Resection after intraarterial chemotherapy of a hepatoblastoma originating in the caudate lobe.

Abstract

A rare case of hepatoblastoma originating in the caudate lobe was treated successfully with intraarterial chemotherapy followed by extensive lobectomy of the left side of the liver. Imaging modalities demonstrated a solitary huge tumor, initially inoperable, occupying almost the entire liver in a 4-month-old female infant. Transcatheter intrahepatic arterial chemotherapy with 10 mg doxorubicin, 20 mg cisplatin, and 3 ml Lipiodol, repeated twice at a 1-month interval, led to a remarkable reduction in tumor size and thereby made it resectable. The volume ratio between the intact hepatic parenchyma and the tumor changed from 1:1.70 to 1:0.13, as assessed by serial computed tomography scans, and the patient's initial alpha-fetoprotein level of 223,210 ng/ml declined to 53 ng/ml. The present case is the first in the literature, to our knowledge, of a resected hepatoblastoma in the caudate lobe. Clinical details of the tumor and surgical issues are discussed.