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Scheers I, Tambucci R, De Magnee C, Pire A, Stephenne X, Reding R, Nault JC. Paediatric hepatocellular adenomas: Lessons from a systematic review of relevant literature. JHEP Rep 2024; 6:101078. [PMID: 38699071 PMCID: PMC11061330 DOI: 10.1016/j.jhepr.2024.101078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 03/03/2024] [Accepted: 03/08/2024] [Indexed: 05/05/2024] Open
Abstract
Hepatocellular adenomas (HCAs) are rare benign liver tumours. Predisposing factors and complication rates appear to differ among children and adults. In the present study, we aimed to systematically characterise paediatric HCAs and determine their course, complications, and management. Medical history, clinical symptoms, imaging, histopathology, and genetics of children with HCAs were collected through a systematic and comprehensive review of the published literature. A total of 316 children with HCAs were included in the present study. HCAs were diagnosed primarily in girls (59.3%) and at a mean age of 11.5 (range 0-17.7) years. The majority (83.6%) of HCAs occurred in children with predisposing diseases, of which glycogen storage disease was the most common, followed by portosystemic shunts and MODY3 (maturity-onset diabetes of the young type 3). Each of these diseases leads to a well-defined HCA molecular pattern. A significant number of HCAs either bled (24.7%) or transformed (14.8%) over time. HCA transformation was significantly more frequent in children with portosystemic shunts and in β-catenin-mutated HCAs, while haemorrhages were more frequent in children exposed to hormones and those with larger lesions. Management was primarily guided by any predisposing conditions and the number of lesions. Therefore, vascular shunts were closed when possible, while complicated lesions were resected. Liver transplantation has made it possible to treat adenomatosis, as well as any underlying diseases. Progress in understanding genetic and/or malformative contributions, which appear to be significant in paediatric HCAs, have provided insights into tumour pathogenesis and will further guide patient surveillance and management.
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Affiliation(s)
- Isabelle Scheers
- Pediatric Gastroenterology and Hepatology, Cliniques universitaires Saint-Luc. Laboratoire de Pédiatrie, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium
| | - Roberto Tambucci
- Division of Pediatric Surgery and Liver Transplantation, Department of Surgery, Cliniques universitaires Saint Luc, Université catholique de Louvain, Brussels, Belgium
| | - Catherine De Magnee
- Division of Pediatric Surgery and Liver Transplantation, Department of Surgery, Cliniques universitaires Saint Luc, Université catholique de Louvain, Brussels, Belgium
| | - Aurore Pire
- Centre de recherche des Cordeliers, Sorbonne Université, Inserm, Université Paris Cité, team « Functional Genomics of Solid Tumors », Equipe labellisée Ligue Nationale Contre le Cancer, Labex OncoImmunology, F-75006 Paris, France
- Laboratoire de Pédiatrie, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium
| | - Xavier Stephenne
- Pediatric Gastroenterology and Hepatology, Cliniques universitaires Saint-Luc. Laboratoire de Pédiatrie, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium
| | - Raymond Reding
- Division of Pediatric Surgery and Liver Transplantation, Department of Surgery, Cliniques universitaires Saint Luc, Université catholique de Louvain, Brussels, Belgium
| | - Jean-Charles Nault
- Centre de recherche des Cordeliers, Sorbonne Université, Inserm, Université Paris Cité, team « Functional Genomics of Solid Tumors », Equipe labellisée Ligue Nationale Contre le Cancer, Labex OncoImmunology, F-75006 Paris, France
- Liver Unit, Avicenne Hospital, APHP, Bobigny, France, University Sorbonne Paris Nord, Bobigny, France
