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Imaging and clinical features of pediatric hepatocellular carcinoma

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Abstract

Background

Hepatocellular carcinoma (HCC) is rare in children and there is limited data on its imaging features.

Objective

To describe imaging features of pediatric HCC and correlate them with clinical and laboratory findings.

Materials and methods

We retrospectively reviewed imaging in all pediatric HCC cases seen between January 2000 and January 2019. Imaging features defined in LI-RADS (Liver Imaging Reporting and Data System) and tumor extent by PRETEXT (pretreatment extent of disease) criteria were noted by two radiologists. Patient charts were reviewed to collect clinical features, alpha-fetoprotein (AFP) level and pathology findings.

Results

Of the 15 children (7 boys, 8 girls; mean age: 11.8 years, age range: 6–17 years) included in the study, 12/15 had computed tomography, 9/15 had magnetic resonance imaging and 9/15 had ultrasound exams available for review. Pathological types of HCC included classic (11/15, 73%), fibrolamellar (3/15, 20%) and mixed cholangiocarcinoma-HCC (1/15, 7%). Eighty percent occurred de novo in normal liver and 67% showed elevated AFP levels. Arterial phase hyperenhancement was seen in 83% of cases, washout in 86%, capsule in 50% and tumor-in-vein in 33%. The mean tumor size was 9.8 cm and 40% were multifocal on imaging. Staging revealed PRETEXT II tumors in 47%, III in 20% and IV in 33%. There were no PRETEXT I tumors. The two most common PRETEXT annotation factors were portal vein and caudate lobe involvement in 71% and 43% of cases, respectively. Fibrolamellar HCC demonstrated central scar, normal AFP levels and normal background liver.

Conclusion

Pediatric HCC are large heterogeneous tumors, as reflected by high PRETEXT staging, and commonly include portal vein and caudate involvement. This affects resectability of these tumors at presentation. Central scar, normal AFP level and normal liver background may help differentiate fibrolamellar HCC from other types of HCC.

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Authors and Affiliations

  1. Department of Diagnostic Imaging, The Hospital for Sick Children, 555 University Ave., Toronto, ON, M5G 1X8, Canada

    Guillermo A. Arias, Oscar M. Navarro & Govind B. Chavhan

  2. Department of Medical Imaging, University of Toronto, Toronto, ON, Canada

    Guillermo A. Arias, Oscar M. Navarro & Govind B. Chavhan

  3. Department of Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada

    Iram Siddiqui

  4. Division of Hematology and Oncology, The Hospital for Sick Children, Toronto, ON, Canada

    Furqan Shaikh

  5. Department of Pediatrics, University of Toronto, Toronto, ON, Canada

    Furqan Shaikh

  6. Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, ON, Canada

    Blayne A. Sayed

  7. Department of Surgery, University of Toronto, Toronto, ON, Canada

    Blayne A. Sayed

Authors
  1. Guillermo A. Arias
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  2. Iram Siddiqui
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  3. Oscar M. Navarro
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  4. Furqan Shaikh
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  5. Blayne A. Sayed
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  6. Govind B. Chavhan
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Corresponding author

Correspondence to Govind B. Chavhan.

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Arias, G.A., Siddiqui, I., Navarro, O.M. et al. Imaging and clinical features of pediatric hepatocellular carcinoma. Pediatr Radiol 51, 1339–1347 (2021). https://doi.org/10.1007/s00247-021-04989-x

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  • DOI: https://doi.org/10.1007/s00247-021-04989-x

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