Hepatoblastoma: Difference between revisions

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'''For patient information, click [[Hepatoblastoma (patient information)|here]]'''
'''For patient information, click [[Hepatoblastoma (patient information)|here]]'''
{{Hepatoblastoma}}
{{Hepatoblastoma}}
{{CMG}}; {{AE}} {{Nnasiri}} {{NM}}
{{CMG}}; {{AE}} {{Nnasiri}}  


{{SK}} Epithelial hepatoblastoma; Fetal hepatoblastoma; Embryonal hepatoblatoma; Macrotrabecular hepatoblastoma; Mixed hepatoblastoma; Rhabdoid hepatoblastoma; Small cell hepatoblastoma; Undifferentiated hepatoblastoma; Cholangioblastic hepatoblastoma; Teratoid hepatoblastoma; Chondroid hepatoblastoma; Osteoid hepatoblastoma; Rhabdomyoblastic hepatoblastoma; Neuroid-melanocytic hepatoblastoma; Well differentiated hepatoblastoma; HB
{{SK}} Epithelial hepatoblastoma; Fetal hepatoblastoma; Embryonal hepatoblatoma; Macrotrabecular hepatoblastoma; Mixed hepatoblastoma; Rhabdoid hepatoblastoma; Small cell hepatoblastoma; Undifferentiated hepatoblastoma; Cholangioblastic hepatoblastoma; Teratoid hepatoblastoma; Chondroid hepatoblastoma; Osteoid hepatoblastoma; Rhabdomyoblastic hepatoblastoma; Neuroid-melanocytic hepatoblastoma; Well differentiated hepatoblastoma; HB


==Overview==
==Overview==
'''Hepatoblastoma''' is the most common primary [[liver tumor]] occurs in infant and children, usually less than 3 years old, more frequently in [[male]], and accounting for over 1% of pediatric [[cancers]]. The [[etiology]] is unknown and not well understood, but it has been associated with [[Beckwith-Weidemann Syndrome|Beckwith-Weidemann]] syndrome, [[familial adenomatous polyposis]], and other factors such as [[low birth weight]], [[preeclampsia]], [[hemihypertrophy]]. The primary treatment is [[surgical]] resection, however, [[chemotherapy]] plays an important role by increasing the number of [[tumors]] that are respectable, [[chemotherapeutic agents]] helps in shrinkage of the [[tumor]] and make it easier to be resected by [[surgery]]. [[Prognosis]] of the [[tumor]] depends on various criteria such as resectability of the [[tumor]], distant [[metastasis]], tumor size, PRETEXT [[Staging (pathology)|staging]], and recurrence of the [[tumor]]. The mainstay of treatment is [[surgery]], but the [[adjuvant]] [[Chemotherapeutic agent|chemotherapeutic]] agents and [[liver transplantation]] also are helpful.


==Historical Perspective==
==Historical Perspective==
[Disease name] was first discovered by [name of scientist], a [nationality + occupation], in [year]/during/following [event].
In 1898, the first case of hepatoblastoma was published in English literature, the [[tumor]] was diagnosed in a 6-week old boy in Prague, by a physician named Misick, who found a large tumor on the [[autopsy]] of his [[liver]]. Decades later on 1962 Willis used the term, hepatoblastoma for this type of [[liver]] [[tumor]] because of it's [[Embryo|embryonal]] origin <ref name="pmid25336801">{{cite journal |vauthors=Aronson DC, Czauderna P, Maibach R, Perilongo G, Morland B |title=The treatment of hepatoblastoma: Its evolution and the current status as per the SIOPEL trials |journal=J Indian Assoc Pediatr Surg |volume=19 |issue=4 |pages=201–7 |date=October 2014 |pmid=25336801 |pmc=4204244 |doi=10.4103/0971-9261.142001 |url=}}</ref>
 
The association between [important risk factor/cause] and [disease name] was made in/during [year/event].
 
In [year], [scientist] was the first to discover the association between [risk factor] and the development of [disease name].
 
In [year], [gene] mutations were first implicated in the pathogenesis of [disease name].
 
There have been several outbreaks of [disease name], including -----.
 
In [year], [diagnostic test/therapy] was developed by [scientist] to treat/diagnose [disease name].


==Classification==
==Classification==
There is no established system for the classification of [disease name].
*Hepatoblastoma are divided into two broad categories:<ref name="pmid12228903">{{cite journal |vauthors=Rowland JM |title=Hepatoblastoma: assessment of criteria for histologic classification |journal=Med. Pediatr. Oncol. |volume=39 |issue=5 |pages=478–83 |date=November 2002 |pmid=12228903 |doi=10.1002/mpo.10171 |url=}}</ref><ref name="pmid24322718">{{cite journal |vauthors=Czauderna P, Lopez-Terrada D, Hiyama E, Häberle B, Malogolowkin MH, Meyers RL |title=Hepatoblastoma state of the art: pathology, genetics, risk stratification, and chemotherapy |journal=Curr. Opin. Pediatr. |volume=26 |issue=1 |pages=19–28 |date=February 2014 |pmid=24322718 |doi=10.1097/MOP.0000000000000046 |url=}}</ref>
 
**[[Epithelial]] type (E-HB)
OR
***[[Fetal]], which has four subtypes:
 
****Well differentiated
[Disease name] may be classified according to [classification method] into [number] subtypes/groups: [group1], [group2], [group3], and [group4].
****Crowded or [[mitotic]]<nowiki/>ally active
 
****[[Pleomorphic]]
OR
****Poorly differentiated
 
****[[Anaplastic]]
[Disease name] may be classified into [large number > 6] subtypes based on [classification method 1], [classification method 2], and [classification method 3].
***[[Embryo]]<nowiki/>nal
[Disease name] may be classified into several subtypes based on [classification method 1], [classification method 2], and [classification method 3].
***Macrotubular small cell [[undifferentiated]] (SCU)
 
***Cholangioblastic
OR
**Mixed [[epithelial]] and [[mesenchymal]] type (MEM-HB). The mixed type is subdivided into:
 
***[[Stromal]] derivatives 
Based on the duration of symptoms, [disease name] may be classified as either acute or chronic.
***[[Teratoma|Teratoid]] variants
 
OR
 
If the staging system involves specific and characteristic findings and features:
According to the [staging system + reference], there are [number] stages of [malignancy name] based on the [finding1], [finding2], and [finding3]. Each stage is assigned a [letter/number1] and a [letter/number2] that designate the [feature1] and [feature2].
 
OR
 
The staging of [malignancy name] is based on the [staging system].
 
OR
 
There is no established system for the staging of [malignancy name].