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Diagnosis and Follow-up of Incidental Liver Lesions in Children. J Pediatr Gastroenterol Nutr 2022; 74:320-327. [PMID: 34984985 DOI: 10.1097/mpg.0000000000003377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Incidental liver lesions are identified in children without underlying liver disease or increased risk of hepatic malignancy in childhood. Clinical and imaging evaluation of incidental liver lesions can be complex and may require a multidisciplinary approach. This review aims to summarize the diagnostic process and follow-up of incidental liver lesions based on review of the literature, use of state-of-the-art imaging, and our institutional experience. Age at presentation, gender, alpha fetoprotein levels, tumor size, and imaging characteristics should all be taken into consideration to optimize diagnosis process. Some lesions, such as simple liver cyst, infantile hemangioma, focal nodular hyperplasia (FNH), and focal fatty lesions, have specific imaging characteristics. Recently, contrast-enhanced ultrasound (CEUS) was Food and Drug Administration (FDA)-approved for the evaluation of pediatric liver lesions. CEUS is most specific in lesions smaller than 3 cm and is most useful in the diagnosis of infantile hemangioma, FNH, and focal fatty lesions. The use of hepatobiliary contrast in MRI increases specificity in the diagnosis of FNH. Recently, lesion characteristics in MRI were found to correlate with subtypes of hepatocellular adenomas and associated risk for hemorrhage and malignant transformation. Biopsy should be considered when there are no specific imaging characteristics of a benign lesion. Surveillance with imaging and alpha fetoprotein (AFP) should be performed to confirm the stability of lesions when the diagnosis cannot be determined, and whenever biopsy is not feasible.
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[Imaging of hepatic tumors in children and adolescents]. Radiologe 2021; 61:629-638. [PMID: 34061213 PMCID: PMC8257542 DOI: 10.1007/s00117-021-00851-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2021] [Indexed: 10/24/2022]
Abstract
BACKGROUND Pediatric liver tumors are relatively rare, but thorough knowledge of their imaging features is still important. OBJECTIVES Frequency and imaging features of benign and malignant liver masses during childhood and adolescence. MATERIALS AND METHODS Discussion of relevant original articles, review manuscripts and expert recommendations concerning imaging of childhood liver tumors. RESULTS The most common malignant tumors of the liver are hepatoblastoma, which usually occur in younger children, as well as in some regions hepatocellular carcinoma. In contrast to most benign masses, such as focal nodular hyperplasia, simple cysts or fatty liver infiltrations, their imaging morphology is not very characteristic. Radiologically, sonography and magnetic resonance imaging (MRI) are used for assessment. Both methods benefit from intravenous contrast agent administration. CONCLUSIONS Childhood liver tumors show a broad spectrum of morphological manifestations. Some entities can be characterized using standard imaging, some require multimodal imaging or histological assessment. In addition to morphological imaging criteria, age and the medical history as well as laboratory data play an important role in establishing the correct diagnosis.
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Karkoska K, Ricci K, VandenHeuvel K, Trout AT, Smith EA, Kotagal M, Weiss B. Metastatic neuroblastoma masquerading as infantile hemangioma in a 4-month-old child. Pediatr Blood Cancer 2021; 68:e28920. [PMID: 33644927 DOI: 10.1002/pbc.28920] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 12/18/2020] [Accepted: 01/10/2021] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Diffuse liver lesions in an infant have a differential diagnosis including infantile hemangioma (IH), which is common in the first year of life, and neuroblastoma (NBL) which presents at a median age of 18 months. RESULTS We describe the case of a 4-month-old girl with a known superficial/deep IH who presented with new axillary nodules and hepatosplenomegaly, initially suspected to reflect IH but later determined to be widely metastatic NBL. CONCLUSION Hepatic IH and metastatic NBL can present similarly. Clinicians must maintain a broad differential when evaluating new findings in a patient with previously diagnosed IH.
