Hepatocellular carcinoma in children presents with massive upper gastrointestinal bleeding: a case report

Area of Science:

• Pediatric Oncology
• Hepatology
• Gastroenterology

Background:

• Hepatocellular carcinoma (HCC) is an exceptionally rare pediatric malignancy, with an incidence of 0.5-1.0 per million children.
• HCC typically arises in the context of chronic liver disease, such as viral hepatitis-induced cirrhosis.
• Abdominal mass is the most frequent clinical presentation in pediatric HCC.

Observation:

• A 9-year-old female patient presented with massive upper gastrointestinal bleeding (UGIB) secondary to esophageal varices.
• The patient had a confirmed diagnosis of hepatocellular carcinoma (HCC) with positive Hepatitis B surface antigen.
• Despite multiple endoscopic interventions (sclerotherapy, banding ligation, glue injection) and the use of a Sengstaken-Blakemore tube for variceal management, massive UGIB persisted.

Findings:

• The patient experienced esophageal rupture following the use of a Sengstaken-Blakemore tube.
• A liver necropsy confirmed the diagnosis of hepatocellular carcinoma (HCC).
• The case underscores the aggressive nature and poor prognosis of pediatric HCC, particularly when complicated by severe bleeding.

Implications:

• This case emphasizes the critical need for early detection and management strategies for pediatric HCC.
• It highlights the challenges in managing severe upper gastrointestinal bleeding in pediatric oncology patients.
• Further research into the pathogenesis and treatment of pediatric HCC, especially in the context of viral hepatitis, is warranted.