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A case of hepatoblastoma misdiagnosed as combined hepatocellular carcinoma and cholangiocarcinoma in an adult.

Park KW, Seo CJ, Yun DY, Kim MK, Kim BS, Han YS, Oh HK, Lee CH - Clin Mol Hepatol (2015)

Bottom Line: Follow-up abdominal CT performed 3 months later showed a 5.5-cm metastatic mass in the left subphrenic area.Metastatic hepatoblastoma was found at multiple sites of the abdomen during follow-up, and so chemotherapy with cisplatin, 5-fluorouracil (5-FU), and vincristine was applied, followed by carboplatin and doxorubicin.Despite surgery and postoperative chemotherapy, she died 12 months after symptom onset.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea.

ABSTRACT
Hepatoblastoma usually occurs in children under the age of 2 years, with very few cases reported in adults. We experienced a case of adult hepatoblastoma in a 36-year-old female with chronic hepatitis B. She had experienced sudden onset abdominal pain. Her serum alpha-fetoprotein level was markedly elevated, and abdominal CT showed a 9-cm mass with internal hemorrhage in the right hepatic lobe with hemoperitoneum, so an emergency hepatic central bisectionectomy was performed. The initial histologic examination revealed that the mass mimicked combined hepatocellular carcinoma and cholangiocarcinoma with spindle-cell metaplasia of the cholangiocarcinoma element. Follow-up abdominal CT performed 3 months later showed a 5.5-cm metastatic mass in the left subphrenic area. Laparoscopic splenectomy with mass excision was performed, and hepatoblastoma was confirmed histologically. A histologic re-examination of previously obtained surgical specimens also confirmed the presence of hepatoblastoma. Metastatic hepatoblastoma was found at multiple sites of the abdomen during follow-up, and so chemotherapy with cisplatin, 5-fluorouracil (5-FU), and vincristine was applied, followed by carboplatin and doxorubicin. Despite surgery and postoperative chemotherapy, she died 12 months after symptom onset.

No MeSH data available.


Related in: MedlinePlus

Follow-up CT (A) and PET (B) scans obtained after the third sessions of cisplatin, 5-FU, and vincristine chemotherapy. (A) Multiple intraperitoneal metastases with large amounts of intraperitoneal fluid were evident. (B) Multiple FDG uptake areas (maximum SUV > 4.46 ) were present in the subphrenic, subhepatic, and hepatorenal areas and in the left upper quadrant of the abdomen, both paracolic gutters, and the pelvic cavity.
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Figure 6: Follow-up CT (A) and PET (B) scans obtained after the third sessions of cisplatin, 5-FU, and vincristine chemotherapy. (A) Multiple intraperitoneal metastases with large amounts of intraperitoneal fluid were evident. (B) Multiple FDG uptake areas (maximum SUV > 4.46 ) were present in the subphrenic, subhepatic, and hepatorenal areas and in the left upper quadrant of the abdomen, both paracolic gutters, and the pelvic cavity.

Mentions: Systemic chemotherapy started with cisplatin (60 mg/m2), 5-fluorourasil (5-FU) (600 mg/m2), vincristine (1.5 mg/m2) and total 3 cycles of chemotherapy were done every 4 week. Entecavir 0.5 mg was also started for chemoprophylaxis of CHB. After the 3rd chemotherapy cycle, follow-up abdominal CT and PET scan showed progression of multiple intraperitoneal metastasis with large amount of intraperitoneal fluid (Fig. 6A, B) and follow-up AFP was further increased to 254 ng/mL. So chemotherapy regimen was changed to carboplatin (350 mg/m2) with doxorubicin (30 mg/m2) every 3 weeks. The patient experienced neutropenia after the new regimen, but recovered shortly after treatment with granulocyte colony-stimulating factor (G-CSF). After second carboplatin with doxorubicin chemotherapy, follow-up AFP was increased 1510.19 ng/mL, but abdominal CT scan showed that amount of ascites was decreased (Fig. 7). Because of radiologic improvements, third and fourth chemotherapy were performed. After 4th chemotherapy, follow-up abdominal CT revealed progression of multiple intraperitoneal metastatic masses, newly developed hepatic metastasis and large amount of intraperitoneal fluid (Fig. 8). A diagnostic paracentesis was performed and showed white blood cell 310/mm3 (poly 20%, lymph 80%), protein 3.6 g/dL and albumin 2.3 g/dL on ascitic fluid analysis. The serum albumin was 3.1 g/dL and serum-ascites albumin gradient (SAAG) was 0.8 g/dL. The AFB stain and culture were all negative in ascitic fluid. The AFP was 6881.93 ng/mL on serum. Regarded as peritoneal carcinomatosis, the patient underwent conservative treatments including the use of repeated therapeutic paracentesis for 1 month before death.


