title: Small cell undifferentiated histology in hepatoblastoma may be unfavorable.
abstract: BACKGROUND
  Chemotherapy has improved the prognosis of hepatoblastoma demonstrably. It renders seemingly unresectable primary tumors amenable to surgery and can cure metastases. Some authors advocate preoperative chemotherapy for patients with tumors that are deemed resectable, relying solely on percutaneous biopsy or even on diagnostic imaging and elevated serum alpha-fetoprotein levels for diagnosis. However, certain cytologic features of hepatoblastoma appear to have important prognostic consequences. Well differentiated fetal hepatoblastomas that are confined to the liver and that have minimal mitotic activity may not require additional therapy if they are resected totally.
  
  
  METHODS
  In the current study 16 completely resected hepatoblastomas that exhibited partial or predominant small cell undifferentiated histology were identified retrospectively and correlated with patient outcome.
  
  
  RESULTS
  Ten of 16 patients with completely resected tumors exhibiting small cell undifferentiated histology developed a disease recurrence. Five of these recurrences were fatal.
  
  
  CONCLUSIONS
  Small cell undifferentiated histology may have an unfavorable effect on outcome in patients with completely resected hepatoblastoma. The focal distribution of small cell histology in the majority of these tumors suggests that treating hepatoblastoma based on limited preexcision biopsies may deprive some patients of appropriate therapy.
authors.affiliation: Department of Pathology, The Children's Hospital and University of Colorado School of Medicine, Denver, Colorado 80218, USA. haas.joel@tchden.org
authors.forename: J E
authors.initials: JE
authors.lastname: Haas
authors.forename: J H
authors.initials: JH
authors.lastname: Feusner
authors.forename: M J
authors.initials: MJ
authors.lastname: Finegold
mesh_terms: D001706:Biopsy; D017024:Chemotherapy, Adjuvant; D005260:Female; D018197:Hepatoblastoma / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery; D006801:Humans; D007223:Infant; D008113:Liver Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery; D008297:Male; D009364:Neoplasm Recurrence, Local; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome