Hepatoblastoma

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Hepatoblastoma
Hepatoblastoma - 2 - very high mag.jpg
Micrograph of a hepatoblastoma. H&E stain.
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Hepatoblastoma is a malignant liver cancer occurring in infants and children and composed of tissue resembling fetal liver cells, mature liver cells, or bile duct cells. They usually present with an abdominal mass. The disease is most commonly diagnosed during a child's first three years of life. [1] Alpha-fetoprotein (AFP) levels are commonly elevated, but when AFP is not elevated at diagnosis the prognosis is poor. [2]

Contents

Signs and symptoms

Patients are usually asymptomatic at diagnosis. [3] As a result, disease is often advanced at diagnosis.

Pathophysiology

Micrograph showing a hepatoblastoma (right of image) and normal liver (left of image). H&E stain. Hepatoblastoma - high mag.jpg
Micrograph showing a hepatoblastoma (right of image) and normal liver (left of image). H&E stain.
Liver tumor types by relative incidence in adults in the United States, with hepatoblastoma at right Liver tumor types in adults by relative incidence.png
Liver tumor types by relative incidence in adults in the United States, with hepatoblastoma at right

Hepatoblastomas originate from immature liver precursor cells, are typically unifocal, affect the right lobe of the liver more often than the left lobe, and can metastasize. They are categorized into two types: "Epithelial Type" and "Mixed Epithelial / Mesenchymal Type."[ citation needed ]

Individuals with familial adenomatous polyposis (FAP), a syndrome of early-onset colonic polyps and adenocarcinoma, frequently develop hepatoblastomas. [5] [6] Also, beta-catenin mutations have been shown to be common in sporadic hepatoblastomas, occurring in as many as 67% of patients. [7] [8]

Recently, other components of the Wnt signaling pathway have also demonstrated a likely role in constitutive activation of this pathway in the causation of hepatoblastoma. [8] [9] Accumulating evidence suggests that hepatoblastoma is derived from a pluripotent stem cell. [10]

Syndromes with an increased incidence of hepatoblastoma include Beckwith–Wiedemann syndrome, trisomy 18, trisomy 21, Acardi syndrome, Li–Fraumeni syndrome, Goldenhar syndrome, von Gierke disease, and familial adenomatous polyposis. [11]

Diagnosis

The most common method of testing for hepatoblastoma is a blood test checking the alpha-fetoprotein level. Alpha-fetoprotein (AFP) is used as a biomarker to help determine the presence of liver cancer in children. At birth, infants have relatively high levels of AFP, which fall to normal adult levels by the second year of life. The normal level for AFP in children has been reported as lower than 50 nanograms per milliliter (ng/ml) and 10 ng/ml in adults. An AFP level greater than 500 ng/ml is a significant indicator of hepatoblastoma. AFP is also used as an indicator of treatment success. If treatments are successful in removing the cancer, the AFP level is expected to return to normal. [12]

Treatment

Surgical removal of the tumor, neoadjuvant chemotherapy prior to tumor removal, and liver transplantation have been used to treat these cancers. [13] [14] Primary liver transplantation provides high, long term, disease-free survival rate in the range of 80%, in cases of complete tumor removal and adjuvant chemotherapy survival rates approach 100%. [15] [16] The presence of metastases is the strongest predictor of a poor prognosis. [17]

Related Research Articles

<span class="mw-page-title-main">Alpha-fetoprotein</span> Fetal analogue of serum albumin

Alpha-fetoprotein is a protein that in humans is encoded by the AFP gene. The AFP gene is located on the q arm of chromosome 4 (4q25). Maternal AFP serum level is used to screen for Down syndrome, neural tube defects, and other chromosomal abnormalities.

<span class="mw-page-title-main">Beckwith–Wiedemann syndrome</span> Genetic overgrowth disorder

Beckwith–Wiedemann syndrome is an overgrowth disorder usually present at birth, characterized by an increased risk of childhood cancer and certain congenital features. A minority (<15%) of cases of BWS are familial, meaning that a close relative may also have BWS, and parents of an affected child may be at increased risk of having other children with BWS. While children with BWS are at increased risk of childhood cancer, most children with BWS do not develop cancer and the vast majority of children who do develop cancer can be treated successfully.

