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Grimaldi C, de Ville de Goyet J, Bici K, Cianci MC, Callea F, Morabito A. The role of liver transplantation in the care of primary hepatic vascular tumours in children. Front Oncol 2022; 12:1026232. [PMID: 36505841 PMCID: PMC9730342 DOI: 10.3389/fonc.2022.1026232] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 10/31/2022] [Indexed: 11/25/2022] Open
Abstract
Liver transplantation (LT) is the standard of care for many liver conditions, such as end-stage liver diseases, inherited metabolic disorders, and primary liver malignancies. In the latter group, indications of LT for hepatoblastoma and hepatocellular carcinoma evolved and are currently available for many non-resectable cases. However, selection criteria apply, as the absence of active metastases. Evidence of good long-term outcomes has validated the LT approach for managing these malignancies in the context of specialist and multidisciplinary approach. Nevertheless, LT's role in treating primary vascular tumours of the liver in children, both benign and malignant, remains somewhat controversial. The rarity of the different diseases and the heterogeneity of pathological definitions contribute to the controversy and make evaluating the benefit/risk ratio and outcomes quite difficult. In this narrative review, we give an overview of primary vascular tumours of the liver in children, the possible indications and the outcomes of LT.
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Affiliation(s)
- Chiara Grimaldi
- Department of Pediatric Surgery, Meyer Children’s Hospital, University of Florence, Florence, Italy,*Correspondence: Chiara Grimaldi,
| | - Jean de Ville de Goyet
- Department of Pediatrics, IRCCS-Istituto Mediterraneo per i Trapianti e Terapie ad altra specializzazione (ISMETT) (Institute for Scientific-Based Care and Research-Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy
| | - Kejd Bici
- Department of Pediatric Surgery, Meyer Children’s Hospital, University of Florence, Florence, Italy
| | - Maria Chiara Cianci
- Department of Neuroscience, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
| | - Francesco Callea
- Department of Histopathology, Bugando Medical Centre, Catholic University of Healthy Allied Sciences, Mwanza, Tanzania
| | - Antonino Morabito
- Department of Neuroscience, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
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2
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Liu APY, Ip JJK, Leung AWK, Luk CW, Li CH, Ho KKH, Lo R, Chan EKW, Chan ACY, Chung PHY, Chiang AKS. Treatment outcome and pattern of failure in hepatoblastoma treated with a consensus protocol in Hong Kong. Pediatr Blood Cancer 2019; 66:e27482. [PMID: 30270490 DOI: 10.1002/pbc.27482] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 09/04/2018] [Accepted: 09/10/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIM We reviewed the results and pattern of failure of the consensus HB/HCC 1996 treatment protocol for pediatric hepatoblastoma (HB) in Hong Kong. The role of SIOPEL and Children's Hepatic tumors International Collaboration (CHIC) risk stratification was evaluated. METHODS Patients enrolled on the protocol from 1996 to 2014 were included. PRETEXT staging, SIOPEL, and CHIC risk groups were retrospectively assigned. RESULTS Sixty patients were enrolled with median age at diagnosis of 1.1 years and median follow-up time of 6.8 years. Alpha-fetoprotein (AFP) was raised (>100 ng/mL) in 58 (97%) patients. Five (8%) had metastases at presentation and 7 (12%) experienced tumor rupture prior to or during treatment. Twenty-nine patients (48%) received a first-line cisplatin, 5-fluorouracil, and vincristine regimen only while 23 (38%) also had alternative chemotherapeutic agents. Hepatic resection could be performed in 48 (80%) patients. Three (5%) patients underwent upfront liver transplantation. Five-year event-free survival and overall survival rates were 69.2% ± 6.1% and 77.6% ± 5.5% respectively. Among the 16 patients with relapse/progression, 9 had intrahepatic failure only, 5 had distant failure only, and 2 had combined local and distant failure. Predictors of inferior outcome included advanced Evans staging, disease involving both lobes, rupture, low AFP, and suboptimal response to first-line chemotherapy. Assigned in 44 patients, PRETEXT staging, SIOPEL, and CHIC risk groups significantly predicted EFS and OS. CONCLUSIONS Although the consensus HB/HCC 1996 protocol led to cure in three-quarters of pediatric HB patients, an upfront risk stratification system is required to identify and improve the outcome of high-risk patients.
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Affiliation(s)
- Anthony P Y Liu
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR
| | - Janice J K Ip
- Department of Radiology, Queen Mary Hospital, Hong Kong SAR
| | - Alex W K Leung
- Department of Paediatrics, Prince of Wales Hospital, Hong Kong SAR
| | - C W Luk
- Department of Paediatrics, Queen Elizabeth Hospital, Hong Kong SAR
| | - C H Li
- Department of Paediatrics and Adolescent Medicine, Tuen Mun Hospital, Hong Kong SAR
| | - Karin K H Ho
- Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital, Hong Kong SAR
| | - Regina Lo
- Department of Pathology, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR
| | - Edwin K W Chan
- Department of Surgery, Prince of Wales Hospital, Hong Kong SAR
| | - Albert C Y Chan
- Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR
| | - Patrick H Y Chung
- Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR
| | - Alan K S Chiang
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR
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3
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Lu Z, Xu H, Yu X, Wang Y, Huang L, Jin X, Sui D. 20(S)-Protopanaxadiol induces apoptosis in human hepatoblastoma HepG2 cells by downregulating the protein kinase B signaling pathway. Exp Ther Med 2018; 15:1277-1284. [PMID: 29434714 PMCID: PMC5776618 DOI: 10.3892/etm.2017.5594] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 10/26/2017] [Indexed: 02/07/2023] Open
Abstract
Hepatoblastoma is the most common primary liver tumor for children aged <5 years old. 20(S)-Protopanaxadiol (PPD) is a ginsenoside extracted from Pananx quinquefolium L., which inhibits tumor growth in several cancer cell lines. The purpose of the present study was to assess the anticancer activities of 20(S)-PPD in human hepatoblastoma HepG2 cells. The cytotoxicity of 20(S)-PPD on HepG2 cells was evaluated using an MTT assay. Apoptosis was detected using DAPI staining and flow cytometry. The expression of apoptosis-associated proteins was identified by western blotting. The results demonstrated that 20(S)-PPD inhibited the viability of HepG2 cell in a dose and time-dependent manner. The IC50 values were 81.35, 73.5, 48.79 µM at 24, 48 and 72 h, respectively. Topical morphological changes of apoptotic body formation following 20(S)-PPD treatment were detected by DAPI staining. The percentage of Annexin V-fluoroscein isothyiocyanate positive cells were 3.73, 17.61, 23.44 and 65.43% in HepG2 cells treated with 0, 40, 50 and 60 µM of 20(S)-PPD, respectively. Furthermore, 20(S)-PPD upregulated the expression of Bax and downregulated the expression of Bcl-2 and also activated caspases-3 and −9, and Poly [ADP-ribose] polymerase cleavage. In addition, 20(S)-PPD inhibited the phosphorylation of protein kinase B (Akt; Ser473). The results indicate that 20(S)-PPD inhibits the viability of HepG2 cells and induces apoptosis in HepG2 cells by inhibiting the phosphoinositide-3-kinase/Akt pathway.
