Liver lesions in children post-oncologic therapy: Review of case reports and institutional observation

Purpose:Focal nodular hyperplasia (FNH), a benign hepatic tumor with ill -defined etiology, has been increasingly reported in childrentreated for extra -hepatic malignancies. Serial imaging or biopsy may be needed when survivors present with liver l e- sions. This study aims to review the literature, compare them with our institutions cohort and propose a less invasive diagn ostic imaging modality for FNH utilizing Magnetic resonance imaging (MRI) with gadoxetate disodium. Methods:We reviewed 13 case reports/series published over the last 20 years and compared them to our retrospective review of 16 childhood cancer su r- vivors (CCS) found to h ave liver lesions on various imaging studies. Several patients underwent biopsy for diagnosis. Results: No specific generalizations could be made in terms of which specific chemotherapeutic agents cause FNH. Seven out of 11 patients underwent radiotherapyand/or hematopoietic stem cell transplant. Additionally, 36% (4/11) had been treated for neuroblastoma. From the literature review, the use of MRI with gadoxetate disodium was difficult to evaluate. Imaging was mainly accomplishe d using ultrasound, compute rized tomographyand MRI with gadolinium.The results were often indeterminate and resulted in biopsy in 6 cases in our institution. In contrast, 5 patients underwent initial MRI with gadoxetate disodium, which confirmed the diagnosis of FNH.Conclusion:CCS have an increased risk of developing liver lesions. Consistent with previously published literature, patients exposed to radiotherapy or cytoreductive agents used for hematopoietic stem cell transplants appeared to be at higher risk.A significant propo rtion (36%, 4/11) of our patients with FNH was previously treated for neuroblastoma. With the introduction of MRI with gadoxetate disodium, imaging may be a viable alternative to biopsy .