina A, Kashanian F, Endrikat J. Safety and Efficacy of Gadoxetate Disodium-Enhanced Liver MRI in Pediatric Patients Aged >2 Months to <18 Years-Results of a Retrospective, Multicenter Study. MAGNETIC RESONANCE INSIGHTS 2016; 9:21-8. [PMID: 27478381 PMCID: PMC4957604 DOI: 10.4137/mri.s39091] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 04/11/2016] [Accepted: 04/11/2016] [Indexed: 01/28/2023]
Abstract
PURPOSE To assess the safety and efficacy of gadoxetate disodium–enhanced liver MR imaging in pediatric patients. MATERIAL AND METHODS Retrospective, multicenter study including pediatric patients aged >2 months to <18 years who underwent contrast-enhanced liver MRI due to focal liver lesions. A single intravenous bolus injection of 0.025 to 0.05 mmol/kg body weight of gadoxetate disodium was administered. Adverse events (AEs) up to 24 hours after injection were recorded and a one-year follow-up was conducted for all serious and unexpected AEs. Efficacy was defined based on the additional diagnostic information obtained from the combined (pre- and postcontrast) image sets as compared with the precontrast image sets by blinded reading. RESULTS A total of 52 patients for safety and 51 patients for efficacy analyses were evaluated. Twenty-two patients (42.3%) reported a total of 51 serious AEs (SAEs) and one AE after one year. No SAE or AE was related to gadoxetate disodium injection. Gadoxetate disodium–related effects on vital signs were not seen. Additional diagnostic information was obtained for 86.3% of patients. The three most improved efficacy variables were lesion-to-background contrast, lesion characterization, and improved border delineation in 78.4%, 76.5%, and 70.6% of patients, respectively. CONCLUSION Gadoxetate disodium in pediatric patients did not raise any clinically significant safety concern. Contrast enhancement provided additional clinically relevant information.
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Affiliation(s)
- James Geller
- Cincinnati Children's Hospital Medical Center, Cancer and Blood Diseases Institute, Ohio, USA
| | - Mureo Kasahara
- National Center for Child Health and Development, Organ Transplantation Center 2-10-1, Tokyo, Japan
| | - Mercedes Martinez
- Department of Pediatrics, Columbia University, Center for Liver Disease and Abdominal Organ Transplantation, New York Presbyterian, NY, USA
| | - Annarosa Soresina
- A.O. Spedali Civili di Brescia, Immunologia Pediatrica, Clinica Pediatrica Piazzale Spedali Civili, 1, Brescia, Italy
| | | | - Jan Endrikat
- Bayer Pharma AG, Berlin, Germany.; Department of Gynecology, Obstetrics and Reproductive Medicine, University Medical School of Saarland, Homburg/Saar, Germany
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Cui X, Liu B, Zheng S, Dong K, Dong R. Genome-wide analysis of DNA methylation in hepatoblastoma tissues. Oncol Lett 2016; 12:1529-1534. [PMID: 27446465 DOI: 10.3892/ol.2016.4789] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Accepted: 06/02/2016] [Indexed: 12/17/2022] Open
Abstract
DNA methylation has a crucial role in cancer biology. In the present study, a genome-wide analysis of DNA methylation in hepatoblastoma (HB) tissues was performed to verify differential methylation levels between HB and normal tissues. As alpha-fetoprotein (AFP) has a critical role in HB, AFP methylation levels were also detected using pyrosequencing. Normal and HB liver tissue samples (frozen tissue) were obtained from patients with HB. Genome-wide analysis of DNA methylation in these tissues was performed using an Infinium HumanMethylation450 BeadChip, and the results were confirmed with reverse transcription-quantitative polymerase chain reaction. The Infinium HumanMethylation450 BeadChip demonstrated distinctively less methylation in HB tissues than in non-tumor tissues. In addition, methylation enrichment was observed in positions near the transcription start site of AFP, which exhibited lower methylation levels in HB tissues than in non-tumor liver tissues. Lastly, a significant negative correlation was observed between AFP messenger RNA expression and DNA methylation percentage, using linear Pearson's R correlation coefficients. The present results demonstrate differential methylation levels between HB and normal tissues, and imply that aberrant methylation of AFP in HB could reflect HB development. Expansion of these findings could provide useful insight into HB biology.
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Affiliation(s)
- Ximao Cui
- Department of Pediatric Surgery, Children's Hospital of Fudan University, Shanghai Key Laboratory of Birth Defects and Key Laboratory of Neonatal Diseases, Ministry of Health, Shanghai 201102, P.R. China
| | - Baihui Liu
- Department of Pediatric Surgery, Children's Hospital of Fudan University, Shanghai Key Laboratory of Birth Defects and Key Laboratory of Neonatal Diseases, Ministry of Health, Shanghai 201102, P.R. China
| | - Shan Zheng
- Department of Pediatric Surgery, Children's Hospital of Fudan University, Shanghai Key Laboratory of Birth Defects and Key Laboratory of Neonatal Diseases, Ministry of Health, Shanghai 201102, P.R. China
| | - Kuiran Dong
- Department of Pediatric Surgery, Children's Hospital of Fudan University, Shanghai Key Laboratory of Birth Defects and Key Laboratory of Neonatal Diseases, Ministry of Health, Shanghai 201102, P.R. China
| | - Rui Dong
- Department of Pediatric Surgery, Children's Hospital of Fudan University, Shanghai Key Laboratory of Birth Defects and Key Laboratory of Neonatal Diseases, Ministry of Health, Shanghai 201102, P.R. China
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Gonzalez RS, Riddle ND. Syndrome-Associated Tumors by Organ System. J Pediatr Genet 2016; 5:105-15. [PMID: 27617151 PMCID: PMC4918701 DOI: 10.1055/s-0036-1580597] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 08/26/2015] [Indexed: 12/20/2022]
Abstract
Certain tumors suggest the possibility of a patient harboring a genetic syndrome, particularly in children. Syndrome-associated tumors of the gastrointestinal tract, genitourinary tract, gynecologic tract, heart, lungs, brain, eye, endocrine organs, and hematopoietic system will be briefly discussed.
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Affiliation(s)
- Raul S. Gonzalez
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, New York, United States
| | - Nicole D. Riddle
- Department of Pathology, Cunningham Pathology LLC, Birmingham, Alabama, United States
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59
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Pugmire BS, Towbin AJ. Magnetic resonance imaging of primary pediatric liver tumors. Pediatr Radiol 2016; 46:764-77. [PMID: 27229495 DOI: 10.1007/s00247-016-3612-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 02/28/2016] [Accepted: 03/15/2016] [Indexed: 12/31/2022]
Abstract
Although primary hepatic neoplasms are less common than other intra-abdominal tumors in children, these neoplasms are a significant source of morbidity and mortality in the pediatric population. MRI is increasingly relied upon in the diagnostic evaluation of these lesions, both before and after treatment, and familiarity with the MRI findings associated with these neoplasms is a must for pediatric radiologists. Advances in MRI technology, particularly the advent of hepatocyte-specific gadolinium-based MRI contrast agents, have allowed for accurate characterization of several types of hepatic neoplasms on the basis of imaging appearance. In this review, we provide an overview of the approach to imaging hepatic neoplasms in children using MRI, including a sample imaging protocol. We also discuss the relevant clinical features and MRI findings of the most clinically relevant entities, including their appearance on post-contrast imaging using hepatocyte-specific gadolinium-based MRI contrast agents.
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Affiliation(s)
- Brian S Pugmire
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., MLC-5031, Cincinnati, OH, 45255, USA
| | - Alexander J Towbin
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., MLC-5031, Cincinnati, OH, 45255, USA.
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Pinto RB, Ramos ARL, Backes AN, dos Santos BJ, Provenzi VO, Carbonera MR, Roenick ML, dos Santos PPA, Falhauber F, de Souza MV, Bassols JV, Artigalás O. Hirschsprung disease and hepatoblastoma: case report of a rare association. SAO PAULO MED J 2016; 134:171-5. [PMID: 26465815 PMCID: PMC10496547 DOI: 10.1590/1516-3180.2014.9200311] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 07/07/2014] [Accepted: 11/03/2014] [Indexed: 01/01/2023] Open
Abstract
CONTEXT Hirschsprung disease is a developmental disorder of the enteric nervous system that is characterized by absence of ganglion cells in the distal intestine, and it occurs in approximately 1 in every 500,000 live births. Hepatoblastoma is a malignant liver neoplasm that usually occurs in children aged 6 months to 3 years, with a prevalence of 0.54 cases per 100,000. CASE REPORT A boy diagnosed with intestinal atresia in the first week of life progressed to a diagnosis of comorbid Hirschsprung disease. Congenital cataracts and sensorineural deafness were diagnosed. A liver mass developed and was subsequently confirmed to be a hepatoblastoma, which was treated by means of surgical resection of 70% of the liver volume and neoadjuvant chemotherapy (ifosfamide, cisplatin and doxorubicin). CONCLUSION It is known that Hirschsprung disease may be associated with syndromes predisposing towards cancer, and that hepatoblastoma may also be associated with certain congenital syndromes. However, co-occurrence of hepatoblastoma and Hirschsprung disease has not been previously described. We have reported a case of a male patient born with ileal atresia, Hirschsprung disease and bilateral congenital cataract who was later diagnosed with hepatoblastoma.
