Liver tumors in children with chronic liver diseases

Abstract

Liver tumors are rare in children, but the incidence may increase in some circumstances and particularly in chronic liver diseases. Most liver tumors consequent to chronic liver diseases are malignant hepatocellular carcinoma. Other liver tumors include hepatoblastoma, focal nodular hyperplasia, adenoma, pseudotumor, and nodular regenerative hyperplasia. Screening of suspected cases is beneficial. Imaging and surrogate markers of alpha-fetoprotein are used initially as noninvasive tools for surveillance. However, liver biopsy for histopathology evaluation might be necessary for patients with inconclusive findings. Once the malignant liver tumor is detected in children with cirrhosis, liver transplantation is currently considered the preferred option and achieves favorable outcomes. Based on the current evidence, this review focuses on liver tumors with underlying chronic liver disease, their epidemiology, pathogenesis, early recognition, and effective management.

Keywords: Liver tumor; Chronic liver disease; Children; Hepatocellular carcinoma; Liver cancer; Liver neoplasm

Core Tip: Liver tumors in children are rare, although children with underlying chronic liver diseases may present a higher risk. Early detection and timely management lead to a good prognosis and outcome. Recently, contrast enhanced ultrasound has been the preferred modality for surveillance to identify and classify the etiology of liver tumors. As the more frequent liver tumors in children with chronic liver diseases are mainly malignant, liver transplant should be considered as the first option to achieve favorable results. In addition, regular assessment is necessary in asymptomatic benign liver tumors with the potential for malignant transformation.