<span class="mw-page-title-main">Gardner's syndrome</span> Medical condition

Gardner's syndrome is a subtype of familial adenomatous polyposis (FAP). Gardner syndrome is an autosomal dominant form of polyposis characterized by the presence of multiple polyps in the colon together with tumors outside the colon. The extracolonic tumors may include osteomas of the skull, thyroid cancer, epidermoid cysts, fibromas, as well as the occurrence of desmoid tumors in approximately 15% of affected individuals.

<span class="mw-page-title-main">Familial adenomatous polyposis</span> Medical condition

Familial adenomatous polyposis (FAP) is an autosomal dominant inherited condition in which numerous adenomatous polyps form mainly in the epithelium of the large intestine. While these polyps start out benign, malignant transformation into colon cancer occurs when they are left untreated. Three variants are known to exist, FAP and attenuated FAP are caused by APC gene defects on chromosome 5 while autosomal recessive FAP is caused by defects in the MUTYH gene on chromosome 1. Of the three, FAP itself is the most severe and most common; although for all three, the resulting colonic polyps and cancers are initially confined to the colon wall. Detection and removal before metastasis outside the colon can greatly reduce and in many cases eliminate the spread of cancer.

<span class="mw-page-title-main">Benign tumor</span> Mass of cells which cannot spread throughout the body

A benign tumor is a mass of cells (tumor) that does not invade neighboring tissue or metastasize. Compared to malignant (cancerous) tumors, benign tumors generally have a slower growth rate. Benign tumors have relatively well differentiated cells. They are often surrounded by an outer surface or stay contained within the epithelium. Common examples of benign tumors include moles and uterine fibroids.

<span class="mw-page-title-main">Mismatch repair cancer syndrome</span> Medical condition

Mismatch repair cancer syndrome (MMRCS) is a cancer syndrome associated with biallelic DNA mismatch repair mutations. It is also known as Turcot syndrome and by several other names.

A blastoma is a type of cancer, more common in children, that is caused by malignancies in precursor cells, often called blasts. Examples are nephroblastoma, medulloblastoma, and retinoblastoma. The suffix -blastoma is used to imply a tumor of primitive, incompletely differentiated cells, e.g., chondroblastoma is composed of cells resembling the precursor of chondrocytes.

In oncology, AFP-L3 is an isoform of alpha-fetoprotein (AFP), a substance typically used in the triple test during pregnancy and for screening chronic liver disease patients for hepatocellular carcinoma (HCC). AFP can be fractionated by affinity electrophoresis into three glycoforms: L1, L2, and L3 based on the reactivity with the lectin Lens culinaris agglutinin (LCA). AFP-L3 binds strongly to LCA via an additional α 1-6 fucose residue attached at the reducing terminus of N-acetylglucosamine; this is in contrast to the L1 isoform. It is the L1 isoform which is typically associated with non-HCC inflammation of liver disease condition. The L3 isoform is specific to malignant tumors and its detected presence can serve to identify patients whom need increased monitoring for the development of HCC in high risk populations. AFP-L3% is now being considered as a tumor marker for the North American demographic.

<span class="mw-page-title-main">Adenomatous polyposis coli</span> Protein-coding gene in the species Homo sapiens

Adenomatous polyposis coli (APC) also known as deleted in polyposis 2.5 (DP2.5) is a protein that in humans is encoded by the APC gene. The APC protein is a negative regulator that controls beta-catenin concentrations and interacts with E-cadherin, which are involved in cell adhesion. Mutations in the APC gene may result in colorectal cancer.

<span class="mw-page-title-main">Fundic gland polyposis</span> Medical condition

Fundic gland polyposis is a medical syndrome where the fundus and the body of the stomach develop many fundic gland polyps. The condition has been described both in patients with familial adenomatous polyposis (FAP) and attenuated variants (AFAP), and in patients in whom it occurs sporadically.

