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Hepatic benign and malignant masses in children: a single UK tertiary centre experience
Omar Nasher1, Helen Woodley2, Samah Alizai3
1Department of Paediatric Surgery, The Leeds Teaching Hospitals NHS Trust, Leeds Children's Hospital, Leeds, UK. omar.nasher@nhs.net.
Insights
In a UK tertiary liver unit, most paediatric liver masses were benign (64%), contrary to common belief. Hepatoblastoma was the most frequent malignant liver lesion in children.
Area of Science:
- Paediatric Hepatology
- Gastroenterology
- Oncology
Background:
- Liver masses in children are rare but require accurate diagnosis.
- Published literature often suggests a higher prevalence of malignant paediatric liver lesions.
Purpose of the Study:
- To review the incidence, spectrum, and diagnostic investigations of liver masses in paediatric patients.
- To compare findings with existing literature on paediatric liver mass prevalence.
Main Methods:
- Retrospective cohort study of 107 patients (<16 years) at a UK tertiary referral centre (July 2012-July 2019).
- Data collected on clinical presentation, referral source, investigations (USS, MRI, CT, etc.), and histopathology.
- Analysis of diagnostic workup and outcomes for paediatric liver masses.
Main Results:
- 64% of liver masses were benign (haemangioma, hepatic cyst, focal nodular hyperplasia), 36% were malignant.
- Hepatoblastoma (76%) and hepatocellular carcinoma (8%) were the most common malignant types.
- Lesions were often detected incidentally (33%) or via palpable mass (29%); 77% were referred from other hospitals.
Conclusions:
- Contrary to common assumptions, neoplastic (malignant) liver lesions constitute just over one-third of paediatric cases presenting to a tertiary centre.
- This study highlights the importance of accurate diagnostic pathways for paediatric liver masses, with a significant proportion being benign.
Purpose:
The aim of this study was to review the incidence, spectrum and investigation of liver masses presenting to our tertiary liver unit.
Methods:
A retrospective single-centre cohort study of paediatric patients (age < 16 years) diagnosed with a liver mass who were investigated at a UK paediatric hepatobiliary tertiary referral centre. Data relating to the clinical findings at presentation, source of referral, diagnostic investigations and histopathology findings were recorded and analysed.
Results:
107 patients were identified between July 2012 and July 2019 (55 females). 69 (64%) patients had benign liver lesions, whereas the remaining 38 (36%) were found to have malignant masses. The liver lesions were most commonly detected incidentally (33%) with the second most common presentation being with palpable mass (29%). 82 (77%) patients were referred from other hospitals. All patients underwent USS, 74% MRI, 36% CT, 5% CEUS, 1% PET and 5% HIDA scan with 47% ultimately undergoing biopsy. 72% of patients had AFP measured. The most common benign liver masses were haemangioma 33 (48%), hepatic cyst 17 (25%) and FNH 12 (19%). Amongst the malignant lesions, 29 (76%) were hepatoblastoma and 3 (8%) were hepatocellular carcinoma.
Conclusions:
This large review series demonstrates that just over 1/3 of patients presenting to a paediatric tertiary referral centre with a focal liver lesion had neoplastic liver lesions, despite the published literature commonly stating that 2/3 of paediatric liver masses are malignant.