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Affiliation(s)
- Raquel Borges Pinto
- MD. Physician, Department of Pediatric Gastroenterology, Hospital da Criança Conceição, Grupo Hospitalar Conceição (GHC), Porto Alegre, Rio Grande do Sul, Brazil.
| | - Ana Regina Lima Ramos
- MD. Physician, Department of Pediatric Gastroenterology, Hospital da Criança Conceição, Grupo Hospitalar Conceição (GHC), Porto Alegre, Rio Grande do Sul, Brazil.
| | - Ariane Nadia Backes
- MD. Physician, Department of Pediatric Surgery, Hospital da Criança Conceição, Grupo Hospitalar Conceição (GHC), Porto Alegre, Rio Grande do Sul, Brazil.
| | - Beatriz John dos Santos
- MD. Physician, Department of Pediatric Gastroenterology, Hospital da Criança Conceição, Grupo Hospitalar Conceição (GHC), Porto Alegre, Rio Grande do Sul, Brazil.
| | - Valentina Oliveira Provenzi
- MD. Physician, Department of Pathological Anatomy, Hospital Nossa Senhora da Conceição, Grupo Hospitalar Conceição (GHC), Porto Alegre, Rio Grande do Sul, Brazil.
| | - Mário Rafael Carbonera
- MD. Physician, Department of Pediatric Surgery, Hospital da Criança Conceição, Grupo Hospitalar Conceição (GHC), Porto Alegre, Rio Grande do Sul, Brazil.
| | - Maria Lúcia Roenick
- MD. Resident, Department of Pediatric Surgery, Hospital da Criança Conceição, Grupo Hospitalar Conceição (GHC), Porto Alegre, Rio Grande do Sul, Brazil.
| | - Pedro Paulo Albino dos Santos
- MD. Physician, Department of Pediatric Oncology and Hematology, Hospital da Criança Conceição, Grupo Hospitalar Conceição (GHC), Porto Alegre, Rio Grande do Sul, Brazil.
| | - Fabrizia Falhauber
- MD. Physician, Department of Pediatric Oncology and Hematology, Hospital da Criança Conceição, Grupo Hospitalar Conceição (GHC), Porto Alegre, Rio Grande do Sul, Brazil.
| | - Meriene Viquetti de Souza
- MD. Resident, Department of Pediatrics, Hospital da Criança Conceição, Grupo Hospitalar Conceição (GHC), Porto Alegre, Rio Grande do Sul, Brazil.
| | - João Vicente Bassols
- MD. Physician, Department of Pediatric Surgery, Hospital da Criança Conceição, Grupo Hospitalar Conceição (GHC), Porto Alegre, Rio Grande do Sul, Brazil.
| | - Osvaldo Artigalás
- MD. Physician, Department of Medical Genetics, Hospital da Criança Conceição, Grupo Hospitalar Conceição (GHC), Porto Alegre, Rio Grande do Sul, Brazil.
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Shi Y, Geller JI, Ma IT, Chavan RS, Masand PM, Towbin AJ, Chintagumpala M, Nuchtern JG, Tiao GM, Thompson PA, Vasudevan SA. Relapsed hepatoblastoma confined to the lung is effectively treated with pulmonary metastasectomy. J Pediatr Surg 2016; 51:525-9. [PMID: 26607968 DOI: 10.1016/j.jpedsurg.2015.10.053] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 09/15/2015] [Accepted: 10/13/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND In children diagnosed with hepatoblastoma (HB), the lungs are the most common site of metastasis at both initial presentation and relapse. Previous studies have encouraged pulmonary metastasectomy to achieve a disease-free state after resection of the primary hepatic lesion. However, there is no consensus about how to manage recurrent pulmonary metastasis. PROCEDURE A retrospective, multi-institutional review was performed from 2005 to 2014 to identify HB patients ≤18years of age who had disease recurrence associated with pulmonary metastases alone. RESULTS Ten patients between the ages of 8 and 33months were identified. Pulmonary metastatic recurrence was detected by measuring alpha-fetoprotein (AFP) levels and/or with CT scans of the chest. All patients subsequently underwent pulmonary metastasectomy without post-operative complications. At last follow-up, 8 patients were alive and had normal AFP levels. The 8 survivors had a median follow-up from therapy completion of 18.5months. Two patients who presented with extrapulmonary recurrence subsequently died of treatment refractory disease. CONCLUSIONS This review supports surgical resection as a safe and, in the context of multimodal therapy, efficacious approach to manage HB patients who present with isolated pulmonary relapse.
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Affiliation(s)
- Yan Shi
- Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital Liver Tumor Center, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas
| | - James I Geller
- Division of Oncology, Cincinnati Children's Hospital Medical Center, Cancer and Blood Diseases Institute, Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio
| | - Irene T Ma
- Department of Surgery, Mayo Clinic Arizona, Phoenix, Arizona
| | - Rishikesh S Chavan
- Pediatric Hematology-Oncology, Department of Pediatrics, Tulane University School of Medicine, New Orleans, Louisiana
| | - Prakash M Masand
- Department of Pediatric Radiology, Texas Children's Hospital, Department of Radiology, Texas Children's Hospital Liver Tumor Center, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX
| | - Alexander J Towbin
- Department of Radiology and Medical Imaging, Cincinnati Children's Hospital, Department of Radiology, University of Cincinnati, Cincinnati, Ohio
| | - Murali Chintagumpala
- Division of Hematology/Oncology, Department of Pediatrics, Texas Children's Hospital Liver Tumor Center, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Jed G Nuchtern
- Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital Liver Tumor Center, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Greg M Tiao
- Department of Pediatric and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
| | - Patrick A Thompson
- Division of Hematology-Oncology, Department of Pediatrics, University of North Carolina, Chapel Hill, North Carolina.
| | - Sanjeev A Vasudevan
- Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital Liver Tumor Center, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas.
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62
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Natural compounds for pediatric cancer treatment. Naunyn Schmiedebergs Arch Pharmacol 2015; 389:131-49. [DOI: 10.1007/s00210-015-1191-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 11/08/2015] [Indexed: 12/13/2022]
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Mortality and morbidity in primarily resected hepatoblastomas in Japan: Experience of the JPLT (Japanese Study Group for Pediatric Liver Tumor) trials. J Pediatr Surg 2015; 50:2098-101. [PMID: 26388131 DOI: 10.1016/j.jpedsurg.2015.08.035] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 08/24/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND In the Japanese Study Group for Pediatric Liver Tumor (JPLT) protocols (JPLT-1 and 2) for evaluating the cure rate of risk-stratified hepatoblastoma, primary resection was permitted in PRETEXT I and II cases, followed by postoperative chemotherapy. METHODS In approximately 500 enrolled cases, resection was performed as the initial treatment in 60 cases, including all 18 PRETEXT I, 30 PRETEXT II, and 12 ruptured cases. The clinical features, surgical procedures, complications, and survival rates were compared in these three groups. RESULTS All 18 PRETEXT I cases underwent complete resection by lobectomy or segmentectomy (n=14) or nonanatomical partial hepatectomy (NPH) (n=4). The 30 PRETEXT II cases underwent primary resection by right or left lobectomy (n=16), NPH (n=10), or other procedures (n=4). Of these 30 cases, operational death occurred in 1 newborn, and recurrence occurred in 7 cases (14.6%), including 6 NPH cases and 4 older cases (aged >3years). Of the 12 ruptured cases, 7 (58.3%) showed recurrence. Event-free survival rates at 5years in the 3 groups were 88%, 70%, and 32%, respectively. CONCLUSIONS Primary resection for PRETEXT I or II HB cases should be performed by anatomical resection according to strict surgical guidelines. More intensified chemotherapy is required for primary resected cases whose tumors have ruptured.
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El Ochi MR, Bellarbi S, Rouas L, Lamalmi N, Malihy A, Alhamany Z, Cherradi N. [Contribution of radio-guided biopsy in the histopathological diagnosis of childhood tumors of: experience of Rabat Child Hospital]. Pan Afr Med J 2015; 21:318. [PMID: 26587165 PMCID: PMC4633739 DOI: 10.11604/pamj.2015.21.318.5657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 08/19/2015] [Indexed: 11/30/2022] Open
Abstract
La biopsie radioguidée constitue une alternative à la biopsie chirurgicale invasive et à la cytologie pour le diagnostic des tumeurs pédiatriques. L'intérêt de notre étude est d’évaluer la valeur diagnostique des biopsies radioguidées examinées au laboratoire d'anatomopathologie de l'hôpital d'Enfants de Rabat (HER). L’étude a porté sur 78 biopsies radioguidées recueillies dans notre laboratoire entre janvier 2008 et décembre 2011. l’âge moyen des patients était de 5 ans et 10 mois avec une prédominance masculine (65,4%). La tumeur était abdominale dans 80% des cas, thoracique dans 15% cas, thoracique et abdominale dans 2,5% et sacrée dans 1,2%. Les biopsies étaient écho-guidées dans 90% des cas et scannoguidées dans 10% des cas. Le diagnostic histopathologique était posé dans 89% des cas. L'immuno-histochimie a été indiquée dans 35% des cas. Les diagnostics les plus fréquents étaient: tumeurs neuroblastiques (42 cas), lymphomes non hodgkiniens (10 cas), rhabdomyosarcomes (6 cas), autres (sarcome d'Ewing, néphroblastomes, tumeur myofibroblastique inflammatoire, maladies de Hodgkin, leucémie aiguë, hépatoblastome et ostéosarcome). Dans notre série, la biopsie radioguidée a permis un diagnostic histopathologique certain dans 89% des cas. Elle nécessite une étroite collaboration entre clinicien, radiologue et anatomopathologiste pour discuter son indication, afin de diminuer le nombre de biopsies peu ou non représentatives.
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Affiliation(s)
- Mohamed Réda El Ochi
- Laboratoire d'Anatomie et de Cytologie Pathologique, Hôpital d'Enfant, Rabat, Maroc
| | - Salma Bellarbi
- Laboratoire d'Anatomie et de Cytologie Pathologique, Hôpital d'Enfant, Rabat, Maroc
| | - Lamiae Rouas
- Laboratoire d'Anatomie et de Cytologie Pathologique, Hôpital d'Enfant, Rabat, Maroc
| | - Najat Lamalmi
- Laboratoire d'Anatomie et de Cytologie Pathologique, Hôpital d'Enfant, Rabat, Maroc
| | - Abderrahmane Malihy
- Laboratoire d'Anatomie et de Cytologie Pathologique, Hôpital d'Enfant, Rabat, Maroc
| | - Zaitouna Alhamany
- Laboratoire d'Anatomie et de Cytologie Pathologique, Hôpital d'Enfant, Rabat, Maroc
| | - Nadia Cherradi
- Laboratoire d'Anatomie et de Cytologie Pathologique, Hôpital d'Enfant, Rabat, Maroc
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Abstract
Hepatic neoplasia is a rare but serious complication of metabolic diseases in children. The risk of developing neoplasia, the age at onset, and the measures to prevent it differ in the various diseases. We review the most common metabolic disorders that are associated with a heightened risk of developing hepatocellular neoplasms, with a special emphasis on reviewing recent advances in the molecular pathogenesis of the disorders and pre-clinical therapeutic options. The cellular and genetic pathways driving carcinogenesis are poorly understood, but best understood in tyrosinemia.
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Affiliation(s)
- Deborah A Schady
- Department of Pathology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX 77030, USA
| | - Angshumoy Roy
- Department of Pathology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX 77030, USA
| | - Milton J Finegold
- Department of Pathology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX 77030, USA
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66
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Friedman GK, Beierle EA, Gillespie GY, Markert JM, Waters AM, Chen CY, Denton NL, Haworth KB, Hutzen B, Leddon JL, Streby KA, Wang PY, Cripe TP. Pediatric cancer gone viral. Part II: potential clinical application of oncolytic herpes simplex virus-1 in children. MOLECULAR THERAPY-ONCOLYTICS 2015; 2:S2372-7705(16)30018-3. [PMID: 26436134 PMCID: PMC4589754 DOI: 10.1038/mto.2015.16] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Oncolytic engineered herpes simplex viruses (HSVs) possess many biologic and functional attributes that support their use in clinical trials in children with solid tumors. Tumor cells, in an effort to escape regulatory mechanisms that would impair their growth and progression, have removed many mechanisms that would have protected them from virus infection and eventual virus-mediated destruction. Viruses engineered to exploit this weakness, like mutant HSV, can be safely employed as tumor cell killers, since normal cells retain these antiviral strategies. Many preclinical studies and early phase trials in adults demonstrated that oncolytic HSV can be safely used and are highly effective in killing tumor cells that comprise pediatric malignancies, without generating the toxic side effects of nondiscriminatory chemotherapy or radiation therapy. A variety of engineered viruses have been developed and tested in numerous preclinical models of pediatric cancers and initial trials in patients are underway. In Part II of this review series, we examine the preclinical evidence to support the further advancement of oncolytic HSV in the pediatric population. We discuss clinical advances made to date in this emerging era of oncolytic virotherapy.
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Affiliation(s)
- Gregory K Friedman
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Elizabeth A Beierle
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | - James M Markert
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Alicia M Waters
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Chun-Yu Chen
- Division of Hematology/Oncology/Blood and Marrow Transplantation, Cancer and Blood Diseases, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio, USA ; Center for Childhood Cancer and Blood Diseases, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio, USA
| | - Nicholas L Denton
- Division of Hematology/Oncology/Blood and Marrow Transplantation, Cancer and Blood Diseases, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio, USA
| | - Kellie B Haworth
- Division of Hematology/Oncology/Blood and Marrow Transplantation, Cancer and Blood Diseases, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio, USA ; Center for Childhood Cancer and Blood Diseases, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio, USA
| | - Brian Hutzen
- Division of Hematology/Oncology/Blood and Marrow Transplantation, Cancer and Blood Diseases, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio, USA
| | - Jennifer L Leddon
- Division of Hematology/Oncology/Blood and Marrow Transplantation, Cancer and Blood Diseases, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio, USA
| | - Keri A Streby
- Division of Hematology/Oncology/Blood and Marrow Transplantation, Cancer and Blood Diseases, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio, USA ; Center for Childhood Cancer and Blood Diseases, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio, USA
| | - Pin-Yi Wang
- Division of Hematology/Oncology/Blood and Marrow Transplantation, Cancer and Blood Diseases, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio, USA
| | - Timothy P Cripe
- Division of Hematology/Oncology/Blood and Marrow Transplantation, Cancer and Blood Diseases, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio, USA ; Center for Childhood Cancer and Blood Diseases, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio, USA
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67
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Erez A, DeBerardinis RJ. Metabolic dysregulation in monogenic disorders and cancer - finding method in madness. Nat Rev Cancer 2015; 15:440-8. [PMID: 26084394 DOI: 10.1038/nrc3949] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Cancer is a prime example of a disease process in which carcinogenic and metabolic changes are intertwined to promote cell survival and growth. One approach to unravel this complex relationship is by studying rare, monogenic disorders caused by mutations in genes encoding metabolic enzymes or regulators. There are hundreds of these diseases, most of which manifest in childhood and are collectively termed 'inborn errors of metabolism' (IEMs). Several IEMs demonstrate the consequences of chronic, systemic loss of a particular metabolic activity that can result in malignancy. In this Opinion article, we present a conceptual categorization of IEMs associated with cancer and discuss how assessment of these rare diseases might inform us about the biological foundations of common types of cancer and opportunities for cancer diagnosis and therapy.
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Affiliation(s)
- Ayelet Erez
- Weizmann Institute of Science, Rehovot, Israel 76100
| | - Ralph J DeBerardinis
- Children's Medical Center Research Institute, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Room NL12.138B, Dallas, Texas 75390-8502, USA
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Wiederkehr JC, Avilla SG, Mattos E, Coelho IM, Ledesma JA, Conceição AF, Wiederkehr HA, Wiederkehr BA. Associating liver partition with portal vein ligation and staged hepatectomy (ALPPS) for the treatment of liver tumors in children. J Pediatr Surg 2015; 50:1227-31. [PMID: 25783345 DOI: 10.1016/j.jpedsurg.2014.10.019] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Revised: 09/28/2014] [Accepted: 10/01/2014] [Indexed: 12/11/2022]
Abstract
Resection is the only curative treatment option for primary and secondary malignant tumors of the liver. Although curative resection is associated with long-term survival rates, it can only be performed in 10% of patients with primary tumors and 25% of patients with liver metastases. Liver insufficiency is one of the most serious postoperative complications of patients undergoing extensive liver resections. When total liver resection is necessary liver transplant is mandatory, with the burden of long-term immunosuppression and its complications. Among several different strategies to increase the resectability of liver tumors, portal vein occlusion (embolization or ligature), bilateral tumor resection in two stages, and resection combined with loco regional therapy are the most popular. A new strategy for patients with marginally resectable liver tumors previously considered to be unresectable was formally reported by Baumgart et al. in 2011, originally developed by Hans Schlitt in 2007. This technique consists of a two-staged hepatectomy with initial portal vein ligation and in situ splitting of the liver parenchyma, and it is known as ALPPS (associating liver partition with portal vein ligation for staged hepatectomy). The aim of this study is to present the first series of pediatric patients with marginally resectable liver tumors previously considered to be unresectable treated with two-stage hepatectomy with initial portal vein ligation and in situ splitting of the liver parenchyma. Two patients were diagnosed with hepatoblastoma, and one each with rhabdomyosarcoma, hepatocellular carcinoma, and nodular focal hyperplasia. ALPPS technique was considered whenever the future liver remnant (FLR) was 40% or less of the total liver volume (TLV) determined by CT or MRI scans. The ratio of FLR to TLV before the first procedure ranged from 0.15 to 0.38, with a mean±sd of 0.253±0.07. In all patients, a rapid growth of the FLR was observed. Estimates of the FRL volume prior to surgical treatment ranged from 110cc to 750cc, with a mean±sd of 361.6±213.75cc. Just before the second procedure, the volume of the remnant liver ranged from 225cc to 910cc, with a mean±sd of 563.6cc±221.7cc. The FRL volume increase had a mean±sd of 72.56%±29.05%, with a median of 83.8%. The second procedure was performed after 7 to 12days with a median of 11days. The only postoperative complication observed in one patient was an asymptomatic right pleural effusion that was aspirated during the second procedure with no further complications. ALPPS was shown to be effective and a safe procedure to treat large tumors in children.
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Affiliation(s)
- Julio Cesar Wiederkehr
- Federal University of Paraná, Curitiba Brazil; Division of Liver Transplantation and Surgery, Hospital Pequeno Príncipe, Curitiba Brazil.
| | - Sylvio Gilberto Avilla
- Division of Liver Transplantation and Surgery, Hospital Pequeno Príncipe, Curitiba Brazil
| | - Elisângela Mattos
- Division of Liver Transplantation and Surgery, Hospital Pequeno Príncipe, Curitiba Brazil
| | - Izabel Meister Coelho
- Division of Liver Transplantation and Surgery, Hospital Pequeno Príncipe, Curitiba Brazil
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Tannuri ACA, Cristofani LM, Teixeira RAP, Filho VO, Tannuri U. New concepts and outcomes for children with hepatoblastoma based on the experience of a tertiary center over the last 21 years. Clinics (Sao Paulo) 2015; 70:387-92. [PMID: 26106955 PMCID: PMC4462574 DOI: 10.6061/clinics/2015(06)01] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 03/05/2015] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The aim of this study was to summarize the experience of a tertiary center in treating hepatoblastoma for the last 21 years. PATIENTS AND METHODS Fifty-eight cases were included. The tumor extent and prognosis were assessed using the PRETEXT system. The following data were analyzed: age at diagnosis, comorbidities, prematurity, treatment modalities, histopathological findings, surgical details and complications, treatment outcomes, chemotherapy schedules, side effects and complications. Treatment outcomes included the occurrence of local or distant recurrence, the duration of survival and the cause of death. The investigation methods were ultrasonography, CT scan, serum alpha-fetoprotein level measurement and needle biopsy. Chemotherapy was then planned, and the resectability of the tumor was reevaluated via another CT scan. RESULTS The mean numbers of neoadjuvant cycles and postoperative cycles of chemotherapy were 6±2 and 1.5±1.7, respectively. All children except one were submitted for surgical resection, including 50 partial liver resections and 7 liver transplantations. Statistical comparisons demonstrated that long-term survival was associated with the absence of metastasis (p=0.04) and the type of surgery (resection resulted in a better outcome than transplantation) (p=0.009). No associations were found between vascular invasion, incomplete resection, histological subtype, multicentricity and survival. The overall 5-year survival rate of the operated cases was 87.7%. CONCLUSION In conclusion, the experience of a Brazilian tertiary center in the management of hepatoblastoma in children demonstrates that long survival is associated with the absence of metastasis and the type of surgery. A multidisciplinary treatment involving chemotherapy, surgical resection and liver transplantation (including transplantations using tissue from living donors) led to good outcomes and survival indexes.
