Rehder Justin, Desai Jay, Goode Tyric, Rudder William, Fox Jennifer, Anderson Kathleen, Wilder Alexandra, Fleetwood Vidyaratna, Kao Jerome, Vaheesan Kirubahara, Varma Chintalapati R, Jain Ajay, Nazzal Mustafa
Neurology/Surgery, Saint Louis University School of Medicine, Saint Louis, USA.
Surgery, Sisters of St. Mary (SSM) Health Saint Louis University Hospital, Saint Louis University School of Medicine, Saint Louis, USA.
Cureus. 2025 Jul 1;17(7):e87107. doi: 10.7759/cureus.87107. eCollection 2025 Jul.
Hepatoblastoma (HB) is a rare but highly malignant tumor that commonly arises in utero. The mainstay treatment is surgical resection, with adjuvant treatment options including chemotherapy, hepatic artery chemoembolization, and liver transplantation. Yttrium-90 (Y90) transarterial radioembolization (TARE Y90) is a developing treatment option that utilizes radioactive beads delivered specifically to blood vessels supplying the tumor. This treatment method has previously been utilized in the treatment of adult tumors but has rarely been utilized in the pediatric population. In this report, we discuss the case of a toddler with an unresectable HB who underwent TARE Y90 as an adjuvant treatment to chemotherapy, ending in a successful liver transplantation. This patient was a 19-month-old female who presented with an abdominal mass and laboratory findings significant for anemia, thrombocytosis, elevated lactate dehydrogenase (LDH), direct hyperbilirubinemia, and alpha-fetoprotein (AFP) elevation. A computed tomography (CT) scan and magnetic resonance imaging (MRI) displayed a large, multilobular mass involving all lobes of the liver without evidence of metastasis, and biopsy results were consistent with HB. Following four rounds of chemotherapy, an MRI of the abdomen revealed a decrease in tumor size. Due to the continued uptrend of AFP raising concern for lack of control of the tumor, treatment with TARE Y90 microspheres radioembolization as a bridging therapy was initiated. Repeat scans showed an interval increase in the HB size, likely secondary to tumor necrosis with edema and hyperemia. Nine months following the diagnosis, the patient underwent an orthotopic liver transplant and a sixth cycle of chemotherapy. This report illustrates the use of TARE Y90 in a pediatric patient diagnosed with HB, thereby inducing a direct cytotoxic effect on tumor cells. Adjunctive therapy Y90 radioembolization worked by controlling tumor size and AFP levels, facilitating the crucial aspect of liver transplantation with tumor resection with negative margins. The patient did not suffer any of the known side effects of TARE Y90 therapy, which include, but are not limited to, post-embolization syndrome, biliary complications, stricture, cholangitis, pulmonary complications, and gastrointestinal ulcers. This therapy, along with chemotherapy, has the potential to be a novel approach as a bridge to resection or orthotopic liver transplant in HB patients. Further case reports and a manuscript compiling the use of Y90 radioembolization therapy in pediatric HB patients would be useful in evaluating the efficacy of the treatment in pediatric patients.
肝母细胞瘤（HB）是一种罕见但高度恶性的肿瘤，通常在子宫内发生。主要治疗方法是手术切除，辅助治疗选项包括化疗、肝动脉化疗栓塞和肝移植。钇-90（Y90）经动脉放射性栓塞（TARE Y90）是一种正在发展的治疗选择，它利用专门输送到供应肿瘤的血管的放射性微球。这种治疗方法以前曾用于治疗成人肿瘤，但很少用于儿科患者。在本报告中，我们讨论了一名患有不可切除HB的幼儿的病例，该幼儿接受了TARE Y90作为化疗的辅助治疗，最终成功进行了肝移植。该患者是一名19个月大的女性，出现腹部肿块，实验室检查结果显示有贫血、血小板增多、乳酸脱氢酶（LDH）升高、直接胆红素血症和甲胎蛋白（AFP）升高。计算机断层扫描（CT）和磁共振成像（MRI）显示一个大的多叶肿块累及肝脏的所有叶，无转移迹象，活检结果与HB一致。经过四轮化疗后，腹部MRI显示肿瘤大小减小。由于AFP持续上升，令人担心肿瘤未得到控制，因此开始采用TARE Y90微球放射性栓塞作为桥接治疗。重复扫描显示HB大小有间隔性增加，可能继发于肿瘤坏死伴水肿和充血。诊断后九个月，患者接受了原位肝移植和第六轮化疗。本报告说明了TARE Y90在一名诊断为HB的儿科患者中的应用，从而对肿瘤细胞产生直接的细胞毒性作用。辅助治疗Y90放射性栓塞通过控制肿瘤大小和AFP水平发挥作用，有助于进行肿瘤切除切缘阴性的肝移植这一关键环节。患者未出现TARE Y90治疗的任何已知副作用，这些副作用包括但不限于栓塞后综合征、胆道并发症、狭窄、胆管炎、肺部并发症和胃肠道溃疡。这种治疗方法与化疗一起，有可能成为HB患者切除或原位肝移植的一种新的桥接方法。进一步的病例报告以及一份汇编Y90放射性栓塞治疗在儿科HB患者中应用情况的手稿，将有助于评估该治疗方法在儿科患者中的疗效。
