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Aboughalia H, Chisholm KM, Iyer RS. Focal nodular hyperplasia masquerading as malignancy in an infant with elevated alpha-fetoprotein: A case report with literature review. Clin Imaging 2020; 69:228-232. [PMID: 32971452 DOI: 10.1016/j.clinimag.2020.08.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 08/17/2020] [Accepted: 08/24/2020] [Indexed: 01/30/2023]
Abstract
We describe a unique case of focal nodular hyperplasia (FNH) in a 6-month-old-girl with elevated alpha-fetoprotein (AFP). Given the patient's age and elevated AFP, a diagnosis of hepatoblastoma was presumed. However, the histopathologic assessment of the lesion was typical for focal nodular hyperplasia. This was further corroborated using hepatobiliary contrast agent to exclude the possibility of a collision or a composite liver tumor.
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Affiliation(s)
- Hassan Aboughalia
- Radiology Department, University of Washington Medical Center, Seattle, WA, United States of America.
| | - Karen M Chisholm
- Department of Laboratory Medicine, University of Washington, Seattle, WA, United States of America.
| | - Ramesh S Iyer
- Radiology Department, Seattle Children's Hospital, University of Washington School of Medicine, United States of America.
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2
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Singh HK, Patkar S, Polnaya AM, Ramadwar M, Goel M. Giant Hepatic Adenoma in a 12-Year-Old Girl. J Gastrointest Cancer 2017; 50:156-159. [PMID: 28865036 DOI: 10.1007/s12029-017-9999-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Hemant Kumar Singh
- Department of Gastroenterology and Hepatobiliary Surgical Oncology, Tata Memorial Hospital, Dr. E. Borges Road, Parel, Mumbai, Maharashtra, 400012, India
| | - Shraddha Patkar
- Department of Gastroenterology and Hepatobiliary Surgical Oncology, Tata Memorial Hospital, Dr. E. Borges Road, Parel, Mumbai, Maharashtra, 400012, India
| | - A M Polnaya
- Department of Intervention Radiology, Tata Memorial Hospital, Mumbai, 400012, India
| | - Mukta Ramadwar
- Department of Pathology, Tata Memorial Hospital, Mumbai, 400012, India
| | - Mahesh Goel
- Department of Gastroenterology and Hepatobiliary Surgical Oncology, Tata Memorial Hospital, Dr. E. Borges Road, Parel, Mumbai, Maharashtra, 400012, India.
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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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Farruggia P, Alaggio R, Cardella F, Tropia S, Trizzino A, Ferrara F, D'Angelo P. Focal nodular hyperplasia of the liver: an unusual association with diabetes mellitus in a child and review of literature. Ital J Pediatr 2010; 36:41. [PMID: 20504362 PMCID: PMC2883986 DOI: 10.1186/1824-7288-36-41] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2009] [Accepted: 05/26/2010] [Indexed: 12/12/2022] Open
Abstract
Hepatic hemangioma, adenoma and focal nodular hyperplasia are the most frequent benign lesions of the liver, but they are all infrequent among pediatric population. The reports of focal nodular hyperplasia in children have recently increased in number, with many cases associated to drug intake, particularly to chemotherapy. We here describe, to our knowledge, the first case of focal nodular hyperplasia in association with diabetes mellitus in childhood.
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Affiliation(s)
- Piero Farruggia
- Unit of Pediatric Hematology and Oncology, G, Di Cristina Children's Hospital, and Department of Pediatrics, University of Palermo, Palermo, Italy.
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5
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Abstract
Focal nodular hyperplasia of the liver is a benign disorder usually affecting young women. Its treatment in children is traditionally conservative. Because of its rarity in childhood, its differential diagnosis with other hepatic tumors in children and infants is challenging. We present the case of a 7-month-old infant with large focal nodular hyperplasia affecting the whole left liver lobe. Because of progressive enlargement of the lesion and compression of the portal vein, the baby underwent successful surgical treatment. Different therapeutic options and relative indications are discussed.
