Characteristics of hepatitis B virus-associated hepatocellular carcinoma in children: A multi-center study

Douglas B. Mogul, Simon C. Ling, Karen F. Murray, Sarah J. Schwarzenberg, Erin R. Rudzinski, Kathleen B. Schwarz

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11 Scopus citations

Abstract

Introduction: Pediatricians and liver specialists in the United States and Canada continue to encounter hepatitis B virus (HBV) infection in high-risk populations, including unvaccinated children, adopted children, and immigrants. Although hepatocellular carcinoma (HCC) is a known complication of HBV, there exists a paucity of data regarding the clinical presentation of HBV-associated HCC in children in these countries. Methods: Investigators at 4 medical centers with large numbers of HBV-positive children queried their pathology and/or oncology databases to identify all cases of HBV-infected children <18 years old presenting with HCC between 1990 and 2015. Clinical data were extracted from chart review. Results: The group identified 8 patients, 8 to 17 years old, including 6 (75%) males. All individuals were assumed to be infected through vertical transmission. Three (38%) presented initially to the emergency room, 2 (25%) to a general pediatrician, 1 (13%) to a hepatologist, and the initial location was not documented in 2 (25%) cases. Three patients were asymptomatic, but the most common symptoms were abdominal pain (50%) and fatigue (38%). Hepatomegaly was present in 5 (63%) patients. Viral load was not documented in any patient. Only 3 patients had their HBeAg status documented and all individuals were HBeAg(-) and anti-HBe(+). Aspartate aminotransferase (AST) ranged from 13 to 575IU/L, and alanine aminotransferase (ALT) ranged from 14 to 212IU/L; 4 patients had AST and ALT < 1.5 times the upper limit of normal. Three patients had elevated bilirubin and gamma glutamyl transpeptidase (GGT), and 3 had normal bilirubin and GGT; 1 patient had unknown bilirubin and a separate patient had unknown GGT. Alpha-fetoprotein (AFP) was elevated in 3 patients (range 2.556-7.600ng/mL), normal in 2 patients, and not documented in 3 patients. Ultrasound was initially used to identify the tumor in 5 patients whereas computerized axial tomography scan was used in 3 patients. Six patients had multiple nodules on initial imaging. Conclusions: Although rare, HBV-associated HCC occurs in young children, often with normal liver enzymes, bilirubin, GGT, and AFP. Only routine imaging with ultrasound or computerized axial tomography scan consistently identified the tumor. These data may help inform screening for HCC including age of initiation and the role for imaging over laboratory testing.

Original languageEnglish (US)
Pages (from-to)437-440
Number of pages4
JournalJournal of pediatric gastroenterology and nutrition
Volume67
Issue number4
DOIs
StatePublished - Oct 2018

Bibliographical note

Funding Information:
Disclosures of funding: D.M. receives research support from the Agency for Healthcare Research and Quality; S.L. receives research support from

Funding Information:
D.M. receives research support from the Agency for Healthcare Research and Quality; S.L. receives research support from Bristol Myers Squibb, and Abbvie; K.M. receives research support from Gilead, Merck, Shire, and the National Institutes of Health; is a consultant for Gilead, and has stock ownership in Merck. S.J.S. receives research support from the Cystic Fibrosis Therapeutic Disease Network, the Cystic Fibrosis Foundation, and National Institutes of Health. K.S. receives research support from Gilead, Bristol Myers Squibb, Roche, Genentech, and the NIH; is a consultant for Gilead, Roche, and Up to Date. The remaining authors report no conflicts of interest.

Funding Information:
Bristol Myers Squibb, and Abbvie; K.M. receives research support from Gilead, Merck, Shire, and the National Institutes of Health; is a consultant for Gilead, and has stock ownership in Merck. S.J.S. receives research support from the Cystic Fibrosis Therapeutic Disease Network, the Cystic Fibrosis Foundation, and National Institutes of Health. K.S. receives research support from Gilead, Bristol Myers Squibb, Roche, Genentech, and the NIH; is a consultant for Gilead, Roche, and Up to Date. The remaining authors report no conflicts of interest.

Publisher Copyright:
Copyright © 2018 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition.

Keywords

  • Hepatitis B
  • Hepatocellular carcinoma
  • Screening

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