title: Pediatric hepatocellular carcinoma in a developing country: Is the etiology changing?
abstract: HCC is the second most common malignant liver tumor of childhood. It typically affects children with a median age of 10-14 yr on background hepatitis B-related liver disease and is often metastatic or locally advanced at diagnosis. Children below the age of five yr typically constitute <10% of all children with HCC. In these children, it occurs on a background of congenital or metabolic liver disease. The records of all children with HCC who presented to our department over a six-yr study period were reviewed. Twelve patients with a median age of 5.9 yr (range 1.6-15.4) were diagnosed to have HCC. All patients underwent liver transplantation, and none were resected. Eleven patients had background congenital or metabolic liver disease. All five of those with hereditary tyrosinemia type 1 who presented to us were found to have HCC. No patient had hepatitis B-related liver (HBV) disease. Eight (66.7%) patients had incidentally discovered HCC on examination of the explant. Incidentally discovered HCC were smaller, well differentiated, and did not show microvascular invasion compared to those diagnosed preoperatively. There was no recurrence with a median follow-up of five months. The patient demographic for pediatric HCC is changing probably as a consequence of successful immunization against HBV. Younger patients with congenital and metabolic liver disease in whom liver transplantation is the ideal treatment are likely to constitute an ever-increasing proportion of patients with pediatric HCC as HBV disease is controlled or eradicated.
authors.affiliation: Institute of Liver Disease and Transplantation, Global Health City, Chennai, India.
authors.forename: Kumar
authors.initials: K
authors.lastname: Palaniappan
authors.affiliation: Institute of Liver Disease and Transplantation, Global Health City, Chennai, India.
authors.forename: Vibhor V
authors.initials: VV
authors.lastname: Borkar
authors.affiliation: Institute of Liver Disease and Transplantation, Global Health City, Chennai, India.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Safwan
authors.affiliation: Institute of Liver Disease and Transplantation, Global Health City, Chennai, India.
authors.forename: Mukul
authors.initials: M
authors.lastname: Vij
authors.affiliation: Institute of Liver Disease and Transplantation, Global Health City, Chennai, India.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Govil
authors.affiliation: Institute of Liver Disease and Transplantation, Global Health City, Chennai, India.|National Foundation for Liver Research, Chennai, India.
authors.forename: Naresh
authors.initials: N
authors.lastname: Shanmugam
authors.affiliation: Institute of Liver Disease and Transplantation, Global Health City, Chennai, India. mohamedrela@gmail.com.|National Foundation for Liver Research, Chennai, India. mohamedrela@gmail.com.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Rela
mesh_terms: D000293:Adolescent; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology* / Q000209:etiology*; D002648:Child; D002675:Child, Preschool; D003906:Developing Countries; D005260:Female; D006801:Humans; D007194:India; D007223:Infant; D008099:Liver / Q000601:surgery; D008113:Liver Neoplasms / Q000453:epidemiology* / Q000209:etiology*; D016031:Liver Transplantation; D008297:Male; D012189:Retrospective Studies; D020176:Tyrosinemias / Q000150:complications / Q000601:surgery
keywords: hepatitis B; incidental hepatocellular carcinoma; liver transplantation; metabolic liver disease; pediatric hepatocellular carcinoma