==Pathophysiology==
==Pathophysiology==
*The exact pathogenesis of hepatoblastoma is not fully understood. Loss of function mutations in APC leads to intracellular accumulation of the protooncogene b-catenin, an effector of Wnt signal transduction.
*The exact [[pathogenesis]] of hepatoblastoma is not fully understood. <ref name="pmid19619488">{{cite journal |vauthors=MacDonald BT, Tamai K, He X |title=Wnt/beta-catenin signaling: components, mechanisms, and diseases |journal=Dev. Cell |volume=17 |issue=1 |pages=9–26 |date=July 2009 |pmid=19619488 |pmc=2861485 |doi=10.1016/j.devcel.2009.06.016 |url=}}</ref>
*Hepatoblastomas originate from primitive hepatic stem cells.
*Loss of function [[mutations]] in [[APC]] leads to [[intracellular]] accumulation of the [[protooncogene]] [[beta-catenin]], which leads to [[germline]] [[mutation]] of [[Wnt signalling pathway|Wnt signal]] [[transduction]] and pathway.
*B-catenin mutations have been shown to be common in the majority of sporadic hepatoblastomas.
*Hepatoblastomas originate from primitive [[hepatic]] [[stem cells]].
 
*[[Beta-catenin|B-catenin]] [[mutations]] have been shown to be common in the majority of [[sporadic]] hepatoblastomas.
 
*Studies revealed that [[tumor]] occurs more often in families affected by [[familial adenomatous polyposis]]([[FAP]]), which is caused by inactivation of the [[adenomatous polyposis coli]] ([[APC]]), a [[tumor-suppressor gene]] that [[down-regulate]] the amount of [[beta-catenin]].
*[[Immunohistochemical]] markers such as expression of CK19, [[beta-catenin]] and EpCAM were correlated with [[tumor]] behaviour, response to [[chemotherapy]] and survival.<ref name="pmid29755772">{{cite journal |vauthors=Kiruthiga KG, Ramakrishna B, Saha S, Sen S |title=Histological and immunohistochemical study of hepatoblastoma: correlation with tumour behaviour and survival |journal=J Gastrointest Oncol |volume=9 |issue=2 |pages=326–337 |date=April 2018 |pmid=29755772 |pmc=5934143 |doi=10.21037/jgo.2018.01.08 |url=}}</ref>


[[File:Hepatoblastoma.jpg|150px|thumb|left|Hepatoblastoma H&E[https://commons.wikimedia.org/wiki source:wikipedia]]]<br style="clear:left" />
[[File:Hepatoblastoma.jpg|150px|thumb|left|Hepatoblastoma H&E[https://commons.wikimedia.org/wiki source:wikipedia]]]<br style="clear:left" />


==Causes==
==Causes==
*Underlying causes of hepatoblastoma poorly understood and most tumors are sporadic but there are some risk factors and conditions that have a strong association with this tumor such as:<ref name="pmid23558166">{{cite journal |vauthors=Heck JE, Meyers TJ, Lombardi C, Park AS, Cockburn M, Reynolds P, Ritz B |title=Case-control study of birth characteristics and the risk of hepatoblastoma |journal=Cancer Epidemiol |volume=37 |issue=4 |pages=390–5 |date=August 2013 |pmid=23558166 |pmc=3679264 |doi=10.1016/j.canep.2013.03.004 |url=}}</ref><ref name="pmid17425379">{{cite journal |vauthors=Finegold MJ, Lopez-Terrada DH, Bowen J, Washington MK, Qualman SJ |title=Protocol for the examination of specimens from pediatric patients with hepatoblastoma |journal=Arch. Pathol. Lab. Med. |volume=131 |issue=4 |pages=520–9 |date=April 2007 |pmid=17425379 |doi=10.1043/1543-2165(2007)131[520:PFTEOS]2.0.CO;2 |url=}}</ref><ref name="pmid30270492">{{cite journal |vauthors=Mussa A, Duffy KA, Carli D, Ferrero GB, Kalish JM |title=Defining an optimal time window to screen for hepatoblastoma in children with Beckwith-Wiedemann syndrome |journal=Pediatr Blood Cancer |volume=66 |issue=1 |pages=e27492 |date=January 2019 |pmid=30270492 |doi=10.1002/pbc.27492 |url=}}</ref>
*Underlying causes of hepatoblastoma poorly understood and most tumors are sporadic but there are some [[risk factors]] and conditions that have a strong association with this [[tumor]] such as:<ref name="pmid23558166">{{cite journal |vauthors=Heck JE, Meyers TJ, Lombardi C, Park AS, Cockburn M, Reynolds P, Ritz B |title=Case-control study of birth characteristics and the risk of hepatoblastoma |journal=Cancer Epidemiol |volume=37 |issue=4 |pages=390–5 |date=August 2013 |pmid=23558166 |pmc=3679264 |doi=10.1016/j.canep.2013.03.004 |url=}}</ref><ref name="pmid17425379">{{cite journal |vauthors=Finegold MJ, Lopez-Terrada DH, Bowen J, Washington MK, Qualman SJ |title=Protocol for the examination of specimens from pediatric patients with hepatoblastoma |journal=Arch. Pathol. Lab. Med. |volume=131 |issue=4 |pages=520–9 |date=April 2007 |pmid=17425379 |doi=10.1043/1543-2165(2007)131[520:PFTEOS]2.0.CO;2 |url=}}</ref><ref name="pmid30270492">{{cite journal |vauthors=Mussa A, Duffy KA, Carli D, Ferrero GB, Kalish JM |title=Defining an optimal time window to screen for hepatoblastoma in children with Beckwith-Wiedemann syndrome |journal=Pediatr Blood Cancer |volume=66 |issue=1 |pages=e27492 |date=January 2019 |pmid=30270492 |doi=10.1002/pbc.27492 |url=}}</ref>
**Beckwith-Weidemann,
**[[Beckwith-Weidemann Syndrome|Beckwith-Weidemann syndrome]]
**Familial adenomatous polyposis (FAP)  
**[[Familial adenomatous polyposis]] (FAP)  
**Down syndrome
**[[Down syndrome]]
**Edward syndrome (trisomy 18)  
**[[Edward's syndrome|Edward syndrome]] ([[trisomy 18]])  
**Nephroblastoma,  
**[[Nephroblastoma]],  
**Low birth weight infants are at higher risk of developing a hepatoblastoma  
**[[Low birth weight]] infants are at higher risk of developing a hepatoblastoma  
**Preeclampsia   
**[[Preeclampsia]]  
**Parental tobacco smoking
**Parental [[tobacco]] [[smoking]]
**Oxygen therapy  
**[[Oxygen therapy]]
**Certain medication (furosemide)  
**Certain medication ([[furosemide]])  
**Radiation  
**[[Radiation]]
**Total parenteral nutrition (TPN)
**[[Total parenteral nutrition]] ([[TPN]])


*The most common genetic mutation which plays role in etiology of sporadic cases include:<ref name="pmid17962810">{{cite journal |vauthors=Curia MC, Zuckermann M, De Lellis L, Catalano T, Lattanzio R, Aceto G, Veschi S, Cama A, Otte JB, Piantelli M, Mariani-Costantini R, Cetta F, Battista P |title=Sporadic childhood hepatoblastomas show activation of beta-catenin, mismatch repair defects and p53 mutations |journal=Mod. Pathol. |volume=21 |issue=1 |pages=7–14 |date=January 2008 |pmid=17962810 |doi=10.1038/modpathol.3800977 |url=}}</ref>
*The most common [[genetic]] [[mutation]] which plays role in [[etiology]] of sporadic cases include:<ref name="pmid17962810">{{cite journal |vauthors=Curia MC, Zuckermann M, De Lellis L, Catalano T, Lattanzio R, Aceto G, Veschi S, Cama A, Otte JB, Piantelli M, Mariani-Costantini R, Cetta F, Battista P |title=Sporadic childhood hepatoblastomas show activation of beta-catenin, mismatch repair defects and p53 mutations |journal=Mod. Pathol. |volume=21 |issue=1 |pages=7–14 |date=January 2008 |pmid=17962810 |doi=10.1038/modpathol.3800977 |url=}}</ref>
**The Wnt signaling pathway which results in the accumulation of beta-catenin
**The [[Wnt signaling pathway]] which results in the accumulation of [[beta-catenin]].