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Affiliation(s)
- Zeyuan Lu
- Department of Pharmacology, School of Pharmaceutical Sciences, Jilin University, Changchun, Jilin 130021, P.R. China
| | - Huali Xu
- Department of Pharmacology, School of Pharmaceutical Sciences, Jilin University, Changchun, Jilin 130021, P.R. China
| | - Xiaofeng Yu
- Department of Pharmacology, School of Pharmaceutical Sciences, Jilin University, Changchun, Jilin 130021, P.R. China
| | - Yuchen Wang
- Department of Pharmacology, School of Pharmaceutical Sciences, Jilin University, Changchun, Jilin 130021, P.R. China
| | - Long Huang
- Department of Pharmacology, School of Pharmaceutical Sciences, Jilin University, Changchun, Jilin 130021, P.R. China
| | - Xin Jin
- Department of Pharmacology, School of Pharmaceutical Sciences, Jilin University, Changchun, Jilin 130021, P.R. China
| | - Dayun Sui
- Department of Pharmacology, School of Pharmaceutical Sciences, Jilin University, Changchun, Jilin 130021, P.R. China
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4
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Muthuvel E, Chander V, Srinivasan C. A Clinicopathological Study of Paediatric Liver Tumours in a Tertiary Care Hospital. J Clin Diagn Res 2017; 11:EC50-EC53. [PMID: 28511396 PMCID: PMC5427322 DOI: 10.7860/jcdr/2017/24223.9592] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Accepted: 12/08/2016] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Paediatric primary liver tumours are the third largest group of solid abdominal neoplasms in children next to neuroblastoma and Wilms tumour, accounting for about 0.5% to 2% of all paediatric neoplasms, in which hepatoblastoma is the most common. AIM The present study was done to estimate the incidence of paediatric liver tumours over a period of five years and also, to study the clinical behaviour, alpha-fetoprotein correlation and histopathological features of paediatric liver tumours. MATERIALS AND METHODS The details of patients treated for paediatric liver tumours for a period of five years were retrospectively retrieved from the tumour board and medical records. The gross features and all the slides were reviewed and the pathologic diagnosis was confirmed and clinicopathological correlation was then done. RESULTS A total of 39 paediatric liver tumours were detected during five years, of which 32 (82%) were malignant and seven (18%) were benign with a male to female ratio of 1:1.1. Hepatoblastoma was the most common liver tumour accounting for 28 cases (71.8%), of which 25 cases (89.4%) were of pure epithelial type. The second most common primary tumour was epithelioid haemangioendothelioma with six cases (15.4%) with female preponderance, followed by two cases each of hepatocellular carcinoma and undifferentiated embryonal sarcoma and one case of hepatocellular adenoma. Serum AFP level was increased in hepatoblastoma and in hepatocellular carcinoma, normal in hepatocellular adenoma and embryonal sarcoma. Serum AFP level was increased in few cases of epithelioid haemangioendothelioma. CONCLUSION The spectrum of liver tumours in children is different from that in the adults. Hepatoblastoma is the most common paediatric liver tumour, followed by epithelioid haemangioendothelioma. Through better understanding of pathological diagnosis, refined surgical staging, newer and more effective radiological techniques and standardized multimodal therapies, a substantial number of children diagnosed with this highly malignant tumour can expect to survive the disease.
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Affiliation(s)
- Esakki Muthuvel
- Associate Professor, Department of Pathology, Saveetha Medical College, Chennai, Tamil Nadu, India
| | - Vimal Chander
- Assistant Professor, Department of Pathology, Saveetha Medical College, Chennai, Tamil Nadu, India
| | - Chitra Srinivasan
- Professor and Head, Department of Pathology, Saveetha Medical College, Chennai, Tamil Nadu, India
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5
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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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6
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Samuk I, Tekin A, Tryphonopoulos P, Pinto IG, Garcia J, Weppler D, Levi DM, Nishida S, Selvaggi G, Ruiz P, Tzakis AG, Vianna R. Abdominal transplantation for unresectable tumors in children: the zooming out principle. Pediatr Surg Int 2016; 32:337-46. [PMID: 26711121 DOI: 10.1007/s00383-015-3852-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/15/2015] [Indexed: 12/15/2022]
Abstract
PURPOSE To present our experience in abdominal transplantations to manage unresectable abdominal neoplasms in children and to describe the role of extensive surgeries in such cases. METHODS This is a retrospective study of 22 abdominal transplantations in 21 patients for abdominal tumors over 16 years. Transplantation techniques included liver transplant (LT), multivisceral transplant (MVTx), and intestinal autotransplant (IA). Follow-up intervals ranged from 0.3 to 168 months (median 20 months). RESULTS LT alone was performed in 15 patients for primary malignant (11) and benign (4) liver tumors. Pathological classification included HB hepatoblastoma (6), HCC hepatocellular cancer (3), hepatic epithelioid hemangioendothelioma HEH (1), angiosarcoma (1), benign vascular tumors (3), and adenoma (1). IA was performed in four patients for lesions involving the root of the mesentery; tumors of the head of pancreas (3) and mesenteric hemangioma (1). MVTx was performed in 2 patients for malignancies; pancreaticoblastoma (1), recurrent hepatoblastoma (1), and in one patient as a rescue procedure after IA failure. Four of the eleven patients who underwent LT for malignant liver tumor had metastatic disease at presentation. Six of them died of recurrent neoplasm (3), transplant-related complications (2), and underlying disease (1). All LT patients who had benign tumors are alive with functioning grafts. All IA patients survived and are on an oral diet, with one patient requiring TPN supplementation. One of the three patients who underwent MVTx died of metastatic disease. CONCLUSIONS Allo/auto transplantation for abdominal tumors is a valuable modality when conventional treatments fail or are not feasible.
