1
|
Dhali A, Mandal TS, Das S, Ray G, Halder P, Bose D, Pal SK, Ray S, Chowdhury A, Dhali GK. Clinical Profile of Hepatoblastoma: Experience From a Tertiary Care Centre in a Resource-Limited Setting. Cureus 2022; 14:e26494. [PMID: 35919215 PMCID: PMC9339225 DOI: 10.7759/cureus.26494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2022] [Indexed: 11/05/2022] Open
|
2
|
Joseph N, Rai S, Singhal K, Saha S, Chakraborty D, Badoni G, Revanth T, Lobo FD. Clinico-histopathological Profile of Primary Paediatric Intra-abdominal Tumours: a Multi-hospital-Based Study. Indian J Surg Oncol 2021; 12:517-523. [PMID: 34658579 DOI: 10.1007/s13193-021-01365-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 06/01/2021] [Indexed: 10/21/2022] Open
Abstract
Paediatric cancers are gradually on the rise in India. Its proportion among children aged < 15 years constitutes close to 5% of the total cancer affected population. A high proportion of this constitutes intra-abdominal tumours. This study was done to study the demographic profile, clinical features and management of intra-abdominal tumours among children. Data of all histopathologically confirmed patients aged < 15 years with various primary intra-abdominal tumours diagnosed from 2009 to 2019 were included in this study. The median age of the patients (n = 50) was 3 years (IQR 1.4, 6). The median age at diagnosis of cancer (n = 23) was 2.5 years (IQR 1, 4). Tumours were more common among males (70%). The most common tumour in this study was Wilm's tumour (17 (34%)). Forty-eight (96%) patients had malignant tumours. Fever was present among the majority (27 (54%)) of the patients. The most common anti-cancer drug used for management was Vincristine, used among 23 patients. Remission was more among infants with Wilm's tumour (P = 0.0221) and among patients with Hodgkin's lymphoma (HL) (P = 0.0444). Default with treatment was more among patients with stage 4 malignancy (P = 0.0186). Recovery following treatment was more among patients with germ cell tumour (P = 0.0082). Reasons for default with treatment in the late stages of malignancies need to be identified in future research studies. Supplementary Information The online version contains supplementary material available at 10.1007/s13193-021-01365-x.
Collapse
Affiliation(s)
- Nitin Joseph
- Post Graduate Diploma in Family Medicine, Department of Community Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka India
| | - Sharada Rai
- Department of Pathology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka India
| | - Kshitiz Singhal
- Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka India
| | - Sreejita Saha
- Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka India
| | - Deboshruti Chakraborty
- Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka India
| | - Gauri Badoni
- Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka India
| | - Thella Revanth
- Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka India
| | - Flora D Lobo
- Department of Pathology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka India
| |
Collapse
|
3
|
Hu H, Zhang W, Wang Y, Zhang Y, Yi Y, Gao Y, Chen L, Huang D. Prognostic analysis for children with hepatoblastoma with lung metastasis: A single-center analysis of 98 cases. Asia Pac J Clin Oncol 2020; 17:e191-e200. [PMID: 32920996 DOI: 10.1111/ajco.13421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 06/15/2020] [Indexed: 12/19/2022]
Abstract
AIMS To analyze the factors affecting the prognosis of hepatoblastoma (HB) with lung metastasis in children. METHODS The HB patients with lung metastases admitted to Beijing Tongren Hospital, Capital Medical University were collected. The clinical data, overall results, and prognostic factors were analyzed. Multivariate analysis was done by the Cox proportional hazards model for patients' prognosis. RESULTS Finally, 98 HB patients (64 boys and 34 girls) with lung metastasis met the inclusion criteria, in which 64 patients had lung metastases at diagnosis (median age, 22.3 months) and 34 patients developed lung metastases while on treatment (median time, 6.5 months). The survival time and 5-year survival rate of patients with standard treatment were significantly longer than that of without standard treatment (P < .001). The survival time and 3-year survival rate had no difference between patients underwent lung metastasectomy and without lung metastasectomy (P = .099), between different diagnosis time of lung metastasis in HB patients (P = .37), between each histology type (P = .313), and different PRETEXT stage (P = .353). While the survival time and 3-year survival rate of patients with lung metastasis alone were significantly longer than that of patients with extrapulmonary involvement (P = .007). Multivariate Cox proportional hazards model revealed that the lung metastasis accompanied with extrapulmonary involvement was a risk factor affecting prognosis (HR = 0.460, 95% CI 0.239-0.888). CONCLUSIONS For HB children with lung metastatic, extrapulmonary involvement might be a high-risk factor of prognosis and standardized treatment with lung metastasectomy might prolong the survival time of them.