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Affiliation(s)
- Kristine Karkoska
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Kiersten Ricci
- Division of Hematology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Katherine VandenHeuvel
- Department of Pathology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Andrew T Trout
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Ethan A Smith
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Meera Kotagal
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Brian Weiss
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.,Division of Oncology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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Shet NS, Flynn JF, Maloney E, Iyer RS. Use of Eovist in Pediatric Patients: Pearls and Pitfalls. Curr Probl Diagn Radiol 2019; 49:266-274. [PMID: 31047739 DOI: 10.1067/j.cpradiol.2019.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 04/02/2019] [Indexed: 12/25/2022]
Abstract
Magnetic resonance imaging is excellent at characterizing pediatric hepatobiliary pathology. Noncontrast MRI is helpful due to T2 hyperintensity associated with bile, but contrast enhancement offers additional means of lesional characterization. In particular, hepatocyte-specific contrast agents such as gadoxetate disodium (Eovist) exhibit partial hepatobiliary excretion which may be leveraged in these contexts. In this review, we will discuss gadoxetate disodium usage, including a sample-imaging protocol, and demonstrate applications and limitations in the pediatric population.
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Affiliation(s)
- Narendra S Shet
- Division of Diagnostic Imaging and Radiology; Children's National Health System; Washington, DC.
| | - John F Flynn
- Division of Diagnostic Imaging and Radiology; Children's National Health System; Washington, DC
| | - Ezekiel Maloney
- Department of Radiology; Seattle Children's Hospital; Seattle, WA
| | - Ramesh S Iyer
- Department of Radiology; Seattle Children's Hospital; Seattle, WA
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Spijkers S, Littooij AS, Humphries PD, Lam MGEH, Nievelstein RAJ. Imaging features of extranodal involvement in paediatric Hodgkin lymphoma. Pediatr Radiol 2019; 49:266-276. [PMID: 30515533 PMCID: PMC6334729 DOI: 10.1007/s00247-018-4280-z] [Citation(s) in RCA: 4] [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: 05/24/2018] [Revised: 09/06/2018] [Accepted: 10/05/2018] [Indexed: 12/15/2022]
Abstract
Detecting extranodal disease in paediatric Hodgkin lymphoma is of great importance for both treatment and prognosis. Different imaging techniques can be used to identify these extranodal sites. This pictorial essay provides an overview of imaging features of extranodal disease manifestation in paediatric Hodgkin lymphoma.
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Affiliation(s)
- Suzanne Spijkers
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht/Wilhelmina Children's Hospital, Heidelberglaan 100, 3584, CX, Utrecht, The Netherlands.
| | - Annemieke S. Littooij
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht/Wilhelmina Children’s Hospital, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Paul D. Humphries
- Department of Specialist Radiology, University College London Hospital, London, UK ,Department of Radiology, Great Ormond Street Hospital for Children, London, UK
| | - Marnix G. E. H. Lam
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht/Wilhelmina Children’s Hospital, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Rutger A. J. Nievelstein
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht/Wilhelmina Children’s Hospital, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
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Shamir SB, Kurian J, Kogan-Liberman D, Taragin BH. Hepatic Imaging in Neonates and Young Infants: State of the Art. Radiology 2017; 285:763-777. [DOI: 10.1148/radiol.2017170305] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Stephanie B. Shamir
- From the Department of Radiology, Montefiore Medical Center and Albert Einstein College of Medicine, 111 E 210 St, Bronx, NY 10467
| | - Jessica Kurian
- From the Department of Radiology, Montefiore Medical Center and Albert Einstein College of Medicine, 111 E 210 St, Bronx, NY 10467
| | - Debora Kogan-Liberman
- From the Department of Radiology, Montefiore Medical Center and Albert Einstein College of Medicine, 111 E 210 St, Bronx, NY 10467
| | - Benjamin H. Taragin
- From the Department of Radiology, Montefiore Medical Center and Albert Einstein College of Medicine, 111 E 210 St, Bronx, NY 10467