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Affiliation(s)
- Inbal Samuk
- Pediatric and Adolescent Surgery, Schneider Children's Medical Center, Sackler School of Medicine, Tel Aviv University, 14 kaplan Street, Petach-Tikvha, 49202, Israel. .,Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.
| | - Akin Tekin
- Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Ignacio G Pinto
- Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.,Universidad de Oviedo, Beca, Spain
| | | | - Debbie Weppler
- Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - David M Levi
- Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Seigo Nishida
- Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Gennaro Selvaggi
- Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Phillip Ruiz
- Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.,Pathology, University of Miami, Miami, USA
| | - Andreas G Tzakis
- Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Rodrigo Vianna
- Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
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7
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Misra S, Bihari C. Desmoplastic nested spindle cell tumours and nested stromal epithelial tumours of the liver. APMIS 2016; 124:245-51. [PMID: 26994733 DOI: 10.1111/apm.12502] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 11/27/2015] [Indexed: 01/10/2023]
Abstract
Desmoplastic nested spindle cell tumour of liver (DNSTL), nested stromal-epithelial tumour (NSET) and calcifying nested stromal-epithelial tumour (CNSET) are recently described entities with similar morphology, immunohistochemistry and molecular genetics. These are rare entities with only three large case series described till date. These tumours commonly present in the paediatric age group. NSETs, in addition have been described to be associated with ectopic adrenocorticotropic hormone (ACTH) production and Cushingoid features. It is important to discuss this rare group of tumours with a low malignant potential as the most common radiological differential diagnosis is hepatoblastoma, which has a relatively poorer prognosis. Thus, a pathologist needs to keep this entity in mind, so as to offer a correct histological diagnosis.
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Affiliation(s)
- Sunayana Misra
- Department of Pathology, Institute of Liver and Biliary Sciences, Delhi, India
| | - Chhagan Bihari
- Department of Pathology, Institute of Liver and Biliary Sciences, Delhi, India
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8
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Matkowskyj KA, Rao MS, Yang GY. Pathologic Features of Primary and Metastatic Hepatic Malignancies. Cancer Treat Res 2016; 168:257-293. [PMID: 29206377 DOI: 10.1007/978-3-319-34244-3_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
In the mammalian liver, 60 % of the cellular components are hepatocytes while the remainder (35 %) includes biliary epithelium, Kupffer cells, endothelial cells, fat storing cells and connective tissue cells. Although neoplasms of hepatocytes are the most common, a significant number of both benign and malignant primary liver neoplasms arising from other cell types can develop, such as tumors of bile duct epithelium (Table 1). In addition, the liver is one of the most susceptible sites for metastatic tumors arising from other organs of the body. Not too long ago, liver tumors were left untreated because the liver was considered a complex and mysterious organ inaccessible to surgery. Advances in imaging procedures and surgical techniques over the past 40 years have revolutionized the approaches to the treatment of benign and malignant liver tumors. Subsegmentectomy, segmentectomy, lobectomy, and transplantation are routinely performed for the treatment of primary and metastatic liver tumors with minimal morbidity and mortality. Since accurate diagnosis remains the key to clinical and surgical management, the emphasis of this chapter is on classification, morphological features and differential diagnosis of malignant neoplasms of the liver.
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9
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Park KW, Seo CJ, Yun DY, Kim MK, Kim BS, Han YS, Oh HK, Lee CH. A case of hepatoblastoma misdiagnosed as combined hepatocellular carcinoma and cholangiocarcinoma in an adult. Clin Mol Hepatol 2015; 21:300-8. [PMID: 26523273 PMCID: PMC4612292 DOI: 10.3350/cmh.2015.21.3.300] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Revised: 02/14/2014] [Accepted: 02/21/2014] [Indexed: 01/20/2023] Open
Abstract
Hepatoblastoma usually occurs in children under the age of 2 years, with very few cases reported in adults. We experienced a case of adult hepatoblastoma in a 36-year-old female with chronic hepatitis B. She had experienced sudden onset abdominal pain. Her serum alpha-fetoprotein level was markedly elevated, and abdominal CT showed a 9-cm mass with internal hemorrhage in the right hepatic lobe with hemoperitoneum, so an emergency hepatic central bisectionectomy was performed. The initial histologic examination revealed that the mass mimicked combined hepatocellular carcinoma and cholangiocarcinoma with spindle-cell metaplasia of the cholangiocarcinoma element. Follow-up abdominal CT performed 3 months later showed a 5.5-cm metastatic mass in the left subphrenic area. Laparoscopic splenectomy with mass excision was performed, and hepatoblastoma was confirmed histologically. A histologic re-examination of previously obtained surgical specimens also confirmed the presence of hepatoblastoma. Metastatic hepatoblastoma was found at multiple sites of the abdomen during follow-up, and so chemotherapy with cisplatin, 5-fluorouracil (5-FU), and vincristine was applied, followed by carboplatin and doxorubicin. Despite surgery and postoperative chemotherapy, she died 12 months after symptom onset.