==Differentiating hepatoblastoma from Other Diseases==
==Differentiating hepatoblastoma from Other Diseases==
*Hepatoblastoma must be differentiated from other diseases that cause rapidly enlarging abdominal mass in pediatrics such as:<ref name="pmid26835349">{{cite journal |vauthors=Hiyama E |title=Pediatric hepatoblastoma: diagnosis and treatment |journal=Transl Pediatr |volume=3 |issue=4 |pages=293–9 |date=October 2014 |pmid=26835349 |pmc=4728840 |doi=10.3978/j.issn.2224-4336.2014.09.01 |url=}}</ref>
*Hepatoblastoma must be differentiated from other diseases that cause rapidly enlarging abdominal mass in pediatrics such as:<ref name="pmid26835349">{{cite journal |vauthors=Hiyama E |title=Pediatric hepatoblastoma: diagnosis and treatment |journal=Transl Pediatr |volume=3 |issue=4 |pages=293–9 |date=October 2014 |pmid=26835349 |pmc=4728840 |doi=10.3978/j.issn.2224-4336.2014.09.01 |url=}}</ref>
**Hepatocellular carcinoma (HCC),
**[[Hepatocellular carcinoma]] ([[HCC]]) of liver
**Focal nodular hyperplasia  
**[[Focal]] [[nodular]] [[hyperplasia]] of liver
**Hepatic adenoma  
**[[Hepatic adenoma]] of liver
**Lymphoma, and metastases
**[[Lymphoma]], and [[metastases]] to liver


==Epidemiology and Demographics==
==Epidemiology and Demographics==
The incidence/prevalence of [disease name] is approximately [number range] per 100,000 individuals worldwide.
*Hepatoblastoma is the most common primary liver [[cancer]] in infants and children, [[tumor]] involves right lobe of [[liver]] more often.<ref name="pmid12939582">{{cite journal |vauthors=Darbari A, Sabin KM, Shapiro CN, Schwarz KB |title=Epidemiology of primary hepatic malignancies in U.S. children |journal=Hepatology |volume=38 |issue=3 |pages=560–6 |date=September 2003 |pmid=12939582 |doi=10.1053/jhep.2003.50375 |url=}}</ref>
*The incidence/[[prevalence]] of hepatoblastoma is approximately 0.05–0.15 patients per 100000 population in children younger than 15 years.<ref name="pmid23600968">{{cite journal |vauthors=Allan BJ, Parikh PP, Diaz S, Perez EA, Neville HL, Sola JE |title=Predictors of survival and incidence of hepatoblastoma in the paediatric population |journal=HPB (Oxford) |volume=15 |issue=10 |pages=741–6 |date=October 2013 |pmid=23600968 |pmc=3791112 |doi=10.1111/hpb.12112 |url=}}</ref>
*Peak [[incidence]] means of 18 months, mostly in [[infants]] and children younger than 3 years old, with a male predilection.
*Hepatoblastoma accounts for one percent of all primary [[malignancies]] in [[pediatrics]].


==Risk Factors==
==Risk Factors==


*Common risk factors in the development of hepatoblastoma include:<ref name="pmid23558166">{{cite journal |vauthors=Heck JE, Meyers TJ, Lombardi C, Park AS, Cockburn M, Reynolds P, Ritz B |title=Case-control study of birth characteristics and the risk of hepatoblastoma |journal=Cancer Epidemiol |volume=37 |issue=4 |pages=390–5 |date=August 2013 |pmid=23558166 |pmc=3679264 |doi=10.1016/j.canep.2013.03.004 |url=}}</ref>
*Common risk factors in the development of hepatoblastoma include:<ref name="pmid23558166">{{cite journal |vauthors=Heck JE, Meyers TJ, Lombardi C, Park AS, Cockburn M, Reynolds P, Ritz B |title=Case-control study of birth characteristics and the risk of hepatoblastoma |journal=Cancer Epidemiol |volume=37 |issue=4 |pages=390–5 |date=August 2013 |pmid=23558166 |pmc=3679264 |doi=10.1016/j.canep.2013.03.004 |url=}}</ref>
**Low birth weight infants
**[[Low birth weight]] infants
**Preeclampsia  
**[[Preeclampsia]]
**Fetal distress
**[[Fetal distress]]
**Premature labor
**[[Premature labor]]
**Chromosomal anomalies such as Down syndrome, Edward syndrome.
**[[Chromosomal anomalies]] such as [[Down syndrome]], [[Edwards syndrome]].
**Parental tobacco smoking before and during pregnancy
**Parental [[tobacco]] [[smoking]] before and during [[pregnancy]]
**Oxygen therapy,
**[[Oxygen therapy]]
**Certain medication (furosemide)   
**Certain medication ([[furosemide]])   
**Total parenteral nutrition (TPN)
**[[Total parenteral nutrition]] ([[TPN]])


==Screening==
==Screening==
There is insufficient evidence to recommend routine screening for [disease/malignancy].
*There is no screening method for detecting hepatoblastoma.
 
*[[Ultrasound]] is the main tool for suspected [[hepatic]] lesions in children.<ref name="pmid27526937">{{cite journal |vauthors=Shelmerdine SC, Roebuck DJ, Towbin AJ, McHugh K |title=MRI of paediatric liver tumours: How we review and report |journal=Cancer Imaging |volume=16 |issue=1 |pages=21 |date=August 2016 |pmid=27526937 |pmc=4986178 |doi=10.1186/s40644-016-0083-3 |url=}}</ref>
OR
*Serum [[alpha-fetoprotein]] ([[AFP]]) is the most important [[clinical]] marker of hepatoblastoma and helps to estimate [[malignant]] change, response to the treatment, and [[relapse]]. <ref name="pmid26835349">{{cite journal |vauthors=Hiyama E |title=Pediatric hepatoblastoma: diagnosis and treatment |journal=Transl Pediatr |volume=3 |issue=4 |pages=293–9 |date=October 2014 |pmid=26835349 |pmc=4728840 |doi=10.3978/j.issn.2224-4336.2014.09.01 |url=}}</ref>
 
According to the [guideline name], screening for [disease name] is not recommended.
 
OR
 
According to the [guideline name], screening for [disease name] by [test 1] is recommended every [duration] among patients with [condition 1], [condition 2], and [condition 3].


