melphalan and Focal-Nodular-Hyperplasia

Focal nodular hyperplasia (FNH) is a benign, poorly understood hepatic tumor that is rare in children. Although there is no evidence for malignant degeneration, FNH can occur adjacent to a malignancy. Here, the case of a 4-year-old boy with a hepatic mass and history of stage IV neuroblastoma is presented. Initial imaging and core-needle biopsy were consistent with FNH. However, after left lateral segmentectomy, pathologic examination revealed a malignant tumor most consistent with small cell undifferentiated hepatoblastoma as well as 3 foci of FNH in the surrounding parenchyma.

Topics: Adrenal Gland Neoplasms; Antibodies, Monoclonal; Antibodies, Monoclonal, Murine-Derived; Antineoplastic Combined Chemotherapy Protocols; Bone Marrow Transplantation; Carboplatin; Child, Preschool; Cisplatin; Combined Modality Therapy; Cyclophosphamide; Etoposide; Fluorouracil; Focal Nodular Hyperplasia; Granulocyte Colony-Stimulating Factor; Hepatectomy; Hepatoblastoma; Humans; Ifosfamide; Immunoglobulin G; Incidental Findings; Liver Neoplasms; Male; Melphalan; Mesna; Neoplasms, Radiation-Induced; Neoplasms, Second Primary; Neuroblastoma; Radiotherapy, Adjuvant; Tomography, X-Ray Computed; Vincristine

Nodular regenerative hyperplasia (NRH) of the liver is an infrequent entity that is usually diagnosed after the appearance of clinical signs of portal hypertension such as hepatomegaly, splenomegaly or upper gastrointestinal bleeding due to esophageal varices, which are the most frequently found clinical manifestations in NRH. Ascites is a less frequent finding and has always been described in association with other manifestations of portal hypertension. We describe a new case of NRH with atypical presentation in which ascites was the sole clinical manifestation.

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Ascites; Bronchopneumonia; Combined Modality Therapy; Disease Progression; Fatal Outcome; Focal Nodular Hyperplasia; Humans; Hypertension, Portal; Liver Regeneration; Lumbar Vertebrae; Male; Melphalan; Multiple Myeloma; Plasmacytoma; Prednisone; Spinal Neoplasms