Abstract
Background
Focal nodular hyperplasia (FNH) of the liver is a rare benign lesion that may be related to the vascular and hepatic damage induced by completion of tumor therapy and a reaction to localized vascular abnormality. The aim of this study was to analyze the clinical course in pediatric solid tumor patients with FNH.
Methods
We analyzed thirty-two patients with pediatric solid tumors who received multiagent chemotherapy (15 advanced neuroblastomas, 7 hepatoblastomas, 5 rhabdomyosarcomas, 2 nephroblastomas, 1 rhabdoid tumor of the kidney, 1 clear cell sarcoma of the kidney and 1 pancreatoblastoma). All of them had been previously treated at our hospital, and have been alive for over 3 years without recurrence.
Results
FNH lesions were discovered in three (9.4%) of 32 patients, and were neuroblastoma (NB) stage 4. All 3 patients received induction chemotherapy and high-dose alkylating agents, and developed grade 3 (National Cancer Institute Common Toxicity Criteria; NCI-CTC) liver dysfunction during completion of tumor therapy without veno-occlusive disease. Two of the 3 patients received the same induction chemotherapy and high doses of alkylating agents with total body irradiation for cytoreductive agents prior to peripheral blood cell transplantation. FNH lesions in both female patients who received estrogen replacement therapy after completion of tumor therapy have expanded and are increasing.
Conclusion
FNH appears to be a late complication of iatrogenic disease in NB stage 4 patients. The therapeutic agents for NB stage 4 and estrogen replacement therapy should be considered as risk factors for the development of FNH.
Similar content being viewed by others
References
Mathieu D, Vilgrain V, Mahfouz AE et al (1997) Benign liver tumors. Magn Reson Imaging Clin N Am 5:255–288
Bouyn CI, Leclere J, Raimondo G et al (2003) Hepatic focal nodular hyperplasia in children previously treated for a solid tumor. Incidence, risk factors, and outcome. Cancer 97:3107–3113
Joyner BL Jr, Levin TL, Goyal RK et al (2005) Focal nodular hyperplasia of the liver: a sequela of tumor therapy. Pediatr Radiol 35:1234–1239
Citak EC, Karadeniz C, Oguz A et al (2007) Nodular regenerative hyperplasia and focal nodular hyperplasia of the liver mimicking hepatic metastasis in children with solid tumors and a review of literature. Pediatr Hematol Oncol 24:281–289
Sugito K, Kusafuka T, Kawashima H et al (2010) Usefulness of power Doppler ultrasonography and superparamagnetic iron oxide enhanced magnetic resonance imaging for diagnosis of focal nodular hyperplasia of the liver after treatment of neuroblastoma. Pediatr Hematol Oncol 27:250–256
Sawaguchi S, Kaneko M, Uchino J et al (1990) Treatment of advanced neuroblastoma with emphasis on intensive induction chemotherapy. A report from the Study Group of Japan. Cancer 66:1879–1887
Kaneko M, Tsuchida Y, Uchino J et al (1999) Treatment results of advanced neuroblastoma with the first Japanese study group protocol. Study Group of Japan for Treatment of Advanced Neuroblastoma. J Pediatr Hematol Oncol 21:190–197
Sasaki F, Matsunaga T, Iwafuchi M et al (2002) Outcome of hepatoblastoma treated with the JPLT-1 (Japanese Study Group for Pediatric Liver Tumor) Protocol-1: a report from the Japanese Study Group for Pediatric Liver Tumor. J Pediatr Surg 37:851–856
Hosoi H, Teramukai S, Matsumoto Y et al (2007) A review of 331 rhabdomyosarcoma cases in patients treated between 1991 and 2002 in Japan. Int J Clin Oncol 12:137–145
Oue T, Fukuzawa M, Okita H et al (2009) Outcome of pediatric renal tumor treated using the Japan Wilms Tumor Study-1 (JWiTS-1) protocol: a report from the JWiTS group. Pediatr Surg Int 25:923–929
Perilongo G, Shafford E, Maibach R et al (2004) Risk-adapted treatment for childhood hepatoblastoma: final report of the second study of the International Society of Paediatric Oncology-SIOPEL 2. Eur J Cancer 40:411–421
Stocker JT, Ishak KG (1981) Focal nodular hyperplasia of the liver: a study of 21 pediatric cases. Cancer 48:336–345
Cheon JE, Kim WS, Kim IO et al (1998) Radiological features of focal nodular hyperplasia of the liver in children. Pediatr Radiol 28:878–883
Nguyen BN, Fléjou JF, Terris B et al (1999) Focal nodular hyperplasia of the liver: a comprehensive pathologic study of 305 lesions and recognition of new histologic forms. Am J Surg Pathol 23:1441–1454
Weimann A, Ringe B, Klempnauer J et al (1997) Benign liver tumors: differential diagnosis and indications for surgery. World J Surg 21:983–990
Cherqui D, Rahmouni A, Charlotte F et al (1995) Management of focal nodular hyperplasia and hepatocellular adenoma in young women: a series of 41 patients with clinical, radiological, and pathological correlations. Hepatology 22:1674–1681
International Working Party (1995) Terminology of nodular hepatocellular lesions. Hepatology 22:983–993
Ndimbie OK, Goodman ZD, Chase RL et al (1990) Hemangiomas with localized nodular proliferation of the liver. A suggestion on the pathogenesis of focal nodular hyperplasia. Am J Surg Pathol 14:142–150
Wanless IR, Albrecht S, Bilbao J et al (1989) Multiple focal nodular hyperplasia of the liver associated with vascular malformations of various organs and neoplasia of the brain: a new syndrome. Mod Pathol 2:456–462
Horn B, Reiss U, Matthay K et al (2002) Veno-occlusive disease of the liver in children with solid tumors undergoing autologous hematopoietic progenitor cell transplantation: a high incidence in patients with neuroblastoma. Bone Marrow Transplant 29:409–415
McDonald GB, Sharma P, Matthews DE et al (1984) Venocclusive disease of the liver after bone marrow transplantation: diagnosis, incidence, and predisponsing factors. Hepatology 4:116–122
Lawrence TS, Robertson JM, Anscher MS et al (1995) Hepatic toxicity resulting from cancer treatment. Int J Radiat Oncol Biol Phys 31:1237–1248
Trotter JF, Everson GT (2001) Benign focal lesions of the liver. Clin Liver Dis 5:17–42
Scalori A, Tavani A, Gallus S et al (2002) Oral contraceptives and the risk of focal nodular hyperplasia of the liver: a case–control study. Am J Obstet Gynecol 186:195–197
Conflict of interest
No author has any conflict of interest.
Author information
Authors and Affiliations
Corresponding author
About this article
Cite this article
Sugito, K., Uekusa, S., Kawashima, H. et al. The clinical course in pediatric solid tumor patients with focal nodular hyperplasia of the liver. Int J Clin Oncol 16, 482–487 (2011). https://doi.org/10.1007/s10147-011-0210-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10147-011-0210-x