S Naseem Ahmed, K A Shakoor.
Hepatocellular Carcinoma following Hepatitis B Viral Infection in Children: A Case Report with Review of Literature.
Med Channel Jan ;7(3):45-50.

This report describes the case of an adult type hepatocellular carcinoma (HCC) in a 12 year old boy with hepatitis B ,surface antigen (HBsAg) positivity and no cirrhosis. The HCC is an uncommon childhood tumor and is associated with HBsAg. This case was initially misdiagnosed as hepatoblastoma; which is a common hepatic malignancy of childhood. It is important to identify cancer in children because when cancer strikes them it behaves differently front cancer in adults. This article represents various characteristics of HCC in children with a review of the literature in an effort to highlight the morphological differences between hepatoblastoma and HCC.

A Twelve year old male presented with pain in the left hypochondrium and epigastrium, vomiting, loss of appetite for one month and abdominal distension for 15 days. There was no history of jaundice, blood transfusion or skin prick. The child was not immunized. On general examination the child was anemic and ill looking with average height and built. The abdomen was grossly distended and tender in the right hypochondrium, incisura, epigastrium and left hypochondrium with visible veins on the upper abdomen. The liver was tender, firm and enlarged to 10 cms in the right hypochondrium and 9 cms in the left hypochondrium below the right subcostal margin. Spleen was palpable.

Laboratory investigations revealed mild anemia with a high erythrocytes sedimentation rate (50) and positive HBsAg. X ray abdomen showed elevated diaphragm. While the electrolytes, APTT, PT, Urine D/R and x-ray chest were unremarkable. Ultrasonography revealed enlarged liver with altered ecchogenecity and irregular margins. The spleen was enlarged. Gross ascites was also- noted. A liver biopsy of the patient done and a diagnosis of hepatoblastoma made at National Institute of Child Health (NICH).

The specimen received in our histopathology laboratory was consisted of a good case of trucut liver biopsy tissue showed almost completely effacement of the lobular parenchymal architecture and replaced by neoplastic hepatocytes which show a characteristic sinusoidal (trabecular) pattern of growth. The liver cells were arranged in more than one cell thick cords with sinusoidal endothelial lininng cells on the surface. The tumor cells showed moderate nuclear pleomorphism, hyperchromasia, prominent nucleoli and increased mitotic activity. Focal areas of tumor necrosis were also identified. The tumor cells showed strong positivity for glycogen. Immunohistochemical studies were also carried out which revealed strong positivity for low molecular weight cytokeratin (Cam5.2) and alpha fetoprotein. The tumor cells showed no reactivity with cytokeratin AE1/AE3. On the basis of histological and immunohistochemical studies a definite diagnosis of well differentiated hepatocellular carcinoma was made; which is uncommon in children and associated with hepatitis B viral infections.

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