==Natural History, Complications, and Prognosis==
==Natural History, Complications, and Prognosis==
If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
*Prognosis is based on different factors including:<ref name="pmid30521216">{{cite journal |vauthors=Musick SR, Babiker HM |title= |journal= |volume= |issue= |pages= |date= |pmid=30521216 |doi= |url=}}</ref><ref name="pmid29755772">{{cite journal |vauthors=Kiruthiga KG, Ramakrishna B, Saha S, Sen S |title=Histological and immunohistochemical study of hepatoblastoma: correlation with tumour behaviour and survival |journal=J Gastrointest Oncol |volume=9 |issue=2 |pages=326–337 |date=April 2018 |pmid=29755772 |pmc=5934143 |doi=10.21037/jgo.2018.01.08 |url=}}</ref>
 
**Age of diagnosis, younger children have a better prognosis.
OR
**[[Metastases]],  
 
**[[Alpha-fetoprotein]] ([[AFP]]) levels, drop in [[Alpha-fetoprotein|AFP]] level after [[chemotherapy]] means better response to treatment.
Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].
**[[Histologic]] subtype, the well-differentiated [[fetal]] subtype has a better [[prognosis]] compared with small cell undifferentiated ones.
 
**Pretreatment extent of disease (PRETEXT) which was developed to stage the [[tumor]] before [[surgical]] removal and compare the [[efficacy]] of varous adjuvant [[chemotherapeutic agents]]. It is based on [[anatomy]] of [[liver]] and depending on [[tumor]] free sectors of [[liver]].<ref name="pmid15718322">{{cite journal |vauthors=Aronson DC, Schnater JM, Staalman CR, Weverling GJ, Plaschkes J, Perilongo G, Brown J, Phillips A, Otte JB, Czauderna P, MacKinlay G, Vos A |title=Predictive value of the pretreatment extent of disease system in hepatoblastoma: results from the International Society of Pediatric Oncology Liver Tumor Study Group SIOPEL-1 study |journal=J. Clin. Oncol. |volume=23 |issue=6 |pages=1245–52 |date=February 2005 |pmid=15718322 |doi=10.1200/JCO.2005.07.145 |url=}}</ref> 
OR
*Complications of hepatoblastoma includes:
 
**[[Pancytopenia]]
Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [#]%.
**[[Anemia]]
**[[Intraperitoneal|Intraperitonea]]<nowiki/>l [[tumor]] [[rupture]]
**Complications related to [[chemotherapy]] such as [[renal failure]]
**Post-[[transplant]] complications such as [[hepatic]] ductal [[obstruction]], [[biliary]] leakage, [[thrombosis]].<ref name="pmid25251521">{{cite journal |vauthors=Becker K, Furch C, Schmid I, von Schweinitz D, Häberle B |title=Impact of postoperative complications on overall survival of patients with hepatoblastoma |journal=Pediatr Blood Cancer |volume=62 |issue=1 |pages=24–8 |date=January 2015 |pmid=25251521 |doi=10.1002/pbc.25240 |url=}}</ref>
**[[Psychosocial]] effects of treatment and painful procedures


==Diagnosis==
==Diagnosis==
===Diagnostic Study of Choice===
===Diagnostic Study of Choice===
The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
*The diagnosis of hepatoblastoma is made when [[abdominal mass]] is detected on [[ultrasound]] or [[spiral CT scan]], but a definitive diagnosis requires the histological evaluation of [[biopsy]] specimen after surgery.<ref name="pmid26835349">{{cite journal |vauthors=Hiyama E |title=Pediatric hepatoblastoma: diagnosis and treatment |journal=Transl Pediatr |volume=3 |issue=4 |pages=293–9 |date=October 2014 |pmid=26835349 |pmc=4728840 |doi=10.3978/j.issn.2224-4336.2014.09.01 |url=}}</ref>
 
OR
 
The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].
 
OR
 
The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].
 
OR
 
There are no established criteria for the diagnosis of [disease name].


===History and Symptoms===
===History and Symptoms===
The majority of patients with [disease name] are asymptomatic.
*The majority of patients with hepatoblastoma have an [[abdominal mass]] or [[abdominal distension]]. <ref name="pmid26835349">{{cite journal |vauthors=Hiyama E |title=Pediatric hepatoblastoma: diagnosis and treatment |journal=Transl Pediatr |volume=3 |issue=4 |pages=293–9 |date=October 2014 |pmid=26835349 |pmc=4728840 |doi=10.3978/j.issn.2224-4336.2014.09.01 |url=}}</ref>
 
*Other symptoms of hepatoblastoma include:
OR
**[[Abdominal discomfort]]
**Generalized [[Fatigue (medical)|fatigue]]
**Loss of appetite ([[Anorexia]])
**[[Nausea]] and [[vomiting]]


The hallmark of [disease name] is [finding]. A positive history of [finding 1] and [finding 2] is suggestive of [disease name]. The most common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3]. Common symptoms of [disease] include [symptom 1], [symptom 2], and [symptom 3]. Less common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3].
*Ruptured tumor can cause symptoms of [[peritoneal]] irritation due to [[intraperitoneal]] bleeding such as severe [[abdominal pain]], nausea, vomiting, and severe [[anemia]].<ref name="pmid16273660">{{cite journal |vauthors=Ke HY, Chen JH, Jen YM, Yu JC, Hsieh CB, Chen CJ, Liu YC, Chen TW, Chan DC |title=Ruptured hepatoblastoma with massive internal bleeding in an adult |journal=World J. Gastroenterol. |volume=11 |issue=39 |pages=6235–7 |date=October 2005 |pmid=16273660 |pmc=4436650 |doi= |url=}}</ref>


===Physical Examination===
===Physical Examination===
*Physical examination of patients with hepatoblastoma is usually remarkable for single, mildly painful, rapidly enlarging abdominal mass that is found in the right lobe of the liver.<ref name="pmid23330017">{{cite journal |vauthors=Zhang Q, Ming J, Zhang S, Guo D, Qiu X |title=A rare case of adult hepatoblastoma with neuroendocrine differentiation misdiagnosed as neuroendocrine tumor |journal=Int J Clin Exp Pathol |volume=6 |issue=2 |pages=308–13 |date=2013 |pmid=23330017 |pmc=3544231 |doi= |url=}}</ref><ref name="pmid26835349">{{cite journal |vauthors=Hiyama E |title=Pediatric hepatoblastoma: diagnosis and treatment |journal=Transl Pediatr |volume=3 |issue=4 |pages=293–9 |date=October 2014 |pmid=26835349 |pmc=4728840 |doi=10.3978/j.issn.2224-4336.2014.09.01 |url=}}</ref>
*Physical examination of patients with hepatoblastoma is usually remarkable for single, mildly painful, rapidly enlarging [[abdominal mass]] that is found in the right lobe of the [[liver]].<ref name="pmid23330017">{{cite journal |vauthors=Zhang Q, Ming J, Zhang S, Guo D, Qiu X |title=A rare case of adult hepatoblastoma with neuroendocrine differentiation misdiagnosed as neuroendocrine tumor |journal=Int J Clin Exp Pathol |volume=6 |issue=2 |pages=308–13 |date=2013 |pmid=23330017 |pmc=3544231 |doi= |url=}}</ref><ref name="pmid26835349">{{cite journal |vauthors=Hiyama E |title=Pediatric hepatoblastoma: diagnosis and treatment |journal=Transl Pediatr |volume=3 |issue=4 |pages=293–9 |date=October 2014 |pmid=26835349 |pmc=4728840 |doi=10.3978/j.issn.2224-4336.2014.09.01 |url=}}</ref>
*Most tumors are solitary; but can be multifocal as well.
*Most tumors are [[solitary]]; but can be multifocal as well.


