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CC BY 4.0 · Indian J Med Paediatr Oncol
DOI: 10.1055/s-0045-1801884
Original Article

Clinical and Pathological Spectrum of Hepatoblastoma with Emphasis on Treatment-Induced Changes: Experience from Tertiary Care Center

Divya Achutha Ail
1   Department of Pathology, Yenepoya Medical College (Deemed to be University), Mangalore, Karnataka, India
,
Malini Eapen 
2   Department of Pathology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
,
Pavithran Keechilat
3   Department of Medical Oncology, Amrita Institute of Medical Science and Research Centre, Kochi, Kerala, India
,
Sudheendran Surendran
4   Department of GI Surgery, Solid Organ Transplant Institute, Amrita Institute of Medical Science and Research Centre, Kochi, Kerala, India
,
Naveen Viswanath
5   Department of Paediatric Surgery, Amrita Institute of Medical Science and Research Centre, Kochi, Kerala, India
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Funding None.
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Abstract

Introduction Hepatoblastoma is a rare pediatric liver tumor. Advances in imaging/surgical techniques and use of neoadjuvant chemotherapy (NACT) in recent times have resulted in improved survival of children with hepatoblastoma. Yet it has dismal prognosis in some children. Unlike other pediatric malignant tumors, pathological tumor regression grading in hepatoblastoma following NACT is not in routine practice. Assessing tumor-induced maturation and delineating it from non-neoplastic liver at resection margin are often challenging in this setting.

Objective We aim to describe the clinicopathological spectrum of hepatoblastoma encountered in our center with emphasis on exploring the role of grading the therapy-induced changes by correlating with existing prognostic factors and patient survival.

Materials and Methods All cases of hepatoblastoma having undergone resection after NACT over 9 years were included. Pathology slides (hematoxylin and eosin/immunohistochemistry) were reviewed. Therapy-related changes were scored and compared with pretreatment extent (PRETEXT)/posttreatment extent (POSTTEXT) staging, alpha fetoprotein (AFP) levels, and patient survival.

Results A total of 15 children diagnosed with hepatoblastoma were included in the study. The median age of diagnosis was 10 months. PRETEXT III was the commonest stage and fetal variant was the commonest histological subtype. Fibrosis, necrosis, maturation, calcification, and ductular reaction were the therapy-induced changes encountered in 93, 80, 60, 53 and 33% cases, respectively. Higher percentage of therapy-induced changes was associated with good prognosis and better survival. Glypican-3 positivity delineated tumor-induced maturation from the non-neoplastic liver.

Conclusion This study describes the spectrum of hepatoblastoma at a single center and emphasizes that grading therapy-induced changes may have a significant role in patient prognosis and guide further treatment interventions for effective management of patients. Glypican-3 eases microscopic assessment of resection margins in the presence of therapy-induced maturation.

Keywords

hepatoblastoma - child - liver neoplasm - neoadjuvant therapy - immunohistochemistry - prognosis

Authors' Contributions

D.A. contributed to data curation, writing of the original draft, preparation, and editing of the manuscript. M.E. contributed to the conceptualization, methodology, and supervision of the study, and editing of the manuscript. P.K. contributed to the visualization, investigation, supervision, and reviewing of the study. S.S. contributed to the visualization, investigation, supervision, and reviewing of the study. N.V. contributed to the visualization, investigation, supervision, and reviewing of the study.




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Artikel online veröffentlicht:
20. Februar 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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