Pediatric liver tumors: clinical manifestations of various liver tumors and the challenging treatment of hepatoblastoma

Abstract

Hepatoblastoma is a representative pediatric liver tumor, but other tumors are encountered in daily clinical practice. Hepatoblastoma itself is rare in Japan with only 40–60 cases per year, but it is even rarer to encounter other tumors. In addition to hepatoblastoma and hepatocellular carcinoma, hepatocellular neoplasm, not other specified (HCN-NOS) have recently become hot topics in older children. Other liver malignant tumors include hepatic undifferentiated fetal sarcoma and malignant rhabdoid tumors. Benign tumors include FNH, mesenchymal hamartoma, and hemangioma. Among liver tumors, especially hepatoblastoma, surgical resection has been considered the most important. In recent years, the widespread adoption of liver transplantation has made it possible to completely resect the tumor even in cases that were previously considered inoperable. However, in liver transplantation, liver resection remains the first choice owing to problems such as the use of immunosuppressants and invasiveness to healthy donors. It may be possible to resect PRETEXT IV cases and tumors close to blood vessels with some ingenuity. In addition, the importance of total resection is the same for metastatic lesions. For the lung, which is a typical metastasis destination, it is possible to remove even minute metastatic lesions by the ICG fluorescence method.