===Laboratory Findings===
===Laboratory Findings===
An elevated/reduced concentration of serum/blood/urinary/CSF/other [lab test] is diagnostic of [disease name].
*Laboratory findings that help with the diagnosis of hepatoblastoma includes:<ref name="pmid49416">{{cite journal |vauthors=Exelby PR, Filler RM, Grosfeld JL |title=Liver tumors in children in the particular reference to hepatoblastoma and hepatocellular carcinoma: American Academy of Pediatrics Surgical Section Survey--1974 |journal=J. Pediatr. Surg. |volume=10 |issue=3 |pages=329–37 |date=June 1975 |pmid=49416 |doi= |url=}}</ref>
 
**High levels of [[Alpha-fetoprotein]] ([[AFP]])
OR
**Mild [[liver]] function disturbances
 
**[[Anemia]] on [[Complete blood counts|complete blood count]]
Laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].
**[[Thrombocytosis]] (more frequent because of the effect of [[thrombopoietin]])<ref name="pmid6153151">{{cite journal |vauthors=Nickerson HJ, Silberman TL, McDonald TP |title=Hepatoblastoma, thrombocytosis, and increased thrombopoietin |journal=Cancer |volume=45 |issue=2 |pages=315–7 |date=January 1980 |pmid=6153151 |doi= |url=}}</ref>
 
**[[Thrombocytopenia]] (less common)
OR
 
[Test] is usually normal among patients with [disease name].
 
OR
 
Some patients with [disease name] may have elevated/reduced concentration of [test], which is usually suggestive of [progression/complication].
 
OR
 
There are no diagnostic laboratory findings associated with [disease name].


===Electrocardiogram===
===Electrocardiogram===
There are no ECG findings associated with [disease name].
*There are no [[ECG]] findings associated with hepatoblastoma.
 
OR
 
An ECG may be helpful in the diagnosis of [disease name]. Findings on an ECG suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].


===X-ray===
===X-ray===
There are no x-ray findings associated with [disease name].
*[[Chest-X-Ray|Chest]] [[Chest X-ray|x-rays]] can be useful especially since this [[tumor]] has the affinity to [[metastasize]] to [[lungs]].<ref name="pmid11042582">{{cite journal |vauthors=Perilongo G, Brown J, Shafford E, Brock P, De Camargo B, Keeling JW, Vos A, Philips A, Pritchard J, Plaschkes J |title=Hepatoblastoma presenting with lung metastases: treatment results of the first cooperative, prospective study of the International Society of Paediatric Oncology on childhood liver tumors |journal=Cancer |volume=89 |issue=8 |pages=1845–53 |date=October 2000 |pmid=11042582 |doi= |url=}}</ref>
 
OR
 
An x-ray may be helpful in the diagnosis of [disease name]. Findings on an x-ray suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
 
OR
 
There are no x-ray findings associated with [disease name]. However, an x-ray may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].
 
===Echocardiography or Ultrasound===
There are no echocardiography/ultrasound  findings associated with [disease name].
 
OR
 
Echocardiography/ultrasound  may be helpful in the diagnosis of [disease name]. Findings on an echocardiography/ultrasound suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].


OR
===Ultrasound===
 
*Imaging studies play an important role in the diagnosis, [[Staging (pathology)|staging]], and treatment of disease, most tumors can be resected surgically and [[ultrasound]] is often used in order to detect [[tumor]] size, also the initial diagnosis is made by [[abdominal]] [[ultrasound]].
There are no echocardiography/ultrasound  findings associated with [disease name]. However, an echocardiography/ultrasound  may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].


===CT scan===
===CT scan===
There are no CT scan findings associated with [disease name].
*[[CT scan]] is very helpful to diagnose the disease, children with hepatoblastoma undergo either a CT or [[MRI]] scan at diagnosis. <ref name="pmid27955729">{{cite journal |vauthors=Aronson DC, Meyers RL |title=Malignant tumors of the liver in children |journal=Semin. Pediatr. Surg. |volume=25 |issue=5 |pages=265–275 |date=October 2016 |pmid=27955729 |doi=10.1053/j.sempedsurg.2016.09.002 |url=}}</ref>
 
*Surgeons prefer an [[angiographic]] or [[biphasic]] [[CT scan]] because of better depiction of the [[hepatic]] arterial, [[portal]] venous and [[hepatic vein]] and other [[liver]] structures.  
OR
*Concerns about [[radiation]] exposures in [[pediatrics]] has changed this modality in favor of [[MRI]], although [[MRI]] is much lengthy exam than [[CT]] has the advantage of multiplanar [[soft-tissue]] characterization, and when [[diffusion-weighted imaging]] techniques are used, [[MRI]] is exquisitely sensitive for detecting tiny [[liver]] lesions.
 
*[[Spiral CT scan]] findings of hypervascular lesions in the [[liver]] with delayed contrast excretion are highly suggestive of a [[malignant]] [[liver]] [[tumor]].
[Location] CT scan may be helpful in the diagnosis of [disease name]. Findings on CT scan suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
 
OR
 
There are no CT scan findings associated with [disease name]. However, a CT scan may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].


===MRI===
===MRI===
There are no MRI findings associated with [disease name].
*[[MRI]] has the advantage of multiplanar [[soft-tissue]] characterization, lack of harmful [[ionizing radiation]] and when [[diffusion-weighted imaging]] techniques are used, [[MRI]] is exquisitely sensitive for detecting tiny [[liver]] lesions.<ref name="pmid27526937">{{cite journal |vauthors=Shelmerdine SC, Roebuck DJ, Towbin AJ, McHugh K |title=MRI of paediatric liver tumours: How we review and report |journal=Cancer Imaging |volume=16 |issue=1 |pages=21 |date=August 2016 |pmid=27526937 |pmc=4986178 |doi=10.1186/s40644-016-0083-3 |url=}}</ref>
 
OR
 
[Location] MRI may be helpful in the diagnosis of [disease name]. Findings on MRI suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
 
OR
 
There are no MRI findings associated with [disease name]. However, a MRI may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].


