Recurrence of hepatocellular carcinoma as a mixed hepatoblastoma after liver transplantation

Background-Hepatoblastoma is an exceptional cause of primary malignant live r tumour in the adult. Patient-The case is reported of an adult patient transplanted for alcoholic cirrhosis complicated by multifocal hepatocellular carcinoma in whom a rec urrence in the form of a mixed hepatoblastoma invading the whole transplant ed liver developed three months after liver transplantation. Methods-Complete clinical, histopathological, and immunohistochemical data were reviewed. Results-The recurrent tumour invaded the whole liver. The major component w as a mixed hepatoblastoma, with an epithelial component expressing cytokera tin and a mesenchymal component expressing vimentin. The tumour also contai ned a minor hepatocarcinomatous component expressing alpha fetoprotein. The rapid growth of the tumour prevented any attempt at treatment. Although di rect evidence is lacking, the most likely hypothesis to explain the observa tions is a marked phenotypic change in the initial malignant population at recurrence. Conclusion-This case supports a possible filiation between hepatocellular c arcinoma and hepatoblastoma in adults.