Thyroid Cancer Risk Factors in Children with Thyroid Nodules: A One-Center Study.

Thyroid nodules are common in the adult population (13%), but in childhood, they are relatively rarely diagnosed (0.2-5%). The risk factors and diagnostic and therapeutic algorithms are well-known and effectively used in adults, but no clear procedures supported by scientific research are available in the pediatric population. Our aim in this study was to identify predictive factors for thyroid cancer in a pediatric population. We retrospectively analyzed 112 children (80 girls and 32 boys, aged 0.6-18 years, with an average group age of 13.4 ± 4.5 years) with thyroid nodules who presented or were referred between 2010 and 2021. A total of 37 children qualified for partial or total thyroidectomy. After histopathological nodule examination, the most common cases were benign lesions in 23 patients (57.5%) and malignant lesions in 14 children (32.5%). Solitary benign thyroid nodules were found in 16 children (40%). Malignancy risk was higher in children with increased nodule diameter (greater than 7 mm; p = 0.018) or hypoechogenic lesions in ultrasound (p = 0.010), with no correlation between increased blood flow in the vessels and tumor diagnosis. The relative risk of developing thyroid cancer for class III was found to be higher in comparison to adults and 11.1 times higher than for classes I and II combined.

Ultrasound evaluation of long-term outcome in boys operated on due to testicular torsion.

ABSTRACT: We aimed at verifying the usefulness of spectral Doppler ultrasonography in determining development of the testis after torsion in boys.The study involved 28 patients and 30 control cases divided into 3 developmental groups: pre-pubertal, early pubertal, and pubertal. It presented surgical management in testicular torsion (TT), volume, and echogenicity of testes, as well as peak-systolic velocity (PSV), end-diastolic velocity (EDV), and vascular resistance index (RI) in the capsular and intra-testicular arteries, regarding developmental groups, detorsed testes, uninvolved ones, and testes in the control group.Orchiectomy was performed in 13 boys with complete TT, in 11 lasting for over 24 hours, and in 2 lasting for 9 and 10 hours, respectively. Orchiectomy mainly involved patients aged up to 6 years, who at the time of the follow-up ultrasound belonged to the pre-pubertal group.There is no clear correlation between the type of testicular torsion, its duration, and the echogenicity of the testis. Testicular torsion has a negative effect on the volume of detorsed testis with compensatory hypertrophy of the uninvolved testis. The study represents a new approach to the issue of long-term gonadal blood supply abnormalities after treatment of testicular torsion in childhood.

Testicular torsion: its effect on autoimmunisation, pituitary-testis axis and correlation with primary gonadal dysfunction in boys.

BACKGROUND: Torsion of the testis is an urgent surgical condition that endangers the viability of the gonad and the fertility of the patient. Our aim was to assess potential autoimmune processes and hormonal abnormalities in boys operated on due to that illness. METHODS: The authors evaluated the levels of antibodies against sperm and Leydig cells, concentrations of follicle-stimulating, luteinizing and anti-Müllerian hormone, testosterone, oestradiol and vascular endothelial growth factor in the serum in 28 boys operated on due to torsion of the testis. Patients' sexual maturity was assessed according the Tanner scale (group G1, G4 and G5). RESULTS: No antibodies against sperm or Leydig cells were found in the serum. Statistically significant differences in follicle-stimulating and anti-Müllerian hormone concentrations were observed in the G1, and they were higher in the study than in the control group. There were no statistically significant differences in luteinizing hormone, testosterone, oestradiol and vascular endothelial growth factor concentrations in the study group or control group. Testosterone concentration was unrelated to total testicular volume. CONCLUSIONS: Results did not confirm the autoimmune process in boys with torsion of the testis. The pituitary-testis axis seems to have sufficient compensation capabilities. However, study results suggest that primary gonadal dysfunction may predispose to torsion. IMPACT: Significant differences exist between the literature data and own results on the formation of antibodies and hormonal changes due to testicular torsion in boys. It is a novel, prospective study on antibodies against sperms and Leydig cells in the serum and on hormonal processes occurring as a result of the testicular torsion from the prenatal period to the adolescence with division into pubertal groups. The study has revealed sufficient compensation capabilities of the pituitary-testis axis and no autoimmune process in boys with torsion of the testis.

Testicular Sonographic Color Doppler Dynamic Tissue Perfusion Measurements in Adolescents with Varicocele.