===Other Imaging Findings===
===Other Imaging Findings===
There are no other imaging findings associated with [disease name].
*Other imaging studies such as [[PET scan]] or even [[bone scan]] when there is evidence of [[metastasis]] to [[bone]] may be helpful in the diagnosis of hepatoblastoma. PET scan can be helpful in localizing recurrent hepatoblastoma.<ref name="pmid16170514">{{cite journal |vauthors=Figarola MS, McQuiston SA, Wilson F, Powell R |title=Recurrent hepatoblastoma with localization by PET-CT |journal=Pediatr Radiol |volume=35 |issue=12 |pages=1254–8 |date=December 2005 |pmid=16170514 |doi=10.1007/s00247-005-1568-6 |url=}}</ref><ref name="pmid8293620">{{cite journal |vauthors=Archer D, Babyn P, Gilday D, Greenberg MA |title=Potentially misleading bone scan findings in patients with hepatoblastoma |journal=Clin Nucl Med |volume=18 |issue=12 |pages=1026–31 |date=December 1993 |pmid=8293620 |doi= |url=}}</ref>
 
OR
 
[Imaging modality] may be helpful in the diagnosis of [disease name]. Findings on an [imaging modality] suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].


===Other Diagnostic Studies===
===Other Diagnostic Studies===
There are no other diagnostic studies associated with [disease name].
OR
[Diagnostic study] may be helpful in the diagnosis of [disease name]. Findings suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
OR


Other diagnostic studies for [disease name] include [diagnostic study 1], which demonstrates [finding 1], [finding 2], and [finding 3], and [diagnostic study 2], which demonstrates [finding 1], [finding 2], and [finding 3].
*Other diagnostic studies for hepatoblastoma include evaluation of [[serum]] level of [[alpha-fetoprotein]], serum [[hCG]] level in rare cases of [[precocious puberty]].<ref name="pmid2411379">{{cite journal |vauthors=Nakagawara A, Ikeda K, Tsuneyoshi M, Daimaru Y, Enjoji M, Watanabe I, Iwafuchi M, Sawada T |title=Hepatoblastoma producing both alpha-fetoprotein and human chorionic gonadotropin. Clinicopathologic analysis of four cases and a review of the literature |journal=Cancer |volume=56 |issue=7 |pages=1636–42 |date=October 1985 |pmid=2411379 |doi= |url=}}</ref><ref name="pmid6187430">{{cite journal |vauthors=Morinaga S, Yamaguchi M, Watanabe I, Kasai M, Ojima M, Sasano N |title=An immunohistochemical study of hepatoblastoma producing human chorionic gonadotropin |journal=Cancer |volume=51 |issue=9 |pages=1647–52 |date=May 1983 |pmid=6187430 |doi= |url=}}</ref>


==Treatment==
==Treatment==
===Medical Therapy===
===Medical Therapy===
*The mainstay of therapy for hepatoblastoma is surgery, however, the vast majority of the tumors cannot be completely resected because of their large size or metastasis.<ref name="pmid26308249">{{cite journal |vauthors=Pham TA, Gallo AM, Concepcion W, Esquivel CO, Bonham CA |title=Effect of Liver Transplant on Long-term Disease-Free Survival in Children With Hepatoblastoma and Hepatocellular Cancer |journal=JAMA Surg |volume=150 |issue=12 |pages=1150–8 |date=December 2015 |pmid=26308249 |doi=10.1001/jamasurg.2015.1847 |url=}}</ref>
*The mainstay of therapy for hepatoblastoma is [[Surgery|surger]]<nowiki/>y, however, the vast majority of the tumors cannot be completely resected because of their large size or [[metastasis]].<ref name="pmid26308249">{{cite journal |vauthors=Pham TA, Gallo AM, Concepcion W, Esquivel CO, Bonham CA |title=Effect of Liver Transplant on Long-term Disease-Free Survival in Children With Hepatoblastoma and Hepatocellular Cancer |journal=JAMA Surg |volume=150 |issue=12 |pages=1150–8 |date=December 2015 |pmid=26308249 |doi=10.1001/jamasurg.2015.1847 |url=}}</ref>
*Liver transplantation can be considered for tumors that cannot be removed by surgery.
*Liver [[transplantation]] can be considered for [[tumors]] that cannot be removed by surgery.<ref name="pmid10839879">{{cite journal |vauthors=Reyes JD, Carr B, Dvorchik I, Kocoshis S, Jaffe R, Gerber D, Mazariegos GV, Bueno J, Selby R |title=Liver transplantation and chemotherapy for hepatoblastoma and hepatocellular cancer in childhood and adolescence |journal=J. Pediatr. |volume=136 |issue=6 |pages=795–804 |date=June 2000 |pmid=10839879 |doi= |url=}}</ref>
*Chemotherapy is an important adjuvant therapy, and cisplatin is the most commonly used chemotherapeutic agent, it can reduce the volume of tumors that are too big for surgical removal.<ref name="pmid12778356">{{cite journal |vauthors=Häberle B, Bode U, von Schweinitz D |title=[Differentiated treatment protocols for high- and standard-risk hepatoblastoma--an interim report of the German Liver Tumor Study HB99] |language=German |journal=Klin Padiatr |volume=215 |issue=3 |pages=159–65 |date=2003 |pmid=12778356 |doi=10.1055/s-2003-39375 |url=}}</ref>
*[[Chemotherapy]] is an important [[adjuvant therapy]], and [[cisplatin]] is the most commonly used [[chemotherapeutic agent]], it can reduce the volume of [[tumors]] that are too big for surgical removal.<ref name="pmid12778356">{{cite journal |vauthors=Häberle B, Bode U, von Schweinitz D |title=[Differentiated treatment protocols for high- and standard-risk hepatoblastoma--an interim report of the German Liver Tumor Study HB99] |language=German |journal=Klin Padiatr |volume=215 |issue=3 |pages=159–65 |date=2003 |pmid=12778356 |doi=10.1055/s-2003-39375 |url=}}</ref>


===Surgery===
===Surgery===
*Surgery is the mainstay of treatment for hepatoblastoma.<ref name="pmid30084209">{{cite journal |vauthors=Uchida H, Sakamoto S, Sasaki K, Takeda M, Hirata Y, Fukuda A, Hishiki T, Irie R, Nakazawa A, Miyazaki O, Nosaka S, Kasahara M |title=Surgical treatment strategy for advanced hepatoblastoma: Resection versus transplantation |journal=Pediatr Blood Cancer |volume=65 |issue=12 |pages=e27383 |date=December 2018 |pmid=30084209 |doi=10.1002/pbc.27383 |url=}}</ref>
*[[Surgery]] is the mainstay of treatment for hepatoblastoma.<ref name="pmid30084209">{{cite journal |vauthors=Uchida H, Sakamoto S, Sasaki K, Takeda M, Hirata Y, Fukuda A, Hishiki T, Irie R, Nakazawa A, Miyazaki O, Nosaka S, Kasahara M |title=Surgical treatment strategy for advanced hepatoblastoma: Resection versus transplantation |journal=Pediatr Blood Cancer |volume=65 |issue=12 |pages=e27383 |date=December 2018 |pmid=30084209 |doi=10.1002/pbc.27383 |url=}}</ref>
*The feasibility of surgery depends on the resectability of tumor at diagnosis.
*The feasibility of [[surgery]] depends on the resectability of [[tumor]] at diagnosis.


