Pediatric Hepatocellular Carcinoma Clinical Presentation

Updated: Mar 12, 2020
  • Author: Paulette Mehta, MD, MPH; Chief Editor: Max J Coppes, MD, PhD, MBA  more...
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Presentation

History

Elements to ascertain include a prior history of hepatitis B or hepatitis C, chronic cirrhosis, or other diseases that tend to induce liver dysfunction. Co-infection with human immunodeficiency virus (HIV) may further enhance a patient's risk of developing hepatocellular carcinoma (HCC).

Patients typically report abdominal pain, weight loss, and diminished appetite. In patients with a history of chronic liver disease, a change in routine symptoms may indicate the presence of a liver tumor.

Most children with hepatocellular carcinoma present with a slowly enlarging, right upper-quadrant mass that may be found during a routine physical examination, brought to medical attention by the patient, or discovered by the patient's parents. Many children also experience localized pain, nausea, and vomiting. Nearly 25% of patients present with jaundice. [12]

In adults, chronic hepatitis secondary to alcohol exposure, viral hepatitis, and hereditary hemochromatosis are predisposing factors. Aflatoxins and other environmental factors also are likely to play a role in the pathogenesis in adults. In contrast, children are far more likely to have inherited errors of metabolism, such as tyrosinemia or urea cycle enzymopathies. Liver diseases that cause cirrhosis (eg, alpha-1 antitrypsin deficiency) increase the risk of developing hepatocellular carcinoma.

Children with biliary atresia, chronic cholestasis, or glycogen-storage diseases are at increased risk. Symptoms can be masked in children with preexisting hepatic diseases, and, accordingly, a change in a chronic disease pattern merits careful consideration for the possibility of a new malignancy.

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Physical Examination

The physical examination often reveals abnormalities attributable to a hepatic tumor. In advanced cases, or when the primary tumor is large, the liver may be palpable below the right costal margin. In addition, deep palpation often reveals pain, especially over the site of the liver. Scleral icterus and other signs of jaundice are frequently present. The patient's history may indicate weight loss, the extent of which may be observed during the examination.

In patients in whom metastatic disease of the lungs is suspected, percussion of the lungs may reveal a difference in density; this finding suggests a pleural effusion. Other painful sites discovered on the examination should lead to radiographic imaging to determine the extent of malignant spread, particularly if the patient has bone pain at presentation.

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