Differential diagnosis and management of liver tumors in infants

Table 1 Hepatic tumors characterisctics

	Clinical findings	Laboratory findings	Biopsy findings	Therapy	Outcome
Hepatic hemangioma	Cutaneous hemangiomas	Decreased T3, T4	Glut-1 positive/negative	Observation Propranolol Embolization	Favourable
Focal nodular hyperplasia	Bleeding Torsion	-	Glutamine synthetase	Observation Surgery	Favourable
Mesenchymal hamartoma	Hepatomegaly	-	Vimentin, desmin, a-1 antitrypsin, actin, cytokeratins	Surgery	Favourable
Hepatoblastoma	Hepatomegaly	Elevated AFP	Small cells Embryonal epithelial cells	Chemotherapy Surgery	EFS 30%-90%
Billiary tract rhabdomyosarcoma	Jaundice Hilum of the liver	Cholestasis	Embryonal or botryoid subtype	Chemotherapy Radiation therapy Surgery	EFS 60%-90%
Angiosarcoma	Metastatic disease	-	Glut-1 negative	Chemotherapy Radiation therapy Surgery	Unfavourable
Malignant rhabdoid tumor	Metastatic disease	-	INI1/BAF 47	Chemotherapy Surgery	Unfavourable
Undifferentiated embryonal sarcoma	Right lobe of the liver	-	SMA, a-ACT, desmin, vimentin	Chemotherapy Surgery	Unfavourable
Metastatic hepatic disease from NB	Hepatomegaly	Elevated catecholamines	MYC-N	Chemotherapy Radiation therapy Surgery	EFS 50%-90%

AFP: Alpha-fetoprotein; MYC-N: MYC-N proto-oncogene protein; EFS: Event free survival; SMA: Smooth muscle actin; ACT: Actin; INI1/BAF: INI1/BAF protein; NB: Neuroblastoma.