===Primary Prevention===
===Primary Prevention===
There are no established measures for the primary prevention of hepatoblastoma.
*There are no established measures for the primary [[Prevention (medical)|prevention]] of hepatoblastoma.


===Secondary Prevention===
===Secondary Prevention===
There are no established measures for the secondary prevention of [disease name].
*There are no established measures for the [[secondary prevention]] of hepatoblastoma.
 
OR
 
Effective measures for the secondary prevention of [disease name] include [strategy 1], [strategy 2], and [strategy 3].


==References==
==References==

Latest revision as of 19:27, 13 March 2019


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Hepatoblastoma Microchapters

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Overview

Historical Perspective

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History and Symptoms

Physical Examination

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X Ray

CT

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Ultrasound

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Nima Nasiri, M.D.[2]

Synonyms and keywords: Epithelial hepatoblastoma; Fetal hepatoblastoma; Embryonal hepatoblatoma; Macrotrabecular hepatoblastoma; Mixed hepatoblastoma; Rhabdoid hepatoblastoma; Small cell hepatoblastoma; Undifferentiated hepatoblastoma; Cholangioblastic hepatoblastoma; Teratoid hepatoblastoma; Chondroid hepatoblastoma; Osteoid hepatoblastoma; Rhabdomyoblastic hepatoblastoma; Neuroid-melanocytic hepatoblastoma; Well differentiated hepatoblastoma; HB

Overview

Hepatoblastoma is the most common primary liver tumor occurs in infant and children, usually less than 3 years old, more frequently in male, and accounting for over 1% of pediatric cancers. The etiology is unknown and not well understood, but it has been associated with Beckwith-Weidemann syndrome, familial adenomatous polyposis, and other factors such as low birth weight, preeclampsia, hemihypertrophy. The primary treatment is surgical resection, however, chemotherapy plays an important role by increasing the number of tumors that are respectable, chemotherapeutic agents helps in shrinkage of the tumor and make it easier to be resected by surgery. Prognosis of the tumor depends on various criteria such as resectability of the tumor, distant metastasis, tumor size, PRETEXT staging, and recurrence of the tumor. The mainstay of treatment is surgery, but the adjuvant chemotherapeutic agents and liver transplantation also are helpful.

Historical Perspective

In 1898, the first case of hepatoblastoma was published in English literature, the tumor was diagnosed in a 6-week old boy in Prague, by a physician named Misick, who found a large tumor on the autopsy of his liver. Decades later on 1962 Willis used the term, hepatoblastoma for this type of liver tumor because of it's embryonal origin [1]

Classification

Pathophysiology

Hepatoblastoma H&Esource:wikipedia


Causes

Differentiating hepatoblastoma from Other Diseases

Epidemiology and Demographics

  • Hepatoblastoma is the most common primary liver cancer in infants and children, tumor involves right lobe of liver more often.[11]
  • The incidence/prevalence of hepatoblastoma is approximately 0.05–0.15 patients per 100000 population in children younger than 15 years.[12]
  • Peak incidence means of 18 months, mostly in infants and children younger than 3 years old, with a male predilection.
  • Hepatoblastoma accounts for one percent of all primary malignancies in pediatrics.

Risk Factors

Screening

Natural History, Complications, and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

  • Physical examination of patients with hepatoblastoma is usually remarkable for single, mildly painful, rapidly enlarging abdominal mass that is found in the right lobe of the liver.[18][10]
  • Most tumors are solitary; but can be multifocal as well.

Laboratory Findings

Electrocardiogram

  • There are no ECG findings associated with hepatoblastoma.

X-ray

Ultrasound

  • Imaging studies play an important role in the diagnosis, staging, and treatment of disease, most tumors can be resected surgically and ultrasound is often used in order to detect tumor size, also the initial diagnosis is made by abdominal ultrasound.

CT scan

MRI

Other Imaging Findings

  • Other imaging studies such as PET scan or even bone scan when there is evidence of metastasis to bone may be helpful in the diagnosis of hepatoblastoma. PET scan can be helpful in localizing recurrent hepatoblastoma.[23][24]

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

  • Surgery is the mainstay of treatment for hepatoblastoma.[30]
  • The feasibility of surgery depends on the resectability of tumor at diagnosis.

Primary Prevention

  • There are no established measures for the primary prevention of hepatoblastoma.

