title: Invasion of the cardiovascular system in childhood malignant hepatic tumors.
abstract: OBJECTIVE
  To evaluate the utility of transthoracic echocardiography for the early detection of subclinical cardiac metastasis in childhood malignant hepatic tumors.
  
  
  METHODS
  From April 1995 until February 2000, 12 consecutive children with malignant hepatic tumor were enrolled in this study. To determine the degree of invasion of the cardiovascular system, transthoracic echocardiography was performed for all patients at the time of initial diagnosis and also at subsequent follow-up investigations every 6 months until the patient was deemed to be disease-free, or until the patient died.
  
  
  RESULTS
  There were seven patients diagnosed with hepatocellular carcinoma (six boys, one girl) and five patients diagnosed with hepatoblastoma (three boys, two girls). Most tumors were multiple (7/12) and involved both lobes of the liver (7/12). Inferior vena cava thrombi were observed in four patients. Three patients exhibited intracardiac tumor metastasis, and lung metastasis was noted in four patients. Lung metastasis was significantly more common in children with cardiovascular involvement (4/4) compared with those without (0/8). The ages of the patient, levels of alpha-fetoprotein, and types of tumor did not differ between the two groups.
  
  
  CONCLUSIONS
  Echocardiography may be useful for the early detection of cardiovascular metastases of malignant hepatic tumors in children; this was the case for 33% of the patients in this series. The frequent occurrence of cardiovascular tumor involvement and the high degree of association between lung metastasis and cardiovascular involvement observed in this small series suggest that transthoracic echocardiography should be studied prospectively in a large series of children with hepatic tumors.
authors.affiliation: Institute of Clinical Medicine and Departments of Pediatrics and Pathology, National Cheng Kung University Hospital, Tainan, Taiwan.
authors.forename: Jieh-Neng
authors.initials: JN
authors.lastname: Wang
authors.forename: Jiann-Shiuh
authors.initials: JS
authors.lastname: Chen
authors.forename: Hung-Yi
authors.initials: HY
authors.lastname: Chuang
authors.forename: Yao-Jong
authors.initials: YJ
authors.lastname: Yang
authors.forename: Kong-Chao
authors.initials: KC
authors.lastname: Chang
authors.forename: Jing-Ming
authors.initials: JM
authors.lastname: Wu
mesh_terms: D000293:Adolescent; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging / Q000556:secondary* / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D017548:Echocardiography, Transesophageal; D005260:Female; D005500:Follow-Up Studies; D006338:Heart Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary* / Q000628:therapy; D006509:Hepatitis B / Q000150:complications; D018197:Hepatoblastoma / Q000000981:diagnostic imaging / Q000556:secondary* / Q000628:therapy; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000628:therapy; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary*; D008297:Male; D009361:Neoplasm Invasiveness; D011446:Prospective Studies; D015996:Survival Rate; D000509:alpha-Fetoproteins / Q000032:analysis
chemical_list: D000509:alpha-Fetoproteins