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Affiliation(s)
- Ana Cristina Aoun Tannuri
- Faculdade de Medicina da Universidade de Sao Paulo, Pediatric Surgery Division, Pediatric Liver Transplantation Unit and Laboratory of Research in Pediatric Surgery (LIM 30), Sao Paulo/SP, Brazil
| | - Lilian Maria Cristofani
- Faculdade de Medicina da Universidade de Sao Paulo, Pediatric Oncology Division, Sao Paulo/SP, Brazil
| | | | - Vicente Odone Filho
- Faculdade de Medicina da Universidade de Sao Paulo, Pediatric Oncology Division, Sao Paulo/SP, Brazil
| | - Uenis Tannuri
- Faculdade de Medicina da Universidade de Sao Paulo, Pediatric Surgery Division, Pediatric Liver Transplantation Unit and Laboratory of Research in Pediatric Surgery (LIM 30), Sao Paulo/SP, Brazil
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70
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The role of BH3-mimetic drugs in the treatment of pediatric hepatoblastoma. Int J Mol Sci 2015; 16:4190-208. [PMID: 25690034 PMCID: PMC4346952 DOI: 10.3390/ijms16024190] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Revised: 02/01/2015] [Accepted: 02/09/2015] [Indexed: 12/20/2022] Open
Abstract
Pediatric hepatoblastoma (HB) is commonly treated by neoadjuvant chemotherapy and surgical tumor resection according to international multicenter trial protocols. Complete tumor resection is essential and survival rates up to 95% have now been achieved in those tumors classified as standard-risk HB. Drug resistance and occurrence of metastases remain the major challenges in the treatment of HB, especially in high-risk tumors. These conditions urgently require the development of alternative therapeutic strategies. One of those alternatives is the modulation of apoptosis in HB cells. HBs regularly overexpress anti-apoptotic proteins of the Bcl-family in comparison to healthy liver tissue. This fact may contribute to the development of chemoresistance of HB cells. Synthetic small inhibitory molecules with BH3-mimetic effects, such as ABT-737 and obatoclax, enhance the susceptibility of tumor cells to different cytotoxic drugs and thereby affect initiator proteins of the apoptosis cascade via the intrinsic pathway. Besides additive effects on HB cell viability when used in combination with cytotoxic drugs, BH3-mimetics also play a role in preventing metastasation by reducing adhesion and inhibiting cell migration abilities. Presumably, including additive BH3-mimetic drugs into existing therapeutic regimens in HB patients might allow dose reduction of established cytotoxic drugs and thereby associated immanent side effects, while maintaining the antitumor activity. Furthermore, reduction of tumor growth and inhibition of tumor cell dissemination may facilitate complete surgical tumor resection, which is mandatory in this tumor type resulting in improved survival rates in high-risk HB. Currently, there are phase I and phase II clinical trials in several cancer entities using this potential target. This paper reviews the available literature regarding the use of BH3-mimetic drugs as single agents or in combination with chemotherapy in various malignancies and focuses on results in HB cells.
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71
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Rabah F, El-Banna N, Bhuyan D, Al-Ghaithi I, Al-Hinai M, Al-Sabahi A, Al-Mashaikhi N, Beshlawi I. Hepatoblastomas in Oman: Unveiling success. Sultan Qaboos Univ Med J 2015; 15:e85-e90. [PMID: 25685391 PMCID: PMC4318612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Revised: 05/21/2014] [Accepted: 07/08/2014] [Indexed: 06/04/2023] Open
Abstract
OBJECTIVES Primary malignant liver tumours account for more than 1% of all paediatric malignancies, with the most common form being hepatoblastomas (HB). Such malignancies among Arab populations have rarely been addressed in the literature. Using data from Oman's sole national referral centre for childhood solid malignancies, this study aimed to present the nationwide Omani experience with HB over the past 21 years. METHODS This retrospective study reviewed the medical records of all children with HB who were managed in the Royal Hospital, Muscat, Oman, between January 1991 and April 2012. Clinical, radiological and laboratory characteristics were examined as well as treatments and outcomes. RESULTS During the study period, 15 patients with HB were treated. Of these, 10 have survived to date. Nine of the survivors were no longer receiving treatment and one patient still had the disease but was in a stable condition. Of the remaining five patients, three did not survive and two were lost to follow-up. The survival rate among patients who completed therapy was 91%. CONCLUSION HB has an excellent prognosis in Oman. The main obstacle to improving outcomes among Omani patients is non-compliance with therapy.
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Affiliation(s)
- Fatma Rabah
- Department of Child Health, Sultan Qaboos University Hospital, Muscat, Oman
| | - Nagwa El-Banna
- Department of Paediatric Haemato-Oncology, Royal Hospital, Muscat, Oman
| | - Dipali Bhuyan
- Department of Paediatric Haemato-Oncology, Royal Hospital, Muscat, Oman
| | | | - Mohamed Al-Hinai
- Department of Paediatric Haemato-Oncology, Royal Hospital, Muscat, Oman
| | - Amal Al-Sabahi
- Department of Paediatric Haemato-Oncology, Royal Hospital, Muscat, Oman
| | | | - Ismail Beshlawi
- Department of Child Health, Sultan Qaboos University Hospital, Muscat, Oman
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Khaderi S, Guiteau J, Cotton RT, O’Mahony C, Rana A, Goss JA. Role of liver transplantation in the management of hepatoblastoma in the pediatric population. World J Transplant 2014; 4:294-298. [PMID: 25540737 PMCID: PMC4274598 DOI: 10.5500/wjt.v4.i4.294] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Revised: 10/09/2014] [Accepted: 10/29/2014] [Indexed: 02/05/2023] Open
Abstract
Hepatoblastoma (HB) is the most common primary liver tumor in children and accounts for two-thirds of all malignant liver neoplasms in the pediatric population. For patients with advanced HB (unresectable or unresponsive to chemotherapy), combined treatment with chemotherapy and liver transplantation is an excellent option. The etiology of HB is mostly obscure because of its extreme rarity although some inherited syndromes and very low birth weight have been associated with it. The prognosis for children with HB has significantly improved in the past three decades thanks to advancements in chemotherapy, surgical resection and postoperative care. In 2002 a surgical staging system called pretreatment extent of disease (PRETEXT) was designed to allow a universal, multidisciplinary approach to patients with HB. Between one-third to two-thirds of patients initially present with unresectable tumors or distant metastases, but up to 85% of these tumors become operable after neoadjuvant chemotherapy. Patients with PRETEXT categories 1, 2, and some 3 are referred for neoadjuvant chemotherapy followed by surgical resection with the goal of complete tumor removal. Classic treatments regimens include a combination of cisplatin, fluorouracil, and vincristine or cisplatin and doxorubicin. Liver transplantation is the only treatment option for unresectable HB. In 2010 the pediatric end-stage liver disease, a pediatric-specific scoring system that determines a patient’s ranking on the liver transplant list, began to award additional “exception” points for patients with HB. We analyzed the Standard Transplant Analysis and Research dataset to assess the impact of changes in exception point criteria for HB on outcomes after liver transplantation at Texas Children’s Hospital in Houston, Texas. We found that patients who were listed for transplantation with current HB exception criteria experienced a shorter waitlist time but survival was similar between the two eras.
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73
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Chen B, Chen J, Luo Q, Guo C. Effective strategy of the combination of high-intensity focused ultrasound and transarterial chemoembolization for improving outcome of unresectable and metastatic hepatoblastoma: a retrospective cohort study. Transl Oncol 2014; 7:788-94. [PMID: 25500089 PMCID: PMC4311047 DOI: 10.1016/j.tranon.2014.09.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2014] [Revised: 09/14/2014] [Accepted: 09/19/2014] [Indexed: 11/17/2022] Open
Abstract
The combination of high-intensity focused ultrasound (HIFU) and transarterial chemoembolization (TACE) has been experimentally performed in a variety of malignant tumors, and its validity has not yet been evaluated for hepatoblastoma (HB). We evaluated the disease-response rate, resection rate, and toxicity in children with unresectable or metastatic HB (stage III and stage IV HB) after sequential treatment with TACE plus HIFU in a controlled clinical trial. The 35 patients with unresectable or metastatic HB were nonrandomly assigned to HIFU ablation (n = 12) or C5V chemotherapy (n = 23). The rates of complete resection, tumor response, and treatment toxicity were evaluated for both regimens. Nine patients who received C5V and 10 patients who received TACE plus HIFU became operable (P = .02). The 3-year event-free survival and overall survival rates were 43.03% and 56.68% in the C5V group and 38.57% and 57.86% in the TACE plus HIFU group, respectively. Acute grade 3 or 4 adverse events, including neutropenia, thrombocytopenia, and anemia, were more frequent in patients treated with C5V therapy than in patients receiving TACE plus HIFU. HIFU ablation achieved a higher rate of complete resection and a lower rate of severe complications compared with C5V treatment in children with advanced HB (Chinese Clinical Trials Registry No. ChiCTR-PRCH-08000182).
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Affiliation(s)
- Bailin Chen
- Department of Pediatric General Surgery and Liver Transplantation, Children's Hospital, Chongqing Medical University, Chongqing, PR China
| | - Jiaping Chen
- Department of Pediatric General Surgery and Liver Transplantation, Children's Hospital, Chongqing Medical University, Chongqing, PR China
| | - Qianfu Luo
- Department of Pediatric General Surgery and Liver Transplantation, Children's Hospital, Chongqing Medical University, Chongqing, PR China
| | - Chunbao Guo
- Department of Pediatric General Surgery and Liver Transplantation, Children's Hospital, Chongqing Medical University, Chongqing, PR China.
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α-Fetoprotein assay on dried blood spot for hepatoblastoma screening in children with overgrowth-cancer predisposition syndromes. Pediatr Res 2014; 76:544-8. [PMID: 25167201 DOI: 10.1038/pr.2014.126] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2013] [Accepted: 05/23/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND Beckwith-Wiedemann syndrome (BWS) and hemihyperplasia (HH) are overgrowth conditions with predisposition to hepatoblastoma for which early diagnosis patients undergo cancer screening based on determination of the tumor marker α-fetoprotein (αFP). Repeated blood draws are a burden for patients with consequent compliance issues and poor adherence to surveillance protocol. We sought to analyze feasibility and reliability of αFP dosage using an analytical micromethod based on blood dried on filter paper (DBS). METHODS Overall 143 coupled αFP determinations on plasma and DBS collected simultaneously were performed, of which 31 were in patients with hepatoblastoma predisposition syndromes and 112 were in controls. The plasma αFP dosage method was adapted to DBS adsorbed on paper matrix for newborn screening. RESULTS There was strong correlation between plasmatic and DBS αFP (r2 = 0.999, P < 0.001). Cohen's k coefficient for correlation was 0.96 for diagnostic cut-off of 10 U/ml (P < 0.001), commonly employed in clinical practice. The measurements on plasma and DBS were highly overlapping and consistent. CONCLUSION The DBS method allowed to dose αFP reliably and consistently for the concentrations commonly employed in clinical settings for the screening of hepatoblastoma, opening new scenarios about conducting cancer screening in overgrowth syndromes.