<span class="mw-page-title-main">Aggressive fibromatosis</span> Medical condition

Aggressive fibromatosis or desmoid tumor is a rare condition. Desmoid tumors arise from cells called fibroblasts, which are found throughout the body and provide structural support, protection to the vital organs, and play a critical role in wound healing. These tumors tend to occur in women in their thirties, but can occur in anyone at any age. They can be either relatively slow-growing or malignant. However, aggressive fibromatosis is locally aggressive and can cause life-threatening problems or even death when they compress vital organs such as intestines, kidneys, lungs, blood vessels, or nerves. Most cases are sporadic, but some are associated with familial adenomatous polyposis (FAP). Approximately 10% of individuals with Gardner's syndrome, a type of FAP with extracolonic features, have desmoid tumors.

<span class="mw-page-title-main">Catenin beta-1</span> Mammalian protein found in Homo sapiens

Catenin beta-1, also known as beta-catenin (β-catenin), is a protein that in humans is encoded by the CTNNB1 gene.

<span class="mw-page-title-main">Cronkhite–Canada syndrome</span> Medical condition

Cronkhite–Canada syndrome is a rare syndrome characterized by multiple polyps of the digestive tract. It is sporadic, and it is currently considered acquired and idiopathic.

Mediastinal germ cell tumors are tumors that derive from germ cell rest remnants in the mediastinum. They most commonly occur in the gonad but occasionally elsewhere.

<span class="mw-page-title-main">Liver cancer</span> Medical condition

Liver cancer is cancer that starts in the liver. Liver cancer can be primary or secondary. Liver metastasis is more common than that which starts in the liver. Liver cancer is increasing globally.

<span class="mw-page-title-main">CTNNBIP1</span> Protein-coding gene in the species Homo sapiens

Beta-catenin-interacting protein 1 is a protein that is encoded in humans by the CTNNBIP1 gene.

<span class="mw-page-title-main">AXIN1</span> Protein-coding gene in the species Homo sapiens

Axin-1 is a protein that in humans is encoded by the AXIN1 gene.

Elevated alpha-fetoprotein refers to a state where alpha-fetoprotein levels are outside of the reference range.

<span class="mw-page-title-main">Cancer syndrome</span> Genetic condition that predisposes a person to cancer

A cancer syndrome, or family cancer syndrome, is a genetic disorder in which inherited genetic mutations in one or more genes predispose the affected individuals to the development of cancers and may also cause the early onset of these cancers. Cancer syndromes often show not only a high lifetime risk of developing cancer, but also the development of multiple independent primary tumors.

Gardner fibroma (GF) is a benign fibroblastic tumor. GF tumors typically develop in the dermis and adjacent subcutaneous tissue lying just below the dermis. These tumors typically occur on the back, abdomen, and other superficial sites but in rare cases have been diagnoses in internal sites such as the retroperitoneum and around the large blood vessels in the upper thoracic cavity. The World Health Organization, 2020, classified Gardner fibroma as a benign tumor in the category of fibroblastic and myofibroblastic tumors.