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Affiliation(s)
- Giuseppe De Luca
- Department of Oncology, Santobono-Pausilipon National Children's Hospital, Naples 80129, Italy
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6
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Fabre M, Yilmaz F, Buendia MA. [Hepatic tumors in childhood: experience on 245 tumors and review of literature]. Ann Pathol 2005; 24:536-55. [PMID: 15785401 DOI: 10.1016/s0242-6498(04)94017-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This review on the pathology of hepatic tumors in childhood, from a personal series of 245 tumors, focuses on incidence, management, description of frequent tumors such as hepatoblastoma, fibrolamellar carcinoma, and undifferentiated sarcoma for malignant tumors, focal nodular hyperplasia, hepatocellular adenoma, and mesenchymal hamartoma for benign tumors. Malignant and benign entities of recent description, including the following: crowded, small cell undifferentiated and cholangioblastic variants of hepatoblastomas, mesenchymal hamartoma miming hepatoblastoma, liver adenoma and adenomatosis in diabete MODY3 families, gastrointestinal stromal tumor with liver metastasis associated to Carney triad, macronodules in non-cirrhotic portal fibrosis are reviewed. For each entity, the clinical presentation, the diagnostic criteria and the differential diagnosis are described. The role of immunohistochemistry and molecular biology in the diagnosis and identification of new molecular mechanisms triggered by oncogenic activation with new prognostic markers, and therapeutic targets is emphasized.
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Affiliation(s)
- Monique Fabre
- Service d'Anatomie et de Cytologie Pathologiques, Faculté de Médecine Paris XI et Hôpital de Bicêtre, 78, rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France.
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7
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Affiliation(s)
- Adrian Reuben
- Division of Gastroenterology and Hepatology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
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Somech R, Brazowski E, Kesller A, Weiss B, Getin E, Lerner A, Rief S. Focal nodular hyperplasia in children. J Pediatr Gastroenterol Nutr 2001; 32:480-3. [PMID: 11396818 DOI: 10.1097/00005176-200104000-00017] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- R Somech
- Department of Pediatrics, Dana Children's Hospital, Tel Aviv, Israel
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9
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Abstract
Liver tumors in children are rare, potentially complex, and encompass a broad spectrum of disease processes. Any age group may be affected, including the fetus. Most present with abdominal distension and/or a mass. Accurate preoperative diagnosis is usually possible using a combination of ultrasound scanning and cross-sectional imaging techniques (CT and/or MR), supplemented by liver biopsy and measurement of tumor markers. The most common benign tumors are hemangiomas, but mesenchymal hamartoma, focal nodular hyperplasia, and adenoma also are found. In Western countries, hepatoblastoma is the most common primary malignant liver tumor; disease-free survival is now possible in more than 80% of affected patients because of advances in combination chemotherapy, improved techniques of surgical resection, and the selective use of liver transplantation. In contrast, there has been less progress in the management of hepatocellular cancer, which still poses many therapeutic challenges.
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Affiliation(s)
- M D Stringer
- Children's Liver Centre, St James University Hospital, Leeds, UK
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Reymond D, Plaschkes J, Lüthy AR, Leibundgut K, Hirt A, Wagner HP. Focal nodular hyperplasia of the liver in children: review of follow-up and outcome. J Pediatr Surg 1995; 30:1590-3. [PMID: 8583330 DOI: 10.1016/0022-3468(95)90162-0] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The authors used a conservative approach to treat focal nodular hyperplasia of the liver (FNH) and were interested in the long-term results of different therapeutic approaches in order to establish the most appropriate treatment. A review of the literature was conducted, and 31 pediatric case reports were identified in which follow-up and outcome data were noted. Tumor resection was performed in 18 cases (58%), operative biopsy alone in nine (29%), vascular ligation in two, and embolization of hepatic arteries in two. The outcome appears to be good for both groups of patients, ie, those with observation alone and those with resection. More information is to be collected regarding the new procedures (embolization and ligation). This is a retrospective analysis, and data from future international prospective studies are needed.