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Anupindi SA, Biko DM, Ntoulia A, Poznick L, Morgan TA, Darge K, Back SJ. Contrast-enhanced US Assessment of Focal Liver Lesions in Children. Radiographics 2017; 37:1632-1647. [DOI: 10.1148/rg.2017170073] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Sudha A. Anupindi
- From the Department of Radiology, The Children’s Hospital of Philadelphia, University of Pennsylvania, Perelman School of Medicine, 3401 Civic Center Blvd, Philadelphia, PA 19104
| | - David M. Biko
- From the Department of Radiology, The Children’s Hospital of Philadelphia, University of Pennsylvania, Perelman School of Medicine, 3401 Civic Center Blvd, Philadelphia, PA 19104
| | - Aikaterini Ntoulia
- From the Department of Radiology, The Children’s Hospital of Philadelphia, University of Pennsylvania, Perelman School of Medicine, 3401 Civic Center Blvd, Philadelphia, PA 19104
| | - Laura Poznick
- From the Department of Radiology, The Children’s Hospital of Philadelphia, University of Pennsylvania, Perelman School of Medicine, 3401 Civic Center Blvd, Philadelphia, PA 19104
| | - Trudy A. Morgan
- From the Department of Radiology, The Children’s Hospital of Philadelphia, University of Pennsylvania, Perelman School of Medicine, 3401 Civic Center Blvd, Philadelphia, PA 19104
| | - Kassa Darge
- From the Department of Radiology, The Children’s Hospital of Philadelphia, University of Pennsylvania, Perelman School of Medicine, 3401 Civic Center Blvd, Philadelphia, PA 19104
| | - Susan J. Back
- From the Department of Radiology, The Children’s Hospital of Philadelphia, University of Pennsylvania, Perelman School of Medicine, 3401 Civic Center Blvd, Philadelphia, PA 19104
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Clinical application of a three-dimensional imaging technique in infants and young children with complex liver tumors. Pediatr Surg Int 2016; 32:387-95. [PMID: 26809670 DOI: 10.1007/s00383-016-3864-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/12/2016] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Three-dimensional (3D) imaging instead of two-dimensional (2D) computed tomography (CT) for diagnosis and preoperative planning in infants and young children with complex liver tumors is a promising technique for precision hepatectomy. METHODS This study was a retrospective analysis of 26 infants and young children with giant liver tumors involving the hepatic hilum who underwent precise hepatectomy at the Affiliated Hospital of Qingdao University between February 2012 and January 2015. All patients received upper abdominal contrast-enhanced CT scanning before surgery. 16 patients used Hisense CAS system for 3D reconstruction as the reconstruction group. While ten patients underwent 3D CT reconstruction by the CT Workstation as the control group. The clinical outcomes were analyzed and compared between the two groups. The 3D reconstruction of abdominal organs and blood vessels was generated using the Hisense CAS system. Diagnosis and preoperative planning assisted by the system was used for preoperative and intraoperative decision-making for precise hepatectomy. RESULTS All patients underwent successful surgery. The 3D models clearly demonstrated the association of liver tumors with the intrahepatic vascular system and provided a preoperative assessment of resectability, assisting surgeons in preoperative procedural planning. Anatomic hepatectomy was successfully completed in the reconstruction group. The mean operation time was shorter in the reconstruction group (137.81 ± 17.51 min) than in the control group (192 ± 34.66 min) (P < 0.01). The mean intraoperative blood loss was lesser in the reconstruction group (21.81 ± 14.05 ml) than in the control group (53.50 ± 21.35 ml) (P < 0.01). The difference was statistically significant. DISCUSSION 2D CT scan images cannot accurately display the spatial relationship between the tumor and surrounding vasculature. The 3D reconstruction model used in this study gave detailed and accurate anatomical information and allowed for the assessment of tumor resectability and provided a detailed road map for preoperative decision-making and predicted the postoperative liver function. CONCLUSIONS 3D visualization technology provides preoperative assessment and allows individualized surgical planning. Surgical controllability, accuracy, and safety can be improved in infants and young children undergoing precise hepatectomy for complex liver tumors.
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