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Affiliation(s)
- Keun Woo Park
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Chang Jin Seo
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Dae Young Yun
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Min Keun Kim
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Byung Seok Kim
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Young Seok Han
- Department of Surgery, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Hoon Kyu Oh
- Department of Pathology, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Chang Hyeong Lee
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
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10
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Paraneoplastic recurrent hypoglycaemic seizures: an initial presentation of hepatoblastoma in an adolescent male-a rare entity. Case Rep Pediatr 2014; 2014:104543. [PMID: 25525545 PMCID: PMC4267168 DOI: 10.1155/2014/104543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 11/04/2014] [Indexed: 11/18/2022] Open
Abstract
Hepatoblastoma (HB) is a rare malignant tumour of the liver and usually occurs in the first three years of life. Hepatoblastoma in adolescents and young adults is extremely rare; nevertheless the prognosis is much worse than in childhood, because these kinds of tumours are usually diagnosed late. Characteristic imaging and histopathological and AFP levels help in the diagnosis of hepatoblastoma. Paraneoplastic features of hepatoblastoma are not uncommon at presentation and include erythrocytosis, thrombocytosis, hypocalcaemia, isosexual precocious puberty, and rarely hypoglycaemia. Even though hypoglycaemia is commonly seen in hepatocellular carcinoma, its association with hepatoblastoma is very rare. We present a case of 15-year-old male patient presenting with complaints of recurrent hypoglycaemic seizures ultimately leading to diagnosis of hepatoblastoma. Managed successfully with neoadjuvant chemotherapy, surgery and adjuvant chemotherapy with adriamycin and cisplatin based regimens. An extensive review of literature in the PubMed and MEDLINE did not reveal much data on paraneoplastic recurrent hypoglycaemic seizures as an initial presentation of hepatoblastomas in adolescents and young adults.
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11
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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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12
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Laiq Z, Bishop JA, Ali SZ. Liver lesions in children and adolescents: cytopathologic analysis and clinical correlates in 44 cases. Diagn Cytopathol 2011; 40:586-91. [PMID: 21309009 DOI: 10.1002/dc.21587] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2010] [Revised: 09/26/2010] [Accepted: 09/29/2010] [Indexed: 11/07/2022]
Abstract
The role of fine needle aspiration (FNA) as a first-line diagnostic modality is well-established for neoplastic and nonneoplastic liver masses in adults. However, cytopathologic analysis of such lesions in children and adolescents has not been well studied. An 18-year retrospective review of the cytopathology archives at The Johns Hopkins Hospital identified 44 cases of hepatic FNA in children and adolescents (i.e., 21 years and younger). The cytopathologic material was reviewed and correlated with subsequent surgical pathology diagnoses and/or clinical follow-up. Among the 44 FNAs studied, 40 (90.9%) were deemed diagnostic for evaluation and 4 (9.1%) were nondiagnostic. Twenty four (60%) of the diagnostic FNAs were neoplasms, 10 (25%) were nonneoplastic lesions, and 6 (15%) were "atypical" or "suspicious." There were 21 (87.5%) malignant and 3 (12.5%) benign tumors. Among the malignant cases, metastases/secondary tumors accounted for 12 (54.5%) followed by hepatocellular carcinoma (HCC)--7 (38.1%). The types of metastatic/secondary neoplasms were Wilms tumor (2), germ cell tumor (2), acute leukemias (2), and miscellaneous others (6). Among the nonneoplastic lesions focal nodular hyperplasia was most common--4 (40%). Among the "atypical" cases, 4 (66.6%) turned out to be benign on follow-up, 2 were HCC, and 1 was Hodgkin lymphoma. Immunoperoxidase (IPOX) studies were done in 20 (45.5%) cases to confirm the cytopathologic diagnoses. Overall, FNA showed a sensitivity of 95.2% and a specificity of 100% for a malignant diagnosis.
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Affiliation(s)
- Zenab Laiq
- Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland 21287, USA
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13
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Mixed hepatoblastoma in a young male adult: a case report and literature review. Case Rep Med 2010; 2010:919457. [PMID: 21113306 PMCID: PMC2990241 DOI: 10.1155/2010/919457] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2010] [Accepted: 10/27/2010] [Indexed: 11/18/2022] Open
Abstract
Hepatoblastoma (HB) is a rare malignant tumour of the liver and usually occurs in the first three years of life. Most of these tumours arise in the embryo; hence it seems to be unusual that hepatoblastoma occurs in adults and is an exceptional cause of primary malignant liver tumour in adult patients. The diagnosis is often overlooked, and patients might be diagnosed at late stages of the disease at risk of increased mortality. In this paper we report a case of a 30-year-old man with mixed hepatoblastoma and abdominal pain, hepatomegaly and fever. The patient under went noninvasive diagnostic methods: duplex scanning, Computed Tomography (CT), and Magnetic Resonance imaging (MRI). In our experience, despite the important role of histological sample provided by biopsy in defining the diagnosis, very important was the role of MRI, more than ultrasonography and enhanced CT. The MRI detects tumor features as size, margins, and ratio with neighboring organs in order to get the best surgical approach.
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14
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Abe K, Thung SN, Wu HC, Tran TT, Le Hoang P, Truong KD, Inui A, Jang JJ, Su IJ. Pre-S2 deletion mutants of hepatitis B virus could have an important role in hepatocarcinogenesis in Asian children. Cancer Sci 2009; 100:2249-54. [PMID: 19719772 PMCID: PMC11159494 DOI: 10.1111/j.1349-7006.2009.01309.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Although many studies on the risk factors and their carcinogenesis in adult hepatocellular carcinoma (HCC) have been reported, they remain poorly understood in childhood HCC. A retrospective study of 42 HCC cases in Asian children was conducted. Hepatitis B virus (HBV)-DNA in HCC tissues was detected in 36 of 42 (86%) cases tested, while no hepatitis C virus (HCV)-RNA was detectable in any of HCCs. Twenty of 36 (56%) HCC cases were accompanied by cirrhosis. Surprisingly, very high prevalence of the HBV pre-S deletion mutant was recognized in 27 of 30 (90%) HCCs examined. They occurred most frequently in pre-S2 (20/27, 74%) followed by pre-S1 (5/27, 18.5%), and both pre-S1/S2 (2/27, 7.4%). Interestingly, the pre-S2 mutant consistently appeared with deletion at nt 4-57 in all of the 20 cases with the pre-S2 mutant (100%) and within this locus in the two cases with both pre-S-1/S2 mutants. Type II ground-glass hepatocytes in non-tumorous livers were seen in 15 of the 22 HCCs with the pre-S2 deletion mutant (68%). This hotspot mutation in the pre-S2 was further confirmed by complete genomic sequence of HBV in a Japanese boy who eventually developed HCC. Our result strongly suggests that HBV is a major contributor to the development of HCC in Asian children. The HBV pre-S2 deletion mutant at nt 4-57 which has a CD8 T-cell epitope could be responsible for the emergence and aggressive outcome of childhood HCC. Determination of this hotspot mutation in the pre-S2 region could be a useful index for predicting the clinical outcome of HCC development.