Collapse
Affiliation(s)
- Huimin Hu
- Department of Pediatrics, Beijing Tongren Hospital, Capital Medical University, Beijing, P.R. China
| | - Weiling Zhang
- Department of Pediatrics, Beijing Tongren Hospital, Capital Medical University, Beijing, P.R. China
| | - Yizhuo Wang
- Department of Pediatrics, Beijing Tongren Hospital, Capital Medical University, Beijing, P.R. China
| | - Yi Zhang
- Department of Pediatrics, Beijing Tongren Hospital, Capital Medical University, Beijing, P.R. China
| | - You Yi
- Department of Pediatrics, Beijing Tongren Hospital, Capital Medical University, Beijing, P.R. China
| | - Yanan Gao
- Department of Pediatrics, Beijing Tongren Hospital, Capital Medical University, Beijing, P.R. China
| | - Liping Chen
- Department of Pediatrics, Beijing Tongren Hospital, Capital Medical University, Beijing, P.R. China
| | - Dongsheng Huang
- Department of Pediatrics, Beijing Tongren Hospital, Capital Medical University, Beijing, P.R. China
| |
Collapse
|
4
|
Archana B, Thanka J, Sneha LM, Xavier Scott JJ, Arunan M, Agarwal P. Clinicopathological profile of hepatoblastoma: An experience from a tertiary care center in India. INDIAN J PATHOL MICR 2020; 62:556-560. [PMID: 31611439 DOI: 10.4103/ijpm.ijpm_200_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Hepatoblastoma is the most common primary hepatic malignancy in the pediatric population. Advances in pathological evaluation, imaging, risk stratification, neo-adjuvant chemotherapy, and surgery including transplantation have improved survival of these children in the western countries. However, a successful outcome in developing countries such as India with limited resources poses great challenges to the clinician and the family. Histology plays a major role in determining the prognosis of these patients. Methods A retrospective study was done on 10 children diagnosed with hepatoblastoma between January 2010 and December 2015 in our institution. Clinical, laboratory, radiological, histopathological diagnoses, treatment, and outcome data were collected and analyzed. Results The median age of these children at diagnosis was 11 months, and only 1 child was premature at birth. Most children were presented with abdominal distension. One child had lung metastasis at presentation. Elevated alpha fetoprotein levels were present in 90% of the children. The histological types were fetal, embryonal, macrotrabecular, and mixed epithelial-mesenchymal types. SIOPEL risk stratification was done, which showed 40% of the children to be of high risk. Three children had PRETEXT 1, 2, and 4, respectively. Conclusion Our study is significant with respect to the information on PRETEXT staging, risk status, and histological favorability. In developing countries with limited resources and low-socioeconomic status, it is important to have a multidisciplinary team approach and tailor treatment to manage these patients effectively and improve the overall survival.
