2. Incidentally picked up SOL in the
liver
Dr. Chintamani Godbole
Registrar, Dept of Surgical Gastroenterology
Jaslok Hospital and Research Centre, Mumbai
3. Case Summary:
•9 month old male child
•Born of a full term normal delivery
•Perinatal course uneventful
•Normal development and milestones
•Short history of fever & cold; detected to have
hepatomegaly by paediatrician on routine
examination
4. • Born of a non-consanguinous marriage, elder
sibling 4 yr old girl - healthy
• No significant family history
• No h/o jaundice, failure to thrive, vomiting,
excessive crying, weight loss
5. Examination:
•Healthy child
•General – normal , no nodes
•Abdominal – Hepatomegaly – mainly right
lobe, firm, non tender
•No splenomegaly, other lump in abdomen
•No free fluid, dilated veins, umbilicus normal
6. Investigations:
Hb- 10.3 gm/dl
PT – INR – 1.0
TLC – 7900/mm3
T. Bil – 0.3 mg/dl
Platelets- 306000/mm3
D. Bil – 0.15 mg/dl
Creat – 0.5 mg/dl
SGOT – 47 U/L
SGPT – 12 U/L
AlK PO4 – 124 U/L
GGT – 29 U/L
S. Albumin – 3.7 g/dl
7. USG abdomen:
•Large(5 cm) ,well defined, solid, hypoechoic
mass in right lobe, increased vascularity on
doppler.
•Rest liver, viscera normal
•Portal vein normal – 5.8mm
•No lymphnodes, splenomegaly
•Biliary tree normal
8.
9.
10. CECT :
•Well encapsulated heterogenously enhancing
mass with areas of necrosis involving segment V
and VI of the liver.
•Size 5.9 x 5.6 cms
12. CT guided biopsy of lesion.
• Round to polygonal cells arranged as
trabeculae and small acini and areas showing
loose mesenchymal tissue
• Cytokeratin, Glypican ++
• Suggestive of Hepatoblastoma – mixed
epithelial, mesenchymal.
13. Chemotherapy:
•Single agent: Cisplatin based
•Each cycle – dose – 90mg / m2
•2 cycles of chemotherapy given
•S. AFP – prechemo – 56223 ng/ml
-- post chemo – 14000 ng/ml
• CT repeated
15. Surgery:
•Non-anatomical resection of the tumour - Seg
5 and part of seg 6 with 1 cm margin of normal
liver
•Histology
Necrotic tumor, viable cells, margins free
16. • Post operative received 4 more cycles of
cisplatin
• Steady fall of AFP
• Immediate post op – 114 ng/ml
• 6 months later – 2.4 ng/ml
• Currently on follow up 18 months postop
doing well AFP normal
