Clinical features
- < 2% of childhood liver tumours
- 4-10% of benign childhood tumours
- Unusual in the first year of life
- 7-15% occur in children
- Association with hepatic cavernous haemangioma (20%), glycogen storage disease type Ia, portal hypertension, hemi hypertrophy, brain tumours and congenital cardiovascular anomalies
- X-ray shows mass with a central scar
- Angiography shows centrifugal hypervascularity
- Left lobe 60%, right lobe 30% and bilateral 10%
Cytopathology
- Smears represent normal liver constituents:
- Sheets of benign hepatocytes
- Bile duct epithelial cells
- Benign spindle cells rarely seen
- Reticulin framework decreased in cell block
Immunocytochemistry
Non-contributory
Modern diagnostic techniques
Non-contributory
Differential diagnosis
- Hepatocellular adenoma
- Rare in children
- Absence of bile ducts (the presence of bile ducts rules out adenoma)
- Normal liver parenchyma
- Impossible to rule out
- Cirrhotic regenerative nodule
- Impossible to rule out if the clinical context is appropriate
- Well-differentiated hepatocellular carcinoma
- Increased nuclear/cytoplasmic ratio
- Endothelium-lined epithelial groups
- Uniform tumour cells
- Trabecular thickening in cell block
- Reticulin framework decreased in cell block
- Diffuse CD34 reactivity (sinusoidal capillarization)
- CEA: abnormal canaliculus pattern
Main points
- Excision unnecessary if diagnosis can be trusted