Hepatic regenerating nodules: a mimic of recurrent cancer in children.
BACKGROUND
Pseudometastatic lesions of the liver may be discovered incidentally in children previously treated for malignant tumour.


OBJECTIVE
To describe the radiological pattern of these lesions and to analyse their pathogenesis.


METHODS
Nine children, 2-12 years' old at the time of diagnosis, are described in this retrospective multicentre report. The primary tumours were: nephroblastoma (n = 2), neuroblastoma (n = 2), Ewing's tumour/PNET (n = 2), non-Hodgkin's lymphoma (n = 1), and osteosarcoma (n = 2), treated by surgery (8/9), chemotherapy (9/9), intensive chemotherapy and bone-marrow transplantation (5/9), and radiotherapy (7/9). Three children suffered veno-occlusive disease (VOD) during treatment. The hepatic assessment was performed by sonography (8/9), Doppler (7/9), multiphase spiral CT (8/9) and MRI (7/9).


RESULTS
Lesions were discovered 15 months to 16 years after completing treatment. CT was the most sensitive modality for diagnosis. Lesions were multiple in eight cases, measured 2-50 mm, and appeared hypervascular on the arterial phase of CT and/or MRI in every case. Metastases were excluded on the basis of histological verification (n = 2) and clinical and radiological follow-up.


CONCLUSIONS
Pseudometastatic hypervascular hepatic nodules can appear after treatment of a malignant tumour in children. The hypothesis of benign regenerative lesions secondary to treatment and/or VOD is considered.
Brisse
H
H
Department of Radiology, Institut Curie, Paris, France.
Servois
V
V
Bouche
B
B
Avni
F
F
Petit
P
P
Thibault
F
F
Zucker
J M
JM
Devalck
C
C
Neuenschwander
S
S
D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000556:secondary*; D008115:Liver Regeneration; D008297:Male; D016609:Neoplasms, Second Primary / Q000175:diagnosis*; D012189:Retrospective Studies