Collapse
Affiliation(s)
- B Archana
- Department of Pathology, SRIHER, Chennai, Tamil Nadu, India
| | - J Thanka
- Department of Pathology, SRIHER, Chennai, Tamil Nadu, India
| | - Latha M Sneha
- Department of Paediatric Oncology, SRIHER, Chennai, Tamil Nadu, India
| | | | - M Arunan
- Department of Radiology, SRIHER, Chennai, Tamil Nadu, India
| | - Prakash Agarwal
- Department of Paediatric Surgery, SRIHER, Chennai, Tamil Nadu, India
| |
Collapse
|
5
|
Manuprasad A, Radhakrishnan V, J SB, Ramakrishnan A, Ganesan T, Ganesan P, Ramamurthy J, Dhanushkodi M, Sagar T. Hepatoblastoma: 16-years’ experience from a tertiary cancer centre in India. PEDIATRIC HEMATOLOGY ONCOLOGY JOURNAL 2018. [DOI: 10.1016/j.phoj.2018.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
6
|
Zhong S, Zhao Y, Fan C. Hepatoblastoma with pure fetal epithelial differentiation in a 10-year-old boy: A rare case report and review of the literature. Medicine (Baltimore) 2018; 97:e9647. [PMID: 29480877 PMCID: PMC5943836 DOI: 10.1097/md.0000000000009647] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Hepatoblastoma is a rare malignant embryonal tumor that only accounts for approximately 1% of all pediatric cancers and mostly develops in children younger than 5 years old. Moreover, the occurrence of hepatoblastoma in adults is extremely rare. PATIENT CONCERNS Herein, we present a rare case of hepatoblastoma with pure epithelial differentiation in a 10-year-old boy.Pathological examination was performed. The tumor was 15 cm × 15 cm in size with clear margins. The cut surface was multiple nodular and grey-yellow. Histologically, the small cuboidal tumor cells were arranged in trabeculae with 2-3 cell layers. The tumor cells had eosinophilic or clear cytoplasm, formed dark and light areas, and were positive for alpha-fetoprotein, CK, CK8/18, CD10, hepatocyte, and GPC3. CD34 staining revealed that the sinusoids were lined by endothelial cells in the tumor tissues. The Ki67 index was approximately 20%. DIAGNOSES Based on these findings, the case was diagnosed as hepatoblastoma with pure fetal epithelial differentiation. INTERVENTIONS The tumor was completely removed. OUTCOMES No recurrence was found 3 months after the operation. LESSONS Hepatoblastoma with pure epithelial differentiation can also occur in older children. Children rarely notice and report any physical abnormality, and this may be among the primary reasons for the late diagnosis of the tumor. Annual heath checks may be beneficial in the detection of these rare tumors and improvement of patient outcomes.
Collapse
Affiliation(s)
- Shanshan Zhong
- Department of Pathology, First Affiliated Hospital and College of Basic Medical Sciences of China Medical University
| | - Yang Zhao
- Department of Hepatobiliary and Spleenary Surgery, The Affiliated Shengjing Hospital, China Medical University, Shenyang, China
| | - Chuifeng Fan
- Department of Pathology, First Affiliated Hospital and College of Basic Medical Sciences of China Medical University
| |
Collapse
|
7
|
Agarwala S, Gupta A, Bansal D, Vora T, Prasad M, Arora B, Kapoor G, Chinnaswamy G, Radhakrishnan V, Laskar S, Kaur T, Dhaliwal RS, Rath GK, Bakhshi S. Management of Hepatoblastoma: ICMR Consensus Document. Indian J Pediatr 2017; 84:456-464. [PMID: 28353129 DOI: 10.1007/s12098-017-2301-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Accepted: 01/25/2017] [Indexed: 10/19/2022]
Abstract
Dramatic advancement has been made in the management of children with hepatoblastoma (HB) over the past 3 decades owing to the improvement in diagnostic imaging, new chemotherapeutic agents, better surgical care and availability of liver transplantation. These advances are the end results of contributions from 4 major study groups across the globe including International Society of Pediatric Oncology - Liver Tumor Strategy Group (SIOPEL), Children's Oncology Group (COG), German Pediatric Hematology Oncology Group (GPOH) and Japanese Pediatric Liver Tumor Study Group (JPLT). The current manuscript is written with the objective of developing a consensus guideline for practitioners at a National level. Based on literature and personal experience over last 3 decades, the Indian Council of Medical Research (ICMR) Expert group has made recommendations for management of children with HB in resource-challenged nations including India.
Collapse
Affiliation(s)
- Sandeep Agarwala
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, 110029, India.
