Hepatocellular Carcinoma: An Unusual Presentation of this Rare Clinical Entity in Children

Date of submission: 26-06-2020 | Date of acceptance: 21-12-2020 | Published: 03-04-2021

Abstract

Malignant hepatic tumors are rare in children and hepatocellular carcinomas only represent 20% of cases. A previously healthy 10-year old male was admitted for sudden abdominal pain. Ultrasound imaging showed an ileo-ileal intussusception with spontaneous resolution, but in face of worsening pain, fever and a palpable epigastric mass, an MRI was done, showing a liver lesion. Laboratory exams presented elevated liver enzymes and C-reactive protein so a liver abscess was considered and treated with metronidazole plus ceftriaxone. All the microbiology tests were negative so as tumoral markers. Despite a clinical and laboratory improvement, the lesion persisted on imaging. A liver biopsy confirmed a hepatocellular carcinoma and the patient was submitted to surgical resection and chemotherapy. Contrarily to adults in whom most cases are secondary to chronic liver disease, children may not have risk factors for the disease, which makes it harder to do a prompt diagnosis.