Hepatoblastoma in Infant: A Rare Case Report and Literature Review
Main Article Content
Abstract
Introduction: Hepatoblastoma is the most common liver malignancy in children. Hepatoblastoma in infants is rare and usually presents as an abdominal mass without specific symptoms. Diagnosis is difficult, supported by adequate imaging modalities, liver biopsy, and hepatoblastoma marker testing.
Case Presentation: A 3-month-old boy presented with a chief complaint of abdominal mass 3 days after birth without any other complaints. Nutritional status was normal. Vital signs were stable. Physical examination revealed anemic conjunctiva, hepatomegaly, and a palpable lump in the right upper quadrant of the abdomen. The laboratory results were Hb 8.2 g/dL, AST 45 U/l, ALT 13 U/L, gamma-GT 218.2 U/L, alkaline phosphatase 200 U/L, total bilirubin 3.00 mg/dL, direct bilirubin 1.40 mg/dL, Rubella IgG Reactive (20.60 IU/mL), CMV IgG Reactive (145.1 AU/mL), LDH 404 U/L, and Alpha-fetoprotein 5720.45 ng/mL. Abdominal ultrasound was consistent with a malignant liver mass, possibly hepatoblastoma, with a heteroechoic mass +/- 6.57 x 7.21 x 6.76 cm in the right and left liver lobes. A computed tomography scan of the abdomen confirmed the hepatoblastoma in segments V, VI, VII, and VIII of the right lobes with hepatomegaly.
Conclusion: The possibility of hepatoblastoma should be considered when an infant presents with a complaint of an abdominal mass without specific symptoms. In children younger than 2 years, radiologic confirmation of hepatoblastoma is sufficiently accurate, especially when supported by elevated AFP in facilities with limited liver biopsies.
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References
I. Aronson DC, Meyers RL. Malignant tumors of the liver in children. Seminars in Pediatric Surgery. 2016 Oct;25(5):265–75.
II. Lim I, Bondoc A, Geller J, Tiao G. Hepatoblastoma—The Evolution of Biology, Surgery, and Transplantation. Children. 2018 Dec 21;6(1):1.
III. Chavhan GB, Siddiqui I, Ingley KM, Gupta AA. Rare malignant liver tumors in children. Pediatr Radiol. 2019 Oct;49(11):1404–21.
IV. Ranganathan S, Lopez-Terrada D, Alaggio R. Hepatoblastoma and Pediatric Hepatocellular Carcinoma: An Update. Pediatr Dev Pathol. 2020 Apr;23(2):79–95.
V. Hubbard AK, Spector LG, Fortuna G, Marcotte EL, Poynter JN. Trends in International Incidence of Pediatric Cancers in Children Under 5 Years of Age: 1988–2012. JNCI Cancer Spectrum. 2019 Mar 1;3(1):pkz007.
VI. Kahla JA, Siegel DA, Dai S, Lupo PJ, Foster JH, Scheurer ME, et al. Incidence and 5‐year survival of children and adolescents with hepatoblastoma in the United States. Pediatric Blood & Cancer. 2022 Oct;69(10):e29763.
VII. Pateva IB, Egler RA, Stearns DS. Hepatoblastoma in an 11-year-old: Case report and a review of the literature. Medicine. 2017 Jan;96(2):e5858.
VIII. Feng J, Polychronidis G, Heger U, Frongia G, Mehrabi A, Hoffmann K. Incidence trends and survival prediction of hepatoblastoma in children: a population‐based study. Cancer Communications. 2019 Dec;39(1):1–9.
IX. Sergi CM, Hager J, editors. Liver Cancer [Internet]. Exon Publications; 2021 [cited 2024 Jul 19]. Available from: https://exonpublications.com/index.php/exon/issue/view/14
X. Masand PM. Magnetic resonance imaging features of common focal liver lesions in children. Pediatr Radiol. 2018 Aug;48(9):1234–44.
XI. Towbin AJ, Meyers RL, Woodley H, Miyazaki O, Weldon CB, Morland B, et al. 2017 PRETEXT: radiologic staging system for primary hepatic malignancies of childhood revised for the Paediatric Hepatic International Tumour Trial (PHITT). Pediatr Radiol. 2018 Apr;48(4):536–54.
XII. Geramizadeh B, Foroughi R, Shojazadeh A. Hepatocellular Malignant Neoplasm, Not Otherwise Specified: A New Name in Liver Tumors: A Brief Narrative Review of Published Cases. Gastrointest Tumors. 2021;8(2):96–100.
XIII. Weldon CB, Madenci AL, Tiao GM, Dunn SP, Langham MR, McGahren ED, et al. Evaluation of the diagnostic biopsy approach for children with hepatoblastoma: A report from the children’s oncology group AHEP 0731 liver tumor committee. Journal of Pediatric Surgery. 2020 Apr;55(4):655–9.
XIV. Zheng M, Li J, Hu C, Tan T, Yang J, Pan J, et al. Liver biopsy for hepatoblastoma: a single institution’s experience. Pediatr Surg Int. 2020 Aug;36(8):909–15.
XV. Rajasimman AS, Patil V, Gala KB, Shetty N, Kulkarni S, Ramadwar MS, et al. Accuracy of contrast-enhanced CT in liver neoplasms in children under 2 years age. Pediatr Radiol [Internet]. 2024 Jun 3 [cited 2024 Jul 18]; Available from: https://link.springer.com/10.1007/s00247-024-05958-w
XVI. Trobaugh-Lotrario AD, Maibach R, Aronson DC, Rangaswami A, Häberle B, O’Neill AF, et al. Outcomes of Patients Treated for Hepatoblastoma with Low Alpha-Fetoprotein and/or Small Cell Undifferentiated Histology: A Report from the Children’s Hepatic Tumors International Collaboration (CHIC). Cancers. 2023 Jan 11;15(2):467.
XVII. Katzenstein HM, Langham MR, Malogolowkin MH, Krailo MD, Towbin AJ, McCarville MB, et al. Minimal adjuvant chemotherapy for children with hepatoblastoma resected at diagnosis (AHEP0731): a Children’s Oncology Group, multicentre, phase 3 trial. The Lancet Oncology. 2019 May;20(5):719–27.
XVIII. Xiu WL, Liu J, Zhang JL, Wang JM, Wang XF, Wang FF, et al. Computer-assisted three-dimensional individualized extreme liver resection for hepatoblastoma in proximity to the major liver vasculature. World J Gastrointest Surg. 2024 Apr 27;16(4):1066–77.
XIX. Katzenstein HM, Malogolowkin MH, Krailo MD, Piao J, Towbin AJ, McCarville MB, et al. Doxorubicin in combination with cisplatin, 5‐flourouracil, and vincristine is feasible and effective in unresectable hepatoblastoma: A Children’s Oncology Group study. Cancer. 2022 Mar;128(5):1057–65.
XX. Chen W, Zhang L, Zhang B, Fang Y, He Y. Development and validation of nomogram-based models for personalized survival assessment in pediatric hepatoblastoma patients. Transl Cancer Res. 2024 Feb;13(2):699–713.
XXI. Kim PH, Shin HJ, Yoon HM, Choi YH, Namgoong JM, Kim DY, et al. Children’s Hepatic Tumors International Collaboration-Hepatoblastoma Stratification (CHIC-HS) System for Pediatric Patients with Hepatoblastoma: A Retrospective, Hospital-Based Cohort Study in South Korea. Cancer Res Treat. 2022 Jan 15;54(1):253–8.