HEPATOCELLULAR-CARCINOMA AND LIVER-CELL DYSPLASIA IN CHILDREN WITH CHRONIC LIVER-DISEASE

The histology of 72 livers from 72 children who underwent liver transp lantation was reviewed. Nine children (12.5%) had hepatocellular carci noma (HCC) and/or liver cell dysplasia (LCD) in their native livers. A ges at the time of transplantation ranged from 2 months to 11 years. P rimary liver diseases included tyrosinemia (3), biliary atresia (2), c hronic active hepatitis B (1), chronic active non-A non-B non-C hepati tis (1), idiopathic neonatal hepatitis (1), and neonatal iron storage disease (1). Explanted livers showed large multifocal HCC in two cases , incidental HCC in three, and dysplastic nodules in four. LCD also wa s present in three cases in conjunction with HCC. All patients had cir rhosis. Alpha-fetoprotein was measured in six children and was elevate d in all six (range, 300 to 1,770,000 ng/mL; normal. 0 to 15 ng/mL). A bdominal computed tomography, ultrasonography, and/or magnetic resonan ce imaging showed large masses in two cases, but did not detect the tu mors of less than 2 cm or the dysplastic nodules in the other seven ch ildren. After a follow-up period of 2 months to 3 years (mean, 19.8 +/ - 12.1 months), eight children are alive and have no evidence of recur rence. The patient with neonatal iron storage disease died 2 months af ter transplantation, without evidence of tumor recurrence. The authors conclude that children with end-stage liver disease of diverse causes referred for liver transplantation may have LCD and/or HCC. Serial de termination of alpha-fetoprotein and images studies may detect early l esions curable by liver transplantation. Copyright (C) 1994 by W.B. Sa unders Company