| | - Alisha Gupta
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Deepak Bansal
- Pediatric Hematology Oncology Unit, Department of Pediatrics, Advanced Pediatric Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Tushar Vora
- Department of Pediatric Oncology, Tata Memorial Hospital, Parel, Mumbai, India
| | - Maya Prasad
- Department of Pediatric Oncology, Tata Memorial Hospital, Parel, Mumbai, India
| | - Brijesh Arora
- Department of Pediatric Oncology, Tata Memorial Hospital, Parel, Mumbai, India
| | - Gauri Kapoor
- Department of Pediatric Hematology & Oncology, Rajiv Gandhi Cancer Institute and Research Center, Delhi, India
| | - Girish Chinnaswamy
- Department of Pediatric Oncology, Tata Memorial Hospital, Parel, Mumbai, India
| | - Venkatraman Radhakrishnan
- Department of Medical Oncology and Pediatric Oncology, Cancer Institute (W.I.A), Adyar, Chennai, India
| | - Siddharth Laskar
- Department of Radiation Oncology, Tata Memorial Hospital, Parel, Mumbai, India
| | - Tanvir Kaur
- NCD Division, Indian Council of Medical Research (ICMR), New Delhi, India
| | | | - G K Rath
- Dr. B.R.A Institute-Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Sameer Bakhshi
- Department of Medical Oncology, Dr. B.R.A Institute-Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
8
|
Shanmugam N, Scott JX, Kumar V, Vij M, Ramachandran P, Narasimhan G, Reddy MS, Kota V, Munirathnam D, Kelgeri C, Sundaram K, Rela M. Multidisciplinary management of hepatoblastoma in children: Experience from a developing country. Pediatr Blood Cancer 2017; 64. [PMID: 27781375 DOI: 10.1002/pbc.26249] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Revised: 08/10/2016] [Accepted: 08/15/2016] [Indexed: 12/27/2022]
Abstract
BACKGROUND Advances in chemotherapy, liver resection techniques, and pediatric liver transplantation have vastly improved survival in children with hepatoblastoma (HB). These are best managed by a multidisciplinary team (MDT) in a setting where all treatment options are available. Until recently, this was difficult to achieve in India. METHODS All children (<16 years) with HB treated in a pediatric liver surgery and transplantation unit between January 2011 and July 2016 were reviewed. Data regarding the clinical presentation, preoperative management, surgical treatment, postoperative course, and outcomes were extracted from a prospectively managed database. RESULTS Thirty children were treated for HB during the study period. Nine children were PRETEXT 4, 7 were PRETEXT 3, 13 were PRETEXT 2, and 1 was PRETEXT 1 (where PRETEXT is pretreatment extension). All children received a neoadjuvant chemotherapy before surgery followed by an adjuvant chemotherapy. Nineteen children had complete resection, while six underwent primary living donor liver transplantation. There were six mortalities including five children who poorly responded to chemotherapy with progressive tumor extension. At a median follow-up of 30 months, two children who underwent resection and one child who underwent liver transplant had disease recurrence. CONCLUSION Improved outcomes can be achieved in children with HB even in countries with limited resources when they are managed by MDTs with expertise in pediatric oncology, liver resection, and liver transplantation.
Collapse
Affiliation(s)
- Naresh Shanmugam
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Global Health City, Chennai, Tamil Nadu, India
| | - Julius Xavier Scott
- Department of Pediatric Hematology and Oncology, Global Health City, Chennai, Tamil Nadu, India
| | - Vimal Kumar
- Department of Pediatric Hematology and Oncology, Global Health City, Chennai, Tamil Nadu, India
| | - Mukul Vij
- Department of Histopathology, Global Health City, Chennai, Tamil Nadu, India
| | - Priya Ramachandran
- Institute of Liver Diseases & Transplantation, Global Health City, Chennai, Tamil Nadu, India
| | - Gomathy Narasimhan
- Institute of Liver Diseases & Transplantation, Global Health City, Chennai, Tamil Nadu, India
| | - Mettu Srinivas Reddy
- Institute of Liver Diseases & Transplantation, Global Health City, Chennai, Tamil Nadu, India
| | - Venugopal Kota
- Institute of Liver Diseases & Transplantation, Global Health City, Chennai, Tamil Nadu, India
| | | | - Chayarani Kelgeri
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Global Health City, Chennai, Tamil Nadu, India
| | - Karthick Sundaram
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Global Health City, Chennai, Tamil Nadu, India
| | - Mohamed Rela
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Global Health City, Chennai, Tamil Nadu, India
| |
Collapse
|
9
|
Yadav SP, Dhingra N. Treating pediatric liver tumors in India: A challenging proposition. Indian Pediatr 2012; 49:839. [DOI: 10.1007/s13312-012-0172-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|