References

  1. "Archived copy". Archived from the original on 2019-05-31. Retrieved 2010-09-15.{{cite web}}: CS1 maint: archived copy as title (link)[ full citation needed ]
  2. De Ioris M, Brugieres L, Zimmermann A, Keeling J, Brock P, Maibach R, et al. (March 2008). "Hepatoblastoma with a low serum alpha-fetoprotein level at diagnosis: the SIOPEL group experience". European Journal of Cancer. 44 (4): 545–550. doi:10.1016/j.ejca.2007.11.022. PMID   18166449.
  3. Willert, Jennifer. "Pediatric Hepatoblastoma Clinical Presentation: History, Physical, Causes". emedicine.medscape.com.
  4. Table 37.2 in: Sternberg, Stephen (2012). Sternberg's diagnostic surgical pathology. Place of publication not identified: LWW. ISBN   978-1-4511-5289-0. OCLC   953861627.
  5. Hirschman BA, Pollock BH, Tomlinson GE (August 2005). "The spectrum of APC mutations in children with hepatoblastoma from familial adenomatous polyposis kindreds". The Journal of Pediatrics. 147 (2): 263–266. doi:10.1016/j.jpeds.2005.04.019. PMID   16126064.
  6. Sanders RP, Furman WL (November 2006). "Familial adenomatous polyposis in two brothers with hepatoblastoma: implications for diagnosis and screening". Pediatric Blood & Cancer. 47 (6): 851–854. doi:10.1002/pbc.20556. PMID   16106429. S2CID   34824663.
  7. Anna CH, Sills RC, Foley JF, Stockton PS, Ton TV, Devereux TR (June 2000). "Beta-catenin mutations and protein accumulation in all hepatoblastomas examined from B6C3F1 mice treated with anthraquinone or oxazepam". Cancer Research. 60 (11): 2864–2868. PMID   10850429.
  8. 1 2 Tan X, Apte U, Micsenyi A, Kotsagrelos E, Luo JH, Ranganathan S, et al. (July 2005). "Epidermal growth factor receptor: a novel target of the Wnt/beta-catenin pathway in liver". Gastroenterology. 129 (1): 285–302. doi:10.1053/j.gastro.2005.04.013. PMC   1821080 . PMID   16012954.
  9. Koch A, Waha A, Hartmann W, Hrychyk A, Schüller U, Waha A, et al. (June 2005). "Elevated expression of Wnt antagonists is a common event in hepatoblastomas". Clinical Cancer Research. 11 (12): 4295–4304. doi: 10.1158/1078-0432.CCR-04-1162 . PMID   15958610.
  10. Ruck P, Xiao JC (November 2002). "Stem-like cells in hepatoblastoma". Medical and Pediatric Oncology. 39 (5): 504–507. doi:10.1002/mpo.10175. PMID   12228907.
  11. Zimmerman A, Saxena R. Hepatoblastoma. In: WHO Classification of Tumours of the Digestive System, 4th, Bosman FT, Carneiro F, Hruban RH, Theise ND (Eds), IARC, Lyon 2010. p.229.
  12. Sarto I, Klausberger T, Ehya N, Mayer B, Fuchs K, Sieghart W (August 2002). "A novel site on gamma 3 subunits important for assembly of GABA(A) receptors". The Journal of Biological Chemistry. 277 (34): 30656–30664. doi: 10.1074/jbc.M203597200 . PMID   12065588.
  13. Ang JP, Heath JA, Donath S, Khurana S, Auldist A (February 2007). "Treatment outcomes for hepatoblastoma: an institution's experience over two decades". Pediatric Surgery International. 23 (2): 103–109. doi:10.1007/s00383-006-1834-1. PMID   17119981. S2CID   11332782.
  14. Otte JB, Pritchard J, Aronson DC, Brown J, Czauderna P, Maibach R, et al. (January 2004). "Liver transplantation for hepatoblastoma: results from the International Society of Pediatric Oncology (SIOP) study SIOPEL-1 and review of the world experience". Pediatric Blood & Cancer. 42 (1): 74–83. doi:10.1002/pbc.10376. PMID   14752798. S2CID   20741138.
  15. Pediatric Hepatoblastoma at eMedicine
  16. Otte JB, de Ville de Goyet J, Reding R (October 2005). "Liver transplantation for hepatoblastoma: indications and contraindications in the modern era". Pediatric Transplantation. 9 (5): 557–565. doi:10.1111/j.1399-3046.2005.00354.x. PMID   16176410. S2CID   74339.
  17. Czauderna P, Mackinlay G, Perilongo G, Brown J, Shafford E, Aronson D, et al. (June 2002). "Hepatocellular carcinoma in children: results of the first prospective study of the International Society of Pediatric Oncology group". Journal of Clinical Oncology. 20 (12): 2798–2804. doi:10.1200/JCO.2002.06.102. PMID   12065556. Archived from the original on 2013-04-15.