Assessment of malignant liver tumors in children

A spectrum of findings on computed tomography in paediatric abdominal and pelvic tumours in a Ghanaian teaching hospital

Objectives

To review the Computed Tomography( CT )features of pediatric oncological patients with abdominal and pelvic tumours and correlate these findings with their histopathological diagnosis.

Design

This was a retrospective cross-sectional facility-based study.

Setting

This study was conducted in the Pediatric Oncology Unit and Radiology Department of the Korle Bu Teaching Hospital.

Participants

Fifty-six pediatric oncology patients with contrast-enhanced abdominal and pelvic CT scans.

Data Collection

The abdominal and pelvic CT scans findings, patient biodata, and histopathology reports of oncology patients over four years were reviewed.

Statistical analysis

Simple descriptive statistics using frequency distribution, percentages, means, and standard deviation were used to describe the various variables and presented tables.

Results

The four commonest tumours were nephroblastoma, neuroblastoma, lymphoma, and hepatoblastoma. The mean age at diagnosis was 4.8 years, with a slightly higher male predominance. The majority of the tumours were extremely large at presentation. Overall, the CT - histopathology concordance was 79.2%.

Conclusion

Abdominal and pelvic CT scans play an important role in the diagnostic workup of pediatric malignancies by ensuring early and accurate diagnosis of these tumours.

Funding

None declared.

Effect of Centralization on Surgical Outcome of Children Operated for Liver Tumors in Switzerland: A Retrospective Comparative Study

Background: Pediatric liver surgery is complex, and complications are not uncommon. Centralization of highly specialized surgery has been shown to improve quality of care. In 2012, pediatric liver surgery was centralized in Switzerland in one national center. This study analyses results before and after centralization. Methods: Retrospective monocentric comparative study. Analysis of medical records of children (0–16 years) operated for any liver tumor between 1 January 2001 and 31 December 2020. Forty-one patients were included: 14 before centralization (before 1 January 2012) and 27 after centralization (after 1 January 2012). Epidemiological, pre-, intra-, and post-operative data were collected. Fischer’s exact and t-test were used to compare groups. Results: The two cohorts were homogeneous. Operating time was reduced, although not significantly, from 366 to 277 min. Length of postoperative stay and mortality were not statistically different between groups. Yet, after centralization, overall postoperative complication rate decreased significantly from 57% to 15% (p = 0.01), Clavien > III complications decreased from 50% to 7% (p < 0.01), and hepatic recurrences were also significantly reduced (40% to 5%, p = 0.03). Conclusion: Centralization of the surgical management of liver tumors in Switzerland has improved quality of care in our center by significantly reducing postoperative complications and hepatic recurrence.

[Imaging of hepatic tumors in children and adolescents]

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.

Transarterial chemoembolization in children to treat unresectable hepatocellular carcinoma

Children with unresectable HCC have a dismal prognosis and few approved treatment options. TACE is an effective treatment option for adults with HCC, but experience in children is very limited. Retrospective analysis was performed of 8 patients aged 4-17 years (4 male, mean 12.5 years) who underwent TACE for unresectable HCC. Response to TACE was evaluated by change in AFP, RECIST and tumor volume, PRETEXT, and transplantation eligibility by UCSF and Milan criteria. Post-procedure mean follow-up was 8.2 years. Mean overall change in tumor volume for the 8 patients was 51%. Percent change in AFP ranged from a decrease of 100% to an increase of 89.3%, with a mean change of -49.6%. Two patients did not undergo resection or transplantation and died of progressive disease. Six patients underwent orthotopic liver transplantation with mean first TACE-to-transplant interval of 141 days (range 11-514). Following transplantation, 5 patients were alive at the end of the follow-up period and one died of recurrent disease. Based on our initial experience, TACE for children with unresectable HCC appears to be a safe and effective method for managing hepatic tumor burden and for downstaging and bridging to liver transplantation.

2017 PRETEXT: radiologic staging system for primary hepatic malignancies of childhood revised for the Paediatric Hepatic International Tumour Trial (PHITT)

Imaging is crucial in the assessment of children with a primary hepatic malignancy. Since its inception in 1992, the PRETEXT (PRE-Treatment EXTent of tumor) system has become the primary method of risk stratification for hepatoblastoma and pediatric hepatocellular carcinoma in numerous cooperative group trials across the world. The PRETEXT system is made of two components: the PRETEXT group and the annotation factors. The PRETEXT group describes the extent of tumor within the liver while the annotation factors help to describe associated features such as vascular involvement (either portal vein or hepatic vein/inferior vena cava), extrahepatic disease, multifocality, tumor rupture and metastatic disease (to both the lungs and lymph nodes). This manuscript is written by members of the Children's Oncology Group (COG) in North America, the International Childhood Liver Tumors Strategy Group (SIOPEL) in Europe, and the Japanese Study Group for Pediatric Liver Tumor (JPLT; now part of the Japan Children's Cancer Group) and represents an international consensus update to the 2005 PRETEXT definitions. These definitions will be used in the forthcoming Trial to Pediatric Hepatic International Tumor Trial (PHITT).

Differential diagnosis and management of liver tumors in infants

During the first year of life, most of the liver neoplasms are benign in origin, but some of these histologically benign lesions may be challenging in their management. Although most hepatic hemangiomas can be safely observed until involution is documented, some patients will need treatment due to progressive hepatomegaly, hypothyroidism and/or cardiac failure. Large mesenchymal hamartomas may require extensive hepatic resection and an appropriate surgical plan is critical to obtain good results. For malignant neoplasms such as hepatoblastoma, complete surgical resection is the mainstay of curative therapy. The decision about whether to perform an upfront or delayed resection of a primary liver malignant tumor is based on many considerations, including the ease of resection, surgical expertise, tumor histology and stage, and the likely chemosensitivity of the tumor. This article reviews the initial management of the more common hepatic tumors of infancy, focusing on the differential diagnosis and treatment options.

Paediatric ultrasonography of the liver, hepatobiliary tract and pancreas

In the field of paediatric radiology ultrasonography (US) is the most versatile imaging tool available. Children in general, by virtue of their body composition, are excellent candidates for US exams in whom abdominal anatomy and pathology can be visualised in great detail. The fact that during the US study a clinical history can be obtained strongly adds to the value of the US exam. This does require investment in time and expertise and ideally a paediatric radiologist performing the exam. In this review the role of ultrasonography (US) of the liver, biliary tract and pancreas in children is discussed.

Contrast-enhanced sonography in pediatrics

Microbubble US contrast agents are composed of an outer shell of protein, phospholipid or polymer that encase air or perfluorocarbon gas. These contrast agents have been widely used in adult cardiology patients to improve endocardial border delineation and have been proved safe and well tolerated in this patient population. There is also a growing body of literature elucidating the value of contrast-enhanced sonography to distinguish benign from malignant liver lesions in adults and to characterize non-hepatic adult malignancies. Because these agents have not been approved for pediatric use in many countries, less is known of the value of contrast-enhanced sonography in children. In this review I will discuss several proven and potential pediatric applications of contrast-enhanced sonography.