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may be seen at initial contact or during the treatment course. Leukemic cells can infiltrate the hepatic sinusoids and portal tracts in the liver. Infiltration can lead to hepatocellular necrosis and elevated transaminases. In a pediatric study of 147 patients with ALL, elevated transaminases were reported in 34% at presentation. 2 Along with abnormal liver enzymes, 3.4% had IntroductIonLeukemias, lymphomas, and LCH constitute the common hematolymphoid malignancies in children. The reticuloendothelial system includes the liver, which is frequently involved either at the time of presentation or during the disease course. The mechanisms causing various hepatobiliary manifestations are a multitude, including infiltration, drug toxicity, immunodeficiency, etc. (Table 1). They may be subtle in the form of asymptomatic hepatomegaly and/or mildly elevated transaminases to a fulminant presentation like liver failure, often posing a challenge to pediatric gastroenterologists/hepatologists. Their presentation frequently overlaps with chronic infectious and inflammatory conditions causing a delay in diagnosis and impacting survival. In this review, we briefly discuss the aspects of hepatic involvement, focusing on their presentation and approach in clinical practice. Leukemias in ChildrenAmong the pediatric malignancies seen in the <15 years of age-group, one-third are constituted by acute leukemias. 1 Acute leukemias often infiltrate the lymphoreticular organs, like the lymph nodes, liver, and spleen.

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