Neuroblastoma and Liver Lesions
Liver lesions are a relatively common finding on follow up scans for children with high risk neuroblastoma. While they certainly are not found on every child, there are some that will experience this scary finding. It occurs frequently enough that we thought it would be helpful to write an article which details what you need to know - both about liver lesions in general and how they can relate to neuroblastoma. The good news is that, for many, these lesions turn out to be benign.
For many, these are simply a side effect of treatment which
require little or no treatment at all.
Here is what you need to know:
There are many causes for liver lesions. They can include malignant
causes such as cancer, or benign causes like cysts, hepatic adenomas,
hemangiomas, focal nodular hyperplasia, or infectious causes.
As
for the frequency, it will depend on what kind of liver lesion is in
question. It appears that benign causes of liver lesions are more
common than malignant ones.
The number of lesions does not normally point to a diagnosis.
To my knowledge, benign liver lesions do not "change" into cancer. It is either cancerous or not from the beginning.
Treatment
depends on the lesions type and size. Some lesions, such as cysts are
simply observed. Other lesions may be resected, based on what it is and
the size.
With no symptoms and normal liver function tests, the chances
for malignancy is decreased. Hepatic hemangiomas are the most common
benign liver lesions. In one study, 72 percent of people who were
referred for liver lesions turned out to be hemangiomas. The prevalence
of hemangiomas range from 0.4 to 20 percent in the general
population.
For further study, an MRI can help to further define the lesion. A
fine needle biopsy can be considered for further evaluation. Most
hemangiomas are asymptomatic and have a good outcome. If it causes
discomfort, there are a variety of surgical and non-surgical techniques
to treat the lesion.
Hemangiomas are non-cancerous tumors consisting of a collection of
blood vessels. They can be found throughout the body - on the skin, in
the lungs, and commonly in the liver. They often occur as single
lesions, but can also be numerous. Typically, liver hemangiomas do not
cause symptoms and are found incidentally when an ultrasound, CT scan or
MRI of the abdomen is completed. Hemangiomas of 5 cm or greater can
cause symptoms, although even these are usually asymptomatic.
Once confirmed, these tumors usually do not require follow-up. Liver
function tests are normal in patients even with large hemangiomas, so
there is no need to repeatedly check these. Patients with large tumors
may be followed for worsening of symptoms and for any change in size on
imaging. There is no treatment for hemangiomas except for surgery in
very rare cases. Surgical intervention is often avoided if possible.
This PDF has some pretty good
basic information about different types of non cancerous liver lesions.
http://www.cpmc.org/advanced/liver/patients/topics/noncancerous_lesions.pdf
Finally, on to neuroblastoma related liver lesions. Here are some interesting abstracts that describe some of the liver lesions as they relate to neuroblastoma therapy.
http://www.ncbi.nlm.nih.gov/pubmed/19369017
http://www.ncbi.nlm.nih.gov/pubmed/18949676
While liver lesions can be a very scary finding on any post treatment scan, we have illustrated some of the frequent non cancerous findings. If your child with high risk neuroblastoma has lesions like the ones described above found by CT but no supporting evidence found by MIBG you may have reason to take a deep breath.
For once, it may not be the worst thing you can think of.