This document summarizes the case of a 9-month-old male child who was incidentally found to have hepatomegaly during a routine pediatric examination. Further investigations including ultrasound, CT scan and biopsy revealed a 5cm well-encapsulated mass in the right lobe of the liver, which was diagnosed as hepatoblastoma based on markers. The child received two cycles of cisplatin chemotherapy, which reduced the size of the lesion and tumor markers. He then underwent a non-anatomical resection of the liver segments involved. Histology confirmed the margins were clear. Further chemotherapy was administered and the child has been disease-free and with normal tumor markers for 18 months since surgery.

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. Incidentally picked up SOL in the
liver
Dr. Chintamani Godbole
Registrar, Dept of Surgical Gastroenterology
Jaslok Hospital and Research Centre, Mumbai

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. • 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. 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. 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. 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

10. 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

11. •Serum Alfa Foeto Protein - 56,223 ng / ml

12. 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.

13. 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

14. Lesion regressed to 3.9 x
3.8 cms
No new lesions seen

15. 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

16. • 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