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75
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Armeanu-Ebinger S, Hoh A, Wenz J, Fuchs J. Targeting EpCAM (CD326) for immunotherapy in hepatoblastoma. Oncoimmunology 2014; 2:e22620. [PMID: 23482411 PMCID: PMC3583930 DOI: 10.4161/onci.22620] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Hepatoblastoma (HB) is the most common liver cancer in children. Recurrence of HB after chemotherapy and surgery is frequent among high-risk patients and is associated with chemoresistance. Immunotherapy may improve poor treatment outcomes in HB patients. Cytotoxic leukocytes of the innate and adaptive immune system including different populations of cytotoxic T cells play a major role in fighting developing tumors. In this setting, monoclonal antibodies may be employed to specifically direct immune responses toward tumor cells. We addressed this issue by using humanized antibodies that recognize the cell surface molecule EpCAM (CD326, overexpressed in hepatic tumor cells) to enhance immune responses against HB. EpCAM was constantly expressed on HB cells and its expression was independent of previous therapy based on the DNA-damaging agent cisplatin. Co-culture assays performed with two well-described HB cell lines and tumor tissue cultures demonstrated that tumor cell lysis by γδ T cells can be dramatically augmented by applying EpCAM-specific monoclonal antibodies. These data emphasize the value of antitumor immune responses and encourage adapting immunotherapeutic regimens to improve the outcome of high risk HB.
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Affiliation(s)
- Sorin Armeanu-Ebinger
- Department of Paediatric Surgery and Urology; University Children's Hospital; Tuebingen, Germany
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Wildhaber BE, Montaruli E, Guérin F, Branchereau S, Martelli H, Gauthier F. Mesenchymal hamartoma or embryonal sarcoma of the liver in childhood: a difficult diagnosis before complete surgical excision. J Pediatr Surg 2014; 49:1372-7. [PMID: 25148740 DOI: 10.1016/j.jpedsurg.2014.04.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Revised: 03/03/2014] [Accepted: 04/11/2014] [Indexed: 12/21/2022]
Abstract
BACKGROUND Clinical experience shows that the primary diagnosis of mesenchymal hamartoma (MHL) and embryonal sarcoma of the liver (ESL) recurrently is mistaken, leading to inadequate managements. We evaluated the accuracy of the primary diagnosis of those liver tumors, compared with the final histological diagnosis. METHODS Records of 25 children (0-16 years, treated 01/1989-01/2013) with final diagnosis of MHL or ESL were analyzed. RESULTS Final diagnosis was MHL in 18/25 children (10 solid-cystic, 2 cystic, 6 solid) and ESL in 7/25 (4 solid-cystic, 1 cystic, 2 solid). Only 3/7 ESL patients and 15/18 MHL patients fell into the "typical" age group. In 13/25 children primary diagnosis was based on imaging only. Overall, primary diagnosis was concordant with the final diagnosis in 17/25 patients. Of 99/25 biopsied cases, 4/9 biopsy results exposed the wrong final diagnosis; of cystic-solid masses 4/14 were mistaken, of cystic masses 1/3, of solid masses 3/8. CONCLUSION Preoperative diagnosis of MHL and ESL is challenging because of atypical clinical presentation, misleading "typical" radiological findings, and difficult interpretation of biopsies. If feasible, complete surgical resection of, in particular, solid-cystic liver masses in the pediatric age group must be aimed for, to get a definitive, final diagnosis, followed by an adequate treatment strategy.
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Affiliation(s)
- Barbara E Wildhaber
- Hôpitaux Universitaires de Genève, Department of Pediatrics, Division of Pediatric Surgery, 6 Rue Willy Donzé, 1205 Geneva, Switzerland.
| | - Ernesto Montaruli
- Hôpitaux Universitaires de Genève, Department of Pediatrics, Division of Pediatric Surgery, 6 Rue Willy Donzé, 1205 Geneva, Switzerland
| | - Florent Guérin
- Hôpitaux Universitaires Paris Sud-Bicêtre, Department of Pediatric Surgery, 78 Rue du Général Leclerc, 94275 Le Kremlin Bicêtre, France
| | - Sophie Branchereau
- Hôpitaux Universitaires Paris Sud-Bicêtre, Department of Pediatric Surgery, 78 Rue du Général Leclerc, 94275 Le Kremlin Bicêtre, France
| | - Hélène Martelli
- Hôpitaux Universitaires Paris Sud-Bicêtre, Department of Pediatric Surgery, 78 Rue du Général Leclerc, 94275 Le Kremlin Bicêtre, France
| | - Frédéric Gauthier
- Hôpitaux Universitaires Paris Sud-Bicêtre, Department of Pediatric Surgery, 78 Rue du Général Leclerc, 94275 Le Kremlin Bicêtre, France
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Azlin AH, Looi LM, Cheah PL. Tissue Microarray Immunohistochemical Profiles of p53 and pRB in Hepatocellular Carcinoma and Hepatoblastoma. Asian Pac J Cancer Prev 2014; 15:3959-63. [DOI: 10.7314/apjcp.2014.15.9.3959] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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78
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Abstract
PURPOSE The use of neoadjuvant chemotherapy has improved the survival of patients with hepatoblastoma (HB). However, an increased number of treatment complications and toxic deaths, particularly from heart failure, have been observed with doxorubicin treatment. We have applied cisplatin as a single agent to treat children with high-risk HB to improve event-free survival (EFS). METHODS Between 2007 and 2009, 14 patients with untreated high-risk HB were enrolled in this study. All the patients received a single-agent treatment of cisplatin. The initial cisplatin cycle was administered in a continuous intravenous 24-hour infusion of 80 mg/m/24 h. The primary outcome was the rate of complete resection. Secondary outcomes were EFS and overall survival (OS). RESULTS Eleven patients (78.6%) had an overall partial response. Two patients (14.3%) had stable disease. One patient experienced (7.1%) progression. Of the 4 patients who presented with lung metastases initially, 1 patient achieved complete response, 2 patients achieved partial response, and 1 patient experienced progression during preoperative chemotherapy. The complete resection rate was 78.6% (95% CI, 49%-95%). The Kaplan-Meier estimates of 2-year EFS and OS for the whole group were 64.3% (95% CI, 35%-87%) and 85.7% (95% CI, 57%-98%), respectively. The 2-year EFS and OS rates of patients who achieved complete resection were 81.8% (95% CI, 48%-98%) and 100% (95% CI, 62%-100%), respectively. CONCLUSIONS The single-agent cisplatin had less toxicity than cisplatin plus doxorubicin and achieved an equal rate of complete resection in high-risk HB compared with conventional multiagent chemotherapy.
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Abstract
Children with cancer undergo a host of surgeries and procedures that require anesthesia during the various phases of the disease. A safe anesthetic plan includes consideration of the direct effects of tumor, toxic effects of chemotherapy and radiation therapy, the specifics of the surgical procedure, drug-drug interactions with chemotherapy agents, pain syndromes, and psychological status of the child. This article provides a comprehensive overview of the anesthetic management of the child with cancer, focuses on a systems-based approach to the impact from both tumor and its treatment in children, and presents a discussion of the relevant anesthetic considerations.
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Affiliation(s)
- Gregory J Latham
- Department of Anesthesiology and Pain Medicine, Seattle Children's Hospital, University of Washington School of Medicine, 4800 Sand Point Way Northeast, MB.11.500.3, Seattle, WA 98105, USA.
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Fawzy M, Bahnassy A, El-Wakil M, Abdel-Sayed A. Hepatoblastoma Survival and the Prognostic Role of Cancer Stem Cell Markers. INTERNATIONAL JOURNAL OF CANCER THERAPY AND ONCOLOGY 2014. [DOI: 10.14319/ijcto.0201.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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81
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Dong R, Jia D, Xue P, Cui X, Li K, Zheng S, He X, Dong K. Genome-wide analysis of long noncoding RNA (lncRNA) expression in hepatoblastoma tissues. PLoS One 2014; 9:e85599. [PMID: 24465615 PMCID: PMC3894996 DOI: 10.1371/journal.pone.0085599] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Accepted: 11/27/2013] [Indexed: 12/14/2022] Open
Abstract
Long noncoding RNAs (lncRNAs) have crucial roles in cancer biology. We performed a genome-wide analysis of lncRNA expression in hepatoblastoma tissues to identify novel targets for further study of hepatoblastoma. Hepatoblastoma and normal liver tissue samples were obtained from hepatoblastoma patients. The genome-wide analysis of lncRNA expression in these tissues was performed using a 4×180 K lncRNA microarray and Sureprint G3 Human lncRNA Chips. Quantitative RT-PCR (qRT-PCR) was performed to confirm these results. The differential expressions of lncRNAs and mRNAs were identified through fold-change filtering. Gene Ontology (GO) and pathway analyses were performed using the standard enrichment computation method. Associations between lncRNAs and adjacent protein-coding genes were determined through complex transcriptional loci analysis. We found that 2736 lncRNAs were differentially expressed in hepatoblastoma tissues. Among these, 1757 lncRNAs were upregulated more than two-fold relative to normal tissues and 979 lncRNAs were downregulated. Moreover, in hepatoblastoma there were 420 matched lncRNA-mRNA pairs for 120 differentially expressed lncRNAs, and 167 differentially expressed mRNAs. The co-expression network analysis predicted 252 network nodes and 420 connections between 120 lncRNAs and 132 coding genes. Within this co-expression network, 369 pairs were positive, and 51 pairs were negative. Lastly, qRT-PCR data verified six upregulated and downregulated lncRNAs in hepatoblastoma, plus endothelial cell-specific molecule 1 (ESM1) mRNA. Our results demonstrated that expression of these aberrant lncRNAs could respond to hepatoblastoma development. Further study of these lncRNAs could provide useful insight into hepatoblastoma biology.
