title: The clinical course in pediatric solid tumor patients with focal nodular hyperplasia of the liver.
abstract: BACKGROUND
  Focal nodular hyperplasia (FNH) of the liver is a rare benign lesion that may be related to the vascular and hepatic damage induced by completion of tumor therapy and a reaction to localized vascular abnormality. The aim of this study was to analyze the clinical course in pediatric solid tumor patients with FNH.
  
  
  METHODS
  We analyzed thirty-two patients with pediatric solid tumors who received multiagent chemotherapy (15 advanced neuroblastomas, 7 hepatoblastomas, 5 rhabdomyosarcomas, 2 nephroblastomas, 1 rhabdoid tumor of the kidney, 1 clear cell sarcoma of the kidney and 1 pancreatoblastoma). All of them had been previously treated at our hospital, and have been alive for over 3 years without recurrence.
  
  
  RESULTS
  FNH lesions were discovered in three (9.4%) of 32 patients, and were neuroblastoma (NB) stage 4. All 3 patients received induction chemotherapy and high-dose alkylating agents, and developed grade 3 (National Cancer Institute Common Toxicity Criteria; NCI-CTC) liver dysfunction during completion of tumor therapy without veno-occlusive disease. Two of the 3 patients received the same induction chemotherapy and high doses of alkylating agents with total body irradiation for cytoreductive agents prior to peripheral blood cell transplantation. FNH lesions in both female patients who received estrogen replacement therapy after completion of tumor therapy have expanded and are increasing.
  
  
  CONCLUSIONS
  FNH appears to be a late complication of iatrogenic disease in NB stage 4 patients. The therapeutic agents for NB stage 4 and estrogen replacement therapy should be considered as risk factors for the development of FNH.
authors: Department of Pediatric Surgery, Nihon University School of Medicine, 30-1, Ohyaguchi-Kamimachi, Itabashi-ku, Tokyo, 173-8610, Japan. sugitou.kiminobu@nihon-u.ac.jp
authors: Kiminobu
authors: K
authors: Sugito
authors: Shota
authors: S
authors: Uekusa
authors: Hiroyuki
authors: H
authors: Kawashima
authors: Takeshi
authors: T
authors: Furuya
authors: Kensuke
authors: K
authors: Ohashi
authors: Mikiya
authors: M
authors: Inoue
authors: Taro
authors: T
authors: Ikeda
authors: Tsugumichi
authors: T
authors: Koshinaga
authors: Ryouichi
authors: R
authors: Tomita
authors: Hideo
authors: H
authors: Mugishima
authors: Toshiya
authors: T
authors: Maebayashi
mesh_terms: D000293:Adolescent; D000477:Alkylating Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D015914:Estrogen Replacement Therapy / Q000009:adverse effects*; D005260:Female; D020518:Focal Nodular Hyperplasia / Q000139:chemically induced* / Q000473:pathology; D018197:Hepatoblastoma / Q000188:drug therapy; D006801:Humans; D007223:Infant; D007680:Kidney Neoplasms / Q000188:drug therapy*; D008113:Liver Neoplasms / Q000188:drug therapy; D008297:Male; D012208:Rhabdomyosarcoma / Q000188:drug therapy; D009396:Wilms Tumor / Q000188:drug therapy*
chemical_list: D000477:Alkylating Agents