AIM: The aim of the study was an assessment of the effects of varicocele on testis parenchyma and microcirculation with the use of the dynamic tissue perfusion measurements. METHODS: Color Doppler sonographic dynamic testis parenchyma perfusion measurements were performed with Pixel-Flux software in 30 children with left testis varicocele. The right testes without varicocele comprised the control group. RESULTS: Testicular parenchymal perfusion in testes with varicocele was reduced when compared to the control testes. The differences were found in all measured perfusion parameters. Statistical significance was found in the case of mean velocity and resistance index parameters. According to the grade of varicocele, the perfusion was the most reduced in patients with grade III of varicocele. CONCLUSION: Testicular parenchymal perfusion decreases in patients with varicocele, mostly in higher grades of varicocele. In case of validation, the method can be used in determining the damage of the testis with varicocele and the need for surgery.

Nuck Canal Hernias, Typical and Unusual Ultrasound Findings.

BACKGROUND: Inguinal hernia in girls is a very rare condition. The cause of this pathology is incomplete closure of the processus vaginalis of the peritoneum, in girls named the canal of Nuck. Failed obliteration of this canal could result in hernia or hydrocele. Also less frequent findings, such as uterus herniated to the canal, were observed. OBJECTIVE: The purpose of this study was to describe the possible findings in female inguinal hernias and its ultrasound appearance. METHODS: Thirty-five patients with surgically confirmed hernias of the canal of Nuck were identified at our institution between January 2007 and November 2015. All the patients underwent ultrasonography before surgery. RESULTS: In 14 cases, there was hydrocele of the canal of Nuck. In 9 cases, intestinal hernia was found. In 10 patients, the hernia content appeared as mass-containing cysts and was confirmed at surgery as ovary. In 1 patient, the ovary was herniated together with uterus. In 1 patient, atypical hypoechoic lesion was found, which turned out to be angiofibrolipoma. In all patients, ultrasound diagnosis was confirmed by surgery. CONCLUSIONS: Ultrasound examination performed with high-frequency transducer is an examination of choice in female patients with pathological mass in inguinal region.

The use of testicular prostheses in boys.

Lack of the testis is an important factor in psycho-sexual development of the boys, and implantation of the prosthesis plays a very essential role in the treatment of that group of patients. Currently there are no standards regarding when prosthesis should be implanted, and which access is connected with minimal rates of complications. We present our experience of primary prosthesis implantations in boys treated in our department.From 2000 to 2014, primary implantation of the testicular prosthesis was performed in 290 boys. The early and late post-operative complications and long-term therapeutic results were analyzed, considering age at the time of implantation, the time between the initial operation and implantation of the prosthesis, and the surgical approach.Best results were observed in 267 patients and bad outcome in 23 patients. Prosthesis implantation in young boys operated within the first three years of life or during the first year after primary surgery was connected with statistically fewer complications (P = .002 and P < .05, respectively). Supra-scrotal access was connected with the lowest rate of complications (P = .01).Long-term therapeutic results in boys with testicular prostheses were good in the majority of cases. Implantation of the first prosthesis should be performed early between 1 and 3 years of life in boys with lack of the testis. Implantation of a prosthesis should also be performed within 1 year after removing of testis or during orchiectomy. Supra-scrotal access should be chosen for testicular prosthesis implantation due to the best long-term results.

Treatment of impalpable testis - one clinic's experience.

INTRODUCTION: Undescended testes are recognised in 1% to 2% of boys during the first year of life, and about 20% of them are impalpable. Ultrasonography (US) may establish the localisation of the testis but the final diagnosis is usually determined laparoscopically. AIM: To evaluate long-term results of laparoscopic treatment of boys with impalpable testes and sensitivity of preoperative ultrasound. MATERIAL AND METHODS: Between 2011 and 2015, we operated on 545 boys with undescended testes. Sixty-two of them with 65 impalpable testes were treated laparoscopically - the study group. Mean age was 3.5 years. The study group was divided into 5 groups according to type of treatment. The volume and position of the operated gonad were assessed manually and by ultrasound. RESULTS: In group 1 testicular agenesis was observed in 19 patients. In group 2 revision of the inguinal canal revealed testicular agenesis in 7 and atrophy in 4 patients. In group 3 conversion to classic orchiopexy was performed in 10 patients. In group 4 one-stage orchiopexy was performed in 9 patients on 12 testes. In group 5 a two-stage F-S procedure was performed in 13 patients. Ten testes in group 4 had a volume in the normal range (84%) and also 10 testes in group 5 (77%). CONCLUSIONS: Laparoscopy in impalpable testes is the procedure of choice and allows definitive management, even when conversion to open procedure is necessary. Sensitivity of preoperative ultrasound is generally about 60% for true intra-abdominal testes, so diagnostic laparoscopy is necessary.

The role of ultrasound in the management of undescended testes before and after orchidopexy - an update.

The aim of this study was to evaluate the testicular volume and structure using ultrasound (US) before and up to 3 years after orchidopexy in children with different age.A total of 128 patients underwent orchidopexy for undescended testes. Afterwards, patients were invited for annual follow-up and control scrotal US. The total number of analyzed testes after orchidopexy was 184. Patients were divided according to age at the time of surgery: group I (2-4 years old), group II (5-7), and group III (8-10). In all patients, the testicular volume ratio was calculated as the operated testes volume versus the control testes mean volume.There was an increase in the median ratio in all age groups, from 0.86 to 0.95 in group I, 0.82 to 0.92 in group II and 0.78 to 0.90 in group III. In group of the patients 2 to 4 years old the growth of the ratio 3 years after surgery was statistically significant.Abnormalities in the structure of the testes, which may indicate severe damage to the testis, were seen in approximately 20% of patients on initial exams. On follow-up exams, this type of structure remained in 7% of patients. Testes with an initial ratio <0.25 and inhomogeneous structure did not show any significant growth.Scrotal US can be used for an accurate comparative assessment of the structure and growth of the testes before and after orchidopexy.Abnormalities in the structure of the testes may identify testes requiring more advanced methods of evaluation.

A new CO2 laser technique for the treatment of pediatric hypertrophic burn scars: An observational study.

Treatment of hypertrophic scars arising as a result of thermal burns in children is still a big problem. The results of the treatment are not satisfactory for patients and parents, and new methods of treatment are still investigated.We present the use of one of the most modern carbon dioxide (CO2) lasers (Lumenis Encore laser equipped with a Synergistic Coagulation and Ablation for Advanced Resurfacing module) in the treatment of hypertrophic scars in children after burns.From March to April of 2013, a group of 47 patients aged 6 to 16 years underwent 57 laser surgery treatments. The average time from accident was 7.5 years. The results of treatment were investigated in 114 areas. The assessed areas were divided into 2 groups: 9-cm area 1, where the thickness of the scar measured by physician was the lowest and 9-cm area 2, where the thickness of the scar was the biggest. The results were considered on the Vancouver Scar Scale (VSS) independently by the surgeon and by parents 1, 4, and 8 months after the procedure. In addition, ultrasound evaluation of the scar thickness before and after laser procedure was made.VSS total score improved in all areas assessed by both the physician and parents. The biggest change in total VSS score in area 1 in the evaluation of the investigator was obtained at follow-up after the 1st month of treatment (average 7.23 points before and 5.18 points after the 1st month after surgery-a difference of 2.05 points). Scar ratings by parents and the physician did not differ statistically (P < 0.05). In the ultrasound assessment, the improvement was statistically significant, more frequently for both minimum and maximum thickness of the scars (B-mode measures) (P < 0.05).The use of a CO2 laser in the treatment of hypertrophic scars in children is an effective and safe method. The use of a CO2 laser improves the appearance and morphology of scarring assessed using the VSS by both the parents and the physician. The treatment also reduced the thickness of scars evaluated by ultrasound.

Closure of the thoracic duct from the left-side access: A case report.

BACKGROUND: We report a 16-year-old patient with a massive left-sided chylothorax after chemotherapy due to mixed germinal tumor of the testis with massive metastases located in the retroperitoneal space and posterior mediastinum. Chemotherapy resolved the metastases in the mediastinum but evoked a huge pleural effusion in the left pleural cavity, requiring surgical intervention.Left-sided access was used. The 5-mm camera and 3 5-mm working ports were inserted. The parietal pleura was incised and the esophagus located and protected. Behind the esophagus, the thoracic duct and concomitant tissue were clipped with titanium clips, and additionally, thrombin glue was used. Stopping of the lymph leakage was observed during surgery. A local argon pleurodesis was used to finish the procedure. The thoracic tube was removed on the third postoperative day. CONCLUSION: Left-side access may be a good alternative in the left-sided chylothorax, but the crucial points are location and protection of the esophagus during the procedure, which is also the landmark that allows for locating the thoracic duct.