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Affiliation(s)
- Rui Dong
- Department of Pediatric Surgery, Children's Hospital of Fudan University and The Key Laboratory of Neonatal Disease, Chinese Ministry of Health, Shanghai, China
| | - Deshui Jia
- State Key Laboratory of Oncogenes and Related Genes, Shanghai Cancer Institute, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ping Xue
- Department of Pediatric Surgery, Children's Hospital of Fudan University and The Key Laboratory of Neonatal Disease, Chinese Ministry of Health, Shanghai, China
| | - Ximao Cui
- Department of Pediatric Surgery, Children's Hospital of Fudan University and The Key Laboratory of Neonatal Disease, Chinese Ministry of Health, Shanghai, China
| | - Kai Li
- Department of Pediatric Surgery, Children's Hospital of Fudan University and The Key Laboratory of Neonatal Disease, Chinese Ministry of Health, Shanghai, China
| | - Shan Zheng
- Department of Pediatric Surgery, Children's Hospital of Fudan University and The Key Laboratory of Neonatal Disease, Chinese Ministry of Health, Shanghai, China
| | - Xianghuo He
- State Key Laboratory of Oncogenes and Related Genes, Shanghai Cancer Institute, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Kuiran Dong
- Department of Pediatric Surgery, Children's Hospital of Fudan University and The Key Laboratory of Neonatal Disease, Chinese Ministry of Health, Shanghai, China
- * E-mail:
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82
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Timely identification of children with cancer. Open Med (Wars) 2013. [DOI: 10.2478/s11536-013-0226-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
AbstractBackground. Cancer in childhood is rare, but nevertheless one of the most frequent causes of disease related death. Initial symptoms are often unspecific, frequently leading to a delay of cancer diagnosis. As a timely diagnosis can be crucial for the clinical outcome, our aim is to point out when unspecific symptoms should be considered suspect of being associated with specific cancer entities. Data sources. A systematic literature research in PubMed and current biliographies, as well as an evaluation of published epidemiologic data was performed. Results. This article reviews the typical presenting features and epidemiologic characteristics of the more common childhood malignancies, elucidates when specific and virtually unspecific symptoms require further evaluation, and gives advice how to start a rational diagnostic workup. Furthermore, genetic syndromes requiring increased watchfulness for cancer in childhood are demonstrated. Conclusion. Patients showing suspect symptoms should early be referred to specialized centres to assure optimal diagnostic and therapeutic capabilities.
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Allan BJ, Parikh PP, Diaz S, Perez EA, Neville HL, Sola JE. Predictors of survival and incidence of hepatoblastoma in the paediatric population. HPB (Oxford) 2013; 15:741-6. [PMID: 23600968 PMCID: PMC3791112 DOI: 10.1111/hpb.12112] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Accepted: 03/17/2013] [Indexed: 12/12/2022]
Abstract
OBJECTIVES This study evaluates current trends in incidence, clinical outcomes and factors predictive of survival in children with hepatoblastoma (HB). METHODS The Surveillance, Epidemiology and End Results (SEER) database was queried for the period 1973-2009 for all patients aged <20 years with HB. RESULTS A total of 606 patients were identified. The age-adjusted incidence was 0.13 patients per 100 000 in 2009. An annual percentage change of 2.18% (95% confidence interval (CI) 1.10-3.27; P < 0.05) was seen over the study period. Overall survival rates at 5, 10 and 20 years were 63%, 61% and 59%, respectively. Ten-year survival rates significantly improved in patients with resectable disease who underwent operative treatment in comparison with those with non-resectable HB (86% versus 39%; P < 0.0001). Multivariate analysis showed surgical treatment (hazard ratio (HR) = 0.23, 95% CI 0.17-0.31; P < 0.0001), Hispanic ethnicity (HR = 0.61, 95% CI 0.43-0.89; P = 0.01), local disease at presentation (HR = 0.43, 95% CI 0.29-0.63; P < 0.0001) and age < 5 years (HR = 0.63, 95% CI 0.41-0.95; P < 0.03) to be independent prognostic factors of survival. CONCLUSIONS The incidence of paediatric HB has increased over time. Hepatoblastoma is almost exclusively seen in children aged < 5 years. When HB presents after the age of 5 years, the prognosis is most unfavourable. Tumour extirpation markedly improves survival in paediatric patients with local disease.
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Affiliation(s)
- Bassan J Allan
- Division of General Surgery, University of Miami Miller School of MedicineMiami, FL, USA
| | - Punam P Parikh
- Division of General Surgery, University of Miami Miller School of MedicineMiami, FL, USA
| | - Sofia Diaz
- Division of General Surgery, University of Miami Miller School of MedicineMiami, FL, USA
| | - Eduardo A Perez
- Division of Paediatric Surgery, DeWitt-Daughtry Family Department of Surgery, University of Miami Miller School of MedicineMiami, FL, USA
| | - Holly L Neville
- Division of Paediatric Surgery, DeWitt-Daughtry Family Department of Surgery, University of Miami Miller School of MedicineMiami, FL, USA
| | - Juan E Sola
- Division of Paediatric Surgery, DeWitt-Daughtry Family Department of Surgery, University of Miami Miller School of MedicineMiami, FL, USA
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Hiyama E. Current therapeutic strategies for childhood hepatic malignant tumors. Int J Clin Oncol 2013; 18:943-5. [PMID: 24057320 DOI: 10.1007/s10147-013-0607-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Indexed: 10/26/2022]
Abstract
The two main malignant hepatic tumors in children are hepatoblastomas (HBLs) and hepatocellular carcinomas (HCCs). The past two decades have brought significant improvement to the outcomes of children diagnosed with malignant hepatic tumors, especially HBL, due to improvements in diagnosis and treatment. Histological diagnosis is essential for differential diagnosis of these tumors. In surgery, liver resection has become a safe and secure technique because of progress in anatomical knowledge and surgical dissection; also liver transplantation has become widely used for unresectable tumors. Moreover, the introduction of effective chemotherapeutic regimens has significantly improved the survival of children with HBL due to an increase in the number of patients ultimately undergoing tumor resection, and a reduction in the incidence of post-surgical recurrence. These improvements are the result of multicenter cooperative trials conducted by the Japanese Study Group for Pediatric Liver Tumor, the Children's Oncology Group, and the International Childhood Liver Tumor Strategy Group, including work of the German Association of Pediatric Hematology and Oncology. This paper summarizes the results of these studies and calls on the current international collaboration study called the Children's Hepatic Tumors International Collaboration Project to establish global clinical research on childhood hepatic malignant tumors.
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Affiliation(s)
- Eiso Hiyama
- Department of Pediatric Surgery, Hiroshima University Hospital, 1-2-3, Kasumi, Minami-ku, Hiroshima, 734-8551, Japan,
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85
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Abstract
Hepatoblastoma (HB), the most common hepatic neoplasm in children is associated with germline mutations in adenomatous polyposis coli tumor-suppressor gene that cause familial adenomatous polyposis syndrome. Individuals with familial adenomatous polyposis have a 750 to 7500× the risk of developing HB. We report 3 children with APC gene mutation, who underwent resection or liver transplant for HB. In addition to HB, all 3 patients had multiple independent adenoma-like nodules lacking qualities of intrahepatic metastases. Twenty-five nodules were subjected to immunohistochemical analysis using a panel of antibodies including glypican-3 (GPC3), β-catenin, cytokeratin AE1/AE3, CD34, Ki-67, glutamine synthetase (GS), and fatty acid binding protein. The nodules were round, ranged in size from 0.2 to 1.5 cm, and paler than the background liver. All lacked the chemotherapy effect. The nodules were circumscribed but nonencapsulated and composed of well-differentiated hepatocytes with occasional minor atypical features and absent or rare portal tracts. One lesion displayed a "nodule-within-nodule" pattern. The nodules demonstrated diffuse GS overexpression. Nine (36%) nodules were focally reactive for GPC3, and 1 (4%) displayed focal nuclear β-catenin expression. The associated HB showed diffuse expression of GS, GPC3, and β-catenin nuclear staining. We interpret these nodules as neoplastic with most being adenomas (GPC3 negative) that show features of independent origin and represent early stages of carcinogenesis, implying potential to progress to HB or hepatocellular carcinoma. To our knowledge, this is the first report of multifocal neoplasms in patients with HB and APC gene mutation.
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86
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A single-institution retrospective cases series of childhood undifferentiated embryonal liver sarcoma (UELS): success of combined therapy and the use of orthotopic liver transplant. J Pediatr Hematol Oncol 2013; 35:451-5. [PMID: 23138115 DOI: 10.1097/mph.0b013e318271c948] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND/INTRODUCTION Undifferentiated embryonal liver sarcoma (UELS) makes up 9% to 15% of all malignant liver tumors in children. UELS is characteristically diagnosed between the ages of 6 and 10 years and presents with abdominal pain, vomiting, and an abdominal mass. There is currently no standardized treatment for UELS except attempt at complete surgical resection. There have been only about 150 cases of UELS reported in the literature all with historically poor overall survival of <37.5% at 5 years. This report is one of the largest single-institution reports of UELS consisting of 5 patients over 2 decades. The purpose of this study is to characterize presentation and to report treatment success in UELS in children, adolescents, and young adults and the use of liver transplantation and, lastly, to suggest a use of positron emission tomography/computed tomography (PET/CT) in monitoring of this disease process. METHODS We conducted an Institutional Review Board-approved retrospective chart review. Data were collected from UELS patients younger than 21 years seen at the University of California Los Angeles over the past 20 years (January 2001 to September 2011). Descriptive analysis was conducted including multiple parameters of patient demographics, tumor characteristics, treatment modalities, and morbidity and mortality. RESULTS Five patients with UELS were identified. Patients initially presented with fever, abdominal pain, or nausea. Ages ranged from 10 to 19 years old (median age 13 y old), and there was a 4:1 male-to-female predominance. Tumor size ranged from 6 to 22 cm in largest diameter. One patient presented with metastatic disease to the lungs and heart and 1 patient recurred 2 years from diagnosis with bilateral paraspinal masses. Treatment included local control surgery with neoadjuvant and adjuvant chemotherapy with an anthracycline/alkylating agent combination. One patient with recurrent and refractory disease achieved local control with an orthotopic liver transplantation (OLT). Metastatic disease was controlled with surgery and radiation therapy. 18-Fluorodeoxyglucose PET/CT was a useful imaging tool for judging response to therapy with complete loss of metabolic activity in tumor after neoadjuvant chemotherapy in 2 representative cases. Although follow-up is short for some patients, overall survival in these 5 patients was 100% with follow-up ranging from 21 to 68 months. Disease-free survival ranged from 8 to 46 months with no patients with residual disease. CONCLUSIONS UELS is an aggressive high-grade primary liver sarcoma with high metastatic potential. This report represents one of the largest single-institution studies of UELS. Using multimodality therapy, patients have achieved 100% overall survival even in the setting of extensive disease, metastases, and recurrence. In cases of unresectable primary tumor or recurrent and refractory disease isolated to the liver, OLT is a potential therapeutic option. We report success with adjuvant chemotherapy and complete surgical resection with OLT as an alternative in unresectable or refractory cases. We also suggest a possible utility of PET/CT in monitoring treatment response in this disease.