Secondary Prevention

References

  1. ↑ Aronson DC, Czauderna P, Maibach R, Perilongo G, Morland B (October 2014). "The treatment of hepatoblastoma: Its evolution and the current status as per the SIOPEL trials". J Indian Assoc Pediatr Surg. 19 (4): 201–7. doi:10.4103/0971-9261.142001. PMC 4204244. PMID 25336801.
  2. ↑ Rowland JM (November 2002). "Hepatoblastoma: assessment of criteria for histologic classification". Med. Pediatr. Oncol. 39 (5): 478–83. doi:10.1002/mpo.10171. PMID 12228903.
  3. ↑ Czauderna P, Lopez-Terrada D, Hiyama E, Häberle B, Malogolowkin MH, Meyers RL (February 2014). "Hepatoblastoma state of the art: pathology, genetics, risk stratification, and chemotherapy". Curr. Opin. Pediatr. 26 (1): 19–28. doi:10.1097/MOP.0000000000000046. PMID 24322718.
  4. ↑ MacDonald BT, Tamai K, He X (July 2009). "Wnt/beta-catenin signaling: components, mechanisms, and diseases". Dev. Cell. 17 (1): 9–26. doi:10.1016/j.devcel.2009.06.016. PMC 2861485. PMID 19619488.
  5. ↑ 5.0 5.1 Kiruthiga KG, Ramakrishna B, Saha S, Sen S (April 2018). "Histological and immunohistochemical study of hepatoblastoma: correlation with tumour behaviour and survival". J Gastrointest Oncol. 9 (2): 326–337. doi:10.21037/jgo.2018.01.08. PMC 5934143. PMID 29755772.
  6. ↑ 6.0 6.1 Heck JE, Meyers TJ, Lombardi C, Park AS, Cockburn M, Reynolds P, Ritz B (August 2013). "Case-control study of birth characteristics and the risk of hepatoblastoma". Cancer Epidemiol. 37 (4): 390–5. doi:10.1016/j.canep.2013.03.004. PMC 3679264. PMID 23558166.
  7. ↑ Finegold MJ, Lopez-Terrada DH, Bowen J, Washington MK, Qualman SJ (April 2007). "Protocol for the examination of specimens from pediatric patients with hepatoblastoma". Arch. Pathol. Lab. Med. 131 (4): 520–9. doi:10.1043/1543-2165(2007)131[520:PFTEOS]2.0.CO;2. PMID 17425379.
  8. ↑ Mussa A, Duffy KA, Carli D, Ferrero GB, Kalish JM (January 2019). "Defining an optimal time window to screen for hepatoblastoma in children with Beckwith-Wiedemann syndrome". Pediatr Blood Cancer. 66 (1): e27492. doi:10.1002/pbc.27492. PMID 30270492.
  9. ↑ Curia MC, Zuckermann M, De Lellis L, Catalano T, Lattanzio R, Aceto G, Veschi S, Cama A, Otte JB, Piantelli M, Mariani-Costantini R, Cetta F, Battista P (January 2008). "Sporadic childhood hepatoblastomas show activation of beta-catenin, mismatch repair defects and p53 mutations". Mod. Pathol. 21 (1): 7–14. doi:10.1038/modpathol.3800977. PMID 17962810.
  10. ↑ 10.0 10.1 10.2 10.3 10.4 Hiyama E (October 2014). "Pediatric hepatoblastoma: diagnosis and treatment". Transl Pediatr. 3 (4): 293–9. doi:10.3978/j.issn.2224-4336.2014.09.01. PMC 4728840. PMID 26835349.
  11. ↑ Darbari A, Sabin KM, Shapiro CN, Schwarz KB (September 2003). "Epidemiology of primary hepatic malignancies in U.S. children". Hepatology. 38 (3): 560–6. doi:10.1053/jhep.2003.50375. PMID 12939582.
  12. ↑ Allan BJ, Parikh PP, Diaz S, Perez EA, Neville HL, Sola JE (October 2013). "Predictors of survival and incidence of hepatoblastoma in the paediatric population". HPB (Oxford). 15 (10): 741–6. doi:10.1111/hpb.12112. PMC 3791112. PMID 23600968.
  13. ↑ 13.0 13.1 Shelmerdine SC, Roebuck DJ, Towbin AJ, McHugh K (August 2016). "MRI of paediatric liver tumours: How we review and report". Cancer Imaging. 16 (1): 21. doi:10.1186/s40644-016-0083-3. PMC 4986178. PMID 27526937.
  14. ↑ Musick SR, Babiker HM. PMID 30521216. Missing or empty |title= (help)
  15. ↑ Aronson DC, Schnater JM, Staalman CR, Weverling GJ, Plaschkes J, Perilongo G, Brown J, Phillips A, Otte JB, Czauderna P, MacKinlay G, Vos A (February 2005). "Predictive value of the pretreatment extent of disease system in hepatoblastoma: results from the International Society of Pediatric Oncology Liver Tumor Study Group SIOPEL-1 study". J. Clin. Oncol. 23 (6): 1245–52. doi:10.1200/JCO.2005.07.145. PMID 15718322.
  16. ↑ Becker K, Furch C, Schmid I, von Schweinitz D, Häberle B (January 2015). "Impact of postoperative complications on overall survival of patients with hepatoblastoma". Pediatr Blood Cancer. 62 (1): 24–8. doi:10.1002/pbc.25240. PMID 25251521.
  17. ↑ Ke HY, Chen JH, Jen YM, Yu JC, Hsieh CB, Chen CJ, Liu YC, Chen TW, Chan DC (October 2005). "Ruptured hepatoblastoma with massive internal bleeding in an adult". World J. Gastroenterol. 11 (39): 6235–7. PMC 4436650. PMID 16273660.
  18. ↑ Zhang Q, Ming J, Zhang S, Guo D, Qiu X (2013). "A rare case of adult hepatoblastoma with neuroendocrine differentiation misdiagnosed as neuroendocrine tumor". Int J Clin Exp Pathol. 6 (2): 308–13. PMC 3544231. PMID 23330017.
  19. ↑ Exelby PR, Filler RM, Grosfeld JL (June 1975). "Liver tumors in children in the particular reference to hepatoblastoma and hepatocellular carcinoma: American Academy of Pediatrics Surgical Section Survey--1974". J. Pediatr. Surg. 10 (3): 329–37. PMID 49416.
  20. ↑ Nickerson HJ, Silberman TL, McDonald TP (January 1980). "Hepatoblastoma, thrombocytosis, and increased thrombopoietin". Cancer. 45 (2): 315–7. PMID 6153151.
  21. ↑ Perilongo G, Brown J, Shafford E, Brock P, De Camargo B, Keeling JW, Vos A, Philips A, Pritchard J, Plaschkes J (October 2000). "Hepatoblastoma presenting with lung metastases: treatment results of the first cooperative, prospective study of the International Society of Paediatric Oncology on childhood liver tumors". Cancer. 89 (8): 1845–53. PMID 11042582.
  22. ↑ Aronson DC, Meyers RL (October 2016). "Malignant tumors of the liver in children". Semin. Pediatr. Surg. 25 (5): 265–275. doi:10.1053/j.sempedsurg.2016.09.002. PMID 27955729.
  23. ↑ Figarola MS, McQuiston SA, Wilson F, Powell R (December 2005). "Recurrent hepatoblastoma with localization by PET-CT". Pediatr Radiol. 35 (12): 1254–8. doi:10.1007/s00247-005-1568-6. PMID 16170514.
  24. ↑ Archer D, Babyn P, Gilday D, Greenberg MA (December 1993). "Potentially misleading bone scan findings in patients with hepatoblastoma". Clin Nucl Med. 18 (12): 1026–31. PMID 8293620.
  25. ↑ Nakagawara A, Ikeda K, Tsuneyoshi M, Daimaru Y, Enjoji M, Watanabe I, Iwafuchi M, Sawada T (October 1985). "Hepatoblastoma producing both alpha-fetoprotein and human chorionic gonadotropin. Clinicopathologic analysis of four cases and a review of the literature". Cancer. 56 (7): 1636–42. PMID 2411379.
  26. ↑ Morinaga S, Yamaguchi M, Watanabe I, Kasai M, Ojima M, Sasano N (May 1983). "An immunohistochemical study of hepatoblastoma producing human chorionic gonadotropin". Cancer. 51 (9): 1647–52. PMID 6187430.
  27. ↑ Pham TA, Gallo AM, Concepcion W, Esquivel CO, Bonham CA (December 2015). "Effect of Liver Transplant on Long-term Disease-Free Survival in Children With Hepatoblastoma and Hepatocellular Cancer". JAMA Surg. 150 (12): 1150–8. doi:10.1001/jamasurg.2015.1847. PMID 26308249.
  28. ↑ Reyes JD, Carr B, Dvorchik I, Kocoshis S, Jaffe R, Gerber D, Mazariegos GV, Bueno J, Selby R (June 2000). "Liver transplantation and chemotherapy for hepatoblastoma and hepatocellular cancer in childhood and adolescence". J. Pediatr. 136 (6): 795–804. PMID 10839879.
  29. ↑ Häberle B, Bode U, von Schweinitz D (2003). "[Differentiated treatment protocols for high- and standard-risk hepatoblastoma--an interim report of the German Liver Tumor Study HB99]". Klin Padiatr (in German). 215 (3): 159–65. doi:10.1055/s-2003-39375. PMID 12778356.
  30. ↑ Uchida H, Sakamoto S, Sasaki K, Takeda M, Hirata Y, Fukuda A, Hishiki T, Irie R, Nakazawa A, Miyazaki O, Nosaka S, Kasahara M (December 2018). "Surgical treatment strategy for advanced hepatoblastoma: Resection versus transplantation". Pediatr Blood Cancer. 65 (12): e27383. doi:10.1002/pbc.27383. PMID 30084209.
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