Successful Surgical Resection and Chemotherapy for Unresectable Hepatoblastoma With Pulmonary Metastases and for Lung Recurrence After Liver Transplantation: A Case Report |
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| Institution: | 1. Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Osaka, Japan;2. Department of Pediatric Surgery, Osaka Women''s and Children''s Hospital, Osaka, Japan;3. Department of Hematology/Oncology, Osaka Women''s and Children''s Hospital, Osaka, Japan;4. Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan;1. Department of Urology, Yamagata University Faculty of Medicine, Yamagata, Japan;2. Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine, Yamagata, Japan;1. Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan;2. International Institute for Bio-Resource Research, Meiji University, Kawasaki, Japan;3. Institute of Medical Science, University of Tokyo, Tokyo, Japan;1. Department of Urology, Dokkyo Medical University Saitama Medical Center, Koshigaya City, Saitama, Japan;2. Transplant Center, Dokkyo Medical University Saitama Medical Center, Koshigaya City, Saitama, Japan;3. Department of Pathology, Dokkyo Medical University Saitama Medical Center, Koshigaya City, Saitama, Japan;4. Division of Transplant Surgery, Tokyo Metropolitan Health and Hospitals Corporation Ohkubo Hospital, Shinjuku Ward, Tokyo, Japan;5. Department of Nephrology, Dokkyo Medical University Saitama Medical Center, Koshigaya City, Saitama, Japan |
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| Abstract: | BackgroundLiver transplantation (LTx) is indicated for unresectable hepatoblastoma (HB) without distal metastasis. However, to our knowledge, there is no consensus on the management of unresectable HB with pulmonary metastases, or on the treatment of recurrent HB. We report a successful case of metastatic HB treated with repeated lung resection, chemotherapy, and LTx. This study strictly complied with the Helsinki Congress and the Istanbul Declaration regarding donor source.Case ReportOur case was a 1-year-old boy who developed pre-treatment extent of disease (PRETEXT) Ⅲ HB with multiple pulmonary metastases. The liver tumor was unresectable because it involved all hepatic veins. After 3 cycles of chemotherapy (cisplatin/carboplatin plus doxorubicin), the remaining 2 pulmonary metastases were resected and living donor liver transplantation (LDLT) was performed. Five months after LDLT, a tumor recurrence was detected in the right lung. Repeat lung resection was performed followed by 1 cycle of chemotherapy (carboplatin plus doxorubicin). There has been no recurrence for 18 months since the last lung resection.DiscussionPrevious reports revealed that 14 patients, including the present case, underwent LTx after resection of metastatic HB pulmonary lesions. Of these patients, the 2-year survival rate after LTx was 91%. Recurrence was reported in 5 patients, 2 of whom were successfully treated with repeated resection of the metastatic lesions. LTx after resection of lung recurrence may be a potential treatment for unresectable HB with pulmonary metastases. |
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