Embryonal/Fetal Subtype Hepatoblastoma: A Case Report

Abstract

We present a case of five months old female infant hospitalized for the evaluation of an abdominal mass. The infant was born mature and prenatally, perinatally and family history were insignificant. The physical examination at hospitalisation revealed an infant with very good general status without fever. At the abdomen examination revealed a palpable mass in the epigastric area and over the midline in the left abdomen under the rib border without pain and with relatively smooth surface.Laboratory investigations revealed thrombocytosis and high values of the serum alpha-fetoprotein (AFP) >35350ng/ml, betahuman chorionic gonadotropin (βHCG) < 0.605 mIU/ml, lactate dehydrogenase (LDH) 991 U/I, ferritin 163.44 ng/ml, c-reactive protein (CRP) 1.89 mg/dl, aspartate aminotransferase (AST) 74 U/I, alanine aminotransferase (ALT) 19 U/I, gamma-glutamyl transpeptidase (GGT) 252 U/I, hematocrit (Ht) 37%, hemoglobin (Hb) 11g/dl, platelets (PLT) 834000/mm The patient's age, clinical-imaging data, thrombocytosis and high value of AFP raised the suspicion of a hepatoblastoma.The patient was operated and a well-defined tumor 10/10 cm without vascular invasion was detected in the segments II-III 5]. A left lobectomy (segmentectomy 2 and 3) was performed. Surgery SectionThe pathological diagnosis was of embryonal/fetal subtype hepatoblastoma, totally removed. In multiple section received from the tumour, there has been a histological picture of hepatic neoplasm of areas consisting of trabecular solid or rosette like formation with cells with dark staining nuclei and frequent mitosis. There are cells with less atypia among which several foci of hepatopoeiesis. Mesenchymal elements are not recognised. Immunohistochemical analysis showed the neoplasmatic cells were positive to a FP, focally positive to CD99 and negative to S-100.The postsurgical evolution was favourable. The patient was transferred to the Department of Pediatrics where she tolerated welltreatment with Cisplatin 2mg/Kg for 3 courses every 2 weeks.Two months after the surgery the clinical biological evaluation was normal without hepatosplenomegaly, normal platelets values and AFP was 823ng/ml. The echographic re-evaluation indicate a hepatic parenchyma without foci lesions. DisCussionThe incidence of hepatoblastoma in USA and Europe seems to be 1.2 to 1.5 cases per million population and the rates in boys (1.57) are higher than in girls (1.09). In all pediatric malignancies it is still a rare tumor, comprising approximately 1% [1-3].The suspicion of child's hepatic tumor is based on history, clinical, biological and imaging data.The clinical presentation usually is an asymptomatic abdominal\ mass and sometimes accompanied with fever, fatigue, anorexia and weight loss. Severe symptoms such as obstructive jaundice and tumor rupture are relatively rare occurrences [1,4].Embryonal/Fetal Subtype Hepatoblastoma: A Case Report aBstRaCt Hepatoblastoma is the most common primary liver tumor of childhood and after neuroblastoma and nephroblastoma the third most common abdominal...

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