Incidentally picked up SOL in the Liver
Presenter:
Chintamani Godbole - Jaslok Hospital, Mumbai

Moderator:
Sanjay Nagral ...
Incidentally picked up SOL in the
liver
Dr. Chintamani Godbole
Registrar, Dept of Surgical Gastroenterology
Jaslok Hospita...
Case Summary:
•9 month old male child
•Born of a full term normal delivery
•Perinatal course uneventful
•Normal developmen...
• Born of a non-consanguinous marriage, elder
sibling 4 yr old girl - healthy
• No significant family history
• No h/o jau...
Examination:
•Healthy child
•General – normal , no nodes
•Abdominal – Hepatomegaly – mainly right
lobe, firm, non tender
•...
Investigations:
Hb- 10.3 gm/dl

PT – INR – 1.0

TLC – 7900/mm3

T. Bil – 0.3 mg/dl

Platelets- 306000/mm3

D. Bil – 0.15 m...
USG abdomen:
•Large(5 cm) ,well defined, solid, hypoechoic
mass in right lobe, increased vascularity on
doppler.
•Rest liv...
CECT :
•Well encapsulated heterogenously enhancing
mass with areas of necrosis involving segment V
and VI of the liver.
•S...
•Serum Alfa Foeto Protein - 56,223 ng / ml
CT guided biopsy of lesion.
• Round to polygonal cells arranged as
trabeculae and small acini and areas showing
loose mese...
Chemotherapy:
•Single agent: Cisplatin based
•Each cycle – dose – 90mg / m2
•2 cycles of chemotherapy given
•S. AFP – prec...
Lesion regressed to 3.9 x
3.8 cms
No new lesions seen
Surgery:
•Non-anatomical resection of the tumour - Seg
5 and part of seg 6 with 1 cm margin of normal
liver
•Histology
Nec...
• Post operative received 4 more cycles of
cisplatin
• Steady fall of AFP
• Immediate post op – 114 ng/ml
• 6 months later...
Incidenatlly picked up sol
Incidenatlly picked up sol
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Incidenatlly picked up sol

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Incidenatlly picked up sol

  1. 1. Incidentally picked up SOL in the Liver Presenter: Chintamani Godbole - Jaslok Hospital, Mumbai Moderator: Sanjay Nagral – Hepatobiliary Surgeon, Jaslok Hospital, Mumbai Panelists: Ashley D’Cruz –Pediatric Hepatobiliary Surgeon, Narayana Hrudayalaya ,Bangalore Ritu Kakkar – Radiologist, Jaslok Hospital, Mumbai Girish chinnaswamy – Pediatric oncologist Tata hospital, Mumbai
  2. 2. Incidentally picked up SOL in the liver Dr. Chintamani Godbole Registrar, Dept of Surgical Gastroenterology Jaslok Hospital and Research Centre, Mumbai
  3. 3. Case Summary: •9 month old male child •Born of a full term normal delivery •Perinatal course uneventful •Normal development and milestones •Short history of fever & cold; detected to have hepatomegaly by paediatrician on routine examination
  4. 4. • Born of a non-consanguinous marriage, elder sibling 4 yr old girl - healthy • No significant family history • No h/o jaundice, failure to thrive, vomiting, excessive crying, weight loss
  5. 5. Examination: •Healthy child •General – normal , no nodes •Abdominal – Hepatomegaly – mainly right lobe, firm, non tender •No splenomegaly, other lump in abdomen •No free fluid, dilated veins, umbilicus normal
  6. 6. Investigations: Hb- 10.3 gm/dl PT – INR – 1.0 TLC – 7900/mm3 T. Bil – 0.3 mg/dl Platelets- 306000/mm3 D. Bil – 0.15 mg/dl Creat – 0.5 mg/dl SGOT – 47 U/L SGPT – 12 U/L AlK PO4 – 124 U/L GGT – 29 U/L S. Albumin – 3.7 g/dl
  7. 7. USG abdomen: •Large(5 cm) ,well defined, solid, hypoechoic mass in right lobe, increased vascularity on doppler. •Rest liver, viscera normal •Portal vein normal – 5.8mm •No lymphnodes, splenomegaly •Biliary tree normal
  8. 8. CECT : •Well encapsulated heterogenously enhancing mass with areas of necrosis involving segment V and VI of the liver. •Size 5.9 x 5.6 cms
  9. 9. •Serum Alfa Foeto Protein - 56,223 ng / ml
  10. 10. CT guided biopsy of lesion. • Round to polygonal cells arranged as trabeculae and small acini and areas showing loose mesenchymal tissue • Cytokeratin, Glypican ++ • Suggestive of Hepatoblastoma – mixed epithelial, mesenchymal.
  11. 11. Chemotherapy: •Single agent: Cisplatin based •Each cycle – dose – 90mg / m2 •2 cycles of chemotherapy given •S. AFP – prechemo – 56223 ng/ml -- post chemo – 14000 ng/ml • CT repeated
  12. 12. Lesion regressed to 3.9 x 3.8 cms No new lesions seen
  13. 13. Surgery: •Non-anatomical resection of the tumour - Seg 5 and part of seg 6 with 1 cm margin of normal liver •Histology Necrotic tumor, viable cells, margins free
  14. 14. • Post operative received 4 more cycles of cisplatin • Steady fall of AFP • Immediate post op – 114 ng/ml • 6 months later – 2.4 ng/ml • Currently on follow up 18 months postop doing well AFP normal

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