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Affiliation(s)
- Kenji Abe
- Department of Pathology, National Institute of Infectious Diseases, Tokyo, Japan.
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15
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Zheng MH, Zhang L, Gu DN, Shi HQ, Zeng QQ, Chen YP. Hepatoblastoma in adult: review of the literature. J Clin Med Res 2009; 1:13-6. [PMID: 22505959 PMCID: PMC3318863 DOI: 10.4021/jocmr2009.01.1222] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2009] [Indexed: 11/23/2022] Open
Abstract
This study is to review and retrieve data on adult hepatoblastoma (HB) from English literatures in order to gain a better understanding of this disease. We performed Medline, PubMed (from January 1966 to February 2008), and library searches (National Science and Technology Library, Beijing, China, and Wenzhou Medical College Library, from January 1980 to February 2008) using the key words hepatoblastoma in adult, hepatic tumor, hepatoblastoma and adult. Previously reported HB cases were collected and published reviews were also examined. Fifteen cases that met the search criteria were selected. Review of the cases revealed a slight female preponderance. The patients' age ranged from 17 to 82, with median age of 70 for male and 27 for female. The survival time ranged from two weeks to 38 months, and the median survival time was 6 months. In the articles reviewed, HB presented with non-specific initial symptoms, and the diagnosis was not identified until the tumor biopsy after operation or autopsy. Completely surgical resection is still the major treatment for patients with HB and is considered as the only chance of a better prognosis. Due to the rareness of HB in adults, the choice of treatment should be radical resection if possible, and combined with chemotherapy as adopted in children. HB in the adult is extremely rare and the pre-operative diagnosis is often overlooked. The prognosis is so poor that the awareness of the condition in the differential diagnosis in liver tumors could be beneficial.
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Affiliation(s)
- Ming Hua Zheng
- Department of Infection and Liver Diseases, The First Affiliated Hospital of Wenzhou Medical College, Wenzhou, China
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16
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Szavay PO, Luithle T, Warmann SW, Geerlings H, Ure BM, Fuchs J. Impact of pedicle clamping in pediatric liver resection. Surg Oncol 2008; 17:17-22. [PMID: 17855078 DOI: 10.1016/j.suronc.2007.08.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2007] [Revised: 07/17/2007] [Indexed: 11/21/2022]
Abstract
BACKGROUND Vascular clamping techniques are commonly used but so far the impact on pediatric liver surgery has not been investigated. The purpose of this study was to analyze pedicle clamping during pediatric liver resection in terms of hepato-cellular injury and blood loss. METHODS Sixty-seven children undergoing liver resection were analyzed retrospectively. Vascular clamping was used in 28 cases (PC group), in 39 the resection was performed without clamping (NPC group). Major hepatectomies (resection of more than three segments) were carried out in 88%, minor hepatectomies (resection of three and less segments) in 12% of patients. Twenty-six children underwent extended liver resection. Patient data, liver function tests (LFTs) and blood loss were analyzed statistically. RESULTS There were no significant differences in patient preoperative and postoperative data and LFTs between the groups. Within the NPC group the amount of administered fresh frozen plasma (FFP) in total and per kilogram (FFP/kg) was significantly higher (p=0.023 and 0.028) than in the PC group. For patients with extended liver resection, operation times were significantly longer (p=0.016) in the group without vascular clamping (NPCext). In the NPCext group significantly more children required packed red cells, FFP and FFP/kg. LFTs showed no significant differences in all children regardless of vascular clamping. CONCLUSIONS For children undergoing liver resection, vascular clamping offers a blood saving surgical technique. Postoperative LFTs were not statistically different, regardless of vascular clamping. Pedicle clamping proved to be a safe method, not associated with an increase in perioperative complications.
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Affiliation(s)
- Philipp O Szavay
- Department of Pediatric Surgery, Children's Hospital, University of Tuebingen, Hoppe-Seyler-Strasse 3, 72076 Tuebingen, Germany.
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17
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Abstract
Hepatoblastomas are the most common liver tumours in children. However, they are rare as compared to other solid malignancies. Thus, there is a need to integrate data from surgical centers around the world to provide a clearer view on the outcomes of multidisciplinary management of these tumours. We set out to retrospectively review our experience of patients with surgically resected hepatoblastomas looking at primary and secondary outcomes. Children diagnosed with hepatoblastoma and managed surgically (along with chemotherapy) at a single institution between 1 January 2000 and 31 May 2007, were analyzed. Out of the 18 patients, there were 12 male and 6 female patients. The median age was 18 months (range 8-72). A palpable mass in abdomen was the presenting symptom in 88% patients. Sixteen patients (88.8%) underwent major liver resection. Sixteen patients (88.8%) received preoperative chemotherapy. Complete gross resection (stage I and II) was achieved in all 18 patients (100%). The mortality and morbidity rates were 0 and 11.2%, respectively. The 80-month disease-free survival was 67%. This series, the largest from India in terms of surgical resections for hepatoblastoma, reaffirms that major liver resection can be performed with minimal perioperative mortality and morbidity and that the use of chemotherapy has definitely helped in down staging tumours for liver resection.
