Description
Liver tumors in children are uncommon and make up only about 3% of all tumors seen in the pediatric population. Two-thirds of these tumors are benign and one-third are malignant. Most commonly, patients present with an asymptomatic abdominal mass, which the parents notice while bathing the child. Other symptoms may include pain, nausea, weight loss, internal bleeding or precocious puberty.
Diagnosis
Evaluation of liver tumors includes blood tests and radiographic imaging, which may include an abdominal ultrasound but should always include computed tomography (CT scan) to identify the lesion and to determine if it can be removed. Magnetic resonance imaging (MRI) can also be helpful in the diagnosis. A definitive diagnosis is made by obtaining tissue from the tumor by biopsy.
Hemangiomas
Hemangiomas are benign vascular tumors, which represent the most common benign liver tumor in children. Most are asymptomatic and can be observed. However, infantile hemangioendotheliomas may present in infancy with congestive heart failure, hepatomegaly and a consumptive coagulopathy characterized by a low platelet count. Treatment for these patients includes steroids, interferon therapy, embolization or hepatic artery ligation. Resection is reserved for individuals who do not respond to these therapies.
Malignant Liver Tumors
The two most common malignant liver tumors are hepatoblastomas and hepatocellular carcinomas. In children, hepatoblastoma is the most common malignancy of the liver, with most of these tumors diagnosed before 4 years of age. Hepatocellular carcinoma is the next most common, with a peak age incidence between 10 and 15 years old. Sarcomas are much less common but constitute the remainder of the malignancies. For malignant appearing lesions, a biopsy should be performed, unless the CT scan evaluation indicates that the lesion can be completely resected.
Treatment
If a malignant liver tumor is deemed unresectable at the time of presentation, chemotherapy is initiated to shrink the tumor, making it more likely to be removed with surgery later. Hepatoblastomas are often highly chemosensitive and the prognosis is generally excellent if the tumor can be fully resected. Hepatocellular carcinoma is usually less sensitive to chemotherapy with a decreased likelihood of being able to fully resect this type of lesion. Liver transplantation may be considered for select patients who have unresectable tumors. Over the past five years, surgeons at our hospital have performed nearly 40 major liver resections in children.
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