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Anti-alpha-fetoprotein imaging is useful for staging hepatoblastoma
Kalevi J A Kairemo1, Harry Lindahl, Jussi Merenmies
1Children's Hospital and Department of Radiology, University of Helsinki, Helsinki, Finland.
Background:
Liver transplantation (Tx) has become an alternative treatment of malignant childhood liver tumors, and the importance of careful pretransplantation evaluation has been emphasized. Anti-alpha-fetoprotein (AFP) imaging has been suggested for evaluation of adult patients with AFP-positive tumors.
Methods:
Antibody imaging utilizing Tc-99 m-labeled monoclonal anti-AFP Fab' fragments was used to demonstrate pathologic uptake in hepatoblastoma (HB).
Results:
Radical operation or liver Tx was not possible after four cycles of chemotherapy in a child with HB because of a single extrahepatic metastasis. Chemotherapy was continued, and reevaluation with anti-AFP imaging demonstrated a pathologic uptake only in the liver. Subsequently, a right liver lobe resection was performed. Along with a new rise in serum AFP, repeated anti-AFP imaging revealed active liver tumor but no metastases. A liver Tx was performed, and the child is well with a normal serum AFP level 18 months after the operation.
Conclusion:
This is the first case of pediatric HB in which anti-AFP imaging has been successfully used for patient management.