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Wang JD, Chang TK, Chen HC, Jan SL, Huang FL, Chi CS, Lin CC. Pediatric liver tumors: initial presentation, image finding and outcome. Pediatr Int 2007; 49:491-6. [PMID: 17587274 DOI: 10.1111/j.1442-200x.2007.02384.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Few reports have been carried out on the characteristics of pediatric liver tumors. METHODS A retrospective study of 57 patients diagnosed with liver tumors from 1989 through 2004 was conducted. They were classified into groups; 10 benign, 33 primary malignant and 14 metastatic liver tumors. Their demographics, initial presentations, laboratory data, image findings and outcomes were investigated and compared. RESULTS Hepatocellular carcinoma (HCC) with 91% hepatitis B virus-related, constituted 23 of 33 primary malignant liver tumors and had the poorest survival rate. Initially, 70% of patients with primary malignant liver tumors were at disseminated stages. All of HCC and 88% of hepatoblastoma had elevated serum levels of aphal-fetoprotein. However, abnormal liver function tests as alanine aminotransferase, total bilirubin, albumin and alkaline phosphatase were uncommon in patients with pediatric liver tumors. Metastatic liver tumors compared with primary malignant liver tumors showed hypo-echogenicity in abdominal ultrasound (US) exam and a lesser presence of vessel invasion and contrast enhancement in computed tomography studies (P < 0.01). CONCLUSIONS It is important to diagnose primary malignant liver tumors before their clinical symptoms and signs develop. Children with chronic hepatitis B virus infection must be followed every 6 months by serum aphal-fetoprotein and abdominal US even when their liver function tests are normal. Image studies with abdominal US and computed tomography scan can differentiate between primary and metastatic liver tumors.
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Affiliation(s)
- Jiaan-Der Wang
- Department of Pediatrics, Taichung Veterans General Hospital, Taichung, Taiwan.
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19
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von Riedenauer WB, Shanti CM, Abouljoud MS. Resection of giant liver adenoma in a 17-year-old adolescent boy using venovenous bypass, total hepatic vascular isolation, and in situ cooling. J Pediatr Surg 2007; 42:E23-7. [PMID: 17706483 DOI: 10.1016/j.jpedsurg.2007.05.045] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Giant liver adenomas are rare pediatric tumors. Hepatocellular adenomas account for approximately 2% to 4% of all pediatric liver tumors. We present the case of a biopsy-proven 21 x 20.5 x 10.5-cm hepatocellular adenoma in a 17-year-old adolescent boy resected using venovenous bypass and total hepatic isolation. Hepatic adenomas of this size are historically treated with orthotopic liver transplantation. Resection of a massive centrally located giant liver adenoma using total hepatic vascular isolation and venovenous bypass with in situ hepatic cooling and is not previously reported. By combining these techniques, we were able to defer the risks of orthotopic liver transplantation and life-long immunosuppression for our patient. The patient's recovery was uncomplicated and hepatic regeneration was excellent. At 9 months' follow-up, the patient reported enjoying an athletic adolescent life-style with no evidence of recurrence.
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20
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Pham TH, Iqbal CW, Grams JM, Zarroug AE, Wall JCH, Ishitani MB, Nagorney DM, Moir C. Outcomes of primary liver cancer in children: an appraisal of experience. J Pediatr Surg 2007; 42:834-9. [PMID: 17502194 DOI: 10.1016/j.jpedsurg.2006.12.065] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Hepatoblastoma (HB) and hepatocellular carcinoma (HCC) are the most common primary liver cancers in children. Recent advances in management of pediatric liver cancer have improved disease-specific survival (DSS). This is a review of our experience with childhood liver malignancy over the past 3 decades. MATERIALS AND METHODS A retrospective chart review from 1975 to 2005 identified patients who were 18 years old or younger with a histologically confirmed diagnosis of primary liver cancer. Patients were staged according to the Children's Cancer Group and Pediatric Oncology Group (CCG/POG) system. Patients were followed up prospectively through clinic visits and mail correspondence. Standard statistical methods were used for comparison, risk, and survival analyses. RESULTS Fifty-two patients were confirmed to have primary liver cancers, where 24 (46%) patients had HB, 22 (42%) had HCC, 3 (6%) had sarcomas, and 3 (6%) had other histologies. Mean ages at presentation for HB and HCC were 3.2 and 13.1 years old, respectively. The most common presentations were abdominal mass (67%) and pain (40%). Most patients underwent major liver resection (n = 45, 87%), including: lobectomy (n = 25, 48%), and trisegmentectomy (n = 11, 21%). Three patients underwent liver transplantation (n = 3, 6%) for advanced local disease. Forty-five (87%) received primary or neoadjuvant and/or adjuvant chemotherapy. Patients had the following CCG/POG stages: I (n = 31, 60%), II (n = 6, 11.5%), III (n = 9, 17%), and IV (n = 6, 11.5%). Complete gross resection (stage I and II) was achieved in 37 (71%) patients. The perioperative mortality and morbidity rates were 0% and 29%, respectively. Patients with complete resection had significantly better 5-year DSS and median survival compared with incomplete gross resection: 62% vs 9% and 216 vs 18 months, P < .001. Patients treated during the period 1995-2005 had better 5-year DSS and median survival compared with those treated during 1975-1994: 68% vs 32% and 117 vs 27 months, P = .032. All 3 patients who underwent transplantation for conventionally unresectable disease are alive without disease recurrence (follow-up period, 1-15 years). CONCLUSION Complete resection of the pediatric primary liver tumors remains the cornerstone of treatment to achieve cure. Major liver resection can be performed with minimal perioperative mortality and morbidity. Patients with HB appeared to have better survival compared with patients with HCC, and there was significant improvement in the DSS of children treated in the recent decade. Liver transplantation in conjunction with chemotherapy may have an increasing role in the management of locally advanced primary liver cancers.
