Small cell undifferentiated histology in hepatoblastoma may be unfavorable

Chemotherapy has improved the prognosis of hepatoblastoma demonstrably. It renders seemingly unresectable primary tumors amenable to surgery and can cure metastases. Some authors advocate preoperative chemotherapy for patients with tumors that are deemed resectable, relying solely on percutaneous biopsy or even on diagnostic imaging and elevated serum alpha-fetoprotein levels for diagnosis. However, certain cytologic features of hepatoblastoma appear to have important prognostic consequences. Well differentiated fetal hepatoblastomas that are confined to the liver and that have minimal mitotic activity may not require additional therapy if they are resected totally.

In the current study 16 completely resected hepatoblastomas that exhibited partial or predominant small cell undifferentiated histology were identified retrospectively and correlated with patient outcome.

Ten of 16 patients with completely resected tumors exhibiting small cell undifferentiated histology developed a disease recurrence. Five of these recurrences were fatal.

Small cell undifferentiated histology may have an unfavorable effect on outcome in patients with completely resected hepatoblastoma. The focal distribution of small cell histology in the majority of these tumors suggests that treating hepatoblastoma based on limited preexcision biopsies may deprive some patients of appropriate therapy.