Color Doppler dynamic tissue perfusion measurement: a novel tool in the assessment of renal parenchymal perfusion in children with vesicoureteral reflux.

INTRODUCTION: Vesicoureteral reflux (VUR) occurs in 20-50% of children suffering from recurrent urinary tract infections (UTIs) and is associated with an increased risk of renal scarring and impaired renal function. Early detection of renal perfusion deterioration would allow for the implementation of more aggressive treatment and potentially prevent further damage to the renal parenchyma. The aim of the study was to assess renal parenchymal perfusions in children with recurrent UTIs with and without coexisting VUR, and compare the findings with the results of healthy patients. MATERIAL AND METHODS: Color Doppler sonographic dynamic renal parenchymal perfusion measurements were performed with PixelFlux (Chameleon-Software, Germany) software in 77 children with recurrent UTIs and coexisting VUR and in 30 children with UTIs without VUR. The findings were compared with the results of 53 healthy children. RESULTS: Cortical parenchymal perfusion of children suffering from UTIs and VUR was significantly reduced when compared to the control group. Statistically significant differences (p < 0.05) were found in all perfusion parameters (i.e. mean velocity (v mix ), mean perfused area (A mix ), mean perfusion intensity (I mix ), tissue pulsatility index (TPI), and tissue resistance index (TRI)) between the control group and children suffering from UTIs and VUR, particularly VUR grades III and IV. There were no significant differences between the UTI group and the control group. No differences were found between the controls and VUR grade II. CONCLUSIONS: Renal parenchymal perfusion decreases significantly with higher grades of VUR.

Two-dimensional (2D), three-dimensional static (3D) and real-time (4D) contrast enhanced voiding urosonography (ceVUS) versus voiding cystourethrography (VCUG) in children with vesicoureteral reflux.

BACKGROUND: Two-dimensional (2DUS) contrast enhanced voiding urosonography has been used in the diagnosis and treatment monitoring of the vesicoureteral reflux in children for over 15 years. The opportunity of performing this examination with the use of three-dimensional static (3DUS) and real-time (4DUS) techniques opens up new diagnostic horizons. OBJECTIVE: To analyze if 3DUS/4DUS bring additional information leading to an increased detection rate or change in the grading of reflux compared to 2DUS and voiding cystouretrography. MATERIAL AND METHODS: We evaluated 69 patients (mean 4.1 years) who underwent 2DUS/3DUS/4DUS contrast enhanced voiding urosonography (ceVUS) and voiding cystourethrography (VCUG) for the diagnosis and grading of vesicoureteral reflux. RESULTS: 2DUS and 3DUS/4DUS urosonography diagnosed 10 more refluxes (7.25%) than cystourethrography and in 3 refluxes (2.17%) detected a higher grade. In 9 refluxes (6.52%) 3DUS/4DUS urosonography and cystourethrography diagnosed a higher grade than 2DUS. There was a statistically significant difference between cystourethrography and 3DUS/4DUS urosonography when the number of detected refluxes and differences in grading were compared. 4DUS enabled a better visualization of reflux than 3DUS. CONCLUSIONS: 3DUS/4DUS techniques bring additional information leading to a change in reflux grading compared to 2DUS and a detect higher number of refluxes compared to cystourethrography.

Esophageal Duplication Cyst Treated Thoracoscopically During the Neonatal Period: Clinical Case Report.

Esophageal duplication cysts (EDCs) are rare developmental anomalies. They may occur anywhere along the esophagus with the predominant location in the thoracic segment. Presently, most are diagnosed prenatally or in early childhood. The prevalence of EDCs is estimated at 1 in 8200 live births. Usually, cysts are asymptomatic in the neonatal period, but they may cause respiratory distress or feeding difficulties depending on the size and location of the lesion.This report presents a female neonate with a cyst located in the right pleural cavity recognized prenatally. Computed tomography confirmed the diagnosis and revealed a round cystic mass in proximity to the left lung base. Thoracoscopic cyst excision was undertaken on day 15 after delivery. The postoperative period was uneventful. Histological cyst examination confirmed the diagnosis of foregut duplication.This case underlines the importance of early diagnosis and treatment of EDC, before symptoms and complications arise, and confirms that surgery in the neonatal period is safe and effective.

Rectal duplication with sciatic hernia.