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Affiliation(s)
- Tuan H Pham
- Department of Surgery, Mayo Clinic, Rochester, MN 55905, USA
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21
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Finegold MJ, Lopez-Terrada DH, Bowen J, Washington MK, Qualman SJ. Protocol for the Examination of Specimens From Pediatric Patients With Hepatoblastoma. Arch Pathol Lab Med 2007; 131:520-9. [PMID: 17425379 DOI: 10.5858/2007-131-520-pfteos] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2006] [Indexed: 11/06/2022]
Affiliation(s)
- Milton J Finegold
- Department of Pathology, Texas Children's Cancer Center at Baylor College, Houston, USA
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22
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Rocourt DV, Shiels WE, Hammond S, Besner GE. Contemporary management of benign hepatic adenoma using percutaneous radiofrequency ablation. J Pediatr Surg 2006; 41:1149-52. [PMID: 16769351 DOI: 10.1016/j.jpedsurg.2006.01.064] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Hepatic adenoma is a benign liver tumor that occurs primarily in women. Complete resection of the adenoma is the standard therapy. The authors present an unusual case report of a histologically proven benign hepatic adenoma occurring in an adolescent boy treated with percutaneous radiofrequency ablation (RFA). A 13-year-old adolescent boy presenting with complaints of back pain was incidentally found to have a 3.5 x 2.5-cm solitary hyperechoic region in the liver on ultrasound. Magnetic resonance imaging scan revealed a lobular solid mass in the posterior segment of the right lobe of the liver that did not have the classic appearance of a hemangioma. An ultrasound-guided percutaneous core biopsy of the lesion was performed. Histologic examination revealed a benign liver adenoma. The tumor was treated with RFA by the interventional radiologist. Postprocedure computed tomography scans obtained at 6 weeks, 8 months, and 1 year and magnetic resonance imaging scan obtained 2 years after the procedure showed complete ablation of the tumor with no evidence of tumor recurrence. Traditionally, surgical resection has been the mainstay of therapy for the treatment of benign hepatic adenoma. In selected cases of histologically proven hepatic adenoma, minimally invasive techniques such as RFA can be safely used as an alternative to open surgical resection.
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23
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Schnater JM, Kuijper CF, Zsiros J, Heij HA, Aronson DC. Pre-operative diagnostic biopsy and surgery in paediatric liver tumours--the Amsterdam experience. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2005; 31:1160-5. [PMID: 16157464 DOI: 10.1016/j.ejso.2005.07.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2005] [Revised: 07/18/2005] [Accepted: 07/28/2005] [Indexed: 11/15/2022]
Abstract
AIM To report 24 years of pre-treatment biopsy and surgical experience in primary liver tumours in children. METHODS Between 1979 and 2003, 53 children presented with a primary liver tumour of whom 48 who underwent surgical resection were evaluated (two died, two were unresectable, and one was transplanted). Biopsy data, per- and post-operative complications, mortality, and survival were retrospectively reviewed. RESULTS Benign tumours were diagnosed in eight patients. Surgical resection for a malignant tumour was performed in 40 patients (26 hepatoblastomas (HB), eight hepatocellular carcinomas (HCC) (four had fibrolamellar HCC), three rhabdomyosarcomas (RMS), one neuroblastoma, one non-hodgkin lymphoma (NHL), and one teratoma). Primary resection was performed in one HB, and four HCCs. The cumulative survival without evidence of disease was 73% for HB (median 7 years) and 88% for HCC (median 3.5 years). CONCLUSION The treatment results are comparable with those of larger international series except for HCC. The existing diagnostic pitfalls in differentiating between the various liver malignancies justify the use of a diagnostic biopsy.
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Affiliation(s)
- J M Schnater
- Pediatric Surgical Centre, Emma Children's Hospital AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
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24
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Hicks J, Mierau GW. The spectrum of pediatric tumors in infancy, childhood, and adolescence: a comprehensive review with emphasis on special techniques in diagnosis. Ultrastruct Pathol 2005; 29:175-202. [PMID: 16036874 DOI: 10.1080/01913120590951185] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The spectrum of pediatric tumors varies considerably, from those derived from blastemal cells in various organ systems to proliferations of soft tissue supporting cells to hamartomatous processes that mimic malignant tumors. Small round cell tumors are often undifferentiated or poorly differentiated, making it difficult sometimes to provide a definitive diagnosis. Both benign and malignant tumors require a coordinated method for diagnosis, and need a comprehensive evaluation to provide the most appropriate diagnosis for designing therapy and predicting prognosis. Pediatric tumors require the integration of routine histopathologic examination with histochemical, immunocytochemical, ultrastructural, cytogenetic, and diagnostic molecular pathology techniques. This review provides updated guidelines with respect to the application of these special techniques in this rapidly evolving diagnostic arena.
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Affiliation(s)
- John Hicks
- Department of Pathology, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas 77030, USA.
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25
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Abstract
Primary hepatic neoplasms in children are relatively infrequent, accounting for between 0.5 and 2.0% of all pediatric neoplasms. They are a diverse group of epithelial and mesenchymal tumors whose incidence can vary considerably with patient age. They are clinically relevant tumors however as two thirds of them are malignant. The therapy of these tumors has evolved over time and it currently involves a combination of surgery, adjuvant and neoadjuvant chemotherapy and possible transplantation.
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Affiliation(s)
- Sukru Emre
- Recanati/Miller Transplantation Institute, Mount Sinai School of Medicine, New York, NY 10029, USA.
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26
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Birch NC, Radio S, Horslen S. Metastatic hepatocellular carcinoma in a patient with niemann-pick disease, type C. J Pediatr Gastroenterol Nutr 2003; 37:624-6. [PMID: 14581809 DOI: 10.1097/00005176-200311000-00023] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Nathan C Birch
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE 68198-6495, USA
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27
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Finegold MJ. Chemotherapy for suspected hepatoblastoma without efforts at surgical resection is a bad practice. MEDICAL AND PEDIATRIC ONCOLOGY 2002; 39:484-6. [PMID: 12228904 DOI: 10.1002/mpo.10172] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND US and European practices differ with respect to treating hepatoblastoma (HB). Should chemotherapy be given prior to resection in all cases, and even without biopsy confirmation (SIOPEL)? PROCEDURE AND RESULTS US data indicate that 40% of HBs are primarily resectable with no operative mortality and that those with pure fetal histology and low mitotic rate do not require toxic chemotherapy. They also suggest that those with a significant fraction of small undifferentiated cells do not respond to otherwise effective chemotherapy. Both US and European studies report a significant error rate in the clinical and imaging diagnosis of HB. CONCLUSIONS Although only 6.5% of confirmed HBs fall into categories that would be managed differently by US standards, there is no justification for denying those patients a more appropriate treatment nor should the 6-10% of cases that are misdiagnosed as HB be treated incorrectly.
