Steatohepatitic variant of hepatocellular carcinoma in a child (a rare clinical case report and a literature review)

Malignant liver tumors are a rare type of pediatric cancer, accounting for 1–2% of all malignant neoplasms in children. Hepatoblastoma is the most common malignant liver tumor, occurring in 80% of cases in children aged 6 months to 3 years. Hepatocellular carcinoma (HCC) usually affects older children, and in adolescents it is more common than hepatoblastoma. Unlike adults, etiological factors for HCC have not been identified in most children. When discussing the histological classification (the 5th edition of the World Health Organization), special attention was drawn to one of the subtypes of HCC – the steatohepatitic variant, which, according to the literature, had never been encountered in children. Here, we present a clinical case of an 11-yearold girl, who was diagnosed with malignant tumor of the right liver lobe. The patient's parents gave consent to the use of their child's data, including photographs, for research purposes and in publications. The diagnosis was made based on the results of a comprehensive diagnostic evaluation, including imaging studies and blood testing for tumor markers. The initial alphafetoprotein level was increased to more than 8000 ng/mL. After successful neoadjuvant multi-agent chemotherapy, the patient underwent surgery involving the resection of hepatic segments V and VI containing the tumor. Histological examination and immunohistochemistry revealed the steatohepatitic variant of HCC. The radicality of the surgery (R0 resection) was confirmed. In some published studies, an association of steatohepatitic HCC (SH-HCC) with obesity and metabolic syndrome is discussed. In others, however, it is suggested that there may be no connection between the development of SH-HCC and obesity or nonalcoholic fatty liver disease. This clinical case report is the first description of SH-HCC in a child. Despite the uniqueness of this case, pediatric oncologists should be aware that the steatohepatitic variant of HCC not associated with obesity or metabolic syndrome can also occur in children. SH-HCC is more likely to result from alterations of common genes or metabolic pathways within the tumor and is an ideal subtype for future genetic studies.