Rectal duplications represent 5% of all duplications in the alimentary tract, and they are very rarely diagnosed during the neonatal period. The authors present the method of investigation and the results of surgical treatment of a full-term neonate with a sciatic hernia containing a rectal duplication. The procedure started with three-port laparoscopy, but excision of the tubular duplication of the rectum was possible only by a transanal endorectal pull-through approach. The sciatic hernia was closed, and plastic sutures on the buttock finished the procedure. The coincidence of sciatic hernia with rectal duplication is extremely rare, and the method of treatment depends exclusively on the anatomical conditions.

Central Pancreatectomy as a Good Solution in Frantz Tumor Resection: A Case Report.

Solid pseudopapillary tumors of the pancreas located in the head or body are a challenging clinical problem because they usually demand extensive surgical procedures, and in most reported cases pancreaticoduodenectomy is the operation of choice in such a location. An alternative method of surgery in precisely selected patients is a procedure known as central pancreatectomy. The authors present the case of a 13-year-old girl with a 5 cm tumor located in the body of the pancreas. The favorable anatomical location of the tumor suggested central pancreatic resection. The tumor was excised with 1 cm oncologic margins from both sides, and the distal remnant of the pancreas was protected with a Roux-en-Y loop. In the postoperative period the patient required reoperation because of intensive bleeding in the resection site but the duodenal loop was saved and the patient protected from biliary tract reconstruction and exocrine and endocrine insufficiency. Progress in pancreatic surgery, especially in children, allows less radical options for the reason that preservation of endocrine and exocrine function is very important and protects them, especially from insulin-dependent diabetes in the future.

Thoracoscopic repair of esophageal atresia with a distal fistula - lessons from the first 10 operations.

INTRODUCTION: Thoracoscopic esophageal atresia (EA) repair was first performed in 1999, but still the technique is treated as one of the most complex pediatric surgical procedures. AIM: The study presents a single-center experience and learning curve of thoracoscopic repair of esophageal atresia and tracheo-esophageal (distal) fistula. MATERIAL AND METHODS: From 2012 to 2014, 10 consecutive patients with esophageal atresia and tracheo-esophageal fistula were treated thoracoscopically in our center. There were 8 girls and 2 boys. Mean gestational age was 36.5 weeks and mean weight was 2230 g. Four children had associated anomalies. The surgery was performed after stabilization of the patient between the first and fourth day after birth. Five patients required intubation before surgery for respiratory distress. Bronchoscopy was not performed before the operation. RESULTS: In 8 patients, the endoscopic approach was successfully used thoracoscopically, while in 2 patients conversion to an open thoracotomy was necessary. In all patients except 1, the anastomosis was patent, with no evidence of leak. One patient demonstrated a leak, which did not resolve spontaneously, necessitating surgical repair. In long-term follow-up, 1 patient required esophageal dilatation of the anastomosis. All patients are on full oral feeding. CONCLUSIONS: The endoscopic approach is the method of choice for the treatment of esophageal atresia in our center because of excellent visualization and precise atraumatic preparation even in neonates below a weight of 2000 g.

Intraoperative contrast-enhanced urosonography during endoscopic treatment of vesicoureteral reflux in children.

BACKGROUND: There are many controversies surrounding the effectiveness of endoscopic treatment of vesicouretheral reflux (VUR) in children, thus it is of highest priority to analyze factors influencing the outcome of therapy and to search for new methods that would increase the success rate and reduce the number of reinjections. OBJECTIVE: The aim of the study was to analyze whether intraoperative contrast-enhanced urosonography (ce-US) may increase the effectiveness of endoscopic anti-reflux therapy. MATERIALS AND METHODS: Intraoperative contrast-enhanced urosonography (ce-US) with SonoVue® was performed in 17 patients (25 ureteral units) undergoing endoscopic treatment of VUR. Ce-US was performed in the operating room before the procedure and after injection of the bulking material. When VUR persisted, the operator repeated the injection, which was followed by ce-US. The results were compared with those obtained from a control group (15 patients; 22 ureteral units). RESULTS: A repeat injection during a single endoscopic treatment was required in 24% of cases. The overall success rate confirmed at 6-12 months' follow-ups was 84%. The success rate was significantly higher in comparison to the control group (success: 64%). CONCLUSION: Intraoperative ce-US performed during endoscopic treatment of VUR enables immediate monitoring of outcome and provides the opportunity for repeat injection during the same procedure, thus increasing the efficacy of the procedure and reducing the number of reinjections.