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87
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CITED1 expression in liver development and hepatoblastoma. Neoplasia 2013; 14:1153-63. [PMID: 23308048 DOI: 10.1593/neo.12958] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Revised: 10/16/2012] [Accepted: 10/19/2012] [Indexed: 11/18/2022] Open
Abstract
Hepatoblastoma, the most common pediatric liver cancer, consists of epithelial mixed embryonal/fetal (EMEF) and pure fetal histologic subtypes, with the latter exhibiting a more favorable prognosis. Few embryonal histology markers that yield insight into the biologic basis for this prognostic discrepancy exist. CBP/P-300 interacting transactivator 1 (CITED1), a transcriptional co-activator, is expressed in the self-renewing nephron progenitor population of the developing kidney and broadly in its malignant analog, Wilms tumor (WT). In this current study, CITED1 expression is detected in mouse embryonic liver initially on post-coitum day 10.5 (e10.5), begins to taper by e14.5, and is undetectable in e18.5 and adult livers. CITED1 expression is detected in regenerating murine hepatocytes following liver injury by partial hepatectomy and 3,5-diethoxycarbonyl-1,4-dihydrocollidine. Importantly, while CITED1 is undetectable in normal human adult livers, 36 of 41 (87.8%) hepatoblastoma specimens express CITED1, where it is enriched in EMEF specimens compared to specimens of pure fetal histology. CITED1 overexpression in Hep293TT human hepatoblastoma cells induces cellular proliferation and upregulates the Wnt inhibitors Kringle containing transmembrane protein 1 (KREMEN1) and CXXC finger protein 4 (CXXC4). CITED1 mRNA expression correlates with expression of CXXC4 and KREMEN1 in clinical hepatoblastoma specimens. These data show that CITED1 is expressed during a defined time course of liver development and is no longer expressed in the adult liver but is upregulated in regenerating hepatocytes following liver injury. Moreover, as in WT, this embryonic marker is reexpressed in hepatoblastoma and correlates with embryonal histology. These findings identify CITED1 as a novel marker of hepatic progenitor cells that is re-expressed following liver injury and in embryonic liver tumors.
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88
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Murphy AJ, Ayers GD, Hilmes MA, Mukherjee K, Wilson KJ, Allen WM, Fernandez-Pineda I, Shinall MC, Zhao Z, Furman WL, McCarville MB, Davidoff AM, Lovvorn HN. Imaging analysis of hepatoblastoma resectability across neoadjuvant chemotherapy. J Pediatr Surg 2013; 48:1239-48. [PMID: 23845613 PMCID: PMC3735614 DOI: 10.1016/j.jpedsurg.2013.03.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Accepted: 03/08/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE Hepatoblastomas often require neoadjuvant chemotherapy to facilitate partial hepatectomy, which necessitates freedom of tumor borders from the confluence of hepatic veins (COHV), portal vein bifurcation (PVB), and retrohepatic inferior vena cava (IVC). This study aimed to clarify the effect of incremental neoadjuvant cycles on the AHEP0731 protocol criteria of hepatoblastoma resectability. METHODS Hepatoblastoma responses to neoadjuvant chemotherapy were analyzed among patients (n=23) treated at two children's hospitals between 1996 and 2010. Using digital imaging data, ellipsoid and point-based models were created to measure tumor volume regression and respective distances from tumor borders nearest to the COHV, PVB, and IVC. RESULTS Hepatoblastoma volumes regressed with incremental neoadjuvant chemotherapy cycles (p<0.001). Although tumor borders regressed away from the COHV (p=0.008), on average only 1.1mm was gained. No change from tumor borders to the PVB was detected (p=0.102). Distances from tumor borders to the IVC remained stable at one hospital (p=0.612), but increased only 0.15 mm every 10 days of therapy at the other (p=0.002). Neoadjuvant chemotherapy induced slightly more tumors to meet the threshold vascular margin of 1cm (baseline to completion): COHV, 11 (47.8%) to 17 (73.9%; p=0.058); PVB, 11 (47.8%) to 15 (65.2%; p=0.157); and IVC, 4 (17.4%) to 10 (43.5%; p=0.034). No differences were detected in demographic or disease-specific characteristics between patients who did or did not achieve this 1-cm margin after conclusion of chemotherapy. CONCLUSION Hepatoblastoma volumes regress significantly with increasing neoadjuvant chemotherapy cycles. However, tumors often remain anchored to the major hepatic vasculature, showing marginal improvement in resectability criteria.
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Affiliation(s)
- Andrew J. Murphy
- Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Gregory D. Ayers
- Center for Quantitative Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Melissa A. Hilmes
- Department of Pediatric Radiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kaushik Mukherjee
- Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kevin J. Wilson
- Institute of Imaging Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Wade M. Allen
- Institute of Imaging Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Myrick C. Shinall
- Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Zhiguo Zhao
- Center for Quantitative Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Wayne L. Furman
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Mary Beth McCarville
- Department of Radiological Sciences, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Andrew M. Davidoff
- Department of Surgery, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Harold N. Lovvorn
- Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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Cistaro A, Treglia G, Pagano M, Fania P, Bova V, Basso ME, Fagioli F, Ficola U, Quartuccio N. A comparison between ¹⁸F-FDG PET/CT imaging and biological and radiological findings in restaging of hepatoblastoma patients. BIOMED RESEARCH INTERNATIONAL 2013; 2013:709037. [PMID: 24063012 PMCID: PMC3770017 DOI: 10.1155/2013/709037] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Accepted: 07/20/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND In this study we retrospectively evaluated if ¹⁸F-FDG-PET/CT provided incremental diagnostic information over CI in a group of hepatoblastoma patients performing restaging. PROCEDURE Nine patients (mean age: 5.9 years; range: 3.1-12 years) surgically treated for hepatoblastoma were followed up by clinical examination, serum α-FP monitoring, and US. CI (CT or MRI) and PET/CT were performed in case of suspicion of relapse. Fine-needle aspiration biopsies (FNAB) were carried out for final confirmation if the results of CI, PET/CT, and/or α-FP levels were suggestive of relapse. PET/CT and CI findings were analyzed for comparison purposes, using FNAB as reference standard. RESULTS α-FP level was suggestive of disease recurrence in 8/9 patients. Biopsy was performed in 8/9 cases. CI and PET/CT resulted to be concordant in 5/9 patients (CI identified recurrence of disease, but ¹⁸F-FDG-PET/CT provided a better definition of disease extent); in 4/9 cases, CI diagnostic information resulted in negative findings, whereas PET/CT correctly detected recurrence of disease. ¹⁸F-FDG-PET/CT showed an agreement of 100% (8/8) with FNAB results. CONCLUSIONS ¹⁸F-FDG-PET/CT scan seems to better assess HB patients with respect to CI and may provide incremental diagnostic value in the restaging of this group of patients.
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Affiliation(s)
- Angelina Cistaro
- 1Positron Emission Tomography Centre, IRMET S.p.A., Euromedic Inc., 10136 Turin, Italy
- 2Co-ordinator of PET Pediatric AIMN InterGroup, 10136 Turin, Italy
- 3Associate researcher of Institute of Cognitive Sciences and Technologies, National Research Council, 00185 Rome, Italy
- *Angelina Cistaro:
| | - Giorgio Treglia
- 4Department of Nuclear Medicine and PET/CT Centre, Oncology Institute of Southern Switzerland, 6500 Bellinzona, Switzerland
| | - Manuela Pagano
- 5Pediatric Unit, Hospital Cirie' ASL To4, 10073 Cirie' (TO), Italy
| | - Piercarlo Fania
- 1Positron Emission Tomography Centre, IRMET S.p.A., Euromedic Inc., 10136 Turin, Italy
| | - Valentina Bova
- 6Department of Radiological Sciences, HSR Giglio, 90015 Cefalù (PA), Italy
| | - Maria Eleonora Basso
- 7Paediatric Oncohematologic Unit, Department of Paediatric Oncology, Regina Margherita Children's Hospital, 10126 Turin, Italy
| | - Franca Fagioli
- 8Department of Haematology, Oncology, Immunology and Infectious Diseases, Regina Margherita Children's Hospital, 10126 Turin, Italy
| | - Umberto Ficola
- 9Nuclear Medicine Unit, La Maddalena Hospital, 90146 Palermo, Italy
| | - Natale Quartuccio
- 10Nuclear Medicine Unit, Department of Biomedical Sciences and of Morphologic and Functional Images, University of Messina, 98125 Messina, Italy
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Hoh A, Dewerth A, Vogt F, Wenz J, Baeuerle PA, Warmann SW, Fuchs J, Armeanu-Ebinger S. The activity of γδ T cells against paediatric liver tumour cells and spheroids in cell culture. Liver Int 2013; 33:127-36. [PMID: 23088518 DOI: 10.1111/liv.12011] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Accepted: 08/13/2012] [Indexed: 12/22/2022]
Abstract
BACKGROUND Chemoresistance and advanced tumour stage at time of diagnosis are the major reasons for poor treatment results in hepatoblastoma (HB) and paediatric hepatocellular carcinoma (HCC). Positive results with transplantation of liver and bone marrow revealed the impact of the immune system on the treatment of liver malignancies. AIM Cytotoxic-immune-cells-like natural killer (NK) and T cells are major player in the defence against developing tumours. This study aimed to specifically analyse the ability of ex-vivo expanded γδ T cells to recognise and lyse HB and HCC cell lines in coculture assays. METHODS Cell viability after treatment with γδ T cells was evaluated with two HB (HUH6 and HepT1) and one HCC cell line (HC-AFW1) using a MTT-based cytotoxicity assay. The binding of T cells to target cells was monitored using immunofluorescence microscopy. RESULTS Incubation of hepatic tumour cell lines with γδ T cells led to a significant decrease in tumour cell viability. This was enhanced by zoledronic acid and histone deacetylase inhibitors. MT110, an EpCAM/CD3-bispecific BiTE antibody could bluntly enhance tumour cell lysis close to completion. γδ T cells efficiently interacted with HB and HCC cells in a spheroid culture model. CONCLUSION Bispecific antibodies such as MT110 might be used to intensify the antitumoural effect of γδ T cells in context of adoptive immune cell transfer. Optimised immunotherapeutic strategies might therefore improve the outcome of high risk hepatoblastoma and hepatocellular carcinoma.
