ABSTRACT
Focal nodular hyperplasia (FNH) is a benign non-neoplastic lesion of the liver usually found in adults. It is uncommon in children, comprising 2-10% of all pediatric liver tumours. In children, it can occur at all ages, with increased frequency between 6-10 years. We present two cases of FNH in childhood- the first being that of a 5-month-old infant, and the second in a 6-year-old boy. The possibility of congenital FNH had been excluded in the first case. The second case posed diagnostic difficulty initially and was wrongly treated for hepatoblastoma by neoadjuvant chemotherapy, but later correctly diagnosed to be FNH. Both the children are doing well on follow-up. Paediatric FNH though rare, should be kept in mind while dealing with a hepatic mass. Radiological features can be variable and needle sampling may not be sufficient to reach to a diagnosis. Histological examination with glutamine synthetase immunostaining should be performed in doubtful cases to differentiate FNH from other paediatric liver masses, as management differs.
ABSTRACT
INTRODUCTION@#This study aimed to assess safety, local tumour progression (LTP) and risk factors for LTP after radiofrequency ablation (RFA) of liver tumours in a single centre.@*METHODS@#All consecutive patients treated with RFA for liver tumours between January 2009 and October 2012 were included. Previously treated lesions that progressed were excluded. Using electronic medical records, the following data was captured: patient demographics, pre-procedural laboratory results, Child-Pugh status, tumour characteristics, development of tumoral seeding, RFA complications and LTP. Possible risk factors for LTP were identified using Cox regression.@*RESULTS@#In total, 555 liver tumours were treated in 337 patients. 483 (87.0%) hepatocellular carcinomas, 52 (9.4%) colorectal metastases and 20 (3.6%) other tumour types were treated. Mean tumour size was 2.1 ± 1.1 (range 0.4-6.8) cm. Mean follow-up duration was 387 days. 416 (75.0%) lesions had no LTP at the last imaging. 70 (12.6%) patients had minor complications requiring observation, while 7 (1.3%) patients had significant complications requiring prolonged hospitalisation or further interventions. Only one case of tumour seeding was detected. Using multivariate Cox regression, the following factors were statistically significant in predicting LTP: hilar location (relative ratio [RR] 3.988), colorectal metastases (RR 2.075), size (RR 1.290) and younger age (RR 0.982).@*CONCLUSION@#RFA of liver tumours is safe and effective, with a low significant complication rate of 1.3%. Hilar lesions are most prone to LTP, followed by lesions that were larger in size and colorectal metastases. 75.0% of patients showed no LTP at the last follow-up.
ABSTRACT
INTRODUÇÃO: O hepatocarcinoma fibrolamelar, variante do hepatocarcinoma, é neoplasia rara, responsável por 2% das de origem hepatocelular. RELATO DO CASO: Homem de 24 anos iniciou sintoma doloroso abdominal quatro meses antes da primeira consulta com hiporexia, emagrecimento, vômitos, aumento hepático e nodulação em hipocôndrio direito. Ressonância magnética abdominal mostrou lesão hepática heterogênea, hipervascular, com cicatriz central (provável calcificação), sugestivo de hepatocarcinoma fibrolamelar e presença de hepatomegalia moderada. Realizou-se trissegmentectomia hepática (segmentos VI, VII, VIII), com margem de segurança, sendo a via de acesso a por incisão subcostal direita. Houve confirmação de carcinoma hepatocelular (variante fibrolamelar) moderadamente diferenciado. Na evolução em seis meses encontrava-se bem com exame ultrassonográfico de controle normal, exceto sinais da ressecção efetuada. CONCLUSÃO: Apesar de prognóstico sombrio, o tratamento cirúrgico do hepatocarcinoma fibrolamelar é boa opção quando ampla hepatectomia pode ser realizada.
BACKGROUND: Fibrolamellar hepatocarcinoma is rare and responsible for 2% of the hepatocarcinomas. CASE REPORT: Man with 24 years old was attended by medical institution with abdominal pain, abdominal tumor mass, vomiting and bad general conditions. MRI showed hepatic tumor suggesting hepatocarcinoma. An hepatectomy (segments VI, VII, VIII) was done. It was confirmed malignancy with fibrolamellar hepatocarcinoma. In six months follow-up ultrasonography showed normal aspect of the remained liver. CONCLUSION: Although the bad prognosis of the tumor, hepatectomy should always be tried, if technical resection is feasible.