Hepatoblastoma and tumors in a child's liver

What are liver tumors?

These occur rarely in children, and represent 1% of all solid pediatric tumors; they are malignant in two-thirds of cases.

Benign liver tumors

They are mostly of vascular origin (hemangioma, hemangioendothelioma), followed, in order of frequency, by congenital mesenchymal hamartoma, focal nodular hyperplasia and adenoma.

Malignant liver tumors

The majority (90%, excluding metastases) are divided into two groups:

• Hepatoblastoma, which usually occurs before the age of 3 years; its annual incidence is 1 case in 1 million children.
• Hepatocellular carcinoma, which is much more rare, occurs in adolescents. If it is associated with pre-existing liver disease, it often appears earlier in childhood. 

Finally, a third type of tumor exists, which is much more rare. This is sarcoma, which represents 10% of malignant liver tumors and generally affects school aged children.

What are the symptoms?

The tumor most often takes the form of an abdominal mass, which is usually palpable, and is sometimes accompanied by abdominal pain.

How is it diagnosed?

The assessment is done with a CT scan or nuclear magnetic resonance imaging (MRI). The images allow for the evaluation of the extent of the tumor.
Often, a biopsy of the tumor is carried out under general anesthesia in order to figure out what its precise nature is and to offer the most appropriate treatment.

What are the treatments?

For benign tumors, simple ultrasound monitoring is often indicated and surgery should rarely be performed. The goal for treating malignant tumors is to achieve complete surgical removal of the tumor.
This procedure is almost always accompanied by chemotherapy before and after the operation. In some cases, interventional radiology techniques are proposed.

What is the prognosis?

Advances in medico-surgical management of malignant tumors have greatly contributed to the improvement of the prognosis for children with one of these tumors.