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[Pediatric liver tumor: What to do?]
D Pariente1, S Franchi-Abella1
1Service de radiologie pédiatrique, hôpital Bicêtre, hôpitaux universitaires Paris Sud, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre cedex, France.
Insights
Pediatric liver masses require careful evaluation, as malignant tumors and benign pseudotumors can present similarly. Age-specific diagnostic approaches and imaging are crucial for accurate diagnosis of pediatric hepatic masses.
Area of Science:
- Pediatric Radiology
- Pediatric Oncology
- Hepatology
Context:
- Two-thirds of pediatric liver tumors are malignant, necessitating accurate differentiation from benign pseudotumors like abscesses or hematomas.
- Pediatricians are often the first to encounter hepatic masses in children, requiring age-stratified diagnostic considerations.
Purpose:
- To outline the age-dependent diagnostic strategies for pediatric hepatic masses.
- To highlight key laboratory findings and imaging modalities for evaluating pediatric liver lesions.
- To emphasize the importance of multidisciplinary referral for definitive diagnosis and management.
Summary:
- Diagnostic approaches for pediatric liver masses vary by age, with hepatoblastoma and hemangioma common before age three, and hepatocarcinoma, sarcoma, focal nodular hyperplasia, and adenoma more frequent in older children.
- Key laboratory tests include alpha-fetoprotein, beta-hCG, and urinary catecholamines, while ultrasonography serves as the primary imaging modality.
- Further characterization with CT or MRI, guided by clinical status and equipment availability, is essential for diagnosis and management by specialized pediatric oncology, surgery, and radiology teams.
Impact:
- Facilitates timely and accurate diagnosis of pediatric liver masses, improving patient outcomes.
- Provides a framework for pediatricians to initiate appropriate diagnostic workups for suspected hepatic lesions.
- Guides the selection of advanced imaging techniques for definitive diagnosis and treatment planning in pediatric liver tumors.
Abstract:
Two-thirds of pediatric liver tumors are malignant, but pseudotumors such as abscesses or hematoma can simulate a tumor. The pediatrician is often the first to discover a hepatic mass in a child. The diagnostic gamut varies depending on the child's age. Before the age of three years, the main diagnoses are hepatoblastoma and hemangioma, while after the age of three, hepatocarcinoma, sarcoma, focal nodular hyperplasia, and adenoma are more frequent. The laboratory findings to search for are alpha-fetoprotein whatever the age (increased in hepatoblastoma and hepatocarcinoma), beta-hCG, and urinary catecholamines in infants. Liver function is usually normal. Ultrasonography is the first-line examination to request. It confirms the hepatic location of the mass, differentiates solid from cystic tumors (cystic mesenchymal hamartoma and undifferentiated sarcoma), hypervascular findings (hemangioma in the infant, focal nodular hyperplasia in the older child), portal or hepatic thrombosis suggesting a malignant tumor, and findings of portacaval fistula predisposing to focal nodular hyperplasia and adenoma. At the end of this clinical, biological, and ultrasound examination, the pediatrician will refer the patient to a specialized center for further investigation and management, which are at best performed by pediatric oncologists, surgeons, and radiologists. Diagnostic confirmation and extension work-up will require CT or MRI depending on the patient's age and clinical state and the availability of equipment.