Inflammatory myofibroblastic tumour in a 5-year-old child - a case report and review of the literature.

Inflammatory myofibroblastic tumour is an uncommon tumour of intermediate malignant potential. Its aetiology is still unclear. It occurs predominantly in children and young adults. This report presents a case of pulmonary inflammatory myofibroblastic tumour in a 5-year-old girl. The patient had a history of recurrent respiratory tract infections. A chest radiograph and computed tomography chest scan showed a round mass in the lower lobe of her left lung. Thoracoscopic marginal excision of the tumour with an Endo-GIA stapler device (TYCO healthcare) was performed. Histological examination confirmed the final diagnosis of inflammatory myofibroblastic tumour. Postoperative recovery was uncomplicated and the patient was discharged 6 days after surgery. Round masses located in the lungs are very rare in children and the possibility of myofibroblastic tumour as well as metastatic lesions should be taken into consideration in such cases. Thoracoscopic excision is the best option in distally located lesions.

2D/3D/4D contrast-enhanced voiding urosonography in the diagnosis and monitoring of treatment of vesicoureteral reflux in children - can it replace voiding cystourethrography?

INTRODUCTION: Vesicoureteral reflux appears in 20-50% of pediatric patients with recurrent urinary tract infections. The most common method of diagnosing this disease is voiding cystourethrography. However, contemporary pediatric radiology does not favor this method due to exposure to X-radiation. AIM: The aim of this study was to assess the usefulness of 2D/3D/4D contrast-enhanced voiding urosonography in the diagnosis and treatment monitoring of vesicoureteral reflux in children and the possibility of using contrast-enhanced voiding urosonography to replace voiding cystourethrography. MATERIAL AND METHODS: Voiding cystourethrography and contrast-enhanced voiding urosonography were conducted in 80 pediatric patients in order to assess sensitivity, specificity, positive and negative predictive values as well as the number of vesicoureteral refluxes detected by each of the two methods. The second stage of the study involved performing voiding urosonography in an extended protocol in 58 children in order to determine the usefulness of three-dimensional (3D/4D) examinations in the assessment of vesicoureteral reflux and the ability to assess the urethra. RESULTS: The concordance between the two methods was 86.95%. The sensitivity of voiding urosonography was 84.51%, specificity - 90.99%, positive predictive value - 85.71% and negative predictive value - 90.17%. A 3D/4D assessment of the urinary bladder and transperineal 2D morphological assessment of the urethra were possible in all patients (100%). Assessment of the urethra during micturition with the use of 2D/3D/4D techniques was possible in all patients in whom voiding was elicited (95.83%), and 3D/4D assessment of vesicoureteral reflux was possible in all patients with reflux (100%). Although the application of 3D/4D techniques allowed accurate specification of the grade of reflux in all cases (100%), it appeared particularly useful in differentiating between grades II and III (70.97%). CONCLUSIONS: Contrast-enhanced voiding urosonography allows the diagnosis and monitoring of treatment of vesicoureteral reflux in pediatric patients as well as assessment of the urethra in both girls and boys. The method is characterized by high sensitivity and specificity. Moreover, it is safe, relatively inexpensive and can replace voiding cystourethrography.

Non-resectable hepatic tumors in children - role of liver transplantation.

BACKGROUND: There is a group of children with primary hepatic tumors which can not be resected by conventional partial liver resection. Total hepatectomy followed by liver transplantation may be the only solution in such cases. Authors reviewed own experience with the liver transplantation for unresectable tumors in children and assessed the possible indications and role of transplantation in these patients. MATERIAL AND METHODS: Liver transplantation was performed in 17 children with unresectable hepatic tumors out of total number of 350 children transplanted. Hepatocarcinoma was present in 8 children, hepatoblastoma in 6 and benign giant hemangioma in 3. There was no other option for the treatment which would lead to the oncological cure of children with malignant tumors. All patients with giant hemangiomas were infants transplanted urgently due to circulatory and then multiorgan failure. RESULTS: Survival within whole group is 75.5% (13 of 17 pts), 3 children died of malignant tumor recurrence, one of other causes. All 3 children with benign tumors are alive and well. Actual follow-up is from 3 months to 7 years. CONCLUSIONS: Liver transplantation should be considered as option in the treatment of all children with unresectable hepatic tumors. With the careful and individual patient selection significant chances for survival can be achieved in this group of patients which would otherwise not survive with the conventional treatment.