17.4Clinical Manifestations

•Expansive palpable mass in the upper abdomen or generalized enlargement of the abdomen

•Weight loss

•Anorexia

•Vomiting

•Abdominal pain

•Pallor

•Jaundice and ascites

•Occasionally precocious puberty in hepatocellular carcinoma

•Metastatic pattern: Commonly in lungs; rarely in bone, brain, and bone marrow

17.5Laboratory Diagnosis

•Serum a-fetoprotein levels elevated in 70% of children with hepatoblastoma, in 40% with hepatocellular carcinoma; human serum b-chorionic gonadotropin (b-HCG) levels can be high in both; both parameters are markers of diagnosis, therapeutic response, and follow-up

•Level of bilirubin increased in about 15% of children with hepatoblastoma and in about 25% of children with hepatocellular carcinoma

•Often anemia, occasionally thrombocytopenia, or more commonly thrombocytosis are observed

17.6Radiological Diagnosis

•Ultrasound and X-ray of abdomen: Enlarged liver with displacement of stomach and colon, elevated diaphragm on the right side; occasionally calcification within the tumor mass is observed

•CT scan and MRI useful for determination of extension and involvement of adherent organs

•Liver scintigraphy: Useful to obtain additional information about localization of tumor, postoperative regeneration of liver, and relapse

17.7Differential Diagnosis of Hepatoblastoma and Hepatocellular Carcinoma

•Hemangioendothelioma

•Adenoma

•Cavernous hemangioma