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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
Incidentally picked up SOL in the
liver
Dr. Chintamani Godbole
Registrar, Dept of Surgical Gastroenterology
Jaslok Hospital and Research Centre, Mumbai
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
• 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
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
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
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
Incidenatlly picked up sol
Incidenatlly picked up sol
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
•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 mesenchymal tissue
• Cytokeratin, Glypican ++
• Suggestive of Hepatoblastoma – mixed
epithelial, mesenchymal.
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
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
Necrotic tumor, viable cells, margins free
• 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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Incidenatlly picked up sol

  • 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