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.

Table 2 Pre-treatment evaluation system of tumor extension staging system

PRETEXT I	One section is involved and three adjoining sections are free
PRETEXT II	One or two sections are involved, but two adjoining sections are free
PRETEXT III	Two or three sections are involved, and no two adjoining sections are free
PRETEXT IV	All four sectors involved, any involvement of caudate lobe indicates a minimum of PRETEXT II

PRETEXT: Pre-treatment evaluation system of tumor extension.