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Affiliation(s)
- Milton J Finegold
- Department of Pathology, Texas Children's Hospital, Houston, Texas 77030, USA.
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28
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Wu ML, Okonkwo AM, Jeruss JS, Rao MS. Pathologic features of primary and metastatic hepatic malignancies. Cancer Treat Res 2002; 109:15-38. [PMID: 11775434 DOI: 10.1007/978-1-4757-3371-6_2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Affiliation(s)
- M L Wu
- Northwestern University Medical School, Chicago, IL, USA
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29
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Abstract
Applications of MR imaging of the pediatric abdomen are expanding rapidly. New techniques of MR imaging, such as MRA or MRCP, are becoming commonplace. MR imaging is particularly helpful in the diagnosis and characterization of liver and biliary tree disease in children. Consistent and reproducible quality imaging is achieved with faster imaging sequences tailored to reduce motion artifacts. The lack of radiation, the ability to directly acquire multiple imaging planes, and the superior contrast resolution, particularly with the administration of gadolinium, have contributed to the acceptance of MR imaging as an invaluable tool in the pediatric age group.
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Affiliation(s)
- Rita C Carneiro
- Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
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30
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Brotto M, Finegold MJ. Distinct patterns of p27/KIP 1 gene expression in hepatoblastoma and prognostic implications with correlation before and after chemotherapy. Hum Pathol 2002; 33:198-205. [PMID: 11957145 DOI: 10.1053/hupa.2002.31294] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Over the past 3 years, numerous studies have examined the diagnostic and prognostic significance of p27/Kip1 expression in various tumors. Almost all studies report decreased p27 expression in more aggressive tumors. Information about morphologic changes due to chemotherapy in hepatoblastoma (Hbs) is limited, and so is information about distinct patterns of p27 gene expression. Twenty-nine hepatoblastomas were evaluated for possible prognostic correlation between p27 expression in different histotypes of hepatoblastoma, changes during chemotherapy, and outcome. These observations should prompt prospective randomized studies designed to investigate the predictive role of p27 expression in different Hbs histotypes. Patients were treated according to the Children's Cancer Group and Pediatric Oncology Group protocols, which included initial surgery before chemotherapy wherever possible. Follow-up ranged from 1 to 133 months. The results show that primary well-differentiated fetal tumors without mitotic activity are strongly p27 positive. The embryonal pattern displays a variable p27 protein expression pattern, with focal positivity between completely negative zones; p27 is positive where the mitotic activity is low or absent and negative where the mitogenic activity is high. The vast majority of small undifferentiated cell components are p27 negative. p27 protein expression is downregulated after chemotherapy in the remaining fetal well-differentiated component of Hbs. Although this may imply selection of a more aggressive clone, all patients with this histology were cured in this series. Aggressiveness and ultimate prognosis for incompletely resected tumors after chemotherapy remain indeterminate.
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Affiliation(s)
- Maurizio Brotto
- Department of Pathology, Texas Children's Hospital, Houston, TX 77030, USA
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31
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Affiliation(s)
- R P Scott
- Department of Surgery, Charles R. Drew University of Medicine and Science, Los Angeles, California, USA.
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32
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Glick RD, Nadler EP, Blumgart LH, La Quaglia MP. Extended left hepatectomy (left hepatic trisegmentectomy) in childhood. J Pediatr Surg 2000; 35:303-7; discussion 308. [PMID: 10693685 DOI: 10.1016/s0022-3468(00)90029-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND/PURPOSE Extended left hepatectomy, also referred to as left hepatic trisegmentectomy, in which segments II, III, IV, V, and VIII are excised, is rarely performed in children. Experience with 7 such resections is reported to describe the anatomy, technique, indications, and outcomes of the operation. METHODS The medical records of all pediatric patients treated at our institution over the last 15 years who underwent extended left hepatectomy were reviewed. Demographic information as well as operative, pathological, and follow-up data were analyzed. RESULTS Seven patients underwent extended left hepatectomy over this period. There were 5 boys and 2 girls ranging in age between 4 months and 9 years with a median age of 3.1 years. Follow-up ranged from 8 months to 5 years with a median of 3.5 years. Diagnoses included hepatoblastoma (HB, n = 3), focal nodular hyperplasia (FNH, n = 1), leiomyosarcoma (LMS, n = 1), hepatocellularcarcinoma (HCC, n = 1), and metastatic neuroblastoma (NB, n = 1). All surgical margins were grossly negative. Median operative blood loss was 13 mL/kg (range, 5 to 32 mL/kg), and mean hospital stay was 9 days (range, 7 to 12 days). No major intra- or postoperative complications were encountered, and there was no perioperative mortality. The 3 HB patients, 1 FNH patient, 1 LMS patient, and 1 NB patient are without evidence of disease, whereas the 1 child with HCC died of recurrent and distant disease. The 6 surviving children have normal hepatic function. CONCLUSION Although technically challenging and rarely performed, extended resection of the left hepatic lobe is feasible in children and can yield curative results with minimal morbidity.
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Affiliation(s)
- R D Glick
- Department of Surgery (Pediatric and Hepatobiliary Surgery), Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA
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Jensen MO, Lindquist KD, Delle Donne EP, Becker WK. Liver metastases: new approaches to a difficult challenge. Abstracts & commentary. CURRENT SURGERY 2000; 57:3-7. [PMID: 16093019 DOI: 10.1016/s0149-7944(00)00154-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Affiliation(s)
- M O Jensen
- Department of Surgery, University of North Dakota, School of Medicine and Health Sciences, Grand Forks, North Dakota, USA
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