Hepatoblastoma presenting as isosexual precocity. The clinical importance of histologic and serologic parameters

A 2-year-old boy presented with sexual precocity secondary to a hormone-producing hepatoblastoma. The tumor demonstrated an aggressive histologic pattern and stained immunohistochemically for alpha-fetoprotein and beta-subunit human chorionic gonadotrophin. After a successful liver transplant these tumor markers were closely followed. We conclude that histologic subclassification of hepatoblastoma is most useful for predicting likelihood of resectability. Tumors with predominantly fetal-type histology tend to be better circumscribed and are more likely to be resectable with improved survival relative to tumors with predominantly embryonal histology. The presence or absence of mesenchymal elements does not seem to have prognostic importance. Anaplastic features predict a poor outcome, but it remains for these to be uniformly defined and applied. Small uniform cellular histology with neuroblastoma-like differentiation appears to be particularly ominous. Serologic tumor markers, especially alpha-fetoprotein (AFP) and human chorionic gonadotrophin (HCG) are useful as monitors of potential tumor recurrence, but their efficacy is compromised by the unpredictable variation of tumor cell metabolism, undoubtedly a result of the genetic instability and heterogeneity of proliferating malignant cells.