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MESH Headings
- Antibodies, Bispecific/pharmacology
- Antigens, Neoplasm/immunology
- CD3 Complex/immunology
- Carcinoma, Hepatocellular/immunology
- Carcinoma, Hepatocellular/pathology
- Cell Adhesion Molecules/immunology
- Cell Line, Tumor
- Cell Survival
- Coculture Techniques
- Cytotoxicity, Immunologic/drug effects
- Diphosphonates/pharmacology
- Epithelial Cell Adhesion Molecule
- Hepatoblastoma/immunology
- Hepatoblastoma/pathology
- Histone Deacetylase Inhibitors/pharmacology
- Humans
- Imidazoles/pharmacology
- Liver Neoplasms/immunology
- Liver Neoplasms/pathology
- Lymphocyte Activation/drug effects
- Microscopy, Fluorescence
- Receptors, Antigen, T-Cell, gamma-delta/immunology
- Single-Chain Antibodies/pharmacology
- Spheroids, Cellular
- T-Lymphocytes/drug effects
- T-Lymphocytes/immunology
- Zoledronic Acid
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Affiliation(s)
- Alexander Hoh
- Department of Paediatric Surgery and Urology, University Childreǹs Hospital, Tuebingen, Germany
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91
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Opioid growth factor (OGF) for hepatoblastoma: a novel non-toxic treatment. Invest New Drugs 2012; 31:1066-70. [DOI: 10.1007/s10637-012-9918-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Accepted: 12/17/2012] [Indexed: 10/27/2022]
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92
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Atteby Y, Line C, Joseph OK, Nguessan K, Soumahoro O, Leonard M, Joseph A. Liver tumours in children: diagnostic and therapeutic approach in the Tropics. ASIAN PACIFIC JOURNAL OF TROPICAL DISEASE 2012. [DOI: 10.1016/s2222-1808(12)60107-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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93
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Murphy AJ, Rauth TP, Lovvorn HN. Chronic biloma after right hepatectomy for stage IV hepatoblastoma managed with Roux-en-Y biliary cystenterostomy. J Pediatr Surg 2012; 47:e5-9. [PMID: 23164033 PMCID: PMC3505688 DOI: 10.1016/j.jpedsurg.2012.06.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Revised: 06/07/2012] [Accepted: 06/08/2012] [Indexed: 01/12/2023]
Abstract
We report the complex case of a 12-month-old girl with stage IV hepatoblastoma accompanied by thrombosis and cavernous transformation of the portal vein. After neoadjuvant chemotherapy, she underwent right hepatectomy, which was complicated by iatrogenic injury of her left hepatic duct, and subsequently developed a postoperative biloma and chronic biliocutaneous fistula. Concomitant with multiple percutaneous interventions to manage the biloma nonoperatively while the child completed her adjuvant chemotherapy, she progressed to develop chronic malnutrition, jaundice, and failure to thrive. Once therapy was completed and the child was deemed free of disease, she underwent exploratory laparotomy with Roux-en-Y biliary cystenterostomy for definitive management, resulting in resolution of her biliary fistula, jaundice, and marked improvement in her nutritional status. Roux-en-Y biliary cystenterostomy is a unique and efficacious management option in the highly selected patient population with chronic biliary leak refractory to minimally invasive management.
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Affiliation(s)
- Andrew J Murphy
- Monroe Carrell Jr Children's Hospital at Vanderbilt, Department of Pediatric Surgery, Nashville, TN 37232-9780, USA.
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94
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Yadav SS, Lawande MA, Patkar DA, Pungavkar SP. Rare case of hemorrhagic brain metastasis from hepatoblastoma. J Pediatr Neurosci 2012; 7:73-4. [PMID: 22837789 PMCID: PMC3401665 DOI: 10.4103/1817-1745.97634] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Saroj S Yadav
- Department of Magnetic Resonance Imaging, Dr. Balabhai Nanavati Hospital, Mumbai, India
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95
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Falix FA, Aronson DC, Lamers WH, Hiralall JK, Seppen J. DLK1, a serum marker for hepatoblastoma in young infants. Pediatr Blood Cancer 2012; 59:743-5. [PMID: 22180200 DOI: 10.1002/pbc.24024] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Accepted: 11/04/2011] [Indexed: 11/08/2022]
Abstract
Hepatoblastoma is a malignant pediatric liver tumor. The currently used diagnostic serum marker for hepatoblastoma, α-fetoprotein (AFP), is not always reliable in infants with hepatoblastoma, due to the physiologically elevated levels of AFP in this age group. In this report, we show that Delta-like 1 homolog (DLK1), a protein highly expressed during fetal development, but almost completely absent after birth, and an established liver-stem cell marker, is a new candidate serum marker of hepatoblastoma, especially in young infants.
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Affiliation(s)
- Farah A Falix
- Pediatric Surgical Center of Amsterdam, Emma Children's Hospital AMC, Amsterdam, The Netherlands
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96
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Zhang SC, Wang WL, Cai WS, Jiang KL, Yuan ZW. Engineered measles virus Edmonston strain used as a novel oncolytic viral system against human hepatoblastoma. BMC Cancer 2012; 12:427. [PMID: 23009685 PMCID: PMC3488522 DOI: 10.1186/1471-2407-12-427] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Accepted: 09/23/2012] [Indexed: 12/26/2022] Open
Abstract
Background Hepatoblastoma (HB) is the most common primary, malignant pediatric liver tumor in children. The treatment results for affected children have markedly improved in recent decades. However, the prognosis for high-risk patients who have extrahepatic extensions, invasion of the large hepatic veins, distant metastases and very high alpha-fetoprotein (AFP) serum levels remains poor. There is an urgent need for the development of novel therapeutic approaches. Methods An attenuated strain of measles virus, derived from the Edmonston vaccine lineage, was genetically engineered to produce carcinoembryonic antigen (CEA). We investigated the antitumor potential of this novel viral agent against human HB both in vitro and in vivo. Results Infection of the Hep2G and HUH6 HB cell lines, at multiplicities of infection (MOIs) ranging from 0.01 to 1, resulted in a significant cytopathic effect consisting of extensive syncytia formation and massive cell death at 72–96 h after infection. Both of the HB lines overexpressed the measles virus receptor CD46 and supported robust viral replication, which correlated with CEA production. The efficacy of this approach in vivo was examined in murine Hep2G xenograft models. Flow cytometry assays indicated an apoptotic mechanism of cell death. Intratumoral administration of MV-CEA resulted in statistically significant delay of tumor growth and prolongation of survival. Conclusions The engineered measles virus Edmonston strain MV-CEA has potent therapeutic efficacy against HB cell lines and xenografts. Trackable measles virus derivatives merit further exploration in HB treatment.
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Affiliation(s)
- Shu-Cheng Zhang
- Department of Pediatric Surgery, Major Laboratory of Chinese Health Ministry for Congenital Malformations, Shengjing Hospital of China Medical University, 36 Sanhao Street Heping District, Shenyang 110004, P.R. China.
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97
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Abstract
Liver tumors in children can be classified into benign or malignant; some of the benign lesions can have the potential of malignant transformation, and therefore the therapeutic approach may change. These neoplasms account for nearly 1-2% of all pediatric tumors and they have gained significant attention in the last decades due to data suggesting that the incidence may be increasing 5% annually. We know that with new and improved imaging modalities some of these lesions may be detected more often than before. Recent studies showed that liver cancer represented 2% of malignancies in infants by 1980s and this was doubled in incidence to 4% in the following 10 yr. In this review our aim is to discuss all primary liver tumors in children with attention to their clinicopathological and immunohistochemical features followed by the current standard of care.
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Affiliation(s)
- Sukru Emre
- Department of Surgery, Yale University School of Medicine, Yale, New Haven, CT, USA.
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98
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Ovchinsky N, Moreira RK, Lefkowitch JH, Lavine JE. Liver biopsy in modern clinical practice: a pediatric point-of-view. Adv Anat Pathol 2012; 19:250-62. [PMID: 22692288 PMCID: PMC3404724 DOI: 10.1097/pap.0b013e31825c6a20] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Liver biopsy remains the foundation of evaluation and management of liver disease in children, although the role of the liver biopsy is changing with development of alternative methods of diagnosis and advancement of hepatic imaging techniques. The indications for liver biopsy are evolving as current knowledge of etiologies, noninvasive biomarker alternatives, and treatment options in pediatric liver disease are expanding. The procedure can often be complicated in children by technical difficulties, cost, and smaller specimen size. Communication and partnership of clinicians with pathologists experienced in pediatric liver diseases are essential. DNA sequencing, novel imaging modalities, noninvasive biomarkers of fibrosis and apoptosis, proteomics, and genome-wide association studies offer potential alternative methods for evaluation of liver disease in children. This review presents specific indications, considerations, methods, complications, contraindications, and alternatives for pediatric liver biopsy.
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Affiliation(s)
| | - Roger K. Moreira
- Department of Pathology and Cell Biology, Columbia University College
| | - Jay H. Lefkowitch
- Department of Pathology and Cell Biology, Columbia University College
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99
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Rare hepatic malignant tumors: dynamic CT, MRI, and clinicopathologic features: with analysis of 54 cases and review of the literature. ACTA ACUST UNITED AC 2012; 38:511-26. [DOI: 10.1007/s00261-012-9918-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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100
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Rougemont AL, McLin VA, Toso C, Wildhaber BE. Adult hepatoblastoma: learning from children. J Hepatol 2012; 56:1392-403. [PMID: 22326463 DOI: 10.1016/j.jhep.2011.10.028] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2011] [Revised: 10/17/2011] [Accepted: 10/17/2011] [Indexed: 01/16/2023]
Abstract
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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Affiliation(s)
- Anne-Laure Rougemont
- Division of Clinical Pathology, Geneva University Hospitals, 1211 Geneva 4, Switzerland
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