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Affiliation(s)
- D Reymond
- Department of Pediatrics, University Hospitals, Bern, Switzerland
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Saxena R, Humphreys S, Williams R, Portmann B. Nodular hyperplasia surrounding fibrolamellar carcinoma: a zone of arterialized liver parenchyma. Histopathology 1994; 25:275-8. [PMID: 7821896 DOI: 10.1111/j.1365-2559.1994.tb01328.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
We report a case of acetaminophen-induced liver necrosis in a 14-year-old girl. At autopsy, a 9 cm subcapsular nodule was present in the right lobe of the liver which showed distinct zonation: a central greyish white area of fibrolamellar carcinoma with a peripheral fleshy, tan-coloured rim ranging from 1 to 2 cm in thickness. This peripheral zone consisted of nodular, hyperplastic parenchyma resembling the changes seen in focal nodular hyperplasia, and stood out from the adjacent necrotic parenchyma. The sparing of this zone from the deleterious effects of acetaminophen provides indirect evidence of a predominantly arterial rather than portal blood supply to this region. The arterial supply was most probably derived from the tumour vasculature and may explain the parenchymal hyperplasia sometimes reported adjacent to a fibrolamellar carcinoma. Awareness of this phenomenon is essential when evaluating a needle biopsy, as sampling of this region may lead to a false negative diagnosis.
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Affiliation(s)
- R Saxena
- Institute of Liver Studies, London, UK
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12
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Reymond D, Aebi C, Hirt A, Leibundgut K, Plaschkes J, Lüthy AR, Tschäppeler H, Zimmermann A. Focal nodular hyperplasia of the liver in childhood. MEDICAL AND PEDIATRIC ONCOLOGY 1993; 21:283-6. [PMID: 8469225 DOI: 10.1002/mpo.2950210410] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- D Reymond
- Department of Pediatrics, University Hospitals, Inselspital, Bern
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13
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Tomá P, Taccone A, Martinoli C. MRI of hepatic focal nodular hyperplasia: a report of two new cases in the pediatric age group. Pediatr Radiol 1990; 20:267-9. [PMID: 2336287 DOI: 10.1007/bf02019663] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
At present, magnetic resonance is a useful modality for the diagnostic assessment of focal nodular hyperplasia of the liver. In the pediatric age group, diagnosis for this kind of pathology is more effective and conclusive when performed by MR, because of the limited variety and the restricted expression of primary hepatic tumors. MR diagnosis is based on the presence of a central connective tissue that is scar hyperintense on T2-weighted sequences, which can be regarded as a typical finding, though not specific. The other criteria used to differentiate it from primary malignant tumors on MRI are the homogeneity of the tissue surrounding the scar and its signal intensity, which is similar to that of adjacent normal hepatic parenchyma.
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Affiliation(s)
- P Tomá
- Department of Pediatric Radiology, Istituto G. Gaslini, Genova, Italy
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Hagay ZJ, Leiberman RJ, Katz M, Witznitzer A. Oral contraceptives and focal nodular hyperplasia of the liver. Arch Gynecol Obstet 1988; 243:231-4. [PMID: 3223780 DOI: 10.1007/bf00932273] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
A variety of benign liver tumors associated with the use of oral contraceptives has been described. However, there is controversy regarding the possible relation of focal nodular hyperplasia of the liver to oral contraceptive therapy. Over a ten-year period at the Soroka Medical Center, two young women were found to have hepatic tumors diagnosed as focal nodular hyperplasia. In both cases the hepatic nodules were an incidental finding at laparotomy and were thought to be metastatic tumors. The clinical and pathological findings in both cases are reported. The features of focal nodular hyperplasia and its possible relation to oral contraceptive use is discussed.
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Affiliation(s)
- Z J Hagay
- Division of Obstetrics and Gynecology, Soroka University Hospital, Beer-Sheva, Israel
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