A case of hepatoblastoma misdiagnosed as combined hepatocellular carcinoma and cholangiocarcinoma in an adult.

Park KW, Seo CJ, Yun DY, Kim MK, Kim BS, Han YS, Oh HK, Lee CH - Clin Mol Hepatol (2015)

Follow-up CT (A) and PET (B) scans obtained after the third sessions of cisplatin, 5-FU, and vincristine chemotherapy. (A) Multiple intraperitoneal metastases with large amounts of intraperitoneal fluid were evident. (B) Multiple FDG uptake areas (maximum SUV > 4.46 ) were present in the subphrenic, subhepatic, and hepatorenal areas and in the left upper quadrant of the abdomen, both paracolic gutters, and the pelvic cavity.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4612292&req=5

Figure 6: Follow-up CT (A) and PET (B) scans obtained after the third sessions of cisplatin, 5-FU, and vincristine chemotherapy. (A) Multiple intraperitoneal metastases with large amounts of intraperitoneal fluid were evident. (B) Multiple FDG uptake areas (maximum SUV > 4.46 ) were present in the subphrenic, subhepatic, and hepatorenal areas and in the left upper quadrant of the abdomen, both paracolic gutters, and the pelvic cavity.
Mentions: Systemic chemotherapy started with cisplatin (60 mg/m2), 5-fluorourasil (5-FU) (600 mg/m2), vincristine (1.5 mg/m2) and total 3 cycles of chemotherapy were done every 4 week. Entecavir 0.5 mg was also started for chemoprophylaxis of CHB. After the 3rd chemotherapy cycle, follow-up abdominal CT and PET scan showed progression of multiple intraperitoneal metastasis with large amount of intraperitoneal fluid (Fig. 6A, B) and follow-up AFP was further increased to 254 ng/mL. So chemotherapy regimen was changed to carboplatin (350 mg/m2) with doxorubicin (30 mg/m2) every 3 weeks. The patient experienced neutropenia after the new regimen, but recovered shortly after treatment with granulocyte colony-stimulating factor (G-CSF). After second carboplatin with doxorubicin chemotherapy, follow-up AFP was increased 1510.19 ng/mL, but abdominal CT scan showed that amount of ascites was decreased (Fig. 7). Because of radiologic improvements, third and fourth chemotherapy were performed. After 4th chemotherapy, follow-up abdominal CT revealed progression of multiple intraperitoneal metastatic masses, newly developed hepatic metastasis and large amount of intraperitoneal fluid (Fig. 8). A diagnostic paracentesis was performed and showed white blood cell 310/mm3 (poly 20%, lymph 80%), protein 3.6 g/dL and albumin 2.3 g/dL on ascitic fluid analysis. The serum albumin was 3.1 g/dL and serum-ascites albumin gradient (SAAG) was 0.8 g/dL. The AFB stain and culture were all negative in ascitic fluid. The AFP was 6881.93 ng/mL on serum. Regarded as peritoneal carcinomatosis, the patient underwent conservative treatments including the use of repeated therapeutic paracentesis for 1 month before death.

Bottom Line: Follow-up abdominal CT performed 3 months later showed a 5.5-cm metastatic mass in the left subphrenic area.Metastatic hepatoblastoma was found at multiple sites of the abdomen during follow-up, and so chemotherapy with cisplatin, 5-fluorouracil (5-FU), and vincristine was applied, followed by carboplatin and doxorubicin.Despite surgery and postoperative chemotherapy, she died 12 months after symptom onset.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea.

ABSTRACT
Hepatoblastoma usually occurs in children under the age of 2 years, with very few cases reported in adults. We experienced a case of adult hepatoblastoma in a 36-year-old female with chronic hepatitis B. She had experienced sudden onset abdominal pain. Her serum alpha-fetoprotein level was markedly elevated, and abdominal CT showed a 9-cm mass with internal hemorrhage in the right hepatic lobe with hemoperitoneum, so an emergency hepatic central bisectionectomy was performed. The initial histologic examination revealed that the mass mimicked combined hepatocellular carcinoma and cholangiocarcinoma with spindle-cell metaplasia of the cholangiocarcinoma element. Follow-up abdominal CT performed 3 months later showed a 5.5-cm metastatic mass in the left subphrenic area. Laparoscopic splenectomy with mass excision was performed, and hepatoblastoma was confirmed histologically. A histologic re-examination of previously obtained surgical specimens also confirmed the presence of hepatoblastoma. Metastatic hepatoblastoma was found at multiple sites of the abdomen during follow-up, and so chemotherapy with cisplatin, 5-fluorouracil (5-FU), and vincristine was applied, followed by carboplatin and doxorubicin. Despite surgery and postoperative chemotherapy, she died 12 months after symptom onset.

No MeSH data available.


Related in: MedlinePlus